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Dentine hypersensitivity

When in discussion with dental professionals, patients might complain of 'sensitive teeth'. There are a number of potential causes for this symptom, and the differential diagnosis should exclude other potential causes – cracked tooth syndrome, fractured restorations, chipped teeth, dental caries, gingival inflammation, post-restorative sensitivity, marginal leakage, pulpitis or palatogingival grooves – before dentine hypersensitivity is confirmed.1

Dentine hypersensitivity, which has been defined as a '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' has a number of potential causes, including gingival recession and tooth wear.1

Gingival recession is frequently the result of plaque-induced gum disease and/or excessive brushing. Tooth wear (attrition, abrasion, erosion, abfraction) can lead to exposure of dentine tubules.1

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THE HYDRODYNAMIC THEORY

There have been many theories of dentine hypersensitivity proposed over the years, but the hydrodynamic theory is by far the best supported.1

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THE CYCLE OF DECLINE

Poor oral hygiene can lead to gingival recession and, ultimately, a 'spiral of decline'.

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TREATMENT OF DENTINE

A long-term programme is often needed for this long-term problem, which may include dietary advice to tackle excessive consumption of acidic foods. Patients may also need advice on change of brushing technique/reduction in brushing frequency, or it may be beneficial to consider not brushing immediately after meals, but at a different time.1

Regular interdental cleaning may also be beneficial.

References

  1. Canadian Advisory Board on Dentin Hypersensitivity. Consensus-based recommendations for the diagnosis and management of dentin hypersensitivity. J Can Dent Assoc 2003; 69(4): 221–226.