Managing Hypersensitive Dentin

Dentinal hypersensitivity (DH) is a common condition that afflicts 10% to 30% of adults.1 The pain produced by DH can range from subtle (i.e., a minor annoyance) to severe, in which it disrupts daily activities. It can significantly impact patients’ quality of life; this includes the ability to comfortably perform routine oral hygiene. Often, patients may attempt to circumvent sensitivity by modifying habits or behaviors; examples include avoiding hot or cold foods and beverages, and/or eliminating offending items from their diets. Compared to the general population, patients with periodontitis, smokers with periodontitis, and patients with gingival recession tend to have higher incidence of DH. Generally the distribution of DH in the dentition favors maxillary premolars and molars.2 Individuals between 20 to 40 years old present with the greatest incidence of DH; in part, this may be explained by physiologic changes in dentin permeability with aging.3

This article will review the chairside treatment options that can be considered along with counseling and at-home therapy, which remain integral to effective management. Dental professionals should be able to provide recommendations for toothpastes, mouthrinses and pastes to help patients initially address DH at home.4 These strategies are minimally invasive and treat general regions (e.g., multiple teeth or an arch) of exposed cervical dentin, nonspecifically.

Clinical treatments represent an additional level of therapy, and are based on hydrodynamic theory, a well-accepted understanding of sensitivity’s mechanism of action5 in which pain results from fluids within exposed dentinal tubules being disturbed by either temperature, physical or osmotic changes (Figure 1). These fluid movements stimulate a baroreceptor that produces a neural signal. For example, when thermal stimulus is applied to a cervical site with patent dentinal tubules it causes fluid movement within the tubules, resulting in depolarization of nociceptors. Similarly, applying air will desiccate the surface, prompting peripheral flow of fluid toward the dehydrated surface (Figure 2). This fluid movement also depolarizes the nociceptors that evoke the same response. Consequently, the treatment of DH — whether in-office or at home — focuses on two goals: occluding the dentinal tubules, and otherwise impeding the stimulation of pulpal nociceptors.

FIGURE 1. According to hydrodynamic theory, pain from dentinal hypersensitivity results from fluids within exposed dentinal tubules (the dark lines) becoming disturbed by temperature, physical or osmotic changes. Image courtesy of STEVE GSCHMEISSNER/SCIENCE SOURCE

FIGURE 1. According to hydrodynamic theory, pain from dentinal hypersensitivity results from fluids within exposed dentinal tubules (the dark lines) becoming disturbed by temperature, physical or osmotic changes. STEVE GSCHMEISSNER/SCIENCE SOURCE

In-office management can be delineated into four principal approaches. Chemical occlusion of tubules is the main strategy employed with the use of fluoride applications, gluteraldehyde agents, oxalates and calcium-containing agents. Physical blocking of the dentinal tubules results from strategies utilizing application of restorative materials, such as resins, bonding agents and glass ionomers. Nerve desensitization is an approach used in a limited number of chairside products and clinical studies involving the active agent potassium nitrate, a component of many over-the-counter sensitivity dentifrices. Lasers represent perhaps the most contemporary strategy in chairside management of cervical dentinal hypersensitivity. Furthermore, a number of recent studies evaluate the use of lasers in combination with the other aforementioned agents…..more

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