This document provides information on dentinal hypersensitivity, including its definition, mechanisms, incidence, etiology, clinical features, diagnosis, and treatment strategies. It defines dentinal hypersensitivity as a sharp, short pain from exposed dentin in response to stimuli like thermal, chemical, or tactile sources. The predominant mechanism is the hydrodynamic theory, where stimuli cause the movement of fluid within dentinal tubules, stimulating nerves and causing pain. Common causes are gingival recession and loss of enamel or cementum. Diagnosis involves history, clinical exam, and tests to rule out other conditions.
Tooth hypersensitivity is a common problem encountered in everyday life and clinical practice. This presentation clearly shows causes, methods of prevention and treatment in such cases.
Dentin hypersensitivity is a common condition characterized by short, sharp pain from exposed dentin in response to stimuli. It is caused by fluid movement within dentinal tubules activating nerve fibers when stimuli like hot/cold foods or drinks cause fluid movement. Symptoms include pain from cold, hot, sweet or sour foods/drinks. Treatment focuses on occluding open dentinal tubules through products like desensitizing toothpastes containing potassium or strontium salts, or in-office treatments like varnishes, resins or iontophoresis. Proper oral hygiene and a diet low in acidic foods can help prevent further sensitivity.
This document provides an overview of dentinal hypersensitivity. It begins with definitions of dentinal hypersensitivity and discusses the history of treatments. The mechanisms and theories of dentinal sensitivity are then explored, including the hydrodynamic theory. Clinical considerations and various methods for measuring and eliciting hypersensitivity are also summarized. The document concludes with a discussion of management strategies for treating dentinal hypersensitivity.
DENTIN HYPERSENSITIVITY - ETIOLOGY, DIAGNOSIS AND TREATMENTDr.Shraddha Kode
This document discusses dentin hypersensitivity (DH), including its definition, prevalence, causes, diagnostic process, and treatment options. It notes that DH is pain from exposed dentin in response to stimuli that cannot be explained by other dental issues. It affects 20-50 year olds, especially women, and commonly occurs in canines and premolars. Treatment includes at-home options like desensitizing toothpastes and in-office options like potassium nitrate, resins, or lasers to occlude tubules or disturb nerve transmission. Newer treatments showing promise include arginine-based toothpastes and nano-hydroxyapatite due to their ability to quickly and effectively reduce DH pain.
Oral mucosal lesions in denture wearersAamir Godil
The document discusses oral mucosal lesions that can occur in denture wearers. It describes several types of denture-related mucosal lesions (DMLs) such as traumatic ulcers, denture-induced stomatitis, and denture hyperplasia. It also discusses non-denture related lesions including fissured tongue and lichen planus. A statistical analysis found the most common DMLs were traumatic ulcers and denture stomatitis. Complete denture wearers had higher rates of DMLs while partial denture wearers saw more stomatitis. The document provides details on clinical presentation and management of several specific oral lesions.
This document discusses dental hypersensitivity. It defines hypersensitivity as pain from exposed dentin in response to stimuli that cannot be explained by dental defects or pathology. Approximately one in seven people experience hypersensitivity. Common causes include loss of enamel from factors like toothbrushing abrasion or dietary erosion. Theories on the mechanisms of hypersensitivity include direct nerve stimulation in dentinal tubules or fluid movement within tubules stimulating nerve endings in the pulp. Treatment options include agents and procedures that occlude dentinal tubules like calcium hydroxide or iontophoresis to block nerve activity and reduce sensitivity.
The document discusses various methods for endodontic diagnosis including obtaining a thorough medical and dental history, examining subjective symptoms, performing clinical observations and tests, and interpreting radiographs. A key part of diagnosis involves determining the cause of pain or pathology through differential diagnosis and comparing current symptoms to other potential conditions. The diagnostic process aims to identify both diseased and healthy teeth through indirect evaluation of a patient's response to various stimuli and tests.
Tooth hypersensitivity is a common problem encountered in everyday life and clinical practice. This presentation clearly shows causes, methods of prevention and treatment in such cases.
Dentin hypersensitivity is a common condition characterized by short, sharp pain from exposed dentin in response to stimuli. It is caused by fluid movement within dentinal tubules activating nerve fibers when stimuli like hot/cold foods or drinks cause fluid movement. Symptoms include pain from cold, hot, sweet or sour foods/drinks. Treatment focuses on occluding open dentinal tubules through products like desensitizing toothpastes containing potassium or strontium salts, or in-office treatments like varnishes, resins or iontophoresis. Proper oral hygiene and a diet low in acidic foods can help prevent further sensitivity.
This document provides an overview of dentinal hypersensitivity. It begins with definitions of dentinal hypersensitivity and discusses the history of treatments. The mechanisms and theories of dentinal sensitivity are then explored, including the hydrodynamic theory. Clinical considerations and various methods for measuring and eliciting hypersensitivity are also summarized. The document concludes with a discussion of management strategies for treating dentinal hypersensitivity.
DENTIN HYPERSENSITIVITY - ETIOLOGY, DIAGNOSIS AND TREATMENTDr.Shraddha Kode
This document discusses dentin hypersensitivity (DH), including its definition, prevalence, causes, diagnostic process, and treatment options. It notes that DH is pain from exposed dentin in response to stimuli that cannot be explained by other dental issues. It affects 20-50 year olds, especially women, and commonly occurs in canines and premolars. Treatment includes at-home options like desensitizing toothpastes and in-office options like potassium nitrate, resins, or lasers to occlude tubules or disturb nerve transmission. Newer treatments showing promise include arginine-based toothpastes and nano-hydroxyapatite due to their ability to quickly and effectively reduce DH pain.
Oral mucosal lesions in denture wearersAamir Godil
The document discusses oral mucosal lesions that can occur in denture wearers. It describes several types of denture-related mucosal lesions (DMLs) such as traumatic ulcers, denture-induced stomatitis, and denture hyperplasia. It also discusses non-denture related lesions including fissured tongue and lichen planus. A statistical analysis found the most common DMLs were traumatic ulcers and denture stomatitis. Complete denture wearers had higher rates of DMLs while partial denture wearers saw more stomatitis. The document provides details on clinical presentation and management of several specific oral lesions.
This document discusses dental hypersensitivity. It defines hypersensitivity as pain from exposed dentin in response to stimuli that cannot be explained by dental defects or pathology. Approximately one in seven people experience hypersensitivity. Common causes include loss of enamel from factors like toothbrushing abrasion or dietary erosion. Theories on the mechanisms of hypersensitivity include direct nerve stimulation in dentinal tubules or fluid movement within tubules stimulating nerve endings in the pulp. Treatment options include agents and procedures that occlude dentinal tubules like calcium hydroxide or iontophoresis to block nerve activity and reduce sensitivity.
The document discusses various methods for endodontic diagnosis including obtaining a thorough medical and dental history, examining subjective symptoms, performing clinical observations and tests, and interpreting radiographs. A key part of diagnosis involves determining the cause of pain or pathology through differential diagnosis and comparing current symptoms to other potential conditions. The diagnostic process aims to identify both diseased and healthy teeth through indirect evaluation of a patient's response to various stimuli and tests.
