DENTIN

HYPERSENSITIVITY
THIS IS TEST
 CONTENTS

DEFINITION
ETIOLOGY
THEORIES OF DENTIN HYPERSENSITIVITY
CLINICAL FEATURES
DIOGNOSIS
TREATMENT
DEFINITION

THE INTERNATIONAL WORKSHOP ON DENTIN

HYPERSENSITIVITY(1983) HAS PROPOSED THE
FOLLOWING DEFINITION FOR THIS CONDITION:
IT IS CHARACTERISED BY SHORT,SHARP
PAIN ARISING FROM EXPOSED DENTIN IN
RESPONSE TO STIMULI TYPICALLY
THERMAL,EVAPORATIVE,TACTILE,OSMOTIC
OR CHEMICAL AND WHICH CANNOT BE
ASCRIBED TO ANY OTHER FORM OF
DENTAL DEFECT OR PATHOLOGY
ORAL ANATOMY AND
DENTAL TISSUES
 ETIOLOGY
ENAMEL LOSS CEMENTAL LOSS
OCCLUSAL WEAR GINGIVAL RECESSION
TOOTH BRUSH ABRASION PERIODONTAL DISEASE
DIETARY EROSION ROOT PLANING
ABFRACTION PERODONTAL SURGERY
PARAFUNCTIONAL HABITS
GINGIVAL RECESSION
 ETIOLOGY

ABFRACTION TOOTH BRUSH

ABRASION
THEORIES OF DENTIN HYPERSENSITIVITY

1.DIRECT INNERVATION THEORY

2.ODONTOBLAST DEFORMATION
THEORY/TRANSDUCER
THEORY
3.HYDRODYNAMIC THEORY
DIRECT INNERVATION
THEORY

FIRST THEORY TO BE
PUT FORWARD
NERVE FIBERS
PRESENT WITHIN
DENTINAL TUBULES
INTIATE IMPULSES
WHEN THEY ARE
INJURED AND CAUSES
DENTINAL
HYPERSENSITIVITY.
 DIRECT INNERVATION THEORY

DISPUTES ABOUT THIS THEORY:

NERVE FIBERS ARE PRESENT ONLY IN
THE PREDENTIN AND INNER DENTINAL
ZONES
WHEN PAIN INDUCING SUBSTANCES
LIKE POTTASIUM
CHLORIDE,ACETYLCHOLINE ARE
APPLIED TO EXPOSED DENTIN,THEY FAIL
TO ELICIT PAINFUL RESPONSE.
 ODONTOBLAST DEFORMATION THEORY

ODONTOBLAST OR THEIR PROCESSES ARE

DAMAGED WHEN EXTERNAL STIMULI ARE APPLIED
TO EXPOSED DENTIN.
THEY CONDUCT IMPULSES TO THE NERVES IN THE
PREDENTIN AND UNDERLYING PULP AND THEN TO
CNS.
DISFAVOURED AS THE ODONTOBLASTIC
PROCESSES EXTEND ONLY PARTLY THROUGH
THE DENTIN AND NOT UPTO DEJ.
ODONTOBLASTIC MEMBRANE POTENTIAL IS TOO
LOW TO PERMIT TRANSDUCTION.
THERE ARE NO DEMONSTRABLE
NEUROTRANSMITTERS IN THE NEURAL
TRANSMISSION OF THE PULP.
HYDRODYNAMIC THEORY

THE MOST WIDELY ACCEPTED

MECHANISM OF ACTION OF
DENTIN HYPERSENSITIVTY ,
THE HYDRODYNAMIC THEORY
WHICH WAS PROPOSED BY GYSI
IN 1900 AND VALIDATED BY
BRANNSTROM IN 1996
 MECHANISM:

WHENEVER DENTIN IS
EXPOSED AND STIMULATED BY
TACTILE,CHEMICAL,THERMAL
OR OSMOTIC STIMULI THERE
IS RAPID MOVEMENT OF FLUID
THROUGH TUBULES.
THIS CAUSES:
DIRECT STIMULATION OF
LOW THRESHOLD A- DELTA
NERVE FIBERS
INDIRECT STIMULATION OF
A-DELTA NERVE FIBERS IN
PULP BY DISPLACING
ODONTOBLASTIC CELL
BODIES.
MECHANISM
 DIAGNOSIS

COMPLETE CLINICAL RADIOGRAPHIC

HISTORY EXAMINATION EXAMINATION
SIGNS AND VISUAL ASSESMENT RULE OUT PERI
SYMPTOMS APICAL LESION
INTENSITY PHYSICAL
ASSESMENT
FREQUENCY AND DEPTH OF
DURATION PERIODONTAL
POCKET DEPTH
DIETARY CHANGES PERCUSSION
TESTING
RESPONSE TO COLD
AIR
 DIFFERENTIAL
DIAGNOSIS

1. FRACTURED RESTORATIONS
2. FRACTURED ENAMEL EXPOSING
DENTIN
3. DENTAL CARIES
4. POST RESTORATION SENSITIVITY
5. CRACKED TOOTH SYNDROME
6. BLEACHING SENSITIVITY
 PREVENTION

