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dentine hypersensitivity


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A condition often resulting in pain caused by exposure of dentine to external stimuli. Such stimuli may involve tissue loss and exposure of dentinal tubules (e.g. loss of enamel and cementum or gingival recession), opening up of dentinal tubules without tissue loss (e.g. by the removal of the smear layer during a restorative procedure, acid in dental plaque, diet, gastric reflux, agents in a dentifrice, or vital bleaching), by an inappropriate tooth brushing technique, or as a result of temperature change (e.g. cold drinks, ice cream, cold weather etc.). Dentine hypersensitivity is a common occurrence following root debridement and bleaching procedures. The mechanism transmitting the sensation through the dentine to the pulp is not thoroughly understood in spite of numerous research studies. Current theories include the belief that nerve fibres of the pulp pass into the dentinal tubules (innervation theory), that odontoblasts act as receptors, transmitting nerve impulses (odontoblast receptor theory), or that there is fluid movement within the dentinal tubules ( hydrodynamic theory). Treatment strategies may be professionally undertaken or home-based by the application of desensitizing agents such as topical fluoride varnish, potassium chloride, strontium chloride, magnesium sulphate, calcium silicate, and strontium acetate.

Further Reading:

Addy M. Dentine hypersensitivity: new perspectives on an old problem. Int Dent J 2002;5:367–75.Canadian Advisory Board on Dentine Hypersensitivity. Consensus based recommendations for the diagnosis and management of dentine hypersensitivity. J Can Dent Assoc 2003;69(4):221–6.

Treatment strategies for dentine hypersensitivity

Treatment strategies for dentine hypersensitivity

Level 1

Treatment applied at home by the patient:

• oral hygiene instruction and dietary advice

• home use of fluoride gels/mouth rinses

• anti-hypersensitivity toothpastes

Level 2

In-office treatment to occlude the tubules:

• gels, varnishes, iontophoresis

• primers containing hydroxyethyl methacrylate (HEMA)

Level 3

In-office treatment to occlude and seal the tubules:

• *glass ionomer and adhesive resin systems

In-office treatment

1A Varnishes and precipitants

Shellacs

5% sodium fluoride varnish

0.4% stannous fluoride, 0.14% hydrofluoric acid solutions

3% mono-potassium-monohydrogen oxalate

6% acid ferric oxalate

calcium phosphate preparations

calcium hydroxide

1B Primers containing hydroxyethyl methacrylate (HEMA)

5% gluteraldehyde35% HEMA in water

2 Treatment agents that undergo setting or polymerization reactions

Conventional glass ionomer cementsResin-reinforced glass ionomers/compomers

Adhesive resin primers

Adhesive resin bonding systems

3 Use of mouth guards with various gels

4 Iontophoresis

5 Lasers

Pashley D. H., Potential treatment modalities for dentine hypersensitivity: in-office products. In Tooth wear and sensitivity: Clinical Advances in Restorative Dentistry, ed. Addy, Embry, Edgar, Orchardson, 2000, London: Martin Dunnitz; 351–365.

Subjects: Dentistry.


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