Dentine hypersensitivity and management .pptx

dentine hypersensitivity

1. Dentine hypersensitivity

2. What is dentine hypersensitivity? Dentine hypersensitivity is characterized by a short sharp pain arising from exposed dentine in response to stimuli, typically thermal, evaporative, tactile, osmotic or chemical and which cannot be ascribed to any other form of dental defect or disease.

3. Aetiology: we must consider that in order for DH to occur, dentine has to be exposed ,through either loss of enamel or gingival recession .

4. Erosion, abrasion, attrition and possibly abfraction lead to exposure of tubules .

5. The presence of gingival recession does not mean that DHS is inevitable.

6. Over-zealous toothbrushing and improper toothbrushing techniques have been associated with gingival damage and loss of gingival tissue through mechanical trauma.

7. DHS may also be provoked by some routine dental procedures such as scaling and polishing, thereby making a regular dental visit unpleasant and painful for the patient. It is important to recognize that some other dental treatments, such as crown preparation and whitening procedures, can cause sensitivity. Additionally, it has been reported that localized DHS can lead to sensitive areas being avoided during toothbrushing , which in turn increase the risk of periodontal diseases and sequelae .

8. Epidemiology: The prevalence was highest in females than males Canines and first premolars are most frequently affected, followed by incisors and second premolars , with molars being least affected. DHS can present at any age, but the majority of individuals range from 20–50 years, with a peak in prevalence in the age range 30–39 years .

9. Theories of Dentin Sensitivity Neural Theory: The neural theory attributes to activation of nerves ending lying within the dentinal tubules. These nerve signals are then conducted along the parent primary afferent nerve fibers in the pulp, into the dental nerve branches and then into the brain . Neural theory considered that entire length if tubule contains free nerve endings.

10. Odontoblastic Transduction Theory The theory assumed that odontoblasts extend to the periphery. The stimuli initially excite the process or body of the odontoblast. The membrane of odontoblasts may come into close apposition with that of nerve endings in the pulp or in the dentinal tubule and the odontoblast transmits the excitation of these associated nerve endings. However, in the most recent study; Thomas (1984) indicated that the odontoblastic process is restricted to the inner-third of the dentinal tubules. Accordingly it seems that the outer part of the dentinal tubules does not contain any cellular elements but is only filled with dentinal fluid.

11. Hydrodynamic Theory This theory proposes that a stimulus causes displacement of the fluid that exists in the dentinal tubules. The displacement occurs in either an outward or inward direction and this mechanical disturbance activates the nerve endings present in the dentin or pulp.

12. Fig. 33.1 Theories of dentin hypersensitivity . (1) Neural theory: Stimulus applied to dentin causes direct excitation of the nerve fibers ; (2) Odontoblastic transduction theory: Stimulus is transmitted along the odontoblast and passes to the sensory nerve endings through synapse; (3) Hydrodynamic theory: Stimulus causes displacement of fluid present in dentinal tubules which further excite nerve fibers

13. diagnosis : This examination could involve triggers such as thermal and evaporative stimuli ( eg a short blast of cold air from the 3-in-1 syringe), or mechanical/tactile stimuli ( eg running a sharp explorer over the area of exposed dentine) result in a short sharp pain that generally lasts just for the duration of the stimulus. However, pain/discomfort may sometimes continue for a short time post stimulation

14. the Cumulative Hypersensitivity Score (CHI) score has been validated for use as a standard measure of the severity of DH per patient (rather than per tooth). A blast of air from the 3 in 1 tip may be applied across all teeth quickly and the highest score recorded in each intra-oral sextant is added together (up to a total of 18). It provides a valid representation of the severity of sensitivity occurring on all tooth surfaces. The scores per sextant are as follows:

15. 0 – tooth/subject does not respond to air stimulus 1 – tooth/subject responds to air stimulus but does not request discontinuation of stimulus 2 – tooth/subject responds to air stimulus and requests discontinuation or moves from stimulus 3 – tooth/subject responds to air stimulus and has time to consider the stimulus. The pain is exaggerated and the patient requests discontinuation of the stimulus. This might reflect a pathological condition, which is not strictly in accordance with the definition of DH

16. DIFFERENTIAL DIAGNOSIS • Chipped teeth • Fractured restoration • Restorative treatments • Dental caries • Cracked tooth syndrome • Other enamel invaginations

17. Dentine hypersensitivity management strategies PATIENT EDUCATION  Show patient the affected site(s)  Explain probable cause for recession  Explain factors triggering sensitive teeth episodes  Encourage patients to modify their oral hygiene regimen in order to reduce damage to gingivae  Reduce excessive consumption of acid foods and drinks

18. Treatment Reducing the pulpal nerve response; or Providing an artificial smear layer either to occlude or reduce the diameter of the dentine tubules

19. Reducing the pulpal nerve response A nerve cell has more potassium ions inside and more sodium ions outside the cell membrane. If additional potassium ions are flooded around the cell, they are pumped through the cell membrane and the cell is less able to activate in response to stimulus. Therefore, treatments that increase the potassium ion concentration within the tubules and pulp tissues and then maintain the higher concentration can reduce the pulpal nerve response and lessen the problem of DHS.

20. Potassium-containing toothpastes can lead to decreases in dentinal hypersensitivity in response to various stimuli but take at least two weeks, of twice daily use, to become effective and the greatest reductions may not be achieved for eight weeks .

21. Occluding the dentine tubules As a natural dentine smear layer is effective at preventing DHS for most patients, it is appropriate that treatments exist to create an artificial smear layer. These can either be used by the patients themselves, again in the form of a toothpaste, or alternatively as a professionally applied product in the dental clinic.

22. Tooth Paste : the immediate and lasting benefits of Pro-Relief toothpaste, which uses ‘Pro- Argin technology’. This contains calcium carbonate and the amino acid arginine, which combine together to seal and plug the open dentine tubules. GSK has made similar statements for Sensodyne Rapid Relief, which contains strontium acetate. GSK has also developed Repair and Protect, which uses ‘ Novamin technology’. Novamin is a calcium sodium phosphosilicate compound which releases calcium and phosphate ions when it comes into contact with water or saliva. These ions bind to the exposed dentine surface, forming a strong, protective and acid-resistant layer As with potassium-based toothpastes, other well-known brands such as Macleans , Crest, Oral-B and Arm and Hammer also produce toothpastes that occlude tubules and create a smear layer

23. Professionally applied products In general, these products are either a fluoride varnish , such as Colgate Duraphat , that forms calcium fluoride globules to occlude tubules, or clear resins , such as Seal and Protect from Dentsply, and Gluma from Heraeus Kulzer . Dentine bonding agents , when topically applied to the cervical margin of sensitive teeth, are an effective way of reducing DHS.

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