Treatment of DentinHypersensitivity

Dr. Ahmed Al Mokhatieb

• is exemplified by brief, sharp, well-localized pain in response tothermal, evaporative, tactile, osmotic, or chemical stimuli that cannot be ascribed toany other form of dental defect or pathology

• Pulpal pain is usually more prolonged,dull, aching, and poorly localized and usually lasts longer than the applied stimulus.

• Up to 30% of adults have dentin hypersensitivity at some period of their lives

• Current techniques for treatment may be only transient in nature and results are not alwayspredictable

• Two chief methods of treatment of dentin hypersensitivity 1 tubular occlusion 2blockage of nerve activity

• A differential diagnosis needs to be accomplished before any treatment because many symptoms are common to a variety of causes

Items to be considered: • the pain—sharp, dull, or throbbing• how many teeth and their location• which part of the tooth elicits the pain• the intensity of the pain

• Clinical and radiographic examination is necessary to elucidate the cause

The following questions need to be asked• Can the pain be localized to one tooth or area of the tooth?• Is the area sensitive to a moderate flow of air from an air water syringe?• Is the tooth sensitive to percussion? Is there sensitivity to biting pressure or on

release?

The following questions need to be asked

• What is the extent of the pain after the stimuli is removed?• Do radiographs demonstrate caries or periapical pathology?• Is the dentin exposed as a result of recession and are there any cracked cusps,

open margins, or occlusal hyperfunction?

MECHANISM• There are regional differences in dentin sensitivity• Freshly exposed dentin in the coronal part of the tooth is more sensitive than cervical

dentin

• Hypersensitive dentin, however, is found most often in the cervical area

• The sensitivity of dentin has a direct correlation with the size and patency of the dentinal tubules

• Absi and colleagues discovered that hypersensitive teeth have an increased number of patent tubules and wider tubules than those of no sensitive teeth

CAUSES• There is no principal cause.

• The loss of enamel and removal of cementum from the root with exposure of dentin, however, is a major contributing factor

CAUSES• Causes include gingival recession due to root prominence and thin overlying

mucosa, dehiscences and fenestrations, frenum pulls, and orthodontic movement, which causes a root to be moved outside its alveolar housing

• Loss of enamel may be a consequence of attrition, erosion, abrasion, and abfraction.

• The loss of enamel, however, is usually a combination of two or more of these factors

BLEACHING

• The sensitivity that occurs with bleaching is a result of a reversible pulpitis that is caused by the flow of dentinal fluid from osmolarity changes in the pulp

• These changes occur when the bleaching material rapidly penetrates enamel and dentin to the pulp. Hydrogen peroxide and urea penetrate through integral enamel, through the dentin, and into the pulp in 5 to 10 minutes

BLEACHING• Most often, the sensitivity is generalized• The estimates of tooth hypersensitivity caused by whitening are usually

approximately 60%• Usually higher concentrations of peroxide results in a greater degree of sensitivity.• The addition of low levels of potassium nitrate to tray bleaches has reduced but

not eradicated sensitivity.

PERIODONTAL TREATMENT

Unfortunately, patient discomfort often occurs whileundergoing periodontal treatment. Postoperative pain and dentin hypersensitivityare often occurrences. Some patients find both the nonsurgical and surgical treatmentpainful. It has been reported that periodontal therapy can be an important source ofdentin hypersensitivity.

TREATMENT—SELF-APPLIED AND OFFICE SUPPLIED

Self-applied treatments to reduce sensitivity consist of materials that occlude dentinaltubules, coagulate or precipitate tubular fluids, encourage secondary dentin formation,or obstruct pulpal neural response. Desensitizing toothpastes that contain potassiumsalts, either nitrates or chlorides, are believed to act by depolarizing the nervesurrounding the odontoblastic process, resulting in interference of transmission.Usually

LASER TREATMENT

The treatment seems to be only transient, however, and the sensitivity returns intime. In order for a laser to actually alter the dentin surface, it has to melt and resolidifythe surface. This effectively closes the dentinal tubules. This does not occur. It isfelt that laser treatment reduces sensitivity by coagulation of protein and withoutaltering the surface of the dentin. Dicalcium phosphate-bioglass in combinationwith Nd:YAG laser treatment has sealed dentin tubules to a depth of 10 mm, anddicalcium phosphate-bioglass plus 30% phosphoric acid occluded exposed tubulesup to 60 mm.

FLUORIDE TREATMENT

Fluorides reduce the permeability of dentin probably by precipitationof insoluble calcium fluoride inside the dentinal tubules and reduce sensitivity.

PRO-ARGIN

This material was able to plug and seal exposed dental tubules todecrease sensitivity.

OXALATE

Pashley and Galloway38 felt that using potassium oxalate resulted in calcium oxalatecrystals, occluding the tubules

CASEIN PHOSPHOPEPTIDE–AMORPHOUS CALCIUM PHOSPHATE

The peptides present in Recaldent become bound to the dentin surface and this causes a mineral deposit formation in the dentin surface resulting in decreased opening of the dentinal tubules

CALCIUM PHOSPHATE PRECIPITATION

Chiang and colleagues44 found a mesoporous silica biomaterial containing nanosizedcalcium oxide particles mixed with 30% phosphoric acid can occlude dentinal tubulesand considerably reduce dentin permeability even in the presence of pulpal pressure.

CARBONATE HYDROXYAPATITE NANOCRYSTALS AND SODIUMFLUORIDE/POTASSIUM NITRATE DENTIFRICE

Synthetic hydroxyapatite (carbonate hydroxyapatite) biomimetic nanocrystals,introduced recently, have demonstrated the ability to remineralize altered enamelsurfaces and close dentinal tubules.There is a progressive closing of the dentinaltubules in several minutes and subsequently a remineralized layer forms in a fewhours.

GLUTARALDEHYDE

based on aqueous glutaraldehyde, which occludes the tubules by cross-linking of dentinalproteins.

SEAL & PROTECT AND ADMIRA PROTECT

The material is applied to a slightly moist surface, air dried, and light cured and then a second application is applied and light cured for 10 seconds.

PREHYBRIDIZED DENTIN

Prehybridized dentin or immediate dentin sealing has been suggested to make thedentin less sensitive while a restoration is fabricated in the laboratory. Becausea hybrid layer is created immediately after preparation, teeth treated with the immediatedentin sealing technique were better able to tolerate thermal and functional loadsin comparison to teeth that were sealed when the restorations were placed.51

VARNISH