How to Manage Tooth Sensitivity
Many possible causes may expose dentin and predispose patients to hypersensitivity, including toothbrush abrasion, acid erosion, anatomical factors, and gingival recession.
Many possible causes may expose dentin and predispose patients to hypersensitivity, including toothbrush abrasion, acid erosion, anatomical factors, and gingival recession. In particular, periodontitis and periodontal therapy can lead to exposure of root surfaces, which may cause sensitivity. To ensure optimal care, identification, prevention, and treatment strategies to address patient discomfort are critical to allow for effective management of periodontal conditions. See how familiar you are with strategies for hypersensitivity management.
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Prevalence of Tooth Sensitivity
The prevalence of dentinal hypersensitivity in the general population ranges from 4% to 57%, with higher values noted for individuals with periodontitis. A systematic review also showed that, prior to periodontal therapy, the prevalence of root sensitivity ranged from 9% to 23%, but it increased to 54% to 55% after treatment. Root sensitivity has also been reported as long as 5 years following surgical periodontal treatment.
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Identification of dentinal hypersensitivity is difficult and may be subjective. For example, in population studies, self-reported rates were significantly higher than those determined by clinical testing. For patients who have recently undergone periodontal therapy, consideration of the timing in post-operative pain onset, as well as the location, severity, and reproducibility of the sensitivity symptoms—in combination with the elimination of other possible sources—offer insight into the proper diagnosis.
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Start With Dentifrice
Managing dentinal hypersensitivity through agents added to dentifrices is often a first-line therapy and may be combined with in-office treatment. These ingredients—which may include potassium nitrate, strontium acetate, arginine and calcium carbonate, calcium sodium phosphosilicate, and fluoride—either reduce nerve conduction or occlude tubules.
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Professionally Applied Treatments
In-office dentin desensitizers are often used in combination with patient-delivered desensitizers (eg, dentifrice) and may contain fluoride, arginine and calcium carbonate, bonding agents, glutaraldehyde, oxalate, or casein phosphopeptide/amorphous calcium phosphate. These agents may be used as monotherapy or in combination with other treatments.
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A Laser Approach
Lasers, such as neodymium-doped yttrium aluminium garnet, erbium yttrium aluminium garnet, diode and CO2, have been studied for use in managing sensitivity. While these lasers (at the wavelengths and protocols tested) did not permanently alter dentin surfaces through melting the dentin to occlude dentinal tubules, it is believed they may reduce sensitivity through increased coagulation of proteins, which precipitate to block the tubules. Other laser technologies, such as helium-neon and gallium aluminium arsenate, have also been investigated to determine their effect on nerve activity.
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Cervical restorations may be used to treat dentinal hypersensitivity by covering tubules with restorative resins. This approach has demonstrated greater efficacy than patient-applied dentifrices—and has a more immediate effect, as well.
Soft tissue grafting procedures can reduce sensitivity at sites with gingival recession and increase periodontal root coverage—potentially increasing the width of keratinized gingiva.
Root canal therapy is generally used to treat irreversible pulpitis and pulpal necrosis, and the procedure eliminates all sensory feeling associated with the tooth. While this would certainly eliminate dentinal hypersensitivity, except in extreme cases, this condition is not an indication for endodontic treatment.
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Clinicians should take a systematic approach to treatment and select therapies based on the diagnosis and etiologies identified during patient assessment. Less invasive, first-line therapies should be investigate first before attempting more invasive procedures to treat dentinal hypersensitivity.