Addressing dentin hypersensitivity.What Is Dentin dentin /den·tin/ (den´tin) the chief substance of the teeth, surrounding the tooth pulp and covered by enamel on the crown and by cementum on the roots.den´tinal adventitious dentin secondary d. Hypersensitivity hypersensitivity, heightened response in a body tissue to an antigen or foreign substance. The body normally responds to an antigen by producing specific antibodies against it. The antibodies impart immunity for any later exposure to that antigen. ? Dentin hypersensitivity is defined as a short, sharp pain arising from exposed dentin in response to stimuli, which cannot be ascribed to any other form of dental defect or pathology. (1) The hydrodynamic theory hydrodynamic theory, n the principles of physics relating to the study of fluidity and the movement of particles within fluids. helps explain why dentin hypersensitivity occurs. According to the theory, fluid within the dentinal tubules can flow in either an inward or outward direction depending on pressure differences in the surrounding tissue. A stimulus that makes contact with a tooth surface with open tubules causes a fluid disturbance, or change in flow direction, which is perceived as pain by the patient. Common stimuli, or triggers, of dentin hypersensitivity include: beverages that are cold, hot, sweet or sour; cold air; and aggressive brushing or flossing flossing, n the mechanical cleansing of interproximal tooth surfaces with stringlike, waxed or unwaxed dental floss or tape. flossing aids, n. . The most common triggers of dentin hypersensitivity are cold air, food or drinks. Who Suffers from Dentin Hypersensitivity? * Up to one in five people suffer from dentin hypersensitivity, yet it is not routinely addressed by dental professionals. (2) * Although sensitivity affects people of all ages, those between the ages of 20 and 50 report dentin hypersensitivity frequently, especially between the ages of 20 to 30. (3) * Dentin hypersensitivity is reported more frequently in women than men. (4) * Dentin hypersensitivity also is a common side effect of tooth whitening tooth whitening Dentistry Any process is intended to whiten yellowed or stained teeth Complications Improperly applied, whiteners have been associated with tooth disintegration. See Cosmetic dentistry. procedures; 55-75% of patients suffer from whitening-related sensitivity. (5) Data show that up to 42% of patients with dentin hypersensitivity don't tell their dental professional they are suffering. (6) Many patients are reluctant to talk to dental professionals about their tooth sensitivity because they are unaware that there is treatment for their pain or they fear a more serious condition. To avoid pain, patients may drink cold beverages through a straw or avoid foods like ice cream and citrus fruits. Some may even avoid brushing and flossing certain teeth. Improper oral hygiene Oral Hygiene Definition Oral hygiene is the practice of keeping the mouth clean and healthy by brushing and flossing to prevent tooth decay and gum disease. could lead to more serious oral conditions. Fortunately, dental professionals can offer a simple, effective and painless treatment. Identifying and Treating Dentin Hypersensitivity Dental professionals can play a key role in identifying and managing this painful condition. By engaging patients in a dialogue about sensitivity, and asking about potential triggers, dental professionals can more easily identify patients who are suffering. The following questions should be asked at each patient visit: * Do you avoid specific foods or beverages that cause tooth sensitivity or pain? * Do you experience discomfort from cold, hot, sweet or sour foods or beverages? * Have you recently undergone a whitening whit·en·ing n. 1. An agent used to make something white or whiter. 2. The act or process of making white or whiter. Noun 1. or bleaching treatment? * If so, did you discontinue or interrupt treatment because of tooth sensitivity? * Are you considering utilizing whitening or bleaching treatments in the future? Patients should be advised to brush with a desensitizing de·sen·si·tize tr.v. de·sen·si·tized, de·sen·si·tiz·ing, de·sen·si·tiz·es 1. To render insensitive or less sensitive. 