Understanding Dentinal Hypersensitivity : Causes, Symptoms and Effective Solutions.

Dentinal hypersensitivity, also commonly called tooth sensitivity is a short, sharp pain arising from exposed dentin in response to stimuli typically thermal, evaporative, tactile, osmotic or chemical which cannot be ascribed to any other form of dental defect or pathology.

Clinical Features:

• It is one of the most encountered dental problem.
• Intensity of pain varies from mild discomfort to severe sensitivity.
• Pain is rapid in onset, sharp in character and short in duration.
• External stimuli may elicit the expression.

ü  Thermal stimuli

o   Hot/cold food and beverages

o   cold blast of air

ü  Osmotic stimuli –

o   Sweet food

ü  Acidic stimuli –

o   Citrus fruits (Orange, lemon)

o   acidic beverages 

o   medicines

ü  mechanical stimuli –

o   Toothbrush ( vigorous toothbrushing )

o   dental instruments

Predisposing factors/ Etiology:

1. Loss of enamel
2. attrition
3. abrasion 
4. erosion
5. abfraction
6. gingival recession
7. periodontal problems
8. patient habits
9. tooth malposition 

Enamel is the upper layer of teeth protecting the dentin which avoids sensitivity. Loss of this layer of enamel causes the dentin to get exposed. Dentin contains the dentinal tubules which carry the pain stimulus thus leading to dentinal hypersensitivity. Enamel loss can occur in various forms like attrition, abrasion, erosion, abfraction which causes the dentinal layer to get exposed to the oral cavity. 

Attrition is the loss of tooth structure due to tooth to tooth contact, such as grinding  of teeth. Abrasion is wearing off of tooth structure due to friction or mechanical process like vigorous tooth brushing. Dental erosion is the loss of the surface of your teeth due to acids you eat or drink, or acids coming up from your stomach.  Abfraction is the pathological loss of tooth substance caused by biomechanical loading forces that result in flexure and failure of enamel and dentin at a location away from the loading.

Treatments strategies:

1.     Potassium nitrate desensitization- Using a toothpaste containing 5% potassium nitrate daily for 4 weeks can be an effective way to desensitize dentin

Recent advances -

2.     Arginine- Arginine is being incorporated in a number of recently developed toothpastes (Colgate Sensitive Pro-Relief) The combination of arginine with calcium carbonate and phosphate results in precipitate formation on open dentinal tubules

-        Arginine in office paste(8%)

-        Arginine mouthwash (0.8%)

 

3.     Calcium sodium phosphosilicate - NovaMin is the trade name of calcium sodium phosphosilicate bioactive glass. It acts by occlusion of dentinal tubules by precipitating calcium and phosphate. It is available in the form of toothpaste (5%CSPS) and prophylaxis paste (15%CSPS) eg. Sensodyne Repair and protect

 

4.     Fluorides  - They decrease the dentinal permeability by precipitating calcium fluoride       crystals inside the dentinal tubules. they are used in the form of 2% sodium fluoride or 0.4% stannous fluoride.

 

5.     Crown placement

6.     Periodontal Grafting

7.     lasers