Dr. Liya Alice Thomas
First year MDS
CONTENTS
• INTRODUCTION
• HISTORICAL REVIEW
• ETIOLOGY/PREDISPOSING FACTORS
• PREVALENCE
• THEORIES
• CLINICAL FEATURES
• ...
INTRODUCTION
• Common global oral health problem
• Most frequently encountered clinical
problem
• One of the oldest record...
DEFINITION
• “Dentine hypersensitivity is characterized
by short, sharp pain arising from
exposed dentin in response to st...
SO WHAT IS ROOT SENSITIVITY
• PERIODONTAL PERIODONTAL
DISEASE TREATMENT
• Different etiology BUT similar pain
symptoms
HISTORIC REVIEW
YEAR PERSON DISCOVERY
1855 JD WHITE Dentinal pain was caused by
movement of fluid in dentinal
tubules
1941...
INCIDENCE AND PREVALENCE
• AGE: all age groups
peak incidence : 30-39 yrs
old age : sensitivity because of-
1)secondary & ...
• SEX : women more frequently affected
(15%)
• INTRAORAL DISTRIBUTION: buccal
cervical zones of permanent teeth
ETIOLOGY &
PREDISPOSING FACTORS
GINGIVAL RECESSION
PRE-DISPOSING FACTORS :-
1)Alveolar bone
2)Tooth anatomy & tooth position
3)Oral hygiene
4)Gingival dis...
(1)ANATOMY OF ALVEOLAR
BONE :
• Most frequently cited predisposing factor
• Thin, fenestrated or absent LABIAL
BONE(Aldrit...
(2)TOOTH ANATOMY & POSITION
:
• Tooth anatomy (Olsson and Lindhe 1991) & tooth
position (Gorman 1967,Modheer and Odenrick ...
(3) ORAL HYGIENE :
(4) GINGIVAL DISEASES :
• ANUG
• ANUP
• Chronic periodontitis with associated
bone loss can cause recession although
the B...
(5) TRAUMA :
• Non-surgical(scaling & root planing)
• Impaction of foreign objects in the
gingiva(Jenkins and Allen 1994)
...
(6) OTHER FACTORS :
• Frenal pull at the gingival margin
(Mazdyasma and stoner 1980,Powell and McEniery
1981)
• Occlusal t...
NEUROPHYSIOLOGY OF
TEETH
• Teeth are supplied by the alveolar
branches of the fifth cranial nerve,
namely the trigeminal n...
• The cell bodies of the sensory neurons of
the pulp are located in the trigeminal
ganglion. Hundreds, perhaps thousands,
...
• Two types of sensory nerve fibres are
seen :
Myelinated fibres (A delta{90%} & A
beta)
Unmyelinated fibres
A delta fib...
THEORIES OF DENTIN
HYPERSENSITIVITY
A number of theories have been proposed
over the years to explain the pain
mechanism of dentinal hypersensitivity - :
Dir...
(1)DIRECT NEURAL
STIMULATION
• One of the first theories put forth
Drawbacks :
• Nerves are present only in the predentine
& inner dentinal zones but donot extend
upto the DEJ which is the ...
(2)Odontoblast Deformation
Theory/Tranducer theory
• Rapp et al
Drawbacks :
• Odontoblastic processes extend only
partly through the dentin and not upto
the DEJ
• No demonstrable neurotr...
(3) Hydrodynamic theory
• Brannstrom
• Dentin has over 300,000 tubules/mm2
which is filled with dentinal fluid.
• In a vit...
• WIDTH of the tubule is important as the
rate of fluid flow is dependent on the
fourth power of the radius.
• If tubule d...
• Higher velocity of fluid flow also occurs in
tubules with smaller dimeter
• Dentin will only be sensitive if the tubules...
CLINICAL FEATURES
–Patients generally complain that pain
arising from dentine hypersensitivity is
usually rapid in onset, ...
DIAGNOSIS
(A) CASE HISTORY :
• History & nature of pain
• Number & location of the sensitive teeth
• Intensity of the pain...
