Dentin Hypersensitivity

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Dentin Hypersensitivity
Zhang Qi Wuhan University School of Stomatology
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Introduction
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Definition
Dentin hypersensitivity is a common
condition of transient tooth pain caused by a
variety of exogenous stimuli.
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Characteristic
Short , sharp pain.
Most in cervical, then occlusal
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Stimuli
The exogenous stimuli include

• Thermal (cold)

• Tactile (touch)

• Osmotic changes
• (sweets, drying the surface)

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Etiology
The primary clinical cause is exposed dentinal
tubules.
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Two phases of development of dentin
hypersensitity

• First, dentin has to be exposed.

lesion localization

• The dentinal tubules must be opened

lesion initiation
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The most common clinical cause for exposed
dentinal tubules is gingival recession.
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Common Reasons for Gingival Recession

• Inadequate attached gingiva
• Prominent roots
• Tooth brush abrasion
• Pocket reduction periodontal surgery
• Oral habits resulting in gingival laceration
• Excessive tooth cleaning
• Excessive flossing
• others

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Reasons for Continued Dentinal Tubular Exposure

1. Poor plaque control, acidic bacterial byproducts
2. Excess oral acids, sodas, fruit juice
3. Cervical decay
4. Toothbrush abrasion
5. Tartar control toothpaste

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Mechanism
Hydrodynamic theory
M.Brännström in 1967
The fluids within the tubule are disturbed
either by temperature changes or physical
osmotic changes. These fluid changes stimulate a
baroreceptor which leads to neural discharge
(depolarization).
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Baroreceptor a never receptor sensitive to
pressure
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Treatment
A challenge for both the patients and dentists.

• Its difficult measuring/comparing
• different patients pain.

• Its difficult for patients
• to change the habits.

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Treatment Strategies

• Plug the dentinal tubules
• preventing fluid flow.

• Desensitize the nerve
• making it less responsive to
  stimulation.

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Nerve Desensitization
Potassium Nitrate the only one approved by
FDA and ADA
KNO3 penetrates through the dentinal tubules
to the nerve K may depolarize the nerve
and prevent it from
repolarizing Thereby, Preventing it
from sending pain signals to the brain.
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Covering Dentinal Tubules

• Composite or GIC restoration
• Crown placement
• Periodontal surgery

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Occluding Dentinal Tubules
To plug the inside of the dentinal tubules
Ions or salts stannous fluoride, sodium
fluoride, potassium oxalate,
etc Precipitates glutaraldehyde Resin
dentin sealers
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Laser another choice
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Treatment Steps

• Thorough exam to identify etiology and
• eliminate tooth fracture and irreversible
  pulpitis.

2. Potassium nitrate containing
product/toothpaste 2day for at least 2
weeks.
3. Potassium nitrate containing product
in a tight fitting dental tray.
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4. In-office tubule occluding product.
5. In-office tubule sealer.

• Dental restoration, or a periodontal surgery,
• that covers the exposed dentin.

7. Endodontic procedure to remove the pulp.
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The patient should be informed of the series of
steps that may be necessary to eliminate the
problem.
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Acknowledgements