DENTINOGENESIS, DENTIN HYPERSENSITIVITY, HERBAL TREATMENT IN DENTIN HYPERSENSITIVITY, HOELS CELL,

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Dr. Manoranjan Mahakur
1st year MDS
Department of Pedodontics
&
Preventive Dentistry

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PREDENTIN
Metadentin
1- PRIMARY
2-SECONDARY
3- TERTIARY
1-MANTLE
2-CIRCUMPULPAL
1-PERITUBULAR
2- INTERTUBULAR
1- INTERGLOBULAR
2-TOMES GRANULAR
LAYER
DENTIN
ODONTOBLAST
HOEHLS
1-VON EBNER
2-OWEN
3-NEO NATAL
1-DEAD TRACT
2-SCLEROTIC
DENTIN
Recap ………

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DENTINOGENESIS content at a glimpse……
 Introduction
 Stages of Dentinogenesis
1-Odontoblast and its differentiation.
2- Deposition of organic matrix
3-Mineralization modification of organic
matrix.
4- MantL dentin formation
5-Circumpulpal dentin formation
6-Peritubular dentin formation

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Introduction…..
 Dentinogenesis = the process of dentine formation
 Starts after tooth germ has reached the
bell stage
EARLY BELL STAGE LATE BELL STAGE
HISTO
DIFFERENTIATION
MORPHO
DIFFERENTIATION

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Odontoblast and its differentiation…
 Dentin forming cell
 Origin- ectomesenchymal LIFE CYCLE OF
ODONTOBLAST
QUIESCENT STAGE
Decreased in size Decreased dentin formation
FORMATIVE STAGE
Odontoblast process Increase length
DIFFERENTIATION STAGE
Form Preodontoblast Attached to BM
TGF,
BMP,
IGF
MAP 1B

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RECIPROCAL INTERACTION……..

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DEPOSITION OF ORGANIC MATRIX
ORGANIC MATRIX
PREDENTIN
GROUND SUBSTANCE
Ca ,Po4
DENTIN

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COLLAGEN MATRIX FORMATION…….
MANTLE DENTIN
GROUND
SUBSTANCE
LARGE
FIBERS
90 degree to
BM
SMALL
FIBERS
ORGANIC
MATRIX
MANTLE
DENTIN
Ca2
Po4

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COLLAGEN MATRIX FORMATION…….
CIRCUMPULPAL DENTIN
GROUND
SUBSTANCE
SMALL
FIBERS
= TO BM
ORGANIC
MATRIX
Ca2
Po4

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COLLAGEN MATRIX FORMATION…….
MANTLE & CIRCUMPULPAL DENTIN

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FORMATION OF PERITUBULAR DENTIN…….
New dentin formed changed the previous dentin
Diameter of odontoblast process
Create a space
More mineralized dentin deposited
PERITUBUAR DENTIN

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2.MINERALIZATION OF DENTIN
MATRIX FORMATION
MATRIX VESICLE
RUPTURE OF VESICLE
DEPOSITION OF Ca2 and PO4
MINERALIZATION OF DENTIN
ODONTOBLAST
MOVE
TO CENTER

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COLLAGEN MATRIX FORMATION…….
MANTLE & CIRCUMPULPAL DENTIN

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PATTERN OF MINERALIZATION
LINEAR GLOBULAR
SLOW RATE
UNIFORM
(CIRCUMPULPAL DENTIN)
RAPID
NON UNIFORM
MANTLE DENTIN
MIXED

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CONTROL OF MINERALIZATION………
• INITIATIONCACLIUM
• INHIBIT GROWTH OF HYDROXY APPETITE
• PROMOT BINDING OF Ca2 &Po4OSTEONECTIN
• MINERALIZATIONOSTEOPECTIN
• PREVENT PREMATURE CALCIFICATIONPROTEOGYCAN
• Transport of ca,
• Aggregation of fiber,stabilization of crysytalDPP
• ATTRACT AND CONCENTRATE CALCIUMGLA PRTEIN

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GENES & REGULATION OF DENTINOGENESIS…..
• REGULATE
SIALOPHOSPHOPROTEIN mRNA.Wnt10a
• REGULATE DENTIN MATRIX
PROTEINM06-G3
• REGULATE SIGNALING AND
DEVELOPMENT
HEPARAN
SULPHATE
• MINERALIZATIONTGF,BSP

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COLLAGEN MATRIX ………

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MINERALIZATION………

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REDENTINOGENESIS………
EXPOSED PULPCA(OH)2 MTA
ATTACHED PULP CELL
INCREASED BIOSYNTHESIS OF
PULP CELL
DYSTROPIC LAYER

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DIFFERENTIATION OF
ODONTOBLAST
EXPRESS DSP
REPARATIVE DENTIN
DEPOSITION OF
FIBRONECTIN RICH
MATRIX
BSP 2,6
OPN
TGF ß 1
Ca

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LESION
LOCALIZATION
LESION
INITIATION
Incidence range 4-74%
Female>>> male
Age prevalence 20-50yrs
Mostly involved
premolar and canine
Mostly left side

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IN OFFICE
DESENSITIZING
HOME
DESENSITIZING
DENTIN
HYPERSENSITIVE
DIFFERENTIAL
DIAGNOSIS
CLINICAL
HISTORY
ENDODONTIC
THERAPY
TEST
PREVENTION

