Hypersensitivity Flashcards
What are some types of tactile stimuli?
Denture clasps
Toothbrushing
Dental Instrumentation
Thermal (hot, cold, food air)
What is evaporative stimuli?
Dehydration of oral fluids (HVE/air-water syring)
What is osmotic stimuli?
Alteration of pressure in dentinal tubules through a selective membrane
What are some chemical stimuli?
Acids (wine, citrus)
Some spices
Whitening products
Carbonated beverages
Acidogenic carb exposure
Gastric regurgitation
Characteristics of hypersensitivity
Sharp, short pain
Transient pain
Rapid onset
Presents as chronic condition with acute episodes
Caused by stimuli that does not normally cause pain
Qualities of the dentition that aid in hypersensitivity
Dentinal tubules filled w/ fluid
Pulp highly innervated
Nerve fibers closer to pulp, wrap around odontoblastic processes
Tubules are wider and more numerous in sensitive areas
What leads to dentin exposure? What may cause this to happen?
Gingival recession>loss of cementum or enamel>dentin exposure
-tooth brush abrasion
-fractured tooth
-decrease in pH
What factors may cause gingival recession?
-tooth brush abrasion
-short frenum
-apical migration due to periodontal disease
-gingival shrinkage
-perio surgery
-orthodontic movement
-metal jewelry
What is abfraction?
Wedge-shaped cervical lesion
From lateral/occlusal stress
Enamel rods chip away
Malocclusion or clenching can be factors
Night guards may be required
What is Brannstrom’s theory on hypersensitivity?
Hydrodynamic theory
Stimulus on outer aspect causes movement of fluid in dentinal tubules
Transmits pain by stimulating nerves in the pulp
What are some types of natural desensitization?
Sclerosis of dentin
Secondary dentin
What is sclerosis of dentin?
Occurs from traumatic stimuli
Thicker layer of peritubular dentin is formed
Results in smaller diameter tubules w/ less ability for fluid movement
What is secondary dentin?
Creates a walling off effect from the dentin to the pulp
Happens gradually over time
Happens with aging, results in smaller pulp size
What is a smear layer?
Organic and inorganic debris covers the tubules
Accumulates after SRP, abrasive TP, attrition abrasion
Occludes tubules, blocking stimuli
Changes constantly- ex. from acid exposure, ultrasonic
How does calculus work as a natural desensitizer?
Provides a blanketing effect
Covers exposed dentin
What is the prevalence of hypersensitivity?
Affects mostly 18-44 year olds
More so in perio disease populations
Occurs primarily at cervical 3rd
While recession is more prevalent with aging, why is sensitivity not?
Secondary dentin forms over time with aging, walling off the pulp from dentin and making the pulp smaller
How can acute pain affect people mentally?
May cause anxiety
How can chronic pain affect people mentally?
May cause depression
What is the etiology of pain?
Can be systemic, pulpal, periapical or restorative
Differential diagnosis is needed to determine treatment
What is most often the cause of pulpal pain upon chewing?
Fractured teeth
What can cause pulpal pain?
Deep dental caries
Infection
Fracture
Pulpal inflammation
How is pulpal pain characterized?
Severe
Lasts longer
Intermittent
Throbbing
Sometimes worse at night
What open ended questions would you ask when trying to come up with a differential diagnosis?
Location?
Degree of pain
Onset/duration
Source of stimuli
Intensity
Alleviating factors
What do we do as clinicians to determine causes of pts pain when they are confused or cannot tell us?
Visual assessment
Palpation
Evaluation of sinuses
Articulating paper to check occlusion
Radiographs
Percussion
Check mobility
Bite stick
Transillumination
Thermal pulp testing
What else can we use to determine etiology of pain?
Discussion of diet
Do they have adequate HC? Does this contribute?
Clenching/bruxing?
What are our treatment goals with these patients?
Pain relief
Eliminate or reduce contributing factors
What kind of approach do we use for mild/moderate pain and severe pain?
Conservative for mild/mod (sens.TP)
Aggressive for severe (filling tooth)
Try most conservative first
Trial and error may be necessary
Evaluate interventions after 2-4 weeks
How do desensitizing agents work?
Prevent nerve depolarization
Prevents stimulus from moving through tubules
What is the only type of desensitizing agent that prevents depolarization?
Potassium nitrate (potassium salts)
-Found in Sensodyne
What habit changes can we aid our pts in?
Encourage diet changes
Help pt schedule brushing time w/ acid consumption
Guide them towards non-acidic mouthwashes
Biofilm control (tubules decrease by 20% after removal)
Referral for eating disorders
Avoid discomforting stimuli
Toothbrushing tips for sensitivity
Soft toothbrushing
Short strokes
End in more senesitive areas
Use non-dominant hand
Power toothbrush
What are the requirements for desensitizing agents?
Rapid acting
Long-term effects
Non-irritating to the pulp
Painless
Easy to apply
No staining
How are desensitizing agents categorized?
By their mechanism of action
What are the 3 types of potassium salts that reduce depolarization?
Potassium nitrate
Potassium oxalate
Potassium chloride
How does potassium nitrate work?
Penetrates into tubules and reaches nerves
Blocks nerve signals that trigger pain
Takes several uses before effective
How does fluoride work as a desensitizing agent?
Precipitates in tubules causing decrease in lumen diameter
Creates a barrier blocking tubules
Can be varnish or gel
How do oxalates work as desensitizing agents? What kinds?
Block tubules- works fast
K+ oxalate
Ferric Oxalate
How does calcium phosphate work as a desensitizing agent?
Releases calcium and phosphate into saliva for formation of hydroxyapatite
Occludes tubules
-used for caries control
-do not use w/ fluoride, will bind
When was amorphous calcium phosphate (ACP) introduced? What does it due and where can it be found?
-1991
- Plugs tubules
- Calcium and phosphate ions release in saliva (not stable)
- Found in prophy paste, fluoride and TP
How does calcium sodium phosphoscilicate work? How is it delivered?
NovaMin
Calcium and phosphate form a layer on the tooth and crystalizes to form hydroxyapatite
Delivered in solid bioactive glass particles- reacts with saliva
Found in air powder polish
What is the brand name for casein phosphopeptide- amorphous calcium phosphate (CPP-ACP)? Who can it not be used on?
Recaldent
Cannot be used on people with dairy allergies- contains a milk derived protein
Can be formulated w/ or w/o fluoride
How is tricalcium phosphate used?
Helps to remineralize teeth- deposits an acid-resistant material
Added to varnish 5%
Occludes dentin tubules
Created to be able to work w/ fluoride
When would you use arginine and calcium phosphate? Why?
Use before phrophylaxis to reduce sensitivity during scaling.
Plugs dentinal tubules and helps maintain neutral pH
What desensitizing agents are found in self-applied forms?
Dentifrices can contain:
- 5% potassium nitrate
- Fluoride
- Stannous fluoride
What types of self-aplied desensitizers are available?
Toothpastes
Mouthrinses
Gels
What are some types of professionally applied desensitizers?
Fluoride gel trays
Fluoride varnish
Oxalates
Unfilled/partially filled resins
Dentin bonding agents
Glass ionomer
Soft tissue graft
Why does tooth whitening cause sensitivity? What can be used to prevent this?
-Byproducts pass through tubules
-HP contacts pulp- no harm
-Dehydration of tooth
-Desensitizing can be done for 2 weeks leading up to whitening procedure
-Encourage a recovery period between treatments using an agent
