UNDER THE ABLE GUIDANCE OF Dr Rashmi Thakral Dr Vivek Vijay Dr Megha Rana Dr Shefali Sharma PREESNTED BY Dr Shalini gupta

Ratnesh Kr Thakur (571)

Pranshu Chauhan Sachin Dev Singh (576) Saurabh Menwal (581)
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DEFINITION

Defined as a transient pain arising from exposed dentine, typically in response to electrical, thermal, tactile, or osmotic stimuli which can not be explained as arising from any other form of dental defect or pathology.
Dowell & Addy (1983)

 AGE: Peak prevalence in young adults decreases with age SEX: More in women SITE: Most common buccally TEETH INVOLVED: canines and premolars, SIDE: Left side > right

ETIOLOGY

Loss of enamel Loss of cementum

Gingival recession
Plaque formation

Enamel can be lost because of

Attrition Bruxism Physiologic AbrasionDietary component Incorrect brushing Erosion Environmental Dietary Endogenous
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 Loss

of cementum can result

due to removal of thin layer of cementum in the cervical area of root by Scaling Root planing Vigorous tooth brushing

Gingival recession can be attributed to

Pocket formation Increased brushing Type of brush After surgery, scaling & root planing.

 Dental

plaque Bacteria present

in plaque lowers the pH by producing organic acid. These acid lead to removal of smear layer & lead to sensitivity.

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CLINICAL SIGNS AND SYMPTOMS

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Pain rapid in onset, sharp in character and of short duration Occurs in response to certain stimuli. Occasionally, the pain may persist as a dull ache for variable periods after removal of the stimulus.

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MECHANISM

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Four theories have been proposed TRANSDUCER THEORY MODULATION THEORY GATE CONTROL THEORY HYDRODYNAMIC THEORY

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HYDRODYNAMIC THEORY
Most widely accepted theory of the mechanism of dental hypersensitivity. Given by Brannstrom According to this theory, a dentinalgia results from a stimulus causing minute changes in the fluid movement with in the dentinal tubules.

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The application of heat to the tooth would cause the fluid in the tubules to expand & move pulpward. In contrast, cold stimuli, scraping, drilling, & high osmotic forces would contract the fluid & move it outward.

Movement of tubular fluid in either direction, to or from the pulp, would stimulate the nerves in the pulp.
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METHODS USED TO MEASURE TOOTH HYPERSENSITIVITY

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Tactile Thermal Osmotic

Electrical
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TACTILE

This is simplest method used to test for hypersensitivity. A slight pressure by a sharp dental explorer over the sensitive area of tooth usually the CEJ causes pain.

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THERMAL

A simple thermal method for testing tooth sensitivity is directing a burst of room temperature air from a dental syringe onto the test tooth.

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OSMOTIC

Prepare a fresh saturated solution of sucrose & allow it to reach room temperature after isolation of the test tooth with cotton roles.

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ELECTRICAL
Sensitive tooth show lower pain threshold than healthy teeth depending whether the stimulating electrode is placed on the crown or root. E.g.- Electric pulp tester.

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MANAGEMENT OF DENTINE HYPERSENSITIVITY

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Treatment of tooth hypersensitivity can be broadly divided as - Office management - Home management

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MECHANISM OF ACTION
The most likely mechanism of action of desensitising agents is that they reduce the diameter of dentinal tubules so as to limit the displacement of fluid in them. It is attained by;

1) Formation of smear layer produced by burnishing the exposed surface.

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2) Topical application of agents that form insoluble precipitates within the tubules. 3) Impregnation of tubules with plastic resins. 4) Sealing of the tubules with plastic resins.

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OFFICE MANAGEMENT
Method of treatment generally fall in to one of the following categories Burnishing the dentine exposed root surface with wood in order to form a smear layer that will plug the dentinal tubules. Impregnation of tubules with resins. Application of dentine bonding agents to seal off the tubules. Patient education & dietary counseling. Plaque control measures.
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Cavity varnishes Anti-inflammatory agents - corticosteoroids Iontophoresis Dental resins & Adhesives Patient education Diet Brushing technique Plaque control Lasers R.C.T.
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Various dentifrices are used

Strontium chloride (10%) Potassium nitrate (5%)

Dibasic sodium citrate

Formaldehyde Fluoride & other dentifrices
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HOME MANAGEMENT

The most common agent used by the patient for oral hygiene are dentifrices. Many dentifrice products contain fluorides,additional active ingredients for desensitization are strontium chloride, potassium nitrate and sodium citrate.

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Various dentifrices for desentising purpose are; 1) Sensodyne and thermodent (contain strontium chloride). 2) Denquel and promise (contain potassium nitrate). 3) Protect (contain sodium citrate). 4) Fluoride rinsing solution and gel can also be used after the usual plaque control procedure.

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