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recession and dentine hypersensitivity Flashcards

To enable the student to understand the aetiology, diagnosis and management of gingival recession and dentine hypersensitivity. Define gingival recession and dentine hypersensitivity Describe prevalence and aetiology Understand the possible consequences of recession including dentine hypersensitivity

1
Q

what is the definition of gingival recession

A

Location of the marginal tissue apical to the cemento - enamel junction with exposure of the root surface with a subtle colour change

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2
Q

what are examples of mucoginigval deformities and conditions around the teeth

A 
Gingival phenotype
Gingival / soft tissue recession
Lack of gingiva
Decreased vestibular depth
Aberrant frenum / muscle position
Gingival excess
Abnormal colour
Condition of the exposed root surface
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3
Q

what is the prevalence of gingival recession 1mm or more in people aged 30+

A

58%

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4
Q

what happens to prevalence and extent with age

A

increases

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5
Q

what is the prevalence and extent in 30-39 year olds

A

37.8%

and extent of 8.6%

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6
Q

what is the prevalence and extent in 80-90 year olds

A

90.4

and extent of 56.3%

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7
Q

what is the distribution of recession

A

maxillary 6s

and mandibular central incisors

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8
Q

which teeth can suffer from dentine hypersensitivity

A

upper and lower canine

1st premolar and incisor teeth

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9
Q

where can there be greater gingival recession

A

left side of the jaw
in males vs females
and afrocarribeans rather than caucasians

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10
Q

where is good OHI associated

A

with buccal surfaces

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11
Q

and where is poor OHI associated

A

with lingual surfaces of lower anterior teeth

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12
Q

what is the aetiology of gingival recession

A

periodontal disease OR

normal sulcus and undisposed interdental crystal bone

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13
Q

which teeth are more likely to have gingival recession

A

teeth near the buccal surface

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14
Q

how else can we have crestal bone loss

A

by orthodontic movement-

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15
Q

what can orthodontic tooth movement cause

A

dehiscence

greater risk of recession with XS proclination of lower incisors and arch expansion

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16
Q

what is recession based on

A

the volume of soft tissue surrounding the tooth

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17
Q

when is there a greater risk of recession-regarding orthodontics

A

when XS proclination of lower incisors and arch expansion

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18
Q

give examples of trauma

A 
foreign objects- lip/tongue piercing
nail biting
hard tooth brushing 
poorly designed dentures- maintained 
trauma from malocclusion 
chemical trauma- cocaine
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19
Q

what is tissue called when its bound to the bone

A

mucoperiosteum

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20
Q

what features of the mucogingival junction can make it more prone to recession

A

thin and less volume of the tissue can make it more likely to recess

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21
Q

what is the local plaque retention factors

A

high muscle attachment

frenal pull

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22
Q

what procedure can we do to increase the volume of tissue

A

gum graft surgery

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23
Q

what can also occur post treatment

A

recession- need to warn patients sometimes

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24
Q

why does smoking have an effect on recession

A

once the smoke is taken in it pools behind the upper anterior teeth- direct effect on tissues

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25
Q

what are the consequences of recession

A 
tooth loss
bleeding gums 
plaque retention 
root caries
aesthetics
abrasion
dentine hypersensitivity
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26
Q

what is dentine hypersensitivity characterised by

A

short sharp-pain arising from exposed dentine in response to certain stimuli-which cannot be attributed to any other dental disease or defect

27
Q

what can dentine hypersensitivity go on to do

A

a dull ache which means the pulp has also been affected

28
Q

when is the peak incidence of dentine hypersensitivity

A

20-40 years

29
Q

what is the self reported percentage of hypersensitivity

A

8-30%

30
Q

what is the % of dentine hypersensitivity in more varied practice population

A

3.8%

31
Q

which gender is more prone to dentine hypersensitivity

A

females

32
Q

where does dentine hypersensitivity occur more

A

buccal, labial,cervical areas of teeth

33
Q

which teeth are most affected in order by DH

A 
first premolars
canines 
incisors
second premolars
molars
34
Q

what do you need to have for DH

A 
DENTINE EXPOSURE(lesion localisation)+tubules made open(lesion initiation)+ stimulus 
pulp must be vital***
35
Q

what can the stimuli be

A

thermal( hot or cold- cold more)
spicy
acid
sweet

36
Q

how does DH occur

A

hydrodynamic theory due to osmosis and fluid in the dentinal tubules
or the microorganisms and their metabolites which can penetrate

37
Q

how can we detect DH

A

by touching-
probing
tooth brushing

38
Q

what is the hydrodynamic theory

A

fluid flow causes a pressure change across the dentine

causes distortion A delta fibres pain

39
Q

which fibres cause pain

A

A delta fibres

40
Q

who thought of the hydrodynamic theory

A

Brannstrom

41
Q

what else can affect fluid flow in dentinal tubules

A

width of the tubules

42
Q

what does rate of fluid flow depend on

A

4TH power of the radius of the tubules

43
Q

why do older people not suffer from DH

A

due to the fact secondary dentine is deposited in the dentinal tubules so it blocks fluid flow

44
Q

what does sensitive dental tubules show

A

disrupted smear layer
more dental tubules at the surface and not occluded
wider tubules

45
Q

what is root sensitivity

A

DH from gingival recession due to perio disease and treatment

46
Q

what might cause root sensitivity

A

potentially microorganisms invading root dental tubules

47
Q

dentine exposure can occur from

A

enamel of enamel by restorative procedues
erosion
abrasion
attrition

48
Q

does toothbrushing alone has an affect on hard tissues

A

NO

toothpaste has an effect-abrasive effect

49
Q

what might affect teeth indirectly in regard to teeth

A

toothbrushing technique

50
Q

what might remove the smear layer-regards to toothpaste

A

abrasive particles

detergents

51
Q

what might tubules be occluded with

A

with particulate matter from paste

52
Q

when can TSL increase

A

by toothpaste abrasion if inter oral environment acidic-eg do not brush straight after breakfast

53
Q

what is erosion influenced by

A 
pH
type 
chemical strength
exposure times
other sources of acid
54
Q

what do we look at in history examination and diagnosis

A

record extent of recession
descriptive
index-rarely used
aetiological factors

55
Q

what are the stages of treatment planning

A

pain management
prevent progression
perio screening and treatment

56
Q

how do we manage hypersensitivity

A

tubule occlusion -
promotes formation of new tissue eg new smear layer
app of artificial barrier
blocking pulpal nerve response

57
Q

what are the ideal qualities of barrier materials

A 
retentive
insoluble
penetrate tubules
form mechanical tags into tubules
seal the end of tubules
58
Q

what can we use for home use of managing HS

A 
toothpaste 
gels 
contain potassium, strontium oxalate and fluoride salts 
potassium nitrate 
novamin
59
Q

what does novamin release

A

Ca and P to form a hydroxyapatite like layer

60
Q

what did west et al (1997) show for a placebo effect

A

40%

61
Q

what is good about strontium acetate

A

withstands immersion in acid

62
Q

what can we use in surgery to manage HS

A

VARNISH- DURAPHAT (5%Naf)
reinforced GIC
1-3 LAYERS of adhesive resin bonding system
desensitizing polish paste calcium carbonate and arginine

63
Q

WHAT CAN WE ADVISE to prevent DH

A

toothbrushing technique-
modified bass technique
roll toothbrush
electric- with pressure sensor

64
Q

what advice do we give with smoking cessation

A

ask
advise
act

CSA (51 decks)

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