The patient should be informed of the series of steps that may be necessary to eliminate the problem.
Reasons for Continued Dentinal Tubular Exposure
1. 2. 3. 4. 5. Poor plaque control, acidic bacterial byproducts Excess oral acids, sodas, fruit juice Cervical decay Toothbrush abrasion Tartar control toothpaste
Baroreceptor: a never receptor sensitive to pressure
Treatment
A challenge for both the patients and dentists.
It’s difficult measuring/comparing different patient’s pain. It’s difficult for patients to change the habits.
Characteristic
Short , sharp pain. Most in cervical, then occlusal
StimuliΒιβλιοθήκη The exogenous stimuli include: Thermal (cold)
Tactile (touch) Osmotic changes (sweets, drying the surface)
3. Potassium nitrate containing product in a tight fitting dental tray.
4. In-office tubule occluding product. 5. In-office tubule sealer. 6. Dental restoration, or a periodontal surgery, that covers the exposed dentin. 7. Endodontic procedure to remove the pulp.
The dentinal tubules must be opened —lesion initiation
The most common clinical cause for exposed dentinal tubules is gingival recession.
Common Reasons for Gingival Recession
Treatment Strategies
Plug the dentinal tubules preventing fluid flow. Desensitize the nerve making it less responsive to stimulation.
Nerve Desensitization
Covering Dentinal Tubules
Composite or GIC restoration Crown placement
Periodontal surgery
Occluding Dentinal Tubules
To plug the inside of the dentinal tubules
Dentinal Hypersensitivity
Mi Hui-hui Department of Stomatology, Shihezi University School of Medicine
Introduction
Definition:
Dentin hypersensitivity Refers to the teeth are within the scope of physical stimulation, including mechanical, chemical, temperature and osmotic pressure of the phenomenon of short, sharp pain or discomfort
Etiology
The primary clinical cause is exposed dentinal tubules.
Two phases of development of dentin hypersensitity
First, dentin has to be exposed.
—lesion localization
Ions or salts: stannous fluoride, sodium fluoride, potassium oxalate, etc Precipitates: glutaraldehyde Resin: dentin sealers
Laser: another choice
Treatment Steps
Potassium Nitrate the only one approved by FDA and ADA
KNO3 penetrates through the dentinal tubules to the nerve; K+ may depolarize the nerve and prevent it from repolarizing; Thereby, Preventing it from sending pain signals to the brain.
1. 2. 3. 4. 5. 6. 7. 8. Inadequate attached gingiva Prominent roots Tooth brush abrasion Pocket reduction periodontal surgery Oral habits resulting in gingival laceration Excessive tooth cleaning Excessive flossing others
1. Thorough exam to identify etiology and eliminate tooth fracture and irreversible pulpitis.
2. Potassium nitrate containing product/toothpaste 2×day for at least 2 weeks.
Mechanism
Hydrodynamic theory —M.Brä nnströ m in 1967
The fluids within the tubule are disturbed either by temperature changes or physical osmotic changes. These fluid changes stimulate a baroreceptor which leads to neural discharge (depolarization).