Received : 08‑04‑15 Review completed : 14‑05‑15 Review Article Accepted : 23‑05‑15 DENTIN HYPERSENSITIVITY AND ITS MANAGEMENT: A REVIEW Tusharluthra, * Sandeep Gupta, ** Sudhanshu Bharadwaj, *** Ashish Choubey, † Hitendra Yadav, †† Harimran Singh ††† * Assistant Professor, Department of Orthodontics, Rama Dental College, Kanpur, Uttar Pradesh, India ** Reader, Department of Conservative Dentistry, Maharana Pratap College of Dentistry, Gwalior, Madhya Pradesh, India *** Post Graduate Student, Department of Conservative Dentistry, Maharana Pratap College of Dentistry, Gwalior, Madhya Pradesh, India † Post Graduate Student, Department of Conservative Dentistry, Maharana Pratap College of Dentistry, Gwalior, Madhya Pradesh, India †† Post Graduate Student, Department of Pedodontics & Preventive Dentistry, Maharana Pratap College of Dentistry, Gwalior, Madhya Pradesh, India ††† Post Graduate Student, Department of Oral and Maxillofacial Surgery, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India _________________________________________________________________________ ABSTRACT It has been stated in the literature that Dentinal Dentinal hypersensitivity is a very common hypersensitivity develops in two phases: clinical condition of the teeth, which is Lesion localization characterized by short sharp pain arising from Lesion initiation exposed dentin in response to stimuli, there Lesion localization are number of theories of which Brannstrom It occurs by loss of protective covering over the hydrodynamic theory is most widely accepted. dentin which leads to exposing it to external The condition generally involves the facial enviornment. It include loss of enamel via- surfaces of the teeth near the cervical aspect & attrition, abrasion, erosion. Another cause of is very common in premolars & canines. lesion localization is gingival recession which can KEYWORDS: Dentinal hypersensitivity; be due to tooth brush abrasion, pocket reduction etiology; desensitizing agent; management surgery, tooth preparation for crown, excessive flossing or secondary to periodontal diseases.[4] INTRODUCTION Lesion initiation Dentinal hypersensitivity is defined as an It occurs after the protective covering of smear exaggerated response to a stimulus that usually layer is removed leading to exposure & opening [4] causes no response in a healthy tooth & also an of dentinal tubule. exaggerated response to a non harmful stimulus. Mechanism The non harmful stimuli are the thermal, tactile or The intradentinal nerve are confined to the pre osmotic stimuli that when applied on the exposed dentin & the most pulpal part of dentin. This dentin, evoke pain without causing pathologic support the likelihood of an indirect stimulatory alteration to the dentin-pulpo complex. A mechanism evoking pain several theories have modification of this definition is suggested by the been put forward to explain the mechanism of [5,6] Canadian advisory board on Dentinal dentinal hypersensitivity. They are- hypersensitivity in 2003 which suggested that 1. Transduction theory: It states that odontoblast disease should be substituted for pathology. The act as a receptors by themselves & rely signal definition provides the clinical description of the to a nerve terminal, but majority of studies condition & identifies Dentinal hypersensitivity have concluded that odontoblsts are matrix as a distinct clinical identity.[1,2,3] forming cells & hence they are not considered Epidemiology to be excitable cells. About 8 to 30% of the population present 2. Modulation theory: According to this theory Dentinal hypersensitivity & the most affected age the nerve impulses in the pulp are modulated is 20-40 yrs. The first premolar are the most through the liberation of polypeptide from the affected teeth reaching more than half of the teeth odontoblast when injured. These substance ay & the most affected region is the cervical area of selectively alter the permeability of the buccal surface.[2] odontoblastic cell membrane through Pathogenesis hyperpolarization. So that pulp neurons are IJOCR July - Sep 2015; Volume 3 Issue 3 59 Dentin hypersensitivity & management Tusharluthra, Gupta S, Bharadwaj S, Choubey A, Yadav H, Singh H more prone to discharge upon receipt of Potassium oxalate subsequent stimuli. Silicate 3. Hydrodynamic theory: According to Sodium Monofluorophosphate Brannstrom hydrodynamic theory when an Sodium fluoride appropriate stimulus is applied to the outer Sodium fluoride/stannous fluoride dentin surface there is displacement of the combination fluid of dentinal tubule that give rise to the stannous fluoride mechanical stimulation of the pain at the strontium acetate with fluoride pulpodentinal border. strontium chloride Diagnosis Protein