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Questions and Answers
What is the typical presentation of dentine hypersensitivity?
What is the typical presentation of dentine hypersensitivity?
What is the primary mechanism behind dentine hypersensitivity?
What is the primary mechanism behind dentine hypersensitivity?
Which of the following factors can contribute to dentine hypersensitivity?
Which of the following factors can contribute to dentine hypersensitivity?
In managing patients with dentine hypersensitivity, what role should a dental therapist play?
In managing patients with dentine hypersensitivity, what role should a dental therapist play?
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What is typically absent during an episode of dentine hypersensitivity?
What is typically absent during an episode of dentine hypersensitivity?
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Which factor is important to assess in a patient's history during the examination of dentine hypersensitivity?
Which factor is important to assess in a patient's history during the examination of dentine hypersensitivity?
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What is a recommended homecare action for patients suffering from dentine hypersensitivity?
What is a recommended homecare action for patients suffering from dentine hypersensitivity?
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Which of the following agents is NOT mentioned as a mechanism for treating dentine hypersensitivity?
Which of the following agents is NOT mentioned as a mechanism for treating dentine hypersensitivity?
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Which action should be taken if a patient exhibits sensitivity after dental examination?
Which action should be taken if a patient exhibits sensitivity after dental examination?
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What form of pain is primarily associated with dentine hypersensitivity?
What form of pain is primarily associated with dentine hypersensitivity?
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Which dental profession is indicated for referral if further management is needed for dentine hypersensitivity?
Which dental profession is indicated for referral if further management is needed for dentine hypersensitivity?
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What aspect of dentine should be assessed during a clinical examination for hypersensitivity?
What aspect of dentine should be assessed during a clinical examination for hypersensitivity?
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In the context of managing dentine hypersensitivity, which approach involves stopping the pain by occluding tubules?
In the context of managing dentine hypersensitivity, which approach involves stopping the pain by occluding tubules?
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Which theory suggests that nerves extend through dentinal tubules to the tooth surface to transmit pain directly?
Which theory suggests that nerves extend through dentinal tubules to the tooth surface to transmit pain directly?
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What is the primary method by which fluid moves in osmosis?
What is the primary method by which fluid moves in osmosis?
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Which of the following stimuli can cause pain from exposed dentine?
Which of the following stimuli can cause pain from exposed dentine?
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What is one common cause of dentine exposure?
What is one common cause of dentine exposure?
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How is hydrodynamic theory defined?
How is hydrodynamic theory defined?
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Which of these methods can contribute to the exposure of dentine?
Which of these methods can contribute to the exposure of dentine?
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Which statement best describes the result of dentine hypersensitivity?
Which statement best describes the result of dentine hypersensitivity?
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Which condition can lead to mechanical stimulation of exposed dentine?
Which condition can lead to mechanical stimulation of exposed dentine?
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Which of the following substances can precipitate in an acidic environment to help occlude dentinal tubules?
Which of the following substances can precipitate in an acidic environment to help occlude dentinal tubules?
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What is the primary role of fluoride in the management of dentine hypersensitivity?
What is the primary role of fluoride in the management of dentine hypersensitivity?
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Why should one spit and not rinse after using certain dental agents?
Why should one spit and not rinse after using certain dental agents?
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What effect does elevated extracellular potassium concentration have on nerve fibers?
What effect does elevated extracellular potassium concentration have on nerve fibers?
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What ingredient is found in Sensodyne's Rapid product to help occlude tubules?
What ingredient is found in Sensodyne's Rapid product to help occlude tubules?
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Which agent is not suggested for home use to address dentine hypersensitivity?
Which agent is not suggested for home use to address dentine hypersensitivity?
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Continual daily use of certain treatments is recommended to achieve what benefit?
Continual daily use of certain treatments is recommended to achieve what benefit?
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Which chemical ions are primarily involved in the mechanism of dentinal tubule occlusion?
Which chemical ions are primarily involved in the mechanism of dentinal tubule occlusion?
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Study Notes
Dentine Hypersensitivity
- Dentine hypersensitivity is a painful response to stimuli, characterized by short, sharp pain, rapid onset, and quick resolution, in the absence of other symptoms.
- This pain is triggered by exposed dentine, a tooth's inner layer, in response to stimuli like temperature changes (hot/cold), chemicals (acid, whitening agents), or mechanical pressure (brushing, chewing).
- The pain mechanism involves stimuli activating the nerve endings in the pulp through exposed dentinal tubules.
GDC Learning Outcomes for Oral and Dental Science
- Understanding oral diseases including their aetiology (causes) and pathogenesis (development) is crucial for preventative and treatment strategies.
- Comprehensive and contemporaneous patient histories are essential for accurate diagnosis.
- Recognizing changes in patient's oral health status and addressing them appropriately are key aspects of effective care.