(B) CLINICAL EXAMINATION :
• SUbjECTIvE
EvALUATION
1. Verbal rating scales
2. Visual analogue
scales
3. Verbal descriptor
...
SUbjECTIvE EvALUATION
(1)VERBAL RATING
SCALES :
• Keele 1948
• Four point scale grading pain as SLIGHT ,
MODERATE , SEVERE...
(2)VISUAL ANALOGUE
SCALES :
• 10cm line.extremes of the line represent
limits of pain
• More sensitive in discriminating b...
(3)VERBAL DESCRIPTOR
CHECKLISTS :
• Allows quantitative assessment of both
the sensory and affective dimensions of
pain us...
(4)McGILL WORD
DESCRIPTORS :
• It is used to determine the nature of the
discomfort & to monitor response to
treatment.
DI...
ObjECTIvE EvALUATION
(1)MECHANICAL
STIMULATION :
(2) CHEMICAL(OSMOTIC)
STIMULATION :
• Hypertonic solution of sucrose or calcium
chloride (Anderson & Matthews 1967,Clark e...
(3) THERMAL
STIMULATION:
(4)DEHYDRATING/EVAP
ORATIVE STIMULI :
• Combined thermal & evaporative
stimulus
• Short air blasts have been recommended
t...
(5)ELECTRICAL
STIMULATION :
• Quantification of electric current can be
used to measure sensitivity
• Determine a conditio...
DIFFERENTIAL DIAGNOSIS
• Cracked tooth syndrome(in heavily restored teeth)
• Incorrect placement of dentin adhesives
(nano...
PREVENTION
(1) DIETARY
COUNSELLING :
• Reduce dietary acids
(2)TOOTHBRUSHING
TECHNIQUES :
(3) PLAQUE CONTROL :
(4)REDUCE OR
ELIMINATE
PARAFUNCTIONAL
HABITS• Professionally fabricated occlusal
night guards
• Re-positioning splints
• S...
TREATMENT
DESENSITIZATION BY OCCLUDING
DENTINAL TUBULES
A)Formation of smear layer
B)Topical agents C)Restorations
1.calcium hydroxi...
A) Formation of smear layer :
• Isolating the affected tooth &
burnishing the dentin with an
orangewood stick.
• Results i...
B) Topical Agents :
i)CALCIUM HYDROXIDE –
Mixed with distilled water to
form a thick paste
Applied for a few minutes on
...
ii)CALCIUM PHOSPHATE PASTES –
Amorphous calcium phosphate (ACP)
Blocks tubules & reduces permeability by 85%
Can also b...
iii)SILVER NITRATE –
It reduces fluid movement by
precipitating protein or silver
chloride within the dentinal
tubules.
...
iv)STRONTIUM CHLORIDE –
SrCl2 was the first tubule blocking agent to be
introduced into toothpastes
3 MOA :
a)nerve depo...
V)FLUORIDES –
Agents like sodium fluoride , stannous
fluoride or acidulated phosphate fluoride
may be used for few minute...
STANNOUS FLUORIDE
Research has shown Stannous fluoride to be
effective against dentinal hypersensitivity –
2 to 4 weeks –...
Limitation – potential for temporary extrinsic
tooth staining associated with long-term use
Open tubules following treatm...
SODIUM FLUORIDE
Increase in resistance of dentin to acid
decalcification as well as precipitations in
exposed dentinal tu...
vi)IONOTOPHORESIS -
Electrical potential is used to transfer the ions
into the body for therapeutic purposes
METHOD :-
...
Commonly used solutions –
a)30% potassium oxalate
b)6% ferric oxalate
ADV:long term relief
DISADV:1) uses expensive equ...
vii)POTASSIUM OXALATE –
Oxalate ions + calcium ions =
calcium oxalate crystals
Very effective method
viii)VARNISHES –
Forms a barrier over exposed dentin
& reduces the permeability
Temporary relief
Eg:duraflor,duraphat
ix)DENTIN ADHESIVES-
Dentin bonding agents are used
Micromechanical bonding through
formation of an interdiffusion hybri...