This document discusses dentin hypersensitivity and its management. It defines dentin hypersensitivity and describes the physiology of dentin and theories of sensitivity such as the odontoblast receptor theory and hydrodynamic theory. It covers the incidence, etiology, clinical features, diagnosis, and various management approaches including desensitizing agents like potassium salts, lasers and restorative methods. Prevention involves patient education on proper oral hygiene techniques and dietary modifications.
The document discusses various methods for assessing pulp vitality, including neural sensitivity tests and tests of pulp vascularity. It focuses on neural sensitivity tests, describing the thermal test and cold test in detail. The thermal test involves applying heat or cold to the tooth to stimulate the Aδ and C nerve fibers and assess the pulp's sensory response. A positive response indicates pulp vitality, while no response suggests pulp necrosis. Limitations of these tests include their inability to assess blood flow and ineffectiveness in older patients or teeth with extensive work. The document provides details on techniques, mechanisms, and interpretations of these common pulp sensitivity tests.
An overview of the diagnostic process in endodontics, including information about the pain system, referred pain, non-odontogenic pain, the diagnostic process, tests and treatment planning in endodontics.
This document compares and contrasts microabrasion and macroabrasion techniques for treating tooth discoloration. Microabrasion involves using a paste of hydrochloric acid and pumice or silicon carbide to dissolve and abrade the enamel surface. It is a conservative treatment that removes only superficial stains. Macroabrasion uses diamond or carbide burs to remove defects at a faster rate but with less control than microabrasion. Both techniques can improve the appearance of teeth affected by conditions like fluorosis but microabrasion allows for better control and more conservative removal of tooth structure.
This document discusses the posterior palatal seal, which is the area of soft tissue along the junction of the hard and soft palates that can be compressed by a maxillary denture to aid in retention. It defines the posterior palatal seal and describes its functions, which include resisting forces on the denture and maintaining contact during function. The document outlines important anatomical structures like the vibrating lines and hamular notch that influence determination of the posterior palatal seal area. It also discusses techniques for locating and marking the seal, as well as factors that must be considered like a patient's soft palate classification.
Rubber dam isolation provides several key advantages for dental procedures, including complete isolation of the teeth from saliva, bacteria, and other fluids. This aids in preventing contamination and infection. Rubber dams also protect both the patient and dentist. However, there are some disadvantages as well, such as the dam taking time to apply and remove and some patients finding it claustrophobic. Proper guidelines for application include isolating multiple surrounding teeth. The key parts of a rubber dam kit and steps for application and removal are described.
mucogingival surgery or plastic surgery of muco-gingival tissue is a surgical procedure targeted to correct and eliminate anatomic, developmental and traumatic alterations of gingiva.
Restoration of endodontically treated teethNivedha Tina
This document discusses various methods for restoring endodontically treated teeth. It covers the history of restoring pulpless teeth dating back to 1747. Key factors in selecting a restorative approach include the amount of residual root and crown structure remaining as well as the tooth's function and position. Methods discussed include direct composite restorations, indirect restorations, fiber posts, cast posts, and full crowns. The document also addresses the vulnerability of root filled teeth to fracture and emphasizes the importance of preserving tooth structure.
Recent advances in management of dental hypersensitivityManoj Paradhi
Dentin hypersensitivity is characterized by short, sharp pain from exposed dentin in response to stimuli that cannot be attributed to other dental issues. The hydrodynamic theory is the most accepted explanation for the mechanism, where stimuli cause rapid fluid movement within dentinal tubules activating nerve fibers. Management focuses on occluding tubules with agents like potassium nitrate toothpastes or sealants, or blocking pulpal nerves. Treatment aims to reduce dentin permeability and fluid movement providing relief from hypersensitivity.
Biologic width - Importance in Periodontal and Restorative DentistryDr.Shraddha Kode
The document discusses the biologic width, which refers to the dimensions of the soft tissue attached to the tooth coronal to the alveolar bone crest. It consists of the junctional epithelium, connective tissue attachment, and the sulcular depth, totaling approximately 2-3 mm. Violation of the biologic width by placing restorative margins too far subgingivally can lead to bone resorption, gingival recession, or hyperplasia. The document outlines techniques for assessing biologic width dimensions and various surgical or orthodontic procedures to correct violations. Maintaining at least 3 mm of distance from the restorative margin to alveolar bone is important for periodontal health.
- Traumatic injuries to primary and permanent teeth are common, with maxillary central incisors most frequently affected. Injuries range from enamel fractures to luxations and avulsions.
- Epidemiological studies show that approximately 1/3 of children experience dental trauma to primary teeth and 1/5 experience trauma to permanent teeth. Injuries most often occur from falls at home for young children and from sports for adolescents.
- Proper classification and diagnosis of dental injuries is important to determine appropriate treatment and management. Conditions range from concussion with no displacement to intrusive luxation with tooth displacement into bone.
The dentist has significant influence over the appearance of a patient's lower face when providing complete dentures. Several anatomical landmarks of the face are important reference points for establishing occlusal planes and positioning teeth, such as the interpupillary line and Camper's plane. Incorrect positioning of teeth or denture bases can distort normal facial features like the mentolabial sulcus and philtrum. Maintaining the proper vertical dimension and anterior tooth positioning is crucial for restoring facial aesthetics in edentulous patients.
This document discusses principles of tooth preparation. It begins by defining tooth preparation as the process of removing tooth structure to receive a restoration. The principles of tooth preparation aim to satisfy biologic, mechanical, and esthetic needs. Specifically, it is important to preserve tooth structure, provide adequate retention and resistance form, maintain structural integrity of the restoration, ensure marginal integrity, and preserve the periodontium. Factors like taper, surface area, and roughness influence the retention of a restoration. Care must also be taken to avoid damaging adjacent teeth, soft tissues, or the pulp during preparation.
The document discusses overdentures, which are removable partial or complete dentures that cover and rest on one or more remaining natural teeth, tooth roots, or dental implants. Key points include:
- Retaining natural teeth can preserve alveolar bone and periodontal receptors important for function.
- Abutment teeth are prepared with short copings or left uncovered, and attachments may be added to improve retention.
- Overdentures can improve retention, stability, support and proprioception compared to conventional dentures.
- Proper case selection and maintenance are important for long term success.
This document discusses dental elevators used for tooth extractions. It describes different types of elevators based on their design, principles of use, and applications. Straight, triangular, and pick-up elevators are discussed. Elevators remove whole teeth, roots, or root fragments using lever, wedge, and wheel/axle principles. Proper technique involves supporting the jaws, directing force along the tooth axis, and using finger guards to control forces and prevent damage to adjacent tissues.