- Roles and responsibilities of dental therapists and other dental team members within the treatment plan should be understood.
Pre-reading for Histology of Enamel and Dentine
- This area of study focuses on the microscopic structure of enamel and dentine, which are crucial to understanding tooth structure and function.
Learning Objectives for Dentine Hypersensitivity
- Understand the typical presentation of dentine hypersensitivity.
- Identify and describe the factors that contribute to its development.
- Recognize the role of the dental professional in patient management and advice, including preventive treatments.
- Understand the mechanism of dentine hypersensitivity.
What is Dentine Hypersensitivity?
- Dentine hypersensitivity is the response to external stimuli by exposed dentine.
- It's characterized by an overreaction, having too much sensitivity to normally non-painful stimuli.
Tooth Anatomy and Dentine Hypersensitivity
- The structure of a tooth is relevant in understanding dentine hypersensitivity.
- Anatomically, exposed dentinal tubules with no enamel protection are crucial in the development of pain.
How Pain is Registered - Theories
- A,B, and C pain theories describe how the nerves respond to pain stimuli.
- Theory A directly involves pain sensation.
- Theory B describes how the exposed tooth surface can transmit the pain from the dentinal tubules.
- Theory C describes the movement of fluid within the dentinal tubules as a cause of pain.
Hydrodynamic Theory
- The hydrodynamic theory proposes that fluid flow within dentinal tubules in response to stimuli carries signalling molecules to the nerve endings, inducing pain.
- This theory has implications for understanding pain mechanisms in dentine hypersensitivity.
Osmosis in Dentine Hypersensitivity
- Osmosis plays a role in dentine hypersensitivity by transporting fluid between areas of differing concentration.
- Understanding osmosis within the dentinal tubules helps to understand the fluid movement and pain perception in exposed parts of the tooth.
Stimuli for Dentine Hypersensitivity
- Thermal stimuli (temperature changes, hot or cold)
- Chemical stimuli (acids in foods, whitening gels)
- Mechanical stimuli (tooth brushing, chewing, eating)
Aetiology of Dentine Hypersensitivity
- Exposed dentine is the primary cause of the painful response.
Causes of Exposed Dentine (and therefore dentine hypersensitivity)
- Receding gums
- Tooth brushing habits/abrasion
- Periodontal disease
- High frenum
- Eating habits
- Nail biting
- Dental treatments (filling work, root canal procedures)
- Orthodontic treatment
- Opening items (e.g. jewellery)
- Piercings
Clinical Examination for Dentine Hypersensitivity
- Carefully asses the morphology of teeth to identify areas at risk (exposed).
- Identify the source of the pain in the suspected area.
- Applying pain stimuli to affected areas (3 in 1 trigger).
Diagnosis of Dentine Hypersensitivity
- Based on patient history (symptoms, triggers) and clinical examination.
Dental Hygiene and Therapists Role
- Identify if the pain is from hypersensitivity.
- Determine potential causes; diet history, oral health, etc.
- Educate patients on the issue and its management.
- Provide preventative care and advice.
Patient Management of Dentine Hypersensitivity
- Provide patients with recommendations for at-home care and management, such as using specific dental products (e.g., toothpastes, mouthwashes).
Mechanisms of Action for Dentine Desensitizing Agents
- Removal of the stimulus causing hypersensitive response
- Desensitize the nerves
- Occlude the tubules to prevent damage
- Prevent tubules from exposing to the stimulus
How Agents Work
- Calcium Phosphosilicate
- Calcium triphosphate
- Bioactive glass
- Strontium Chloride/Acetate
- Fluoride
Occluding Dentinal Tubules
- Agents that create a barrier within the tubules and reduce fluid flow, decreasing the pain response are effective in sealing off the exposed areas.
Challenge and Solutions
- Chemical ions dissolving away readily.
- Implementing solutions that cause the chemicals to stick the tooth surface:
- Using proteins
- Applying chemicals which precipitate in acidic environments.
- Higher concentration of fluoride use
- Daily use for long-term effects
- Spitting (holding chemicals on the tooth surface).
Agents for Use at Home
- Colgate (arginine)
- Sensodyne (stannous fluoride)
- Fluoride
Potassium Nitrate in Dentine Hypersensitivity
- Maintaining a potassium concentration equilibrium in the oral environment is essential for reducing pain responses.
Professional Treatment
- Specific dental materials/products, procedures
- Desensitizing agents
- Treatment of the underlying cause
Summary
- Identify the pain
- Identify the cause (aetiology)
- Educate the patient
- Refer to a GDP if needed
- Provide advice on self-care
Recommended Reading
- Review of terminology, epidemiology, and management of conditions related to Dentine Hypersensitivity
- Current guidelines in General Dental Practice for the management of hypersensitivity.
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