Define dentinal hypersensitivity
Dentinal hypersensitivity is known as dentinal pain due to thermal, mechanical, chemical or osmotic stimuli. The pain subsides quickly when the stimulus is removed
Identify risk factors contributing to dentinal hypersensitivity
Gingival recession, attrition and abfraction, loss of enamel
• Non-surgical / surgical periodontal therapy
§ resulting in resolution of inflammation = exposes more tooth root surface
§ shrinkage of oedematous tissue
- Attachment loss due to repeated instrumentation in shallow pockets with no calculus
- Incorrect tooth brushing pressure (dependent on biotypes)
- Use of abrasive toothpastes
- Restorative procedures / oral surgery: polymerisation shrinkage or not using an appropriate lining
- Anatomy of CEJ: may be a gap between the CEJ
- Thin cementum which is readily removed during surface debridement & polishing
- Chemical reactions: associated with plaque, bulimia and diet
- Parafunctional habits: grinders
- Root caries
Identify situations that mimic dentinal hypersensitivity
Cracked tooth syndrome
• Defective restorations & marginal leakage
• Fractured or chipped teeth or restorations
• Dental caries
• Sensitivity following restorative treatment
• Incomplete polymerization of restorative materials
Define and discuss causes of classic recession
An inflammation free clinical condition characterized by apical retreat of the facial oral gingiva
• Dehiscence and fenestrations are seen
Causes
• Primarily caused by morphology and anatomy: facial plate of bone is very thin
• Anterior and premolars are most affected
• Improper, traumatic tooth brushing
• Frenum pulls
• Orthodontic treatment: tooth movement labially, arch expansion
• Interdental papilla fill entire embrasure area in young patients
Define Stillman’s cleft
Relatively rapid formation of a small groove in the gingiva which can extend into a pronounced recession
Define McCall’s festoon
As a consequence of recession, the remaining attached gingiva may become thickened and rolled
List characteristics of classical recession
May be localized or generalised
• Periodontal supporting structures are usually healthy
• Teeth are not excessively mobile
• No tooth loss due to classical gingival recession alone
• If OH is inadequate, may lead to secondary inflammation and eventually pocket formation
Discuss the diagnosis of gingival recession
Established through:
• Patient history
• Clinical examinations and application of a stimuli
• Radiographs: it’s not caries
Determine cause of recession:
• Classical recession
• Pocket formation- periodontitis, treated or untreated
Consider risk factors:
• cervical abrasion
• predisposition to root caries
Consider symptoms:
• Increased secondary dentin
• Dentinal sensitivity
Measure:
• Vertical measurement from CEJ to base
• Horizontal measurement: width of tooth
Define dehiscence and fenestrations
Dehiscence:
Incomplete coverage by bone from the CEJ down to an area of the root
Fenestrations:
Bone loss on the facial or lingual aspect of a tooth that exposes the root surface to the mucosa/ periosteum
Discuss the management of hypersensitivity
Instrumenting areas with existing hypersensitivity may result in sharp pain. LA may be necessary for patient comfort
- Most instrumentation of root surfaces does not cause dental hypersensitivity because of the smear layer
- The smear layer is debris from the tooth surface that covers dentinal tubules inhibiting fluid flow, thus preventing sensitivity
• Most areas of hypersensitivity eventually desensitize on their own because dentinal tubules go through a natural process of crystallization and occlusion
• Strategies for intervention and management can include:
○ Chemical management
○ Patient education
List the classifications for recession
- Class I: recession does not extend to the mucogingival junction and there is no tissue loss in the interproximal area. Localised
- Class II: recession extends to or beyond the mucogingival junction. There is no periodontal or tissue loss in the interproximal area. Localised
- Class III: recession extends to or beyond the mucogingival junction, into the mobile mucosa. Bone or soft tissue loss is present in the interdental area
- Class IV: recession extends to or beyond the mucogingival junction with alveolar bone and soft tissue loss.
Explain Brännström’s hydrodynamic theory of pain transmission
- A stimulus (cold, heat or blast of air) on exposed dentin causes rapid fluid movement within dentinal tubules
- This fluid movement stimulates nerve endings of the pulp associated with odontoblastic processes, causing pain
Discuss and cite examples of tactile (mechanical ) pain stimuli
Toothbrush bristles • Eating utensils • Dental & periodontal instruments • Friction from denture clasps or other appliances • Oral habits
Discuss and cite examples of chemical pain stimuli
Acids in different forms ○ excessive intake of carbonated beverages ○ bacterial plaque acid production ○ citrus fruit acid ○ wine ○ condiments ○ spices ○ stomach acids (assoc. with gastric reflux, morning sickness, etc.)
Discuss and cite examples of thermal pain stimuli
hot or cold foods / beverages
• Air
Discuss and cite examples of osmotic pain stimuli
• concentrated salt or sugar solutions induce fluid movement which stimulates nerve endings & causes pain
Define dentinal hypersensitivity
transit pain arising from exposed dentine. the cause of identical hypersensitivity depends on particle or total loss of enamel
discuss desensitizing dentifrices available
Sensodyne Duraphat Arginine- colagte sensitive pro laser sodium citrate glutaraldehyde with HEMA GIC Silver fluoride- Riva Star Potassium Iodine- Riva Star
list steps involved in diagnosing dentinal hypersensitivity
- Thorough patient history
- radiographic evaluation
- clinical examination
- specific questioning about stimuli
- clinical application of air, cold spray or mechanical exploration
List four ways dentinal hypersensitivity can naturally and spontaneously resolve
- teeth goo through a natural process of occlusion of open tubules. This can be accelerated through the use of desensitizing dentifrices and fluoride and saliva minerals
- Tubular scelorsis- occurs naturally as root dentine ages but can also be caused by trauma, abrasion and bacterial invasion
- secondary dentine- which forms due to irritation and stimulation
- calculus formation
state the ingredients in toothpaste for sensitive teeth
- potassium nitrate
- Strontium chloride
state desensitising fluorides (are not remineralising )
- Stannous Fluoride
- Sodium Fluoride
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Periodontal Phenotypes Recession and Anomalies18
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Dentinal Hypersensitivity22
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Preventive Management of Root Caries13
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Introduction to Oral Lesions21
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Tooth Wear and Erosion14
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Treating Patients with Diabetes22
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Cardiovascular Disease23
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Signs, Symptoms & Medical Side Effects of CVD16
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Smoking and the Oral Cavity15
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Smoking cessation19
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Chemotherapeutics In Periodontal disease24
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Periodontal Prognosis and Maintenance17
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Restorations and Periodontal considerations12
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Social and Psychological aspects of Aging13
