1. Treatment of Dentin Hypersensitivity
Dr. Ahmed Al Mokhatieb

2. is exemplified by brief, sharp, well-localized pain in response to
thermal, evaporative, tactile, osmotic, or chemical stimuli that cannot be ascribed to
any other form of dental defect or pathology
Pulpal pain is usually more prolonged,
dull, aching, and poorly localized and usually lasts longer than the applied stimulus.

3. Up to 30% of adults have dentin hypersensitivity at some period of their lives
Current techniques for treatment may be only transient in nature and results are not always
predictable

4. Two chief methods of treatment of dentin hypersensitivity
1 tubular occlusion
2blockage of nerve activity

5. A differential diagnosis needs to be accomplished before any treatment because many symptoms are common to a variety of causes

6. Items to be considered:
the pain—sharp, dull, or throbbing
how many teeth and their location
which part of the tooth elicits the pain
the intensity of the pain

7. Clinical and radiographic examination is necessary to elucidate the cause

8. The following questions need to be asked
Can the pain be localized to one tooth or area of the tooth?
Is the area sensitive to a moderate flow of air from an air water syringe?
Is the tooth sensitive to percussion? Is there sensitivity to biting pressure or on release?

9. The following questions need to be asked
What is the extent of the pain after the stimuli is removed?
Do radiographs demonstrate caries or periapical pathology?
Is the dentin exposed as a result of recession and are there any cracked cusps, open margins, or occlusal hyperfunction?

10. MECHANISM
There are regional differences in dentin sensitivity
Freshly exposed dentin in the coronal part of the tooth is more sensitive than cervical dentin

11. Hypersensitive dentin, however, is found most often in the cervical area
The sensitivity of dentin has a direct correlation with the size and patency of the dentinal tubules
Absi and colleagues discovered that hypersensitive teeth have an increased number of patent tubules and wider tubules than those of no sensitive teeth

12. CAUSES
There is no principal cause.
The loss of enamel and removal of cementum from the root with exposure of dentin, however, is a major contributing factor

13. CAUSES
Causes include gingival recession due to root prominence and thin overlying mucosa, dehiscences and fenestrations, frenum pulls, and orthodontic movement, which causes a root to be moved outside its alveolar housing

14. Loss of enamel may be a consequence of attrition, erosion, abrasion, and abfraction.
The loss of enamel, however, is usually a combination of two or more of these factors

15. BLEACHING
The sensitivity that occurs with bleaching is a result of a reversible pulpitis that is caused by the flow of dentinal fluid from osmolarity changes in the pulp
These changes occur when the bleaching material rapidly penetrates enamel and dentin to the pulp. Hydrogen peroxide and urea penetrate through integral enamel, through the dentin, and into the pulp in 5 to 10 minutes

16. BLEACHING
Most often, the sensitivity is generalized
The estimates of tooth hypersensitivity caused by whitening are usually approximately 60%
Usually higher concentrations of peroxide results in a greater degree of sensitivity.
The addition of low levels of potassium nitrate to tray bleaches has reduced but not eradicated sensitivity.

17. PERIODONTAL TREATMENT
Unfortunately, patient discomfort often occurs while
undergoing periodontal treatment. Postoperative pain and dentin hypersensitivity
are often occurrences. Some patients find both the nonsurgical and surgical treatment
painful. It has been reported that periodontal therapy can be an important source of
dentin hypersensitivity.

18. TREATMENT—SELF-APPLIED AND OFFICE SUPPLIED
Self-applied treatments to reduce sensitivity consist of materials that occlude dentinal
tubules, coagulate or precipitate tubular fluids, encourage secondary dentin formation,
or obstruct pulpal neural response. Desensitizing toothpastes that contain potassium
salts, either nitrates or chlorides, are believed to act by depolarizing the nerve
surrounding the odontoblastic process, resulting in interference of transmission.
Usually

19. LASER TREATMENT
The treatment seems to be only transient, however, and the sensitivity returns in
time. In order for a laser to actually alter the dentin surface, it has to melt and resolidify
the surface. This effectively closes the dentinal tubules. This does not occur. It is
felt that laser treatment reduces sensitivity by coagulation of protein and without
altering the surface of the dentin. Dicalcium phosphate-bioglass in combination
with Nd:YAG laser treatment has sealed dentin tubules to a depth of 10 mm, and
dicalcium phosphate-bioglass plus 30% phosphoric acid occluded exposed tubules
up to 60 mm.

20. FLUORIDE TREATMENT
Fluorides reduce the permeability of dentin probably by precipitation
of insoluble calcium fluoride inside the dentinal tubules and reduce sensitivity.
PRO-ARGIN
This material was able to plug and seal exposed dental tubules to
decrease sensitivity.
OXALATE
Pashley and Galloway38 felt that using potassium oxalate resulted in calcium oxalate
crystals, occluding the tubules

21. CASEIN PHOSPHOPEPTIDE–AMORPHOUS CALCIUM PHOSPHATE
The peptides present in Recaldent become bound to the dentin surface and this causes a mineral deposit formation in the dentin surface resulting in decreased opening of the dentinal tubules
CALCIUM PHOSPHATE PRECIPITATION
Chiang and colleagues44 found a mesoporous silica biomaterial containing nanosized
calcium oxide particles mixed with 30% phosphoric acid can occlude dentinal tubules
and considerably reduce dentin permeability even in the presence of pulpal pressure.

22. CARBONATE HYDROXYAPATITE NANOCRYSTALS AND SODIUM
FLUORIDE/POTASSIUM NITRATE DENTIFRICE
Synthetic hydroxyapatite (carbonate hydroxyapatite) biomimetic nanocrystals,
introduced recently, have demonstrated the ability to remineralize altered enamel
surfaces and close dentinal tubules.There is a progressive closing of the dentinal
tubules in several minutes and subsequently a remineralized layer forms in a few
hours.
GLUTARALDEHYDE
based on aqueous glutaraldehyde, which occludes the tubules by cross-linking of dentinal
proteins.

23. SEAL & PROTECT AND ADMIRA PROTECT
The material is applied to a slightly moist surface, air dried, and light cured and then a second application is applied and light cured for 10 seconds.
PREHYBRIDIZED DENTIN
Prehybridized dentin or immediate dentin sealing has been suggested to make the
dentin less sensitive while a restoration is fabricated in the laboratory. Because
a hybrid layer is created immediately after preparation, teeth treated with the immediate
dentin sealing technique were better able to tolerate thermal and functional loads
in comparison to teeth that were sealed when the restorations were placed.51
VARNISH