GLUMA DESENSITIZER
• 5% gluteraldehyde and 35%HEMA
in water
• Control DH & decrease post
operative sensitvity in restorati...
INDICATIONS :
• Cervical erosions
• Exposed dentin surface
• Gingival recession
• Under crowns
• Bridges
• Inlays & onlays...
C)Restorations :
• Glass Ionomer Cement or a
Composite Resin Restoration is
used
• Long lasting relief
D) Lasers :
a.CO2 laser
b.Nd:YAG laser
c. Er:YAG laser
d.He:Ne Laser
• MOA- Coagulation & precipitaion of
plasma proteins ...
 ADVANTAGES :
i. analgesic
ii.bio-stimulant
iii.anti-inflammatory effects
iv.painless, safe, fast, conservative
treatment...
 DISADVANTAGES
i. High cost
ii. Professional expertise
iii. Thermal side effects
Lasers as a treatment modality for denti...
DESENSITIZATION BY BLOCKING
PULPAL SENSORY NERVES
POTASSIUM SALTS :
• Excitability of intradental nerves
• MOA : raise con...
• DISADV : works slowly over a period of time
HOW TO USE???
Brushing mouthguard type soft tray
RECENT ADVANCES
A. Pro-Argin technology
B. NovaMin
C. Casein Derivatives
A) PRO-ARGIN
TECHNOLOGY
• “Saliva based composition”
i>Arginine (an aminoacid which is positively
charged at physiological...
• COLGATE has combined ARGININE ,
CALCIUM CARBONATE & FLUORIDE and
this has been clinically proven to provide
lasting reli...
B) NOVAMIN
• Bioactive glass ceramic material that
provides calcium and phosphate
• Calcium sodium phosphosilicate
reacts ...
D) CASEIN DERIVATIVES
• Predominant phosphoprotein in BOVINE
milk
• In alkaline conditions calcium phosphate
is prsent as ...
USES :
• Preventive therapy in high caries risk
patients
• Reduce dental erosion
• Repair enamel involving white spot
lesi...
F)CALM-IT DESENSITIZER
• Calm-it™ Desensitizer is
glutaraldehyde-based desensitizer
that functions by reacting/cross-
link...
• Protection for upto 6-months-This
simple & effective technique
reduces hypersensitivity &
eliminates discomfort from cer...
G) GLU-SENSE
• The no-drip HEMA/Glutaraldehyde
desensitizer that goes where you
place it.
• 35%HEMA/5%Glutaraldehyde gel
f...
• Rub on sensitive area for 30 seconds &
allow to dry. Tooth does not need to
be completely dry before application.
No etc...
H)GEL-KAM DENTIN
BLOCK
• Consists of 0.9% sodium fluoride,0.4%
stannous fluoride & 0.14% hydrogen
fluoride that can be app...
CONCLUSION
Screen patients (does the patient suffer
from stabs of pain or sensitivity)
Obtain patient history
Examine pati...
Is your patient’s history consistent with
dentin hypersensitivity
Confirm the diagnosis
Initiate management
Follow up
Seek...
REFERANCES
 Textbook of operative dentistry-Vimal K Sikri III edition
 Clinical Operative Dentistry-Ramya Raghu,Raghu Sr...
Liya dentinehypersensitivity
Liya dentinehypersensitivity
Liya dentinehypersensitivity
Liya dentinehypersensitivity
Liya dentinehypersensitivity
Liya dentinehypersensitivity
Liya dentinehypersensitivity
Liya dentinehypersensitivity
Liya dentinehypersensitivity
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  • saliva
  • Dentinal hypersensitivity is a problem that
    plagues many dental patients. When a patient
    presents with dentinal hypersensitivity symptoms,
    they should be examined and informed of the
    multiple treatment options that may be necessary
    to eliminate the problem. The patient should be
    responsible for the decision making process since
    some of their daily habits may be contributing
    to the problem and if not changed the condition
    will persist.