This document discusses techniques for mandibular anesthesia. It focuses on the inferior alveolar nerve block, which anesthetizes the inferior alveolar nerve, mental nerve, and incisive nerve. The technique involves locating anatomical landmarks like the coronoid notch and pterygomandibular raphe, then inserting the needle 1 cm above the occlusal plane of the mandibular posteriors and advancing it to the bone near the mandibular foramen to deposit the solution within 1 mm of the inferior alveolar nerve. Precautions are taken to avoid forceful bone contact. Failure can occur if the injection is too low or anterior, or due to accessory innervation. Complications include hematoma, tr
Endodontic surgery is a procedure performed to remove or correct causes of dental disease and restore tissues to health. It is often a last resort to save a tooth and requires great skill. Indications include inability to eliminate pathology with root canal treatment, inability to fully clean and fill the root canal, or iatrogenic problems like instrument breakage. Contraindications include resolved pathology, health issues, anatomic constraints, or periodontal disease. Preparation includes referral data, radiographs, diagnosis, and informed consent. Common flap designs are triangular, rectangular, or submarginal. Types of endodontic surgery include incision and drainage, trephination, periapical surgery like apicoectomy, repair of perforations,
This document discusses dentin hypersensitivity. It defines dentin hypersensitivity as short, sharp pain from exposed dentin in response to stimuli like heat, cold, tactile pressure or osmotic changes. It discusses the prevalence, distribution, etiology and theories of the condition. The key theory proposed is the hydrodynamic theory, which suggests that fluid movement in dentinal tubules in response to stimuli activates nerve endings and causes pain. Proper management of dentin hypersensitivity aims to occlude dentinal tubules to block this fluid movement.
This document discusses hypersensitivity of dentin, including its definition, causes, risk factors, and treatment approaches. Dentin hypersensitivity is defined as short, sharp pain in response to stimuli like heat, cold, sweets or drying. It is caused by the exposure of dentin and opening of dentinal tubules. Risk factors include poor oral hygiene, abrasive toothpastes, acid erosion and periodontal procedures. The hydrodynamic theory, which proposes that fluid movement in open dentinal tubules stimulates nerves, is the most widely accepted explanation. Treatment focuses on plugging tubules or desensitizing nerves, and can involve desensitizing toothpastes, mouthwashes or professional treatments.
This document discusses dentin hypersensitivity and its management. It defines dentin hypersensitivity and describes the physiology of dentin and theories of sensitivity such as the odontoblast receptor theory and hydrodynamic theory. It covers the incidence, etiology, clinical features, diagnosis, and various management approaches including desensitizing agents like potassium salts, lasers and restorative methods. Prevention involves patient education on proper oral hygiene techniques and dietary modifications.
The document discusses various methods for assessing pulp vitality, including neural sensitivity tests and tests of pulp vascularity. It focuses on neural sensitivity tests, describing the thermal test and cold test in detail. The thermal test involves applying heat or cold to the tooth to stimulate the Aδ and C nerve fibers and assess the pulp's sensory response. A positive response indicates pulp vitality, while no response suggests pulp necrosis. Limitations of these tests include their inability to assess blood flow and ineffectiveness in older patients or teeth with extensive work. The document provides details on techniques, mechanisms, and interpretations of these common pulp sensitivity tests.
An overview of the diagnostic process in endodontics, including information about the pain system, referred pain, non-odontogenic pain, the diagnostic process, tests and treatment planning in endodontics.
This document compares and contrasts microabrasion and macroabrasion techniques for treating tooth discoloration. Microabrasion involves using a paste of hydrochloric acid and pumice or silicon carbide to dissolve and abrade the enamel surface. It is a conservative treatment that removes only superficial stains. Macroabrasion uses diamond or carbide burs to remove defects at a faster rate but with less control than microabrasion. Both techniques can improve the appearance of teeth affected by conditions like fluorosis but microabrasion allows for better control and more conservative removal of tooth structure.
This document discusses the posterior palatal seal, which is the area of soft tissue along the junction of the hard and soft palates that can be compressed by a maxillary denture to aid in retention. It defines the posterior palatal seal and describes its functions, which include resisting forces on the denture and maintaining contact during function. The document outlines important anatomical structures like the vibrating lines and hamular notch that influence determination of the posterior palatal seal area. It also discusses techniques for locating and marking the seal, as well as factors that must be considered like a patient's soft palate classification.
Rubber dam isolation provides several key advantages for dental procedures, including complete isolation of the teeth from saliva, bacteria, and other fluids. This aids in preventing contamination and infection. Rubber dams also protect both the patient and dentist. However, there are some disadvantages as well, such as the dam taking time to apply and remove and some patients finding it claustrophobic. Proper guidelines for application include isolating multiple surrounding teeth. The key parts of a rubber dam kit and steps for application and removal are described.
mucogingival surgery or plastic surgery of muco-gingival tissue is a surgical procedure targeted to correct and eliminate anatomic, developmental and traumatic alterations of gingiva.
Restoration of endodontically treated teethNivedha Tina
This document discusses various methods for restoring endodontically treated teeth. It covers the history of restoring pulpless teeth dating back to 1747. Key factors in selecting a restorative approach include the amount of residual root and crown structure remaining as well as the tooth's function and position. Methods discussed include direct composite restorations, indirect restorations, fiber posts, cast posts, and full crowns. The document also addresses the vulnerability of root filled teeth to fracture and emphasizes the importance of preserving tooth structure.
Recent advances in management of dental hypersensitivityManoj Paradhi
Dentin hypersensitivity is characterized by short, sharp pain from exposed dentin in response to stimuli that cannot be attributed to other dental issues. The hydrodynamic theory is the most accepted explanation for the mechanism, where stimuli cause rapid fluid movement within dentinal tubules activating nerve fibers. Management focuses on occluding tubules with agents like potassium nitrate toothpastes or sealants, or blocking pulpal nerves. Treatment aims to reduce dentin permeability and fluid movement providing relief from hypersensitivity.
Biologic width - Importance in Periodontal and Restorative DentistryDr.Shraddha Kode
The document discusses the biologic width, which refers to the dimensions of the soft tissue attached to the tooth coronal to the alveolar bone crest. It consists of the junctional epithelium, connective tissue attachment, and the sulcular depth, totaling approximately 2-3 mm. Violation of the biologic width by placing restorative margins too far subgingivally can lead to bone resorption, gingival recession, or hyperplasia. The document outlines techniques for assessing biologic width dimensions and various surgical or orthodontic procedures to correct violations. Maintaining at least 3 mm of distance from the restorative margin to alveolar bone is important for periodontal health.
- Traumatic injuries to primary and permanent teeth are common, with maxillary central incisors most frequently affected. Injuries range from enamel fractures to luxations and avulsions.
- Epidemiological studies show that approximately 1/3 of children experience dental trauma to primary teeth and 1/5 experience trauma to permanent teeth. Injuries most often occur from falls at home for young children and from sports for adolescents.
- Proper classification and diagnosis of dental injuries is important to determine appropriate treatment and management. Conditions range from concussion with no displacement to intrusive luxation with tooth displacement into bone.
