Clinical Dentin Hypersensitivity: Understanding the Causes and Prescribing a Treatment

Abstract Dentin hypersensitivity is a common condition of transient tooth pain associated with a variety of exogenous stimuli. There is substantial variation in the response to such stimuli from one person to another. Except for sensitivity associated with tooth bleaching or other tooth pathology, the clinical cause of dentin hypersensitivity is exposed dentinal tubules as a result of gingival recession and subsequent loss of cementum on root surfaces. The most widely accepted theory of how the pain occurs is Brännström's hydrodynamic theory of dentin hypersensitivity. Dentinal hypersensitivity must be differentiated from other conditions that may cause sensitive teeth prior to treatment. Three principal treatment strategies are used. Dentinal tubules can be covered by gingival grafts or dental restorations. The tubules can be plugged using compounds that can precipitate together into a large enough mass to occlude the tubules. The third strategy is to desensitize the nerve tissue within the tubules using potassium nitrate. Several over-the-counter products are available to patients to treat this condition.

Download Full-text

Dentinal Hypersensitivity: A Review

The Journal of Contemporary Dental Practice ◽

10.5005/jcdp-6-2-107 ◽

2005 ◽

Vol 6 (2) ◽

pp. 107-117 ◽

Cited By ~ 75

Author(s):

Patricia A. Walters

Keyword(s):

Potassium Nitrate ◽

Diagnostic Techniques ◽

Hydrodynamic Theory ◽

First Line ◽

Dentinal Tubules ◽

Non Invasive ◽

Sharp Pain ◽

Sensitive Teeth ◽

Dental Professional ◽

Dentinal Hypersensitivity

Abstract Dentinal hypersensitivity is generally reported by the patient after experiencing a sharp pain caused by one of several different stimuli. The pain response varies substantially from one person to another. The condition generally involves the facial surfaces of teeth near the cervical aspect and is very common in premolars and canines. The most widely accepted theory of how the pain occurs is Brannstrom's hydrodynamic theory, fluid movement within the dentinal tubules. The dental professional, using a variety of diagnostic techniques, will discern the condition from other conditions that may cause sensitive teeth. Treatment of the condition can be invasive or non-invasive in nature. The most inexpensive and efficacious first line of treatment for most patients is a dentifrice containing a desensitizing active ingredient such as potassium nitrate and/or stannous fluoride. This review will address the prevalence, diagnosis, and treatment of dentinal hypersensitivity. In addition the home care recommendations will focus on desensitizing dentifrices. Citation Walters PA. Dentinal Hypersensitivity: A Review. J Contemp Dent Pract 2005 May;(6)2:107-117.

Download Full-text

Multi-factoriality of dentine hypersensitivity

Medicinski pregled ◽

10.2298/mpns0808359s ◽

2008 ◽

Vol 61 (7-8) ◽

pp. 359-363 ◽

Cited By ~ 5

Author(s):

Ivana Stojsin ◽

Ljubomir Petrovic ◽

Igor Stojanac ◽

Milan Drobac

Keyword(s):