  • Liya dentinehypersensitivity

    1. 1. Dr. Liya Alice Thomas First year MDS
    2. 2. CONTENTS • INTRODUCTION • HISTORICAL REVIEW • ETIOLOGY/PREDISPOSING FACTORS • PREVALENCE • THEORIES • CLINICAL FEATURES • METHODS OF EVALUATION • MANAGEMENT • RECENT ADVANCES
    3. 3. INTRODUCTION • Common global oral health problem • Most frequently encountered clinical problem • One of the oldest recorded complaints of discomfort • Response to a stimuli varies from person to person
    4. 4. DEFINITION • “Dentine hypersensitivity is characterized by short, sharp pain arising from exposed dentin in response to stimuli typically thermal, evaporative, tactile, osmotic or chemical and which cannot be ascribed to any other form of dental defect or pathology”. [HOLLAND ET AL,1997]
    5. 5. SO WHAT IS ROOT SENSITIVITY • PERIODONTAL PERIODONTAL DISEASE TREATMENT • Different etiology BUT similar pain symptoms
    6. 6. HISTORIC REVIEW YEAR PERSON DISCOVERY 1855 JD WHITE Dentinal pain was caused by movement of fluid in dentinal tubules 1941 LUKOMSKY Advocated sodium fluoride as desensitising agent 1963 BRANNSTROM Hydrodynamic theory of dentinal pain 1986 KLEINBERG Summarised different approaches that are used to treat hypersensitivity 1915 ALFRED GYSI Fluid in the tubule is incompressible
    7. 7. INCIDENCE AND PREVALENCE • AGE: all age groups peak incidence : 30-39 yrs old age : sensitivity because of- 1)secondary & tertiary dentin 2)pulp fibrosis 3)sclerosis of tubules
    8. 8. • SEX : women more frequently affected (15%) • INTRAORAL DISTRIBUTION: buccal cervical zones of permanent teeth
    9. 9. ETIOLOGY & PREDISPOSING FACTORS
    10. 10. GINGIVAL RECESSION PRE-DISPOSING FACTORS :- 1)Alveolar bone 2)Tooth anatomy & tooth position 3)Oral hygiene 4)Gingival diseases 5)Trauma 6)Other factors
    11. 11. (1)ANATOMY OF ALVEOLAR BONE : • Most frequently cited predisposing factor • Thin, fenestrated or absent LABIAL BONE(Aldritt 1968,Bernimoulan and Curilovie 1977,Lost 1984)
    12. 12. (2)TOOTH ANATOMY & POSITION : • Tooth anatomy (Olsson and Lindhe 1991) & tooth position (Gorman 1967,Modheer and Odenrick 1980) can influence alveolar bone thickness • Orthodontic tooth movement
    13. 13. (3) ORAL HYGIENE :
    14. 14. (4) GINGIVAL DISEASES : • ANUG • ANUP • Chronic periodontitis with associated bone loss can cause recession although the BUCCAL area does not appear to be a site of predilection for periodontal lesions
    15. 15. (5) TRAUMA : • Non-surgical(scaling & root planing) • Impaction of foreign objects in the gingiva(Jenkins and Allen 1994) • Factitious injury(Glenwright and Stranhan 1994) • Toothbrushing (Sandholm et al 1982 , Bergstrom and Eliasson 1988 , Knocht et al 1993)
    16. 16. (6) OTHER FACTORS : • Frenal pull at the gingival margin (Mazdyasma and stoner 1980,Powell and McEniery 1981) • Occlusal trauma (Parfitt and Mjor 1964, Trott and Love 1966) • Emotional stress (Stone 1948)
    17. 17. NEUROPHYSIOLOGY OF TEETH • Teeth are supplied by the alveolar branches of the fifth cranial nerve, namely the trigeminal nerve (the maxillary branch in the upper jaw and the mandibular in the lower jaw). • Pulp is a highly innervated tissue that contains sensory trigeminal afferent axons. • Sympathetic efferent fibers control the blood flow