The dentist has significant influence over the appearance of a patient's lower face when providing complete dentures. Several anatomical landmarks of the face are important reference points for establishing occlusal planes and positioning teeth, such as the interpupillary line and Camper's plane. Incorrect positioning of teeth or denture bases can distort normal facial features like the mentolabial sulcus and philtrum. Maintaining the proper vertical dimension and anterior tooth positioning is crucial for restoring facial aesthetics in edentulous patients.
This document discusses principles of tooth preparation. It begins by defining tooth preparation as the process of removing tooth structure to receive a restoration. The principles of tooth preparation aim to satisfy biologic, mechanical, and esthetic needs. Specifically, it is important to preserve tooth structure, provide adequate retention and resistance form, maintain structural integrity of the restoration, ensure marginal integrity, and preserve the periodontium. Factors like taper, surface area, and roughness influence the retention of a restoration. Care must also be taken to avoid damaging adjacent teeth, soft tissues, or the pulp during preparation.
The document discusses overdentures, which are removable partial or complete dentures that cover and rest on one or more remaining natural teeth, tooth roots, or dental implants. Key points include:
- Retaining natural teeth can preserve alveolar bone and periodontal receptors important for function.
- Abutment teeth are prepared with short copings or left uncovered, and attachments may be added to improve retention.
- Overdentures can improve retention, stability, support and proprioception compared to conventional dentures.
- Proper case selection and maintenance are important for long term success.
This document discusses dental elevators used for tooth extractions. It describes different types of elevators based on their design, principles of use, and applications. Straight, triangular, and pick-up elevators are discussed. Elevators remove whole teeth, roots, or root fragments using lever, wedge, and wheel/axle principles. Proper technique involves supporting the jaws, directing force along the tooth axis, and using finger guards to control forces and prevent damage to adjacent tissues.
This document discusses techniques for mandibular anesthesia. It focuses on the inferior alveolar nerve block, which anesthetizes the inferior alveolar nerve, mental nerve, and incisive nerve. The technique involves locating anatomical landmarks like the coronoid notch and pterygomandibular raphe, then inserting the needle 1 cm above the occlusal plane of the mandibular posteriors and advancing it to the bone near the mandibular foramen to deposit the solution within 1 mm of the inferior alveolar nerve. Precautions are taken to avoid forceful bone contact. Failure can occur if the injection is too low or anterior, or due to accessory innervation. Complications include hematoma, tr
Endodontic surgery is a procedure performed to remove or correct causes of dental disease and restore tissues to health. It is often a last resort to save a tooth and requires great skill. Indications include inability to eliminate pathology with root canal treatment, inability to fully clean and fill the root canal, or iatrogenic problems like instrument breakage. Contraindications include resolved pathology, health issues, anatomic constraints, or periodontal disease. Preparation includes referral data, radiographs, diagnosis, and informed consent. Common flap designs are triangular, rectangular, or submarginal. Types of endodontic surgery include incision and drainage, trephination, periapical surgery like apicoectomy, repair of perforations,
This document discusses dentin hypersensitivity. It defines dentin hypersensitivity as short, sharp pain from exposed dentin in response to stimuli like heat, cold, tactile pressure or osmotic changes. It discusses the prevalence, distribution, etiology and theories of the condition. The key theory proposed is the hydrodynamic theory, which suggests that fluid movement in dentinal tubules in response to stimuli activates nerve endings and causes pain. Proper management of dentin hypersensitivity aims to occlude dentinal tubules to block this fluid movement.
This document discusses hypersensitivity of dentin, including its definition, causes, risk factors, and treatment approaches. Dentin hypersensitivity is defined as short, sharp pain in response to stimuli like heat, cold, sweets or drying. It is caused by the exposure of dentin and opening of dentinal tubules. Risk factors include poor oral hygiene, abrasive toothpastes, acid erosion and periodontal procedures. The hydrodynamic theory, which proposes that fluid movement in open dentinal tubules stimulates nerves, is the most widely accepted explanation. Treatment focuses on plugging tubules or desensitizing nerves, and can involve desensitizing toothpastes, mouthwashes or professional treatments.
The document discusses dentin hypersensitivity, including its definition, prevalence, theories of pain transmission, clinical features, diagnosis, differential diagnosis, and methods of prevention and treatment. Dentin hypersensitivity is characterized by short, sharp pain from exposed dentin in response to stimuli and cannot be attributed to other dental issues. It affects 4-57% of patients and is more common in those with periodontitis. The hydrodynamic theory of fluid movement in dentinal tubules activating nerve endings is widely accepted. Prevention and treatment methods include topical agents, iontophoresis, restorations, and tissue regeneration procedures.
Tooth hypersensitivity | by: Dr Muneera GhaithanDenTeach
Tooth hypersensitivity - learn about why teeth are sensitive to cold and other stimulus including (sensitivity theories - causes and factors causing the teeth to be sensitive)
حساسية الاسنان - تعرف لماذا الاسنان حساسة للبرودة وللمؤثرات الاخرى هذا الموضوع يتضمن (نظريات حساسية الاسنان - الاسباب التي تجعل الاسنان اكثر حساسية)
Prepared by: Dr Muneera Ghaithan
This document discusses endodontic diagnosis and treatment planning. It begins with an introduction to endodontics and causes of pulpitis. Signs and symptoms of pulpitis are then outlined. The diagnostic process involves subjective history, objective examination, and tests like percussion, palpation, thermal sensitivity, electric pulp testing, and radiographs. Based on the diagnosis, a treatment plan is formulated which may involve root canal treatment, referral, or extraction. The document provides details on diagnosing and treating different pulpal and periapical conditions like reversible/irreversible pulpitis, abscesses, cysts, and necrosis.
This document discusses endodontic diagnosis and treatment planning. It begins by introducing endodontics and describing common causes of pulpitis like decay, trauma, and infection. Signs and symptoms of pulpitis include tooth pain from hot/cold, pressure, and swelling. Diagnosis involves subjective questions to the patient and objective examination of the tooth. Diagnostic tests include percussion, palpation, thermal sensitivity testing, electric pulp testing, and radiographs. Based on the diagnostic findings, the dentist determines if the pulp is normal, inflamed with reversible or irreversible pulpitis, or non-vital. The treatment plan is tailored to the diagnosis but commonly involves accessing the root canal, cleaning and shaping it, and filling
Dentin hypersensitivity is characterized by short, sharp pain from exposed dentin in response to stimuli like heat, cold, sweet foods, or toothbrushing. It occurs when gums recede or enamel is lost, exposing open dentin tubules. The hydrodynamic theory explains that stimuli cause fluid movement in dentin tubules, activating nerve endings and causing pain. Treatment focuses on desensitizing nerves with potassium nitrate toothpaste or occluding tubules with agents like fluoride, CPP-ACP, or resins to block fluid flow and pain signals.
Dentin hypersensitivity is a painful condition caused by exposed dentin. It occurs most commonly in 30-40 year old females and affects canines and premolars. Dentin contains tubules that normally contain fluid and extend into the tooth from the pulp. When factors like erosion expose the tubules, stimuli can cause fluid movement, activating nerves and causing sharp pain. Current trends to manage this include products that occlude tubules, such as arginine-based compounds, and treatments like lasers, bio-glass, and casein phosphopeptides. Proper diagnosis and removal of predisposing factors are important to effectively treat dentin hypersensitivity.
