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8/9/2019 Dentine Hypersensitivity IMPT
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Dentin HypersensitivityObjectives:
Define dentin hypersensitivity.
Discuss the causative stimuli for dentin hypersensitivity.
Explain how dentin hypersensitivity can be managed-
treated.
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What is dentin hypersensitivity?
It is a short, sharp pain arising fromexposed dentin in response to stimulitypically thermal, evaporative, tactile,osmotic, or chemical that cannot beascribed to any other form of dental
defect or pathology.
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How common is dentin hypersensitivity?
In general population, prevalenceranges from 8 percent to 57 percent.
In periodontal practices it can be ashigh as 80 percent.
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Causes of hypersensitivity
Gingival recession due to occlusalproblems, overcontoured crownmargins, excessive brushing, anderosion due to improper diet.
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Susceptible tooth surfaces to
hypersensitivity include: Receded gingival tissues, exposing the
cementum and dentin.
Lost enamel or apically migrated junctionalepithelium.
Facial surfaces of maxillary canines, firstpremolars, followed by incisors, secondpremolars, and then molars due to morevigorous tooth brushing on the facial gingivalsurface.
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FYIApproximately 10 percent of teeth have
an area of exposed dentin at thecementoenamel junction.
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ROOT SURFACE MORPHOLOGY
Cementum is thin or nonexistent on thecervical root; therefore whenattachment fibers are lost, the hardtissue exposed to the oral environmentis dentin.
For sensitivity to be felt, exposed dentinmust have dentinal tubules that areopen to the oral cavity and pulp.
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Non-sensitive tooth
When a non-sensitive tooth with anexposed root surface does not react toa triggering stimulus, it has fewer opendentinal tubules at exposed surfaces,and the diameters of the tubules are
much narrower than those in teeth thatdo react to triggering stimuli andexperience sensitivity.
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DID YOU KNOW???????That the average diameter of tubules in
sensitive teeth is two times wider than
tubules in non-sensitive teeth.And
Difference in the diameter of the dentinaltubules significantly increases the rate of fluidflow within the tubule, which most likelycontributes to pain stimulation.
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Causative Stimuli that cause hypersensitivity.
There are various stimuli that, when incontact with exposed and open dentinal
surfaces can cause a painful sensation in atooth.
Tooth brush abrasion and abrasive dentifrices
Chemical erosion
Intrinsic Thermal
Tactile
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Toothbrush abrasion and
abrasive dentifrices. Aggressive scrub brushing and/or the use of
abrasive pastes may erode cervical dentin,
but this action produces a smear layerwhich is a protective surface layer---that mayhelp to counteract sensitivity.
If a dentifrice is too abrasive, if it is used tofrequently, or if it is applied with too muchforce, the paste may remove the beneficialsmear layer, resulting in open tubules andsensitivity.
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Chemical erosion Enamel and dentin are susceptible to
chemical wear from excessive acid attacks.
Sources of acids include: Extrinsic (diet)naturally occurring in foods/
beveragesi.e., citrus fruits, juices, cider,carbonated drinks, and wines.
Intrinsic- gastric acids (vomiting,gastroesophageal acid reflux disease (GERD)
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Thermal causes of
hypersensitivity.
Hot and or cold foods and beverages
Cold air on exposed dentinal surfaces;cold is the most common cause of
hypersensitivity.
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Tactile causes of
hypersensitivity.
A foreign object touching an exposeddentinal surface such as a toothbrushbristles, toothpicks, denture clasps, ordental instruments.
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Other causes of hypersensitivity.
Dental caries
Pulpitis Tooth fractures
Fractured or leaking restorations.
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Desensitizing Treatments
How do they work?
Desensitizing treatments can eitherinterupt pulpal nerve activationrepolarization and pain transmission orreducing the fluid flow within the dentinaltubules by creating a smear layer or by
blocking (occluding) the tubule ends.
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Patient applied treatments Desensitizing dentifrices
Agents that have been accepted by the
American Dental Association Council onDental Therapeutics 0.24 percent sodium fluoride, AquafreshSensitive Teeth, CrestSensitivity Protection.
Potassium nitrate- most widely available activeagent in desensitizing dentifrices.
5 percent postassium nitrate, sodiummonofluoriophosphateSensodyne Extra Whitening.
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Mode of action.
Potassium nitrate depolarizes nervefibers; fluoride forms precipitate withindentin tubules.
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Self-applied fluoride rinses
Both stannous and sodium fluoridesocclude dentinal tubules.
Examples
0.63 percent stannous fluoride (Gel-KamOral Care Rinse, daily prescription rinse)
0.2 percent neutral sodium fluoride(Fluorinse, weekly prescription rinse)
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Mode of action
Fluoride forms precipitate withindentinal tubules.
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Self-applied fluoride gels and
pastes
Examples include:
0.4 percent stannous fluoride (Gel-KamGel, Omni Gel); available over the counter
1.1 percent sodium fluoride Available byprescription
0.2 percent neutral sodium fluoride(Prevident 5000 Plus) by prescription
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Mode of action.
Fluoride forms precipitate within dentintubules.
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Professionally applied
treatments.
Many agents can be topically applied toexposed dentinal surfaces to block(occlude/obturate) dentinal tubules.
Examples;
Fluorides
varnish
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Varnish
5 percent sodium fluoride
Duraphat
Mode of action; forms a protective layer(blocks) of calcium fluoride that preventsfluid flow in the tubules.
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Properties of a fluoride varnish Sets in the presence of moisture
Provides immediate fluoride uptake
Remains on teeth until brushed off Because the sodium fluoride in the varnish
may interact with other fluoride preparations,avoid applying a professionally applied topicalfluoride get treatment after the fluoride
varnish is applied. If the patient is taking daily fluoride
supplements, they should not be taken forseveral days after fluoride varnish application.
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Application of a fluoride
varnish Use a brush to apply varnish
Postapplication instructions to patient.After varnish is applied, the patient should
avoid eating hard foods and/or toothbrushing for at least two hours.
This recommendation is necessary because
any early mechanical cleansing/rubbing ofthe treated tooth surface can remove thevarnish.