Extreme Dentin Hypersensitivity

Thank you for your question. Yes, I believe from what you have told us that this patient's consumption of diet soda and extreme dentin hypersensitivity (DH) are directly related. As we know, DH is a transient pain of exposed dentin that cannot be attributed to any other dental defect or pathology. I am not sure why this patient has exposed dentin, but my guess would be since she has meticulous oral hygiene that her exposed dentin may be due to toothbrush abrasion. DH is a short, sharp pain in response to stimuli that include: tactile/mechanical, thermal, chemical, osmotic, and evaporative. Research has shown that hypersensitive dentin has more open tubules with larger openings than non-sensitive dentin. This explains why some patients with exposed dentin experience DH and others do not. These stimuli produce fluid movement in the tubules which activates the nerve (Hydrodynamic Theory). When the stimulus is removed so is the pain. Dietary factors play a large role in the management of DH. Acidic beverages such as diet sodas, wine, orange juice, and apple juice open up the dentinal tubules and are a "chemical" stimulus that creates fluid flow in the tubules. Frequent consumption of acidic beverages also causes erosion of the enamel. The first line of management in this case would be to see if this patient could stop drinking diet sodas to remove the stimulus and to halt possible enamel erosion as well as to identify and modify any destruction oral hygiene habits that may contribute to more exposed dentin. In addition, she may find a benefit to using a sensitivity toothpaste that contains potassium nitrate (KNO3). It may take 2-4 weeks of sensitivity toothpaste use before she finds relief. Further management strategies may include coverage of exposed dentin by gingival grafting or restorations, or the use of professional and home products that can be applied to exposed dentin to occlude the dentinal tubules. A combination of behavioral changes and the use of sensitivity products is critical to the management of DH.