Gingival Recession and Dentine Hypersensitivity Flashcards Preview

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1

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

2

New classification scheme for periodontal and peri-implant diseases and conditions (2018):

Other Conditions Affecting the Periodontium-Mucogingival Deformities and Conditions-

3

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

4

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

5

Greater gingival recession:

Left side of jaw
Males V females
Afrocarribeans V white Caucasians

6

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

7

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

8

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

9

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

10

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

11

Periodontal disease

pocket redcuing following successful NSPT, surgical trratment may also result in more gingiva; recession

12

Clinical Outcome of gingival recession:

Dentine Hypersensitivity
Aesthetic concerns
Plaque retention and inflammtion
tooth abrasion
root caries

13

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

14

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

15

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

16

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

17

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)

18

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

19

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

20

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

21

Sensitive dentine shows:

A disrupted smear layer
Many more dentinal tubules at the surface
Tubules not occluded by deposits
Tubule diameter wider

22

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

23

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

24

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

25

The role of toothpaste

Abrasive particles might remove the smear layer and open tubules
Detergents might help to remove the smear layer
Tubules could be occluded with particulate matter from the paste

26

Erosion

Intrinsic or extrinsic source of acids
enamel and dentine loss and surface softening
 tooth surface loss by toothpaste abrasion if intra-oral environment acid

27

what factors other then PH in progression of erosion?

pH of the acid is not the only factor in erosion
Type, chemical strength, temperature, exposure time are other variables
Think of fruits other than citrus, health supplements, mouthwashes, fruit teas, alcopops, wine etc.

28

History, examination and diagnosis?

Record extent of recession (millers classification)
Descriptive
Index
Identify aetiological factors

29

Classically, dentine hypersensitivity is:

Of a sharp nature, duration usually as long as stimulus
Main stimuli cold or evaporative

30

Differential diagnosis for dentine hypersensitivity

Cracked tooth syndrome
Incorrect placement of dentine bonding agents
Fractured restorations
Pulpal response to caries and restorative treatment
Restoration left high in occlusion
Palatogingival groove
Chipped tooth
Vital bleaching