Dentin Hypersensitivity: Causes and Symptoms

Cold = Fluid flow away from the pulp Heat = Fluid flow toward the pulp Sugar solution = Fluid flow toward the pulp Salt solution = Fluid flow away from the pulp

Bulimia = Erosion Gastroesophageal reflux disease (GERD) = Attrition Gingival recession = Abrasion Periodontal procedures = Erosion

Jet of air = Diagnosing dentin hypersensitivity Probe or explorer = Measuring dentin tubule diameter Radiographic examination = Identifying etiological factors Vital tooth bleaching = Treating dentin hypersensitivity

Number of open dentin tubules = Intensity of pain Diameter of open dentin tubules = Frequency of pain Osmolarity of dentinal fluid = Type of pain Speed of neural responses = Duration of pain

Sugar solution = Fluid flow toward the solution Salt solution = Fluid flow toward the solution Water solution = No effect on fluid flow Oil solution = Fluid flow away from the solution

Etiological factors = Understanding the cause of pain Predisposing factors = Identifying vulnerable patients Dental history = Determining past dental treatments Radiographic examination = Ruling out other dental conditions

Hydrodynamic Theory = The fluid flow within the dentin tubules moves either in outward or inward direction, and activates the mechanoreceptors present on A delta fibers. Tooth Sensitivity Theory = Dentin hypersensitivity is caused by dental caries, microleakage, cracked tooth or fractured restorations. Dental Caries Theory = The number and the diameter of the dentin tubules are considered important factors in initiating pain from dentin hypersensitivity. Pain Receptor Theory = Pain is caused by the exposure of the dentin surface and can be triggered by thermal, chemical, tactile, evaporative, and osmotic stimuli.

Sharp transient pain = Produced by one of several different stimuli: thermal, chemical, tactile, evaporative, and osmotic. Short-lived pain = Pain caused by the exposure of the dentin surface. Localized pain = More prevalent in patients who are between the ages of 20 and 40. Chronic pain = Pain caused by dental caries, microleakage, cracked tooth or fractured restorations.

20-40 years = More prevalent in this age group. 15-25 years = Less prevalent in this age group. 40-60 years = Less common in this age group. Above 60 years = Rarely affected by dentin hypersensitivity.

Canines and premolars = The teeth with the highest incidence in the cervical region. Incisors = Less commonly affected by dentin hypersensitivity. Molars = Rarely affected by dentin hypersensitivity. All teeth = Equally affected by dentin hypersensitivity.

Thermal stimuli = Produces sharp transient pain. Chemical stimuli = Causes pain by exposing the dentin surface. Tactile stimuli = Triggers pain by activating mechanoreceptors. Osmotic stimuli = Has no effect on dentin hypersensitivity.

Number and diameter of dentin tubules = Considered important factors in initiating pain from dentin hypersensitivity. Dentin surface exposure = Causes pain by exposing the dentin surface. A delta fibers = Not related to dentin hypersensitivity. Dental caries = Causes pain due to tooth sensitivity.

Formation of reparative dentin = i. Self-limiting pain hypersensitivity Dentin sclerosis causing obliteration of tubules = ii. Predisposing factor elimination Calculus formation on the surface of dentin = iii. Decrease in dentin permeability Proper oral hygiene practice = iv. Management of gastroesophageal reflux disease

Avoid excessive brushing with excessive pressure = i. Ensure proper oral hygiene practice Avoid brushing immediately after taking acidic drinks = ii. Prevent erosive loss of tooth structure Manage patient with gastroesophageal reflux disease = iii. Reduce excessive pressure while brushing Use of nonabrasive dentifrice = iv. Avoid overinstrumentation of root surfaces

Occlude the dentinal tubules = i. Formation of smear layer and plugging the tubule Formation of smear layer = ii. Increasing formation of intratubular dentin Formation of intratubular dentin = iii. Principal treatment option for dentin hypersensitivity Manage patient with gastroesophageal reflux disease = iv. Reduce fluid movement in dentinal tubules

Eliminate the predisposing factors = i. Initial focus of management Occlude the dentinal tubules = ii. Principal treatment option Avoid overinstrumentation of root surfaces = iii. Prevention method Fabrication of occlusal splint = iv. Medical help for GERD

Fluid movement in dentinal tubules = i. Stimulates peripheral nerve endings Excessive brushing with excessive pressure = ii. Predisposing factor Formation of reparative dentin = iii. Decrease in dentin permeability Gastroesophageal reflux disease = iv. Medical condition to be managed

Ensure proper oral hygiene practice = i. Prevent erosive loss of tooth structure Avoid brushing immediately after taking acidic drinks = ii. Reduce excessive pressure while brushing Use of nonabrasive dentifrice = iii. Prevent erosive loss of tooth structure Avoid taking food causing erosive loss of tooth structure = iv. Proper oral hygiene practice

Dentifrice for treating dentin hypersensitivity = Sodium monofluorophosphates Dentifrice for treating tooth decay = Sodium fluoride

Varnishes = Covering open tubules with a thin film Dentin Bonding Agents = Sealing dentinal tubules Oxalates = Precipitating and occluding open dentinal tubules Gingival Grafts = Reducing hypersensitivity by decreasing dentinal permeability

Potassium nitrate = Reducing intradental nerve excitability Fluoride-containing varnish = Decreasing dentinal permeability 5% glutaraldehyde with 35% HEMA = Coagulating proteins inside dentinal tubules Gingival grafts = Treating gingival recession

Sodium fluoride = Fluoride-containing varnish Potassium oxalate = Oxalates Glutaraldehyde = Dentin Bonding Agents Strontium chloride = Dentifrice

Varnishes = Providing temporary relief Dentin Bonding Agents = Sealing dentinal tubules for sustained relief Oxalates = Reducing hypersensitivity by precipitating and occluding open tubules Gingival grafts = Treating progressive gingival recession

3% potassium oxalate = Causing gastric irritation Dentin Bonding Agents = Causing intradental nerve excitability Fluoride-containing varnish = Decaying tooth structure Gingival grafts = Receding gingiva

Arginine-based product = Binds to negatively charged tubules, attracting a calcium rich layer from saliva to infiltrate and block the dentinal tubules Laser therapy = Occlusion of dentinal tubules Fluoride iontophoresis = Drives fluoride ions more deeply into the dentinal tubules Prednisolone solution = Induces remineralization resulting in occlusion of dentinal tubules

Arginine-based product = Provides instant relief Laser therapy = Painless for the patient Fluoride iontophoresis = Drives fluoride ions more deeply into the dentinal tubules Prednisolone solution = Induces remineralization resulting in occlusion of dentinal tubules

Arginine = Positively charged, binds to negatively charged tubules Bicarbonate = pH buffer Calcium carbonate = Source of calcium Saliva = Provides a calcium rich layer to infiltrate and block the dentinal tubules

Arginine-based product = Applied by slow speed handpiece on exposed dentin Laser therapy = Unknown Fluoride iontophoresis = Uses an electrical potential to transfer ions Prednisolone solution = Applied topically on exposed root surface

Arginine-based product = Blocks the dentinal tubules with a dentin plug Laser therapy = Occludes the dentinal tubules Fluoride iontophoresis = Drives fluoride ions more deeply into the dentinal tubules Prednisolone solution = Occludes the dentinal tubules

Arginine-based product = Available as home care toothpaste Laser therapy = Available for in-office treatment Fluoride iontophoresis = Available for in-office treatment Prednisolone solution = Available for in-office treatment