ORIGINAL ARTICLE

Prevalence of dentin hypersensitivity

after orthodontic treatment:
A cross-sectional study
Ana Cla
udia Dalmolin, Bruna Caroline Finkler, Camila Vieira Almeida, Laura Borato Bechtold, Kellen Rutes Silva,
Gabrielle Gomes Centenaro, Ulisses Coelho, Ma
rcia Tha
ıs Pochapski, and Fa

bio Andre

dos Santos
Ponta Grossa, Paran
a, Brazil

Introduction: The prevalence of cervical dentin hypersensitivity in patients after corrective orthodontic treat-
ment has been poorly studied, although such hypersensitivity is very common. This study aimed to assess
the prevalence of dentin hypersensitivity in patients who received corrective orthodontic treatment, the impact
of general oral problems on quality of life, and the impact of hypersensitivity on the quality of life of this population.
Methods: This observational, cross-sectional study evaluated 232 patients who finished orthodontic treatment
between 2000 and 2020 for self-reported hypersensitivity and clinically diagnosed hypersensitivity. The following
tests were used: tactile, evaporative (bellows), evaporative (triple syringe), and thermal. The patients were also
evaluated regarding their quality of life using questionnaires (Oral Health Impact Profile-14 and Dentine
Hypersensitivity Experience Questionnaire). We evaluated data with nonparametric statistics. Results: The
prevalence of hypersensitivity was higher in women and in those aged \30 years; the most affected teeth
were the mandibular incisors and premolars; different diagnostic tests for hypersensitivity may indicate different
prevalence values; patients with hypersensitivity had a lower quality of life in most of the domains of both of the
tests that were used. Conclusions: The prevalence of hypersensitivity among patients after orthodontic treat-
ment may be higher than in the general population. Further investigation is needed to indicate the possible fac-
tors associated with orthodontic tooth movement. (Am J Orthod Dentofacial Orthop 2023;164:431-40)

T
he pain generated during orthodontic treatment
has been widely studied.1-4 However, few studies
have evaluated dental pain after removing
orthodontic devices.5,6
Gingival recession, bone dehiscence, and bone loss
are problems that have been investigated as possible
side effects of corrective orthodontic treatment.7,8
Gingival recession is positively correlated with cervical
dentin hypersensitivity.9 Cervical dentin hypersensitivity
is a painful condition that occurs with common stimuli
(such as chemical, osmotic, tactile, evaporative, and/or
thermal stimuli)10 when the dentinal tubules are exposed
From the Department of Dentistry, School of Dentistry, State University of Ponta
Grossa, Ponta Grossa, Paran
a, Brazil.
All authors have completed and submitted the ICMJE Form for Disclosure of Po-
tential Conflicts of Interest, and none were reported.
This work was partially supported by the Coordenaç~ao de Aperfeiçoamento de
Pessoal de N
ıvel Superior, Brasil, Finance Code 001.
Address correspondence to: F
abio Andr
e dos Santos, Department of Dentistry,
School of Dentistry, State University of Ponta Grossa, Carlos Cavalcanti Ave,
4748, M-13, Uvaranas, Ponta Grossa, Paran
a, Brazil 84030-900; e-mail,
fasantos@uepg.com.
Submitted, November 2022; revised and accepted, February 2023.
0889-5406/$36.00
Ó 2023 by the American Association of Orthodontists. All rights reserved.
https://doi.org/10.1016/j.ajodo.2023.02.018
to the oral environment11 because of enamel loss
(erosive and/or abrasive processes), or damage to the pe-
riodontium components (gingival recession and attach-
ment loss).12 The cervical dentin hypersensitivity
mechanism of action is explained by the hydrodynamic
theory,12 which argues that stimuli cause the movement
of fluids to present inside the dentinal tubules, gener-
ating mechanical forces capable of activating intradental
nerve endings, which leads to the pain process.13,14
The diagnosis of cervical dentin hypersensitivity is
performed by excluding other pain-causing dental pa-
thologies such as dental caries, postoperative sensitivity,
marginal infiltration, fractured restorations, gingival
inflammation, and pulpitis.10,15,16 Although there is no
universally accepted guide to the diagnosis of cervical
dentin hypersensitivity,17 the most used methods are
the visual and tactile inspection of gingival recession
and erosion in enamel and dentin,17 and the confirma-
tion of acute and short-term pain by stimulation (ie,
use of an air jet, tactile stimulation with a periodontal
probe scratching the tooth surface,10,16,17 or thermal
stimuli are also used).11
Cervical dentin hypersensitivity is associated with a
negative impact on quality of life,4 whereas orthodontic
431