1. DIET COUNSELLING REGARDING

CONSUMPTION OF ACIDIC FRUITS AND
BEVERAGES
2. CORRECTION OF BRUSHING
TECHNIQUE
3. CARE DURING OPERATIVE
PROCEDURES
4. CARE DURING PERIODONTAL
PROCEDURES
 MANAGEMENT
1. DESENSITISATION BY OCCLUDING DENTINAL
TUBULES
A)FORMATION OF SMEAR LAYER OVER EXPOSED
DENTIN
B)USE OF TOPICAL AGENTS TO OCCLUDE
EXPOSED TUBULES
CALCIUM HYDROXIDE PASTE
CALCIUM PHOSPHATE PASTE
SILVER NITRATE
FLUORIDES
FLUORIDE IONTOPHRESIS
POTASSIUM NITRATE
VARNISHES
DENTIN ADHESIVES
 MANAGEMENT

C)PLACEMENT OF RESTORATIONS
GLASS IONOMER CEMENTS
COMPOSITE RESINS
D)USE OF LASERS
CO2 LASER
Nd:YAG,Er:YAG LASER
He:Ne LASER
2. DESENSITIZING BY BLOCKING PULPAL SENSORY
NERVES
A)POTASSIUM NITRATE TOOTHPASTE
 CALCIUM HYDROXIDE

IT INCREASES THE
REMINERALISATION OF THE
EXPOSED DENTIN THUS
REDUCING DENTIN PERMIABILITY
DISADVANTAGE:IT CAUSES
TEMPORARY OCCLUSION OF
TUBULES
 CALCIUM PHOSPHATE PASTE

IT REDUCES DENTIN HYPERSENSITIVITY BY

BLOCKING TUBULES AND DENTIN
PERMEABILITY IS REDUCED
COMMERCIALLY AVAILABLE PRODUCT GC
TOOTH MOUSSE
IT CONTAINS AMORPHOUS CALCIUM
PHOSPHATE AND CAESIN PHOSPHOPEPTIDE
 SILVER NITRATE

IT REDUSES FLUID MOVEMENT BY

PRECIPITATING PROTEIN OR SILVER
CHLORIDE WITHIN THE DENTINAL TUBULES
IT IS NOT USED NOWADAYS AS IT STAINS
DENTIN AND ALSO DAMAGES PULP AND
GINGIVA
 STRONTIUM CHLORIDE

The mode of action is linked to

their ability to form mineralised
deposits within the tubule lumen
and on the surface of the exposed
dentine that help prevent
transmission of the applied
stimulus.
 FLUORIDES

AGENTS-SODIUM FLUORIDE,STANNOUS FLUORIDEOR

ACIDULATED PHOSPHATE FLUORIDE.
USED AS MOUTH RINSES,TOOTHPASTES OR TOPICAL
APPLICATION ON EXPOSED DENTIN.
ACTION IS BY FORMING FLUORAPATITE WITHIN
TUBULES WHICH BLOCK FLUID MOVEMENT WITHIN
DENTIN.
 FLUORIDE IONTOPHORESIS

IONTOPHORESIS- PROCEDURE IN WHICH IONS OF

CHOSEN MEDICAMENT ARE DRIVEN INTO SPECIFIC
TISSUES BY MEAHS OF ELECTRIC CURRENT.
FLOURIDE IONTOPHORESIS TRANSFERS FLUORIDE IONS
INTO DENTIN FOR DESENSITIZING IT.
UNIT HAS
-POSITIVE ELECTRODE IS PLACED ON PATIENTS FACE OR
ARM
-NEGETIVE ELECTRODE IS PLASTIC TIP PLACED AROUND
THE TOOH
2% SODIUM FLUORIDE IS APPLIED ON THE EXPOSED
DENTIN AND IS TRANSFERRED DEEP INTO THE DENTIN
ON ACTIVATION OF THE UNIT.
IT IS REPORTED TO PROVIDE LONG-TERM RELIEF FROM
HYPERSENSITIVE DENTIN.
 POTASSIUM OXALATE

SOLUTION IS APPLIED ON DENTIN

OXALATE IONS REACT WITH CALCIUM IONS
IN DENTINAL FLUID TO FORM INSOLUABLE
CALCIUM OXALATE CRYSTALS THAT BLOCK
TUBULES AND PREVENT FLUID MOVEMENT .
 MANAGEMENT

VARNISHES USE OF LASERS

THEY ACT BY FORMING A THEY OCCLUDE THE
BARRIER OVER EXPOSED DENTINAL TUBULES BY
DENTIN. PRODUCING LOCAL
THIS REDUCES CHANGES AROUND THE
HYPERSENSITIVITY AS IT EXPOSED DENTIN
REDUCES DENTIN THEY ALSO PRODUCE
PERMEABILITY. THEY CHANGES IN CENTRAL
PROVIDE ONLY PULP NEURON.
TEMPORARY RELIEF.
 POTASSIUM NITRATE

POTASSIUM ION MAY

DEPOLARIZE THE NERVE
AND PREVENT IT FROM
REPOLARIZING, THEREBY,
PREVENTING IT FROM
SENDING PAIN SIGNALS TO
THE BRAIN.
POTASSIUM IONS ARE
THOUGHT TO DIFFUSE
ALONG DENTINAL
TUBULES AND DECREASE
THE EXCITABILITY OF
INTRADENTAL NERVES BY
ALTERING THEIR
MEMBRANE POTENTIAL
REDUCING NERVE
EXCITATION, AND THE
DENTIN HYPERSENSITIVITY THE COMMON
COLD OF DENTISTRY