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DENTIN HYPERSENSITIVITY
THIS IS TEST
• DEFINITION
• ETIOLOGY
• THEORIES OF DENTIN HYPERSENSITIVITY
• CLINICAL FEATURES• DIOGNOSIS• TREATMENT
CONTENTS
THE INTERNATIONAL WORKSHOP ON DENTIN HYPERSENSITIVITY(1983) HAS PROPOSED THE FOLLOWING DEFINITION FOR THIS CONDITION:
“ IT IS CHARACTERISED 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”
DEFINITION
ORAL ANATOMY AND DENTAL TISSUES
CEMENTAL LOSS• GINGIVAL RECESSION
• PERIODONTAL DISEASE
• ROOT PLANING
• PERODONTAL SURGERY
ETIOLOGY
ENAMEL LOSS• OCCLUSAL
WEAR
• TOOTH BRUSH ABRASION
• DIETARY EROSION
• ABFRACTION
• PARAFUNCTIONAL HABITS
GINGIVAL RECESSION
ABFRACTION TOOTH BRUSH ABRASION
ETIOLOGY
1.DIRECT INNERVATION THEORY2.ODONTOBLAST DEFORMATION
THEORY/TRANSDUCER THEORY
3.HYDRODYNAMIC THEORY
THEORIES OF DENTIN HYPERSENSITIVITY
• FIRST THEORY TO BE PUT FORWARD
• NERVE FIBERS PRESENT WITHIN DENTINAL TUBULES INTIATE IMPULSES WHEN THEY ARE INJURED AND CAUSES DENTINAL HYPERSENSITIVITY.
DIRECT INNERVATION THEORY
DIRECT INNERVATION THEORY
DISPUTES ABOUT THIS THEORY:• NERVE FIBERS ARE PRESENT ONLY IN
THE PREDENTIN AND INNER DENTINAL ZONES
• WHEN PAIN INDUCING SUBSTANCES LIKE POTTASIUM CHLORIDE,ACETYLCHOLINE ARE APPLIED TO EXPOSED DENTIN,THEY FAIL TO ELICIT PAINFUL RESPONSE.
ODONTOBLAST DEFORMATION THEORY
• ODONTOBLAST OR THEIR PROCESSES ARE DAMAGED WHEN EXTERNAL STIMULI ARE APPLIED TO EXPOSED DENTIN.
• THEY CONDUCT IMPULSES TO THE NERVES IN THE PREDENTIN AND UNDERLYING PULP AND THEN TO CNS.
• DISFAVOURED AS THE ODONTOBLASTIC PROCESSES EXTEND ONLY PARTLY THROUGH THE DENTIN AND NOT UPTO DEJ.
• ODONTOBLASTIC MEMBRANE POTENTIAL IS TOO LOW TO PERMIT TRANSDUCTION.
• THERE ARE NO DEMONSTRABLE NEUROTRANSMITTERS IN THE NEURAL TRANSMISSION OF THE PULP.
THE MOST WIDELY ACCEPTED MECHANISM OF ACTION OF DENTIN HYPERSENSITIVTY , THE HYDRODYNAMIC THEORY WHICH WAS PROPOSED BY GYSI IN 1900 AND VALIDATED BY BRANNSTROM IN 1996
HYDRODYNAMIC THEORY
WHENEVER DENTIN IS EXPOSED AND STIMULATED BY TACTILE,CHEMICAL,THERMAL OR OSMOTIC STIMULI THERE IS RAPID MOVEMENT OF FLUID THROUGH TUBULES.
THIS CAUSES:• DIRECT STIMULATION OF
LOW THRESHOLD A- DELTA NERVE FIBERS
• INDIRECT STIMULATION OF A-DELTA NERVE FIBERS IN PULP BY DISPLACING ODONTOBLASTIC CELL BODIES.