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432
treatment positively impacts patients’ quality of life.18
However, no studies indicate the prevalence of dentin
hypersensitivity in patients after orthodontic treatment
or studies that evaluate the impact of dentin hypersen-
sitivity on the quality of life of patients after corrective
orthodontic treatment. Thus, this study intended to
evaluate the prevalence of cervical dentin hypersensitiv-
ity, the impact of general oral problems on the quality of
life, and the impact of dentin hypersensitivity on the
quality of life of patients who received corrective ortho-
dontic treatment.
MATERIAL AND METHODS
This observational, cross-sectional study was
approved by the Research Ethics Committee (no.
3231565); it complied with the Declaration of Helsinki,
and free and informed consent was obtained from the
study volunteers. The study followed the STROBE
(STrengthening the Reporting of OBservational studies
in Epidemiology) guidelines. The sample size calculation
was based on the prevalence of gingival recession after
orthodontic treatment (14.6%),8 because we did not
find studies that evaluated cervical dentin hypersensitiv-
ity after orthodontic treatment, and gingival recession is
strongly correlated with cervical dentin hypersensitiv-
ity.9,19 Thus, the sample size obtained was 192 volun-
teers. Considering losses in follow-up, the sample size
was increased by 20% (39 patients); thus, it was esti-
mated that a sample size of 231 volunteers (Fig 1) was
needed to have a confidence level of 95% with a margin
of error of 5%.20
The study was conducted with patients who
completed corrective orthodontic treatment between
2000 and 2020 in 2 graduate schools in Southern Brazil.
We contacted 379 patients, and 237 agreed to partici-
pate in the research.
The patients were interviewed (between 2019 and
2020) regarding their age, education, family income,
length of time using an orthodontic appliance, the
type of toothpaste they used, and self-reporting
regarding the presence of dentin hypersensitivity. Sub-
jects who responded positively to tooth hypersensitivity
(n 5 153) were assessed for subjective hypersensitivity
by asking them to indicate, using an 11-point numerical
rating scale, their self-perception regarding the pain
level because of dentin hypersensitivity experienced in
their daily lives. The Oral Health Impact Profile (OHIP-
14) and Dentin Hypersensitivity Experience Question-
naire (DHEQ-15) were applied. A clinical examination
was subsequently performed for gingival recession and
dentin hypersensitivity, which was assessed by 4
different parameters in the following sequence to avoid
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Dalmolin et al
bias: (1) tactile analysis, (2) evaporative analysis with
bellows, (3) evaporative analysis with a triple syringe,
and (4) thermal analysis (0.65
C 6 6.69
C).
Statistical analysis
The statistical analyses performed were: chi-square
(demographic and dichotomous data for hypersensitiv-
ity), Kruskal-Wallis test with Dunn’s post-hoc test
(numerical rating scale), and the Mann-Whitney U test
(assessment of the OHIP-14 and DHEQ-15 question-
naires). The P value that was considered statistically
significant was P #0.05.
RESULTS
A total of 232 patients were evaluated (5 volunteers
dropped out), of which 62% were women and 82%
were aged \30 years. The patients were aged 12-57
years; they used orthodontic appliances for 46 6 26
months (6-120 months); when they were evaluated,
they had removed the appliance 52 6 39 months previ-
ously (0-240 months). A total of 67% of participants
self-reported suffering from dentin hypersensitivity,
56% of the patients in the tactile test reported pain in
at least 1 tooth, 39% in the air jet test with bellows,
57% in the air jet test with a triple syringe, and 92% in
the thermal test.
In the chi-square analysis, a difference was observed
between genders in the tests using air jet (bellows and
triple syringe); in the age groups in the bellows test; in
the types of toothpaste in the tactile test; and the
absence and presence of recession in the bellows test.
No differences were observed between the levels of edu-
cation or between the levels of family income (Table I).
A total of 6,591 teeth were evaluated in the test with
tactile stimulation, of which 533 had sensitivity (an
average of 2.2 sensitive teeth per patient). In the test
with air jet stimulation with bellows, 6,249 teeth were
evaluated, of which 412 had sensitivity (an average of
1.7 sensitive teeth per patient). A total of 3,322 teeth
were assessed using the test with air jet stimulation
with a triple syringe, of which 319 had sensitivity (an
average of 1.3 sensitive teeth per patient). In the test
with thermal stimulation, 6,549 teeth were evaluated,
of which 3,050 had sensitivity (an average of 13.1 sensi-
tive teeth/patient). The teeth with the highest numerical
rating for scale values were the premolars and mandib-
ular incisors (Fig 2).
Of the 232 patients evaluated, 153 reported having
dentin hypersensitivity in their daily routine, 73 reported
not having hypersensitivity, and 6 did not answer this
question. All the patients answered the OHIP-14 and
DHEQ-15 questionnaires. In the analysis of the
American Journal of Orthodontics and Dentofacial Orthopedics
Dalmolin et al 433

