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DENTINHYPERSENSITIVITY      THIS IS TEST
CONTENTS•   DEFINITION•   ETIOLOGY•   THEORIES OF DENTIN HYPERSENSITIVITY•   CLINICAL FEATURES•    DIOGNOSIS•    TREATMENT
DEFINITIONTHE INTERNATIONAL WORKSHOP ON DENTINHYPERSENSITIVITY(1983) HAS PROPOSED THE FOLLOWINGDEFINITION FOR THIS CONDITI...
ORAL ANATOMY AND DENTAL         TISSUES
ETIOLOGYENAMEL LOSS                CEMENTAL LOSS•   OCCLUSAL WEAR          •   GINGIVAL RECESSION•   TOOTH BRUSH          ...
GINGIVAL RECESSION
ETIOLOGYABFRACTION        TOOTH BRUSH ABRASION
THEORIES OF DENTIN HYPERSENSITIVITY 1. DIRECT INNERVATION THEORY 2. ODONTOBLAST DEFORMATION    THEORY/TRANSDUCER THEORY 3....
DIRECT INNERVATION THEORY• FIRST THEORY TO BE PUT  FORWARD• NERVE FIBERS PRESENT  WITHIN DENTINAL  TUBULES INTIATE  IMPULS...
DIRECT INNERVATION THEORYDISPUTES ABOUT THIS THEORY:•    NERVE FIBERS ARE PRESENT ONLY IN THE     PREDENTIN AND INNER DENT...
ODONTOBLAST DEFORMATION THEORY• ODONTOBLAST OR THEIR PROCESSES ARE DAMAGED  WHEN EXTERNAL STIMULI ARE APPLIED TO EXPOSED  ...
HYDRODYNAMIC THEORYTHE MOST WIDELY ACCEPTEDMECHANISM OF ACTION OF DENTINHYPERSENSITIVTY , THEHYDRODYNAMIC THEORY WHICH WAS...
MECHANISM:WHENEVER DENTIN IS EXPOSEDAND STIMULATED BYTACTILE,CHEMICAL,THERMALOR OSMOTIC STIMULI THERE ISRAPID MOVEMENT OF ...
MECHANISM
DIAGNOSISCOMPLETE HISTORY     CLINICAL             RADIOGRAPHIC                     EXAMINATION          EXAMINATIONSIGNS ...
DIFFERENTIAL DIAGNOSIS1.   FRACTURED RESTORATIONS2.   FRACTURED ENAMEL EXPOSING DENTIN3.   DENTAL CARIES4.   POST RESTORAT...
PREVENTION1. DIET COUNSELLING REGARDING   CONSUMPTION OF ACIDIC FRUITS AND   BEVERAGES2. CORRECTION OF BRUSHING TECHNIQUE3...
MANAGEMENT1.   DESENSITISATION BY OCCLUDING DENTINAL TUBULES       A)FORMATION OF SMEAR LAYER OVER EXPOSED DENTIN       B)...
MANAGEMENT        C)PLACEMENT OF RESTORATIONS             GLASS IONOMER CEMENTS              COMPOSITE RESINS       D)USE ...
CALCIUM HYDROXIDE• IT INCREASES THE  REMINERALISATION OF THE EXPOSED  DENTIN THUS REDUCING DENTIN  PERMIABILITY• DISADVANT...
CALCIUM PHOSPHATE PASTE• IT REDUCES DENTIN HYPERSENSITIVITY BY  BLOCKING TUBULES AND DENTIN PERMEABILITY  IS REDUCED• COMM...
SILVER NITRATE• IT REDUSES FLUID MOVEMENT BY PRECIPITATING  PROTEIN OR SILVER CHLORIDE WITHIN THE  DENTINAL TUBULES• IT IS...
STRONTIUM CHLORIDE• The mode of action is linked to their ability to  form mineralised deposits within the tubule  lumen a...