MECHANISM:
MECHANISM
DIAGNOSIS
COMPLETE HISTORY
CLINICAL EXAMINATION
RADIOGRAPHIC EXAMINATION
SIGNS AND SYMPTOMS
VISUAL ASSESMENT RULE OUT PERI APICAL LESION
INTENSITY PHYSICAL ASSESMENT
FREQUENCY AND DURATION
DEPTH OF PERIODONTAL POCKET DEPTH
DIETARY CHANGES PERCUSSION TESTING
RESPONSE TO COLD AIR
1. FRACTURED RESTORATIONS2. FRACTURED ENAMEL EXPOSING
DENTIN 3. DENTAL CARIES4. POST RESTORATION SENSITIVITY5. CRACKED TOOTH SYNDROME6. BLEACHING SENSITIVITY
DIFFERENTIAL DIAGNOSIS
1. DIET COUNSELLING REGARDING CONSUMPTION OF ACIDIC FRUITS AND BEVERAGES
2. CORRECTION OF BRUSHING TECHNIQUE
3. CARE DURING OPERATIVE PROCEDURES
4. CARE DURING PERIODONTAL PROCEDURES
PREVENTION
1. DESENSITISATION BY OCCLUDING DENTINAL TUBULES
A)FORMATION OF SMEAR LAYER OVER EXPOSED DENTIN
B)USE OF TOPICAL AGENTS TO OCCLUDE EXPOSED TUBULES
CALCIUM HYDROXIDE PASTE
CALCIUM PHOSPHATE PASTE
SILVER NITRATE
FLUORIDES
FLUORIDE IONTOPHRESIS
POTASSIUM NITRATE
VARNISHES
DENTIN ADHESIVES
MANAGEMENT
C)PLACEMENT OF RESTORATIONS
GLASS IONOMER CEMENTS
COMPOSITE RESINS
D)USE OF LASERS
CO2 LASER
Nd:YAG,Er:YAG LASER
He:Ne LASER
2. DESENSITIZING BY BLOCKING PULPAL SENSORY NERVES
A)POTASSIUM NITRATE TOOTHPASTE
MANAGEMENT
• IT INCREASES THE REMINERALISATION OF THE EXPOSED DENTIN THUS REDUCING DENTIN PERMIABILITY
• DISADVANTAGE:IT CAUSES TEMPORARY OCCLUSION OF TUBULES
CALCIUM HYDROXIDE
• IT REDUCES DENTIN HYPERSENSITIVITY BY BLOCKING TUBULES AND DENTIN PERMEABILITY IS REDUCED
• COMMERCIALLY AVAILABLE PRODUCT – GC TOOTH MOUSSE
• IT CONTAINS AMORPHOUS CALCIUM PHOSPHATE AND CAESIN PHOSPHOPEPTIDE
CALCIUM PHOSPHATE PASTE
• IT REDUSES FLUID MOVEMENT BY PRECIPITATING PROTEIN OR SILVER CHLORIDE WITHIN THE DENTINAL TUBULES
• IT IS NOT USED NOWADAYS AS IT STAINS DENTIN AND ALSO DAMAGES PULP AND GINGIVA
SILVER NITRATE
• The mode of action is linked to their ability to form mineralised deposits within the tubule lumen and on the surface of the exposed dentine that help prevent transmission of the applied stimulus.
STRONTIUM CHLORIDE
• AGENTS-SODIUM FLUORIDE,STANNOUS FLUORIDEOR ACIDULATED PHOSPHATE FLUORIDE.
• USED AS MOUTH RINSES,TOOTHPASTES OR TOPICAL APPLICATION ON EXPOSED DENTIN.
• ACTION IS BY FORMING FLUORAPATITE WITHIN TUBULES WHICH BLOCK FLUID MOVEMENT WITHIN DENTIN.
FLUORIDES
• IONTOPHORESIS- PROCEDURE IN WHICH IONS OF CHOSEN MEDICAMENT ARE DRIVEN INTO SPECIFIC TISSUES BY MEAHS OF ELECTRIC CURRENT.
• FLOURIDE IONTOPHORESIS TRANSFERS FLUORIDE IONS INTO DENTIN FOR DESENSITIZING IT.
• UNIT HAS
-POSITIVE ELECTRODE IS PLACED ON PATIENTS FACE OR ARM
-NEGETIVE ELECTRODE IS PLASTIC TIP PLACED AROUND THE TOOH• 2% SODIUM FLUORIDE IS APPLIED ON THE EXPOSED
DENTIN AND IS TRANSFERRED DEEP INTO THE DENTIN ON ACTIVATION OF THE UNIT.
• IT IS REPORTED TO PROVIDE LONG-TERM RELIEF FROM HYPERSENSITIVE DENTIN.
FLUORIDE IONTOPHORESIS
• SOLUTION IS APPLIED ON DENTIN• OXALATE IONS REACT WITH CALCIUM IONS
IN DENTINAL FLUID TO FORM INSOLUABLE CALCIUM OXALATE CRYSTALS THAT BLOCK TUBULES AND PREVENT FLUID MOVEMENT.
POTASSIUM OXALATE
VARNISHES
THEY ACT BY FORMING A BARRIER OVER EXPOSED DENTIN.
THIS REDUCES HYPERSENSITIVITY AS IT REDUCES DENTIN PERMEABILITY. THEY PROVIDE ONLY TEMPORARY RELIEF.
USE OF LASERS
THEY OCCLUDE THE DENTINAL TUBULES BY PRODUCING LOCAL CHANGES AROUND THE EXPOSED DENTIN
THEY ALSO PRODUCE CHANGES IN CENTRAL PULP NEURON.
MANAGEMENT
POTASSIUM ION MAY DEPOLARIZE THE NERVE AND PREVENT IT FROM
REPOLARIZING, THEREBY, PREVENTING IT FROM
SENDING PAIN SIGNALS TO THE BRAIN.
POTASSIUM IONS ARE THOUGHT TO DIFFUSE
ALONG DENTINAL TUBULES AND DECREASE
THE EXCITABILITY OF INTRADENTAL NERVES BY
ALTERING THEIR MEMBRANE POTENTIAL
REDUCING NERVE EXCITATION, AND THE
ASSOCIATED PAIN
POTASSIUM NITRATE
DENTIN HYPERSENSITIVITY “THE COMMON COLD OF DENTISTRY”