Fig 1. Study flowchart.

OHIP-14, significant differences were identified by the These differences are shown in questions 3-9 of the
Mann-Whitney test between volunteers who reported OHIP-14, which belonged to the following domains:
pain for dentin hypersensitivity and those who did not. physical pain; psychological discomfort; physical

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434 Dalmolin et al

Table I. Prevalence of dentin hypersensitivity diagnosed in patients after orthodontic treatment using different tests
(n 5 232)
Self-reported dentin Triple syringe
hypersensitivity Tactile stimulation Bellows stimulation stimulation Thermal stimulation

P P P P
Variable No Yes value No Yes value No Yes P value No Yes value No Yes value
Gender 0.081 0.284 0.005* 0.045* 0.718
Male 34 (15) 52 (23) 43 (19) 45 (19) 59 (27) 22 (10) 24 (21) 20 (17) 8 (3) 80 (35)
Female 40 (18) 101 (44) 60 (26) 84 (36) 75 (34) 64 (29) 26 (22) 47 (40) 11 (5) 131 (57)
Total 74 (33) 153 (67) 103 (45) 129 (55) 134 (61) 86 (39) 50 (43) 67 (57) 19 (8) 211 (92)
Age 0.699 0.052 0.022* 0.502 0.847
\30 y 62 (27) 125 (55) 90 (39) 100 (43) 116 (53) 64 (29) 44 (38) 56 (48) 16 (7) 174 (76)
$30 y 12 (5) 28 (13) 13 (6) 29 (12) 18 (8) 22 (10) 6 (5) 11 (9) 3 (1) 37 (16)
Total 74 (32) 153 (68) 103 (45) 129 (55) 134 (61) 86 (39) 50 (43) 67 (57) 19 (8) 211 (92)
Education 0.116 0.212 0.821 0.105 0.096
Basic 27 (12) 40 (18) 35 (15) 36 (16) 24 (11) 39 (18) 18 (15) 15 (13) 9 (4) 61 (27)
College 47 (21) 112 (49) 93 (40) 67 (29) 62 (28) 94 (43) 32 (27) 52 (45) 10 (4) 149 (65)
Total 74 (33) 152 (67) 128 (55) 103 (45) 86 (39) 133 (61) 50 (42) 67 (58) 19 (8) 210 (92)
Family income 0.990 0.723 0.544 0.062 0.867
#2 min wages 14 (8) 29 (15) 26 (14) 18 (9) 14 (8) 25 (14) 7 (7) 19 (19) 3 (2) 41 (21)
.2 min wages 48 (25) 99 (52) 83 (43) 65 (34) 59 (32) 84 (46) 35 (35) 38 (39) 9 (5) 138 (72)
Total 62 (33) 128 (67) 109 (57) 83 (43) 73 (40) 109 (60) 42 (42) 57 (58) 12 (7) 179 (93)
Time using 0.964 0.160 0.731 0.396 0.683
orthodontic
appliance
#3 y 39 (18) 79 (37) 57 (26) 61 (28) 74 (35) 44 (20) 26 (24) 32 (30) 8 (4) 110 (51)
.3 y 33 (15) 66 (30) 38 (18) 60 (28) 58 (27) 38 (18) 18 (17) 31 (29) 8 (4) 89 (41)
Total 72 (33) 145 (67) 95 (44) 121 (56) 132 (62) 82 (38) 44 (41) 63 (59) 16 (8) 199 (92)
Toothpaste 0.114 0.010* 0.092 0.127 0.166
Conventional 67 (31) 125 (59) 86 (40) 104 (49) 117 (56) 67 (32) 39 (37) 52 (49) 14 (7) 174 (82)
Desensitizing 4 (2) 18 (8) 4 (2) 19 (9) 11 (6) 13 (6) 3 (3) 11 (11) 0 (0) 24 (11)
Total 71 (33) 143 (67) 90 (42) 123 (58) 128 (62) 80 (38) 42 (40) 63 (60) 14 (7) 198 (93)
Gingival recession 0.181 0.526 \0.010* 0.120 0.669
Absent 12 (6) 19 (9) 18 (9) 32 (16) 49 (25) 8 (4) 10 (9) 8 (8) 0 (0) 31 (15)
Present 46 (23) 125 (62) 62 (31) 89 (44) 65 (34) 71 (37) 32 (30) 57 (53) 1 (1) 170 (84)
Total 58 (29) 144 (71) 80 (40) 121 (60) 114 (59) 79 (41) 42 (39) 65 (61) 1 (1) 201 (99)
Note. The values are presented as n (%).
*Statistically significant difference determined with c2 test.

