Dental Problems and Hypersensitivity

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Questions and Answers

What is the primary consequence of exposing cementum?

Exposure of dentin and pulp

Exposure of enamel and pulp

Exposure of pulp and hypersensitivity

Exposure of dentin and hypersensitivity (correct)

Which of the following is a characteristic of cracked tooth syndrome?

Fracture of the root only

Incomplete fracture of the tooth, involving dentin only (correct)

Fracture of the enamel only

Complete fracture of the tooth

What is the primary cause of hypersensitivity in a tooth that has undergone a big restoration?

Trauma

Dentin desiccation

Cracked tooth syndrome (correct)

Inadequate cavity preparation

Which of the following is a post-operative etiological factor of hypersensitivity?

Cavity preparation Signup and view all the answers

Why is proper cooling mandatory during cavity preparation?

To prevent pulpal tissue destruction Signup and view all the answers

What can cause the actual aspiration of odontoblastic nuclei into the tubules?

Instrumentation pressure Signup and view all the answers

What is the approximate number of dentinal tubules exposed per square millimeter of dentin cutting?

30,000 to 45,000 Signup and view all the answers

Which of the following is NOT a preoperative etiological factor for dentinal hypersensitivity?

Galvanism Signup and view all the answers

What can result from the use of chemicals to sterile the cavity?

Dentin desiccation Signup and view all the answers

What is the result of polymerization shrinkage in restorative dentistry?

Stresses at the interface, microleakage, and secondary caries Signup and view all the answers

What is the primary difference between reversible and irreversible hypersensitivity?

The treatment required to alleviate hypersensitivity Signup and view all the answers

What is the consequence of under-cured resin in a restoration?

Incompletely cured inner layer, resulting in marginal fracture and chemical toxicity Signup and view all the answers

What is the primary cause of dentinal hypersensitivity in microleakage?

Ingress of fluids and microorganisms Signup and view all the answers

Which of the following is a characteristic of galvanism-induced hypersensitivity?

Hypersensitivity in tooth with lower potential Signup and view all the answers

What is the typical characteristic of pain in cracked tooth syndrome?

Sharp pain on biting and eating citrus fruits Signup and view all the answers

What is the primary concern with inadequate liner and/or base in restorative dentistry?

Increased risk of pulpal reaction Signup and view all the answers

What is a contributing factor to hypersensitivity due to faulty occlusal and/or proximal relationships?

Occlusal contact if high Signup and view all the answers

What can lead to heat generation during finishing procedures?

Finishing procedures Signup and view all the answers

What is a common cause of hypersensitivity in non-vital teeth?

Expansion of air voids under or within a restoration Signup and view all the answers

What is NOT a factor contributing to pulpal hypersensitivity?

Occlusal contact if low Signup and view all the answers

What can lead to excessive pressure on the periodontal ligament?

Tight proximal contact Signup and view all the answers

What can lead to mechanical trauma of the free gingiva?

Undercontoured restorations Signup and view all the answers

What is a consequence of direct pulp capping?

Pulp hyperemia Signup and view all the answers

What is a characteristic of a successful direct pulp capping?

The tooth is asymptomatic for several weeks Signup and view all the answers

What is the primary reason for identifying etiological factors in dentin hypersensitivity?

To include prevention in the treatment plan before starting active management Signup and view all the answers

What is the primary function of potassium nitrate in desensitizing toothpastes?

To calm the nerve endings inside the dentine Signup and view all the answers

What is the benefit of using a soft or ultrasoft manual toothbrush with soft, end-rounded bristles?

It reduces the risk of gingival recession and abrasion of exposed cementum and dentin Signup and view all the answers

What is the purpose of drinking milk or water after consuming an acidic diet?

To neutralize the acid and reduce the risk of tooth decay Signup and view all the answers

What is the primary consequence of parafunctional habits on the teeth?

Bruxism, teeth flexure, and abfractions Signup and view all the answers

What is the primary function of fluoride in in-office treatments for dentin hypersensitivity?

To reduce dentin sensitivity Signup and view all the answers

What is the primary benefit of using a powered toothbrush with a light grasp?

It requires less pressure on the teeth Signup and view all the answers

What is the primary purpose of avoiding brushing immediately after ingestion of acidic food?

To allow the teeth to re-mineralize before brushing Signup and view all the answers

What is the mechanism by which fluorides decrease the permeability of dentin?

By precipitating insoluble calcium fluoride within the tubules Signup and view all the answers

What is the primary mechanism of action of potassium nitrate in reducing dentin hypersensitivity?

