Podcast
Questions and Answers
What is the typical presentation of dentine hypersensitivity?
What is the typical presentation of dentine hypersensitivity?
Which mechanism describes the stimuli leading to dentine hypersensitivity?
Which mechanism describes the stimuli leading to dentine hypersensitivity?
According to the hydro-dynamic theory, what role does fluid movement in dentinal tubules play?
According to the hydro-dynamic theory, what role does fluid movement in dentinal tubules play?
What kind of stimuli can lead to dentine hypersensitivity?
What kind of stimuli can lead to dentine hypersensitivity?
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Which of the following is an aetiological factor leading to dentine hypersensitivity?
Which of the following is an aetiological factor leading to dentine hypersensitivity?
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Which of the following best describes the management approach for a patient with dentine hypersensitivity?
Which of the following best describes the management approach for a patient with dentine hypersensitivity?
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What is the primary role of the dental professional in managing dentine hypersensitivity?
What is the primary role of the dental professional in managing dentine hypersensitivity?
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How can thermal stimuli lead to dentine hypersensitivity?
How can thermal stimuli lead to dentine hypersensitivity?
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What common behavior might lead to the exposure of dentine and contribute to hypersensitivity?
What common behavior might lead to the exposure of dentine and contribute to hypersensitivity?
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Which factor is NOT typically associated with the onset of dentine hypersensitivity?
Which factor is NOT typically associated with the onset of dentine hypersensitivity?
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What is one mechanism by which fluoride helps in treating dentine hypersensitivity?
What is one mechanism by which fluoride helps in treating dentine hypersensitivity?
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Which ingredient in Sensodyne products is primarily used to occlude dentinal tubules?
Which ingredient in Sensodyne products is primarily used to occlude dentinal tubules?
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Which method can help retain chemical ions on the tooth surface?
Which method can help retain chemical ions on the tooth surface?
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What is a temporary challenge associated with the chemical treatment of dentine hypersensitivity?
What is a temporary challenge associated with the chemical treatment of dentine hypersensitivity?
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How does potassium nitrate reduce sensitivity in dental treatment?
How does potassium nitrate reduce sensitivity in dental treatment?
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What is the role of bioactive glass in desensitizing treatments?
What is the role of bioactive glass in desensitizing treatments?
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Which of the following professional treatments is NOT commonly used for managing dentine hypersensitivity?
Which of the following professional treatments is NOT commonly used for managing dentine hypersensitivity?
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What is essential for achieving long-lived benefits from sensitivity treatments?
What is essential for achieving long-lived benefits from sensitivity treatments?
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Which ingredient is involved in desensitizing the nerves by increasing the extracellular potassium concentration?
Which ingredient is involved in desensitizing the nerves by increasing the extracellular potassium concentration?
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Which of the following strategies is NOT recommended for effective desensitization?
Which of the following strategies is NOT recommended for effective desensitization?
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Study Notes
Dentine Hypersensitivity
- Definition & Presentation: Dentine hypersensitivity is characterized by short-duration, rapid-onset, sharp pain in response to stimuli. The pain quickly resolves. It's specifically pain originating from exposed dentin.
Mechanism of Dentine Hypersensitivity
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Hydrodynamic Theory: A stimulus on the exposed dentin causes movement of fluid within the dentinal tubules. This fluid movement, like water pressure, stimulates the nerve endings in the pulp.
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Osmosis: Fluid moves from high to low concentration through dentin tubules, sensitive to osmotic pressure fluctuations. Dentin tubules contain water (22%).
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Thermal: Temperature changes (hot and cold) cause expansion and contraction of fluid causing the pain sensitivity.
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Chemical: Acids, particularly those in whitening agents, can remove the smear layer (a thin layer of debris) and directly irritate the nerve.
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Mechanical: Activities like brushing, chewing, or eating create mechanical pressure and changes in thermal conditions, exposing the dentin and triggering the pain response.
Aetiological Factors (Causes)
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Recession: The common factor is exposed dentin, often due to gum recession. A variety of behaviors/health factors can cause this, such as:
- Tooth brushing
- Nail biting
- Opening items with teeth
- Piercings
- High frenum
- Periodontal disease (gum disease)
- Lack of keratinised gum tissue
- Orthodontic treatment
Management of Dentine Hypersensitivity
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Assessment: A crucial first step is a thorough examination and detailed history from the patient (“what, where, when, how often, how long, action”). Fast, sharp pain is suggestive of dentin hypersensitivity.
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Treatment Approach: The treatment aims to:
- Identify cause of exposed dentin
- Identify contributing factors (diet, oral hygiene habits)
- Educate the patient
- Provide preventive management
- Refer to a general dentist (GDP) for cases requiring more complex treatment.
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Home Care:
- Improve brushing technique to minimize pressure and abrasion
- Limit exposure to potential irritants (e.g., ice cream)
- Reduce the frequency of whitening products
- Use desensitizing toothpastes.
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Desensitizing Toothpastes (Example):
- Mechanism: Desensitizing toothpastes contain agents (e.g. Stannous fluoride) that occlude (block) dentinal tubules, preventing fluid movement or irritate the nerve. Other active chemicals include arginine, which helps maintain the smear layer and prevent irritation.
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Fluoride: Reduces hypersensitivity by forming calcium-phosphate precipitates that block the tubules (as calcium fluoride, fluoroapatite).
Desensitizing Mechanisms & Challenges and Solutions
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Occlusion: Some chemicals are used to block dentin tubules.
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Challenges: Temporary occlusion is possible but often can't maintain tubule occlusion for a long period. Chemicals may dissolve or need a solid precipitate to help remain in place, which is temporary.
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Solutions/Strategies:
- Protein Carriers: Materials like arginine are used to help substances bind to tooth surfaces.
- Acid-Based Precipitation: Form precipitates in acidic environments (e.g., bioactive glass).
- Higher Concentrations: Using higher fluoride concentrations via toothpaste or varnishes can be helpful.
- Continuous Use: To get the longest benefit. Spit after use, so substances maintain proximity to dentin.
Desensitizing Nerves – Potassium Nitrate
- Mechanism: Using potassium nitrate aims to reduce nerve action potentials using potassium ions. High potassium levels cause depolarization of the nerve membrane, hindering the nerve's ability to send pain signals.
Professional Treatment
- Resin-Based Sealants: Seal exposed dentin
- Topical Fluoride Application: Increased fluoride levels to help block tubules.
- Composite Restoration: Repair/fill exposed dentin.
- Surgical Periodontal Treatment: Treat the gum recession.
- Root Canal Treatment (RCT): In severe cases when the nerve is excessively irritated.
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Description
Explore the phenomenon of dentine hypersensitivity, characterized by sharp pain in response to various stimuli. This quiz covers the mechanisms behind this condition, including the hydrodynamic theory and the effects of thermal, chemical, and mechanical factors on pain sensitivity.