2. Immunology To make (an individual) nonreactive or insensitive to an antigen. toothpaste twice daily and should continue its use indefinitely for long-term relief. The protection against sensitivity builds over time, and noticeable results typically are felt within two weeks. Treating Sensitivity in Whitening Patients Sensitivity is the most common side effect of professionally dispensed and OTC OTC See: Over-the-counter. OTC See over-the-counter market (OTC). whitening treatments. In fact, data suggest that up to 75% of tooth whitening patients may experience sensitivity. (7) Research shows that as many as 41% of dental professionals recommend patients discontinue their whitening procedures to alleviate related sensitivity. (8) What causes whitening-related sensitivity? Sensitivity occurs when the chemical by-products of carbamide carbamide /car·ba·mide/ (kahr´bah-mid) urea. carbamide peroxide a compound of urea and hydrogen peroxide used as a cerumen-softening agent, dental cleanser, bleaching agent, and and hydrogen peroxide hydrogen peroxide, chemical compound, H2O2, a colorless, syrupy liquid that is a strong oxidizing agent and, in water solution, a weak acid. It is miscible with cold water and is soluble in alcohol and ether. used in whitening treatment passes through the enamel and dentin and into the pulp. (9) Companies manufacture dentist-dispensed and OTC whitening products containing peroxide (carbamide or hydrogen peroxide), which work to whiten tooth enamel. New data (10) * A recent study, conducted in dental offices, demonstrated that patients who brushed with Sensodyne[R] Fresh Mint toothpaste (GlaxoSmithKline Consumer Healthcare) two times daily, two weeks before and two weeks during professional whitening treatment experienced significantly less sensitivity compared to a control group using regular toothpaste. * Patients were significantly more sensitivity-free during the first three days of their whitening treatment, which is typically when they experience the greatest degree of whitening-related sensitivity. * Study results revealed that those using desensitizing toothpaste were more satisfied with their whitening experience overall, and would be more willing to repeat whitening treatment in the future. Results were based on patient satisfaction surveys and diary entries. * Whitening results were not affected by the desensitizing toothpaste. To reduce bleaching-induced sensitivity, dental professionals should recommend that whitening patients utilize desensitizing toothpaste two times a day, two weeks prior to and two weeks during whitening treatment. Recommending this brushing protocol can help patients be more comfortable during tooth whitening and help to reduce the number of patients who discontinue whitening treatment due to whitening-related sensitivity. How It Works Potassium nitrate, the key pain-relieving ingredient, works by depolarizing the nerves located at the dentin-pupal interface. Potassium ions penetrate the length of the dentin tubules and prevent repolarization repolarization /re·po·lar·iza·tion/ (re-po?ler-i-za´shun) the reestablishment of polarity, especially the return of cell membrane potential to resting potential after depolarization. of sensory nerve sensory nerve n. An afferent nerve conveying impulses that are processed by the central nervous system to become part of the organism's perception of itself and of its environment. endings. This interrupts transmission of the pain-causing nerve impulses, therefore reducing pain. This information was supplied by GlaxoSmithKline Consumer Healthcare. www.dental-professional.com. References (2,6,8,10.) GlaxoSmithKline: Data on file (1.) Holland GR, Narhi MN, Addy M, et al. guidelines for the design and conduct of clinical trials on dentine hypersensitivity. J Clin Periodontal periodontal /peri·odon·tal/ (per?e-o-don´t'l) 1. pertaining to the periodontal ligament or periodontium. 2. near or around a tooth. per·i·o·don·tal adj. 1. 1997;24:808-13. (3.) Gillam DG, Aris A, Bulman JS, Newman HN, Ley F. Dentine hypersensitivity in subjects recruited for clinical trials: clinical evaluation clinical evaluation Medtalk An evaluation of whether a Pt has symptoms of a disease, is responding to treatment, or is having adverse reactions to therapy , prevalence and intraoral distribution. J Oral Rehab 2002;29: 226-31. (4.) Addy M. Dentine hypersensitivity: new perspectives on an old problem. Int Dent J 2002;52:375-6. (5,7.) Haywood VB. Contemporary esthetics esthetics: see aesthetics. and restorative practice. 1993; 3(suppl.): 2-11 (9.) Haywood VB. Dentine hypersensitivity: bleaching and restorative considerations for successful management. Int Dent J 2002;52:376-85 |
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