Dentin Hypersensitivity Quiz

Dentin Hypersensitivity

• Defined as short, sharp pain from exposed dentin due to stimuli (thermal, evaporative, tactile, osmotic, or chemical), not attributable to other dental issues.

Prevalence

• Affects 60-98% of patients with periodontitis.
• Can occur after periodontal procedures (deep scaling, root planning, gingival surgery).
• Can also occur after tooth whitening and restorative procedures.
• Peak incidence between 20 and 40 years of age.
• Females more commonly affected than males.

Mechanisms of Dentin Sensitivity

• Hydrodynamic theory is the accepted mechanism: A stimulus applied to dentin increases dentinal tubular fluid flow. This activates nerves in the inner pulp or outer pulp layers.
• Cooling, drying, evaporation, and hypertonic chemicals stimulate fluid movement more than other stimuli (like heating or probing).

Localization and Incidence

• More than 90% of hypersensitive areas are at the cervical margin on buccal or labial aspects of teeth.
• Common age range is 20-40 years.
• Buccal cervical zones are prevalent.
• Canines, first premolars, incisors, second premolars, and molars are often affected.
• Right-handed individuals.

Etiology of Dentin Hypersensitivity (DH)

• Exposure of dentin is the cause, either due to enamel loss or gingival recession.
• Gingival recession is the more crucial factor.
• Normal tooth brushing does not cause enamel loss but may contribute to gingival recession.

Loss of Enamel

• Enamel and cementum can be lost gradually or suddenly.
• Sudden exposure leads to acute hypersensitivity.
• Cemento-enamel junction often has a thin enamel layer, making it susceptible to tooth structure loss.
• Tooth wear can be caused by abrasion, erosion, abfraction, or attrition leading to exposed dentin.

Gingival Recession

• Gingival recession is a precursor to cementum loss and dentin exposure.
• Excessive use of oral hygiene devices can cause recession.
• Toothbrush type and technique contribute to factors.
• Periodontitis, necrotizing ulcerative gingivitis, and viral disorders like HIV can cause recession.
• Surgical or nonsurgical periodontal procedures may cause gingival recession and root exposure.

Bleaching Considerations

• Bleaching agents can cause or increase dentin sensitivity.
• Approximately 25% of those who bleach their teeth experience hypersensitivity.
• Potassium nitrate toothpaste, concentrated desensitizing gels, reducing bleaching time, and using fluoride after bleaching are used as countermeasures.
• Lower peroxide concentrations (10-15%) are recommended.

Initiation of Dentin Sensitivity

• Removing the smear layer or tubular plugs exposes the outer ends of dentinal tubules.
• Abrasion and acid erosion are potential factors.
• Plaque is not a significant factor; patients tend to have good plaque control.

Diagnosis and Assessment

• Medical History: Excessive vomiting, GERD, antacid use, alcoholism, autoimmune diseases (e.g., Sjögren's), oral dryness, radiation, medications affecting salivary function.
• Dental History: Bruxism, occlusal guard use, prior dental procedures.
• Dietary History: Acidic food and beverage frequency.
• Oral Hygiene Methods: Tooth brushing method, frequency, dentifrice type, mouth rinses, topical fluorides.
• Clinical Evaluation: Dental explorer, periodontal probe, air jet, pulp vitality testing, percussion testing, radiographs (if needed), and occlusal assessment.

Differential Diagnosis

• Differentiate between dentin and pulp pain.
• Dentin pain, triggered by a stimulus, generally resolves following stimulus removal.

Prevention

• Dietary Modifications: Avoid acidic foods & drinks; use a straw for acidic beverages; consume neutralizing/alkaline substances after acidic foods and drinks.
• Parafunctional Habits: Reduce or eliminate clenching & grinding. Use occlusal guards.

Management

• Natural Desensitization: Involves sclerosis of dentin, reparative/tertiary dentin deposition, smear layer formation, and calculus.
• Clinical Desensitization: Two main strategies:
• Nerve desensitization (e.g., potassium nitrate)
• Covering or plugging dentinal tubules
• Treatment Modes: Includes both at-home (e.g., toothpastes, mouthwashes) and in-office (e.g., topical desensitizing agents, fluoride application) treatments.