This document provides an overview of a continuing education course on dentinal hypersensitivity. The course aims to help dental professionals understand the etiology, diagnosis, and management of dentinal hypersensitivity. It discusses the prevalence of dentinal hypersensitivity, risk factors, anatomical and physiological features, screening and diagnosis, and available treatment options. The document includes sections on the educational objectives, abstract, introduction, etiology and physiology, location and patients at risk, and a conclusion on the importance of treating dentinal hypersensitivity.
This is one of a series of lectures received for students of the college od dentistry , university of baghdad on the subjeect of fixed prosthodontic.This lecture contain brief introduction and termiology on this the subject
This document provides an overview of various periodontal instruments, their parts, classifications, and uses. It describes diagnostic probes and explorers, as well as scaling and curettage instruments like sickle scalers and curettes. It also outlines cleaning/polishing tools, surgical instruments, ultrasonic/sonic devices, the periodontal endoscope, and miscellaneous tools like periotreivers, hoe scalers, files, and chisel scalers.
1) The document describes modifications to a standard Class 2 cavity preparation design based on factors like lesion size and location, tooth structure, and patient oral hygiene. 2) It presents 6 designs (labeled 1-6) that vary the cavity shape, locations of margins, and internal anatomy features to best suit different clinical situations. 3) Each design is indicated for specific caries patterns and locations, and involves different areas of the tooth structure, with variations in how the cavity preparation margins and walls are formed.
The document discusses endodontic access cavity preparation. It defines access cavity preparation as creating an unobstructed opening to reach canal orifices and the apical foramen. There are principles for proper access, including establishing the correct outline form based on internal anatomy, providing direct access to canals and accommodation for instrumentation. Guidelines are provided for access preparation of different tooth types. Common errors include failing to identify all caries, establish proper access, or recognize tooth angulation. Proper access is the foundation for successful root canal treatment.
A post and core restoration is used to build up tooth structure for a crown when there is not enough structure remaining. A post is placed in the root canal and a core is built up around the post to provide support and retention for the crown. Key factors in post and core design include post length and diameter, surface texture, and luting agents to provide retention, as well as post design and cement layer to provide resistance to stresses. Custom post and cores are made using direct or indirect techniques involving impression taking, while prefabricated posts are used for circular root canals.
The endo-crown is a conservative restoration for endodontically treated teeth that have lost significant coronal structure. It involves preparing the tooth with a 2mm occlusal reduction and cylindrical cavity into the pulp chamber. The endo-crown is then bonded into the cavity as a single ceramic piece, providing strength while preserving tooth structure compared to traditional crowns. Studies have shown endo-crowns distribute stresses similarly to natural teeth and provide effective, long-lasting restorations for molars with extensive decay or fractures.
BIOMECHANICAL PRINCIPLES OF TOOTH PREPARATIONAamir Godil
The document discusses the principles of tooth preparation for dental restorations. It is divided into three categories: biologic considerations which focus on tissue health, mechanical considerations related to restoration integrity and durability, and esthetic considerations affecting patient appearance. Key points include the importance of conserving tooth structure, placing margins for easy finishing and hygiene, designing taper and contours for adequate retention and resistance, and selecting materials and techniques to meet esthetic needs. Proper tooth preparation is essential for successful long-term restoration outcomes.
1. Space maintainers are appliances used to maintain space created by premature tooth loss. They prevent crowding, impaction, and other issues by holding space open.
2. Common space maintainers include band and loop, crown and loop, lingual arch, Nance palatal arch, and removable appliances. The best option depends on factors like time since tooth loss and dental age.
3. Space maintainers are generally indicated when space is closing, future orthodontics may be simplified, or to prevent issues like supraeruption. They are contraindicated if space isn't closing or the succedaneous tooth is absent.
Hi, I am Dr Komal Ghiya, pediatric dentist, I am here to upload my own presentations for educational purposes. I hope this presentation will help you in knowing more about pulpectomy in primary teeth
- Endodontic instruments have evolved over time to have standardized sizes and tapers. Ingle and LeVine suggested standardizing diameters that increase by 0.05mm while maintaining a constant taper.
- Instruments are now numbered 6-140 based on tip diameter in hundredths of a millimeter. The diameter increases 0.32mm over the first 16mm of the instrument.
- Instruments can be hand operated, low-speed, engine-driven, or ultrasonic/sonic and are used for cleaning and shaping root canals.
This document discusses different methods for soft tissue management and gingival retraction during dental procedures. It covers the use of retraction cords made of 100% cotton to retract gingiva and achieve hemostasis when soaked in a solution. Various sizes of retraction cords are recommended for different areas of the mouth. Hemostatic agents like aluminum chloride, aluminum sulfate, and ferric sulfate can be used with the cords. Newer retraction cords are designed to eliminate issues like time consumption, patient discomfort, and epithelial attachment damage by maintaining rigidity in the sulcus without needing pressure for application.
SURVEYORS & SURVEYING PROCEDURES IN REMOVABLE PARTIAL PROSTHODONTICSKanika Manral
The document discusses the history and procedures of surveying for removable partial dentures. It describes how surveying has evolved from being done by eye to using specialized surveyor instruments. It outlines the key parts and uses of surveyors, including orienting the cast, marking survey lines to identify contours and undercuts, measuring retention, and identifying interferences. The purpose of surveying is to determine the optimal path of insertion and locations for retention and support of a removable partial denture.
Classification of dental caries rasha adel copyRasha Adel
This document discusses and compares several different systems for classifying dental caries lesions. It outlines 8 classification systems: Black's Classification System, WHO system, ICDAS, Mount-Hume Classification System, Finn's modification of Black's system for primary teeth, Baume's classification, Sturdevant's classification, and a system based on surfaces to be restored. Each system categorizes caries lesions differently based on factors like location, severity, and tooth surfaces involved.
This document summarizes the classification of osseous defects caused by periodontal disease. It describes different types of horizontal bone loss including osseous craters and bulbous bony contours. It also discusses vertical/angular bone loss and classifications proposed by Glickman and Goldman/Cohen. Furcation involvement is classified using scales proposed by Glickman and Tarnow/Fletcher. Understanding the nature of these bone alterations is important for effective diagnosis and treatment planning.
In this lecture I explain the basic concept of root canal filling or what called obturation. The lectures discuss different techniques used in that matter in step-by-step fashion and explanatory pictures.
It is directed to the level of undergraduate mind.
The document discusses post-core-crown restorations. It provides a historical background and summarizes key findings from studies on post length, diameter, form and failure rates. Threaded posts have the highest retention but also highest risk of root fracture. Parallel-sided posts have less retention but distribute stresses more evenly. At least 4mm of gutta-percha should remain at the apex. Post length is generally recommended to be 3/4 of the root length. Proper post diameter is 1/3 the root width or less.
Pulpectomy is a dental procedure to remove infected or dead pulp from the root canals of primary teeth. It aims to maintain the tooth in a non-infected state by cleaning and filling the root canals. A partial pulpectomy removes pulp from a single visit, while a complete pulpectomy is done over two visits with emergency treatment followed by root canal filling. Common filling materials for primary teeth include zinc oxide eugenol paste and iodoform paste, which resorb at a rate similar to the tooth root. The procedure involves local anesthesia, access through the crown, pulp removal, canal cleaning and shaping, irrigation, drying and obturation.
