1 / 39

Dentin Hypersensitivity

Dentin Hypersensitivity. Dentin H ypersensitivity. Dentin hypersensitivity is sensation felt, defined as a sharp short pain arising from exposed dentine Sensitivity is caused by open dentinal tubules in response to stimuli Common dental painful disease

leblancc
Download Presentation

Dentin Hypersensitivity

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Dentin Hypersensitivity

  2. Dentin Hypersensitivity • Dentin hypersensitivity is sensation felt, definedas a sharpshortpainarisingfromexposeddentine • Sensitivity is causedbyopendentinaltubulesinresponsetostimuli • Commondentalpainfuldisease • Oftenunderreportedbypatients

  3. Prevalence of dentin hypersensitivity • globalprevalenceintheadultdentatepoulation 57% • Patientswithperiodontitisincidenceextremehighas 60 to 98% • Symptomscanpresentatanyagefrom 15 years old totheages more tnan 70 • Ages 20 to 40 is a peakprevalence • Womenare more frequentlyaffectedthanmales

  4. Stimuli • Thermal (mainlycold) • Evaporate • Tactile (probe, toothbrush) • Osmotic (sweet, sourfoods) • Chemical

  5. Stimulus • Cold 80% • Air 23% • Touch 20% • Heat 13% • Dietary acid 6.9% • Endogenosus acid 0.7%

  6. Epidemiology • Affected teeth • Premolars 38% • Incisors 26% • Canines 25% • Molars 12% • Location • Cervical 90% • Buccal, occlusal surfaces more prevalent

  7. Structure of dentin • Largestportion of thetoothstructure • Inorganicmaterial (hydroxyapatite) account for 70-75% byweight • 18-20% organicmaterial • 5% water and othermaterials • Dentin is packedwithdentinaltubulesthattransverseitsentirethickness

  8. Dentin tubules • Tubulesareconical, being wideratpulpal end thantheperiphery • Tubulesrunparalelltoeachotherin an S shapecourse • Diameter of tubules: 1-5 Micrometerwith an average of 1,5 • Number of tubulesdecreasesfromabout 65000/mm2 closetothepulptoabout 15000/mm2 nearthe DEJ • Contenttubular fluid • Constantpulpalpressure 25-30 mmHg • Externalstimuliwillcausemovement of thedentinal fluid, a hydrodynamicmovement

  9. Structure of dentin

  10. Dentin hypersensitivitymechanismstheory • Neuraltheory • Odontoblastictransductiontheory • Odontoblastmovementtheory • Hydrodynamictheory (the most widelyacceptedmechanism)

  11. Mechanism of Hypersensitivity The Hydrodynamic Theory: • Exposed dentin tubules • Stimulus (thermal, mechanical, chemical) • Change in rate of dentin fluid flow • Generation action potentials in intradental nerves • Movement of fluid stimulate the free nerve endings (of the A-beta, A-delta) located around the odontoblast body • Action potentials pass to brain to cause pain

  12. Aetiology Two phases development: • Lesion localisation- exposure of dentin • Lesion initiation- opening of dentin tubules (removal of cementum or smear layer)

  13. Aetiology • Loss of enamel – tooth wear • Gingival recession

  14. Loss of enamel • Abrasion • Erosion • Attrition • Abfraction • Fracture

  15. Abrasion • Resultingdirectfrictionforcesbetweentheteeth and theexternalobjects • Toothbrushabrasion is the most common

  16. Abrasion

  17. Attrition • Resultingfromtoothtotoothcontact • Incisal and occlusalsurfaces • Physiologicmovement and contact of teethbytheage • Parafunctionalhabitsassuchasbruxism

  18. Attrition

  19. Abfraction

  20. Erosion • Extrinsic acids • Commonnly associated with acidic foods and drinks • Carbonated drinks • Citrus drinks • Citrus fruits • Wine • Intrinsic acids • Gastric reflux • Bulimia

  21. Erosion • Dietary habits • Prolonged contact

  22. Erosion

  23. Gingival recession • Incorrect tooth-brushing or flossing • Gingivitis • Periodontitis • Periodontal procedures • Gingival trauma (picking hard foods)

  24. Gingivalrecession

  25. Enamelfracture

  26. Toothwhitening • Post dentalbleachingsensitivityreported 55-75% of patients • Increasedtoothporiosity and removal of protective protein layeronthesurface of theteeth • Opened upporesinexposed dentin surfaces

  27. Developmentalanomaly • MolarIncisorHypomineralisation • Enamelhypoplasia • Dentin exposurebecause of weakenamel

  28. Differentialdiagnosis • Dentalcaries • Periodontaldesease • Dentalfractures • ReversibleorIrreversiblepulpitis • Traumaticocclusion • TMJ disorder

  29. Diagnosisindentinehypersensitivity • Tactilehypersensitivityscore: • YeapleProbe (forcemeasuredingrams (10-50g onexposuredsurface) • SchiffCold Air SensitivityScale, usedairblastsimulusonexposuredsurfacefor 1 sec. (scores: 0-3, no paintopainful) • Visual AnalogScale (VAS) subjectivepainintensitymeasurement (0-10, no paintoworstimaginablepain)

  30. Treatment principles • Desensitizing nerves • Occlusion of open tubules block the hydrodynamic mechanism

  31. Treatment I.Desensitizing the nerves • Potassium salts: • potassium nitrate 5% • potassium citrate 3,75% • Potassium chloride 5,5% • Depolarize the excited nervefibers, thus numbing the pain • compatible with Fluoride

  32. Treatment II.Occlusion of dentine tubules Strontium salts High Fluoride Stannosus fuoride HEMA / Glutaraldehyde Restorative resins Ca,Na Phosphosilicate Arginine és calcium carbonate Arginine és PVM/MA copolimer, és Pyrophosphates

  33. Special Tooth pastes

  34. Restorative resin desensitizers

  35. Fillingthelesions

  36. Thankyouforyourattention!

More Related