Hypersensitivity Flashcards by Faye Sitron

What are some types of tactile stimuli?

Denture clasps
Toothbrushing
Dental Instrumentation
Thermal (hot, cold, food air)

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What is evaporative stimuli?

Dehydration of oral fluids (HVE/air-water syring)

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What is osmotic stimuli?

Alteration of pressure in dentinal tubules through a selective membrane

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What are some chemical stimuli?

Acids (wine, citrus)
Some spices
Whitening products
Carbonated beverages
Acidogenic carb exposure
Gastric regurgitation

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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

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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

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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

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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

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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

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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

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What are some types of natural desensitization?

Sclerosis of dentin
Secondary dentin

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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

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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

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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

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How does calculus work as a natural desensitizer?

Provides a blanketing effect
Covers exposed dentin

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What is the prevalence of hypersensitivity?

Affects mostly 18-44 year olds
More so in perio disease populations
Occurs primarily at cervical 3rd

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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

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How can acute pain affect people mentally?

May cause anxiety

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How can chronic pain affect people mentally?

May cause depression

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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