The document discusses tooth preparation for dental restorations. It describes the objectives of tooth preparation as removing defects, protecting the pulp, extending restorations conservatively, and allowing functional and esthetic placement of restorative materials. Factors that affect tooth preparation include pulpal and periodontal status, dental anatomy, occlusion, patient factors, affected dentin, and restorative materials. Different types of cavity preparations are also described, including simple, compound, and complex cavities as well as Class I, Class II, and modified cavity preparations for both amalgam and composite restorations. Techniques for cavity preparation are provided for both conventional and modified designs depending on the restoration needs.
Dentin hypersensitivity is a painful condition caused by exposed dentin. It occurs most commonly in 30-40 year old females and affects canines and premolars. Dentin contains tubules that normally contain fluid and extend into the tooth from the pulp. When factors like erosion expose the tubules, stimuli can cause fluid movement, activating nerves and causing sharp pain. Current trends to manage this include products that occlude tubules, such as arginine-based compounds, and treatments like lasers, bio-glass, and casein phosphopeptides. Proper diagnosis and removal of predisposing factors are important to effectively treat dentin hypersensitivity.
This document provides an overview of dentinal hypersensitivity. It begins with definitions of dentinal hypersensitivity and discusses prevalence, distribution, etiology and theories of the mechanism. Lesion localization and initiation are described as two processes required for sensitivity to occur. Clinical assessment methods are outlined including subjective scales and objective tactile, thermal, and electrical tests. Differential diagnosis and various management approaches are classified and described, including in-office treatment agents that do or do not polymerize, as well as other modalities like mouthguards, iontophoresis, and lasers. The primary mechanism of treatment agents is thought to be reduction of dentinal tubule diameter to limit fluid displacement within tubules.
The document discusses dentin hypersensitivity, including its definition, prevalence, theories of pain transmission, clinical features, diagnosis, differential diagnosis, and methods of prevention and treatment. Dentin hypersensitivity is characterized by short, sharp pain from exposed dentin in response to stimuli and cannot be attributed to other dental issues. It affects 4-57% of patients and is more common in those with periodontitis. The hydrodynamic theory of fluid movement in dentinal tubules activating nerve endings is widely accepted. Prevention and treatment methods include topical agents, iontophoresis, restorations, and tissue regeneration procedures.
This document provides information on dentinal hypersensitivity, including its definition, mechanisms, incidence, etiology, clinical features, diagnosis, and treatment strategies. It defines dentinal hypersensitivity as a sharp, short pain from exposed dentin in response to stimuli like thermal, chemical, or tactile sources. The predominant mechanism is the hydrodynamic theory, where stimuli cause the movement of fluid within dentinal tubules, stimulating nerves and causing pain. Common causes are gingival recession and loss of enamel or cementum. Diagnosis involves history, clinical exam, and tests to rule out other conditions.
This document provides information on dentinal hypersensitivity, including its definition, etiology, mechanism, diagnosis, prevention, and treatment. It defines dentinal hypersensitivity as short, sharp pain from exposed dentin in response to stimuli like heat, cold, sweets, or touch. The pain is caused by fluid movement in open dentinal tubules. To diagnose it, dentists consider a patient's pain history and examine the location and number of sensitive teeth. Treatment includes managing the etiology and using topical agents or laser therapy to occlude tubules, or placing restorations. Potassium nitrate toothpaste can also help by blocking pulpal nerve endings. The document outlines various causative factors, theories of pain transmission
This document discusses dentin hypersensitivity. It defines dentin hypersensitivity as short, sharp pain from exposed dentin in response to stimuli like heat, cold, tactile pressure or osmotic changes. It discusses the prevalence, distribution, etiology and theories of the condition. The key theory proposed is the hydrodynamic theory, which suggests that fluid movement in dentinal tubules in response to stimuli activates nerve endings and causes pain. Proper management of dentin hypersensitivity aims to occlude dentinal tubules to block this fluid movement.
This document provides an overview of dentinal hypersensitivity. It begins with definitions of dentinal hypersensitivity and discusses the history of treatments. The mechanisms and theories of dentinal sensitivity are then explored, including the hydrodynamic theory. Clinical considerations and various methods for measuring and eliciting hypersensitivity are also summarized. The document concludes with a discussion of management strategies for treating dentinal hypersensitivity.
Dentine hypersensitivity / /certified fixed orthodontic courses by Indian den...Indian dental academy
Dentin hypersensitivity is a common condition caused by exposure of dentin tubules. Various theories have attempted to explain the transmission of pain signals, with the hydrodynamic theory currently favored. It proposes that fluid movement in dentin tubules stimulates nerve fibers. Clinical examination involves tactile, thermal, or chemical stimuli to provoke symptoms. Management focuses on occluding dentin tubules through agents, bonding resins, or lasers to block fluid flow. Further research continues to improve treatment approaches for this painful condition.
Dentin hypersensitivity is sharp, short pain from exposed dentin in response to stimuli like heat, cold, sweet or sour foods, or brushing. It occurs when gum recession exposes dentin tubules. The hydrodynamic theory is the leading explanation, where stimuli cause dentin fluid flow, activating nerve fibers. Treatment focuses on plugging tubules, desensitizing nerves, or applying varnishes. At-home options include potassium nitrate toothpastes while in-office options range from fluoride to lasers. Patient education helps manage the condition.
Dentinal hypersensitivity /certified fixed orthodontic courses by Indian den...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable
Here are some suggested du'as before and after studying, and during exams:
Before studying:
اللهم أعني على ذكرك وشكرك وحسن عبادتك
O Allah, help me remember You, be grateful to You and worship You in the best way.
اللهم بارك لي في علمي وزدني من فضلك وانفعني بما علمت
O Allah, bless me in my knowledge, increase me in Your bounty and benefit me with what I
Dentinal hyper sensitivity 3 /certified fixed orthodontic courses by Indian...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
This document discusses the biology of tooth movement and root resorption. It begins by describing the cells and tissues involved in the periodontium, including progenitor cells, synthetic cells (osteoblasts, fibroblasts, cementoblasts), and resorptive cells (osteoclasts, fibroblasts, cementoclasts). It then explains the pressure-tension theory of tooth movement, which involves mechanical forces causing the differentiation of osteoblasts and osteoclasts, and the release of chemical signals like prostaglandins and cytokines. The document outlines the stages of tooth movement, including initial degeneration and hyalinization of tissues under pressure, followed by elimination of destroyed tissue and establishment of new attachment. It notes the differential time
An unsettling discomfort when a cold drink hits your teeth usually means one thing: tooth hypersensitivity or as many prefer to call it ‘sensitive teeth’. For some people, citrus fruits and other acidic foodstuffs are avoided like the plague as they bring on discomfort. Some even dread speaking if it’s too windy or cold outside.
Hypersensitivity can make something as routine as eating unnecessarily difficult. However, there are a number of solutions available which promise to restore normalcy to your teeth and make eating (and speaking, regardless of the weather outside) much more enjoyable.
This document provides instructions for preparing a class II amalgam tooth restoration. It describes initially outlining the occlusal surface and including all pits and fissures. The proximal box is then prepared by isolating the proximal enamel, creating a proximal ditch, and extending the facial and lingual walls. Retention features like locks and grooves are prepared, and the walls are finished with bevels. Final steps include cleaning, inspecting, and applying varnishes or desensitizers to the prepared cavity.