Dentin hypersensitivity is characterized by short, sharp pain from exposed dentin in response to stimuli like heat, cold, sweets or acids. It occurs when gums recede or enamel is lost, exposing open dentinal tubules. The hydrodynamic theory explains that stimuli cause fluid flow in tubules, activating nerve receptors and causing pain. Treatment focuses on removing causes, desensitizing nerves with potassium nitrate toothpaste, or occluding tubules with agents like fluoride, CPP-ACP or resins.
Dentin hypersensitivity is a painful condition caused by exposed dentin. It is characterized by short, sharp pain from thermal, evaporative, tactile, osmotic, or chemical stimuli. Several theories explain its pathogenesis, but the hydrodynamic theory of fluid movement in dentinal tubules is most widely accepted. Management involves diagnosis, prevention of predisposing factors, and treatment. Traditional treatments include occluding tubules with adhesives, fluoride varnishes, or oxalates. Current trends include arginine products, lasers, bioactive glass, and casein phosphopeptides, which act by occluding tubules or modulating nerve sensitivity.
A fast to read summery talking about dentin hypersensitivity in general without deep details.
for more information about the topic further reading is suggested.
reference : Sturdevant’s Art and Science of Operative Dentistry.
for more summaries like this and more follow us on telegram https://t.me/dentistrypptx
and on our facebook page dentistry.pptx
This document provides an overview of a continuing education course on dentinal hypersensitivity. The course aims to help dental professionals understand the etiology, diagnosis, and management of dentinal hypersensitivity. It discusses the prevalence of dentinal hypersensitivity, risk factors, anatomical and physiological features, screening and diagnosis, and available treatment options. The document includes sections on the educational objectives, abstract, introduction, etiology and physiology, location and patients at risk, and a conclusion on the importance of treating dentinal hypersensitivity.
Dentin hypersensitivity is a common condition characterized by short, sharp pains in response to stimuli like hot, cold, sweet or acidic foods. It affects 14-98% of adults and is caused by exposure of dentin, usually due to gum recession. The hydrodynamic theory is the most accepted explanation, where stimuli cause rapid fluid movement in dentinal tubules, stimulating nerve fibers. Treatment focuses on blocking tubules with agents like potassium nitrate, strontium chloride or oxalate. Placement of restorations or periodontal procedures may also help. Patients are advised on controlling factors that exacerbate sensitivity.
The document summarizes different types of pulp diseases. The most common is pulpitis, which is pulp inflammation that can lead to necrosis if left untreated. There are various criteria that make the pulp susceptible to inflammation like a lack of collateral circulation. Causes of pulpitis include bacterial infection from caries, trauma, chemicals from restorative materials, and mechanical irritation. The different types of pulpitis are described based on the extent and severity of inflammation, from reversible focal pulpitis to acute and chronic pulpitis, which can develop into a pulp abscess or chronic hyperplastic pulpitis in some cases. Histological findings and clinical symptoms are provided for each condition.
Here I present to you the basic concept and definition of endodontic diagnosis and treatment planning. It is presented to the level of mind of undergraduate students.
Diagnosis of pulpal pathology ( Abdullah karamat )Abdullah Karamat
This document outlines the process for diagnosing pulpal pathology, including taking a patient history, performing an examination, and ordering investigations. It discusses the 5 stages of diagnosis: collecting symptoms, questioning the patient, performing objective tests, correlating findings, and formulating a diagnosis. Key examination steps are described, such as vital signs, extraoral/intraoral soft tissue exams, percussion, probing, and mobility testing. Common pulpal and periapical conditions are differentiated, including normal pulp, reversible/irreversible pulpitis, pulp necrosis, acute/chronic apical periodontitis, and acute periapical abscess. A variety of pulp sensitivity tests and radiographs are also summarized.
Dentin hypersensitivity is characterized by short, sharp pain from exposed dentin in response to stimuli like heat, cold, sweets or sour foods. Several theories explain this phenomenon, but the hydrodynamic theory of fluid movement in dentinal tubules upon stimulus is most widely accepted. Dentin hypersensitivity has various causes like gum recession, tooth grinding, dental procedures or caries. Diagnosis involves case history and clinical tests. Management depends on severity and includes desensitizing toothpastes, varnishes, restorations or endodontic therapy. Preventive methods focus on diet, oral hygiene and minimizing further tooth structure loss.
This document provides an overview of dentinal hypersensitivity (DH). It defines DH as a short, sharp pain in response to stimuli like thermal, evaporative, tactile or osmotic sources and discusses the characteristics, prevalence, distribution and history of DH. It describes Brannstrom's hydrodynamic theory of how stimuli cause fluid movement in dentinal tubules activating nerves and causing pain. Factors that can lead to exposed dentin and patent dentinal tubules like erosion, abrasion and periodontal disease are provided as the etiology for DH. Methods for diagnosing DH including subjective scales and objective tactile, evaporative, chemical and thermal stimuli are outlined.
Endodontics is the specialty of dentistry that manages the dental pulp and surrounding tissues. It involves diagnosing and treating issues like pulpal nerve damage, which can cause pain or sensitivity. Diagnostic tests are used to examine the tooth and determine the specific condition, such as pulpitis or a periradicular abscess. Common endodontic procedures include pulpotomy, pulpectomy, and root canal therapy which aim to preserve or remove the pulp and disinfect and fill the root canals. Surgical endodontic procedures like apicoectomy and retrograde restoration are needed when non-surgical root canal treatment fails or to address anatomical issues.
This document discusses various chairside and laboratory investigations used in oral medicine. It provides details on 10 types of chairside investigations including pulp vitality tests, diagnosis of tooth fractures, plaque disclosing agents, and diagnostics for early detection of pre-cancerous lesions. Further details are given on specific chairside tests like thermal pulp tests using cold and heat, electrical pulp tests, and the diagnostic methods for cracked tooth syndrome including dental history, visual examination, and tactile examination. The document also lists 5 types of laboratory tests including biopsy, hematology tests, microbiology tests, and serological tests.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
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Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
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Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
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Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
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Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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3. Algorithm
Introduction
Definition
Mechanism of dentin sensitivity
Incidence and distribution
Etiology and predisposing factors
Clinical features
Diagnosis
Differential diagnosis
Treatment strategies
Management
Conclusion
References
3/11/2015 Dentin hypersensitivity 3
4. Introduction
• The term tooth hypersensitivity, dentinal sensitivity or
hypersensitivity is often used intermittently to describe clinical
condition of an exaggerated response to an exogenous stimulus.
• The exogenous stimuli may include thermal, tactile or osmotic
changes.
• The response to stimulus varies from person to person due to
difference in pain tolerance, environmental factors, and
psychology of patient.