    18. 18. • The cell bodies of the sensory neurons of the pulp are located in the trigeminal ganglion. Hundreds, perhaps thousands, of axons enter the pulp through the apical foramen where they branch following the distribution of the blood supply all over the pulp. • The majority of the nerve bundles reach the coronal dentin where they fan out to form the nerve plexus of Raschkow. • These then synapse into the odontoblastic cell layer
    19. 19. • Two types of sensory nerve fibres are seen : Myelinated fibres (A delta{90%} & A beta) Unmyelinated fibres A delta fibres – pulp dentin borderin the coronal portion of the pulp & pulp horns C fibres – core of the pulp
    20. 20. THEORIES OF DENTIN HYPERSENSITIVITY
    21. 21. A number of theories have been proposed over the years to explain the pain mechanism of dentinal hypersensitivity - : Direct Neural Stimulation Odontoblast Deformation Theory/Tranducer theory Hydrodynamic theory
    22. 22. (1)DIRECT NEURAL STIMULATION • One of the first theories put forth
    23. 23. Drawbacks : • Nerves are present only in the predentine & inner dentinal zones but donot extend upto the DEJ which is the most sensitive part of the dentine • Nerves absent in root dentin
    24. 24. (2)Odontoblast Deformation Theory/Tranducer theory • Rapp et al
    25. 25. Drawbacks : • Odontoblastic processes extend only partly through the dentin and not upto the DEJ • No demonstrable neurotransmitters like acetylcholine in the neural transmission of the pulp
    26. 26. (3) Hydrodynamic theory • Brannstrom • Dentin has over 300,000 tubules/mm2 which is filled with dentinal fluid. • In a vital tooth there is constant slow outward movement of the fluid through the tubules.
    27. 27. • WIDTH of the tubule is important as the rate of fluid flow is dependent on the fourth power of the radius. • If tubule diameter doubles a 16 fold increase in fluid flow occurs • Sensitive teeth have many more(8 times) & wider(2 times)tubules at the buccal cervical area compared to non-sensitive teeth.
    28. 28. • Higher velocity of fluid flow also occurs in tubules with smaller dimeter • Dentin will only be sensitive if the tubules are patent from pulp to the oral environment & this patency will change with production and removal of the smear layer hence resulting in an episodic condition.
    29. 29. CLINICAL FEATURES –Patients generally complain that pain arising from dentine hypersensitivity is usually rapid in onset, sharp in character, and short in duration. –Pain is considered to be an exaggerated response of normal pulp- dentin complex and is only felt on application of external stimulus. –No lingering discomfort once the stimulus is removed .
    30. 30. DIAGNOSIS (A) CASE HISTORY : • History & nature of pain • Number & location of the sensitive teeth • Intensity of the pain • Stimuli which initiates the pain • Frequency & duration of sensitivity • Treatment history
    31. 31. (B) CLINICAL EXAMINATION : • SUbjECTIvE EvALUATION 1. Verbal rating scales 2. Visual analogue scales 3. Verbal descriptor checklists 4. McGill word descriptors • ObjECTIvE ASSESSmENT 1. Mechanical stimuli 2. Chemical stimulation 3. Electrical stimulation 4. Dehydrating stimulation 5. Thermal stimulation 6. Hydrostatic pressure
    32. 32. SUbjECTIvE EvALUATION (1)VERBAL RATING SCALES : • Keele 1948 • Four point scale grading pain as SLIGHT , MODERATE , SEVERE & AGONIZING • Restrictive choice of words that may not be very precise with all patients.
