Dental hypersensitivity is a common, rather impactful, habit altering condition. Very often misdiagnosed, inadequately managed and complicating future patient care. Diagnosis, understanding and acceptance makes for the first step but that said even diagnosis is rather challenging.
What are methods for successful diagnosis, patient education and treatment for these patients?
wel indeed it has an huge impact on the patients, and also seen clinically 1 out of 4 patients have the problem, having said that there are many reviews and articles available in peer reviewed journal which explains the diagnosis and treatment part of hypersensitivity. it would be rather difficult to accommodate all of them in this thread.
also patients educations and history plays a very imp role in the prognosis of the condition
- correct brushing technique
- proper use of desensitizing agents
- diet counseling of the patient
- medical conditions like GERD etc
- even in some cases patients profession can also revel the etiology of the condition
as hypersensitivity is a condition directly related to etiology it is very important to intervene the cause rather than blind prescription of desensitizing agents and clinical procedures
I believe that understanding the proximal meeting and their types of cementum and enamel is very important if we counted in the 10% of open junction between cementoenamle junctions could one of the accepted explanations of hypersensitivity in some cases of absence of lesions and the recessions of gingiva , although I think laser is a promising treatment modality for hypersensitivity cases.
Having identified the reasons of dentine hypersensitivity (DH) you should advice the patient in avoiding risk factors and in treating DH. The largest European multi-center study (West et al, J Dent 2013) included more than 3'100 patients and identified erosive tooth wear as one of the most important reasons for DH. A recent review (Lin et al, JCP 2013) stated that any treatment is better than no treatment. For me, clinically it follows that you should strive for pain relief with the most simple and most inexpensive means, such as prescribing toothpastes that occlude the open dentinal tubules (containing arginine or Novamin). Remember, the fluid flow is proportional to the fourth power of the radius of dentinal tubules, i.e. if you occlude the tubules by half, the fluid movement will be restricted to 1/16th of its original flow rate. If teeth are too sensitive to be brushed with a desensitizing toothpaste, a desensitizing mouthrinse might help in the beginning. In this respect, oxalate containing mouthrinses seem to be most promising.
If these strategies don't work in your patient, you can always go for more invasive treatment options.
@ Dr. Mehta, I agree with you, but in most of our routine patient population even diagnosis is quite a task and thus the immediate response of the dentist is to prescribe de-sensitizing agents. In your experience how successful have these agents been? If not how have you proceeded with the management?
@ Dr. Alenazy. How effective is the laser therapy? Also, is it cost effective?
Well said Dr. Neuhaus. In your opinion what are the other effective invasive treatment options? Also, in long established cases of occlusal malfunctions what treatment options would suffice?
Occlusal dentine hypersensitivity is usually caused by erosive wear (West NX et al 2013). Quite often erosion is caused by silent gastroenterologic reflux disease (GERD). Tooth substance loss can be enhanced by occlusal malfunction such as grinding.
We recommend that initial to medium erosive wear should be treated with sealants or minimum intervention adhesive fillings. This should be accompanied by gastroenterologic clinical findings and, if necessary, delivery of proton pump inhibitors. If erosive wear is too severe and located on multiple occlusal surfaces with loss of vertical dimension, there is no other option than reconstructing all occlusal surfaces in order to restore the teeth and protect the exposed dentine. Today, there are several ways of achieving fully restored function with direct composite fillings, using either a splint technique or a stamp technique. Indirect restorations are in most cases too expensive for the patients.
Attention should be paid to prescribing anti-grinding splints, such as a Michigan splint, in GERD patients. Splints are contraindicated as long as GERD is uncured because the acid concentrates beneath the splint and enhances tooth substance loss.
For cervical lesions (brushing habits checked etc) I'd suggest in this order:
1) desensitizing toothpaste with either arginine or Novamin, eventually accompanied by mouth rinse with oxalate (J&J)
If money is no issue, also try CPP-ACP or Curodont Protect
2) varnish, like dentine adhesive or Seal&Protect. Rather not Gluma because of high allergenic potential and questionable pulp toxicity
3) composite filling;pay special attention to cleanly adapt the cervical filling margin. Excessive finishing and polishing might increase DHS
4) pulpectomy as last option
I would also include the laser therapy! I use it regularly with excellent results.
The treatment for Dentinal Hypersensitivity depends upon the severity of alterations on the teeth including mechanical wear and tear and erosions. if the sensitivity is mild which means the patient can tolerate the cold or hot items but getting sensitvity, then the patient can use flouridated tooth pastes rather than gel type toothpastes, which contains more of abrasives which abrades enamel and worsens the sensitivity problem. Also they can use soft bristle tooth brushes. secondly, if they cannot tolerate senstivity but not getting pain and having the habit of bruxism and under stress, they can go soft splints. finally if the patient is getting sever pain also then they have to go for intentional Root canal treatment and crowns or veneers depending upon the tooth or teeth.
@Dr. Roskamp. How cost effective is laser therapy? Also what would the patient selection protocol be?
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