Transcript of Dentinal hypersensitivity
- 1. PRESENTED BY: SHREEYUKTA PYAKUREL BDS 4TH YEAR, 1ST BATCH
ROLL NUMBER 33
- 2. DEFINITION ETIOLOGY THEORIES OF DENTIN HYPERSENSITIVITY
CLINICAL FEATURES DIAGNOSIS TREATMENT CONCLUSION REFERENCES
- 3. The INTERNATIONAL WORKSHOP ON DENTIN HYPERSENSITIVITY(1983)
has proposed the following definition for this condition: It is
characterized by short, sharp pain arising from exposed dentin in
response to stimuli typically thermal,evaporative,tactile,osmotic
or chemical and which cannot be ascribed to any other form of
dental defect or pathology
- 4. Loss of enamel Gingival recession Attrition Erosion Tooth
malposition
- 5. Abrasion Abfraction Periodontal diseases Patient habits
- 6. 1. DIRECT INNERVATION THEORY 2. ODONTOBLAST RECEPTOR THEORY
3. HYDRODYNAMIC THEORY
- 7. First theory to be put forward Nerve fibers present within
dentinal tubules initiate impulses when they are injured and causes
dentinal hypersensitivity.
- 8. Disputes about this theory: Nerve fibers are present only in
the Predentin and inner dentinal zones When pain inducing
substances like potassium chloride, acetylcholine are applied to
exposed dentin, they fail to elicit painful response.
- 9. Odontoblast or their processes are damaged when external
stimuli are applied to exposed dentin. They conduct impulses to the
nerves in the predentin and underlying pulp and then to CNS
- 10. Disfavored as the odontoblastic processes extend only
partly through the dentin and not upto DEJ. Odontoblastic membrane
potential is too low to permit transduction.
- 11. There are no evidence to demonstrate synapses between
odontoblast and nerve terminals.
- 12. The most widely accepted mechanism of action of dentin
hypersensitivity , the hydrodynamic theory which was proposed by
Gysi in 1900 and validated by Brannstrom in 1996
- 13. Whenever dentin is exposed and stimulated by tactile,
chemical, thermal or osmotic stimuli there is rapid movement of
fluid through tubules. This causes: Direct stimulation of low
threshold a- delta nerve fibers in pulp by displacing odontoblastic
cell bodies.
- 14. COMPLETE HISTORY CLINICAL EXAMINATION RADIOGRAPHIC
EXAMINATION SIGNS AND SYMPTOMS VISUAL ASSESMENT RULE OUT PERI
APICAL LESION INTENSITY PHYSICAL ASSESMENT FREQUENCY AND DURATION
DEPTH OF PERIODONTAL POCKET DIETARY CHANGES PERCUSSION TESTING
RESPONSE TO COLD OR HOT AIR
- 15. SENSITIVITY Pain Intensity varies from mild discomfort to
severe sensitivity Rapid in onset, sharp in character and is of
short duration
- 16. External stimuli which can elicit the expression of
conditions include: Thermal stimuli: i. Hot/cold food and beverages
ii. Cold blast of air Osmotic stimuli i. Sweet food
- 17. Acidic stimuli i. Citrus fruits ii. Acidic beverages
Mechanical stimuli i. Toothbrush ii. Dental instruments
- 18. Most commonly involved teeth are: 1. Buccal surfaces of
Premolars 2. Facial surfaces of Incisors
- 19. 1. Fractured restorations 2. Fractured enamel exposing
dentin 3. Dental caries 4. Post restoration sensitivity 5.
Bleaching sensitivity
- 20. Cracked tooth syndrome
- 21. 1. Diet counseling regarding consumption of acidic fruits
and beverages 2. Correction of brushing technique 3. Care during
operative procedures 4. Care during periodontal procedures
- 22. CLINICAL MANAGEMENT: 1. REMOVAL OF ETIOLOGICAL FACTORS
Improper tooth brushing technique Poor oral hygiene Premature
contact Gingival recession Endogenous/ Exogenous acids
- 23. 2. PATIENT EDUCATION
- 24. A. Desensitizing the nerve B. Occluding the dentinal
tubules C. Dentin adhesives D. Crown placement E. Periodontal
grafting F. Lasers
- 25. Potassium nitrate desensitization Daily use of potassium
nitrate containing toothpaste for 4 weeks Increases the
extracellular potassium ion concentration and thus depolarizes the
nerve. This prevents the transmission of pain signals to the
brain.
- 26. Occluding distal terminal ends of exposed dentinal tubules
FLUORIDES: In form of 2% sodium fluoride or 0.4% stannous fluoride.
Decreases dentinal permeability by precipitating calcium fluoride
crystals inside dentinal tubules.
- 27. Potassium oxalate by forming calcium oxalate crystals
inside dentinal tubules.
- 28. Casein is a milk protein which has been used to develop
casein phosphopeptide (CPP) that gets attaches to amorphous calcium
phosphate (ACP). The CPP-ACP complex has been proved to enable
early enamel remineralization in white spot lesions. They also have
shown potential to prevent and treat dentin hypersensitivity.
- 29. Reduction in sensitivity can result from formation of resin
tags and a hybrid layer when a dentin adhesive is used. The primers
of the multi bottle adhesive system All Bond 2 have a desensitizing
effect even without consistent resin tag formation.
- 30. Nd-YAG Lasers have shown to effectively occlude dentinal
tubules.
- 31. Clinicians have used many materials and techniques to treat
dentin hypersensitivity, including specific dentifrices, laser
irradiation, dentin adhesives, antibacterial agents, fluoride
varnishes, rinses, potassium nitrates, oxalates and others.
- 32. Effective management of dentin hypersensitivity should
incorporate a detailed clinical history along with identification
of etiological factors. A combination of patient education and
effective treatment strategy is effective in alleviating the pain
and discomfort associated with it.
- 33. Sturdevants Art and Science of Operative Dentistry-A South
Asian Edition. Carranzas Clinical Periodontology- 11th Edition.
Textbook of Oral Medicine Oral Diagnosis and Oral Radiology- 2nd
Edition.
- 34. EXAMPLES OF DESENSITIZING PASTE? Sensodyne Thermoseal
Thermoseal RA