Dentin hypersensitivity is a common condition characterized by short, sharp pain from exposed dentin in response to stimuli. It is caused by fluid movement within dentinal tubules activating nerve fibers when stimuli like hot/cold foods or drinks cause fluid movement. Symptoms include pain from cold, hot, sweet or sour foods/drinks. Treatment focuses on occluding open dentinal tubules through products like desensitizing toothpastes containing potassium or strontium salts, or in-office treatments like varnishes, resins or iontophoresis. Proper oral hygiene and a diet low in acidic foods can help prevent further sensitivity.
Precious metal alloys /orthodontic courses by Indian dental academy Indian dental academy
This document discusses precious metal alloys used in dentistry. It begins by defining noble metals as those that do not form oxides, such as gold, palladium, platinum, and silver. It then discusses the properties and uses of these metals in dental alloys. The document outlines the history of dental casting alloys and their classification from Type I to Type IV based on hardness and strength. It also discusses the properties of different alloy types and their applications in all-metal restorations, metal-ceramic restorations, and removable partial dentures.
Operative dentistry is concerned with the prevention and treatment of defects in tooth enamel and dentin. It involves diagnosing carious and non-carious lesions, planning treatment which may involve other dental specialties, and restoring tooth form, function, and esthetics while maintaining the physiological integrity of the teeth. The scope of operative dentistry includes diagnosing the original cause of lesions, and planning treatment in logical procedural steps which can include cooperation with other dental specialties. The objectives are restoration of proper tooth form, function, and esthetics.
The document discusses the history of operative dentistry, which dates back 9,000 years to ancient Pakistan where tooth drilling using flint tools was discovered. It outlines the scope of operative dentistry, which involves diagnosis, prevention and treatment of dental defects and diseases. The principles of operative dentistry include diagnosis, prevention, interception, preservation and restoration of teeth. Accurate diagnosis is a critical aspect that involves distinguishing normal and abnormal conditions and interpreting test results.
This document discusses G.V. Black's established principles of cavity design from 1980 and new concepts that have been developed since. It outlines Black's rules for cavity preparation, which focus on tooth morphology, resistance form, and removal of caries. Modern concepts discussed include micro-cutting, preservation of tooth structure, and using internal tunnels and external grooves. The document emphasizes designing cavities based on considerations like the restorative material, retaining the material, protecting remaining tooth tissue, and optimizing restoration strength.
This document discusses the importance of conducting a complete endodontic examination for all patients. It states that without such an examination, the pulpal status of teeth is unknown. A complete endodontic examination involves a clinical examination, radiographic examination, and vital pulp testing to diagnose the pulpal status and identify any endodontically involved teeth. Conducting these examinations can lead to the identification and treatment of many previously undiagnosed endodontic problems, improving oral health outcomes and generating additional income for the dental practice.
Review on Denture Stomatitis : Classification, clinical features and treatment.iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Dr. Hazem El Ajrami discusses the prevention of periodontal disease. He outlines several key points:
- Periodontal disease is caused by bacterial plaque accumulation along the gums and teeth. Regular removal of plaque through brushing and other methods can prevent periodontal disease.
- Both local factors like untreated cavities, occlusal abnormalities, and systemic factors like diabetes or medications can increase risk of periodontal disease by affecting the body's response to plaque.
- Preventive measures include regular dental cleanings to remove built-up calculus, maintaining good oral hygiene through proper brushing techniques, and eating a balanced diet to stimulate gum health. Periodic checkups are important to monitor for bone
Estimation of dental treatment need in special care . Mohamed Alkeshan
This document discusses dental treatment considerations for patients with special needs. It notes barriers to care for these patients and ways to improve access, including through hospital outpatient programs, university training programs, and mobile dental units. For treatment, protective stabilization, nitrous oxide, or general anesthesia may be used. Home dental care requires parental assistance. Preventive care like fluoride, sealants, and diet management is important. The document reviews managing specific conditions like intellectual disabilities, Down syndrome, and autism. Overall, it stresses the importance of preventive care and treating special needs patients in general practice when possible.
This document discusses hypersensitivity of dentin, including its definition, causes, risk factors, and treatment approaches. Dentin hypersensitivity is defined as short, sharp pain in response to stimuli like heat, cold, sweets or drying. It is caused by the exposure of dentin and opening of dentinal tubules. Risk factors include poor oral hygiene, abrasive toothpastes, acid erosion and periodontal procedures. The hydrodynamic theory, which proposes that fluid movement in open dentinal tubules stimulates nerves, is the most widely accepted explanation. Treatment focuses on plugging tubules or desensitizing nerves, and can involve desensitizing toothpastes, mouthwashes or professional treatments.
Tooth hypersensitivity is a common problem encountered in everyday life and clinical practice. This presentation clearly shows causes, methods of prevention and treatment in such cases.
This case report discusses the treatment of a patient with congenitally missing upper lateral incisors. There were two treatment options considered: opening the spaces for prosthetic replacement or closing the spaces via canine substitution. The parents chose to close the spaces orthodontically. Fixed appliances were used to retract the canines into the lateral incisor spaces and extract mandibular premolars to relieve crowding. After treatment, the canines were reshaped to resemble lateral incisors. The final result had a Class I occlusion and improved esthetics. The report evaluates considerations for treating missing lateral incisors cases.
The document provides information on orthodontic diagnosis and clinical examination. It discusses examining the patient's age, medical history, dental history, chief complaint, and habits which help in diagnosis and treatment planning. The clinical examination evaluates the skeletal, facial, and occlusal characteristics to determine the cause of malocclusion which can be skeletal, dental, soft tissue, or a combination. This includes assessing the anteroposterior, vertical, and transverse jaw relationships to classify the skeletal pattern and guide orthodontic treatment.
This document discusses the examination and diagnosis of complete denture patients. It emphasizes the importance of a thorough case history and physical examination. The case history should explore the patient's dental history, medical history, habits, expectations and mental attitude. The physical examination involves both extraoral and intraoral assessment including facial form, profile, symmetry, complexion and lip support. A systematic examination allows for an accurate diagnosis, prognosis, and treatment plan.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
1. This document discusses whether home tooth whitening kits cause more dentine hypersensitivity compared to those who do not whiten. It provides background on tooth whitening and defines dentine hypersensitivity.
2. Common side effects of home whitening kits include gingival irritation and dentine hypersensitivity, which usually occurs during early treatment and lasts 2-3 days. Dentine hypersensitivity is caused by loss of enamel exposing dentinal tubules.
3. There is no universally accepted long-term treatment, but options include occluding dentinal tubules in-office or nerve desensitization treatments over-the-counter. Home whitening kits may cause short-term increases in dentine hypersensitivity
This document provides an overview of periodontal examination and diagnosis. It discusses taking a medical and dental history, performing a radiographic survey, examining casts, photographs, oral hygiene, the teeth, periodontium, and gingiva. Scoring indices like the Gingival Index, Plaque Index, Bleeding on Probing, and Calculus Index are also described to evaluate inflammation levels. The goal of periodontal diagnosis is to determine disease presence, type, extent, severity and develop a treatment plan.
