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
what is the definition of gingival recession
Location of the marginal tissue apical to the cemento - enamel junction with exposure of the root surface with a subtle colour change
what are examples of mucoginigval deformities and conditions around the teeth
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
what is the prevalence of gingival recession 1mm or more in people aged 30+
58%
what happens to prevalence and extent with age
increases
what is the prevalence and extent in 30-39 year olds
37.8%
and extent of 8.6%
what is the prevalence and extent in 80-90 year olds
90.4
and extent of 56.3%
what is the distribution of recession
maxillary 6s
and mandibular central incisors
which teeth can suffer from dentine hypersensitivity
upper and lower canine
1st premolar and incisor teeth
where can there be greater gingival recession
left side of the jaw
in males vs females
and afrocarribeans rather than caucasians
where is good OHI associated
with buccal surfaces
and where is poor OHI associated
with lingual surfaces of lower anterior teeth
what is the aetiology of gingival recession
periodontal disease OR
normal sulcus and undisposed interdental crystal bone
which teeth are more likely to have gingival recession
teeth near the buccal surface
how else can we have crestal bone loss
by orthodontic movement-
what can orthodontic tooth movement cause
dehiscence
greater risk of recession with XS proclination of lower incisors and arch expansion
what is recession based on
the volume of soft tissue surrounding the tooth
when is there a greater risk of recession-regarding orthodontics
when XS proclination of lower incisors and arch expansion
give examples of trauma
foreign objects- lip/tongue piercing nail biting hard tooth brushing poorly designed dentures- maintained trauma from malocclusion chemical trauma- cocaine
what is tissue called when its bound to the bone
mucoperiosteum
what features of the mucogingival junction can make it more prone to recession
thin and less volume of the tissue can make it more likely to recess
what is the local plaque retention factors
high muscle attachment
frenal pull
what procedure can we do to increase the volume of tissue
gum graft surgery
what can also occur post treatment
recession- need to warn patients sometimes
why does smoking have an effect on recession
once the smoke is taken in it pools behind the upper anterior teeth- direct effect on tissues
what are the consequences of recession
tooth loss bleeding gums plaque retention root caries aesthetics abrasion dentine hypersensitivity
what is dentine hypersensitivity characterised by
short sharp-pain arising from exposed dentine in response to certain stimuli-which cannot be attributed to any other dental disease or defect
what can dentine hypersensitivity go on to do
a dull ache which means the pulp has also been affected
when is the peak incidence of dentine hypersensitivity
20-40 years
what is the self reported percentage of hypersensitivity
8-30%
what is the % of dentine hypersensitivity in more varied practice population
3.8%
which gender is more prone to dentine hypersensitivity
females
where does dentine hypersensitivity occur more
buccal, labial,cervical areas of teeth
which teeth are most affected in order by DH
first premolars canines incisors second premolars molars
what do you need to have for DH
DENTINE EXPOSURE(lesion localisation)+tubules made open(lesion initiation)+ stimulus pulp must be vital***
what can the stimuli be
thermal( hot or cold- cold more)
spicy
acid
sweet
how does DH occur
hydrodynamic theory due to osmosis and fluid in the dentinal tubules
or the microorganisms and their metabolites which can penetrate
how can we detect DH
by touching-
probing
tooth brushing
what is the hydrodynamic theory
fluid flow causes a pressure change across the dentine
causes distortion A delta fibres pain
which fibres cause pain
A delta fibres
who thought of the hydrodynamic theory
Brannstrom
what else can affect fluid flow in dentinal tubules
width of the tubules
what does rate of fluid flow depend on
4TH power of the radius of the tubules
why do older people not suffer from DH
due to the fact secondary dentine is deposited in the dentinal tubules so it blocks fluid flow
what does sensitive dental tubules show
disrupted smear layer
more dental tubules at the surface and not occluded
wider tubules
what is root sensitivity
DH from gingival recession due to perio disease and treatment
what might cause root sensitivity
potentially microorganisms invading root dental tubules
dentine exposure can occur from
enamel of enamel by restorative procedues
erosion
abrasion
attrition
does toothbrushing alone has an affect on hard tissues
NO
toothpaste has an effect-abrasive effect
what might affect teeth indirectly in regard to teeth
toothbrushing technique
what might remove the smear layer-regards to toothpaste
abrasive particles
detergents
what might tubules be occluded with
with particulate matter from paste
when can TSL increase
by toothpaste abrasion if inter oral environment acidic-eg do not brush straight after breakfast
what is erosion influenced by
pH type chemical strength exposure times other sources of acid
what do we look at in history examination and diagnosis
record extent of recession
descriptive
index-rarely used
aetiological factors
what are the stages of treatment planning
pain management
prevent progression
perio screening and treatment
how do we manage hypersensitivity
tubule occlusion -
promotes formation of new tissue eg new smear layer
app of artificial barrier
blocking pulpal nerve response
what are the ideal qualities of barrier materials
retentive insoluble penetrate tubules form mechanical tags into tubules seal the end of tubules
what can we use for home use of managing HS
toothpaste gels contain potassium, strontium oxalate and fluoride salts potassium nitrate novamin
what does novamin release
Ca and P to form a hydroxyapatite like layer
what did west et al (1997) show for a placebo effect
40%
what is good about strontium acetate
withstands immersion in acid
what can we use in surgery to manage HS
VARNISH- DURAPHAT (5%Naf)
reinforced GIC
1-3 LAYERS of adhesive resin bonding system
desensitizing polish paste calcium carbonate and arginine
WHAT CAN WE ADVISE to prevent DH
toothbrushing technique-
modified bass technique
roll toothbrush
electric- with pressure sensor
what advice do we give with smoking cessation
ask
advise
act