disability; and psychological disability. These differences
referred to situations such as having a painful aching in
the mouth, finding it uncomfortable to eat any food, be-
ing self-conscious, feeling tense, feeling that the diet
had been unsatisfactory, having to interrupt meals,
and finding it difficult to relax. The results of the
OHIP-14 indicated higher values for the questions above
in relation to the group that self-reported dentin hyper-
sensitivity, demonstrating a more significant impact of
these situations on quality of life (Table II). In the anal-
ysis of the DHEQ-15 questionnaire, the Mann-Whitney
test showed significant differences between patients
who reported pain for dentin hypersensitivity and those
who reported not having pain. These differences
occurred for all questions, except for question 9 (going
to the dentist) in the social impact domain, and for ques-
tions 13 (feeling old) and 15 (feeling sick), both in the
identity domain. In all the questions of the DHEQ-15,
the volunteers who reported pain had higher values
than those who did not, indicating an impact of dentin
hypersensitivity on quality of life (Table III).
DISCUSSION
In our study, the prevalence of dentin hypersensitiv-
ity in patients who received orthodontic treatment was
between 39% and 91%, considering self-reported dentin
hypersensitivity and dentin hypersensitivity assessed by
the tactile, bellows, triple syringe, and thermal tests.
Although variability regarding prevalence was observed
between the different tests (self-reported, tactile, bel-
lows, triple syringe, and thermal tests), similar sample
behavior was observed for the parameters analyzed in
our research. Most people who self-reported dentin hy-
persensitivity and who showed dentin hypersensitivity

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Dalmolin et al 435

Fig 2. Mean 6 standard error of the mean of the numerical rating scale values for each maxillary and
mandibular tooth (FDI World Dental Federation nomenclature): A and B, Tactile stimulus; C and D,
Evaporative stimulus with bellows; E and F, Evaporative stimulus with a triple syringe; G and H,
Cold thermal stimulus.

with the tactile, bellows, triple syringe, and thermal tests
were women, were aged \30 years, had completed col-
lege (or were attending college), had a family income
higher than 2 minimum wages, had worn braces
for #3 years, used conventional toothpaste and had
gingival recession. Although the sample had similar
behavior for the analyzed tests, the prevalence results
showed heterogeneity. The prevalence for the self-
reported, tactile, bellows, triple syringe, and thermal
tests were, respectively: 67%, 55%, 39%, 57%, and
92%. Heterogeneity between different studies can be
observed in the literature, with prevalence variability
for dentin hypersensitivity ranging from 1.3% to
92.1%. Meta-analysis showed that the average from
the evaluated studies was 33.5%, and the best estimate
was 11.5% for dentin hypersensitivity prevalence.16 The
prevalence in our study showed values higher than the
mean or best estimate values found in the literature.16
This result may indicate that dentin hypersensitivity
was higher among the population that underwent
corrective orthodontic treatment than the general popu-
lation. Our study is the first to evaluate the prevalence of
dentin hypersensitivity in a sample of subjects after
corrective orthodontic treatment. Thus, further studies
are needed to verify how hypersensitivity occurs in sub-
jects after undergoing different orthodontic treatment
strategies.
The patients who received orthodontic treatment had
better oral health related to their quality of life than
those who did not.18 Dentin hypersensitivity is associ-
ated with the physical dimension of pain in the OHIP-
144, and the treatment of hypersensitivity is followed
by an improvement in quality of life.21 This study applied
the OHIP-14 and DHEQ-15 questionnaires to a specific