1) White spot lesions are areas of demineralized enamel that usually develop due to prolonged plaque accumulation around fixed orthodontic appliances.
2) The prevalence of white spot lesions arising during fixed appliance therapy can range from 2-96% depending on the study. Risk factors include poor oral hygiene, inappropriate diet, and lack of preventive measures.
3) Strategies to prevent white spot lesions include the use of high-fluoride toothpaste, fluoride varnish applications twice per year, chlorhexidine rinses for 2 weeks, xylitol gum chewing, and products containing casein phosphopeptide-amorphous calcium phosphate.
The orthodontic patient examination and diagnosis involves interviewing the patient to understand their concerns and dental history. It also includes assessing their medical history to determine if any conditions could impact treatment. Factors like bleeding disorders, diabetes, immunosuppression, and allergies may require special consideration during orthodontic care. A thorough examination provides information needed to develop an appropriate treatment plan.
A detailed medical history is essential for geriatric endodontic patients due to their increased prevalence of medical conditions. Treatment appointments should be of short duration and consider accessibility issues that elderly patients may face. While age-related changes occur in dental tissues, endodontic treatment outcomes are just as predictable for elderly patients as younger ones when performed appropriately. Careful treatment planning is required considering each patient's medical health, oral condition, and prognosis.
Diagnosis and treatment planning of Removable Partial Denture dwijk
This document discusses the process of examining a patient and developing a treatment plan for a removable partial denture. It covers organizing the initial examination, evaluating medical and dental history, performing diagnostic tests and impressions, and analyzing the data to formulate a treatment plan. The goal is to thoroughly understand the patient's condition and needs to develop a successful treatment.
Endodontic treatment and tooth extraction with dental implant placement are two main treatment options for a diseased tooth. There are numerous factors to consider when deciding between the options, including prognosis, risks and benefits, costs, and the patient's medical history and preferences. While implant survival rates are high in the short term, endodontic treatment has shown positive survival rates in both the short and long term. Additionally, endodontic treatment preserves the natural tooth and soft tissue, which is important for aesthetics. The optimal treatment must consider all relevant factors and the patient's best interests.
Supportive periodontal therapy (SPT) involves regular maintenance visits after initial treatment for periodontal disease to prevent recurrence. The goals of SPT are to prevent further loss of attachment and tooth loss through monitoring the dentition. Key parts of SPT include examining the patient, providing re-instruction on oral hygiene, instrumenting reinfected sites, and polishing teeth while applying fluoride. Regular visits every 3-6 months are typically recommended, with more frequent visits for higher-risk patients. Failure to comply with SPT risks recurrence of periodontal disease due to a buildup of plaque and bacteria.
1. Earn
4 CE credits
This course was
written for dentists,
dental hygienists,
and assistants.
Dentinal Hypersensitivity:
Etiology, Diagnosis and
Management
A Peer-Reviewed Publication
Written by Howard E. Strassler, DMD, FADM, FAGD, FACD and Francis G. Serio,
DMD, MS, MBA, FICD, FACD, FADI
PennWell is an ADA CERP recognized provider
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying
quality providers of continuing dental education. ADA CERP does not approve or endorse individual
courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
Concerns of complaints about a CE provider may be directed to the provider or to ADA CERP at
www.ada.org/goto/cerp.
This course has been made possible through an unrestricted educational grant from Colgate-Palmolive Company. The cost of this CE course is $59.00 for 4 CE credits.
Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.
2. Educational Objectives
The overall goal of this course is to provide dental professionals with information on the etiology, diagnosis and
treatment of dentinal hypersensitivity. Upon completion of
this course, the participant will be able to do the following:
1. Know the incidence of dentinal hypersensitivity and
risk factors for this condition
2. Know the anatomical and physiological features, and
the accepted theory, associated with dentinal hypersensitivity
3. Understand the need for screening and diagnosis by
exclusion for dentinal hypersensitivity
4. Know the treatment options available for dentinal
hypersensitivity and considerations in selecting these.
Abstract
Dentinal hypersensitivity has been referred to as one of the
most painful and chronic dental conditions, with a reported
prevalence of between 4% and 57% in the general population
and a higher prevalence in periodontal patients. It may also
occur as a result of, or during, dental treatment. Clinicians
must screen for dentinal hypersensitivity and diagnose by
exclusion, determine appropriate treatment, and provide
treatment and preventive recommendations. Consideration
should also be given to treating dentinal hypersensitivity
associated with dental treatment. Traditional treatments
have included adhesive resins, fluoride varnishes, HEMA,
iontophoresis, gingival grafts and desensitizing dentifrices.
Other technologies include the use of bioglass particles,
ACP, as well as 8% arginine and calcium carbonate paste.
Introduction
During routine dental examinations, our patients frequently inquire about dentinal hypersensitivity that was one
episode or is chronic and recurring due to a given action,
e.g., drinking cold beverages, eating hot foods, breathing
in and out. This common complaint is defined as dentinal
hypersensitivity, but it is also known as root sensitivity,
or just sensitivity. Patients describe this phenomenon as
sharp, short-lasting tooth pain, irrespective of the stimulus.1 Holland et al. described dentinal hypersensitivity as
“characterized 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.”2
The prevalence of dentinal hypersensitivity has been
reported to be between 4% and 57% in the general population.3-10 Among periodontal patients, its frequency is considerably higher (60%–98%).11,12 This hypersensitivity may
be due to cementum removal during root instrumentation.
Dentinal hypersensitivity has been described as generally
occurring in patients 30 to 40 years old,13 but it can occur in
patients significantly younger or older. Women may be affected more often than men.14 Dentinal hypersensitivity af2
fects incisors, canines, premolars and molars, with canines
and premolars reported to be affected most often.15,16
Patients with dentinal hypersensitivity may not specifically seek treatment, because they do not view it as a
significant dental health problem, but will mention it at a
routine dental appointment.17 At other times, patients will
seek treatment recommendations from their dental professionals. Some patients are concerned whenever there is
dental pain,18 and for some the first time they experience
dentinal hypersensitivity creates fear that there is something more serious occurring. The authors of this course
have had patients report sensitivity who believe that it may
be a toothache that requires immediate attention so that the
pain does not get worse. Patients can identify areas of dentinal hypersensitivity before a clinical exam is performed.
This may be chronic, or unpredictable and cause intermittent discomfort that is difficult to pinpoint.19,20 Other patients cannot distinguish between dentinal sensitivity and
gingival sensitivity. Patients may also experience dentinal
hypersensitivity as a result of treatment such as scaling and
root planing or during routine and normal actions associated with treatment, such as when a tooth is dried using an
air spray or scratched with the tip of an explorer. Dental
treatment can also exacerbate pre-existing sensitivity.
Dentinal hypersensitivity has all the criteria to be
considered a true pain syndrome.21 It is important to distinguish sensitivity pain, that of short duration, from pain
of longer duration not treatable with desensitizing agents.