FLUORIDES• AGENTS-SODIUM FLUORIDE,STANNOUS FLUORIDEOR  ACIDULATED PHOSPHATE FLUORIDE.• USED AS MOUTH RINSES,TOOTHPASTES OR...
FLUORIDE IONTOPHORESIS• IONTOPHORESIS- PROCEDURE IN WHICH IONS OF CHOSEN  MEDICAMENT ARE DRIVEN INTO SPECIFIC TISSUES BY  ...
POTASSIUM OXALATE• SOLUTION IS APPLIED ON DENTIN• OXALATE IONS REACT WITH CALCIUM IONS IN  DENTINAL FLUID TO FORM INSOLUAB...
MANAGEMENTVARNISHES                USE OF LASERSTHEY ACT BY FORMING A    THEY OCCLUDE THEBARRIER OVER EXPOSED     DENTINAL...
POTASSIUM NITRATE     POTASSIUM ION MAYDEPOLARIZE THE NERVE AND      PREVENT IT FROMREPOLARIZING, THEREBY, PRE VENTING IT ...
DENTIN HYPERSENSITIVITY “THE COMMON COLDOF DENTISTRY”
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Transcript of "DENTIN HYPERSENSITIVITY "

  1. 1. DENTINHYPERSENSITIVITY THIS IS TEST
  2. 2. CONTENTS• DEFINITION• ETIOLOGY• THEORIES OF DENTIN HYPERSENSITIVITY• CLINICAL FEATURES• DIOGNOSIS• TREATMENT
  3. 3. DEFINITIONTHE INTERNATIONAL WORKSHOP ON DENTINHYPERSENSITIVITY(1983) HAS PROPOSED THE FOLLOWINGDEFINITION FOR THIS CONDITION:“ IT IS CHARACTERISED BY SHORT,SHARP PAINARISING FROM EXPOSED DENTIN IN RESPONSETO STIMULI TYPICALLYTHERMAL,EVAPORATIVE,TACTILE,OSMOTIC ORCHEMICAL AND WHICH CANNOT BE ASCRIBED TOANY OTHER FORM OF DENTAL DEFECT ORPATHOLOGY”
  4. 4. ORAL ANATOMY AND DENTAL TISSUES
  5. 5. ETIOLOGYENAMEL LOSS CEMENTAL LOSS• OCCLUSAL WEAR • GINGIVAL RECESSION• TOOTH BRUSH • PERIODONTAL DISEASE ABRASION • ROOT PLANING• DIETARY • PERODONTAL SURGERY EROSION• ABFRACTION• PARAFUNCTION AL HABITS
  6. 6. GINGIVAL RECESSION
  7. 7. ETIOLOGYABFRACTION TOOTH BRUSH ABRASION
  8. 8. THEORIES OF DENTIN HYPERSENSITIVITY 1. DIRECT INNERVATION THEORY 2. ODONTOBLAST DEFORMATION THEORY/TRANSDUCER THEORY 3. HYDRODYNAMIC THEORY
  9. 9. DIRECT INNERVATION THEORY• FIRST THEORY TO BE PUT FORWARD• NERVE FIBERS PRESENT WITHIN DENTINAL TUBULES INTIATE IMPULSES WHEN THEY ARE INJURED AND CAUSES DENTINAL HYPERSENSITIVITY.
  10. 10. DIRECT INNERVATION THEORYDISPUTES ABOUT THIS THEORY:• NERVE FIBERS ARE PRESENT ONLY IN THE PREDENTIN AND INNER DENTINAL ZONES• WHEN PAIN INDUCING SUBSTANCES LIKE POTTASIUM CHLORIDE,ACETYLCHOLINE ARE APPLIED TO EXPOSED DENTIN,THEY FAIL TO ELICIT PAINFUL RESPONSE.
