CC Hypersensitivity

Additional Tests Saliva Testing

- Figure out possible cause if
haven’t done already
Pt Education
Informed Consent
Emergency and Stabilisation Phase
- Relief of pain
Disease Control and Prevention
Phase
Immediate Rehabilitation Phase
Diet diary
Inform consent gained for
Any material which blocks dentinal tubules will cause immediate
relief
Use: unfilled resin, G-bond, G Bond Plus, DnF (precipirates over
dentinal tubules)
- Find out cause of erosion
- Change behaviour of patient regards to diet (decrease
acidic consumption)/OHI
- Perhaps thorough MHx about medications
- Re-establish biofilm and saliva by encouraging drinking
through straw, Recaldent gum to stimulate saliva
- Can choose to put Remineralising product over erosion
lesion however  if pH drops below critical then there is
no use of doing this

Short Term Review 3 months check

Complex Rehabilitaion Phase once
disease has been stabilised

Long Term Review

Erosion
- Loss of dental hard tissue by a chemical process involving no bacteria

Erosion Mechanism
- Acid displaces saliva
- Dissolves the biofilm (if bombard with acid)
- Creates unsaturated conditions which causes immediate dissolution to tooth surfaces
- Ca and PO4 come out from tooth structure and swallowed
- OPEN system

Dentine Hypersensitivity = exposed dentine tubules which cause pain/sensitivity

Hydrodynamic Theory:
- Increased acid conditions will remove dentine SMEAR LAYER
- LEADS TO OPEN DENTINAL TUBULES
- Dentine is live tissue  live tissue with odontoblastic processes and nerve fibre
- Changes in temperature, hydration, osmolarity (sweet foods) will cause dentinal fluid to flow into
open dentinal tubules and cause pain

Appearance:
- Scooped out lesion
 - Clean, shiny, glazed look
- Acid takes away biofilm and staining

What causes scooping appearance?

- When dentine is exposed is becomes ‘scooped’  this is because dentine is less mineralised than
enamel and therefore dissolves faster

EXPOSED DENTINE AND OPEN DENTINAL TUBULES  sensitivity will indicate active erosion

- Tooth loses vertical structure immediately  ends of enamel rods are damaged
- Remin? Good saliva, F, CPP-ACPF will cause remin but if there is another acid attach (pH<4.5) then
saliva just completely dissolves again
- Therefore, place barrier over tooth surface.

Different to WSL!!!! HOW?

- In WSL we have subsurface demin and change in refractive index

What is Subsurface demin?

- Raw products from deeper in the enamel rod will be released during demineralisation by acid. Ions
deeper may not have a change to come out to the enamel surface, and instead remineralise higher
up on the enamel rod. This leaves demineralisation below the subsurface.

Clinical Approach to Erosion (MI)

- Is erosion present? Is it active?

ACTIVE = OUCH
- Sensitive = active erosion
- Staining = not active
- Longitudinal observations  for example, amalgam may be present on tooth which was initially
flush with margins but over time, tooth structure was eroded and so amalgam will now appear
‘high’

Intrinsic source of acid:

GORD, recurrent vomiting

Extrinsic = diet, medications, environment (occupation)

Management of Erosion:
- Get rid of the cause
- Re-establish biofilm
- Netrualise the acid
- Remin products  provided that next acid attack will not be under critical pH
- Use straws for fluid consumption
- Increase salivary flow
- Protectice covering over teeth  NOT as restorations