Dentin Hypersensitivity

Dentin Hypersensitivity Dentin hypersensitivity is sensation felt, defined as a sharp short pain arising from exposed dentine Sensitivity is caused by open dentinal tubules in response to stimuli Common dental painful disease Often under reported by patients

Prevalence of dentin hypersensitivity global prevalence in the adult dentate poulation 57% Patients with periodontitis incidence extreme high as 60 to 98% Symptoms can present at any age from 15 years old to the ages more tnan 70 Ages 20 to 40 is a peak prevalence Women are more frequently affected than males

Stimuli Thermal (mainly cold) Evaporate Tactile (probe, toothbrush) Osmotic (sweet, sour foods) Chemical

Stimulus Cold 80% Air 23% Touch 20% Heat 13% Dietary acid 6.9% Endogenosus acid 0.7%

Epidemiology Affected teeth Location Premolars 38% Incisors 26% Canines 25% Molars 12% Location Cervical 90% Buccal, occlusal surfaces more prevalent

Structure of dentin Largest portion of the tooth structure Inorganic material (hydroxyapatite) account for 70-75% by weight 18-20% organic material 5% water and other materials Dentin is packed with dentinal tubules that transverse its entire thickness

Dentin tubules Tubules are conical, being wider at pulpal end than the periphery Tubules run paralell to each other in an S shape course Diameter of tubules: 1-5 Micrometer with an average of 1,5 Number of tubules decreases from about 65000/mm2 close to the pulp to about 15000/mm2 near the DEJ Content tubular fluid Constant pulpal pressure 25-30 mmHg External stimuli will cause movement of the dentinal fluid, a hydrodynamic movement

Structure of dentin

Dentin hypersensitivity mechanisms theory Neural theory Odontoblastic transduction theory Odontoblast movement theory Hydrodynamic theory (the most widely accepted mechanism)

Mechanism of Hypersensitivity The Hydrodynamic Theory: Exposed dentin tubules Stimulus (thermal, mechanical, chemical) Change in rate of dentin fluid flow Generation action potentials in intradental nerves Movement of fluid stimulate the free nerve endings (of the A-beta, A-delta) located around the odontoblast body Action potentials pass to brain to cause pain

Aetiology Two phases development: Lesion localisation- exposure of dentin Lesion initiation- opening of dentin tubules (removal of cementum or smear layer)

Aetiology Loss of enamel – tooth wear Gingival recession

Loss of enamel Abrasion Erosion Attrition Abfraction Fracture

Abrasion Resulting direct friction forces between the teeth and the external objects Toothbrush abrasion is the most common

Abrasion

Attrition Resulting from tooth to tooth contact Incisal and occlusal surfaces Physiologic movement and contact of teeth by the age Parafunctional habits as such as bruxism

Attrition

Abfraction

Erosion Intrinsic acids Extrinsic acids Gastric reflux Bulimia Commonnly associated with acidic foods and drinks Carbonated drinks Citrus drinks Citrus fruits Wine Intrinsic acids Gastric reflux Bulimia

Erosion Dietary habits Prolonged contact

Erosion

Gingival recession Incorrect tooth-brushing or flossing Gingivitis Periodontitis Periodontal procedures Gingival trauma (picking hard foods)

Gingival recession

Enamel fracture

Tooth whitening Post dental bleaching sensitivity reported 55-75% of patients Increased tooth poriosity and removal of protective protein layer on the surface of the teeth Opened up pores in exposed dentin surfaces

Developmental anomaly Molar Incisor Hypomineralisation Enamel hypoplasia Dentin exposure because of weak enamel

Differential diagnosis Dental caries Periodontal desease Dental fractures Reversible or Irreversible pulpitis Traumatic occlusion TMJ disorder

Diagnosis in dentine hypersensitivity Tactile hypersensitivity score: Yeaple Probe (force measured in grams (10-50g on exposured surface) Schiff Cold Air Sensitivity Scale, used air blast simulus on exposured surface for 1 sec. (scores: 0-3, no pain to painful) Visual Analog Scale (VAS) subjective pain intensity measurement (0-10, no pain to worst imaginable pain)

Treatment principles Desensitizing nerves Occlusion of open tubules block the hydrodynamic mechanism

Treatment I. Desensitizing the nerves Potassium salts: potassium nitrate 5% potassium citrate 3,75% Potassium chloride 5,5% Depolarize the excited nervefibers, thus numbing the pain compatible with Fluoride

Treatment II. Occlusion of dentine tubules Strontium salts High Fluoride Stannosus fuoride HEMA / Glutaraldehyde Restorative resins Ca,Na Phosphosilicate Arginine és calcium carbonate Arginine és PVM/MA copolimer, és Pyrophosphates

Special Tooth pastes

Restorative resin desensitizers

Filling the lesions

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