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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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slide2

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

  • Pulpal pain is usually more prolonged,

dull, aching, and poorly localized and usually lasts longer than the applied stimulus.

slide3

Up to 30% of adults have dentin hypersensitivity at some period of their lives

  • Currenttechniques for treatment may be only transient in nature and results are not always

predictable

slide4

Two chief methods of treatment of dentin hypersensitivity

1 tubular occlusion

2blockage of nerve activity

slide5

A differential diagnosis needs to be accomplished before any treatment because many symptoms are common to a variety of causes

slide6

Items to be considered:

  • the pain—sharp, dull, or throbbing
  • how many teeth and their location
  • which part of the tooth elicits the pain
  • the intensity of the pain
slide8

The following questions need to be asked

  • Can the pain be localized to one tooth or area of the tooth?
  • Is the area sensitive to a moderate flow of air from an air water syringe?
  • Is the tooth sensitive to percussion? Is there sensitivity to biting pressure or on release?
slide9

The following questions need to be asked

  • What is the extent of the pain after the stimuli is removed?
  • Do radiographs demonstrate caries or periapical pathology?
  • Is the dentin exposed as a result of recession and are there any cracked cusps, open margins, or occlusalhyperfunction?
slide10

MECHANISM

  • There are regional differences in dentin sensitivity
  • Freshly exposed dentin in the coronal part of the tooth is more sensitive than cervical dentin
slide11

Hypersensitive dentin, however, is found most often in the cervical area

  • The sensitivity of dentin has a direct correlation with the size and patency of the dentinal tubules
  • Absi and colleagues discovered that hypersensitive teeth have an increased number of patent tubules and wider tubules than those of no sensitive teeth
slide12

CAUSES

  • There is no principal cause.
  • The loss of enamel and removal of cementum from the root with exposure of dentin, however, is a major contributing factor
slide13

CAUSES

  • Causes include gingival recession due to root prominence and thin overlying mucosa, dehiscences and fenestrations, frenumpulls, and orthodontic movement, which causes a root to be moved outside its alveolar housing
slide14

Loss of enamel may be a consequence of attrition, erosion, abrasion, and abfraction.

  • The loss of enamel, however, is usually a combination of two or more of these factors
slide15

BLEACHING

  • The sensitivity that occurs with bleaching is a result of a reversible pulpitis that is caused by the flow of dentinal fluid from osmolarity changes in the pulp
  • These changes occur when the bleaching material rapidly penetrates enamel and dentin tothe pulp. Hydrogen peroxide and urea penetrate through integral enamel, through the dentin, and into the pulp in 5 to 10 minutes
slide16

BLEACHING

  • Most often, the sensitivity is generalized
  • The estimates of tooth hypersensitivity caused by whitening are usually approximately 60%
  • Usually higher concentrations of peroxide results in a greater degree of sensitivity.
  • The addition of low levels of potassium nitrate to tray bleaches has reduced but not eradicated sensitivity.
slide17

PERIODONTAL TREATMENT

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

dentin hypersensitivity.

slide18

TREATMENT—SELF-APPLIED AND OFFICE SUPPLIED

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.

Usually

slide19

LASER TREATMENT

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.

slide20

FLUORIDE TREATMENT

Fluorides reduce the permeability of dentin probably by precipitation

of insoluble calcium fluoride inside the dentinal tubules and reduce sensitivity.

PRO-ARGIN

This material was able to plug and seal exposed dental tubules to

decrease sensitivity.

OXALATE

Pashley and Galloway38 felt that using potassium oxalate resulted in calcium oxalate

crystals, occluding the tubules

slide21

CASEIN PHOSPHOPEPTIDE–AMORPHOUS CALCIUM PHOSPHATE

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.

slide22

CARBONATE HYDROXYAPATITE NANOCRYSTALS AND SODIUM

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

hours.

GLUTARALDEHYDE

based on aqueous glutaraldehyde, which occludes the tubules by cross-linking of dentinal

proteins.

slide23

SEAL & PROTECT AND ADMIRA PROTECT

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

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

VARNISH