Sensitive Teeth?

Dentinal HypersensitivityDiagnosis And Treatment

By Dr. Dhriti Adak

What is Dentinal Hypersensitivity [DH]?

• DH is characterized by short sharp pain arising from exposed dentin in response to stimuli.

• These stimuli may be– Thermal (usually cold water)– Mechanical (brushing, air spray)– Chemical (acidic fruits, sweets)

Prevalence And Distribution of DH

• According to JADA, the prevalence of DH is 4% to 57%

• Prevalence of DH in periodontitis patients is 60% to 98%

• DH is more commonly observed in patients between the age of 30-40 years, but it can occur at any age

• DH has been commonly seen in females as compared to males

Etiology

• Dentin exposure due to enamel loss

– Erosion

– Abrasion

– Corrosion (constant action of acids)

– Gingival recession (disease or age)

– Chronic Periodontitis

– Patients’ deleterious habits

Theories Of Dentin Sensitivity

• Hydrodynamic Theory proposed by Brannstrom and Astron in 1964

• The presence of lesions involving the enamel and/or the cementum loss in the cervical area

• Consequent opening of dentinal tubules to the oral environment, under certain stimuli

• Allows the movement of dentinal fluid inside the tubules

• This indirectly stimulates the extremities of the pulp nerves, causing pain sensation

• This is the accepted theory

Outline of the hydrodynamic mechanism by which stimuli activate intradental nerves to cause pain

Theories Of Dentin Sensitivity Contd.

• Direct neural stimulation theory: According to this theory the stimuli reaches the nerve endings in the inner dentin. But how it reaches the nerve endings could not be explained. Due to little scientific proof it is not accepted now

• Transduction theory: According to this theory, the Odontoblastic processes are excited by the stimulus and transmit the impulses to the nerve endings. This theory is also of little importance as it has been noticed that there are no neurotransmitters in the dentin

Classification of Dental Desensitizing Agents

At-Home Treatments Can be self-administered by the

patient at home

• Desensitizing Dentrifrices / Toothpastes

• Mouthwashes and Chewing gums

In-Office Treatments Applied by a dental professional in the dental office

• Topically applied desensitizing agents– Fluoride– Potassium Nitrate– Oxalate– Calcium Phosphates

• Adhesives and Resins• Other Procedures

– Iontophoresis– Lasers

At-Home Treatments

• Desensitizing Dentrifrices / Toothpastes

Containing either – Strontium Salts, Fluorides: Occlude dentinal tubules– Potassium Nitrate: decreases the excitability of intradental

nerves

• Mouthwashes and chewing gums:– Containing potassium nitrate and sodium fluoride,

potassium citrate or sodium fluoride or a mixture of fluorides

In-Office Treatments

• Topically applied desensitizing agents:

– Fluoride, such as sodium fluoride and stannous fluoride

can reduce dentin sensitivity

– Fluorides decrease the permeability of dentin in vitro,

possibly by precipitation of insoluble calcium fluoride

within the tubules

In-Office Treatments Contd.

– Potassium nitrate, which usually is applied via a

desensitizing toothpaste.

– Can reduce dentin sensitivity when applied topically in an

aqueous solution or an adhesive gel

In-Office Treatments Contd.

– Oxalate: In 1981, Greenhill and Pashley reported that 30%

potassium oxalate caused a 98% reduction in dentin

permeability in vitro

– Oxalate products reduce dentin permeability and occlude

tubules more consistently in laboratory studies, than they

do in clinical trials

In-Office Treatments Contd.

– Calcium phosphates may reduce dentin sensitivity

effectively

– Calcium phosphates occlude dentinal tubules in vitro and

decrease in vitro dentin permeability

In-Office Treatments Contd.

• Adhesives and Resins:

– Because many topical desensitizing agents do not adhere

to the dentin surface, their effects are temporary

– Stronger and more adhesive materials offer improved and

longer-lasting desensitization

In-Office Treatments Contd.

• Other Procedures

– Iontophoresis This procedure uses electricity to enhance

diffusion of ions into the tissues

– Dental Iontophoresis is used most often in conjunction

with fluoride pastes or solutions and reportedly reduces

DH

In-Office Treatments Contd.

– Lasers: The effectiveness of lasers for treating DH varies from 5 to 100%, depending on the type of laser and the treatment parameters

– Studies have reported that the neodymium:yttrium-aluminum-garnet laser (Nd:YAG), the erbium:YAG laser and galium-aluminium-arsenide low level laser (LLLT) all reduce DH

– In addition to these equivocal results, lasers represent a more expensive and complex treatment modality

Pain Ladder

Pain ladder showing increasing pain and complexity of desensitizingtreatments. Adapted with permission of the World Health Organization.

Management Strategy

Solutions and Products tested in Clinical Trials

Conclusions

• Professionals should appreciate the role causative factors play in localizing and initiating hypersensitive lesions. It is important to identify these factors so that prevention can be included in the treatment plan.

• Active management of DH usually will involve a combination of at-home and in-office therapies.

• In practice, the regimen adopted will depend on the perceived severity of the condition and the number of teeth involved.

Thank You

References

• JADA: The Journal of American Dental Association

• Journal of Oral Science (Vol. 51, No.3, 323-332, 2009)

• The Journal of Contemporary Dental Practice, Volume 6, No.

2, May 15, 2005

• Carranza, 9th edition

• Sturdevant, 3rd edition

• World Wide Web