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Dentinal Hypersensitivity: Causes and Treatment Strategies





By Back Mike Wong • June 25, 2019

You love ice cream, but suddenly that triple fudge cone doesn’t seem so appealing due to dentinal hypersensitivity.  Though statistics vary widely, research indicates that dentinal hypersensitivity affects more than half of all patients, especially in the 20 to 40 age group,1 with women slightly more affected than men.2

Characterized as a short, sharp pain that occurs in response to thermal, tactile, osmotic, chemical or evaporative stimuli, dentinal hypersensitivity seems to occur intermittently. With no other pathology present, it often affects more than one tooth, differing from the dull ache of pulpal pain, which continues after the stimulus has been removed.3,4

Causes of Dentinal Hypersensitivity

Gingival recession plays a significant role in dentinal hypersensitivity. It can expose wide swathes of dentin to external stimuli.2,3,5 But dentinal hypersensitivity may also be caused by a host of other conditions that expose dentin, including abrasion and erosion.3 Bruxism and abfraction are also thought to lead to dentinal hypersensitivity. The latter of these as a cause for dentinal hypersensitivity, however, is up for debate.3,6

At-home whitening is seen as a major offender, due to peroxide content. These products can draw water through tooth structure, which can stimulate nerves3,7 — and not in a good way. Other causes for dentinal hypersensitivity include periodontal disease, scaling and root planing, and cracked-tooth syndrome.

Pain Explained

Whatever the trigger for dentinal hypersensitivity pain is, the most commonly accepted physiological explanation for it is hydrodynamic theory, which holds that pain is the result of fluids within exposed dentinal tubules being set in motion upon thermal, physical or osmotic changes. These movements stimulate nerves, which signal pain.3,8–11

Remedies

The key to counteracting dentinal hypersensitivity pain lies in covering up exposed dentin. This can be accomplished by occluding dentinal tubules, through nerve desensitization or protein precipitation, or by sealing dentin.3,1

In more invasive procedures, lasers can occlude or at least narrow tubules.3,13,14 Bonding and gingival grafting procedures may also help if all else fails.3,15,16 Among the most common conservative approaches are the use of anti-inflammatories, protein precipitants, and agents that plug and seal tubules.3,17

At-home treatments include toothpastes containing potassium salts or fluoride that can block nerve action or the tubules themselves. Calcium phosphate products can help accelerate remineralization. Other beneficial agents include casein phosphopeptide-amorphous calcium phosphate, calcium sodium phosphosilicate, and tricalcium phosphate.3,18–21

In-office treatments include fluoride varnishes for slow, continued release of fluoride.3,22  Glass ionomer-based varnishes offer both fluoride exchange and long-term protection. Varnishes containing glutaraldehyde and hydroxyethylmethacrylate facilitate the coagulation of plasma proteins in tubules, blocking them.3,23 Chlorhexidine-based varnishes and oxylates form mechanical barriers.3,13,24 Desensitizing pastes composed of arginine and calcium carbonate can also be applied chairside to plug dentinal tubules.1,3

Benefits of Isolation

Isolation is beneficial when determining the location of hypersensitivity, and when treating it in-office. Isolite systems offer isolation and a dry field through continuous suction and tissue retraction.  Such systems deliver needed features for application of varnishes and sealants, while maintaining patient comfort and safety.

Dentinal hypersensitivity can strike at any time. By educating patients about the possible causes of this painful condition, and by taking the appropriate measures available to treat those already experiencing it, you can help ensure their next ice cream cone will be a pleasure, not a pain.

