Dentin Hypersensitivity PDF

DENTIN HYPERSENSITIVITY DENTIN HYPERSENSITIVITY Definition Short sharp pain arising from exposed dentin in response to stimuli (thermal, evaporative, tactile, osmotic or chemical) that cannot be ascribed to any.other dental defect or disease Prevalence o The prevalence is between 60 and 98% in pat...

DENTIN HYPERSENSITIVITY DENTIN HYPERSENSITIVITY Definition Short sharp pain arising from exposed dentin in response to stimuli (thermal, evaporative, tactile, osmotic or chemical) that cannot be ascribed to any.other dental defect or disease Prevalence o The prevalence is between 60 and 98% in patients with.periodontitis o Transient hypersensitivity may occur after periodontal procedures such as deep scaling, root planning or gingival.surgery o Hypersensitivity also may occur after tooth whitening and.restorative procedures o Peak age (20-40y.) Mechanisms of dentin sensitivity Neural theory (not accepted).1 Odontoblastic transduction theory (not accepted).2 Hydrodynamic theory.3.Dentinal pain is mediated by a hydrodynamic mechanism · In the hydrodynamic sequence, a pain-provoking stimulus ·.applied to dentin increases the flow of dentinal tubular fluid In turn, this mechanically activates the nerves situated at the ·.inner ends of the tubules or in the outer layers of the pulp Cooling, drying, evaporation and hypertonic chemical stimuli that · stimulate fluid movement more than do stimuli such as heating or. probing  localization and incidence More than 90% of hypersensitive surfaces are at the cervical ·. margin on the buccal or labial aspects of the teeth Age: 20-40 years · Female > male · Buccal cervical zones · Canines, 1st premolars, incisors, 2nd premolars then molars · Right handed tooth brushes → left side · of adult population % 8-30 ·  Etiology of Dentin Hypersensitivity (DH) It has been proposed that DH occurs by exposure of dentin, ·. either by loss of enamel or by gingival recession Gingival recession is the more important of these two factors. · · Normal tooth brushing will not remove enamel, but it has.been cited in the etiology of gingival recession :a) Loss of enamel Both enamel and cementum may be lost either gradually or..suddenly from the tooth surface The sudden exposure of dentinwill elicit more acute. hypersensitivity At the area of the cemento-enamel junction there may be. only a thin layer of enamel, making this area susceptible to.loss of tooth structure :a) Loss of enamel Because the layer of cementum is thin and not highly..mineralized, it easily can be abraded or eroded in this area In approximately 10% of teeth, the enamel and cementum..do not meet, leaving an area of exposed dentin Tooth wear, leading to loss of enamel or root surface, may. result from abrasion, erosion, abfraction or attrition :b) Gingival Recession The occurrence of gingival recession is a precursor to the loss of..cementum and the exposure of dentin Excessive use of any oral hygiene device can lead to gingival. recession Toothbrush type and the technique are the primary contributing..factors Gingival recession may be due to destructive processes of. periodontitis, necrotizing ulcerative gingivitis (NUG), and viral.disorders, such as HIV :b) Gingival Recession Surgical and nonsurgical periodontal treatment can result in.. gingival recession and root exposure :Causes of gingival recession.Ø By age.Ø Toothbrush abrasion.Ø Oral habits: traumatic tooth picking, excessive flossing.Ø Faulty crown preparation Ø Secondary to diseases: NUG, periodontitis c) Bleaching considerations Bleaching agents can potentially cause or increase dentin..sensitivity Averages of 25% of those who bleach their teeth develop..hypersensitivity :Recommendations to reduce sensitivity after bleaching. Using a desensitizing tooth paste that contains potassium ».nitrate High concentrated desensitizing gel using a tray delivery ».method.Reducing bleaching time and using fluoride after bleaching ». Lower concentration of peroxide (10 to 15%) can be used » :initiation.Not all exposed dentin is sensitive · It occurs when the smear layer or tubular plugs are removed, ·.which opens the outer ends of the dentinal tubules Abrasion and erosion may be implicated here, but acid ·.erosion seems to be the predominant factor Plaque is not a significant factor in DH; patients with DH ·.tend to have good plaque control Diagnosis and Assessment of :Dentin Hypersensitivity I) Proper history: Including Medical History. Excessive vomiting Gastroesophageal reflux disease Frequent use of antacids, acidic medications Alcoholism Autoimmune disease (Sjogren’s), Oral dryness, eye dryness Radiation of head and neck Medications that cause salivary hypo function Diagnosis and Assessment of :Dentin Hypersensitivity Dental History. History of bruxism (grinding or clenching) Use of occlusal guard History of previous dental procedures Dietary History. Acidic food and beverage frequency Diagnosis and Assessment of Dentin :Hypersensitivity Oral Hygiene Methods. Tooth brushing method and frequency Type of dentifrice (abrasive?) Use of mouth rinses Use of topical fluorides :Clinical evaluation :Potentially useful diagnostic tools Dental explorer and periodontal probe Air jet: air movement over the exposed dentine surface → outward movement of dentinal fluid → triggers nerve fibers Pulp vitality testing (to assess pulp vitality) Percussion testing (to assess pulp involvement) Radiographs (if needed) and assessment of occlusion Differential diagnosis of Dentin hypersensitivity