What does the hydrodynamic theory suggest about treating hypersensitive dentine
- Occludent patent (open) tubules and so reduce any stimulus-evoked fluid movements
- Reduce intradental nerve excitability, so that the nerves do not respond to the stimulus-evoked fluid movements
Describe the development of dentine hypersensitivity
- Dentine must be exposed and the dentine tubules must be opened
- Dentine hypersensitivity is most common in cervical dentine, where gingival recession is thought to be a more important factor in lesion localisation than loss of cervical enamel
- Lesion initiation involves removal of both the cementum and dentine smear layers
N.B. this is mainly caused by erosive agents but can be potentiated by abrasion (brushing trauma)
What are some of the aetiological and predisposing factors that can lead to dentine hypersensitivity
- Loss enamel
- Gingival recession
- Attrition/ abrasion/ abfraction/ erosion
- Tooth malposition
- Periodontal disease and its treatment
- Patient habits
What are some potential differential diagnoses of pain besides dentine hypersensitivity
- Cracked tooth syndrome
- Fractured restorations
- Fractured teeth
- Dental caries
- Post-op sensitivity
- Acute hyper function of teeth
- Hypoplastic enamel
- Congenitally open CEJ
Describe the character and timing of the pain with tooth hypersensitivity
Sharp
Stabbing
Stimulation provoked
Describe the character and timing of the pain with Reversible pulpitis
Sharp
Stimulation evoked
Describe the character and timing of the pain with Irreversible pulpitis
Sharp
Throbbing
Intermittent/continuous
Describe the character and timing of the pain with Cracked Tooth Syndrome
Sharp
Intermittent
Describe the character and timing of the pain with Periapical periodontitis
Deep
Continuous
Boring
Describe the character and timing of the pain with a lateral periodontal abscess
Deep
Continuous aching
Describe the character and timing of the pain with pericoronitis
Continuous
Describe the character and timing of the pain with Dry Socket (acute alveolar osteitis)
Continuous
4-5 days post extraction
What is the pain intensity for tooth hypersensitivity
Mild to moderate
What is the pain intensity for reversible pulpitis
Mild to moderate
What is the pain intensity for irreversible pulpitis
Severe
What is the pain intensity for Cracked Tooth Syndrome
Moderate to severe
What is the pain intensity for periapical periodontitis
Moderate to severe
What is the pain intensity for a lateral periodontal abscess
Moderate to severe
What is the pain intensity for pericoronitis
Moderate to severe
What is the pain intensity for dry socket (acute alveolar osteitis)
Moderate to severe
What are the provoking factors for tooth hypersensitivity
- Thermal
- Tactile
- Chemical
- Osmotic
What are the provoking factors for reversible pulpitis
- Hot
- Cold
- Sweet
What are the provoking factors for irreversible pulpitis
- Hot
- Chewing
- Lying flat
What are the provoking factors for cracked tooth syndrome
biting
“rebound pain”
What are the provoking factors for periapical periodontitis
Biting
What are the provoking factors for a lateral periodontal abscess
Biting
What are the provoking factors pericoronitis
Biting
What are the reliving factors for dry socket
Irrigation
What are the stages of management of dentine hypersensitivity
- Diagnosis
- Eliminate predisposing factors + desensitising dentrifice or mouthwash
- If pain persists - Topical agent + prevention ± densensiting dentrifice, mouthwash
- If pain persists - Adhesive material or surgery + prevention