A painful response that lingers or that wakens the person
from a sound sleep may be the result of pulpal inflammation. A diagnosis by the dentist is necessary to establish
a cause and effect, and a diagnosis by exclusion must be
made for dentinal hypersensitivity, ruling out other conditions requiring different treatment. After the diagnosis
of dentinal hypersensitivity has been made, depending
on the etiology, recommendations can be made for effective treatment. Calvo noted in 1884: “There is great need
of a medicament, which while lessening the sensitivity of
dentin, will not impair the vitality of the pulp.”22 Recommendations can include in-office, at-home professionally
dispensed or over-the counter treatments.23-26 Regardless of
which treatment recommendations are made and provided,
it is important to follow up with the patient to evaluate the
therapeutic results.
Etiology and Physiology of Dentinal
Hypersensitivity
Dentinal hypersensitivity can have multiple etiologies. It
is important that the patient’s medical and social history,
lifestyle, medications and supplements being taken, diet
and food habits, and oral hygiene be thoroughly reviewed.
Before making a diagnosis of dentinal hypersensitivity,
other oral conditions must be ruled out, including occlusal
trauma, caries, defective restorations, fractured or cracked
www.ineedce.com
3. teeth, potential reversible or irreversible pulpal pathology,
or gingival conditions.14,24 For instance, pain during chewing may be due to a fractured and mobile restoration that
is rubbing against the dentin or diagnostic for a cracked
tooth.27
Dentin is sensitive due to its anatomy and physiology. It
is a porous, mineralized connective tissue with an organic
matrix of collagenous proteins and an inorganic component, hydroxyapatite. Dentinal tubules are micro-canals
that radiate outward through the dentin from the pulp
cavity to the dentinal surface, with different configurations
and diameters in different teeth. For human dentin, one
square millimeter can contain 30,000 tubules, depending
on depth. Each tubule contains a Tomes fiber (cytoplastic
cell process) and an odontoblast that communicates with
the pulp. Within the dentinal tubules there are two types
of nerve fibers, myelinated (A-fibers) and unmyelinated
(C-fibers).28 The A-fibers are responsible for the sensation
of dentinal hypersensitivity, perceived as pain in response
to all stimuli.
The most widely accepted mechanism of dentinal
sensitivity is the hydrodynamic theory, first described by
Brännström.29,30 In this model, the aspiration of odontoblasts into the dentinal tubules, as an immediate effect
of physical stimuli applied to exposed dentin, results in
the outward flow of the tubular contents (dentinal fluids)
through capillary action (Figure 1). The changes to the
dentinal surface lead to stimulation of the A-type nerve
fibers surrounding the odontoblasts. For there to be a
stimulus response, the tubules must be open at both the
dentinal interface and within the pulp. Absi and coworkers
reported that nonsensitive teeth were not responsive to any
physical stimuli; sensitive teeth had up to eight times the
number of open dentinal tubules per surface area compared
to nonresponsive teeth.31 Another theory is an alteration in
pulpal sensory nerve activity.32 The treatment of exposed,
open dentinal tubules is based upon the physiology of the
stimulus response.
Figure 1. The hydrodynamic theory
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Location of Dentinal Hypersensitivity –
Patients at Risk
Why are some root surfaces hypersensitive and others
are not?
Exposed root surfaces due to gingival recession are a
major predisposing factor to dentinal root hypersensitivity (Figure 2).33 According to a recent report of adults over
the age of 60, almost 32% had root caries or a restored root
surface.34 Since root caries are an indication of periodontal
attachment loss and subsequent recession, this defines the
population of adults over 60 with an at-risk of recession in
at least one or more teeth as at least 30%. Another study
concluded that at least 22% of the adult population between
30 and 90 years of age will have evidence of recession in
one or more teeth of 3 mm or more.35 Gingival recession
is more common as patients age and in patients with better
oral hygiene.14,36 Common causes include inadequate attached gingiva, prominent roots with a thin alveolar housing or bony dehiscence, toothbrush abrasion, periodontal
surgery, factitial habits (e.g., picking at cervical area of the
tooth with a fingernail), excessive tooth cleaning, excessive
flossing, loss of gingival attachment due to specific pathologies, and iatrogenic loss of attachment during restorative
procedures.33,37
Figure 2. Gingival recession with exposed root surfaces
Exposed lingual root surfaces
Dentinal hypersensitivity can also occur as a result of a routine dental cleaning, or be exacerbated during scaling and
root planing or routine dental prophylaxis and polishing due
to pre-existing dentin-root hypersensitivity. Patients who
have had or are having periodontal therapy are at risk;12 the
prevalence of root sensitivity has been reported as 9%–23%
before and 54%–55% after periodontal therapy. An increase
in the intensity of root sensitivity occurred one to three weeks
following therapy, after which it slowly decreased. An assessment found that all patients experienced increased discomfort
and dentinal hypersensitivity after periodontal treatment,
including scaling and root planing.37 Fear of pain and discomfort during subgingival instrumentation has been reported to
deter 10% of the population from seeking treatment.38 Once
the root surfaces are exposed, the cementum/dentin is more
susceptible to caries and loss of tooth substance due to erosion, abrasion and abfraction (Figure 3).39-42 Postprocedural
3
4. sensitivity can also be a result of etching beyond restoration
margins, leaving dentinal tubules open, or of finishing and
polishing a restoration that extends to the root surfaces,
which can also leave dentinal tubules open. Root surfaces on
teeth adjacent to a tooth being extracted can be abraded and
scarred with the use of dental elevators during the extraction
procedure. Resective periodontal surgical procedures may
also leave roots exposed. Enamel loss with exposed dentin due
to attrition and tooth wear due to bruxism, occlusal habits and
other forms of parafunctional activity can also contribute to
the etiology of dentinal hypersensitivity (Figure 4).41
Figure 3. Gingival recession with associated noncarious cervical lesions
Biofilm deposits on root surfaces may also increase hypersensitivity. The opening of dentinal tubules can also occur
due to poor oral hygiene techniques leaving bacterial plaque/
biofilm on root surfaces, with the acidic by-products of the
biofilm opening the dentinal tubules. Conversely, overzealous oral hygiene techniques can cause continued dentinal
tubule exposure. Root surfaces exposed to the physical action
of toothbrushing with and without toothpaste can be predisposing factors in removing the smear layer, leaving a tooth
hypersensitive.13,45 Exposure of the oral cavity to acids, e.g.,
ingestion of acidic foods and beverages46-48 or ingestion of
chlorinated pool water,49 as well as bulimia and gastrointestinal reflux disease can also contribute to the opening of the end
of the dentinal tubules (Figure 6).50 Brushing immediately
after ingesting acidic foods or beverages should be avoided.51
Figure 6. Erosion of the maxillary anterior teeth in a bulemic
patient due to stomach acid
Figure 4. Enamel loss with exposed dentin due to attrition
Screening and Diagnosis of Dentinal
Hypersensitivity
In normal function, the tubules sclerose and become plugged,
and when dentin is cut or abraded the mineralized matrix
produces debris that spreads over the dentin surface to form a
smear layer.43,44 This occurs to both enamel and dentin,44 but the
loss of this smear layer, the unplugging of the dentinal tubules,
contributes to dentinal hypersensitivity (Figure 5).