Differential Diagnosis ◽

Average Diameter ◽

Gingival Recession ◽

Dentin Hypersensitivity ◽

Dentine Hypersensitivity ◽

Enamel Defect ◽

Indexing Method ◽

Suitable Treatment ◽

Sensitive Teeth ◽

Enamel Erosion

Introduction. Dentine hypersensitivity has been defined as a sharp, short pain arising from exposed dentin in response to stimuli typically thermal, evaporative tactile, osmoticor, chemical and which cannot be ascribed to any other form of dental defect or pathology. Prevalence. The most affected patients range in age from 20 to 40. The following teeth tend to be most sensitive: cuspids, premolars and incisors, location-concentrated on the facial surface. Morphological bases of dentine hypersensitivity Sensitive teeth have much greater numbers of open tubules per unit area and the average diameter of tubules is almost 2 times greater than tubules in nonsensitive teeth. Mechanisms of dentine hypersensitivity. The most widely accepted theory of how the pain occurs is Brannstroms theory. Etiology Dentine hypersensitivity represents a condition of presumable multifactorial pathology. Two processes are essential for its development: (1) dentin must be exposed through either genetic disturbance, enamel defect (lamellae, tufts and spindles), loss of enamel (erosion, abrasion, attrition, abfraction), gingival recession with rapid loss of cementum and (2) the dentin tubules must be open to both the oral cavity and the pulp. Diagnosis. Diagnostic protocol for this condition consisted of Medical, Dental Dietary, Oral Hygiene History and Intra-oral examinations with air indexing method. Differential Diagnosis: We must take into consideration a number of variables such as: dental caries, cracked tooth, restorative sensitivity, medication sensitivity, bleaching sensitivity and abscessed or non-vital tooth. Conclusion. Dentin hypersensitivity is a problem that bothes many patients. Many conditions share the symptoms of tooth sensitivity so differential diagnosis is essential for suitable treatment or preventive measures.

Download Full-text

CLAREAMENTO DENTAL EM PACIENTES COM HIPERSENSIBILIDADE: SÉRIE DE CASOS

Journal of Dentistry & Public Health ◽

10.17267/2596-3368dentistry.v6i1.530 ◽

2015 ◽

Vol 6 (1) ◽

Author(s):

Sara Souza Castro ◽

Clara Lemos Leal ◽

Saryta Argolo ◽

Juliana Felippi Azevedo ◽

Paula Mathias ◽

...

Keyword(s):

Hydrogen Peroxide ◽

Case Series ◽

Potassium Nitrate ◽

Tooth Bleaching ◽

Dentin Hypersensitivity ◽

Tooth Discoloration ◽

Dentin Sensitivity ◽

Clinical Cases

The possibility of pain resultant from tooth bleaching can limit the indication of this treatment in patients with pre-existing dentin hypersensitivity. Purpose: To provide a case series with alternatives for tooth bleaching that might reduce the pos-operative sensibility. Description of cases: Three patients with dentin sensitivity and complaining of tooth discoloration were selected. For each patient, a technique for tooth bleaching was randomly selected; using 15-35% hydrogen peroxide, and application of an desensitizing agent before or after the bleaching (toothpaste or 2% potassium nitrate). Conclusion: Bleaching was successfully performed in the three clinical cases. However, the previous desensitization using the toothpaste resulted in greater comfort for the patient.

Download Full-text

Dentin hypersensitive: Ethiology and treatment

Padjadjaran Journal of Dentistry ◽

10.24198/pjd.vol27no3.13548 ◽

2015 ◽

Vol 27 (3) ◽

Author(s):

Nuryanni Dihin Utami ◽

Ira Komara

Keyword(s):

Gingival Recession ◽

Neural Response ◽

Dentin Hypersensitivity ◽

Invasive Treatment ◽

Dentinal Tubules ◽

Non Invasive

Dentin hypersensitivity is a response in exposed dentine with a symptom of clinically sharp and short pain. This condition may occur to exposed dentine due to gingival recession or enamel loss. Dentin hypersensitivity treatment aimed to either occlude the open dentinal tubules or block the neural response of the pulp. Invasive treatment are pulpectomy, restoration or surgery, while non invasive treatment are usually done by using tooth paste or mouthwash which is added by desensitizing agent

Download Full-text

Experimental assessment of potassium ions diffusion speed from new gel reducing dental sensitivity

Kazan medical journal ◽

10.17816/kmj2214 ◽

2014 ◽

Vol 95 (5) ◽

pp. 675-679

Author(s):

A N Kozmenko ◽

N A Belokonov

Keyword(s):

