DENTIN HYPERSENSITIVITY

1. DENTIN
HYPERSENSITIVITY
DR. K.S. STELIN(HOD) DR. MARIYAM MOMIN
DR. PARUL ANEJA I YEAR PG
DEPARTMENT OF PERIODONTOLOGY & ORAL IMPLANTOLOGY.

2. CONTENTS
 INTRODUCTION
 THEORIES OF DENTIN HYPERSENSITIVITY
 DEFINITIONS
 ETIOLOGY
 CLINICAL FEATURES
 DIAGNOSIS
 MANAGEMENT
 HOME CARE
 PREVENTION
 CONCLUSION
 REFERENCES

3. INTRODUCTION
Dentin
Hypersensitivity
Dentin
innervation
theory
Odontoblastic
transmission
theory
Hydrodynamic
theory
• Tooth sensitivity to various stimuli
is a peculiar problem faced by
many patients.
• The exact mechanism of dentin
hypersensitivity is not very clear
but several theories have been
proposed to explain this
phenomenon.
Theories of hypersensitivity

4. Dentin innervation theory
Mechanical, chemical or
osmotic stimulus
Direct stimulation of nerves
in the dentin or pulp
Painful response
Hypersensitivity

5. Odontoblastic transmission theory
Mechanical, chemical or osmotic
stimulus
Direct stimulation of odontoblastic
process in dentinal tubules
Painful response
Hypersensitivity

6. Hydrodynamic theory
Mechanical, chemical or osmotic
stimulus
Movement of dentinal fluid within
the dentinal tubules
Stimulation of nerves in the dentin
or pulp
Painful response
Hypersensitivity

7. Theories of Dentin Hypersensitivity

8. Definition
 Dentin 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 – International Workshop on Dentin
Hypersensitivity (1983)
 Sensitivity or hypersensitive dentin implies an abnormal sensitiveness of
an exposed area of dentin exhibiting itself in the form of reflex or localized
pains, sometimes in the absence of apparent external sources of irritation
or otherwise as a result of the contact of heat and cold, salts, sweets and
acid substances or of foods and instruments – MC Gee.

9. Causes of Hypersensitive Dentin
Enamel loss
Bruxism

10. Cemental loss
Root planing
Periodontal diseases
Periodontal surgeries Recession of gingiva

11. Other causes
Changes in temperature Dental caries
Fractured teeth
Sensitivity due to sweets, salty
and acidic substances

12. CLINICAL FEATURES
• Pain is the primary symptom of
hypersensitive dentin.
• Short, sharp pain in response to
heat, cold, tactile stimuli, sweets
or sour foods.
• Symptoms are similar to
acute reversible pulpitis.

13. DIAGNOSIS
Diagnosis of dentin hypersensitivity can be made on the
basis of careful case history & clinical examination.
Careful case history
History &
Nature of
pain
Intensity of
pain
Stimuli
Frequency
& duration
of
sensitivity
History of
restorative
procedures,
periodontal
procedures.

14. Clinical examination
Clinical examination includes the following observations & tests
Clinical observations
Percussion Tactile examination
Tooth pain
Poor
restoration
Exposed
dentin

15. Diagnostic tests
Vitality tests

16. Radiographic examination

17. MANAGEMENT OF DENTIN
HYPERSENSITIVITY
S.
No.
Condition Treatment
1 Localized
hypersensitivity
Try application of varnishes,
dentin adhesives or adhesive
restorations
2 Generalized
hypersensitivity
Prescribe desensitizing
toothpastes & restorations
3 Severe
hypersensitivity
Consider endodontic therapy
Management of hypersensitivity
based on severity
The treatment options for managing dentin
hypersensitivity should be based on extent
& severity of the problem.
Varnish
Dentin adhesives
Desensitizing
toothpastes

18. Restoration
Endodontic therapy

19. Restorative methods
S.No. Condition Treatment
1 Wasting disease GIC or composite with proper pulp
protection if required
2 Dental caries Metallic/ non-metallic restorations
3 Dentin expose Resin impregnation technique, dentin
bonding agents
4 Root cementum expose Application of Ca(OH)2
5 Faulty restoration Replace with suitable restoration
6 Cracked tooth syndrome Full crowns
Restorative management of Hypersensitivity

