Treatment of Dentin Hypersensitivity. Dr. Ahmed Al Mokhatieb. is exemplified by brief, sharp, well-localized pain in response to thermal , evaporative, tactile, osmotic, or chemical stimuli that cannot be ascribed to any other form of dental defect or pathology
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Dr. Ahmed Al Mokhatieb
thermal, evaporative, tactile, osmotic, or chemical stimuli that cannot be ascribed to
any other form of dental defect or pathology
dull, aching, and poorly localized and usually lasts longer than the applied stimulus.
Up to 30% of adults have dentin hypersensitivity at some period of their lives
1 tubular occlusion
2blockage of nerve activity
A differential diagnosis needs to be accomplished before any treatment because many symptoms are common to a variety of causes
Clinical and radiographic examination is necessary to elucidate the cause
Loss of enamel may be a consequence of attrition, erosion, abrasion, and abfraction.
Unfortunately, patient discomfort often occurs while
undergoing periodontal treatment. Postoperative pain and dentin hypersensitivity
are often occurrences. Some patients find both the nonsurgical and surgical treatment
painful. It has been reported that periodontal therapy can be an important source of
Self-applied treatments to reduce sensitivity consist of materials that occlude dentinal
tubules, coagulate or precipitate tubular fluids, encourage secondary dentin formation,
or obstruct pulpal neural response. Desensitizing toothpastes that contain potassium
salts, either nitrates or chlorides, are believed to act by depolarizing the nerve
surrounding the odontoblastic process, resulting in interference of transmission.
The treatment seems to be only transient, however, and the sensitivity returns in
time. In order for a laser to actually alter the dentin surface, it has to melt and resolidify
the surface. This effectively closes the dentinal tubules. This does not occur. It is
felt that laser treatment reduces sensitivity by coagulation of protein and without
altering the surface of the dentin. Dicalcium phosphate-bioglass in combination
with Nd:YAG laser treatment has sealed dentin tubules to a depth of 10 mm, and
dicalcium phosphate-bioglass plus 30% phosphoric acid occluded exposed tubules
up to 60 mm.
Fluorides reduce the permeability of dentin probably by precipitation
of insoluble calcium fluoride inside the dentinal tubules and reduce sensitivity.
This material was able to plug and seal exposed dental tubules to
Pashley and Galloway38 felt that using potassium oxalate resulted in calcium oxalate
crystals, occluding the tubules
The peptides present in Recaldent become bound to the dentin surface and this causes a mineral deposit formation in the dentin surface resulting in decreased opening of the dentinal tubules
CALCIUM PHOSPHATE PRECIPITATION
Chiang and colleagues44 found a mesoporous silica biomaterial containing nanosized
calcium oxide particles mixed with 30% phosphoric acid can occlude dentinal tubules
and considerably reduce dentin permeability even in the presence of pulpal pressure.
FLUORIDE/POTASSIUM NITRATE DENTIFRICE
Synthetic hydroxyapatite (carbonate hydroxyapatite) biomimeticnanocrystals,
introduced recently, have demonstrated the ability to remineralize altered enamel
surfaces and close dentinal tubules.There is a progressive closing of the dentinal
tubules in several minutes and subsequently a remineralized layer forms in a few
based on aqueous glutaraldehyde, which occludes the tubules by cross-linking of dentinal
The material is applied to a slightly moist surface, air dried, and light cured and then a second application is applied and light cured for 10 seconds.
Prehybridized dentin or immediate dentin sealing has been suggested to make the
dentin less sensitive while a restoration is fabricated in the laboratory. Because
a hybrid layer is created immediately after preparation, teeth treated with the immediate
dentin sealing technique were better able to tolerate thermal and functional loads
in comparison to teeth that were sealed when the restorations were placed.51