Diagnostic aids include history of pain, percussion and # palpation tests, inspection of the teeth and surrounding tissues,.thermal and electric pulp tests, and radiographic examination The first consideration should be to determine the etiology of #. the pain Patients are usually more accurate in localizing # ·.hypersensitivity than dentinal or pulpal pain Dentin pain (caused by a noxious agent, i.e. dental caries) can # be intensified by thermal change, sweet, and sour, all of which.could elicit a hypersensitivity reaction as well.Pain from both is usually within the mild to moderate range # Differential diagnosis of Dentin hypersensitivity Pulpal pain can be differentiated from dentin pain since it is #.often described as severe Pulpal pain may also manifest during chewing, which would #.distinguish it from hypersensitivity The pain of pulpitis often occurs without provocation and # occurs after thermal tests, may persist after the stimulus has been removed. While dentin hypersensitivity subsides after.removal of the stimulus Prevention of dentin hypersensitivity :Dietary Modifications-1 The consumption of acidic foods and drinks, such as citrus fruits - and juices, pickled foods, wine, fruit, yogurt, and carbonated beverages should be controlled to avoid erosion of the enamel or.cementum and expose underlying dentin Brushing immediately after ingesting acidic foods should also be -.avoided Additional recommendations can include drinking acidic - beverages through a straw, reducing the quantity and frequency of acid intake, drinking something neutral or alkaline (such as milk or.water) after consuming dietary acids Prevention of dentin hypersensitivity :Reduce or eliminate para-functional habits -2 Para-functional habits, such as teeth clenching and grinding, -.may be a factor of dentin hypersensitivity The abfraction at the cervical portion of the tooth may -.contribute to dentin hypersensitivity Professionally fabricated occlusal night guards can also.reduce the effects of unconscious habits  Management of dentin hypersensitivity Treatment plan for DH should include identifying and eliminating.predisposing etiologic factors Natural Desensitization It includes sclerosis of dentin, -1 deposition of reparative and tertiary dentin, creation of a smear.layer, and calculus formation on the surface of the dentin Clinical Desensitization There are two major strategies of -2 :desensitization I) Nerve desensitization or denervation: Using Potassium nitrate, Potassium ions are thought to diffuse along dentinal tubules and.decrease the excitability of intra-dental nerves.II) Cover or plugging dentinal tubules :Treatment modes It can be simpler to classify treatments according to their mode of :delivery either A. Self-administered by the patient at home or.B. Applied by a dental professional in the dental office A- At home treatments tend to be simple and inexpensive and can treat simultaneously generalized DH affecting many teeth Desensitizing toothpastes /dentifrices: Toothpastes are the most - widely used dentifrices for delivering over-the-counter.desensitizing agents Toothpaste application: Practitioners should educate patients on - how to use desensitizing dentifrices and monitor their tooth.brushing techniques :Treatment modes Dentifrices should be applied by tooth brushing and left in place for a certain period of time. Many patients habitually rinse their mouths with water after tooth brushing. Rinsing with water may cause the active agent to be diluted and cleared from the mouth and, thus, reduce the efficacy of the.toothpastes Mouthwashes and chewing gums: Studies have found that - mouthwashes and chewing gums containing potassium nitrate.and sodium fluoride, or a mixture of fluorides can reduce DH.Bleaching tray: containing desensitizing agents - :Treatment modes B- In office treatments: If at-home care fails to reduce DH compared with baseline levels, the.next level of treatment, an in-office method should be started Topically applied desensitizing agents: Criteria of the successful# :desensitizing agent Non-irritant to the pulp.1 Relatively painless on application.2 Easily applied.3 Rapid in action.4 Effective for a long time.5 Without staining effects.6 :Treatment modes Fluoride: Fluorides such as sodium fluoride and stannous · fluoride can reduce dentin sensitivity. Fluorides decrease the permeability of dentin by precipitation of insoluble calcium.fluoride within the tubules :Treatment modes Potassium nitrate: Potassium nitrate (gel, varnish or paint-on) · also can reduce dentin sensitivity when applied topically by.reduction nerve excitability Oxalate: potassium oxalates cause a 98% reduction in dentin · permeability and occlude tubules. Since then, numerous oxalatebased desensitizing products have be :Treatment modes Calcium phosphates (ACP and CCP): Calcium phosphates · may reduce dentin sensitivity effectively. Calcium phosphates.occlude dentinal tubules and decrease dentin permeability Adhesives and resins: Because many topical desensitizing · agents do not adhere to the dentin surface, their effects are temporary. Stronger and more adhesive materials offer.improved and longer lasting desensitization :Treatment modes Management of bleaching sensitivity Passive management Reduce treatment time · Reduce treatment frequency · Alter peroxide concentrations or brands · Active management Apply neutral fluoride in the tray · Apply 3-5% potassium nitrate in the tray · Pretreat with either fluoride or potassium nitrate ·