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436
Table II. OHIP-14 questionnaire responses from volunteers who self-reported pain or no pain when asked about dentin hypersensitivity in their daily routine
Frequency (%)
y
Mean 6 SD
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Question Pain Never (0) Hardly ever (1) Occasionally (2) Fairly often (3) Very often (4) Sum P value
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Functional limitation
1. Had trouble pronouncing any words Y 73.8 13.0 11.1 0.6 1.3 0.4 6 0.8 65 0.558
N 76.7 15.0 6.8 0.0 1.3 0.3 6 0.7 25
2. Felt sense of taste has worsened Y 86.0 5.9 7.9 0.0 0.0 0.2 6 0.5 33 0.991
N 84.9 12.3 2.7 0.0 0.0 0.1 6 0.4 13
Physical pain
3. Had painful aching Y 22.2 21.5 40.5 11.1 4.5 1.5 6 1.0 236 \0.001*
N 52.0 21.9 23.2 2.7 0.0 0.7 6 0.9 56
4. Found it uncomfortable to eat any foods Y 34.4 14.5 36.4 9.2 5.2 1.3 6 1.1 206 \0.001*
N 65.7 27.3 5.4 1.3 0.0 0.4 6 0.6 31
Psychological discomfort
5. Been self-conscious Y 23.6 15.7 31.5 13.8 13.1 1.7 6 1.3 263 \0.001*
N 53.4 10.9 20.5 5.4 9.5 1.0 6 1.3 78
6. Felt tense Y 54.3 12.5 17.8 9.9 5.2 0.9 6 1.2 150 0.005*
N 73.9 9.5 8.2 2.7 5.4 0.5 6 1.1 41
Physical disability
American Journal of Orthodontics and Dentofacial Orthopedics

7. Felt diet has been unsatisfactory Y 73.2 10.4 11.1 5.2 0.0 0.5 6 0.8 74 0.038*
N 84.9 9.5 2.7 2.7 0.0 0.2 6 0.6 17
8. Had to interrupt meals Y 79.7 11.7 7.8 0.6 0.0 0.2 6 0.6 45 0.018*
N 91.7 6.8 1.3 0.0 0.0 0.1 6 0.3 7
Psychological disability
9. Found it difficult to relax Y 64.7 13.7 15.6 3.9 1.9 0.6 6 1.0 99 0.005*
N 83.5 5.4 8.2 1.3 1.3 0.3 6 0.7 23
10. Been a bit embarrassed Y 71.7 13.8 7.8 1.9 4.6 0.5 6 1.0 82 0.281
N 79.1 8.3 5.5 4.1 2.7 0.4 6 0.9 31
Social disability
11. Been a bit irritable Y 84.3 3.9 7.1 2.6 1.9 0.3 6 0.8 52 0.989
N 83.5 6.8 6.8 2.7 0.0 0.2 6 0.7 21
12. Had difficulty doing usual jobs Y 79.7 7.8 9.1 1.9 1.3 0.3 6 0.8 57 0.180
N 86.3 9.5 2.7 1.3 0.0 0.1 6 0.5 14
Handicap
13. Felt life less satisfying Y 88.8 2.6 7.1 0.0 1.3 0.2 6 0.6 34 0.371
N 91.7 6.8 1.3 0.0 0.0 0.1 6 0.3 7
14. Been totally unable to function Y 94.7 2.6 1.9 0.0 0.6 0.1 6 0.4 14 0.931
N 94.5 4.1 0.0 1.3 0.0 0.1 6 0.3 6

Dalmolin et al
SD, standard deviation.
y
“Y” (ie, yes) indicates self-reported pain and “N” (ie, no) indicates no self-reported pain; *Statistically significant difference (Mann-Whitney test).
Dalmolin et al 437