    33. 33. (2)VISUAL ANALOGUE SCALES : • 10cm line.extremes of the line represent limits of pain • More sensitive in discriminating betwen various treatments and changes in pain intensity • Best available method
    34. 34. (3)VERBAL DESCRIPTOR CHECKLISTS : • Allows quantitative assessment of both the sensory and affective dimensions of pain using a continuum across different pain conditions instead of words intended to distinguish conditions (Gracely et al 1978)
    35. 35. (4)McGILL WORD DESCRIPTORS : • It is used to determine the nature of the discomfort & to monitor response to treatment. DISADV:reliance on the ability of the subject to understand the words presented to them
    36. 36. ObjECTIvE EvALUATION (1)MECHANICAL STIMULATION :
    37. 37. (2) CHEMICAL(OSMOTIC) STIMULATION : • Hypertonic solution of sucrose or calcium chloride (Anderson & Matthews 1967,Clark et al 1987) • Solute in solution diffuses into the dentinal fluid so on repeated application the osmotic pressure difference between the tubular fluid & applied fluid will decrease & reduce the effect of the solution as an osmotic stimulus(Pashley 1986) • Long time intervals should be allowed
    38. 38. (3) THERMAL STIMULATION:
    39. 39. (4)DEHYDRATING/EVAP ORATIVE STIMULI : • Combined thermal & evaporative stimulus • Short air blasts have been recommended to avoid excess evaporation & consequent changes in hypersensitivity (Brannstrom 1963,Pashley et al 1984) & undesirable pulpal effects • Affects wider area-more intense pain response
    40. 40. (5)ELECTRICAL STIMULATION : • Quantification of electric current can be used to measure sensitivity • Determine a condition called PRE-PAIN • Attributed to larger,more rapidly conducting nerve fibres • Current applied should be less than 1 milliampere
    41. 41. DIFFERENTIAL DIAGNOSIS • Cracked tooth syndrome(in heavily restored teeth) • Incorrect placement of dentin adhesives (nanoleakage) • Fractured restorations • Pulpal response to caries & restorative treatment • Improperly contoured restorations (traumatic occlusion) • Chipped teeth • Vital bleaching
    42. 42. PREVENTION (1) DIETARY COUNSELLING : • Reduce dietary acids
    43. 43. (2)TOOTHBRUSHING TECHNIQUES :
    44. 44. (3) PLAQUE CONTROL :
    45. 45. (4)REDUCE OR ELIMINATE PARAFUNCTIONAL HABITS• Professionally fabricated occlusal night guards • Re-positioning splints • Stress management
    46. 46. TREATMENT
    47. 47. DESENSITIZATION BY OCCLUDING DENTINAL TUBULES A)Formation of smear layer B)Topical agents C)Restorations 1.calcium hydroxide paste D)Lasers 2.calcium phosphate paste 3.silver nitrate 4.strontium chloride 5.fluorides 6.potassium oxalates 7.varnishes 8.dentin adhesives
    48. 48. A) Formation of smear layer : • Isolating the affected tooth & burnishing the dentin with an orangewood stick. • Results in the formation of a smear layer which occludes the tubules • Temporary relief
    49. 49. B) Topical Agents : i)CALCIUM HYDROXIDE – Mixed with distilled water to form a thick paste Applied for a few minutes on exposed dentin Increases remineralization Temporary relief
    50. 50. ii)CALCIUM PHOSPHATE PASTES – Amorphous calcium phosphate (ACP) Blocks tubules & reduces permeability by 85% Can also be used to remineralize incipient enamel caries Commercially available product:GC Tooth Mousse contains ACP & caesin phosphopeptide
    51. 51. iii)SILVER NITRATE – It reduces fluid movement by precipitating protein or silver chloride within the dentinal tubules. But it stains dentin and is also damaging to the pulp and gingiva. Not used anymore
    52. 52. iv)STRONTIUM CHLORIDE – SrCl2 was the first tubule blocking agent to be introduced into toothpastes 3 MOA : a)nerve depolarization b)because it is chemically similar to calcium it can replace lost calcium in hydroxyapatite lattice c)deposit a layer of fine particles which can occlude the tubules Commercially available – Sensodyne Tooth wear & sensitivity – Martin Addy, Graham Embery, W Miachael Edgar & Robin Orchardson - 1st edition
    53. 53. V)FLUORIDES – Agents like sodium fluoride , stannous fluoride or acidulated phosphate fluoride may be used for few minutes as mouthrinse, toothpaste or as topical application over exposed dentin. Act by forming fluoroapatite within tubules which blocks fluid movement within dentin.
