Clinician's Guide to the Diagnosis and Management of Tooth Sensitivity

Dentin hypersensitivity was 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 disease.” In this chapter, characteristics of this condition are discussed in addition to its prevalence reported using different methods of diagnosis. The epidemiology of the condition, its impact on the patient’s oral health quality of life, and how to measure it are also discussed.

When dentinal tubules first become exposed, patients note that those areas become more sensitive to tactile, evaporative, and osmotic stimuli. However, over time, especially with poor plaque control, those areas become progressively truly hypersensitive. There are a number of mechanisms responsible for hypersensitivity including localized pulpal inflammation, sprouting of pulpal nerves, and expression of “inflammatory” sodium channels. Often such hypersensitivity spontaneously disappears. These protective mechanisms will be reviewed. The problem arises for patients whose exposed dentin becomes hypersensitive and whose endogenous protective mechanism fails to correct the hypersensitivity.

Dentin hypersensitivity is a prevalent and common complaint in dentistry. Identification of the etiological and predisposing factors for dentin hypersensitivity is of prime importance in the diagnosis and treatment planning of this dental complaint. In order to have a clinical manifestation of dentin hypersensitivity, the dentin must be exposed to the oral environment. Dentin exposure results from one or more etiological factors that lead to loss of enamel and/or loss of cementum and overlaying periodontal tissues. Many dental and medical conditions have been linked to dentin hypersensitivity as etiological or predisposing factors. Some periodontal or restorative treatment may initiate the dentin hypersensitivity symptoms. In this chapter, we will shed light on all the etiological and contributory factors responsible for dentin hypersensitivity.

Diagnosis of dentin hypersensitivity involves holistic assessment of the sufferer, particularly the condition of the involved tooth and to identify the cause of the pain or discomfort in order to prescribe appropriate treatment. Knowledge of the physiology of pain and methods of interpreting it with available clinical diagnostic devices is essential to reach a proper diagnosis. The history of the patient’s pain is the first clinical data the dentist must collect and consider with careful attention being paid to its characteristics as revealed by the patient’s responses, such as the type, duration, frequency, stimulating factors, and disturbed oral functions. Associating patient’s features and other factors capable of exposing dentin and opening up the tubules must be well explored. Ultimately, correct diagnosis necessitates awareness of clinical conditions which are similar in their presenting features. Diverse standardized stimuli and means of quantifying the pain of dentin hypersensitivity are discussed in this chapter.

The aim of this chapter is to review the various treatment approaches used by clinicians to treat dentin hypersensitivity and evaluate their efficacy in reducing dentin hypersensitivity. Evidence from both in vitro and in vivo studies will be assessed to determine whether there is any support for these treatment products and procedures based on their proposed underlying mechanism of action.

The aim of this chapter is to provide the dental professional with the necessary information in order to treat dentin hypersensitivity by using selected at-home and in-office products with an emphasis on developing a workable maintenance programme which will enable the dental professional to effectively manage this troublesome clinical condition.

Studies for investigating dentin hypersensitivity are either epidemiological or testing for the effectiveness of a possible treatment. The latter can be tested in vitro or in vivo. The myriad number of studies evaluating possible treatments for the condition mandates the adoption of rigid criteria for the conduction of such studies in order to validate their results. Literature will be reviewed in this chapter to evaluate the different testing methods for the effectiveness of dentin hypersensitivity treatments.

There are over 30 different treatments for sensitive dentin on the market today which suggests that not one of them gives the immediate and lasting relief from this condition desired by the patient. In this chapter we describe several, emerging, novel experimental technologies that may, in the future, offer such relief. These technologies include: a synthetic “glue” resembling the adhesive that adheres mollusks to rocks in the ocean; a self-etch resin filled with fluorhydroxyapatite (FA) crystrals; and a flexible laminate of Eudragit filled with the FA srystals. Finally the incorporation of dendrimers (artificial proteins) functionalized with anti-inflammatories and anti-microbials to control inflammation beneath sensitive dentin and, overtime, help the pulp repair.