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Dentine hypersensitivity

Dentine hypersensitivity

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Dentine hypersensitivity is sensation felt when the nerves inside the dentin
Dentin
Dentine is a calcified tissue of the body, and along with enamel, cementum, and pulp is one of the four major components of teeth. Usually, it is covered by enamel on the crown and cementum on the root and surrounds the entire pulp...

 of the teeth are exposed to the environment. The sensation can range from irritation all the way to intense, shooting pain. This sensitivity can be caused by several factors, including wear, decaying teeth or exposed tooth root
Root canal
A root canal is the space within the root of a tooth. It is part of a naturally occurring space within a tooth that consists of the pulp chamber , the main canal, and more intricate anatomical branches that may connect the root canals to each other or to the surface of the root.-Root canal anatomy:...

s.

Dentine contains many thousands of microscopic tubular structures that radiate outwards from the pulp; these dentinal tubules are typically 0.5-2 micrometres in diameter. Changes in the flow of the plasma-like biological fluid present in the dentinal tubules can trigger mechanoreceptors present on nerves located at the pulpal aspect thereby eliciting a pain response. This hydrodynamic flow can be increased by cold, air pressure, drying, sugar, sour (dehydrating chemicals), or forces acting onto the tooth. Hot or cold food or drinks, and physical pressure are typical triggers in those individuals with teeth sensitivity.

Treatment can consist of amorphous calcium and phosphate
Amorphous calcium and phosphate
Amorphous calcium phosphate is a substance used as a dental treatment. Calcium and phosphate are natural building blocks of teeth, and when present in insufficient amounts, there can be sensitivity after procedures such as dental bleaching or professional dental cleaning...

, NovaMin
NovaMin
NovaMin is the brand name of a particulate bioactive glass that is used in dental care products for Remineralisation of teeth. It was developed and patented by...

, potassium nitrate
Potassium nitrate
Potassium nitrate is a chemical compound with the formula KNO3. It is an ionic salt of potassium ions K+ and nitrate ions NO3−.It occurs as a mineral niter and is a natural solid source of nitrogen. Its common names include saltpetre , from medieval Latin sal petræ: "stone salt" or possibly "Salt...

, strontium chloride
Strontium chloride
Strontium chloride is a salt of strontium and chloride. It is a typical salt, forming neutral aqueous solutions. Like all compounds of Sr, this salt emits a bright red colour in a flame; in fact is used as a source of redness in fireworks...

, gluma
Gluma
Gluma is a brand-name desensitizer, used in dentistry to treat sensitivity.-Use:Its formula of 5% glutaraldehyde and 35% HEMA in water is used to help control both hypersensitive dentin and reduce the incidence of post-operative sensitivity in restorative dentistry procedures...

, fluoride therapy
Fluoride therapy
Fluoride therapy is the delivery of fluoride to the teeth topically or systemically in order to prevent tooth decay which results in cavities. Most commonly, fluoride is applied topically to the teeth using gels, varnishes, toothpaste/dentifrices or mouth rinse. Systemic delivery involves...

, or calcium sodium phosphosilicate.

Potassium nitrate is commonly used in toothpastes such as Sensodyne
Sensodyne
Sensodyne is a toothpaste, toothbrush and mouthwash marketed for individuals with sensitive teeth and/or dentine hypersensitivity. It is a registered trademark of GlaxoSmithKline which acquired it in 2001 in the purchase of Block Drug which developed it....

 or Crest Sensitive as a remedy and is approved as a monographed drug by the FDA. Nonetheless, there remains some dispute about its effectiveness. Strontium chloride and strontium acetate are used in Sensodyne Original and Sensodyne Mint toothpastes. 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.

One cause of sensitive teeth can be traced to nocturnal gastroesophageal reflux disease
Gastroesophageal reflux disease
Gastroesophageal reflux disease , gastro-oesophageal reflux disease , gastric reflux disease, or acid reflux disease is chronic symptoms or mucosal damage caused by stomach acid coming up from the stomach into the esophagus...

 (acid reflux). Stomach acid can reach the teeth and cause enamel loss and prevent re-mineralization.

Prevalence


A study conducted at Queen's University, Belfast, determined that the prevalence of reported sensitivity was 57.2%. In most cases the incidence occurred in the 30-39 year age group. Although the majority of individuals reported that cold
Cold
Cold describes the condition of low temperature.Cold may also refer to:*Common cold, a contagious viral infectious disease of the upper respiratory system*Chronic obstructive pulmonary disease...

 was the major stimulus for pain
Pain
Pain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...

, other causes such as toothbrushing, hot, and sweet stimuli
Stimulus (physiology)
In physiology, a stimulus is a detectable change in the internal or external environment. The ability of an organism or organ to respond to external stimuli is called sensitivity....

 were reported as well. This study found the prevalence of dentine sensitivity to be much higher than in previous reports. These results suggest an increase in the levels of sensitivity within the general population.

Prevention


Before the proper treatment for a patient is defined, it is important to first prevent, modify, eliminate or control etiologic factors such as plaque
Dental plaque
Dental plaque is a biofilm, usually a pale yellow, that develops naturally on the teeth. Like any biofilm, dental plaque is formed by colonizing bacteria trying to attach themselves to a smooth surface...

, improper toothbrushing, and a diet high in fermentable carbohydrates and/or acidic foods.