Table III. DHEQ-15 questionnaire responses for volunteers who self-reported pain or no pain when asked about
dentin hypersensitivity in their daily routine
Questions Frequency (%)
y
Restrictions Pain 1 2 3 4 5 6 7 Mean 6 SD Sum P value
1. It takes pleasure out of eating and drinking Y 12.3 15.4 13.4 10.3 19.5 14.4 13.4 4.0 6 2.0 391 0.013*
N 33.3 22.2 5.5 11.1 5.5 16.6 5.5 3.0 6 2.0 110
2. It takes a long time to finish some foods and drinks Y 13.4 12.3 7.2 6.1 31.9 17.5 10.3 4.2 6 1.9 409 \0.001*
N 36.1 36.1 5.5 8.3 8.3 5.5 0.0 2.3 6 1.5 84
3. Problems eating ice cream Y 3.1 4.1 4.1 1.0 23.9 32.2 31.2 5.6 6 1.5 538 \0.001*
N 27.7 19.4 19.4 2.7 13.8 11.1 5.5 3.1 6 1.9 112
Coping
4. To change the way I eat or drink Y 10.3 9.2 8.2 13.4 20.6 22.6 14.4 4.4 6 1.9 434 \0.001*
N 42.8 28.5 5.7 8.5 8.5 5.7 0.0 2.2 6 1.5 80
5. To be careful how I breathe on a cold day Y 27.8 14.4 6.1 12.3 16.4 17.5 5.1 3.4 6 2.0 338 \0.001*
N 51.4 22.8 5.7 11.4 5.7 0.0 2.8 2.0 6 1.5 73
6. I make sure some foods do not touch certain teeth Y 15.4 17.5 7.2 7.2 15.4 24.7 11.3 4.0 6 0.1 394 \0.001*
N 52.7 27.7 2.7 5.5 8.3 2.7 0.0 1.9 6 1.4 71
7. I take longer than others to finish a meal Y 16.8 21.0 15.7 23.1 12.6 6.3 3.1 3.2 6 1.6 306 \0.001*
N 47.2 38.8 0.0 8.3 2.7 2.7 0.0 1.8 6 1.2 68
Social
8. I am careful what I eat when I am with others Y 27.8 29.8 12.3 17.5 3.0 6.1 2.0 2.6 6 1.6 254 0.003*
N 52.7 33.3 0.0 11.1 0.0 2.7 0.0 1.8 6 1.1 65
9. Going to the dentist is hard for me Y 38.1 22.6 6.1 10.3 11.3 5.1 5.1 2.6 6 1.9 259 0.489
N 36.1 41.6 2.7 5.5 11.1 0.0 2.7 2.2 6 1.5 81
Emotions
10. I have been anxious about something I eat or drink Y 19.5 24.7 9.2 13.4 16.4 10.3 5.1 3.3 6 1.9 321 \0.001*
N 44.4 38.8 5.5 5.5 2.7 2.7 0.0 1.9 6 1.2 69
11. The sensations in my teeth have been irritating Y 8.2 12.3 11.3 7.2 25.7 17.5 16.4 4.4 6 1.9 432 \0.001*
N 48.6 35.1 2.7 5.4 5.4 2.7 00 1.9 6 1.2 71
12. The sensations in my teeth have been annoying Y 26.8 22.6 14.4 14.4 10.3 6.1 4.1 2.9 6 1.7 282 \0.001*
N 63.8 27.7 0.0 5.5 0.0 2.7 0.0 1.5 6 1.0 57
Identity
13. Feeling old Y 50.5 30.9 2.0 8.2 3.0 1.0 3.0 1.9 6 1.4 189 0.446
N 61.1 25.0 8.3 5.5 0.0 0.0 0.0 1.5 6 0.8 57
14. Feeling damaged Y 28.8 18.5 6.1 9.2 13.4 15.4 7.2 3.3 6 2.1 322 0.003*
N 47.2 30.5 11.1 5.5 2.7 0.0 2.7 1.9 6 1.3 71
15. Feeling as though I am unhealthy Y 44.3 30.9 5.1 9.2 7.2 1.0 1.0 2.0 6 1.4 202 0.170
N 55.5 38.8 0.0 5.5 0.0 0.0 0.0 1.5 6 0.7 56
SD, standard deviation.
y
“Y” (ie, yes) indicates self-reported pain and “N” (ie, no) indicates no self-reported pain; *Statistically significant difference (Mann-Whitney test).

sample of patients who underwent orthodontic treat-
ment and reported dentin hypersensitivity.21 Although
orthodontic treatment generates positive results in rela-
tion to the quality of life, the results of our study showed
that this sample of patients tended to answer the OHIP-
14 questionnaire considering aspects other than the or-
thodontic treatment itself, with negative consequences
for the quality of life in terms of the physical pain, phys-
ical disability, and psychological disability domains.
The oral condition of hypersensitive teeth is associ-
ated with bad oral health related to the quality of
life.22 We did not find published studies that evaluated
the quality of life related to dentin hypersensitivity in
the specific sample of patients that used braces. In our
research, in the responses to the DHEQ-15, patients
who self-reported hypersensitivity had a lower quality
of life in relation to all domains (ie, functional restric-
tions, adaptation, social impact, emotions, and identity).
These results confirmed what was observed in the OHIP-
14 questionnaire; patients who underwent corrective
orthodontic treatment and who presented dentin hyper-
sensitivity had a lower quality of life.
According to the current literature, the pain level pro-
duced by dentin hypersensitivity after removing ortho-
dontic devices returns to normal within 7 days.5
However, our study demonstrated that patients self-
reported dentin hypersensitivity and had different pain
levels in other teeth for various diagnostic tests when
evaluated for dentin hypersensitivity in periods longer
than 7 days. Considering the sample size (n 5 232)
makes it possible to observe a certain biological vari-
ability among patients and that the period analyzed by

