Desensitizing Agents for Dentine Presented by.pptx

Desensitizing Agents for Dentine Presented by.pptx

1. Desensitizing Agents for Dentine Hypersensitivity Presented by Dr. Anu Gautam Dr. Deeksha Chaudhary Department of General Pharmacology and Dental Therapeutics

2. Contents Introduction Desensitizing agent Characteristics of Desensitizing agent Classification of Desensitizing agent Mechanism of action Dentine hypersensitivity Theories of dentine hypersensitivity Aetiology of dentine hypersensitivity Clinical features Diagnosis Treatment strategies Conclusion

3. Introduction The term dentine hypersensitivity has been used for many decades to describe a common painful condition of the teeth. Despite this there are many gaps in our knowledge concerning dentine hypersensitivity. It is perhaps not surprising therefore that one can still have sympathy with statement made in 1987 by Johnson and Co-workers that dentine hypersensitivity is an Enigma, being frequently encountered yet ill understood .

4. Desensitizing agent Desensitizing agents are those agents which reduce the pain in sensitive teeth caused by cold, heat, acids or sweets. These products are non-abrasive and should not be used on a permanent basis unless directed by a dentist. For example: 5% potassium nitrate compounds (Sensodyne, Mediplus DS ) Fig: Sensodyne Fig:Mediplus DS Fig: Mouthwash

5. Ideal properties Rapid acting Long term effect Harmless to the pulp Painless Easy to apply Should not stain teeth Consistently effective Target both underlying cause and symptoms

6. Classification According to Scherman A and Jacobeen-1992. Based on mode of action Chemical agents Corticosteroids Silver nitrate Potassium nitrate Strontium chloride Formaldehyde Potassium nitrate or oxalate Fluorides Sodium citrate Iontophoresis with 2% NaF Fig: Fluoride Fig: Potassium nitrate

7. 2. Physical agents Composites Resins Varnishes Sealants Soft tissue grafts Glass ionomer cements Lasers Fig: Composite Fig: Glass ionomer cement Fig: Resin Fig: Varnish Fig: Sealant

8. Based on mode of administration A) In-office products Treatment agents that do not polymerize Varnishes/ Precipitants Shellacs 5% NaF varnish 1% sodium fluoride, 0.4% stannous fluoride s 3% mono-potassium- monohydrogen oxalate 6% acidic ferric oxalate Calcium phosphate preparations Calcium hydroxide b) Primes containing HEMA (Hydroxy ethyl methacrylate) 5% glutaraldehyde 35% HEMA in water Fig: HEMA Fig: 5% NaF varnish Fig: HEMA

9. ii. Treatment agents that undergo setting or polymerization reactions Conventional glass ionomer cement Resin-modified glass ionomer cement / Compomers Adhesive resin primers Adhesive resin bonding systems iii. Use of mouth guards iv. Iontophoresis v. Lasers Fig: Laser

10. B) In home products Desensitizing toothpastes/ dentifrices Sensodyne Thermodent Mouthwash Fig: Sensodyne Fig: Thermodent Fig: Mouthwash

11. Mechanism of action The most likely mechanisms of action is the reduction in the diameter of the dentinal tubules so as to limit the displacement of fluid in them. According to Trowbridge and Silver (1990) this can be attained by Formation of a smear layer produced by burnishing the exposed surface. Topical application of agents that forms insoluble precipitates within the tubules.

12. Impregnation of tubules with plastic resins. Sealing of the tubules with plastic resins. Act via precipitates of crystalline salts on the dentine surface, which blocks dentinal tubules. Desensitizing agents are effective when used continuously for a period of at least 2 weeks.

13. Dentine Hypersensitivity Dentine hypersensitivity is defined as “ sharp, short pain arising from exposed dentine in response to stimuli typically thermal, chemical, tactile or osmotic and which cannot be explained to any other form of dental defect or pathology”.

14. Theories of Dentine Hypersensitivity Neural theory/Direct innervation theory Odontoblastic transduction theory Hydrodynamic theory/Fluid movement theory

15. Neural theory/Direct Innervation theory This theory advocates that thermal or mechanical stimuli directly affect nerve endings within the dentinal tubules through direct communication with pulpal nerve fibers. Fig: Neural theory

16. Odontoblastic transduction theory According to this theory, membrane of odontoblastic processes are exposed on the dentine surface and can be excited by a variety of chemical and mechanical stimuli. As a result of such stimulation neurotransmitters are released and impulses are transmitted towards the nerve endings in the inner dentine i.e. pre-dentine, odontoblast zone and pulp.

17. Fig: Odontoblastic transduction theory

18. Hydrodynamic theory Stimulus(chemical and mechanical stimuli) Fluid flow in exposed open dentinal tubules Stimulation on intratubular baroreceptors Pain

19. Fig: Hydrodynamic theory

20. Aetiology of Hypersensitivity Exposure of dentine: causes opening of the dentinal tubules Caries Tooth fracture due to trauma Marginally defective restoration Gingival recession Presence of gap junction in cementoenamel junction Tooth wear: attrition, abrasion, erosion, abfraction History of gastroesophageal reflex Cracked tooth syndrome

21. Fig: Dental caries Fig: Cracked tooth syndrome Fig: Gingival recession Fig: Attrition Fig: Abfraction

22. Clinical features Intensity of pain is usually mild to moderate. Sensitivity always related to various stimuli such as hot, cold, sweet, sour and even air during breathing Immediate relief occur after the removal of the stimuli

23. Diagnosis Complete history Signs & symptoms Intensity Frequency & duration Dietary changes Clinical evaluation Visual assessment Physical assessment Depth of periodontal pocket Response to cold air Radiographic examination Rule out periapical lesion

24. A simple clinical method of diagnosing dentine hypersensitivity includes a jet of air or using an exploratory probe on the exposed dentine, in a mesio-distal direction, examining all the teeth in the area in which the patient complains of pain. The severity or degree of pain can be quantified either according to categorical scale(i.e., slight, moderate or severe pain) or using a visual analogue scale.

25. Treatment strategies Patient education Dietary counselling Tooth brushing technique using either strontium chloride/potassium nitrate (5%)/fluoride dentifrices: home care with dentifrices Plaque control Nerve desensitization Potassium nitrate Anti-inflammatory agents corticosteroids Fig: Potassium nitrate

26. Cover or plugging dentinal tubules Plugging (sclerosing) dentinal tubules Ions/salts Calcium hydroxide Ferrous oxide Potassium oxalate Sodium monofluorophosphate Sodium fluoride Stannous fluoride Strontium chloride Sodium fluoride/ stannous fluoride combination Fig: Calcium hydroxide

27. ii. Protein precipitants Fluoride iontophoresis Silver nitrate Strontium chloride hexahydrate Casein phosphopeptides Burnishing b) Dentine sealers Glass ionomer cements Composites Resins Varnishes Sealants Fig: Silver nitrate Fig: Burnishing

28. Periodontal soft tissue grafting Crown placement/ restorative materials Lasers Treatment of the underlying causes Fig: Periodontal soft tissue graft Fig: Lasers

29. Conclusion In conclusion, dentine desensitizing agents are indispensable in modern dentistry, offering effective solutions to alleviate the discomfort of dentine hypersensitivity. By understanding there mechanisms, proper application, and advancements, dental professionals can provide personalized care, improving patient comfort and oral health outcomes. The continued past development of innovative agents ensures an even brighter future in managing this prevalent condition.

30. Thank you

31. Any questions?