Figure 5. Scanning electron micrograph demonstrating open
dentinal tubules
4
Dentists and dental hygienists unfortunately do not all routinely include screening for dentinal hypersensitivity.25 In
1995, a random sample of Dutch dentists completed a survey on the prevalence, conditions and treatment of cervical
hypersensitivity of their patients.52 A similar questionnaire
was administered to U.K. dentists in 2002.53 For both groups,
the results revealed discrepancies in screening, perceptions
and knowledge of treatment. A separate study administered
a questionnaire by mail to 5,000 dentists and 3,000 dental
hygienists in Canada and revealed that fewer than half of the
respondents considered a differential diagnosis for dentinal
hypersensitivity, even though it is by definition a diagnosis
of exclusion.25 Many misidentified the etiology: 64% of the
dentists and 77% of the hygienists incorrectly cited bruxism
and malocclusion as triggers for dentinal hypersensitivity,
while only 7% of dentists and 5% of dental hygienists correctly
identified erosion as a primary cause and 17% of dentists
and 48% of hygienists were unable to identify the accepted
theory of hypersensitivity. Only half of the respondents had
the confidence to manage a patient’s pain and to consider the
modification of predisposing factors to control a patient’s
pain. This survey also demonstrated a lack of understanding
of desensitizing toothpastes – most dentists (56%) and dental hygienists (68%) believed these helped prevent dentinal
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5. hypersensitivity, while 31% and 16%, respectively, did not
believe that desensitizing toothpastes provided relief from
dentinal hypersensitivity.
Dental professionals need to fully understand the etiology and treatment of dentinal hypersensitivity, to screen for
it and to diagnose it by exclusion. It is also worth noting that
patients with unresolved hypersensitivity over many years
provide the dental professional with varied behavioral and
postural clues, some of which are easily recognized. These
include avoidance of routine dental exams, necessary treatment and follow-up care, reluctance to schedule planned
treatment or follow-up care, insistence on the use of local
anesthesia for even the most minor of dental treatments,
tense facial muscles, tooth clenching, a rigid torso, holding
hands tightly on the arm rest, crossed arms, an awkward
head position and an inability to follow routine instructions
for head and body positioning.19
As part of any screening for dentinal hypersensitivity, the
clinician should assess whether there is a localized or generalized problem. In addition, for patients with identified isolated
and generalized dentinal hypersensitivity, a routine dental
cleaning can be anxiety provoking.38 Consideration should
be given to dentinal hypersensitivity associated with dental
treatment – during treatment and postoperatively. While the
focus of controlling pain for many dental professionals during periodontal scaling and root planing and routine dental
cleanings has been the use of local and topical anesthetic
agents,37,54,55 we should also give thought to providing our
patients with treatments to relieve postprocedural dentinal
hypersensitivity.19,26,56,57
Treatment and Prevention of Dentinal
Hypersensitivity
Once the diagnosis of dentinal hypersensitivity has been
made and the etiologic factors identified, treatment and prevention should be primary goals,19,58,59 and a treatment plan
can be developed and implemented. Once a tooth or teeth are
predisposed to dentinal hypersensitivity, they will need to be
re-evaluated for continued treatment. The patient should be
shown correct brushing techniques to prevent further loss of
dentin that would contribute to dentinal hypersensitivity;
improper toothbrushing has also been associated with dentinal hypersensitivity.1 It has been shown that both a manual
and a power brush used with a desensititizing toothpaste are
almost equivalent in effectiveness.60 If there are changes and
behavior modifications or treatments that can be made, these
should be discussed with the patient. Drisko summarized
preventive recommendations (Table 1).61
Treatment of Dentinal Hypersensitivity
Two major groups of products are used to treat dentinal
hypersensitivity: those that block and occlude dentinal tubules, and those that interfere with the transmission of neural impulses. Localized dentinal hypersensitivity can usually
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be treated in-office. For generalized conditions where there is
significant recession on multiple teeth, an at-home treatment
regimen may be a better choice.
Table 1. Preventive Recommendations for
Dentinal Hypersensitivity
Suggestions for patients:
Avoid using large amounts of dentifrice or reapplying it during
brushing.
Avoid medium- or hard-bristle toothbrushes.
Avoid brushing teeth immediately after ingesting acidic foods.
Avoid overbrushing with excessive pressure or for an extended
period of time.
Avoid excessive flossing or improper use of other interproximal
cleaning devices.
Avoid “picking” or scratching at the gumline or using toothpicks
inappropriately.
Suggestions for professionals:
Avoid overinstrumenting the root surfaces during scaling and
root planing, particularly in the cervical area of the tooth.
Avoid overpolishing exposed dentin during stain removal.
Avoid violating the biologic width during restoration placement,
as this may cause recession.
Avoid burning the gingival tissues during in-office bleaching,
and advise patients to be careful when using home bleaching
products.
Professional in-office treatments
In-office desensitizing agents work by occluding and sealing the dentin tubules.62,63 When treating patients with an
in-office treatment, American Dental Association treatment
codes can be noted for insurance reimbursement (Table 2).
Table 2. In-office desensitizing codes
Miscellaneous services
D9910 Application of desensitizing medicament
Includes in-office treatment of root sensitivity. Typically reported on a “per visit” basis for application of topical fluoride or
other desensitizing agents. This code is not used for bases, liners
or adhesives used under restorations.
D9911 Application of desensitizing resin for cervical and/or root
surface
Typically reported on a “per tooth” basis for application of adhesive resins. This code is not used for bases, liners or adhesives
used under restorations.
A recent novel approach is a technology based on arginine, a natural product, and calcium carbonate. This technology was introduced as a result of the need to provide patients
with a treatment regimen to reduce and treat postprocedural
dentinal hypersensitivity after dental cleanings. In 2002,
Kleinberg et al. reported on the development of this novel
desensitizing technology based upon the role that saliva
plays in naturally reducing dentinal hypersensitivity. Saliva
5
6. provides calcium and phosphate, which over time will occlude and block open dentinal tubules from external stimuli
associated with dentinal hypersensitivity.19,56 Reduced salivary flow, hyposalivation and xerostomia are risk factors for
caries and tooth demineralization and may exacerbate dentinal hypersensitivity. While hyposalivation may be due to
medical conditions and aging, it is also a side effect of more
than 500 prescription and over-the-counter medications.64
The mechanism providing for the clinical effectiveness
of this technology utilizes arginine, an amino acid; bicarbonate, a pH buffer; and calcium carbonate, a source of calcium.
This technology, originally introduced as Sensistat® (Ortek
Therapeutics, Roslyn Heights, NY), effectively relieves
dentinal hypersensitivity.56 The technology is proposed to
block dentinal hypersensitivity pain by occluding dentinal
tubules by using arginine, which is positively charged at
physiologic pH of 6.5-7.5, to bind to the negatively charged
dentin surface, and helps attract a calcium-rich layer from
the saliva to infiltrate and block the dentinal tubules. An
in-office product based upon this technology (ProClude®)
was used for the management of tooth sensitivity during
professional dental cleanings. Early studies on this technology demonstrated instant relief from discomfort that lasted
28 days after a single application and reported a 71.7% reduction in sensitivity measured by air-blast and an 84.2%
reduction by the “scratch” test immediately following application.56 The same technology was used in a toothpaste
(DenClude®).
In 2007, Colgate-Palmolive Company acquired the
rights to the technology, now known as Pro-Argin™ technology, and has introduced Colgate® Sensitive Pro-Relief™ Desensitizing Paste (Figure 7). This is applied in-office using a
prophylaxis cup on a prophy angle. The recommendation is
that the paste be applied using a low speed handpiece with
a moderate amount of pressure to burnish the paste into the
exposed tubules, optimizing their occlusion. This product
can be used before or after dental procedures.