Potassium Chloride ◽

Film Formation ◽

Potassium Fluoride ◽

Potassium Nitrate ◽

Potassium Citrate ◽

Potassium Ions ◽

Special Device ◽

Protective Film ◽

Dentinal Tubules ◽

Sensitive Teeth

Aim. To compare the contents of potassium salts in specialized toothpastes, and to estimate the possibility for potassium ions diffusion through dentinal tubules after firm tooth tissues conditioning by a toothpaste containing fluoride. Methods. Toothpastes specially formulated to treat the pain of sensitive teeth: «Sensodyne F» (contains potassium chloride); «PresiDENT Sensitive» (potassium nitrate); «Asepta Sensitive» (potassium citrate) and new gel reducing dental sensitivity (contains potassium chloride) were examined. Speed of potassium ions diffusion through dentinal tubules after firm tooth tissues conditioning by a toothpaste containing fluoric substances were measures by potentiometry and a special device using tooth slice as a membrane. Results. Considering that toothpaste is applied within 5 minutes, while gel - within 15-20 minutes, it is possible to assume that potassium ions bioavailability from 1 g of gel can be assessed as 41 mg, compared to 5.9±0.5 mg from 1 g of paste №1, 0.4±0.05 mg - №2; 7.8±0.5 mg - №3. So, potassium ions bioavailability from 1 g of gel is 7; 102; 5 times higher (respectively) compared to toothpastes. Speed of potassium ions diffusion through dentinal tubules ranged between 0.2 to 1.64 μg/min and depended on the number of membrane potassium channels permeable for potassium. Fluoride toothpastes specially formulated to treat the pain of sensitive teeth reduced the speed of potassium ions diffusion from the solution by 4-7 times by blocking the dentinal tubules. This can be also associated with fluoride-containing protective film formation. Therefore, at the first stage of treatment of teeth hypersensitivity using new gel, it is better to use a toothpaste without fluoride. Conclusion. Compared to the examined toothpastes, new gel for reducing dental sensitivity contains higher number of potassium free ions, which can enter dentinal tubules reducing the effect on free nerve endings. Potassium ions diffusion through dentinal tubules reduced 4-7-fold after conditioning by a toothpaste containing fluoride.

Download Full-text

An Update on Dentinal Hypersensitivity - Aetiology to Management – A Review

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2021/667 ◽

2021 ◽

Vol 10 (37) ◽

pp. 3289-3293

Author(s):

Mrinalini Mrinalini ◽

Urvashi B. Sodvadiya ◽

Mithra N. Hegde ◽

Gowrish S. Bhat

Keyword(s):

Pain Relief ◽

Hydrodynamic Theory ◽

Dentin Hypersensitivity ◽

Herbal Products ◽

Dentinal Tubules ◽

Tooth Structure ◽

Dentin Sensitivity ◽

Nerve Sprouting ◽

Careful Clinical Examination ◽

Dentinal Hypersensitivity

BACKGROUND Dentinal hypersensitivity is a common clinical disease that occurs as a result of dentin exposure. Though the term dentin hypersensitivity and dentin sensitivity is used interchangeably, dentin hypersensitivity is an exaggerated form of dentinal sensitivity which arises due to localized pulpal inflammation, pulpal nerve sprouting, and development of inflammatory sodium channels. It is characterised by short sharp pain emerging from exposed dentinal tubules in reaction to various stimuli. Such dentin exposure could be due to either enamel loss or cemental loss. This is followed by removal of smear layer by mechanical or chemical means. At present, the hydrodynamic theory, which describes fluid movement in response to stimuli within exposed dentinal tubules, is a commonly recognized explanation for dentin hypersensitivity. It is more common in premolars and canines, and it affects the facial surfaces of the teeth towards the cervical aspect. Studies suggested microscopic changes in the structure of sensitive dentin compared with normal dentin. The diagnosis of dentinal hypersensitivity requires careful clinical examination and eliciting the response using various stimuli. Dentinal hypersensitivity is usually managed by the use of physical or chemical agents. They work either by disturbing the neural response to pain stimulus or block fluid flow by occluding the tubule. The desirable features of a desensitising agent include the ability to give instant and longlasting pain relief, being simple to use, well accepted, not harmful to the pulp. It is recommended that the desensitizing agent is used for at least two weeks. Some of the newer agents used for management includes CPP-ACP, proarginine, nanomaterials, herbal products, propolis etc. In cases where there is tooth structure loss, appropriate restorative material is used to cover the exposed dentin. Root canal therapy is considered the last resort for pain relief after all other options have failed to provide relief. The present article outlines the etiopathogenesis, risk factors, diagnosis, prevention and treatment of dentinal hypersensitivity. KEY WORDS Dentinal Hypersensitivity; Dentin Sensitivity; Desensitizing Agents; Iontophoresis

