Dentin hypersensitivity (DHS)
I- Definition:
The Canadian Advisory Board defines dentin hypersensitivity as a sharp, short-lived, acute pain caused by exposed dentin in response to stimuli, usually thermal, evaporative, tactile, osmotic or chemical, that cannot be attributed to any other form of dental abnormality or disease.
II- Epidemiology:
- Sex
- The prevalence of dentin hypersensitivity appears to be greater in women than in men (6 studies versus only one in favor of men).
- Age
Patients suffering from dentin hypersensitivity are preferably in the age group between 30 and 50 years old.
- Socio-economic level:
High-level patients are more affected
III-Etiologies
- Gum recession:
Exposure of the root surface (gingival recession which will cause loss of cementum and denudation of the root dentin).
The origin of the recession is multifactorial, and most often is linked to periodontal disease.
- 2- Loss of enamel:
Erosion, abrasion, attrition and abfraction are tissue losses of chemical and mechanical origin which can lead to dentin exposure which explains the painful phenomenon.
- 3- physiological causes:
- The prevalence of recession tends to increase with age
- Egression of a tooth without antagonist
- Hyposialia in the elderly promoting erosions
- 4- iatrogenic causes:
HSD may appear after:
- Descaling
- Tooth whitening
- Orthodontic treatment using excessive forces
IV- Pathophysiology
- The pain caused by DHS is related to the exposure of dentin to the oral environment after loss of enamel/or cementum with or without gingival recession.
- The most widely accepted mechanism of sensitivity is that of BRÄNNSTROM’s theory. According to this theory, free nerve endings located in and at the periphery of the pulp would be able to detect fluid movement within the tubules.
- At the level of the exposed dentin there are more open tubules (8 times more) with a canaliculus diameter 2 times larger
V- Diagnosis
- A medical interview will provide information on the type of pain, its intensity, its location, the number of teeth involved and the type of triggering stimuli.
- Subjective signs: Patients with dentin hypersensitivity usually experience a sharp , brief pain , in reaction to cold (the most common trigger), touch, air, or osmotic or chemical stimuli.
- Objective signs:
- Air jet (Shiff test): the exposed dentin is exposed using an air syringe and the sensitivity is assessed on a scale from 0 to 3
- Touch test (Yeapele test): a force is applied using a Yeapele probe to the exposed dentine, this will be increased gradually (healthy tooth 70g, DHS tooth 10g)
- Cold test: carried out using a cotton ball soaked in dichlorofluoroethane.
- Dentin hypersensitivity (DHS)
VI- Differential diagnosis:
Will be done with
- Lesion of carious origin
- Crack/fracture
- Pulpite
- Recent restoration
VII-Treatment:
1-Non-invasive reversible outpatient treatment
- 1-a-toothpastes:
1-a-1-Fluorinated compounds: the precipitation of CaF2 which is deposited in the peri- and intratubular regions of the dentin. In doing so, the deposition of calcium fluoride salts leads to a reduction in the diameter of the tubules which results in the decrease of DHS.
1-a-2-Potassium Nitrate: (KNO3): the increase in K+ concentration decreases the action potential of the nerve fiber, thus preventing the generation of the pain message.
1-a-3-Strontium salts; causes tubular occlusion with an unknown mechanism
1-a-4-Pro-Argin Technology: formation of a calcium carbonate-Argenine complex within the tubules and participates in the attraction of salivary Ca+ and PO4- and finally in tubular occlusion.
1-a-5-Novamin Technology: causes an increase in PH, release of CA+ and P5- ions in saliva and finally precipitation of salts and formation of apatite crystals
- 1-b-Mouthwashes
- ELMEX potassium salt -rich mouthwash is used undiluted, for one minute, twice a day (morning and evening) and half an hour after brushing so as not to immediately eliminate the active ingredients of the toothpaste.
1. c. Gels
- Desensitizing gels include: Gel-Kam (containing 0.4% stannous fluoride), Sensodyne Cool Gel, Colgate Prevident Gel (1.1% sodium fluoride). In practice, daily use of 5% potassium nitrate gel for three to five weeks has proven very effective.
2-Non-invasive chairside treatment
- 2-a-fluoride varnish: fluoride-based varnishes have the capacity to precipitate CaF2 globules; these mineral deposits then partially block the tubules and also constitute a reservoir of fluorides
- 2-b-Fluoride pastes: the application of pastes for professional use using thermoformed gutters gives excellent results, there are pastes based on sodium fluoride, pro argenin and others
- 2-c-Adhesives: Adhesives are better tube sealers and contribute to better DHS reduction.
- 2-d-low energy laser: it increases the activity of odontoblasts, stimulates the formation of third dentin and increases the excitability threshold
- 2-medium and high energy e-laser: it causes the evaporation of tissues and the bursting of joints leading to tubular obturation
- 2-f-Ozone therapy and hypnotherapy: appear to effectively reduce DHS.
Dentin hypersensitivity (DHS)
3-Invasive chairside treatment
- A-restorative treatment: restorations can be administered in case of advanced lesions; the choice will be leaning towards composite, CVI and compomer.
- B- periodontal surgery: which attempts to cover the roots exposed in the event of gingival recession
- C- endodontic treatment: the pulp removal of the causal teeth will cause total and immediate sedation of the pain but will remain a very invasive solution
Dentin hypersensitivity (DHS)
Wisdom teeth can be painful if they are misplaced.
Composite fillings are aesthetic and durable.
Bleeding gums can be a sign of gingivitis.
Orthodontic treatments correct misaligned teeth.
Dental implants provide a permanent solution for missing teeth.
Scaling removes tartar and prevents gum disease.
Good dental hygiene starts with brushing twice a day.