CDA Essentials 2018 • Volume 5 • Issue 7

Dentin Hypersensitivity Sarah’s symptoms are in keeping with Dentin Hypersensitivity (DH), a transient, short, sharp tooth pain arising from exposed dentin in response to a stimulus that cannot be attributed to any other form of dental defect or pathology. 1,2 Sarah is not alone. An estimated 36% of adults report having sensitive teeth associated with temperature, air or tactile stimuli. 3 Dentin Hypersensitivity often presents as an acute problem, but when it starts to occur on a chronic basis can lead to neglecting oral hygiene, failing to comply with instructions and avoiding dental appointments. 4,5 Diagnosis, Mechanism and Management Symptoms experienced by patients with dentin pain/sensitivity may also be associated with the following conditions, which should be diagnosed by examination: Sarah, a 28-year old female patient presents for her Hygiene recall visit. Prevent Tooth Pain and Sensitivity with the Latest Tooth Protection Technology PATIENT CASE: SARAH She describes having pain and points to her upper right side premolars and canine. The pain is very short in duration and is often caused by cold liquid, air or even the bristles of her toothbrush. Sarah used to experience pain infrequently, but now it could occur every day, if she is not careful. Upon examination, gingival recession of about 1mm was observed in the area surrounding the first and • Dental Caries, Cracked Teeth, Fractured Teeth and Post-Treatment Neuralgias 2 • Ruling out these causes of pain and confirming Dentin Hypersensitivity may take multiple visits Mechanism of Dentin Hypersensitivity: • Dentin is exposed, open tubules form at the exposed surface (Figure 1a) and trigger pulpal nerves in response to a stimulus 3 • The Hydrodynamic Theory is the most accepted mechanism for Dentin Hypersensitivity. Rapid movement of fluid in open tubules results in nerve stimulation with a short sharp pain (Figure 1b) 3 • Tubules must be open to the oral cavity and the pulp 3 Treatment Modalities include: • Nerve depolarization using potassium-based products to prevent repolarization and thus reducing the transmission of the impulse 6 • Tubule occlusion where a layer forms over and in the tubules, which blocks the movement of dentinal fluid and prevents the nerve stimulation 6 Figure 1a : Open tubules formed in dentin allowing for rapid fluid movement resulting in nerve stimulation 3, 7 Figure 1b: Fluid in tubules extending from exposed dentin triggers nerve stimulation 3,7 second premolar and canine, with inflammation and plaque buildup. The rest of her mouth is plaque free with no observed inflammation. Sarah admits to avoiding the area when she brushes, anticipating it will cause pain. She responded to an airblast and a sweep of the probe on the root surface. Her pain was 7 - 8 on a 10 point scale. No decay was observed. Leonard J. Litkowski, DDS, MS SPONSORED CONTENT