Download Full-text

Prevalence of dentin hypersensitivity in Bihar and Jharkhand- A multicentric study

UNIVERSITY JOURNAL OF DENTAL SCIENCES ◽

10.21276/ujds.2020.6.3.13 ◽

2021 ◽

Vol 6 (3) ◽

pp. 68-73

Author(s):

Sumit Mohan ◽

Jyoti Thakur ◽

Santosh Kumar Verma ◽

Rima Jaiswal ◽

Abhishek Verma ◽

...

Keyword(s):

Health Workers ◽

Age Groups ◽

Gingival Recession ◽

Dentin Hypersensitivity ◽

Multicentric Study ◽

Female Ratio ◽

Dentine Hypersensitivity ◽

Multi Stage ◽

Study Population ◽

Sensitive Teeth

Aim: Dentine hypersensitivity is a common oral problem. This pilot study investigated the prevalence of dentine hypersensitivity in the diverse population across four centres of Bihar and Jharkhand. Materials and Methods: A multi-stage, random sampling method was used to investigate the study population. A total of 5622 subjects were examined at four centres in Bihar and Jharkhand. Subjects were divided into 8 age groups. Participants completed a dentine hypersensitivity questionnaire and underwent clinical examination. The diagnosis of dentine hypersensitivity was confirmed. Gingival recession of sensitive teeth was measured by a Williams periodontal probe. Results: Among 5622 subjects, 1253 were found to be suffering from dentin hypersensitivity indicating a prevalence of 22.28%. Females were more prone to dentin hypersensitivity with male to female ratio of 1:1.31. While subjects in age group of 50-59 were predominantly affected, the molars and premolars were commonly affected with dentin hypersensitivity. Conclusion: The prevalence of dentine hypersensitivity in East India was 22.28%, indicating that it is a common condition. For its effective management, public education about the condition and effective treatment of dentine hypersensitivity are required. Clinical Significance: Assessment of prevalence of hypersensitivity in this demographical location would enable the dental care health workers to devise strategies to educate masses about the prevention and management of this disease

Download Full-text

The control of pain due to dentin hypersensitivity in individuals with molar–incisor hypomineralisation: a protocol for a randomised controlled clinical trial

BMJ Open ◽

10.1136/bmjopen-2020-044653 ◽

2021 ◽

Vol 11 (3) ◽

pp. e044653

Author(s):

Ana Paula Taboada Sobral ◽

Elaine Marcilio Santos ◽

Ana Cecilia Aranha ◽

Paulo Vinícius Soares ◽

Caroline Moraes Moriyama ◽

...

Keyword(s):

