Dentin

Hypersensitivity
Contents
 Introduction
 Prevalence and epidemiology
 Etiopathogenesis
 Mechanism
 Clinical management
Diagnosis
Differential diagnosis
Prevention of DH/removal of etiological factors
Desensitization
 CLASSIFICATION OF DESENSITIZING
AGENTS
I. Mode of administration
At home desensitizing agents
In-office treatment
II. On the basis of mechanism of action
Nerve desensitization
• Potassium nitrate
 Protein precipitation
• Gluteraldehyde
• Silver nitrate
• Zinc chloride
• Strontium chloride hexahydrate
 Plugging dentinal tubules
• Sodium fluoride
• Stannous fluoride
• Strontium chloride
• Potassium oxalate
• Calcium phosphate
• Calcium carbonate
• Bio active glasses (SiO2–P2O5–CaO Na2O)
 Dentine adhesive sealers
• Fluoride varnishes
• Oxalic acid and resin
• Glass ionomer cements
• Composites
• Dentin bonding agents
 Lasers
• Neodymium:yttrium aluminum garnet (Nd-YAG)
laser
• GaAlAs (galium–aluminium–arsenide laser)
• Erbium–YAG laser
 INTRODUCTION
 “Dentine hypersensitivity is characterized by short, sharp pain
arising from exposed dentine in response to stimuli, typically
thermal, evaporative, tactile, osmotic or chemical and which cannot
be ascribed to any other dental defect or pathology”.

-Addy M. Dentine hypersensitivity: Definition, prevalence distribution and aetiology. In: Addy M,
Embery G, Edgar WM, Orchardson R, editors.Tooth wear and sensitivity: Clinical advances in
restorative dentistry.London: Martin Dunitz; 2000. p. 239-48.
PREVALENCE AND
EPIDEMIOLOGY
 Incidence 4 to 74%.
 Higher incidence in females than in males.
 Age group of 20–50 years, with a peak between 30 and 40
years of age.
 Canines and premolars of both the arches are the most
affected teeth.
 Buccal aspect of cervical area is the commonly affected
site.
-PM Bartold Dentin hypersensivity :a review Australian dental journal2006;51(3):212-218
Etiology
Enamel loss
 Occlusal wear

 Tooth brush abrasion

 Dietary erosion

 Abfraction

 Para functional habits

Cemental loss
 Gingival recession

 Periodontal disease

 Root planing

 Periodontal surgery
 Pathogenesis
I)lesion localization  exposing dentin to external
environment.
occurs by exposure of dentin, either by loss of enamel or by
gingival recession.
II) lesion initiation exposure and opening of dentinal
tubules .
Not all exposed dentin is sensitive..This occurs when the smear
layer or tubular plugs are removed, which opens the outer ends of
the dentinal tubules

-Robin Orchardson, Managing dentin hypersensitivity JADA, July 2006 :Vol. 137
 MECHANISM

 Direct innervation theory

 Odontoblast receptor theory
 Fluid movement/hydrodynamic theory(Gysi-1900)
(Martin Brannstrom-1986)
Fredrick A. Curro Tooth hypersensitivity DCNA ; July 1990 ;vol34/No 3
Cohen’s pathways of pulp -10 th edition
Diagnosis

Complete history Clinical examination Radiographic examination

Signs Visual Rule out peri

&symptoms assessment apical lesion
Physical
Intensity
assessment
Frequency & Depth of
duration periodontal
Dietary pocket
changes Response to
cold air
 A simple clinical method of diagnosing DH includes a jet of
air or using an exploratory probe on the exposed dentin, in a
mesio-distal direction, examining all the teeth in the area in
which the patient complains of pain.
 The severity or degree of pain can be quantified either
according to categorical scale (i.e., slight, moderate or severe
pain) or using a visual analogue scale.
- Fredrick A. Curro Tooth hypersensitivity DCNA ; July 1990 ;vol34/No 3
Differential diagnosis

