In-Office Treatments That Deliver Sensitivity Relief

Dentinal hypersensitivity (DH) is among the most common concerns among dental patients.¹ DH is described as sharp pain resulting from exposed dentin in response to chemical, thermal, tactile, and/​or osmotic stimuli, which cannot be attributed to any other type of dental defect or disease.² Research indicates that the prevalence of DH varies between 3% and 98%, depending on the diagnostic methods used and the specific population examined.^3-8 Individuals between the ages of 20 and 50 are the most frequently affected, and DH is more common among women than men.⁹ Research shows that the facial aspects of the cervical margins of canines and first premolars are most affected due to their prominent positions in the dental arches.^1,9

Etiology of Dentinal Hypersensitivity

Dentin comprises the majority of the tooth structure and consists of closely packed porous tissue that contains fluid-filled dentinal tubules.^. Dentin is normally shielded from the external oral environment by the outer mineralized layers of enamel or cementum. However, dentin can become exposed when enamel erodes or gingival tissue recedes, revealing the underlying dentinal tubules. These structural changes may be caused by consuming acidic foods, overly aggressive dental hygiene practices, and parafunctional habits that lead to enamel attrition, erosion, abrasion, and abfraction.^7,10,11

The most widely accepted theory explaining the cause of DH is the hydrodynamic theory, in which stimuli — such as thermal, osmotic, or physical changes — induce movement of fluid within dentinal tubules. This movement activates nerve endings known as baroreceptors, located at the interface of the dentin and pulp. The activation of these baroreceptors results in sharp, rapid pain, leading to discomfort and sensitivity.^1,7,12

Studies have demonstrated that areas of the tooth experiencing sensitivity have a greater number of exposed dentinal tubules, which are also wider in diameter compared to those in nonsensitive areas.^13-15 Therefore, DH is a complex condition characterized by dentin exposure, open dentinal tubules, and heightened nerve responsiveness to external stimuli.¹¹

Diagnosis and Principles of Treatment

Accurate diagnosis is essential for effectively managing DH, as it can often be confused with other conditions, such as dental caries, fractured or chipped enamel/​dentin, pain from reversible pulpitis, and sensitivity from dental bleaching.⁹ Diagnosing DH begins with a comprehensive dental history and clinical examination, ensuring that other potential causes of dental pain are ruled out before confirming DH.

Several techniques are used to identify DH, including applying pure air and pure water, as well as using sounds that mimic stimulation factors to assess the severity of symptoms. In addition, palpation may be used to diagnose pulpitis or periodontal involvement, while transillumination can help identify fractured or cracked teeth.^9,16

Tooth sensitivity treatments target the etiology of DH in two ways. First, they can reduce dentin permeability and limit the shifts of dentinal fluid that trigger nerve activation by occluding the tubules. Second, these treatments may decrease nerve excitability, making the nerves less responsive to stimuli, a process commonly referred to as depolarization.¹⁷

The initial focus of addressing DH should be on noninvasive, at-home treatments. If symptoms persist, more invasive options can be explored in a clinical setting. Following is an overview of various in-office management strategies.

Fluoride Varnishes and Gels

Fluoride varnish blocks the dentinal tubules, creating a mechanical barrier that limits the movement of dentinal fluid. Sodium fluoride (NaF) varnish adheres to tooth surfaces for several hours, making it more effective than fluoride gels or solutions.¹⁸

When NaF varnish is applied to hypersensitive dentin surfaces, the formation of calcium fluoride crystals blocks the open dentinal tubules, regulating the permeability of the exposed dentin. However, the effect of the varnish on occluding dentinal tubules is temporary. The small crystal size of calcium fluoride that forms on the surface of the dentin is gradually removed through brushing. Furthermore, this precipitate may be washed away by saliva or impacted by factors such as acids from dental biofilm, food, and beverages. While fluoride varnish is effective for short-term occlusion of tubules, its effects may decrease over time, requiring reapplication for continued benefits.^19-22

Glutaraldehyde and Hydroxyethyl Methacrylate

Glutaraldehyde and hydroxyethyl methacrylate (HEMA) promote the coagulation of proteins within dentinal tubules. They react with serum albumin in the dentinal fluid, leading to its precipitation, which aids in its desensitizing properties. Additionally, the hydrophilic nature of HEMA facilitates deep penetration into the dentinal tubules.^21,23

Research on the effectiveness of sodium fluoride varnish vs glutaraldehyde and HEMA demonstrates that both agents significantly reduce hypersensitivity; however, glutaraldehyde and HEMA produced a more substantial reduction in hypersensitivity over time compared to sodium fluoride varnish.^21,23 The long-term effects of glutaraldehyde and HEMA require further investigation.

Dentin-Bonding Agents

Bonding agents are increasingly recognized for their effectiveness in reducing sensitivity by sealing dentinal tubules and minimizing nerve activation.²⁴ Research that investigated the use of bonding agents with glutaraldehyde and HEMA found that the effectiveness of dentin bonding agents in reducing hypersensitivity decreased over time.²⁵ In contrast, teeth treated with glutaraldehyde and HEMA delivered more prolonged protection against DH.²⁵ This suggests that while bonding agents may provide effective short-term relief, glutaraldehyde and HEMA might offer more persistent defense against DH.

Arginine-Calcium Carbonate Pastes

Arginine-calcium carbonate pastes work by creating a compound of arginine, calcium, and phosphate that obstructs the tubules. As a result, this process reduces DH by inhibiting fluid movement within the tubules.²⁶ This approach offers a chemical and mechanical solution to managing dentin hypersensitivity effectively.

Laser-Assisted Treatments

Laser-assisted treatment for DH has been shown to effectively relieve both immediate and long-term pain.^27-30 Although it is typically more expensive than traditional topical desensitizing agents, laser treatment produces quick results. However, the exact mechanisms by which the laser functions are still not fully understood. Wavelength, power density, and the optical properties of the target tissue all affect how the tissue reacts. Typically, laser therapy is used in conjunction with desensitizing agents, which can enhance the overall effectiveness of the treatment.^30,31 This approach leverages the rapid response of laser treatment with the proven benefits of chemical agents to enhance overall DH relief.

Calcium Phosphate-Based Therapies

Calcium phosphate-based therapies, such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), utilize casein phosphopeptides to stabilize calcium phosphate, aiding in remineralization.³² Research comparing the effectiveness of sodium fluoride varnish and CPP-ACP paste found that immediately after application, sodium fluoride varnish was more effective in occluding dentinal tubules.³³ Additionally, sodium fluoride varnish demonstrated greater durability against abrasion and thermal fatigue compared to CPP-ACP paste. This suggests that while CPP-ACP offers benefits for DH, sodium fluoride varnish may provide longer-lasting protection against dentin hypersensitivity under challenging conditions.

Conclusion

In-office management strategies for DH include options such as fluoride varnishes, glutaraldehyde with HEMA, dentin-bonding agents, arginine-calcium carbonate pastes, lasers, and calcium phosphate therapies. Treatment decisions should be tailored to the patient’s sensitivity level, preferences, and past care responses. Successful management often combines various treatments, alongside preventive strategies such as dietary counseling and proper oral hygiene, to ensure long-term relief.

References

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From Dimensions of Dental Hygiene. May/June 2025; 23(3):16-19.