dentine hypersensitivity impt

8/9/2019 Dentine Hypersensitivity IMPT

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Dentin HypersensitivityObjectives:

Define dentin hypersensitivity.

Discuss the causative stimuli for dentin hypersensitivity.

Explain how dentin hypersensitivity can be managed-

treated.


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What is dentin hypersensitivity?

It is a short, sharp pain arising fromexposed dentin in response to stimulitypically thermal, evaporative, tactile,osmotic, or chemical that cannot beascribed to any other form of dental

defect or pathology.


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How common is dentin hypersensitivity?

In general population, prevalenceranges from 8 percent to 57 percent.

In periodontal practices it can be ashigh as 80 percent.


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Causes of hypersensitivity

Gingival recession due to occlusalproblems, overcontoured crownmargins, excessive brushing, anderosion due to improper diet.


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Susceptible tooth surfaces to

hypersensitivity include: Receded gingival tissues, exposing the

cementum and dentin.

Lost enamel or apically migrated junctionalepithelium.

Facial surfaces of maxillary canines, firstpremolars, followed by incisors, secondpremolars, and then molars due to morevigorous tooth brushing on the facial gingivalsurface.


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FYIApproximately 10 percent of teeth have

an area of exposed dentin at thecementoenamel junction.


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ROOT SURFACE MORPHOLOGY

Cementum is thin or nonexistent on thecervical root; therefore whenattachment fibers are lost, the hardtissue exposed to the oral environmentis dentin.

For sensitivity to be felt, exposed dentinmust have dentinal tubules that areopen to the oral cavity and pulp.


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Non-sensitive tooth

When a non-sensitive tooth with anexposed root surface does not react toa triggering stimulus, it has fewer opendentinal tubules at exposed surfaces,and the diameters of the tubules are

much narrower than those in teeth thatdo react to triggering stimuli andexperience sensitivity.


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DID YOU KNOW???????That the average diameter of tubules in

sensitive teeth is two times wider than

tubules in non-sensitive teeth.And

Difference in the diameter of the dentinaltubules significantly increases the rate of fluidflow within the tubule, which most likelycontributes to pain stimulation.


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Causative Stimuli that cause hypersensitivity.

There are various stimuli that, when incontact with exposed and open dentinal

surfaces can cause a painful sensation in atooth.

Tooth brush abrasion and abrasive dentifrices

Chemical erosion

Intrinsic Thermal

Tactile


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Toothbrush abrasion and

abrasive dentifrices. Aggressive scrub brushing and/or the use of

abrasive pastes may erode cervical dentin,

but this action produces a smear layerwhich is a protective surface layer---that mayhelp to counteract sensitivity.

If a dentifrice is too abrasive, if it is used tofrequently, or if it is applied with too muchforce, the paste may remove the beneficialsmear layer, resulting in open tubules andsensitivity.


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Chemical erosion Enamel and dentin are susceptible to

chemical wear from excessive acid attacks.

Sources of acids include: Extrinsic (diet)naturally occurring in foods/

beveragesi.e., citrus fruits, juices, cider,carbonated drinks, and wines.

Intrinsic- gastric acids (vomiting,gastroesophageal acid reflux disease (GERD)


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Thermal causes of

hypersensitivity.

Hot and or cold foods and beverages

Cold air on exposed dentinal surfaces;cold is the most common cause of

hypersensitivity.


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Tactile causes of

hypersensitivity.

A foreign object touching an exposeddentinal surface such as a toothbrushbristles, toothpicks, denture clasps, ordental instruments.


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Other causes of hypersensitivity.

Dental caries

Pulpitis Tooth fractures

Fractured or leaking restorations.


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Desensitizing Treatments

How do they work?

Desensitizing treatments can eitherinterupt pulpal nerve activationrepolarization and pain transmission orreducing the fluid flow within the dentinaltubules by creating a smear layer or by

blocking (occluding) the tubule ends.


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Patient applied treatments Desensitizing dentifrices

Agents that have been accepted by the

American Dental Association Council onDental Therapeutics 0.24 percent sodium fluoride, AquafreshSensitive Teeth, CrestSensitivity Protection.

Potassium nitrate- most widely available activeagent in desensitizing dentifrices.

5 percent postassium nitrate, sodiummonofluoriophosphateSensodyne Extra Whitening.


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Mode of action.

Potassium nitrate depolarizes nervefibers; fluoride forms precipitate withindentin tubules.


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Self-applied fluoride rinses

Both stannous and sodium fluoridesocclude dentinal tubules.

Examples

0.63 percent stannous fluoride (Gel-KamOral Care Rinse, daily prescription rinse)

0.2 percent neutral sodium fluoride(Fluorinse, weekly prescription rinse)


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Mode of action

Fluoride forms precipitate withindentinal tubules.


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Self-applied fluoride gels and

pastes

Examples include:

0.4 percent stannous fluoride (Gel-KamGel, Omni Gel); available over the counter

1.1 percent sodium fluoride Available byprescription

0.2 percent neutral sodium fluoride(Prevident 5000 Plus) by prescription


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Mode of action.

Fluoride forms precipitate within dentintubules.


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Professionally applied

treatments.

Many agents can be topically applied toexposed dentinal surfaces to block(occlude/obturate) dentinal tubules.

Examples;

Fluorides

varnish


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Varnish

5 percent sodium fluoride

Duraphat

Mode of action; forms a protective layer(blocks) of calcium fluoride that preventsfluid flow in the tubules.


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Properties of a fluoride varnish Sets in the presence of moisture

Provides immediate fluoride uptake

Remains on teeth until brushed off Because the sodium fluoride in the varnish

may interact with other fluoride preparations,avoid applying a professionally applied topicalfluoride get treatment after the fluoride

varnish is applied. If the patient is taking daily fluoride

supplements, they should not be taken forseveral days after fluoride varnish application.


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Application of a fluoride

varnish Use a brush to apply varnish

Postapplication instructions to patient.After varnish is applied, the patient should

avoid eating hard foods and/or toothbrushing for at least two hours.

This recommendation is necessary because

any early mechanical cleansing/rubbing ofthe treated tooth surface can remove thevarnish.

dentine hypersensitivity impt

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