Gingival Recession and Dentine Hypersensitivity Flashcards
(40 cards)
Define Gingival Recession?
Gingival recession is defined as an apical shift of the gingival margin, causing exposure of the root surface of a tooth. Location of the marginal tissue apical to the cemento - enamel junction with exposure of the root surface
New classification scheme for periodontal and peri-implant diseases and conditions (2018):
Other Conditions Affecting the Periodontium-Mucogingival Deformities and Conditions-
Mucogingival deformities and conditions around teeth
Gingival phenotype Gingival / soft tissue recession Lack of gingiva Decreased vestibular depth Aberrant frenum / muscle position Gingival excess Abnormal colour Condition of the exposed root surface
Prevalence:
Recession of 1mm or more in 58% of adults age 30+
Increased prevalence and extent with age
37.8% and extent of 8.6% of teeth in 30-39 year olds
90.4% and extent of 56.3% in 80-90 year olds
Greater gingival recession:
Left side of jaw
Males V females
Afrocarribeans V white Caucasians
Aetiology of recession:
Bone morphology- Crestal bone Trauma Keratinised Tissue Local Plaque Retention Factors restorative dentistry calculus and plaque Malocclusion High attachment of fraenum Periodontal disease
Bone morphology- Crestal bone
Tooth positioning in the arch can affect the bone morphology around a tooth, gingival recession comes with alveolar bone dehiscence, it is not clear whether this develops before gingival recession or in parallel
Trauma
Foreign bodies: Lower lip piercing/ Finger nail picking
Toothbrushing: Hard toothbrush, frequency, frequency of changing brush, technique
Partial dentures: Poorly designed or maintained/ Oral hygiene
Chemical trauma: Topical cocaine
Keratinised Tissue
It was believed that a certain apico-coronal width of keratinised tissue was required, No minimum width.
Thickness and texture of attached gingiva is important,
thin, fragile tissue pre-disposed to recession in presence of plaque-induced inflammation or trauma
Local Plaque Retention Factors
High muscle attachment and frenal pull
Restorative dentistry:
subgingival margins increase plaque retention
more pronounced inflammation seen in thin gingiva
? Does increase in thickness decrease risk of recession
calculus/plaque: studies correlate the prevalence of generalised recession with high levels of batcerial deposits round the tooth
Periodontal disease
pocket redcuing following successful NSPT, surgical trratment may also result in more gingiva; recession
Clinical Outcome of gingival recession:
Dentine Hypersensitivity Aesthetic concerns Plaque retention and inflammtion tooth abrasion root caries
Define dentine hypersensitivty:
Dentine hypersensitivity is characterised by short, sharp pain arising from exposed dentine in response to certain stimuli, which cannot be attributed to any other dental defect or disease
It may go on to manifest as a dull ache beyond the duration of the stimulus, possibly as an altered (irreversible) pulpal response
Epidemiology of dentine hypersensitivity:
Peak incidence is 20-40 years
Gender bias to sensitivity, F>M
And at an earlier age
Could be due to better OH, F>M
Distribution of dentine hypersensitivity
Most frequently the buccal/labial cervical areas of teeth In order of most often affected teeth First premolars Canines Incisors Second premolars Molars Correspond to areas of gingival recession Correspond to areas of thinning enamel Correspond to areas of cementum loss
Types of stumli :
Thermal- hot and cold
Osmotic (hypertonic solutions)
Sweet/ Spicy/ Acid
Micro-organisms and their metabolites can penetrate tubules (?)
Desiccation-Drying of lesions often stimulates pain
With evaporation of fluids, there may be a thermal element
Electrical -Galvanic reactionsElectric pulp testing
Tactil-Touching/Probing/Tooth brushing
Mechanism of sensitivity conduction
Odontoblasts as receptors?
Inconclusive
Nerves in dentine?
Only seen in 1% of tubules in the cervical margin, however electrical current and cold stimulate nerves directly
Hydrodynamic mechanism?
Currently accepted hypothesis (Brännström, 1963)
Brännström hydrodynamic hypothesis
Dentine hypersensitivity caused by the movement of dentinal tubule contents
Increased outward fluid flow causes a pressure change across the dentine
Distortion of A-delta fibre causes pain
Brännström hydrodynamic hypothesis
Dentine hypersensitivity caused by the movement of dentinal tubule contents
Increased outward fluid flow causes a pressure change across the dentine
Distortion of A-delta fibre causes pain
May be another process involved
Fluid flow changes also result in an electrical discharge
This may be able to stimulate nerves electrically
why does size matter?
Width of tubule
Rate of fluid flow depends on 4th power of the radius
So if a tubule is twice the width fluid flow is 16 times greater
Sensitive dentine shows:
A disrupted smear layer
Many more dentinal tubules at the surface
Tubules not occluded by deposits
Tubule diameter wider
Root sensitivity
Term proposed for dentine hypersensitivity from gingival recession due to periodontal disease and treatment
Potentially microorganisms invading root dentinal tubules. May be different aetiology
Dentine Exposure
Resulting from loss of enamel
Removal of enamel by restorative procedures
Attrition (not in cervical buccal lesions)
Abrasion
Erosion
Combined erosion and abrasion
The role of Toothbrushing
Tooth brushing alone has no significant effect on hard tissues
Plus toothpaste, has potential to abrade dentine considerably
Toothbrush design/bristles may contribute indirectly
