Conservative Dentistry And Endodontics

DENTIN HYPERSENSITIVITY

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DENTIN HYPERSENSITIVITY :It is characterized by short , sharp pain arising from exposed dentin in response to stimuli typically thermal , chemical, osmotic, evaporative, tactile and which cannot be ascribed to any other form of dental defect or pathology.

ETIOLOGY :

ENAMEL LOSS :

  • Occlusal wear
  • Toothbrush abrasion
  • Dietary erosion
  • Abfraction
  • Parafunctional habits

CEMENTAL LOSS:

  • Gingival recession
  • Periodontal disease
  • Root planing
  • Periodontal surgery

DEVELOPMENT OF DENTIN HYPERSENSITIVITY

There are two phases in the devlopment of dentin hypersensitivity .

  1. LESION LOCALISATION : This requires exposure of dentin .Lesion localisation occurs by gingival recession , abrasion , erosion , etc.
  2. LESION IRRITATION: This requires removal of the cementum or smear layers . This occurs due to periodontal procedures or by the action of abrasive or erosive agents.

Several theories have been put forward to explain the dentin hypersensitivity.

  1. Direct nerve innervation theory
  2. Odontoblast deformation theory / transducer phenomenon
  3. Hydrodynamic theory : most accepted theory .

CLINICAL FEATURES:

  1. Pain : short, sharp , rapid in response to external stimuli
  2. Pain may emanate to single or multiple tooth.
  3. Intensity of pain may range from mild to moderate .
  4. presence of gingival recession / cemental loss.
  5. The clinical symptoms are similar tot hat of acute reversible pulpitis .
  6. Most commonly affected teeth : buccal surfaces of premolars and facial surfaces of incisors.

DIAGNOSIS :

CASE HISTORY :

  1. The history and nature of pain
  2. The number and location of sensitive teeth.
  3. The intensity of pain.
  4. The stimuli which initiate the pain
  5. The frequency and duration of pain.

CLINICAL EXAMINATION :

  1. Evidence of dentin exposure ( gingival recession, loss of enamel )
  2. Sensitivity or pain on tactile examination of the suspected teeth .
  3. Percussion sensitivity
  4. Pain lingering after the stimulus is removed .
  5. Vitality tests .
  6. Radio-graphic examination .
  7. Signs of fracture , leaky or poor restorations.

PREVENTION :

  1. Diet counselling
  2. Correction of brushing techniques .
  3. Care during operative procedures.
  4. Care during periodontal procedures like scaling and root planing .

MANAGEMENT :

DESENSITIZATION BY OCCLUDING DENTINAL TUBULES :

  1. Formation of smear layer over exposed dentin
  2. Use of topical agents to occlude the exposed dentinal tubules: calcium hydroxide paste, silver nitrate, fluorides, potassium oxalate, varnishes , dentin adhesives.
  3. Placement of restorations: GIC and composite resins.
  4. Use of lasers :CO2 lasers , Nd: YAG, Er:YAG lasers

DESENSITIZATION BY BLOCKING PULPAL SENSORY NERVES

  1. POTASSIUM NITRATE TOOTHPASTES.: Potassium ions can easily pass through dentin to pulp , here they block the depolarization of the sensory nerve endings present close to the odontoblasts , thus preventing the transmission of impulses to the brain .

REFERENCE: STURDEVANTS 7TH EDITION

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