precipitants Diagnosis of dentinal hypersensitivity starts with formaldehyde a thorough clinical history & examination. A glutaraldehyde simple clinical method of diagnosing dentinal silvernitrate hypersensitivity includes the jet of air or using an strontium chloride hexahydrate exploratory probe on the exposed dentin, in a Zinc chloride mesiodistal direction,by examining all the teeth. Phytocomplexes The severity or degree of pain can be quantified Rhubarb Rhaponicum either according to categorical scale or using a Spinacia oleracea [7-11] visual analog scale. Fluoride iontophoresis Principles of Management strategy (B) DentinSealers Some of the strategy which could be helpful for Glass ionomer cements the management of dentinal hypersensitivity are Composites as follows: Dentinal adhesives Removal of etiological & pre-disposing Resinous dentinal desensitizers factors Varnishes Patient with mild to moderate hypersensitivity Sealants should be adviced at home desensitizing Methyl Methacrylate therapy (C)Periodontal soft tissue grafting Patient with severe hypersensitivity treatment (D) Lasers should be initiated in office (E) Hoemeopathic medications Prevention measure should be given Plantago major importance & patient should be followed up Proplis regularly At home Desensitizing Agent Classification of desensitizing agent [9,10,12,13] The advantage of this mode is that it is simple and 1. Mode of administration can be used in number of teeth. The disadvantage At home desensitizing agents is that about 2-4 week of tie symptom may In office treatment reoccur. Some of the desensitizing agents that can 2. On the bases of mechanism of action be used at hoe are tooth paste, mouth wash, Nerve desensitization e.g., potassium chewing gums ,containing potassium nitrate, nitrate sodium fluoride or potassium citrate can be Cover or plugging dentinal tubule recommended.[1,5,7,9,14] Ions/salts In office treatment Aluminium Theoretically, the in office desensitizing Ammonium hexafluorosilicate therapy should provide in immediate relief. Calcium hydroxide The agent used for office treatment can be Calcium phosphate classified as: Calcium carbonate a) The material that don’t undergo a setting Calcium silicate reaction eg- oxalate, varnishes Sodium citrate dibasic b) The material that undergo a setting Fluorosilicate reaction eg . composite IJOCR July - Sep 2015; Volume 3 Issue 3 60 Dentin hypersensitivity & management Tusharluthra, Gupta S, Bharadwaj S, Choubey A, Yadav H, Singh H c) Lasers can also be used to manage Formaldehyde or glutaraldehyde dentinal hypersenstivty. These precipitate the salivary proteins in dentinal Potassium nitrate tubules & can be useful in the management of It has been reported that the potassium salts move dentinal hypersensitivity. These agents should be along the dentinal tubules & decrease the used with extreme caution,as they are strong excitability of the tooth by blocking the axonic tissue fixatives. action of the intra-dental nerve fibers. The agents Adhesive material reduce the excitability of nerves that transmit The adhesive resins can seal the dentinal tubules pain. Toothpastes which contain 5% potassium effectively by forming the hybrid layer. Various nitrate along with other ingredient have been studies have demonstrated the effectiveness of reported to be effective in reducing dentine resin in management of dentinal hypersensitivity. hypersensitivity. Newer bonding agent modify smear layer and Calcium hydroxide incorporate it into hybrid layer, recently some Calcium hydroxide is effective in managing bonding agent have been introduced in the market dentinal hypersensitivity. It acts by occlusion of with the sole purpose of treating dentinal dentinal tubules through the binding of loose hypersensitivity. Like gluma desensitizer.[3,5,8,11] protein radicals by calcium ions & additionally Varnishes increases the mineralization of the exposed They help other materials to increase their dentine. therapeutic effect. Fluoride varnishes combine Fluorides with acid to increase its effectiveness. Slow & The desensitizing effects of fluoride are probably continuous release of fluoride occurs with related to precipitated fluoride compounds which fluoride varnish. Calcium fluoride gets deposited mechanically block the dentinal tubules or on the tooth surface, resulting in the formation of fluoride within the tubules which mechanically fluorapatite. Copal is used to cover exposed block the tansmission of stimuli. The dentine. chlorhexidine-containing varnish forms a improvement with fluoride appears to be due to mechanical barrier after drying. This reduces an increase in the resistance of dentine to acid sensitivity, & provides an antibacterial & decalcification as well as