20. GIC restoration
Caries
restoration
Full crowns

21. Non Restorative Methods
 Lasers
 Dessication
 Iontophoresis
 Chemical agents
 Dentin bonding agents
 Medicated toothpastes
 Topical fluoride applications
 Resin impregnation techniques
 Application of calcium hydroxide

22. Lasers
Lasers
Melt & recrystallize
tooth surface
Occlude dentinal
tubules.
Role of lasers in treatment
of hypersensitivity

23. Dessication
Prepare cavity
Moisten with
absolute
alcohol/acetone
Application of heat
Dessication of
cavity.

24. Iontophoresis

25. Chemical agents
Application of
potassium oxalate
on dentinal tubules
Formation of Ca.
oxalate in tubules
Blockage of dentinal
tubules
1. Ferric oxalate
2. Potassium nitrate
3. Potassium oxalate
4. Calcium chloride
5. Strontium chloride
6. Calcium phosphate.
Role of chemicals in treatment of
hypersensitivity

26. Dentin Bonding agents

27. Medicated toothpastes
 Toothpaste with strontium chloride
100gm - 85Rs.
100gm - 90Rs. 100gm - 96Rs.
100gm - 75Rs.
100gm - 106Rs.
100gm - 93Rs.
75gm - 32Rs.

28. • Toothpaste with 5% potassium nitrate
100gm – 89Rs. 70gm – 175Rs. 100gm – 98Rs. 100gm – 136Rs.
50gm – 68Rs. 50gm – 80Rs. 100gm – 148Rs. 100gm – 90Rs.
70gm – 100Rs.

29. • Toothpaste with 0.7% sodium monofluorophosphate
70gm – 110Rs. 100gm – 117Rs. 100gm – 90Rs.
50gm – 29Rs. 50gm – 80Rs. 75gm – 80Rs.

30. • Toothpaste with NovaMin
100gm – 175Rs. 100gm – 221Rs.
• Toothpaste with BioMin

31. Topical fluoride applications

32. Resin impregnation
technique

33. Application of calcium
hydroxide

34. Problems associated with non-
carious lesion
S.No. Shape Location
1 Tooth sensitivity Exposure of dentin in the cervical areas may
result in dentin sensitivity.
2 Compromised esthetics Loss of tooth structure in the cervical areas of
teeth may produce an unesthetic appearance,
especially in the anterior region.
3 Risk of tooth fracture Deep, wedge-shaped lesions in the cervical
area of teeth can increase the risk for tooth
fracture due to lowered strength at this critical
region.
4 Pulpal damage Deep cervical lesions are also likely to result in
irreversible pulpitis & pulpal death.
5 Caries prevalence Non-carious lesons also favor plaque
accumulation, which would eventually lead to
the development of caries.
6 Poor periodontal health The gingiva may be irritated and inflamed due
to the non-carious cervical lesions.

35. HOME CARE & PREVENTION
OF HYPERSENSITIVITY
Home treatment
should be
recommended as an
adjunct to chair side
therapy for dentin
sensitivity.
Home desensitizing
agents produce their
benefits more
gradually than
professional therapies
& generally require 1-2
weeks of use for full
effectiveness.

36. Mouthwash for sensitivity
200ml – 94Rs.
150ml – 65Rs. 150ml – 90Rs.

37. Oral gel for sensitivity
100gm – 103Rs.
50gm – 130Rs.
50gm – 68Rs.
100gm – 145Rs. 70gm – 99Rs.

38. Prevention
Preventive measures for dentin
hypersensitivity are as follows:
 Diet counselling, especially
regarding the consumption of acidic
fruits & beverages.
 Correction of brushing technique, in
order to prevent damage to the
cervical enamel & supporting
tissues.
 Care during operative procedures &
while restoring teeth to avoid
iatrogenic damage to tooth structure.
 Care during periodontal procedures,
scaling & root planing.

39. REFERENCES
 Carranza’s Clinical Periodontology- 10th Edition.
 Essentials of Periodontology – (Sahitya Reddy S)
 Case History Recording In Periodontics – Divya Bhat (2nd Edition).

40. Thank You.