 Fractured restorations
 Fractured enamel exposing dentin
 Dental caries
 Post restoration sensitivity
 Cracked tooth syndrome
 Bleaching sensitivity
Prevention of DH/removal of
etiological factors
 Faulty tooth brushing,
 Poor oral hygiene ,
 premature contacts,
 Gingival recession because of periodontal therapy or
physiological reasons,
 Erosive agents
DESENSITIZING AGENTS
 Requirements for an ideal dentine desensitizing agent
 Rapidly acting
 Long-term effect
 Non-irritant to pulp,
 Painless
 Easy to apply
 Should not stain the tooth..

- Grossman L. A systematic method for the treatment of hypersensitive dentine. J Am Dent Assoc 1935;22:592-8.
CLASSIFICATION OF
DESENSITIZING AGENTS
I. Mode of administration
At home desensitizing agents
In-office treatment
II. On the basis of mechanism of action
Nerve desensitization
• Potassium nitrate
 Protein precipitation
• Gluteraldehyde
• Silver nitrate
• Zinc chloride
• Strontium chloride hexahydrate
 Plugging dentinal tubules
• Sodium fluoride
• Stannous fluoride
• Strontium chloride
• Potassium oxalate
• Calcium phosphate
• Calcium carbonate
• Bio active glasses (SiO2–P2O5–CaO–Na2O)
 Dentine adhesive sealers
• Fluoride varnishes
• Oxalic acid and resin
• Glass ionomer cements
• Composites
• Dentin bonding agents
 Lasers
• Neodymium:yttrium aluminum garnet (Nd-YAG) laser
• GaAlAs (galium–aluminium–arsenide laser)
• Erbium–YAG laser
At home desensitizing agents
 Toothpastes, mouthwashes and chewing gums
 Majority of the toothpastes contain potassium salts (potassium
nitrate, potassium chloride or potassium citrate), sodium
fluoride, strontium chloride, dibasic sodium citrate,
formaldehyde, sodium monofluorphosphate and stannous
fluoride.
 Potassium salts act by diffusion along
the dentinal tubules and decreasing the
excitability of the intra dental nerve
fibers by blocking the axonic action
 The results of “at-home” desensitizing therapy should be
reviewed after every 3–4 weeks.
 If there is no relief in DH, “in-office” therapy should be
initiated.
In-office desensitizing agents

Silver nitrate

• It reduces 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
Fluorides
 Decrease the dentinal permeability by precipitation of calcium
fluoride crystals inside the dentinal tubules.
 Sodium fluoride, stannous fluoride, sodium
monofluorophosphate, fluorosilicates and fluoride combined
with iontophoresis.
 0.4% stannous fluoride along with 0.717% of fluoride can
provide an immediate affect after a 5 minute professional
application
potassium oxalate

 30% potassium oxalate had shown a

98% reduction in dentinal
permeability.
 The oxalate reacts with the calcium
ions of dentine and forms calcium
oxalate crystals inside the dentinal
tubules as well as on the dentinal
surface.
Casein phospho peptide–
amorphous calcium
phosphate  The stabilized CPP–ACP prevents the
dissolution of calcium and phosphate
ions and maintains a supersaturated
solution of bio available calcium and
phosphates.
 By virtue of its remineralizing capacity,
it can also help in prevention and
treatment of DH
Bioglass (Novamin)

 Bio glass can promote infiltration and remineralization of

dentinal tubules.
 The basic component is silica, which acts as a nucleation
site for precipitation of calcium and phosphate.
Portland cement

 calcium silicate cement derived from

Portland cement occlude the dentinal
tubules by remineralization
Adhesive materials