3/11/2015 Dentin hypersensitivity 4
5. Definition:
Holland et al in 1997:
Sharp, short pain arising from exposed dentin in response to stimuli
typically thermal, chemical, tactile or osmotic and which can not be
ascribed to any other form of dental defect or pathology.
3/11/2015 Dentin hypersensitivity 5
6. • Sensitivity or hypersensitive dentin implies an abnormal
sensitiveness of an exposed area of dentin, exhibiting itself in
the form of reflex or localized pain, 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.
• Pain is described as an unpleasant sensory and emotional
experience associated with actual or potential tissue damage.
3/11/2015 Dentin hypersensitivity 6
8. Neural theory:
o This theory states that dentin hypersensitivity occurs due to the
direct stimulation of nerve fibers present in the dentin.
3/11/2015 Dentin hypersensitivity 8
9. • No nerve fibers could be demonstrated going to DEJ, which is
the most sensitive area. Thus dentin sensitivity does not solely
depend up on the stimulation of such nerve endings.
Drawbacks:
• Rejected because: outer dentin which is devoid of nerve fibers
is more sensitive than inner dentin.
• Newly erupted tooth doesn’t posses nerve endings even though it
is sensitive.
3/11/2015 Dentin hypersensitivity 9
10. Odontoblastic transduction theory:
o Odontoblasts are derived from neural crest cells. They retain
the ability to transmit and propagate an impulse.
o Theory states that: dentin hypersensitivity occurs due to direct
stimulation of odontoblastic processes that are present in
dentinal tubules.
3/11/2015 Dentin hypersensitivity 10
11. Mechanical,
chemical or osmotic
stimulus
Direct stimulation
of odontoblastic
process in dentinal
tubules
Painful response hypersensitivity
• This is not a popular theory since there are no neurotransmitter
vesicles present in the gap junctions between odontoblasts to
facilitate the synapse or synaptic transmission.
3/11/2015 Dentin hypersensitivity 11
12. Hydrodynamic theory:
o Proposed by Brannstrom.
o Dentinal tubules contain dentinal fluid, odontoblastic process,
and nerve fibers.
o This theory states that fluid in the dentinal tubules can be
affected by various stimuli such as mechanical, chemical and
osmotic.
o Movement of dentinal fluids within the tubules in either
direction stimulates nerves in the dentin or pulp which results in
the painful response.
3/11/2015 Dentin hypersensitivity 12
13. Mechanical,
chemical or osmotic
stimulus
Movement of
dentinal fluid within
the dentin tubules
Stimulation of
nerves in the dentin
or pulp
Painful responseHypersensitivity.
3/11/2015 Dentin hypersensitivity 13
14. Currently most investigators accept that dentin sensitivity is due
to the hydrodynamic fluid shift
Occurs across exposed dentin with open tubules.
Rapid fluid movement in turn activates the mechanoreceptor nerves
of A group in the pulp.
3/11/2015 Dentin hypersensitivity 14
15. • Mathews et al noted that
Stimuli such as cold causes fluid flow away from the pulp.
Produces more rapid and greater pulp nerve response than those
such as heat, which causes an inward flow.
• Dehydration of dentin by air blasts or absorbent paper causes
outward fluid movement and stimulates the mechanoreceptor of
the odontoblast causing pain.
• Prolonged air blast causes formation of protein plug into the
dentinal tubules, reducing the fluid movement and thus
decreasing pain
3/11/2015 Dentin hypersensitivity 15
16. • The pain produced when sugar or salt solutions are placed in
contact with exposed dentin can also be explained by dentinal
fluid movement.
• Dentinal fluid is of relatively low osmolarity, which have
tendency to flow outwards solution of higher osmolarity i.e., salt
or sugar solution.
3/11/2015 Dentin hypersensitivity 16
18. Incidence and distribution
• Most sufferers range from 20-40 years of age and a peak
occurrence is found at the end of the third decade.
• In general slight higher incidence is reported in females than in
males.
• Reduced incidence in older individuals reflect:
Age changes in dentin and pulp.
3/11/2015 Dentin hypersensitivity 18
19. Intra-oral distribution:
• Most commonly noted on buccal cervical zones of permanent
teeth, canines and premolars in either jaw are the most
frequently involved.
• In right handed tooth brushers, dentin hypersensitivity is
greater on the left sided teeth compared with the equivalent
contra-lateral teeth.
3/11/2015 Dentin hypersensitivity 19
20. Etiology and predisposing factors:
• The primary underlying cause for dentin hypersensitivity is
exposed dentinal tubules.
• Dentin may become exposed to by 2 processes
Loss of covering periodontal structures
Loss of enamel.
3/11/2015 Dentin hypersensitivity 20
22. Causes of enamel loss
Attrition by exaggerated occlusal functions
like bruxism
Abrasion from dietary components or
improper brushing technique
Erosion associated with environmental or
dietary components particularly acids
3/11/2015 Dentin hypersensitivity 22
23. Cemental loss
• Root planing
• Periodontal diseases
• Periodontal surgeries
• Recession of the
gingiva.
Other causes
• Changes in
temperature
• The careless use of
scalers
• Action of caries and
wasting diseases
• Action of cracks/
fracture of the enamel
• Action of salts, sweets
and acidic substances.
3/11/2015 Dentin hypersensitivity 23
24. Aggressive or poor oral
hygiene
Extrinsic acids
Intrinsic acids
Gingival recession Erosion
Dentin exposure through
either enamel or gingival
recession
Opening of tubules dentinal
Disturbed flow=sensitivity
Stimulates A delta fibers
DENTIN HYPERSENSITIVITY3/11/2015 Dentin hypersensitivity 24
25. • The most common cause for exposed dentinal tubules is gingival
recession.
• Various factors that cause recession are
Inadequate attached gingiva
Prominent roots
Tooth brush abrasion
Oral habits resulting in gingival laceration
Excessive tooth cleaning
Excessive flossing
Gingival recession secondary
to specific Diseases NUG, Periodotitis.
Crown preparation
3/11/2015 Dentin hypersensitivity 25
26. • The recession may or may not be associated with bone loss.
• If bone loss occurs, more dentinal tubules get exposed.
• When gingival recession occurs the outer protective layer of
root dentin, i.e cementum gets abraded or eroded away.
• This leaves the exposed underlying dentin
• These cells contain nerve endings and when disturbed, nerves
depolarizes and this is interpreted as pain.
3/11/2015 Dentin hypersensitivity 26
28. • Poor plaque control
• Excess oral acids (soda, fruit juice)
• Tooth brush abrasion
• Cervical decay
• Tartar control tooth paste
Reasons for continued dentinal tubular exposure
3/11/2015 Dentin hypersensitivity 28
29. Clinical features:
o Pain is the primary symptom
o The patient usually experiences a short, sharp pain in response
to heat, cold, tactile stimuli, sweets or sour foods.
o Intensity of pain is usually mild to moderate.
o The clinical symptoms of hypersensitive dentin are similar to
those of acute reversible pulpitis.
o Tooth hypersensitivity differs from dentinal or pulpal pain. In
case of dentin hypersensitivity, patient’s ability to locate the
source of pain is very good where as in pulpal pain, it is very
poor. The pulpal pain is explosive, intermittent and throbbing
and can be affected by hot or cold.
o The character of pain does not outlast the stimulus.
