Dentin hypersensitivity

By Dr.Swathi Pai on Wednesday 16 April 2008 with 0 comments



Odontoblast receptors are direct nerve endings near pulp

myelinated

A (alpha, beta, and delta) fibers differ in size and conduction

most are A-delta-responsible for brief, sharp and well-localized pain (low threshold-EPT

response)

non-myelinated

C fibers, >10% sympathetic nerves (high threshold-dull ache of irreversible pulpitis)

The most widely accepted theory of the mechanism of dentin hypersensitivity is Brannstrom’s

Hydrodynamic theory:

-movement of fluid within dentinal tubules transduces surface stimuli by deformation of

pulpal mechanoreceptors, via A-delta fibers

-hypersensitive dentin has 8 times as many open tubules as non-sensitive teeth

-diameter of dentin tubules can be twice that of non-sensitive teeth

-Poiseulle’s Law- multiply the diameter by 2 , the fluid flow increases by 16 times

Sherman and Jacobsen wrote an article in 1992 entitled What “Managing dentin hypersensitivity: treatment to recommend to patients”.

They recommended a conservative stepwise approach to managing dentin hypersensitivity:

Step 1. perform thorough exam to rule out other pain sources and evaluate cause then recommend use of a desensitizing dentifrice with KNO3 for a 2-6 week trial period

Step 2. Seal dentinal tubules via in-office potassium oxalate treatment or fluoride iontophoresis (2-10 week trial) (or better yet, apply a DBA for immediate relief)

Step 3. If conservative treatment does not work, place a composite restoration w/ GI base (or DBA liner)

(Note: when this article was written, the jury was still out about DBA’s as desensitizers. Today, it would seem appropriate to try a desensitizing dentifrice initially, and if unsuccessful go immediately to a DBA alone or DBA under a restoration)

Category: Conservative and Endodontics Notes

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