Fluoride Varnishes

 Effect is for short term

 To improve its efficacy, removal of
smear layer is advocated.
 Conventional dentin bonding agents (DBA) removes the
smear layer, etches the dentinal surface and forms deep
dentinal resin tags inside the dentinal tubules.
 Adhesive resins can seal the dentinal tubules effectively
by forming a hybrid layer
 Newer bonding agents modify the smear layer and
incorporate it in into the hybrid layer
 Recently, some dentin bonding agents have been
introduced in the market with the sole purpose of
treating DH
 Gluma Desensitizer (Heraeus Kulzer, Hanau, Germany)
contains hydroxyethyl methacrylate(HEMA),
benzalkonium chloride, glutaraldehyde and fluoride.
 Glutaraldehyde causes coagulation of the
proteins inside the dentinal tubules.
 It reacts with the serum albumin in the
dentinal fluid, causing its precipitation.
 HEMA forms deep resinous tags and
occludes the dentinal tubules.
de Assis Cde A, Antoniazzi RP, Zanatta FB, Rösing Ck
Efficacy of Gluma Desensitizer on dentin hypersensitivity in
periodontally treated patients. Braz Oral res 2006 Jul-
Sep;20(3):252-6.
Laser

 coagulate the proteins inside the dentinal

tubules and block the movement of fluid
 Nd–YAG laser application occluded the
dentinal tubules.
 Ga Al As laser is thought to act by
affecting the neural transmission in the
dentinal tubules..
-Y. Kimura, P. Wilder-Smith,K. Matsumoto :Lasers in
endodontics: a review; IEJ May 2000 vol33,issue3 : 173–
185, 
 MANAGEMENT
STRATEGY
 Take a detailed clinical and dietary history.

 Differentially diagnose the condition from other dental pain conditions.

 Identify and manage etiological and predisposing factors.
 In case of mild-to-moderate sensitivity, advice at-home desensitizing
therapy.
 If there is no relief or in case of severe sensitivity, initiate in-office
treatment.
 In extreme cases, if patient does not respond to the therapy and there are
individual teeth exhibiting the symptoms, then endodontic therapy can be
initiated.
 A regular review should be made with an emphasis on prevention of the
condition.
Take home message

 primary mode of treating Dentin hypersensitivity

is by using remineralizing agents.
References
 Addy M. Dentine hypersensitivity: Definition, prevalence
distribution and aetiology. In: Addy M, Embery G, Edgar WM,
Orchardson R, editors.Tooth wear and sensitivity: Clinical
advances in restorative dentistry.London: Martin Dunitz; 2000.
p. 239-48.
 PM Bartold Dentin hypersensivity :a review Australian dental
journal2006;51(3):212-218
 Martin Brannstrom, The Hydrodynamic Theory of Dentinal
Pain: Sensationin Preparations, Caries, and the Dentinal
CrackSyndrome J Endod ; oct 1986 ;vol 12 ,no 10;
 David H. PashleyDentin Permeability, Dentin Sensitivity,
and Treatment through Tubule Occlusion J Endod ;Oct
1986 ;VOL. 12, No. 10.
 Fredrick A. Curro Tooth hypersensitivity DCNA July 1990;
vol34/No 3
 Cohen’s pathways of pulp -10 th edition
 Grossman L. A systematic method for the treatment of
hypersensitive dentine. J Am Dent Assoc 1935;22:592-8
 The Journal of Contemporary Dental Practice, July
2005Volume 6, No. 2.
 S Miglani, Vivek A, Bhoomika A Dentin hypersensitivity:
Recent trends in management Journal of Conservative
Dentistry ;Oct-Dec 2010; Vol 13 ;Issue4.
 de Assis Cde A, Antoniazzi RP, Zanatta FB, Rösing Ck
Efficacy of Gluma Desensitizer on dentin hypersensitivity
in periodontally treated patients. Braz Oral res 2006 Jul-
Sep;20(3):252-6.
 Y. Kimura, P. Wilder-Smith,K. Matsumoto :Lasers in
endodontics: a review; IEJ ; 2000 vol33;issue3 ; 173–185.
Special thanks to
Dr. K . Madhusudhana
Prof &H.O.D
Department of conservative Dentistry & Endodontics

Other staff members&

Colleagues