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    l1 9-11 Dentin Hypersensitivity - DR Vivek

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    Ju Ju
    Dentin hypersensitivity is characterized by short, sharp pain from exposed dentin in response to stimuli like heat, cold, sweets or touch. It occurs when enamel or cementum is lost, exposing underlying dentin and open dentinal tubules connected to the pulp. The hydrodynamic theory explains that stimuli cause fluid movement in dentinal tubules, activating pain receptors. Diagnosis involves identifying pain from stimuli without lingering discomfort. Differential diagnosis rules out other causes. Management involves occluding tubules or blocking nerves to desensitize the area.

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    l1 9-11 Dentin Hypersensitivity - DR Vivek

    Uploaded by

    Ju Ju
    41 views28 pages
    Dentin hypersensitivity is characterized by short, sharp pain from exposed dentin in response to stimuli like heat, cold, sweets or touch. It occurs when enamel or cementum is lost, exposing underlying dentin and open dentinal tubules connected to the pulp. The hydrodynamic theory explains that stimuli cause fluid movement in dentinal tubules, activating pain receptors. Diagnosis involves identifying pain from stimuli without lingering discomfort. Differential diagnosis rules out other causes. Management involves occluding tubules or blocking nerves to desensitize the area.

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    l1 9-11 Dentin Hypersensitivity - Dr Vivek

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    Dentin hypersensitivity is characterized by short, sharp pain from exposed dentin in response to stimuli like heat, cold, sweets or touch. It occurs when enamel or cementum is lost, exposing underlying dentin and open dentinal tubules connected to the pulp. The hydrodynamic theory explains that stimuli cause fluid movement in dentinal tubules, activating pain receptors. Diagnosis involves identifying pain from stimuli without lingering discomfort. Differential diagnosis rules out other causes. Management involves occluding tubules or blocking nerves to desensitize the area.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    41 views28 pages

    l1 9-11 Dentin Hypersensitivity - DR Vivek

    Uploaded by

    Ju Ju
    Dentin hypersensitivity is characterized by short, sharp pain from exposed dentin in response to stimuli like heat, cold, sweets or touch. It occurs when enamel or cementum is lost, exposing underlying dentin and open dentinal tubules connected to the pulp. The hydrodynamic theory explains that stimuli cause fluid movement in dentinal tubules, activating pain receptors. Diagnosis involves identifying pain from stimuli without lingering discomfort. Differential diagnosis rules out other causes. Management involves occluding tubules or blocking nerves to desensitize the area.

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    of 28

    DENTIN HYPERSENSITIVITY

    LEARNING OUTCOMES :
    • At the end of the Presentation student is able to :
    1. Describe the diagnosis, clinical features,
    differential diagnosis and prevention of dentin
    hypersensitivity. (C1)
    DEFINITION
    • The International workshop
    on Dentin Hypersensitivity
    (1983) has proposed the
    following definition:
    • “Dentin Hypersensitivity is
    characterized by short, sharp
    pain arising from exposed
    dentin in response to stimuli
    typically thermal,
    evaporative, tactile, osmotic
    or chemical and which
    cannot be ascribed to any
    other form of dental defect
    or pathology. ’’
    • This definition provides a
    clinical description of the
    condition and identifies
    hypersensitivity as a
    distinct clinical entity.
    ETIOLOGY
    ETIOLOGY
    • Whenever there is loss of enamel or cementum
    leading to exposure of the underlying dentin, Dentin
    Hypersensitivity may occur.
    • Enamel may be lost due to wasting diseases like
    attrition, abrasion, erosion or abfraction.
    • Periodontal diseases and Periodontal treatment like
    root planing may result in the removal of cementum
    covering the root surfaces.
    • Not all exposed dentin is sensitive.
    • Dentin Hypersensitivity occurs only when the dentin
    is exposed and the dentinal tubules are patent from
    the surface till the pulp.
    DEVELOPMENT
    • There are 2 phases in the development of Dentin
    Hypersensitivity :
    • 1.Lesion localization – This requires exposure of
    the dentin. ( loss of cementum /
    enamel )

    • Lesion localization occurs by Gingival recession,

    • abrasion, erosion etc.


    2. Lesion initiation – This requires removal of the
    ( loss of layer / I
    • cementum or smear layers. smear
    Mugs
    This occurs due to periodontal procedures or by
    the action of abrasive or erosive agents.
    The essential components of dentin hypersensitivity are
    exposed dentin surfaces with open patent tubules leading to
    vital pulp
    Fluid shifts in the dentinal tubules activate pain
    receptors to cause pain
    MECHANISM OF PAIN TRANSMISSION –
    THEORIES OF DENTIN HYPERSENSITIVITY
    • The exact mechanism of dentin
    hypersensitivity is not very clear but several
    theories have been proposed to explain the
    phenomenon. They include :
    • 1.Direct innervation theory
    • 2.Odontoblast deformation theory
    • 3.Hydrodynamic theory.
    1.DIRECT INNERVATION THEORY
    [Not )
    accepted anymore
    • Nerve fibres present within the dentinal
    tubules initiate impulses when they are
    injured and this causes dentinal
    hypersensitivity.
    • Nerve fibres are present only in the predentin
    and inner dentinal zones but do not extend all
    the way up to DEJ, which is the most sensitive
    area of the dentin.
    2.ODONTOBLAST DEFORMATION THEORY
    (Not accepted I
    anymore
    • This theory suggests that the odontoblasts or
    their processes are damaged when external
    stimuli are applied to exposed dentin.
    • This theory fell in to disfavor as research has
    shown that the odontoblastic processes
    extend only partly through the dentin and not
    up to the dentinoenamel junction.
    HYDRODYNAMIC THEORY
    • Structurally, the dentin has over 30,000 dentinal
    tubules/ mm2.
    • These are filled with dentinal fluid which is the
    intercellular fluid of the pulpal connective tissue.
    • In a vital tooth, there is a constant, slow outward
    movement of this fluid through the dentinal tubules.
    • The hydrodynamic theory states that whenever
    exposed dentin is stimulated by tactile, chemical,
    thermal or osmotic stimuli there is rapid movement
    of the dentinal fluid either towards the pulp or
    outward.
    • This can cause :
    • Direct stimulation of the low threshold A- delta
    nerve fibers in the pulp.
    • Indirect stimulation of A delta nerve fibres in the