Figure 7. Colgate® Sensitive Pro-Relief™ Desensitizing Paste
In clinical trials, this product has been found to provide immediate and lasting relief of hypersensitivity for four weeks
when it is applied in patients immediately after dental scaling, as the final polishing step during a professional cleaning
procedure.57 A second study demonstrated its effectiveness
in relieving dentinal hypersensitivity when applied prior to
dental prophylaxis, with a significant reduction in dentinal
hypersensitivity demonstrated postprocedurally.65 Based
6
on these results, application of the paste pre-procedurally
would reduce patient discomfort during scaling and root
planing and thereby enable thorough treatment without
causing patients pain. An evaluation of this desensitizing
paste containing 8% arginine and calcium carbonate on dentin and enamel, as well as on restorative materials, found no
significant effect on surface roughness.66 In investigating the
mechanism of action of arginine and calcium carbonate paste
using scanning electron microscopy, confocal laser scanning
microscopy and atomic force microscopy, Petrou et al. found
that the technology totally occluded the dentinal tubules rapidly. This was the result of the formation of a deposit on the
surface and plugs in the dentinal tubules that contained high
amounts of phosphate, calcium and carbonate. In addition, it
was determined through hydraulic conductance testing that
these deposits significantly reduced the flow of dentinal fluid
in the tubules.67
Figure 8. Occlusion of dentinal tubules by the Pro-Argin™ technology
SEM of untreated dentin surface with
exposed tubules
SEM of dentin surface showing occlusion of dentin tubules after application of Colgate® Sensitive Pro-Relief TM
Desensitizing Paste
In-office paint-on surface treatments are a popular approach to treating root hypersensitivity, and are especially
effective for localized dentinal hypersensitivity (single teeth).
These products generally occlude and seal the dentin tubules. A variety of products has been reported to effectively
reduce dentinal hypersensitivity, including resin-based
materials.68-71 5% sodium fluoride varnish (Duraphat®,
Colgate-Palmolive, New York, NY) painted over exposed
root surfaces has been shown to be an effective treatment for
dentinal hypersensitivity.62 An aqueous solution of glutaraldehyde and hydroxyethylmethacrylate (HEMA) (Gluma
Desensitizer, Heraeus-Kulzer; Calm-It™, Dentsply-Caulk)
has been reported to be an effective desensitizing agent for
up to nine months.71,72 The mechanism for tubule occlusion appears to be due to the glutaraldehyde.73 The use of
oxalates has also been shown to be effective, with the oxalate
precipitating and occluding the open dentinal tubules.74 In
addition, while there have not been any controlled studies on
its effectiveness, anecdotal evidence suggests that burnishing
a 0.5% solution of prednisolone onto exposed sensitive root
surfaces may mitigate intractable hypersensitivity.
Other treatment options include gingival grafts, adhesive resins, lasers and topically applied agents. Gingival
grafts should be considered, in particular when the recession
is progressive, there are aesthetic concerns or the sensitivity
is unresponsive to more conservative treatment.75 When
the exposed sensitive root surface has surface loss due to
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7. abrasion, erosion and/or abfraction leaving a notching of
the root, consideration should be given to placing either
an adhesive composite resin or glass ionomer restoration,76
which would both restore the tooth to full contour and seal
the dentinal tubules. Lasers have been used successfully to
seal open dentinal tubules either alone or with surface treatments.77-79 Iontophoresis can also be used, a technique that
utilizes a low galvanic current to accelerate ionic exchanges
and precipitation of insoluble calcium with fluoride gels to
occlude the open tubules.80
Figure 9. In-office paint-on surface treatments
Recommendations for use and technique are product specific.
The clinician needs to understand the in-office desensitizing
agents to select one that is appropriate for the patient.
Professionally dispensed self-applied
treatments
A professionally prescribed at-home treatment has been
introduced (SootheRxTM, 3M/ESPE Preventive Care) that
contains a calcium sodium phosphosilicate bioactive glass
(NovaMin®). This has been shown in vitro to seal and clog
open dentinal tubules and to be effective for sensitivity
relief after 6 weeks of home use.81,82 Amorphous calcium
phosphate and casein phosphopeptide-amorphous calcium
phosphate products (Relief ACP, Discus Dental; MI Paste™,
GC America) can also be used for desensitization by brushing them on the teeth, including before and after mouthguard or in-office bleaching. ACP has also been found to
be effective for control of bleaching sensitivity when incorporated into bleaching gels.83-85 The use of ProClude®, the
precursor to Colgate® Sensitive Pro-Relief™ Desensitizing
Paste, was also reported to decrease sensitivity when used
before bleaching.86
is a therapeutic claim and the toothpaste must contain an
active ingredient that is recognized by the FDA as being an
effective desensitizer at that concentration. For anything not
recognized by the FDA as a desensitizing ingredient, a new
drug application is required. The most popular desensitizing
ingredient in toothpastes is potassium nitrate. According to
the FDA monograph, for a potassium nitrate toothpaste
to claim to be desensitizing, it must contain 5% potassium
nitrate87 (Sensodyne®, GlaxoSmithKline; Colgate® Sensitive and Colgate® Sensitive Enamel Protect™, ColgatePalmolive; Crest® Sensitivity, Procter & Gamble).The
mode of action involves penetration of the potassium ions
through the tubules to the A-fibers of the nerves, decreasing
the excitability of these nerves.88-90 Many clinical trials have
provided evidence of a reduction in tooth sensitivity with
toothpastes containing potassium nitrate.91-94 These toothpastes may take up to two weeks to show any effectiveness.
For best results, the toothpaste should be used twice a day as
part of the person’s oral care regimen.
In recent years, vital bleaching has become very popular, with transient tooth sensitivity as a primary reported side
effect with an incidence of 7% to 75%.95-99 For many patients,
this is a barrier to continuing treatment, and 5% potassium
nitrate desensitizing toothpaste has been recommended for
patients undergoing bleaching.100,101 Two effective strategies
using a 5% potassium nitrate desensitizing toothpaste are
brushing with it for two weeks prior to initiating bleaching
and having the patient place it into his or her bleaching tray
and wear the tray for 30 minutes a day one week prior to the
initiation of bleaching.100,101
Conclusion
As part of the routine dental examination and during every
recall appointment, dental professionals should include
in their patient questions queries about whether there
are any sensitive teeth. Patients with dentinal hypersensitivity should be evaluated based upon risk factors and a
proper diagnosis made, after which a treatment plan can be
outlined for the patient. In most circumstances, the least
invasive, most cost-effective treatment is the use of an effective desensitizing toothpaste. Depending on the severity of
dentinal hypersensitivity, clinical management may include
both in-office and self-applied at-home therapies, including
recent and novel technologies that have been introduced.
