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-Surabhi desai
[Fourth year]
Guided by-Dr.Ashish Jain sir.
HOD of conservative and endodontics department
DENTINAL HYPERSENSITIVITY
INTRODUCTION
THERMAL STIMULUS
No
icecream
No tea
WHAT TO DO?
What is
it??????????
INTRODUCTION
DEFINITION
ETIOLOGY
MECHANISM
CLINICAL FEATURES
DISTRIBUTION
DIAGNOSIS
PREVENTION
TREATMENT
DIFFRENTIAL DIAGNOSIS
CONTENTS
Pain is short and sharp.
caused by exposed dentin.
In response of stimulus:
1.thermal
2.Tactile
3.Chemical/osmotic
4.evaporative
INTRODUCTION
STIMULUS
Pain
on???
??
“Dentin hypersensitivity is characterisedby short , sharp pain arising from exposed
dentin in response to stimuli typically thermal, evaporative ,tactile , osmotic or
chemical and which cannot be ascribed to any other form of dental defect or
pathology.”HOLLAND ET AL 1997
DEFINITION:
ETIOLOGY
ETIOLOGY
ENAMEL
LOSS
ETIOLOGY
CEMENTAL
LOSS
The history and nature of pain.Describe the pain.
The number and location of sensitive teeth.
The stimuli which initiate the sensitivity.
Tooth brushing method.
If he has undergone periodontal surgery.
Obtain detailed dietary history.
Probe for gastric acid reflux and vomiting.
DIAGNOSIS
THEORIES OF PAIN
DIRECT
INNERVATION
THEORY
ODONTOLAST
DEFORMATION
THEORY
HYDRODYNAMIC
THEORY
DISTRIBUTION
FEMALE CANINE
PREMOLARPERIODONTITIS
Affects the
buccal aspect
of cervical
area
Age group
25-50
AN OUNCE OF PREVENTION IS
WORTH A POUND OF CURE
How to
prevent???
????????
desensitizationAT HOMEIN OFFICE
by occluding the Dentinal tubules
by blocking the pulpal Sensory nerve
MANAGEMENT:
MECHANISM
DESENSITISATION BY OCCLUDING DENTINAL TUBULES
A)FORMATION OF SMEAR LAYER OVER EXPOSED DENTIN
B)USE OF TOPICAL AGENTS TO OCCLUDE EXPOSED TUBULES
CALCIUM HYDROXIDE PASTE
SILVER NITRATE
FLUORIDE
VARNISHES
DENTIN ADHESIVES
PROTEIN PRECIPITATION
GLUTERALDEHYDE
STRONTIUM CHLORIDE
CLASSIFICATION
C)PLACEMENT OF RESTORATIONS
GLASS IONOMER CEMENTS
COMPOSITE RESINS
D)USE OF LASERS
2. DESENSITIZING BY BLOCKING PULPAL SENSORY
NERVES
A)POTASSIUM NITRATE TOOTHPASTE
OTHERS
CORTICOSTEROID
CLASSIFICATION
Use of topical agents to occlude the dentinal tubules
•Calcium hydroxide- calcium hydroxide powder can be mixed with distilled water to
form paste. This is then applied on the exposed dentin . It increases peritubular
dentin formation.
COMMERCIALLY AVAILABLE
PRODUCT – GC TOOTH MOUSSE.
SILVER NITRATE• It reduces the fluid movement by precipitating the protein within the
dentinal tubules.DISADVANTAGE: this agents is not popularly used nowadays as it stains dentin and is also damaging to the pulp and gingiva.
Strontium chloride •It acts by penetrating the tubules and forming strontium apatite which occludes the exposed dentinal tubules•It is incorporated in desensitizing toothpastes.
Fluorides:
Agents such as sodium fluoride , stannous fluoride, or acidulated phosphate fluoride may be used for a few minutes as mouth
rinses, toothpastes or as topical applications over exposed dentin.
They act by forming fluorapatite within the tubules which blocks fluid movement within
the dentin.
Varnishes:
•Varnishes act by forming a barrier over the exposed dentin.
•This lowers hypersensitivity as it reduces dentin permeability.
Placement of restorations:
•Whenever a considerable amount of dentin is lost,, a glass ionomer or a composite resin restoration may be
placed to replace the lost tooth structure and seal the exposed dentin.
It reducing the excitability of the sensory nerves in response to stimuli.
Potassium nitrate toothpastes: Potassium ions from potassium nitrate toothpastes can easily pass
through the dentin to the pulp .Here they depolarizes of the sensory nerve endings present
close to the odontoblasts BY ALTERING THEIR
MEMBRANE POTENTIAL thus preventing the transmission of impulses to brain.
DESENSITIZATION BY BLOCKING PULPAL SENSORY NERVES:
Nd-YAG) laser
Neodymium:yttrium aluminum garnet
GaAlAs (galium-aluminium-arsenide laser)
Erbium-YAG laser
USE OF LASERS
THEY OCCLUDE THE DENTINAL TUBULES.
The CO2 laser belongs
to the group of the middle-output power lasers.
LASERS
Direct
method
Indirect
method
DIFFERENTIAL DIAGNOSIS
THANK YOU