Some examples of acidic foods are fruits, fruit juices and wine
Wine
Wine is an alcoholic beverage, made of fermented fruit juice, usually from grapes. The natural chemical balance of grapes lets them ferment without the addition of sugars, acids, enzymes, or other nutrients. Grape wine is produced by fermenting crushed grapes using various types of yeast. Yeast...

 whose acids can remove smear layers and open dentinal tubules. Toothbrushing with abrasive toothpaste may abrade the dentin surface which may open up dentinal tubules if combined with erosive agents. One recommendation for patients is to avoid toothbrushing for at least two to three hours after consuming the above mentioned acidic foods or drinks.

Treatments


There are different options to treat dentine hypersensitivity that can be divided in at-home treatments, those the patient can apply, and in-office treatments, those applied by the dentist.

At-home treatments


At-home treatments include desensitizing toothpastes or dentifrices, potassium salts, mouthwashes and chewing gums.

Desensitizing toothpastes containing potassium nitrate
Potassium nitrate
Potassium nitrate is a chemical compound with the formula KNO3. It is an ionic salt of potassium ions K+ and nitrate ions NO3−.It occurs as a mineral niter and is a natural solid source of nitrogen. Its common names include saltpetre , from medieval Latin sal petræ: "stone salt" or possibly "Salt...

 have been used since the 1980s while toothpastes with potassium chloride
Potassium chloride
The chemical compound potassium chloride is a metal halide salt composed of potassium and chlorine. In its pure state, it is odorless and has a white or colorless vitreous crystal appearance, with a crystal structure that cleaves easily in three directions. Potassium chloride crystals are...

 or potassium citrate
Potassium citrate
Potassium citrate is a potassium salt of citric acid with the molecular formula C6H5K3O7. It is a white, slightly hygroscopic crystalline powder. It is odorless with a saline taste....

 have been available since at least 2000. It is believed that potassium ions diffuse along the dentinal tubules to inactivate intradental nerves. However, , this has not been confirmed in intact human teeth and the desensitizing mechanism of potassium-containing toothpastes remains uncertain. Since 2000, several trials have shown that potassium-containing toothpastes can be effective in reducing dentine hypersensitivity, although rinsing the mouth after brushing may reduce their efficacy.

Studies have found that mouthwashes containing potassium salts and fluorides can reduce dentine hypersensitivity, although rarely to any significant degree. , 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.

In-office treatments


In-office treatments might be much more complex and they may include the application of dental sealants, having fillings put over the exposed root that is causing the sensitivity, or a recommendation to wear a specially made night guard or retainer
Retainer (orthodontic device)
Orthodontic retainers are custom-made devices, made usually of wires or clear plastic, that hold teeth in position after surgery or any method of realigning teeth. They are most often used before or after dental braces to hold teeth in position while assisting the adjustment of the surrounding gums...

 if the problems are a result of teeth grinding.

Other possible treatments include fluorides are also used because they decrease permeability of dentin in vitro. Also, potassium nitrate can be applied topically in an aqueous solution or an adhesive gel
Gel
A gel is a solid, jelly-like material that can have properties ranging from soft and weak to hard and tough. Gels are defined as a substantially dilute cross-linked system, which exhibits no flow when in the steady-state...

. Oxalate
Oxalate
Oxalate , is the dianion with formula C2O42− also written 22−. Either name is often used for derivatives, such as disodium oxalate, 2C2O42−, or an ester of oxalic acid Oxalate (IUPAC: ethanedioate), is the dianion with formula C2O42− also written (COO)22−. Either...

 products are also used because they reduce dentin permeability and occlude tubules more consistently. However, while some studies have showed that oxalates reduced sensitivity, others reported that their effects did not differ significantly from those of a placebo
Placebo
A placebo is a simulated or otherwise medically ineffectual treatment for a disease or other medical condition intended to deceive the recipient...

. Nowadays, dentine hypersensitivity treatments use adhesives, which include varnishes, bonding agents and restorative materials because these materials offer improved desensitization.

Other procedures


Other procedures include ionto-phoresis
Iontophoresis
Iontophoresis is a technique using a small electric charge to deliver a medicine or other chemical through the skin. It is basically an injection without the needle...

, usually used in conjunction with fluoride pastes or solutions. Another procedure is the use of low level laser therapy. A study involving 1102 teeth of 388 patients determined that when used with the correct irradiation
Irradiation
Irradiation is the process by which an object is exposed to radiation. The exposure can originate from various sources, including natural sources. Most frequently the term refers to ionizing radiation, and to a level of radiation that will serve a specific purpose, rather than radiation exposure to...

 parameters, LLLT was effective in treating dentinal hypersensitivity. This therapy quickly reduces pain and maintains a prolonged pain-free status in 91.27% of the cases.

See also

  • Tooth
    Tooth
    Teeth are small, calcified, whitish structures found in the jaws of many vertebrates that are used to break down food. Some animals, particularly carnivores, also use teeth for hunting or for defensive purposes. The roots of teeth are embedded in the Mandible bone or the Maxillary bone and are...

  • Dental pulp
  • Toothpaste
    Toothpaste
    Toothpaste is a paste or gel dentifrice used with a toothbrush as an accessory to clean and maintain the aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it serves as an abrasive that aids in removing the dental plaque and food from the teeth, assists in suppressing...

  • Remineralization of teeth
  • Bioactive glass
    Bioactive glass
    Bioactive glasses are a group of surface reactive glass-ceramic biomaterials and include the original bioactive glass, Bioglass. The biocompatibility of these glasses has led them to be investigated extensively for use as implant materials in the human body to repair and replace diseased or damaged...


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