  11. 11. ODONTOBLAST DEFORMATION THEORY• ODONTOBLAST OR THEIR PROCESSES ARE DAMAGED WHEN EXTERNAL STIMULI ARE APPLIED TO EXPOSED DENTIN.• THEY CONDUCT IMPULSES TO THE NERVES IN THE PREDENTIN AND UNDERLYING PULP AND THEN TO CNS.• DISFAVOURED AS THE ODONTOBLASTIC PROCESSES EXTEND ONLY PARTLY THROUGH THE DENTIN AND NOT UPTO DEJ.• ODONTOBLASTIC MEMBRANE POTENTIAL IS TOO LOW TO PERMIT TRANSDUCTION.• THERE ARE NO DEMONSTRABLE NEUROTRANSMITTERS IN THE NEURAL TRANSMISSION OF THE PULP.
  12. 12. HYDRODYNAMIC THEORYTHE MOST WIDELY ACCEPTEDMECHANISM OF ACTION OF DENTINHYPERSENSITIVTY , THEHYDRODYNAMIC THEORY WHICH WASPROPOSED BY GYSI IN 1900 ANDVALIDATED BY BRANNSTROM IN 1996
  13. 13. MECHANISM:WHENEVER DENTIN IS EXPOSEDAND STIMULATED BYTACTILE,CHEMICAL,THERMALOR OSMOTIC STIMULI THERE ISRAPID MOVEMENT OF FLUIDTHROUGH TUBULES.THIS CAUSES:• DIRECT STIMULATION OF LOW THRESHOLD A- DELTA NERVE FIBERS• INDIRECT STIMULATION OF A- DELTA NERVE FIBERS IN PULP BY DISPLACING ODONTOBLASTIC CELL BODIES.
  14. 14. MECHANISM
  15. 15. DIAGNOSISCOMPLETE HISTORY CLINICAL RADIOGRAPHIC EXAMINATION EXAMINATIONSIGNS AND SYMPTOMS VISUAL ASSESMENT RULE OUT PERI APICAL LESIONINTENSITY PHYSICAL ASSESMENTFREQUENCY AND DEPTH OFDURATION PERIODONTAL POCKET DEPTHDIETARY CHANGES PERCUSSION TESTING RESPONSE TO COLD AIR
  16. 16. DIFFERENTIAL DIAGNOSIS1. FRACTURED RESTORATIONS2. FRACTURED ENAMEL EXPOSING DENTIN3. DENTAL CARIES4. POST RESTORATION SENSITIVITY5. CRACKED TOOTH SYNDROME6. BLEACHING SENSITIVITY
  17. 17. PREVENTION1. DIET COUNSELLING REGARDING CONSUMPTION OF ACIDIC FRUITS AND BEVERAGES2. CORRECTION OF BRUSHING TECHNIQUE3. CARE DURING OPERATIVE PROCEDURES4. CARE DURING PERIODONTAL PROCEDURES
  18. 18. MANAGEMENT1. DESENSITISATION BY OCCLUDING DENTINAL TUBULES A)FORMATION OF SMEAR LAYER OVER EXPOSED DENTIN B)USE OF TOPICAL AGENTS TO OCCLUDE EXPOSED TUBULES CALCIUM HYDROXIDE PASTE CALCIUM PHOSPHATE PASTE SILVER NITRATE FLUORIDES FLUORIDE IONTOPHRESIS POTASSIUM NITRATE VARNISHES DENTIN ADHESIVES
  19. 19. MANAGEMENT C)PLACEMENT OF RESTORATIONS GLASS IONOMER CEMENTS COMPOSITE RESINS D)USE OF LASERS CO2 LASER Nd:YAG,Er:YAG LASER He:Ne LASER2. DESENSITIZING BY BLOCKING PULPAL SENSORYNERVES A)POTASSIUM NITRATE TOOTHPASTE
  20. 20. CALCIUM HYDROXIDE• IT INCREASES THE REMINERALISATION OF THE EXPOSED DENTIN THUS REDUCING DENTIN PERMIABILITY• DISADVANTAGE:IT CAUSES TEMPORARY OCCLUSION OF TUBULES
  21. 21. CALCIUM PHOSPHATE PASTE• IT REDUCES DENTIN HYPERSENSITIVITY BY BLOCKING TUBULES AND DENTIN PERMEABILITY IS REDUCED• COMMERCIALLY AVAILABLE PRODUCT – GC TOOTH MOUSSE• IT CONTAINS AMORPHOUS CALCIUM PHOSPHATE AND CAESIN PHOSPHOPEPTIDE
  22. 22. SILVER NITRATE• IT REDUSES FLUID MOVEMENT BY PRECIPITATING PROTEIN OR SILVER CHLORIDE WITHIN THE DENTINAL TUBULES• IT IS NOT USED NOWADAYS AS IT STAINS DENTIN AND ALSO DAMAGES PULP AND GINGIVA
  23. 23. STRONTIUM CHLORIDE• The mode of action is linked to their ability to form mineralised deposits within the tubule lumen and on the surface of the exposed dentine that help prevent transmission of the applied stimulus.
