Treating Sensitivity in Orthodontic Patients
Hypersensitivity in the orthodontic patient can be broadly categorized into two types: hard tissue hypersensitivity, commonly known as dentinal hypersensitivity, and soft tissue hypersensitivity, which is mainly caused by allergies to orthodontic materials.
Hard tissue hypersensitivity, commonly known as dentinal hypersensitivity, is one type of hypersensitivity experienced by orthodontic patients. Various etiological factors can contribute to dentinal hypersensitivity, including tooth whitening, high consumption of acidic food and drinks, and poor toothbrushing technique, resulting in gingival recession. In orthodontic patients, hypersensitivity is most commonly attributed to interproximal enamel reduction (IER), a procedure involving the reduction, recontouring, and polishing of interproximal enamel surfaces.
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Low Incidence Among Orthodontic Patients
Research shows that dentinal hypersensitivity affects between 8% and 54% of the general population, with women more likely to develop it than men. On the other hand, the incidence of IER-induced dentinal hypersensitivity is low. Long-term follow-up (10 years) of orthodontic patients who received IER on all six mandibular anterior teeth showed that only one of the 61 participants developed increased sensitivity of the mandibular incisors.
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Strategy for Management
The efficient management of dentinal hypersensitivity relies primarily on proper diagnosis. Some dental conditions can lead to symptoms similar to those of dentinal hypersensitivity. A differential diagnosis should include cracked tooth syndrome, vital bleaching, fractured restorations, caries causing pulpal response, and others.
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Role of the Dental Hygienist
Dental hygienists can play a vital role in the prevention and management strategies for dentinal hypersensitivity, including:
- Patient education on proper toothbrushing technique during and after orthodontic treatment.
- Periodontal health status evaluations at regular intervals; periodontal therapy must be promptly initiated when indicated.
- Review of patient’s regular diet to screen for etiologic factors contributing to sensitivity.
- Evaluate patients for parafunctional habits; night-time splints may be considered for at-risk patients to help minimize wear of dentition.
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Professional management of dentinal hypersensitivity is often based on the treatment results rather than underlying etiology or predisposing factors. Therefore, a wide range of products are available, many of which show similar efficacy. Treatment can include over-the-counter desensitizing agents, professionally administered agents, restorations, or surgical intervention. Unfortunately, no one treatment works for all. As such, developing a treatment plan specific to the patient’s diagnosis is critical. Factors that must be considered when treatment planning include patient’s age, medical history, oral hygiene and periodontal status, and severity of the sensitivity.
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Dentifrices are the most commonly used desensitizing agent. Advantages of this application method include reduced costs and easy, at-home application with a toothbrush. Dentifrices usually feature desensitizing agents, such as potassium nitrate, stannous fluoride, sodium fluoride, sodium monofluorphosphate, strontium chloride, and others. Their mechanism of action is based on the obliteration of dentinal tubules, caused by calcium phosphate precipitation on the dentin surface. For professional application, in case of no significant loss or weakening of the dental structure, products such as fluoride varnishes, potassium oxalate, resin sealants, and others can be used. For patients with enamel wear from orthodontic brackets, composite resins can be applied to seal and protect. In cases with significant wear of incisal edges, restorative build-ups can be considered, as they offer functional, esthetic, and protective benefits.
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Research suggests that laser-assisted therapy can provide relief from sensitivity-related pain. This is an innovative, fast-acting treatment, with minimal side effects. The diode laser can be used for this application, given its safety and beneficial clinical results. For patients experiencing sensitivity due to gingival recession post-orthodontic treatment, soft tissue grafting provides good prognosis and improved esthetics.