Dentinel Sensitivity

Question 1

what are the components in dentin

Answer 1

• organic components
• inorganic components
• dentinal tubules

Question 2

describe dentinal tubules

Answer 2

• run from pulp to the outer dentinal surface
• contain Tomes fibers
• three types of nerve fibers

Question 3

dentinal tubules can be ____ or _____

Answer 3

open; plugged

Question 4

where are the tomes fibers

Answer 4

extend into the dentinal tubules from the odontooblasts
- communicate with the pulp

Question 5

what are the types of nerve fibers

Answer 5

• A delta
• A beta
• C

Question 6

what causes hypersensitive dentin

Answer 6

• tubules open to cavity
• large number of tubules

Question 7

describe the smear layer

Answer 7

• deposit of salivary proteins
• debris from toothpaste and other matter

Question 8

what is brannstrom’s hydrodynamic theory

Answer 8

• stimuli are transmitted to the pulp surface due to the movement of fluid or semi fluid within open dentinal tubules

Question 9

what is the etiology of dentinal hypersensitivity

Answer 9

• gingival recession
• mulitple factors
• enamel loss

Question 10

what is dentinal sensitivity

Answer 10

short, sharp pain when stimulus reaches exposed dentin

Question 11

what are the factors that affect dentin sensitivity

Answer 11

• thermal
  -chemical
• tactile
• evaporative

Question 12

what is the most common factor causing dentinal hypersensitivity

Answer 12

thermal

Question 13

what causes gingical recession

Answer 13

• anatomy of labial plate
• periodontal disease
• frenum involvement
• toothrbush abrasion
• poor oral hygiene
• inadequate attached gingiva
• periodontal surgery
• iatrogenic loss
• aggressive scaling/root planing
• acute or chronic trauma
• occlusal trauma
• excessive oral hygiene

Question 14

what are the common factors of erosion

Answer 14

• acid reflux disease
• bulimia
• frequency of acidic food/drink

Question 15

what is the prevalence of enamel loss

Answer 15

• all age ranges but higher incidence in 20-40 year old age group
• females more prone

Question 16

what is the common site of occurence of enamel loss

Answer 16

buccal and labial surfaces
- canine/premolar
- incisors
- 2nd premolars and molars

Question 17

what diagnoses do you need to exclude in sensitivity

Answer 17

• dental caries
• fractured teeth
• fractured restorations

Question 18

what causes exposed dentin

Answer 18

• enamel loss
• gingival recession

Question 19

how can you limit hypersensitivity

Answer 19

modify patient behaviors
- dietary modifications
- teeth whitening

Question 20

what can cause enamel loss

Answer 20

• abrasion
• erosion
• abfraction

Question 21

what are the treatment options in office for dentinal hypersensitivity

Answer 21

-varnishes/precipitates
- primers
- placement of restorations
- composite resin based
- restorations with glass ionomer

Question 22

is erosion irreversible

Answer 22

no

Question 23

what are the treatment options for at home dentinal hypersensitivity and mode of action

Answer 23

• dentrifics, gels, rinses
• mode of action: depolarizes nerve endings, tubule occlusion

Question 24

what are the products we use in office

Answer 24

• gluteraldehyde/HEMA based agents
• 5% sodium fluoride varnish

Question 25

what does gluteraldehyde/HEMA based agents do

Answer 25

- reduce hypersensitivity immediately after treatment - reduced dentin permeability

Question 26

what does 5% sodium fluoride varnish do

Answer 26

- forms a barrier over exposed dentin - relief provided by calcium fluoride deposits

Question 27

what is the product used as an in office treatment/at home treatment and what is mechanism of action and how is it used

Answer 27

- MI paste - recaldent (CCP-ACP) - casein phosphopeptide- amrophous calcium phosphate - mechanism of action: replaces calcium and phosphate ions - use: apply with prophy cup or if at home after brushing

Question 28

diagnosis of hypersensitivity is one of:

Answer 28

exclusion

Question 29

how do at home treatments work

Answer 29

- interference with neural transmission - tubule occlusion

Question 30

how do at home treatments interfere with neural transmission

Answer 30

- dentrifices containing 5% potassium nitrate - works by penetrating the length of the tubule to depolarize the nerve endings - frequent and regular applications are needed

Question 31

what ingredients in at home treatments cause tubule occlusion

Answer 31

- main active ingredient is fluoride - stannous fluride- most commonyl used - arginine and calcium cabronate - hydroxyapatite - prescription strength fluoride toothpaste

Question 32

what is the strength of prescription strength fluoride toothpaste

Answer 32

-5,000 ppm - 1.1% sodium fluoride - prevident