    54. 54. STANNOUS FLUORIDE Research has shown Stannous fluoride to be effective against dentinal hypersensitivity – 2 to 4 weeks – 0.4% gel MOA– tin rich surface deposit (in vitro) – nearly complete surface coverage and occlusion of tubules Topical stannous fluoride – reduces sensitivity on exposed cervical root surfaces Patricia A. Walters - J Contemp Dent Prac, May 15, 2005, Vol 6, No 2, 107-117
    55. 55. Limitation – potential for temporary extrinsic tooth staining associated with long-term use Open tubules following treatment After use of SnF2 dentrifice with non-sensitivity fluoride toothpaste
    56. 56. SODIUM FLUORIDE Increase in resistance of dentin to acid decalcification as well as precipitations in exposed dentinal tubules MOA– precipitated fluoride compounds mechanically blocking exposed dentinal tubules or fluoride within tubules blocking transmission of stimuli
    57. 57. vi)IONOTOPHORESIS - Electrical potential is used to transfer the ions into the body for therapeutic purposes METHOD :- Place a negative electrode on the dentin & positive electrode on the patient’s face/arm Isolate teeth with plastic strips or cotton rolls Chemical is applied to tooth surface & current is passed through –ive electrode using 0.5mA current.
    58. 58. Commonly used solutions – a)30% potassium oxalate b)6% ferric oxalate ADV:long term relief DISADV:1) uses expensive equipment 2)requires more than one application
    59. 59. vii)POTASSIUM OXALATE – Oxalate ions + calcium ions = calcium oxalate crystals Very effective method
    60. 60. viii)VARNISHES – Forms a barrier over exposed dentin & reduces the permeability Temporary relief Eg:duraflor,duraphat
    61. 61. ix)DENTIN ADHESIVES- Dentin bonding agents are used Micromechanical bonding through formation of an interdiffusion hybrid layer Eg:Gluma desensitizer(Heraeus Kulzer) Amalgambond(Parkell) Single Bond(3M)
    62. 62. GLUMA DESENSITIZER • 5% gluteraldehyde and 35%HEMA in water • Control DH & decrease post operative sensitvity in restorative procedures • No mixing & no curing.No repetitive steps. • No drip formula, so it stays where you place it,minimising contact with soft tissues.
    63. 63. INDICATIONS : • Cervical erosions • Exposed dentin surface • Gingival recession • Under crowns • Bridges • Inlays & onlays • Veneer & temporaries • Margins around temporary crowns • Under all direct restorations.
    64. 64. C)Restorations : • Glass Ionomer Cement or a Composite Resin Restoration is used • Long lasting relief
    65. 65. D) Lasers : a.CO2 laser b.Nd:YAG laser c. Er:YAG laser d.He:Ne Laser • MOA- Coagulation & precipitaion of plasma proteins in the dentinal fluid without altering the surface of dentin. • A meta-analysis study done by Sgolastra F et al in 2013 proved the efficacy of Nd:YAG over Er:YAG in the treatment of dentinal hypersensitivity.
