International Journal of Dental and Health Sciences Review Article Volume 02,Issue 04

DENTINAL HYPERSENSITIVITY: A PROMISING TREATMENT APPROACH Arun Verma1 ,Shruti Khanna2 1.Professor 2.Post Graduate Student

ABSTRACT: The pain response varies substantially from one person to another. The condition generally involves the facial surfaces of teeth near the cervical aspect and is very common in premolars and canines. The most widely accepted theory of the pain is Brannstrom’s hydrodynamic theory, fluid movement within the dentinal tubules. The dental professional, using a variety of diagnostic techniques, will discriminate such condition from other conditions that may causes sensitivity in teeth. Treatment of the condition can be invasive or non-invasive depending on nature of severity. Keywords: odontoblast, stimuli

INTRODUCTION: either partial or total obliteration of the dentinal tubules or alteration of pulpal Dentine hypersensitivity has been defined sensory activity, or both. as a short, sharp pain arising from exposed dentine in response to stimuli - typically Patency of tubules and vitality of the pulp thermal, evaporative, tactile, osmotic or can be determined by blowing a gentle air chemical - and which cannot be ascribed to stream on the tooth in question for 0.5 to 1 any other dental defect or disease second while covering the adjacent teeth (Canadian Advisory Board on Dentine with gloved fingers. Nonvital teeth or Hypersensitive Teeth, 2003).[1-5] impermeable dentin do not respond to air blasts.[6-15] Even after long periods of exposure to the oral environment, dentinal sensitivity may Epidemiology still be a significant problem despite the exposed tubules becoming occluded by the Incisors 26% smear layer or pellicle. Thus, once Canine 29% sensitivity has become established the pulp may become irreversibly sensitive. Premolars 38% Treatment is therefore aimed at not only restoring the original impermeability of the Molars 12% tubules by occluding them, but also controlling the neural elements within the Occlusal/buccal sites are also now pulp to dampen the external stimulatory becoming more frequently affected in effects. These two modes of control are young adults, probably as a result of dental

*Corresponding Author Address: Dr. Shruti Khanna Email: [email protected] Verma A. et al, Int J Dent Health Sci 2015; 2(4):803-809 wearing caused by a combination of erosion produced or released by odontoblastic and abrasion (Jaeggi and Lussi 2006). processes. Dentine hypersensitivity can present at any age, but the majority of individuals range in age between 20 and 50 years with a peak in prevalence in the age range 30-39 year (Cummins 2009).

It has been reported that there is a slightly higher incidence of dentine hypersensitivity in females compared to males. This difference is, however, not statistically Neural theory: As an extension of the significant. The relationship between odontoblastic theory, this concept dentine hypersensitivity and ageing is advocates that thermal, or mechanical unclear. It has been suggested that with the stimuli, directly affect nerve endings within lifespan of the general population the dentinal tubules through direct increasing, and more people keeping their communication with pulpal nerve fibres. teeth longer, hypersensitivity will increase While this theory has been supported by in prevalence. This seems to make sense on the observation of the presence of the basis that gingival recession and loss of unmyelinated nerve fibres in the outer enamel and cementum is more prevalent in layer of root dentine and the presence of older individuals. The above assumptions putative neurogenic polypeptides, this are somewhat confounded by reports in the theory is still considered theoretical with literature which indicate that most little solid evidence to support it. sufferers of dentine hypersensitivity range in age from 20 to 40 years with the peak Hydrodynamic theory: By far the most incidence occurring at the end of the third widely accepted theory for dentinal decade and decreases during the fourth hypersensitivity is the hydrodynamic theory and fifth decades of life.[16-23] proposed by Brannstrom and co-workers. This theory postulates that fluids within the Theories for dentinal hypersensitivity dentinal tubules are disturbed either by Odontoblastic transduction theory: temperature, physical or osmotic changes According to this theory, odontoblastic and that these fluid changes or movements processes are exposed on the dentine stimulate a baroreceptor which leads to surface and can be excited by a variety of neural discharge. The basis of this theory is chemical and mechanical stimuli. As a result that the fluid filled dentinal tubules open to of such stimulation neurotransmitters are the oral cavity at the dentine surface as well released and impulses are transmitted as within the pulp. In general, the towards the nerve endings. To date no excitement of nerve fibres by different neurotransmitters have been found to be kinds of stimuli can be explained by the hydrodynamic theory. For example,