    • pulp by displacing the odontoblastic cell bodies.


    Such rapid displacement of dentinal fluid in
    thousands of dentinal tubules at the same time
    produces a cumulative effect and this causes
    • hypersensitivity.
    For hydrodynamic theory to be accepted as valid,
    teeth presenting with hypersensitivity must have
    • dentinal tubules which are open at the dentin
    surfaceand patent till the pulp.
    Presently, It is well accepted
    CLINICAL FEATURES
    • Pain is the primary symptom of hypersensitive
    dentin. Exposed dentine 1
    • The patient usually experiences a short, sharp pain
    in response to heat, cold, tactile stimuli, sweet or
    sour foods. ( Response to any external stimuli I
    • This pain is considered to be exaggerated response
    of the normal pulp-dentin complex and is felt on
    application of the external stimulus.
    • There is no lingering (continuous) discomfort once
    the stimulus is removed.
    • The clinical symptoms of dentin hypersensitivity are
    similar to those of acute reversible pulpitis.
    DIAGNOSIS
    • A careful history together with a thorough clinical
    and radiographic examination is necessary before
    arriving at a definitive diagnosis of dentin
    hypersensitivity.
    • Problem may be made difficult when 2 or more
    conditions co exist.
    • Tooth hypersensitivity differs from dentinal or
    pulpal pain.
    • In case of dentin hypersensitivity, patients ability to
    locate the source of pain is very good, where as in
    case of pulpal pain, it is very poor.
    DIAGNOSIS
    • The character of the pain does notoutlast the
    stimulus ; the pain is intensified by thermal changes,
    sweet and sour.
    • Intensity of the pain is usually mild to moderate.
    • The pain can be duplicated by hot and cold
    application or by scratching the dentin.
    • The pulpal pain is intermittent, throbbing and can be
    affected by hot and cold.
    diagnosis is done by using,
    Mechanical (tactile) stimuli:
    - Explorer probe

    - Constant pressure probe (Yeaple)

    Chemical (osmotic) stimuli:


    - Hypertonic solutions
    (e.g. sodium chloride, glucose, sucrose,
    calcium chloride)
    Electrical stimuli:

    - Electrical pulp testers

    Evaporative stimuli:

    - Cold air blast


    I for
    will relief after sustained 5-10 seconds

    due to
    deposition of protein during Amination
    Thermal stimuli:

    }
    - Cold water testing
    Confirmatory
    - Heat

    - Ethyl chloride

    - Ice stick
    DIFFERENTIAL DIAGNOSIS
    • The definitive diagnosis of dentinal hypersensitivity is
    more difficult when there are other conditions
    causing reversible pulpitis present in combination
    with exposed dentin. Dentin Hypersensitivity has to
    be differentiated from :
    @ • 1. Fractured restorations
    • 2. Fractured enamel exposing dentin
    ③ • 3. Dental caries ⑤ occlusal trauma
    ④ • 4. Post restoration sensitivity
    ⑥ Atypical facial odontalgia .

    ① • 5. Cracked tooth syndrome


    • 6. Bleaching sensitivity
    • The management of these conditions is different
    from the treatment of dentinal hypersensitivity.
    • In the first three situations, definitive restoration
    intervention is indicated.
    • In cases where sensitivity occurs soon after a
    restoration is placed, the restorative technique and
    pulp protection have to be re evaluated.
    • Cracked tooth syndrome is a puzzling clinical problem
    which requires specialized diagnostic tools and
    management.
    PREVENTION
    • 1. Diet counselling especially regarding the
    consumption of acidic fruits and beverages.
    • 2. Correction of brushing techniques in order to
    prevent damage to the cervical enamel and
    supporting tissues.
    • 3. Care during operative procedures and while
    restoring teeth to avoid iatrogenic damage to tooth
    structure.
    • 4. Care during periodontal procedures like scaling
    and root planing.
    MANAGEMENT OF DENTIN
    HYPERSENSITIVITY
    • There are 2 basic mechanisms by which dentin
    hypersensitivity can be managed.
    • 1. Desensitization by occluding the dentinal tubules.
    • 2. Desensitization by blocking the pulpal sensory
    nerves.
    :
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    My
    hygiene

    ÷÷÷
    ③ Bulimia

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