    66. 66.  ADVANTAGES : i. analgesic ii.bio-stimulant iii.anti-inflammatory effects iv.painless, safe, fast, conservative treatment, and it is well accepted by the patients
    67. 67.  DISADVANTAGES i. High cost ii. Professional expertise iii. Thermal side effects Lasers as a treatment modality for dentinal hypersensitivity-Teresa Mao, Dr. Julie Toby IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. Volume9, Issue2 (Jul.- Aug. 2013), PP 29-32 www.iosrjournals.org
    68. 68. DESENSITIZATION BY BLOCKING PULPAL SENSORY NERVES POTASSIUM SALTS : • Excitability of intradental nerves • MOA : raise concentration of potassium ions in the extracellular fluid Depolarization of nerve cells Brief excitatory burst
    69. 69. • DISADV : works slowly over a period of time HOW TO USE??? Brushing mouthguard type soft tray
    70. 70. RECENT ADVANCES A. Pro-Argin technology B. NovaMin C. Casein Derivatives
    71. 71. A) PRO-ARGIN TECHNOLOGY • “Saliva based composition” i>Arginine (an aminoacid which is positively charged at physiological pH) ii>Bicarbonate (pH buffer) iii>Calcium carbonate (source of calcium) • Commercially available as ProClude (instant relief which lasts upto 28days)
    72. 72. • COLGATE has combined ARGININE , CALCIUM CARBONATE & FLUORIDE and this has been clinically proven to provide lasting relief
    73. 73. B) NOVAMIN • Bioactive glass ceramic material that provides calcium and phosphate • Calcium sodium phosphosilicate reacts when exposed to aqueous medium to release calcium & phosphate ions which form hydroxy-carbonate apatite
    74. 74. D) CASEIN DERIVATIVES • Predominant phosphoprotein in BOVINE milk • In alkaline conditions calcium phosphate is prsent as an alkaline amorphous phase along with casein referred to as casein phosphopeptide-amorphous calcium phosphate • CPP-ACP : cariostatic agent
    75. 75. USES : • Preventive therapy in high caries risk patients • Reduce dental erosion • Repair enamel involving white spot lesions • Orthodontic decalcification • Desensitizing agent
    76. 76. F)CALM-IT DESENSITIZER • Calm-it™ Desensitizer is glutaraldehyde-based desensitizer that functions by reacting/cross- linking with plasma proteins in dentinal fluid
    77. 77. • Protection for upto 6-months-This simple & effective technique reduces hypersensitivity & eliminates discomfort from cervical erosion. • Tubule penetration in seconds • Compatibility with adhesives, cements, restoratives, amalgams, core build-up & temporary materials
    78. 78. G) GLU-SENSE • The no-drip HEMA/Glutaraldehyde desensitizer that goes where you place it. • 35%HEMA/5%Glutaraldehyde gel formulation • acts in seconds to seal dentinal tubules, preventing the fluid shift in them.
    79. 79. • Rub on sensitive area for 30 seconds & allow to dry. Tooth does not need to be completely dry before application. No etching or light curing necessary. Avoid contact with soft tissue. • Effect lasts 6 months or longer depending on patient. Permanent under restorations. • Does not interfere with cements or bonding agents
    80. 80. H)GEL-KAM DENTIN BLOCK • Consists of 0.9% sodium fluoride,0.4% stannous fluoride & 0.14% hydrogen fluoride that can be applied in a tray.
    81. 81. CONCLUSION Screen patients (does the patient suffer from stabs of pain or sensitivity) Obtain patient history Examine patients to exclude : •Cracked tooth syndrome •Fractured restorations •Caries •Post operative sensitivity •Vital bleaching •Traumatic occlusion No treatment YES NO
    82. 82. Is your patient’s history consistent with dentin hypersensitivity Confirm the diagnosis Initiate management Follow up Seek and treat other causes
    83. 83. REFERANCES  Textbook of operative dentistry-Vimal K Sikri III edition  Clinical Operative Dentistry-Ramya Raghu,Raghu Srinivasan  Tooth wear & sensitivity- Martin Addy,Graham Embery,W. Michael Edgar, Robin Orchardson.  Treatment of dentin hypersensitivity-DCNA 2011  Dentin hypersensitivity: Recent Trends in Management- J CONS DENT, oct-dec 2010  Clinical Dentin Hypersensitivity: Understanding the causes & prescribing the treatment- Journal of Contemporary Dental Practice.  Dentin hypersensitivity : Etiology,diagnosis and management – A peer-reviewed publication.Howard E Strassler DMD,FADM,FACD and Francis G Serio DMD,MS,MBA,FACD
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