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438
the participants ranged from 0 to 240 months after
braces removal, we can infer that the observed dentin
hypersensitivity may have resulted not only from the
use of braces but also from other factors that may
have occurred after orthodontic treatment. These factors
would not necessarily be associated with the use of
braces, but they are associated with dentin hypersensi-
tivity, as demonstrated in the literature, such as enamel
attrition and erosion, corrosion, abrasion and abfraction,
periodontal tissue loss, and gingival recession.17 The
response to a given stimulus varies from person to per-
son. Individual factors, such as emotional, psychological,
and cultural issues, are difficult to assess in research or
clinical situations.23 Furthermore, a patient’s description
of discomfort may not result in a reliable diagnosis.23
Therefore, various diagnostic tests are used to minimize
the risk of bias concerning the significant number of in-
dividual aspects that might influence the subjective
element of pain. Because the response to pain stimuli
varies according to individual factors, the diagnostic
tests used vary among clinicians. There is no consensus
regarding the best diagnostic tools for dentin hypersen-
sitivity. The literature recommends using more than 1
test to diagnose dentin hypersensitivity correctly.12
Tactile stimulus is less invasive than other methods,
such as evaporative stimulus.12 Evaporative stimulus is
frequently used in clinical studies and is a practical test
for dentin hypersensitivity diagnosis.12 Thermal stimulus
(cold) causes a more significant pain response than other
tests, and the literature does not recommend this test.12
Our results demonstrated greater pain levels with cold
stimulus, which agrees with the literature. To effectively
monitor and rapidly analyze pain response, tools that
assess pain intensity, such as visual analog scales or nu-
merical rating scales, are frequently used in clinical trials
and are recommended in the literature.12,24
Oral health–related quality of life relates to how pa-
tients perceive how their oral condition impacts their
quality of life.25 In our study, we used an instrument to
assess the impact of oral health on quality of life
(OHIP-14) and another to verify the influence of dentin
hypersensitivity on quality of life (DHEQ-15). Both the
OHIP-14 and DHEQ-15 have been used in several clinical
trials and observational studies. They have been used to
demonstrate sensitivity to assess variations in the quality
of life, depending on which treatment for dentin hyper-
sensitivity was used.4 The OHIP-14 is the most used
self-response tool in research; it has empirical and con-
ceptual bases for its use and evaluates physical, social,
and psychological aspects.21 Dentin hypersensitivity can
impact everyday activities, such as eating, drinking, social
interactions, and emotional and/or identity issues.25 The
DHEQ-15 is an instrument that can be specifically used to
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Dalmolin et al
demonstrate the consequences of dentin hypersensitivity
on quality of life, without the influence of other condi-
tions,25 which directly complements results obtained by
the OHIP-14 related to the problem of dentin hypersen-
sitivity investigated in this study.
Our study is the first to discuss the prevalence of
dentin hypersensitivity in patients who underwent or-
thodontic treatment. We used the OHIP-14 and
DHEQ-15 questionnaires to determine the impact of
dentin hypersensitivity on the quality of life in these pa-
tients. However, our study does have some limitations.
The limitations of this study include the fact that the
sample was selected through convenience sampling and
only included patients who had completed orthodontic
treatment at 2 graduate schools in the same city. In addi-
tion, the time spent in orthodontic treatment (46 6 26
months; range, 6-120 months) is long, making it diffi-
cult to generalize the results to populations in which or-
thodontic treatment is shorter than reported in this
study. Furthermore, the study design did not provide
preorthodontic and postorthodontic treatment analyses
to verify, for example, the inclination of the teeth and
the presence of bone dehiscence; nor did it provide an-
alyses of the existence of dentin hypersensitivities etio-
logic factors, such as abrasion and erosion. Evaluated
patients completed orthodontic treatment between
2000 and 2020, a relatively long period. During this
time, for some patients, especially those who completed
orthodontic treatment longer ago, cervical dentin hyper-
sensitivity may have arisen because of other factors such
as dental abrasion and/or erosion.7,8,12 However, pa-
