recession and dentine hypersensitivity

Question 1

what is the definition of gingival recession

Answer 1

Gingival margin positioned apical to the cej with exposure of the root surface

Question 2

what is the prevalence of gingival recession 1mm or more in people aged 30+

Answer 2

58%

Question 3

what happens to prevalence and extent of recession with age

Answer 3

increases

Question 4

what is the prevalence and extent in 30-39 year olds

Answer 4

37.8%

and extent of 8.6%

Question 5

what is the prevalence and extent in 80-90 year olds

Answer 5

90.4

and extent of 56.3%

Question 6

what is the distribution of recession

Answer 6

maxillary 6s

and mandibular central incisors

Question 7

which teeth can suffer from dentine hypersensitivity

Answer 7

upper and lower canine

1st premolar and incisor teeth

Question 8

where can there be greater gingival recession

Answer 8

left side of the jaw
in males vs females
and afrocarribeans rather than caucasians

Question 9

where is good OHI associated

Answer 9

with buccal surfaces

Question 10

and where is poor OHI associated

Answer 10

with lingual surfaces of lower anterior teeth

Question 11

what is the aetiology of gingival recession

Answer 11

periodontal disease OR

normal sulcus and undisposed interdental crystal bone

Question 12

which teeth are more likely to have gingival recession

Answer 12

teeth near the buccal surface

Question 13

how else can we have crestal bone loss

Answer 13

by orthodontic movement-

Question 14

what can orthodontic tooth movement cause

Answer 14

dehiscence

greater risk of recession with XS proclination of lower incisors and arch expansion

Question 15

what is recession based on

Answer 15

the volume of soft tissue surrounding the tooth

Question 16

when is there a greater risk of recession-regarding orthodontics

Answer 16

when XS proclination of lower incisors and arch expansion

Question 17

give examples of trauma

Answer 17

foreign objects- lip/tongue piercing
nail biting
hard tooth brushing 
poorly designed dentures- maintained 
trauma from malocclusion 
chemical trauma- cocaine

Question 18

what is tissue called when its bound to the bone

Answer 18

mucoperiosteum

Question 19

what features of the mucogingival junction can make it more prone to recession

Answer 19

thin and less volume of the tissue can make it more likely to recess

Question 20

what is the local plaque retention factors

Answer 20

high muscle attachment

frenal pull

Question 21

what procedure can we do to increase the volume of tissue

Answer 21

gum graft surgery

Question 22

what can also occur post treatment

Answer 22

recession- need to warn patients sometimes

Question 23

why does smoking have an effect on recession

Answer 23

once the smoke is taken in it pools behind the upper anterior teeth- direct effect on tissues

Question 24

what are the consequences of recession

Answer 24

tooth loss
bleeding gums 
plaque retention 
root caries
aesthetics
abrasion
dentine hypersensitivity

Question 25

what is dentine hypersensitivity characterised by

Answer 25

short sharp-pain arising from exposed dentine in response to certain stimuli-which cannot be attributed to any other dental disease or defect

Question 26

what can dentine hypersensitivity go on to do

Answer 26

a dull ache which means the pulp has also been affected

Question 27

when is the peak incidence of dentine hypersensitivity

Answer 27

20-40 years

Question 28

what is the self reported percentage of hypersensitivity

Answer 28

8-30%

Question 29

what is the % of dentine hypersensitivity in more varied practice population

Answer 29

3.8%

Question 30

which gender is more prone to dentine hypersensitivity

Answer 30

females

Question 31

where does dentine hypersensitivity occur more

Answer 31

buccal, labial,cervical areas of teeth

Question 32

which teeth are most affected in order by DH

Answer 32

``` first premolars canines incisors second premolars molars ```

Question 33

what do you need to have for DH

Answer 33

``` DENTINE EXPOSURE(lesion localisation)+tubules made open(lesion initiation)+ stimulus pulp must be vital*** ```

Question 34

what can the stimuli be

Answer 34

thermal( hot or cold- cold more) spicy acid sweet

Question 35

how does DH occur

Answer 35

hydrodynamic theory due to osmosis and fluid in the dentinal tubules or the microorganisms and their metabolites which can penetrate

Question 36

how can we detect DH

Answer 36

by touching- probing tooth brushing

Question 37

what is the hydrodynamic theory

Answer 37

fluid flow causes a pressure change across the dentine | causes distortion A delta fibres pain

Question 38

which fibres cause pain

Answer 38

A delta fibres

Question 39

who thought of the hydrodynamic theory

Answer 39

Brannstrom

Question 40

what else can affect fluid flow in dentinal tubules

Answer 40

width of the tubules

Question 41

what does rate of fluid flow depend on

Answer 41

4TH power of the radius of the tubules

Question 42

why do older people not suffer from DH

Answer 42

due to the fact secondary dentine is deposited in the dentinal tubules so it blocks fluid flow

Question 43

what does sensitive dental tubules show

Answer 43

disrupted smear layer more dental tubules at the surface and not occluded wider tubules

Question 44

what is root sensitivity

Answer 44

DH from gingival recession due to perio disease and treatment

Question 45

what might cause root sensitivity

Answer 45

potentially microorganisms invading root dental tubules

Question 46

dentine exposure can occur from

Answer 46

enamel of enamel by restorative procedues erosion abrasion attrition

Question 47

does toothbrushing alone has an affect on hard tissues

Answer 47

NO | toothpaste has an effect-abrasive effect

Question 48

what might affect teeth indirectly in regard to teeth

Answer 48

toothbrushing technique

Question 49

what might remove the smear layer-regards to toothpaste

Answer 49

abrasive particles | detergents

Question 50

what might tubules be occluded with

Answer 50

with particulate matter from paste

Question 51

when can TSL increase

Answer 51

by toothpaste abrasion if inter oral environment acidic-eg do not brush straight after breakfast

Question 52

what is erosion influenced by

Answer 52

``` pH type chemical strength exposure times other sources of acid ```

Question 53

what do we look at in history examination and diagnosis

Answer 53

record extent of recession descriptive index-rarely used aetiological factors

Question 54

what are the stages of treatment planning

Answer 54

pain management prevent progression perio screening and treatment

Question 55

how do we manage hypersensitivity

Answer 55

tubule occlusion - promotes formation of new tissue eg new smear layer app of artificial barrier blocking pulpal nerve response

Question 56

what are the ideal qualities of barrier materials

Answer 56

``` retentive insoluble penetrate tubules form mechanical tags into tubules seal the end of tubules ```

Question 57

what can we use for home use of managing HS

Answer 57

``` toothpaste gels contain potassium, strontium oxalate and fluoride salts potassium nitrate novamin ```

Question 58

what does novamin release

Answer 58

Ca and P to form a hydroxyapatite like layer

Question 59

what did west et al (1997) show for a placebo effect

Answer 59

40%

Question 60

what is good about strontium acetate

Answer 60

withstands immersion in acid

Question 61

what can we use in surgery to manage HS

Answer 61

VARNISH- DURAPHAT (5%Naf) reinforced GIC 1-3 LAYERS of adhesive resin bonding system desensitizing polish paste calcium carbonate and arginine

Question 62

WHAT CAN WE ADVISE to prevent DH

Answer 62

toothbrushing technique- modified bass technique roll toothbrush electric- with pressure sensor

Question 63

what advice do we give with smoking cessation

Answer 63

ask advise act