3/11/2015 Dentin hypersensitivity 29
30. Diagnosis
• A careful history together with a thorough clinical and
radiographic examination is necessary before arriving at a
definitive diagnosis of dentin hypersensitivity.
3/11/2015 Dentin hypersensitivity 30
31. Careful case history:
The history and nature of pain
The intensity of pain
The stimuli which initiate the sensitivity
The frequency and duration of sensitivity
History of restorative procedures, periodontal procedures and
other related dental procedures.
3/11/2015 Dentin hypersensitivity 31
32. Clinical examination:
Clinical observations:
o Percussion sensitivity
o Sensitivity or pain on tactile examination
o Evidence of dentin exposure (gingival recession, loss of enamel)
o Pain lingering after stimulus is removed.
o Signs of fractured, leaky or poor restorative margins.
Diagnostic test:
o Vitality test to rule out the pulpal involvement
o Radiographic examination, to detect caries, pulpal involvement,
or periodontal involvement.
3/11/2015 Dentin hypersensitivity 32
33. Differential diagnosis
Dentin hypersensitivity is perhaps a symptom complex rather than
a true disease and results from stimulus transmission across
exposed dentin.
• A number of dental conditions are associated with dentin
exposure and may produce same symptoms.
• They are
Chipped tooth
Fractured restoration
Restorative treatments
Dental caries
Cracked tooth syndrome
Other enamel invaginations.
3/11/2015 Dentin hypersensitivity 33
34. Treatment strategies
• Hypersensitivity can resolve without the treatment or may
require several weeks of desensitizing agents before
improvement is seen.
• Treatment of dentin hypersensitivity is challenging for both
patient and the clinician mainly of 2 reasons.
1) Difficult to measure or compare pain among different patients
2) Difficult for patient to change the habits that initially caused
the problem.
3/11/2015 Dentin hypersensitivity 34
35. Management
It is well known that hypersensitivity often resolves without
treatment.
This is probably related to the fact that dentin permeability
decreases spontaneously because of occurrence of natural
processes in the oral cavity.
3/11/2015 Dentin hypersensitivity 35
36. Natural process contributing to
desensitization
Formation of reparative dentin by the pulp
Obturation of tubules by the formation of
mineral deposits. (Dental sclerosis)
Calculus formation on the surface of the
dentin.
3/11/2015 Dentin hypersensitivity 36
37. • Treatment options for managing dentin hypersensitivity should
be based on the extent and severity of the problem.
Sl no Condition Treatment
1 Localized hypersensitivity Try application of varnishes, dentin
adhesive restoration.
2 Generalized hypersensitivity Prescribe desensitizing toothpastes and
restorations.
3 Severe hypersensitivity Consider endodontic therapy
3/11/2015 Dentin hypersensitivity 37
38. • 2 principal treatment options:
Plug the dentinal tubules preventing the
fluid flow.
Desensitize the nerve, making it less
responsive to stimulation. All the
current modalities address these 2
options.
3/11/2015 Dentin hypersensitivity 38
40. Sl no Condition Treatment
1 Wasting diseases GIC or composites with proper pulp protection if
required.
2 Dental caries Metallic or nonmetallic 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 methods:
• When hypersensitivity is associated with significant loss of
tooth structure then restorative methods are employed.
3/11/2015 Dentin hypersensitivity 40
41. Non-restorative methods:
• If the loss of tooth structure is insignificant and generalized,
then the non-restorative methods are indicated.
1. Lasers
2. Desiccation
3. Iontophoresis
4. Chemical agents
5. Dentin bonding agents
6. Medicated tooth pastes
7. Topical fluoride applications
8. Resin impregnation techniques
9. Application of calcium hydroxide.
3/11/2015 Dentin hypersensitivity 41
42. Treatment of dentin hypersensitivity can be divided into:
1. Home care with dentifrices
2. In office treatment procedures
3. Patient education
3/11/2015 Dentin hypersensitivity 42
43. Home care with dentifrices:
• Dentifrice: a substance used with a toothbrush to aid in cleaning
the accessible surfaces of the teeth.
• Its components includes
Abrasive Surfactant Humectant
Thickener Flavoring agent sweetener
Coloring agent
Water
3/11/2015 Dentin hypersensitivity 43
44. o After professional diagnosis, dentinal hypersensitivity can be
treated simply and inexpensively by home use of desensitizing
dentifrices.
o The habit of tooth brushing with a dentifrice for cosmetic
reasons is well established in the population, thus compliance
with this regimen can be easily made.
3/11/2015 Dentin hypersensitivity 44
45. • 10% strontium chloride desensitizing
dentifrice found to be effective in
relieving the pain of tooth
hypersensitivity.
Strontium
chloride
dentifrices
• 5% potassium nitrate dentifrice
found to alleviate pain related to
tooth hypersensitivity.
Potassium nitrate
dentifrices
• 0.7% Sodium monofluorophosphates
dentifrices are the effective mode
of treating tooth hypersensitivity.
Fluoride dentifrices
3/11/2015 Dentin hypersensitivity 45
46. In office treatment procedures
Rationale of therapy:
o According to hydrodynamic theory of hypersensitivity, a rapid
movement of fluid in the dentinal tubules is capable of activating
intra-dental sensory nerves.
o Therefore treatment of hypersensitive teeth should be
directed towards reducing the anatomical diameter of the
tubules, obliteration of the tubules or to surgically cover the
exposed dentinal tubules so as to limit fluid movement.
3/11/2015 Dentin hypersensitivity 46
47. Criteria for selecting desensitizing agent:
Provides immediately and
lasting relief from pain
Well tolerated by
patients
Does not stain the tooth
Easy to apply
Not injurious to the pulp
Relatively inexpensive
3/11/2015 Dentin hypersensitivity 47
48. Treatment options to reduce the diameter of dentinal
tubules can be:
Formation of a smear layer by burnishing the exposed root
surface.
Application of agents that form insoluble precipitates within the
tubules
Impregnation of tubules with plastic resins
Application of dental bonding agents to seal off the tubules.
Covering the exposed dentinal tubules by surgical means.
3/11/2015 Dentin hypersensitivity 48
49. • Prior to treating sensitive root surfaces, hard/soft deposits
should be removed from the teeth.
• Root planning on sensitive dentin may cause considerable
discomfort, in this case teeth should be anesthetized prior to
treatment and the teeth should be isolated and dried with warm
air.
• Varnishes: open tubules can be covered with a thin film of
varnish, providing a temporary relief.
Varnish such as copalite can be used for this purpose.
For more sustained relief a fluoride containing varnish
Duraflor can be applied.
3/11/2015 Dentin hypersensitivity 49
50. Corticosteroids:
• Containing 1% prednisolone in combination with 25% para-
chlorophenol, 25% methacresyl acetate and 50% gum camphor
was found to be effective in preventing postoperative thermal
sensitivity.
