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,Characteristic,Short , sharp pain.,Most in cervical, then occlusal,Stimuli,The exogenous stimuli include:,Thermal (cold),Tactile (touch),Osmotic changes(sweets, drying the surface),Etiology,The primary clinical cause is exposed dentinal tubules.,Two phases of development of dentin hypersensitity,First, dentin has to be exposed.,lesion localization,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,Inadequate attached gingiva Prominent roots Tooth brush abrasion Pocket reduction periodontal surgery Oral habits resulting in gingival laceration Excessive tooth cleaning Excessive flossing others,Reasons for Continued Dentinal Tubular Exposure,Poor plaque control, acidic bacterial byproducts Excess oral acids, sodas, fruit juice Cervical decay Toothbrush abrasion Tartar control toothpaste,Mechanism,Hydrodynamic theory,M.Brnnstrm 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).,Baroreceptor:a never receptor sensitive to pressure,Treatment,A challenge for both the patients and dentists.,Its difficult measuring/comparing different patients pain.,Its difficult for patients to change the habits.,Treatment Strategies,Plug the dentinal tubules preventing fluid flow.,Desensitize the nervemaking it less responsive to stimulation.,Nerve Desensitization,Potassium Nitratethe only one approved by FDA and ADA,KNO3 penetrates through the dentinal tubulesto the nerve; K+ may depolarize the nerve and prevent it from repolarizing; Thereby, Preventing it from sending pain signals to the brain.,Covering Dentinal Tubules,Composite or GIC restorationCrown placementPeriodontal surgery,Occluding Dentinal Tubules,To plug the inside of the dentinal tubules,Ions or salts: stannous fluoride, sodium fluoride, potassium oxalate, etc Precipitates:glutaraldehyde Resin:dentin sealers,Laser: another choice,Treatment Steps,Thorough exam to identify etiology and eliminate tooth fracture and irreversible pulpitis.,2. Potassium nitrate containing product/toothpaste2day for at least 2 weeks.,3. Potassium nitrate containing product in a tight fitting dental tray.,4. In-office tubule occluding product.,5. In-office tubule sealer.,Dental restoration, or a periodontal surgery,that covers the exposed dentin.,7. Endodontic procedure to remove the pulp.,The patient should be informed of the series of steps that may be necessary to eliminate the problem.,Acknowledgements,