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DESENSITIZING AGENT
PROTEIN
PRECIPITATION
PLUGGING
DENTINAL TUBULES
NERVE
DESENSITIZATION
MECHANISM
OF
ACTION
POTASSIUM NITRATE
Silver nitrate
Zinc chloride
Sodium fluoride
Stannous fluoride
Potassium oxalate
Calcium hydroxide
Sodium monofluoro
phosphate

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SOME COMMERCIALLY AVAILABLE
toothpaste
COMMERCIAL NAME COMPOSITION
Senquel,
sensodent k
Sensodyne
Potassiun nitrate 5%
Senquel f
Sensodent kf
Nitra
Thermoseal RA
Thermokind f
Potassium nitrate 5%
Sodium monofluoro
phosphate.7%
F-917 ppm
Sensoform Strontium chloride 10%

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Desensitizing Mouth rinse
COMMERCIAL NAME COMPOSITION
SENQUEL –AD
NITRA OR
SENSOWASH
Potassium nitrate 3%
Sodium fluoride 0.2%

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OTHER METHOD
Fluoride varnishes
Oxalic acid and resin
Glass ionomer cements
Composites
Dentin bonding agents
DENTIN ADHESIVE
Dentin bonding agent are used
Micro mechanical bonding through
formation of an interdiffusion hybrid layer

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NOVAMIN in DH
 It is Bio active glass ceramic
MOA
 Calcium sodium phosphosilicate
Aqueous medium
Release calcium and phosphate ion
Form hydroxy-carbonate appetite
SEAL DT

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Recaldent
Is a complex of Casein Phosphopeptide (CPP) and Amorphous
Calcium Phosphate (ACP)
MAO
Binds readily to surfaces within the oral cavity
Delivers calcium and phosphate ions to the enamel and into the
oral environment
Works with fluoride in toothpaste (for MI Paste & MI Paste Plus
users)

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Laser in DH
Example- Nd:YAG laser, CO2 LASER
MOA- 1-Coagulation and precipitation of plasma
protein in dentinal tubules (Goodies et al 1994)
2-thermal energy liberated alter intra-dental nerve
activity (Orcharelous et al 1998)

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IONTOPHORESIS…
Electrical potential is used to transfer the ion into body
for therapeutic purpose
Used sodium fluoride.
MOA-
 Current may
produce reparative
dentin or nerve
paresthesia.
 Fluoride ion
precipitation may
occlude by calcium
fluoride formation.
Method…
Place a negative electrode on
the dentin & positive Electrode
on the patients arm
Chemical is applied to tooth
surface & current is
passed through –ve electrode
using 0.5mA current

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Advanced THERAPY FOR DH
The PILP system-
The polymer-induced liquid precursor
(PILP) system created by Laurie Gower, PhD, an
associate professor in the department of materials
science and engineering at the University of Florida
in Gainesville.(June 2, 2011)
(study performed at the University of
California, San Francisco (UCSF))

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MOA…
Poly- L-aspartic acid delivers calcium phosphate to the
fibrils and releases it inside the collagen fibril so
minerals form within them.
Its occurs too shortly
Full recovery will occurs.

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ICON DMG…..
Features and Benefits
 Micro invasive technique
No drilling or anesthesia required
Prevents lesion progression
Treated lesions lose whitish appearance and look like
healthy enamel
Easy treatment
 only one visit

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FUTURE THERAPY FOR DH
Gene therapy……
Blocking the nerve
growth factor (NGF) by
pulpal fibroblast near
the lesion .

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HERBAL THERAPY FOR DH

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REFERENCE
 JOURNA F CONSERVATIVE
DENTISTRY 2010 OCT-DEC
Dentin hypersensitivity: Recent
trends in management
Sanjay Miglani, Vivek
Aggarwal, and Bhoomika Ahuja
 International Journal of Dentistry
Volume 2009 (2009), Article
ID 464280, 12 pages
http://dx.doi.org/10.1155/2009/4642
80Review Article Reparative
Dentinogenesis Induced by Mineral
Trioxide Aggregate: A Review from
the Biological and Physicochemical
Points of View
Takashi Okiji and Kunihiko Yoshiba
Orban’s Oral histology and
Embryology
Ten cate’s oral histology
Shafer’s Text book of oral
pathology

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REFERENCE…….
1.Shen P, Cai F, Nowicki A, Vincent J, Reynolds EC. Remineralization of
enamel subsurface lesions by sugar–free chewing gum containing casein
phosphopeptideamorphous calcium phosphate. J Dent Res. 2001
Dec;80(12):2066–70.
2.Morgan MV, Adams GG, Bailey DL, Tsao CE, Reynolds EC. CPP–ACP
gum slows progression and enhances regression of dental caries. J Dent
Res 2006; 85 (Sp. Iss. B): 2445.
3.Walsh LJ. Tooth Mousse: Anthology of Applications. GC Asia Dental, 2007.
4.Cochrane NJ, Cai F, Reynolds EC. QLF and TMR analysis of CPP–ACFP
remineralized enamel in vitro. J Dent Res 2006; 85 (Sp. Iss. B): 0192.

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“I will apply, for the benefit of the sick, all measures
[that] are required, avoiding those twin traps of
overtreatment and therapeutic nihilism”.
(Hippocratic Oath)
Upcoming Seminar ………..
TOOTH MORPHOLOGY
(the architect……..)