dintine sensitivity

LI RUI DEPARTMENT OF PREVENTIVE DENTISTRY

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LOGOLOGOContents

1 Conception 1 Conception

2 Causes and pathology 2 Causes and pathology

3 Diagnosis and treatment 3 Diagnosis and treatment

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LOGOLOGOconception

dd entin entin sensitivity has beensensitivity has been defineddefined as as

““aa shortshort sharp pain arising fromsharp pain arising from exposedexposed dentin dentin inin response to stimuliresponse to stimuli typically thermal,typically thermal, evaporative,tactile,osmotic or chemical and which cannevaporative,tactile,osmotic or chemical and which cann

ot beot be ascribedascribed to any other form of dental defectto any other form of dental defect or pator pathology.”hology.”

(Addy,1983)(Addy,1983)

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LOGOLOGOEtiopathogenesis

The hydrodynamic theory is the most widelyThe hydrodynamic theory is the most widely

accepted physiopathological theory of DSaccepted physiopathological theory of DS

((BrannstromBrannstrom,1972),1972)

stimulistimuli→→centrifugal fluid flow within thecentrifugal fluid flow within the

dentinal tubulesdentinal tubules→→a pressure changea pressure change→→AδAδ

intradentinal nervesintradentinal nerves((pulp-dentinal interfacepulp-dentinal interface

or within the dentinal tubules)or within the dentinal tubules)→→painpain

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LOGOLOGOcauses

toothtooth brushingbrushing

dietdietacidacidageage

text1

attritionattrition abrasion abrasion

erosionerosion

text2

loss of loss of enamel enamel

oror periodontalperiodontal

tissuetissue

text3

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LOGOLOGO Diagnosis

1)1)one investigatorone investigator

2)2)should be calibrated - ideallyshould be calibrated - ideally

3)3)initialinitial stimulus should be as low as possiblestimulus should be as low as possible

4)4)gradual escalation to the threshold levelgradual escalation to the threshold level

5)5)repeated after some timerepeated after some time to obtain an to obtain an averageaverage

ofof valuesvalues

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LOGOLOGO Diagnosis

Mechanical (tactile) stimuliMechanical (tactile) stimuli::1)1)a sharp-tipped probea sharp-tipped probe2)2)mechanicalmechanical pressure stimulatorspressure stimulators3)3)Yeaple probeYeaple probeps:ps:Periodontal probes→variabilityPeriodontal probes→variability((nono))perpendicularperpendicular scratchscratch,,graduallygradually increasedincreased,,no to overno to over

Yeaple probeYeaple probe::the applied force is increased inthe applied force is increased in5-g steps5-g steps until 70g until 70g

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LOGOLOGO Diagnosis

Cold air currentsCold air currents::environmentalenvironmentaltemperature of temperature of 19-24ºC19-24ºCa pressure of a pressure of 45 psi45 psiat a distance of at a distance of 1 cm1 cmperpendicular to theperpendicular to thesurfacesurfaceone secondone second

the screening and initialthe screening and initialselection of teeth andselection of teeth andsubjectssubjects destined fordestined forstudystudy

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LOGOLOGO Diagnosis

If tactile and thermal stimuli are jointly employed inIf tactile and thermal stimuli are jointly employed inoneone same individual, thesame individual, the tactile stimulus tactile stimulus generally generallyshould beshould be applied applied firstfirst to avoid doubts as to whether to avoid doubts as to whether he pain producedhe pain produced after thermal stimulation is due toafter thermal stimulation is due tothe the low temperaturelow temperature or toor to dehydration dehydration induced by induced bythe air currentthe air current

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LOGOLOGO Diagnosis

Chemical (osmotic) stimuliChemical (osmotic) stimuli::hypertonic solutions of glucose and sucrosehypertonic solutions of glucose and sucroseAcid solutions→low pH→demineralizationAcid solutions→low pH→demineralization((nono))

a cotton stick duringa cotton stick during 10 seconds10 secondsosmotic pressures→intratubular fluidosmotic pressures→intratubular fluid

notnot advisedadviseddifficulty of controlling thedifficulty of controlling the response obtainedresponse obtained

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LOGOLOGOMethods for evaluating response after stimulation

Verbal rating scale (VRS)Verbal rating scale (VRS)::The patient uses a numerical code from 0 to 3The patient uses a numerical code from 0 to 3to rate perceivedto rate perceived sensation sensation 0 = no discomfort0 = no discomfort1 = mild discomfort1 = mild discomfort2= important discomfort2= important discomfort3 = important discomfort lasting3 = important discomfort lasting more than 10 secondsmore than 10 secondsonly these few optionsonly these few options,,no detailed descriptionno detailed description

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LOGOLOGO Methods for evaluating response after stimulation

Visual analog scale (VAS)Visual analog scale (VAS)::10-cm straight line10-cm straight line 0 = no pain0 = no pain10 = extreme, unbearable pain10 = extreme, unbearable pain

practical and usefulpractical and usefuldoes not distinguishdoes not distinguish between the sensory andbetween the sensory andaffective components of painaffective components of pain

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LOGOLOGOtreatment productions

self-applied self-applied productsproducts

professional professional useuse

therapeutictherapeutic productsproducts

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LOGOLOGOtreatment productions

adequate counseling adequate counseling on foodson foods

the prescription of desensitizingthe prescription of desensitizing toothpastes and/ortoothpastes and/or

oral rinsesoral rinses

occludingoccludingthe dentinal tubules the dentinal tubules

(strontium salts, oxalates or (strontium salts, oxalates or fluoridatedagents) fluoridatedagents)

or agents capable of modulating nerveor agents capable of modulating nerveexcitability excitability

(potassium salts)(potassium salts)

patientspatientswithwith

low or mild low or mild sensitivitysensitivity

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LOGOLOGOtreatment productions

high-high-concentrationconcentrationfluoridated fluoridated

varnish varnish or lacquer or lacquer can offer can offer

good resultsgood results

moderatemoderate intensityintensity

DSDS