Oral Effects of Soda Consumption

Yes, this patient's extreme dentinal hypersensitivity, which is defined as transient pain from exposed dentin that cannot be attributed to any other dental defect or pathology,1 is most likely related to her consumption of diet soda. I am not sure why a patient with such excellent oral hygiene has exposed dentin, but my guess would be abrasion. This is a loss of tissue and/or tooth structure due to mechanical forces exerted by an abrasive material, and can be caused by improper brushing technique, use of a toothbrush with too-firm bristles, or brushing with an abrasive toothpaste.2 Dentinal hypersensitivity is a short, sharp pain in response to tactile/mechanical, thermal, chemical, osmotic, or evaporative stimuli.1 Research shows that hypersensitive dentin has more open tubules with larger openings than nonsensitive dentin.3 This explains why some patients with exposed dentin experience sensitivity while others do not. These stimuli produce fluid movement in the tubules that activates the nerve (hydrodynamic theory). When the stimulus is removed, the pain disappears. Dietary factors play a large role in the management of dentinal hypersensitivity. Acidic beverages—such as diet sodas, wine, orange juice, and apple juice—open dentinal tubules and can act as chemical stimuli to create fluid flow within them. Frequent consumption of acidic beverages also causes erosion of the enamel.

Management steps for this patient include:
• Advise the patient to stop drinking diet soda; this will remove the stimulus and halt the possibility of enamel erosion from this source.
• Identify and modify any destructive oral hygiene habits that may contribute to additional exposed dentin (eg, provide education on proper brushing technique and recommend a toothbrush with very soft bristles).
• Recommend a toothpaste formulated for sensitive teeth. Those containing potassium nitrate block the pain pathway. It may take up to 4 weeks of using the toothpaste before the patient finds relief, and then it should be used twice per day thereafter.
• Further management strategies include coverage of exposed dentin via restorations or gingival grafting, or the use of professional products that can be applied to exposed dentin to occlude the dentinal tubules.

A combination of behavioral changes and the use of desensitizing products is crucial to the effective management of dentinal hypersensitivity. References

1. Addy M. Dentine hypersensitivity: new perspectives on an old problem. Int Dent J. 2002;52:367–375.
2. Aschcroft AT, Joiner A. Tooth cleaning and tooth wear: a review. J Engineering Tribiology. 2010;224:539–549.
3. Canadian Advisory Board on Dentin Hypersensitivity. Consensus-based recommendations for the diagnosis and management of dentin hypersensitivity. J Canadian Dent Assoc. 2003;69:222–226.