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DentinDentinHypersensitivityHypersensitivityZhangQiZhangQiWuhanUniversitySchoolofStomatologyWuhanUniversitySchoolofStomatologyIntroductionIntroductionDefinition:Definition:Dentinhypersensitivityisacommonconditionoftransienttoothpaincausedbyavarietyofexogenousstimuli.CharacteristicCharacteristicShort,sharppain.Mostincervical,thenocclusalStimuliStimuliTheexogenousstimuliinclude:Thermal(cold)Tactile(touch)Osmoticchanges(sweets,dryingthesurface)EtiologyEtiologyTheprimaryclinicalcauseisexposeddentinaltubules.TwophasesofdevelopmentofTwophasesofdevelopmentofdentinhypersensititydentinhypersensitityFirst,dentinhastobeexposed.—lesionlocalizationThedentinaltubulesmustbeopened—lesioninitiationThemostcommonclinicalcauseforexposeddentinaltubulesisgingivalrecession.CommonReasonsforGingivalRecession1.Inadequateattachedgingiva2.Prominentroots3.Toothbrushabrasion4.Pocketreductionperiodontalsurgery5.Oralhabitsresultingingingivallaceration6.Excessivetoothcleaning7.Excessiveflossing8.othersReasonsforContinuedDentinalTubularExposure1.Poorplaquecontrol,acidicbacterialbyproducts2.Excessoralacids,sodas,fruitjuice3.Cervicaldecay4.Toothbrushabrasion5.TartarcontroltoothpasteMechanismMechanismHydrodynamictheory—M.Brännströmin1967Thefluidswithinthetubulearedisturbedeitherbytemperaturechangesorphysicalosmoticchanges.Thesefluidchangesstimulateabaroreceptorwhichleadstoneuraldischarge(depolarization).Baroreceptor:aneverreceptorsensitivetopressureTreatmentTreatmentAchallengeforboththepatientsanddentists.It’sdifficultmeasuring/comparingdifferentpatient’spain.It’sdifficultforpatientstochangethehabits.TreatmentStrategiesTreatmentStrategiesPlugthedentinaltubulespreventingfluidflow.Desensitizethenervemakingitlessresponsivetostimulation.NerveDesensitizationNerveDesensitizationPotassiumNitratetheonlyoneapprovedbyFDAandADAKNO3penetratesthroughthedentinaltubulestothenerve;K+maydepolarizethenerveandpreventitfromrepolarizing;Thereby,Preventingitfromsendingpainsignalstothebrain.CoveringDentinalTubulesCoveringDentinalTubulesCompositeorGICrestorationCrownplacementPeriodontalsurgeryOccludingDentinalTubulesOccludingDentinalTubulesToplugtheinsideofthedentinaltubulesIonsorsalts:stannousfluoride,sodiumfluoride,potassiumoxalate,etcPrecipitates:glutaraldehydeResin:dentinsealersLaser:anotherchoiceLaser:anotherchoiceTreatmentStepsTreatmentSteps1.Thoroughexamtoidentifyetiologyandeliminatetoothfractureandirreversiblepulpitis.2.Potassiumnitratecontainingproduct/toothpaste2×dayforatleast2weeks.3.Potassiumnitratecontainingproductinatightfittingdentaltray.4.In-officetubuleoccludingproduct.5.In-officetubulesealer.6.Dentalrestoration,oraperiodontalsurgery,thatcoverstheexposeddentin.7.Endodonticproceduretoremovethepulp.Thepatientshouldbeinformedoftheseriesofstepsthatmaybenecessarytoeliminatetheproblem.