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Self-applied over-the-counter treatments
Over-the-counter (OTC) treatments for sensitive teeth
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desensitizing toothpastes. The claim of desensitizing teeth
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Author Profile
Dr. Howard Strassler is professor and director of operative dentistry at the University of Maryland Dental School in the Departments of Endodontics, Prosthodontics, and Operative Dentistry. He
is a fellow in the Academy of Dental Materials and the Academy of
General Dentistry, a member of the American Dental Association,
the Academy of Operative Dentistry, and the International Association for Dental Research. Dr. Strassler has published more than 400
articles in the field of restorative dentistry and innovations in dental
practice, coauthored seven chapters in texts, and lectured nationally
and internationally. Dr. Strassler has a general practice in Baltimore,
Maryland, limited to restorative dentistry and aesthetics.
Dr. Francis Serio is professor and chairman of the department of
periodontics and preventive sciences at the University of Mississippi School of Dentistry, and a Diplomate of the American Board
of Periodontology. Dr. Serio completed his undergraduate studies
at The Johns Hopkins University and received his DMD from the
University of Pennsylvania. He earned his MS and certificate in
Periodontics at the University of Maryland and his MBA from
Millsaps College. Dr. Serio has presented over 120 lectures and continuing education courses in the U.S. and internationally, and has
written or coauthored over 35 scientific articles and four books.
Disclaimer
The authors of this course have no commercial ties with the sponsor
or provider of the unrestricted educational grant for this course.
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Questions
1. Dentinal hypersensitivity has been
referred to as one of the most painful and
least successfully treated chronic dental
conditions.
a. True
b. False
2. The prevalence of dentinal hypersensitivity has been reported to be between
____________ in the general population,
and among periodontal patients,
its frequency is considerably higher
___________.
a.
b.
c.
d.
4% and 37%; 40%–68%
4% and 57%; 40%–68%
4% and 37%; 60%–98%
4% and 57%; 60%–98%
3. The canines and molars are reported
to be affected most often by dentinal
hypersensitivity.
a. True
b. False
4. Patients may experience dentinal
hypersensitivity ___________.
a. episodically in response to stimuli
b. during routine and normal actions associated with
dental treatment
c. postoperatively after dental treatment such as
scaling and root planing
d. all of the above
5. Conditions that need to be ruled out
before making a diagnosis of dentinal hypersensitivity include but are not limited
to ___________.
a.
b.
c.
d.
occlusal trauma
caries and fractured or cracked teeth
potential reversible or irreversible pulpal pathology
all of the above
6. For human dentin, one square millimeter
of dentin can contain 30,000 tubules,
depending on depth.
a. True
b. False
7. The most widely accepted mechanism of
dentin sensitivity is the ___________.
a.
b.
c.
d.
hydrostatic theory
pulpal sensory nerve activity theory
hydrodynamic theory
none of the above
8. Exposed root surfaces due to gingival
recession are ___________ predisposing
factor to dentinal root hypersensitivity.
a.
b.
c.
d.
a minor
a major
the only
none of the above
9. Fear of pain and discomfort during
subgingival instrumentation has been
reported to deter ___________ of the
population from seeking treatment.
a.
b.
c.
d.
5%
10%
15%
20%
10. Enamel loss with exposed dentin due to
attrition and tooth wear due to bruxism,
occlusal habits and other forms of
parafunctional activity can contribute to
the etiology of dentinal hypersensitivity.
a. True
b. False
11. Loss of the ___________ contributes to
dentinal hypersensitivity.
a.
b.
c.
d.
10
intaglia
smear layer
myelinated and nonmyelinated nerve fibers
all of the above
12. Biofilm deposits on root surfaces may
increase hypersensitivity.
a. True
b. False
13. One survey of dentists and dental
hygienists found that fewer than half of
respondents considered a differential
diagnosis for dentinal hypersensitivity,
even though it is by definition a diagnosis
of exclusion.
a. True
b. False
14. Patients with unresolved hypersensitivity
over many years provide the dental professional with varied ___________ clues.
a.
b.
c.
d.
behavioral and censorial
postural and censorial
postural and behavioral
none of the above
15. As part of any screening for dentinal
hypersensitivity, the clinician should
assess whether there is a localized or
generalized problem.
a. True
b. False
16. If a tooth or teeth are predisposed to
dentin hypersensitivity, they can be
definitively treated once and for all and
with no need for the problem to be a
future consideration.
a. True
b. False
17. Avoiding brushing teeth immediately
after the ingestion of acidic foods is a
___________ for dentinal hypersensitivity.
a. treatment recommendation
b. preventive recommendation
c. requirement only if the patient uses a hard-bristled
brush
d. problem
18. The two major groups of products used
to treat dentin hypersensitivity are
c. binding to the negatively charged dentin surface
and helping to attract a calcium-rich layer from the
saliva to infiltrate and block the dentin tubules
d. none of the above
22. In-office paint-on surface treatments
are a popular approach to treating root
hypersensitivity.
a. True
b. False
23. An aqueous solution of glutaraldehyde
and HEMA has been reported to be an
effective desensitizing agent for up to
___________.
a.
b.
c.
d.
three months
six months
nine months
one year
24. Several controlled studies have demonstrated the effectiveness of burnishing
a 0.5% solution of prednisolone onto
exposed sensitive root surfaces to mitigate
intractable hypersensitivity.
a. True
b. False
25. When the exposed sensitive root surface
has surface loss due to abrasion, erosion
and/or abfraction leaving a notching of
the root, consideration should be given to
placing ___________.
a. a temporary restoration
b. an adhesive composite resin or a glass ionomer
restoration
c. a luting cement or a liner
d. none of the above
26. The clinician needs to understand the
in-office desensitizing agents to select one
that is appropriate for the patient.
a. True
b. False
a. those that remove dentinal tubules, and those that
enhance transmission of neural impulses
b. those that occlude and block dentinal tubules, and
those that enhance transmission of neural impulses
c. those that occlude and block dentinal tubules, and
those that interfere with the transmission of neural
impulses
d. none of the above
27. Calcium sodium phosphosilicate bioactive glass, as well as amorphous calcium
phosphate, has been found to be effective
in treating dentinal hypersensitivity.
19. When treating patients with an in-office
professional treatment, the American
Dental Association treatment codes that
can be noted for insurance reimbursement
are ___________.
28. According to an FDA monograph,
for a potassium nitrate toothpaste to
claim to be desensitizing, it must contain
___________.
20. Eight percent arginine and calcium
carbonate paste has been shown to
occlude the dentin tubules and to provide
significant relief for patients postoperatively after scaling and root planing and
oral prophylaxis.
29. Using 5% potassium nitrate desensitizing
toothpaste and brushing with it for two
weeks prior to initiating bleaching is effective in reducing dentinal hypersensitivity
associated with bleaching.
21. Arginine provides relief from hypersensitivity by ___________.
30. Depending on the severity of the
condition, clinical management of
dentinal hypersensitivity may include
both in-office and self-applied at-home
therapies.
a.
b.
c.
d.
D9910 and D9920
D8810 and D9910
D9910 and D9911
none of the above
a. True
b. False
a. binding to the negatively charged oral mucosa and
helping to attract a fluoride-rich layer to infiltrate
and block the dentin tubules
b. binding to the positively charged dentin surface
and helping to attract a calcium-rich layer from the
saliva to infiltrate and block the dentin tubules
a. True
b. False
a.
b.
c.
d.
3% potassium nitrate
5% potassium nitrate
7% potassium nitrate
10% potassium nitrate
a. True
b. False
a. True
b. False
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