recession and dentine hypersensitivity Flashcards by Yusra Khan

what is the definition of gingival recession

Location of the marginal tissue apical to the cemento - enamel junction with exposure of the root surface with a subtle colour change

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what are examples of mucoginigval deformities and conditions around the 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

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

58%

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what happens to prevalence and extent with age

increases

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

37.8%

and extent of 8.6%

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

90.4

and extent of 56.3%

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what is the distribution of recession

maxillary 6s

and mandibular central incisors

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which teeth can suffer from dentine hypersensitivity

upper and lower canine

1st premolar and incisor teeth

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where can there be greater gingival recession

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

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where is good OHI associated

with buccal surfaces

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and where is poor OHI associated

with lingual surfaces of lower anterior teeth

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what is the aetiology of gingival recession

periodontal disease OR

normal sulcus and undisposed interdental crystal bone

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which teeth are more likely to have gingival recession

teeth near the buccal surface

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how else can we have crestal bone loss

by orthodontic movement-

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what can orthodontic tooth movement cause

dehiscence

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

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what is recession based on

the volume of soft tissue surrounding the tooth

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when is there a greater risk of recession-regarding orthodontics

when XS proclination of lower incisors and arch expansion

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give examples of trauma

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

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what is tissue called when its bound to the bone

mucoperiosteum

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

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

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what is the local plaque retention factors

high muscle attachment

frenal pull

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what procedure can we do to increase the volume of tissue

gum graft surgery

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what can also occur post treatment

recession- need to warn patients sometimes

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why does smoking have an effect on recession

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

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what are the consequences of recession

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

what is dentine hypersensitivity characterised by

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

what can dentine hypersensitivity go on to do

a dull ache which means the pulp has also been affected

when is the peak incidence of dentine hypersensitivity

20-40 years

what is the self reported percentage of hypersensitivity

8-30%

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

3.8%

which gender is more prone to dentine hypersensitivity

females

where does dentine hypersensitivity occur more

buccal, labial,cervical areas of teeth

which teeth are most affected in order by DH

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

what do you need to have for DH

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

what can the stimuli be

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

how does DH occur

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

how can we detect DH

by touching- probing tooth brushing

what is the hydrodynamic theory

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

which fibres cause pain

A delta fibres

who thought of the hydrodynamic theory

Brannstrom

what else can affect fluid flow in dentinal tubules

width of the tubules

what does rate of fluid flow depend on

4TH power of the radius of the tubules

why do older people not suffer from DH

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

what does sensitive dental tubules show

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

what is root sensitivity

DH from gingival recession due to perio disease and treatment

what might cause root sensitivity

potentially microorganisms invading root dental tubules

dentine exposure can occur from

enamel of enamel by restorative procedues erosion abrasion attrition

does toothbrushing alone has an affect on hard tissues

NO | toothpaste has an effect-abrasive effect

what might affect teeth indirectly in regard to teeth

toothbrushing technique

what might remove the smear layer-regards to toothpaste

abrasive particles | detergents

what might tubules be occluded with

with particulate matter from paste

when can TSL increase

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

what is erosion influenced by

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

what do we look at in history examination and diagnosis

record extent of recession descriptive index-rarely used aetiological factors

what are the stages of treatment planning

pain management prevent progression perio screening and treatment

how do we manage hypersensitivity

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

what are the ideal qualities of barrier materials

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

what can we use for home use of managing HS

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

what does novamin release

Ca and P to form a hydroxyapatite like layer

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

40%

what is good about strontium acetate

withstands immersion in acid

what can we use in surgery to manage HS

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

WHAT CAN WE ADVISE to prevent DH

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

what advice do we give with smoking cessation

ask advise act