By reducing nerve excitability Signup and view all the answers

What is the primary mechanism of action of oxalate products in reducing dentin hypersensitivity?

By occluding dentinal tubules and reducing dentin permeability Signup and view all the answers

What is the key active ingredient in Orajel Tooth Desensitizer?

2-hydroxyethyl methacrylate Signup and view all the answers

What is the composition of NovaMin?

45% SiO2, 24.5% Na2O, 24.5% CaO, and 6% P2O5 Signup and view all the answers

What is the mechanism of action of Casein Phosphopeptides?

By neutralizing acids from acidogenic bacteria and other sources Signup and view all the answers

What is the role of adhesives and resins in reducing dentin hypersensitivity?

They occlude dentinal tubules and reduce dentin permeability Signup and view all the answers

What is the primary benefit of using Iontophoresis in dentistry?

It enhances diffusion of ions into the tissues Signup and view all the answers

Study Notes

Causes of Dentin Hypersensitivity

Exposure of cementum leading to exposure of dentin and hypersensitivity
Cracked tooth syndrome: incomplete fracture of teeth, involving dentin only or extending to pulp, resulting in teeth hypersensitivity with biting relieved with releasing
Trauma: fracture of enamel, dentin, or root
Preoperative etiological factors:
- Bacterial
- Chemical - Osmotic
- Mechanical
- Thermal
- Idiopathic
Postoperative (Iatrogenic) factors:
- Cavity preparation
- Restorative phase and restorations
- Vital teeth bleaching

Types of Dentin Hypersensitivity

Reversible hypersensitivity: subsides by treating the exposed dentin
Irreversible hypersensitivity: might require root canal treatment or even extraction of the teeth in some severe cases

Factors Affecting Dentin Hypersensitivity

Instrumentation:
- Rotary instruments produce more heat generation than hand instruments
- Dull instruments require higher pressure and subsequently more heat generation
- Heat can destruct pulpal tissue, coagulate protoplasm, and even burn dentin, making proper cooling mandatory
Cutting instruments:
- Every square millimeter of dentin cut exposes 30,000 to 45,000 dentinal tubules, resulting in fluid movement and stimulating nerve damage
Dentin desiccation:
- Heating of dentin during cutting
- Use of chemicals to sterile the cavity
- Use of air as a coolant for final cavity toilet

Restorative Phase and Restorations

Polymerization shrinkage: results in stresses at the interface, resulting in microleakage, microcracks, and secondary caries
Under-cured resin: incompletely cured inner layer, results in marginal fracture, open margin, and chemical toxicity
Micro-leakage: ingress of fluids and microorganisms causes dentinal hypersensitivity due to dentinal fluid movements
Inadequate protection: metallic restoration causes hypersensitivity, especially in the first few days
Fractured restoration: exposed dentin, recurrent caries, and dentin hypersensitivity
Cracked tooth: sharp pain on biting and eating citrus fruits, large restorations, and restorations without cusp protection
Galvanism: hypersensitivity is usually felt in the tooth containing the restoration with the lower potential
Faulty occlusal and/or proximal relationship: occlusal contact affects the periodontal ligament, leading to sensitivity with bite and/or mobility
Finishing procedures: might lead to heat generation, scratch, or cementum loss
Barodontology: expansion of air voids under or within a restoration or gases in a non-vital teeth in an airplane
Gingival reaction: retraction cord and chemical tissue packs, improperly contoured or overhanging temporary dressing
Pulpal reaction: direct pulp capping is considered successful if the tooth remains asymptomatic and gives a positive vitality test

Management of Etiological Factors

Identify and prevent etiological factors in the treatment plan
Home care:
- Desensitizing toothpastes/dentifrices
- Toothbrush and toothpaste application
- Mouthwashes and chewing gums
- Dietary modifications
- Management of parafunctional habits
In-office treatment:
- Fluorides: sodium fluoride and stannous fluoride
- Iontophoresis: uses electricity to enhance diffusion of ions into the tissues
- Potassium nitrate: reduces dentin hypersensitivity by reducing nerve excitability
- Oxalates: reduce dentin permeability and occlude tubules
- Calcium phosphates: occlude dentinal tubules and decrease dentin permeability
- NovaMin: bioactive glass that delivers ionic form of calcium, phosphorus, silica, and sodium for bone and tooth mineralization
- Casein phosphopeptides: a water-based topical cream that provides extra teeth protection and neutralizes acids from acidogenic bacteria and external acid sources

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Description

This quiz covers different dental problems that can lead to hypersensitivity, including exposure of cementum and dentin, cracked tooth syndrome, and trauma. It also discusses the characteristics of each condition and how they can be triggered.