1. Dentin Hypersensitivity

2. 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

3. 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

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

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

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

7. 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

8. 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 mmHg
External stimuli will cause movement of the dentinal fluid, a hydrodynamic movement

9. Structure of dentin

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

11. 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

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

13. Aetiology
Loss of enamel – tooth wear
Gingival recession

14. Loss of enamel
Abrasion
Erosion
Attrition
Abfraction
Fracture

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

16. Abrasion

17. 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

18. Attrition

19. Abfraction

20. 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

21. Erosion
Dietary habits
Prolonged contact

22. Erosion

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

24. Gingival recession

25. Enamel fracture

26. 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

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

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

29. 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)

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

31. 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

32. 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

33. Special Tooth pastes

37. Restorative resin desensitizers

38. Filling the lesions

39. Thank you for your attention!