Clinical Trial ◽

Tooth Enamel ◽

Control Group ◽

Controlled Clinical Trial ◽

Dentin Hypersensitivity ◽

Molar Incisor Hypomineralisation ◽

Randomised Controlled Clinical Trial ◽

Sensitive Teeth ◽

Randomised Controlled ◽

Incisor Hypomineralisation

IntroductionDentin hypersensitivity (DH) is defined as high sensitivity of the vital dentin when exposed to thermal, chemical or tactile stimuli. Two mechanisms are required for the occurrence of DH: (1) the dentin must be exposed and (2) the dentinal tubules must be open and connected to the pulp. Molar–incisor hypomineralisation (MIH) is a qualitative abnormality of a genetic origin that affects tooth enamel and, in most cases, is accompanied by DH. The control of tooth sensitivity is fundamental to the successful treatment of MIH. The aim of the proposed randomised, controlled, clinical trial is to evaluate the effectiveness of different protocols for the control of DH in patients with teeth affected by MIH.Methods and analysisOne hundred and forty patients who meet the inclusion criteria will be allocated to four groups. Group 1 will be the control group (placebo). In Group 2, sensitive teeth will be sealed with PermaSeal (Ultradent). In Group 3, sensitive teeth will receive low-level laser (LLL, AsGaAl) at a wavelength of 780 nm (Laser XT Therapy, DMC, São Carlos, Brazil). In Group 4, sensitive teeth will be treated with both LLL and PermaSeal (Ultradent). DH will be evaluated 15 min after the application of the treatments and the patients will be reevaluated 1 week, 1 month, 3 months and 6 months after the treatments. The primary outcome of this study is change in pain/sensitivity, when evaluated through a Visual Analogue Scale, to determine the effectiveness of the proposed treatments, as well as differences among the evaluation times for each proposed treatment.Ethics and disseminationThis protocol has been ethically approved by the local medical ethical committee (protocol number: 4.020.261). Results will be submitted to international peer-reviewed journals and presented at international conferences.Trial registration numberNCT04407702.

Download Full-text

Treatment of Dentin Hypersensitivity Using Nano-Hydroxyapatite Pastes: A Randomized Three-Month Clinical Trial

Operative Dentistry ◽

10.2341/15-145-c ◽

2016 ◽

Vol 41 (4) ◽

pp. E93-E101 ◽

Cited By ~ 20

Author(s):

L Wang ◽

AC Magalhães ◽

LF Francisconi-dos-Rios ◽

MP Calabria ◽

DFG Araújo ◽

...

Keyword(s):

Clinical Trial ◽

Home Care ◽

General Linear Model ◽

Potassium Nitrate ◽

Dentin Hypersensitivity ◽

Analog Scale ◽

The Third ◽

Significant Difference ◽

Final Score ◽

Nested Analysis

SUMMARY Objectives: This randomized clinical trial tested the three-month desensitizing effect of two protocols using nano-hydroxyapatite formulations compared with Pro-Argin and fluoride varnish. Methods: Twenty-eight subjects with 137 teeth presenting dentin exposure with a minimal hypersensitivity of four on the visual analog scale (VAS) took part of this study. The subjects were randomly assigned to four groups: Desensibilize Nano-P paste (20% hydroxyapatite [HAP], potassium nitrate, and sodium fluoride [NaF]; 9000 ppm fluoride [F]); Desensibilize Nano-P associated with experimental home-care pastes (10% HA, potassium nitrate, and NaF; 900 ppm F); Pro-Relief professional paste (8% arginine with Pro-Argin technology) associated with home-care toothpaste (8% arginine, sodium monofluorophosphate, 1450 ppm F); and Duraphat professional varnish (NaF varnish, 22,600 ppm F). The professional treatments were performed in weekly appointments over three weeks. The home-care products were used continuously for three months. A VAS was used to assess the tooth sensitivity response after standardized evaporative stimulus at baseline and after one month and three months. The baseline score was deducted from the final score, and the means were analyzed using nested analysis of variance, while the comparison between times was performed by a general linear model (p<0.05). Results: At the first month all treatments were effective, but there were no significant differences among them (p=0.94). At the third month, despite the fact that NaF varnish had the lowest effect in reducing hypersensitivity, no significant difference was found among the treatments (p=0.09). Only Pro-Relief increased its effect over time (p=0.049). Conclusions: Nano-hydroxyapatite formulations (with or without home->care product association) were as effective as the other treatments in reducing dentin hypersensitivity over three months.

Download Full-text