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Verma A. et al, Int J Dent Health Sci 2015; 2(4):803-809 dehydration associated with desiccation expanding exponentially, a common side following air movement over the exposed effect of external tooth bleaching is tooth dentine surface results in outward sensitivity. movement of dentinal fluid towards the The osmolarities varied from 4,900 dehydrated surface, which triggersnerve mOsm/kg to 55,000 mOsm/kg. Because fibres and results in a painful sensation.[24- 27] plasma and extracellular fluids have osmolarities of 290 mOsm/kg, these How to measure hypersensitivity?? bleaching gels are all extremely hypertonic and would tend to osmotically draw water Thermal: A simple thermal method for from pulp, through dentin and enamel, and testing for tooth sensitivity is directing a into the bleaching gels. This might burst of room temperature air from a hydrodynamically activate intradental dental syringe onto the test tooth. Blowing nerves.[28-31] air on a tooth involves drying and pain can be easily detected by this method if the Differential Diagnosis teeth are sensitive. Air stimulation has been  Dental caries. standardized as a one – second blast from the air syringe of a dental unit, where its  Cracked tooth syndrome. temperature is set generally between 65 – 70 degrees fahrenheit and at a pressure of  Fractured restorations. 60 psi. An air thermal device has been  Post-restorative sensitivity. devised8. Instruments that involve electric cooling or heating of direct contact metal  Chipped teeth. probes have also been used in some studies  Teeth in acute hyperfunction. Osmotic: An osmotic method consisting of the subjective pain response to a sweet Treatment protocols for dentinal stimulus was used to measure the effect of Hypersensitivity several test dentifrices on dentinal 1. Nerve desensitization sensitivity Potassium nitrate Sensitivity in cases of bleached teeth: Tooth whitening has become an extremely 2. Anti-inflammatory agents popular procedure that has left the dental Corticosteroids office and gone “over-the-counter” as many different consumer products have been 3. Cover or plugging dentinal tubules marketed. All of these products contain either hydrogen peroxide or compounds a. Plugging (sclerosing) dentinal tubules that break down to hydrogen peroxide (ie,  Ions/salts sodium perborate or carbamide peroxide). While the popularity of tooth bleaching is  Calcium hydroxide

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Verma A. et al, Int J Dent Health Sci 2015; 2(4):803-809  Ferrous oxide  Resins

 Potassium oxalate  Varnishes

 Sodium monofluorophosphate  Sealants

 Sodium fluoride  Methyl methacrylate

 Sodium fluoride/stannous fluoride c. Periodontal soft tissue grafting combination d. Crown placement/restorative material  Stannous fluoride e. Lasers  Strontium chloride CONCLUSION  Protein precipitants Dentinal hypersensitivity is a very common  Formaldehyde condition which has been managed by agents and formulations applied locally,  Glutaraldehyde either “in office (iontophoresis, resins, restorations, burnishing of dentin)” or “at  Silver nitrate home (available in the form of gels, cream  Strontium chloride hexahydrate or oral rinse)”. The patient should be responsible for the decision making process  Casein phosphopeptides since some of their daily habits may be contributing to the problem and if not  Burnishing changed the condition will persist.For  Fluoride iontophoresis products developed for personal application at home, potassium nitrate, b. Dentine sealers stannous fluoride, sodium fluoride, sodium  Glass ionomer cements monofluorophosphate and strontium chloride have been found to be safe to use  Composites and beneficial to patients in combating this condition.

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