  24. 24. FLUORIDES• AGENTS-SODIUM FLUORIDE,STANNOUS FLUORIDEOR ACIDULATED PHOSPHATE FLUORIDE.• USED AS MOUTH RINSES,TOOTHPASTES OR TOPICAL APPLICATION ON EXPOSED DENTIN.• ACTION IS BY FORMING FLUORAPATITE WITHIN TUBULES WHICH BLOCK FLUID MOVEMENT WITHIN DENTIN.
  25. 25. FLUORIDE IONTOPHORESIS• IONTOPHORESIS- PROCEDURE IN WHICH IONS OF CHOSEN MEDICAMENT ARE DRIVEN INTO SPECIFIC TISSUES BY MEAHS OF ELECTRIC CURRENT.• FLOURIDE IONTOPHORESIS TRANSFERS FLUORIDE IONS INTO DENTIN FOR DESENSITIZING IT.• UNIT HAS -POSITIVE ELECTRODE IS PLACED ON PATIENTS FACE OR ARM -NEGETIVE ELECTRODE IS PLASTIC TIP PLACED AROUND THE TOOH• 2% SODIUM FLUORIDE IS APPLIED ON THE EXPOSED DENTIN AND IS TRANSFERRED DEEP INTO THE DENTIN ON ACTIVATION OF THE UNIT.• IT IS REPORTED TO PROVIDE LONG-TERM RELIEF FROM HYPERSENSITIVE DENTIN.
  26. 26. POTASSIUM OXALATE• SOLUTION IS APPLIED ON DENTIN• OXALATE IONS REACT WITH CALCIUM IONS IN DENTINAL FLUID TO FORM INSOLUABLE CALCIUM OXALATE CRYSTALS THAT BLOCK TUBULES AND PREVENT FLUID MOVEMENT .
  27. 27. MANAGEMENTVARNISHES USE OF LASERSTHEY ACT BY FORMING A THEY OCCLUDE THEBARRIER OVER EXPOSED DENTINAL TUBULES BYDENTIN. PRODUCING LOCAL CHANGESTHIS REDUCES AROUND THE EXPOSEDHYPERSENSITIVITY AS IT DENTINREDUCES DENTIN THEY ALSO PRODUCEPERMEABILITY. THEY CHANGES IN CENTRAL PULPPROVIDE ONLY TEMPORARY NEURON.RELIEF.
  28. 28. POTASSIUM NITRATE POTASSIUM ION MAYDEPOLARIZE THE NERVE AND PREVENT IT FROMREPOLARIZING, THEREBY, PRE VENTING IT FROM SENDING PAIN SIGNALS TO THE BRAIN. POTASSIUM IONS ARETHOUGHT TO DIFFUSE ALONG DENTINAL TUBULES ANDDECREASE THE EXCITABILITY OF INTRADENTAL NERVES BYALTERING THEIR MEMBRANEPOTENTIAL REDUCING NERVE EXCITATION, AND THE ASSOCIATED PAIN
  29. 29. DENTIN HYPERSENSITIVITY “THE COMMON COLDOF DENTISTRY”
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