Dentin hypersensitivity
According to this theory, when the exposed dentine surface is subjected to thermal, chemical, tactile or evaporative stimuli, the flow of the fluid within the tubules will be increased.
This hydrodynamic flow can be increased by cold, (air pressure), drying, sugar, sour (dehydrating chemicals), or forces acting on to the tooth.
Hot or cold food or drinks, and physical pressure are typical triggers in those individuals with teeth sensitivity.
Research has shown that triggers causing dentinal fluid to move away from the pulp elicit more of a painful response.
Repeated exposures to a low pH cause the mineral content of the teeth on the outer layer of enamel to dissolve therefore leaving the dentine exposed and leading to hypersensitivity.
[12] Most experts on this topic state that the pain of DH is in reality a normal, physiologic response of the nerves in a healthy, non-inflamed dental pulp in the situation where the insulating layers of gingiva and cementum have been lost;[5][3] i.e., dentin hypersensitivity is not a true form of allodynia or hyperalgesia.
Generally, they can be divided into in-office (i.e. intended to be applied by a dentist or dental therapist), or treatments which can be carried out at home, available over-the-counter or by prescription.
Animal research has demonstrated that potassium ions placed in deep dentin cavities cause nerve depolarization and prevent re-polarization.
It is not known if this effect would occur with the twice-daily, transient and small increase in potassium ions in saliva that brushing with potassium-containing toothpaste creates.
In individuals with dentin hypersensitivity associated with exposed root surfaces, brushing twice daily with toothpaste containing 5% potassium nitrate for six to eight weeks reduces reported sensitivity to tactile, thermal and air blast stimuli.
A randomized clinical trial published in 2018 found promising results in controlling and reducing hypersensitivity when potassium oxalate mouthrinse was used in conjugation with toothbrushing.
As of 2006, no controlled study of the effects of chewing gum containing potassium chloride has been made, although it has been reported as significantly reducing dentine hypersensitivity.
Nano-hydroxyapatite (nano-HAp) is considered one of the most biocompatible and bioactive materials and has gained wide acceptance in dentistry in recent years.[when?]
An increasing number of reports have shown that nano-hydroxyapatite shares characteristics with the natural building blocks of enamel having the potential, due to its particle size, to occlude exposed dentinal tubules helping to reduce hypersensitivity and enhancing teeth remineralization.
BioMin, a bioactive glass of calcium fluoro phosphosilicate, provides faster and longer lasting relief against sensitivity through deep tubular occlusion.
[citation needed] Potassium nitrate Glutaraldehyde Silver nitrate Zinc chloride Strontium chloride hexahydrate Sodium fluoride Stannous fluoride Strontium chloride Silver diammine fluoride Potassium oxalate Calcium phosphate Calcium carbonate Bioactive glasses (SiO2–P2O5–CaO–Na2O) Fluoride varnishes Oxalic acid and resin Glass ionomer cements Composites Dentin bonding agents Neodymium:yttrium aluminum garnet (Nd:YAG) laser Galium-aluminium-arsenide (GaAlAs) laser Erbium-yttrium aluminum garnet (Er:YAG) laser In-clinic treatments can include the placement of materials to seal dental tubules or the wearing of appliances at night if the cause of the sensitivity stems from night-time grinding.
Fissure sealants, resin, or glass ionomer materials can be placed over areas of the tooth causing particular sensitivity in order to penetrate the exposed tubules and seal them against the external environment.
[3] The condition is most commonly associated with the maxillary and mandibular canine and bicuspid teeth on the facial (buccal) aspect,[3] especially in areas of periodontal attachment loss.
This discrepancy in range can be explained by DH being underreported due to the difficulties patients face when describing symptoms.
The scale of symptoms for DH are so variant, some patients are unable to eat ice cream or drink cold water, whereas for others, discomfort is episodic in nature.
If a patient does not complain of the symptoms then no additional screening checks are in place for dentin hypersensitivity and often the diagnosis is missed.
Treatment strategies also lead to the removal of cementum, smear layer and exposure of dentinal tubules, furthermore causing DH for patients.
DH decreases during 40–50 years, a plausible explanation or this is the result of sclerosing of canals and formation of tertiary dentine.
Premolars and canines tend to present with hypersensitivity more readily followed by molars5, this is true for upper and lower arches.