• The use of corticosteroids is based on the assumption that
hypersensitivity is linked to pulpal inflammation; hence more
information is needed regarding the relationship between these
2 conditions.
3/11/2015 Dentin hypersensitivity 50
51. Partial obliteration of dentinal tubules.
• Burnishing of dentin:
Burnishing of dentin with a toothpick or orange wood stick results
in the formation of a smear layer.
This layer partially occludes the dentinal tubules which help in
reducing the hypersensitivity.
3/11/2015 Dentin hypersensitivity 51
52. Formation of insoluble precipitates to block tubules:
Certain soluble salts react with ions in tooth structure to form
crystals on the surface of dentin.
To be effective, crystallization should occur in 1-2 mts and the
crystals should be small enough to enter the tubules and must
also be large enough to partially obturate the tubules.
3/11/2015 Dentin hypersensitivity 52
54. Oxalates:
• Relatively inexpensive
• Easy to apply
• Well tolerated by patients.
• Eg: Potassium oxalate and ferric oxalate solution
• They make available oxalate ions that can react with calcium
ions in the dentin fluid to form insoluble calcium oxalate crystals
that are deposited in the apertures of the dentinal tubules.
3/11/2015 Dentin hypersensitivity 54
56. • Silver nitrate has ability to precipitate protein constituents of
odontoblast processes, thereby partially blocking the tubules.
• Zinc chloride- potassium ferrocyanide. When applied forms
precipitate, which is highly crystalline and covers the dentin
surface.
• Formalin 40% is topically applied by means of cotton pellets or
orangewood sticks on teeth.
• Strontium chloride: Topical application of concentrated sodium
chloride on an abraded dentin surface produces a deposit of
strontium that penetrates dentin to a depth of approximately
10-20 micro m and extend into dentinal tubules
3/11/2015 Dentin hypersensitivity 56
57. • Calcium compounds have been popular agent for many years for
the treatment of hypersensitivity.
• The exact mechanism of action is unknown but evidence suggests
that:
* It may block dentinal tubules
* May promote peritubular dentin formation.
* On increasing the concentration of calcium ions around
nerve fibers, may result in decreased nerve excitability.
So calcium hydroxide might be capable of
suppressing nerve activity.
3/11/2015 Dentin hypersensitivity 57
58. A paste of calcium hydroxide and sterile distilled water applied
on exposed root surface and allowed to remain for 3-5mts, can
give immediate relief in 75% of cases.
Dibasic calcium phosphate when burnished with round toothpick
forms mineral deposits near the surface of the tubules and
found to be effective in 93% of patients.
• Recaldent:
CPP-ACP: complex of casein phosphopeptides and amorphous
calcium phosphate.
CPPs are a group of peptides derived from casein. Casein is the part
of protein which naturally occurs in milk.
CPP is responsible for high availability of calcium ions from milk.
3/11/2015 Dentin hypersensitivity 58
59. • CPP keeps calcium and phosphorus in ionic form.
• In this state calcium and phosphate ions can enter the tooth
enamel and thus promote remineralization of the tooth.
Fluoride compounds:
o Lukomsky was the first to propose sodium fluoride as
desensitizing agent.
o Application of NaF leads to precipitation of calcium fluoride
crystals, thus reducing the functional radius of the dentinal
tubules.
3/11/2015 Dentin hypersensitivity 59
60. • 10% solution forms dense layer of tin and
fluoride containing globular particles blocking
the dentinal tubules.
Stannous
fluoride
• Silicic acid forms a gel with the calcium of the
tooth and produces an insulating barrier.
Sodium silico-
fluoride
• Concentration of fluoride in dentin treated
with acidulated sodium fluoride is found to be
higher than dentin treated with sodium
fluoride.
Acidulated
sodium
fluoride
3/11/2015 Dentin hypersensitivity 60
61. Iontophoresis:
• It is the transfer of ions under electrical pressure through
electrodes having opposite charge.
• 1-2% sodium chloride or solution containing potassium, zinc ions
etc are applied.
• These ions are forced into the tubules by applying electrical
force through electrodes.
• Fluoride ions react with calcium get precipitated in the tubules
and thereby blocks the tubules.
• It is an expensive procedure.
.
3/11/2015 Dentin hypersensitivity 61
62. Dental resins and adhesive:
• Objective: seal the dentinal tubules to prevent pain producing
stimuli from reaching pulp.
• GLUMA is a dentin bonding agent that includes glutaraldehyde
primer and 35% HEMA.
• It provides an attachment to dentin that is immediately strong.
• GLUMA is found to be highly effective when other methods of
treatment failed to provide relief.
3/11/2015 Dentin hypersensitivity 62
63. Rinsing and drying for 20sec
Application of bonding agent
Surface is etched with phosphoric acid for 5sec
Resin impregnation technique
Exposed dentin surface is cleansed
3/11/2015 Dentin hypersensitivity 63
64. LASERS:
• Kimura Y et al reviewed treatment of dentin hypersensitivity by
Lasers.
• 2 groups
1) low output power: Helium –neon and
gallium/ aluminium / arsenide lasers.
2) middle output power: Nd:YAG and CO2 lasers.
• Action
Effects of sealing of dentinal tubules: durable
Nerve analgesia
Placebo effect.
3/11/2015 Dentin hypersensitivity 64
66. Patient education:
Dietary counselling:
Dietary acids are capable of causing erosive loss of tooth structure
removing cementum
Opening of dentinal tubules
• Dietary counselling should focus on the quantity and frequency
of acid intake and intake occurring in relation to tooth brushing.
3/11/2015 Dentin hypersensitivity 66
67. • Any treatment may fail if these factors are not controlled.
• A written diet history should be obtained.
• Loss of dentin is greatly increased when brushing is performed
immediately after exposure of the tooth surface to dietary
acids.
• Patients should be cautioned against brushing their teeth soon
after ingestion of citrus food.
3/11/2015 Dentin hypersensitivity 67
68. Tooth brushing technique:
• Incorrect brushing appears to be an etiologic factor in dentin
hypersensitivity, instruction about proper brushing techniques
can prevent further loss of dentin and the hypersensitivity.
3/11/2015 Dentin hypersensitivity 68
69. Plaque control:
• Saliva contain calcium and phosphate ions and is therefore able
to contribute to the formation of mineral deposits within the
exposed dentinal tubules.
• Presence of plaque may interfere with this process, by producing
acid by bacteria, are capable of dissolving any mineral
precipitates that form thus opening tubules.
3/11/2015 Dentin hypersensitivity 69
70. Conclusion
Professional interest in the cause and treatment of dentinal
hypersensitivity has been evident in the dental literature for
approx. 150 years or more.
It satisfies all the criteria to be classified as a true pain syndrome.
Myelinated A fibers are seems to be responsible for the sensitivity
of dentin.
Management of this condition requires determination of etiologic
factors and predisposing influences.
Partial obturation of open tubules the most widely practiced in
office treatment of dentinal hypersensitivity.
3/11/2015 Dentin hypersensitivity 70