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Dentin
Hypersensitivity
4 year - FS
Introduction
Definition:
Dentin hypersensitivity
is a common condition of
transient tooth pain caused
by a variety of exogenous
stimuli.
Characteristic
Short , sharp pain.
Most in cervical, then occlusal
Stimuli
The exogenous stimuli include:
Thermal (cold)
Tactile (touch)
Osmotic changes
(sweets, drying the surface)
Etiology
The primary clinical cause is
exposed dentinal
tubules.
Two phases of development of
dentin hypersensitity
First, dentin has to be exposed.
—lesion localization
The dentinal tubules must be opened
—lesion initiation
The most common clinical cause
for exposed dentinal tubules is
gingival recession.
Common Reasons for Gingival Recession
1.
2.
3.
4.
5.
6.
7.
8.
Inadequate attached gingiva
Prominent roots
Tooth brush abrasion
Pocket reduction periodontal surgery
Oral habits resulting in gingival laceration
Excessive tooth cleaning
Excessive flossing
others
Reasons for Continued
Dentinal Tubular Exposure
1.
2.
3.
4.
5.
Poor plaque control, acidic bacterial byproducts
Excess oral acids, sodas, fruit juice
Cervical decay
Toothbrush abrasion
Tartar control toothpaste
Mechanism
Hydrodynamic theory
—M.Brännström in 1967
The fluids within the tubule are disturbed
either by temperature changes
or physical osmotic changes.
These fluid changes stimulate a baroreceptor
which leads to neural discharge (depolarization).
Baroreceptor:
a never receptor sensitive to pressure
Treatment
A challenge for both the patients and dentists.
It’s difficult measuring/comparing
different patient’s pain.
It’s difficult for patients
to change the habits.
Treatment Strategies
 Plug the dentinal tubules
preventing fluid flow.
 Desensitize the nerve
making it less responsive to stimulation.
Nerve Desensitization
Potassium Nitrate
the only one approved by FDA and ADA
KNO3 penetrates through the dentinal tubules
to the nerve;
K+ may depolarize the nerve and prevent it
from repolarizing;
Thereby, Preventing it
from sending pain signals to the brain.
Covering Dentinal Tubules
 Composite or GIC restoration
 Crown placement
 Periodontal surgery
Occluding Dentinal Tubules
To plug the inside of the dentinal tubules
Ions or salts:
stannous fluoride, sodium fluoride,
potassium oxalate, etc
Precipitates:
glutaraldehyde
Resin:
dentin sealers
Laser: another choice
Treatment Steps
1. Thorough exam to identify etiology and
eliminate tooth fracture and irreversible pulpitis.
2. Potassium nitrate containing product/toothpaste
2×day for at least 2 weeks.
3. Potassium nitrate containing product
in a tight fitting dental tray.
4. In-office tubule occluding product.
5. In-office tubule sealer.
6. Dental restoration, or a periodontal surgery,
that covers the exposed dentin.
7. Endodontic procedure to remove the pulp.
The patient should be informed of
the series of steps that may be
necessary to eliminate
the problem.