tients who received prolonged orthodontic treatment
may have experienced effects from periodontal factors
such as gingival recession,7,8 may have increased dentin
hypersensitivity not caused by the braces but rather by
the prolonged use of them. In addition, this study did
not investigate whether subjects had a history of dentin
hypersensitivity before starting orthodontic treatment. A
prospective study evaluating patients before and after
orthodontic treatment could determine if recessions re-
sulted from the treatment and if they led to cervical
dentin hypersensitivity. Further studies are required to
identify whether there is an association between previ-
ous orthodontic treatment and cervical dentin hypersen-
sitivity, as well as the factors to be investigated, such as
the positioning of the incisors concerning the bone base
and buccal tooth inclination; the identification of
possible bone loss with dehiscence (with computed to-
mography scan analysis); the identification and classifi-
cation of noncarious cervical lesions; the investigation
of the presence of abrasive factors such as types of
toothbrush bristles and brushing strength; and erosive
factors such as an acidic diet. In the case of a prospective
American Journal of Orthodontics and Dentofacial Orthopedics
Dalmolin et al
study, clarifying these factors before and after
orthodontic treatment may help to show the true
relationship between orthodontic treatment and dentin
hypersensitivity.
For practical applications, orthodontists should be
careful when promoting the movement of the teeth to-
ward the buccal bone plate. They should also consider
that dentin hypersensitivity may be a consequence of or-
thodontic treatment that can negatively impact the pa-
tient’s quality of life. Clinicians should pay attention
when choosing the diagnostic method to detect cervical
dentin hypersensitivity in patients because the preva-
lence results in our study showed some variability be-
tween the different diagnostic procedures. Searching
for diagnostic protocols that are easy to apply in clinical
practice and viable in research is essential. In addition,
further investigations are required to confirm whether
the incidence of dentin hypersensitivity is higher in the
postcorrective orthodontic treatment population than
in the general population.
CONCLUSIONS
The prevalence of dentin hypersensitivity in patients
after orthodontic treatment is high among young
women. Gingival recession is associated with dentin hy-
persensitivity after orthodontic treatment; however, it is
low among patients who use desensitizing toothpaste.
After orthodontic treatment, general oral conditions
and dentin hypersensitivity negatively impact on pa-
tient’s quality of life.
ACKNOWLEDGMENTS
The authors thank Dr Sean J. Stroud for reading this
manuscript and offering his valuable comments. This
study was partially supported by the Coordenaç~ao de
Aperfeiçoamento de Pessoal de N
ıvel Superior, Brasil
(CAPES) - Finance Code 001.
AUTHOR CREDIT STATEMENT
Ana Cl
audia Dalmolin contributed to conceptualiza-
tion, methodology, validation, formal analysis, investiga-
tion, resources, data curation, original draft preparation,
and visualization; Bruna Caroline Finkler contributed to
validation, investigation, visualization, and original draft
preparation; Camila Vieira Almeida contributed to valida-
tion, investigation, visualization, and original draft
preparation; Laura Borato Bechtold contributed to
validation, investigation, visualization, and original draft
preparation; Kellen Rutes Silva contributed to validation,
investigation, visualization, and original draft prepara-
tion; Gabrielle Gomes Centenaro contributed to valida-
tion, investigation, visualization, and original draft
American Journal of Orthodontics and Dentofacial Orthopedics
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439
preparation; Ulisses Coelho contributed to conceptualiza-
tion, funding acquisition, resources, manuscript review
and editing, and supervision; M
arcia Tha
ıs Pochapski
contributed to conceptualization, methodology, original
draft preparation, manuscript review and editing, and su-
pervision; F
abio Andr
e dos Santos contributed to concep-
tualization, methodology, formal analysis, resources, data
curation, manuscript review and editing, supervision,
project administration, and funding acquisition.
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September 2023  Vol 164  Issue 3 American Journal of Orthodontics and Dentofacial Orthopedics
Descargado para Anonymous User (n/a) en Pontifical Xavierian University de ClinicalKey.es por Elsevier en febrero 21, 2024. Para uso
personal exclusivamente. No se permiten otros usos sin autorización. Copyright ©2024. Elsevier Inc. Todos los derechos reservados.