REFERENCES

  1. Panagakos F, Schiff T, Guignon A. Dentin hypersensitivity: effective treatment with an in-office desensitizing paste containing 8% arginine and calcium carbonate. Am J Dent. 2009;22(Suppl):3A–7A.
  2. Cunha-Cruz J, Wataha JC, Heaton LJ, et al. The prevalence of dentin hypersensitivity in general practices in the northwest United States. J Am Dent Assoc. 2013;144:288-296.
  3. Trushkowsky RD. Etiology and treatment of dentinal hypersensitivity. Decisions in Dentistry. 2016:2(12);18–24.
  4. Holland GR, Narhi MN, Addy M, Gangarosa L, Orchardson R. Guidelines for the design and conduct of clinical trials on dentine hypersensitivity. J Clin Periodontol. 1997;24:803–813.
  5. Withers S, Zawistowski D. Targeting the pain. Mentor. 2017;8(11):29–32.
  6. Michael JA, Townsend GC, Greenwood LF, Kaidonis JA. Abfraction: separating fact from fiction. Aust Dent J. 2009;54:2–8.
  7. Swift EJ Jr. Tooth sensitivity and whitening. Compend Contin Educ Dent. 2005;26(9Suppl 3):4–10.
  8. Kramer IR. The relationship between dentine sensitivity and movements in the contents of dentinal tubules. Br Dent J.1955;98:391–392.
  9. Brännström M. The elicitation of pain in human dentine and pulp by chemical stimuli. Arch Oral Biol.1962;7:59–62.
  10. Gillam DG. Management of dentin hypersensitivity. Clin Oral Investig. 2015;2:87–94.
  11. Li Y. Innovations for combating dentin hypersensitivity: current state of the art. Compend Contin Educ Dent. 2012;33(Suppl):10–16.
  12. Canadian Advisory Board on Dentin Hypersensitivity. Consensus-based recommendations for the diagnosis and management of dentin hypersensitivity. J Can Dent Assoc.2003;69:221–226.
  13. Lan WH, Lee BS, Liu HC, Lin CP. Morphologic study of Nd:YAG laser usage in treatment of dentinal hypersensitivity. J Endod.2004;30:131–134.
  14. Orhan K, Aksoy U, Can-Karabulut DC, Kalender A. Low-level laser therapy of dentin hypersensitivity: a short-term clinical trial. Lasers Med Sci. 2011;26:591–598.
  15. Ide M, Morel AD, Wilson RF, Ashley FP. The role of a dentine-bonding agent in reducing cervical dentine sensitivity. J Clin Periodontol. 1998;25:286–290.
  16. Douglas de Oliveira DW, Marques DP, Aguiar-Cantuária IC, Flecha OD, Gonçalves PF. Effect of surgical defect coverage on cervical dentin hypersensitivity and quality of life. J Periodontol. 2013;84:768–775.
  17. Al-Saud LM, Al-Nahedh HN. Occluding effect of Nd:YAG laser and different dentin desensitizing agents on human dentinal tubules in vitro: a scanning electron microscopy investigation. Oper Dent. 2012;37:340–355.
  18. Poulsen S, Errboe M, Hovgaard O, Worthington HW. Potassium nitrate toothpaste for dentine hypersensitivity. Cochrane Database Syst Rev. 2001;2:CD001476.
  19. Orchardson R, Gillam DG. Managing dentin hypersensitivity. J Dent Assoc.2006;137:990–998.
  20. Borges BC, Souza-Junior EJ, da Costa Gde F, et al. Effect of dentin pre-treatment with a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste on dentin bond strength in tridimensional cavities. Acta Odontol Scand.2013;71:271–277.
  21. Forsback AP, Areva S, Salonen JI. Mineralization of dentin induced by treatment with bioactive glass S53P4 in vitro. Acta Odontol Scand. 2004;62:14–20.
  22. García-Godoy A, García-Godoy F. Effect of an 8.0% arginine and calcium carbonate in-office desensitizing paste on the shear bond strength of composites to human dental enamel. Am J Dent. 2010;23:324–326.
  23. Dijkman GE, Jongebloed WL, de Vries J, Ogaard B, Arends J. Closing of dentinal tubules by glutaraldehyde treatment, a scanning electron microscopy study. Scand J Dent Res.1994;102:144–150.
  24. Sköld-Larsson K, Sollenius O, Petersson LG, Twetman S. Effect of topical applications of a novel chlorhexidine-thymol varnish formula on mutans streptococci and caries development in occlusal fissures of permanent molars. J Clin Dent.2009;20:223–226.