Dentinal hypersensitivity (DH) is a common clinical condition usually associated with exposed dentinal surfaces. It can affect patients of any age group and most commonly affects the canines and premolars of both the arches. This article concisely reviews the patho-physiology, mechanism and clinical management of the DH. Treatment of DH should start with an accurate diagnosis. Differential diagnosis should be made and all other probable causes should be excluded. An often neglected phase of clinical management of DH is the identification and treatment of the causative factors of DH. By removing the etiological factors, the condition can be even prevented from occurring or recurring. There are various treatment modalities available which can be used at home or may be professionally applied. The "at home" desensitizing agents include toothpastes, mouthwashes or chewing gums and they act by either occluding the dentinal tubules or blocking the neural transmission. This article also discusses the recent treatment options like bioglass, Portland cement, lasers and casein phosphopeptide.
"The direct innervation theory proposes that nerve endings extend through the pulp and dentin up to the dentino-enamel junction . The odontoblast receptor theory suggests that odontoblasts are receptors, relaying a signal to a nerve terminal . Neither the direct innervation theory nor the odontoblast receptor theory is currently favored. "
[Show abstract][Hide abstract] ABSTRACT: This clinical study aimed to evaluate effectiveness of a commercially available toothpaste containing potassium nitrate, sodium monoflurophosphate, and nano-hydroxyapatite as well as antioxidants phloretin, ferulic acid and silymarin in reducing dental hypersensitivity in adults.
The clinical trial enrolled patients with a history of dentin hypersensitivity. A test toothpaste was introduced into the daily routine, which included initial instruction on usage. Patients completed a five-question visual analog scale (VAS) at the inception/baseline, after two days and after two weeks of using the toothpaste to determine their level of tooth sensitivity at baseline with the use of the toothpaste over time.
Patients that had significant sensitivity at baseline had a range of 52% to 76 % improvement after 48 hours and a range of 70% to 84% improvement after two weeks.
A toothpaste containing potassium nitrate, sodium monoflurophosphate, and nano-hydroxyapatite plus antioxidants phloretin, ferulic acid and silymarin applied daily significantly decreased tooth pain of dentin hypersensitivity within a two-day and two-week time period.
Based on the clinical study results, a daily application of a toothpaste containing potassium nitrate, sodium monofluorophosphate, and nano-hydroxyapatite plus antioxidants phloretin, ferulic acid and silymarin can significantly and quickly reduce tooth pain of dentin hypersensitivity.
The Open Dentistry Journal 02/2015; 9(9):92-7. DOI:10.2174/1874364101509010092
"Eventually, bacterial growth may acidify dentin and restorative substances, thereby causing the resin interface to dissolve. Secondary caries may result, and, if untreated, may cause restoration fracture (Sarrett, 2005; Miglani et al., 2010). Thus, composite resin is continuously being researched and improved upon to meet different clinical needs and dental restoration purposes (Dickens-Venz et al., 1994; Skrtic et al., 1996; Dickens-Venz et al., 2003; Chen, 2010; Vouvoudi and Sideridou, 2012). "
[Show abstract][Hide abstract] ABSTRACT: Thermal cycling is used to mimic the changes in oral cavity temperature experienced by composite resins when used clinically. The purpose of this study is to assess the thermal cycling effects of in-house produced composite resin on bonding strength. The dicalcium phosphate anhydrous filler surfaces are modified using nanocrystals and silanization (w/NP/Si). The resin is compared with commercially available composite resins Filtek Z250, Z350, and glass ionomer restorative material GIC Fuji-II LC (control). Different composite resins were filled into the dental enamel of bovine teeth. The bond force and resin–enamel junction graphical structures of the samples were determined after thermal cycling between 5 and 55 °C in deionized water for 600 cycles. After thermal cycling, the w/NP/Si 30 wt%, 50 wt% and Filtek Z250, Z350 groups showed higher shear forces than glass ionomer GIC, and w/NP/Si 50 wt% had the highest shear force. Through SEM observations, more of the fillings with w/NP/Si 30 wt% and w/NP/Si 50 wt% groups flowed into the enamel tubule, forming closed tubules with the composite resins. The push-out force is proportional to the resin flow depth and uniformity. The push-out tubule pore and resin shear pattern is the most uniform and consistent in the w/NP/Si 50 wt% group. Accordingly, this developed composite resin maintains great mechanical properties after thermal cycling. Thus, it has the potential to be used in a clinical setting when restoring non-carious cervical lesions.
Journal of the Mechanical Behavior of Biomedical Materials 10/2014; 38:105–113. DOI:10.1016/j.jmbbm.2014.07.003 · 3.42 Impact Factor
"Desensitizing agents may act by nerve desensitization (potassium nitrate), protein precipitation (glutaraldehyde, silver nitrate, zinc chloride) or plugging dentinal tubules (sodium fluoride, potassium oxalate). Additionally dentin adhesive sealers, lasers, and homeopathic medication might be used for the same purpose.4 "
[Show abstract][Hide abstract] ABSTRACT: PURPOSE
The purpose of this study is to evaluate if pre-treatment with desensitizers have a negative effect on microtensile bond strength before cementing a restoration using recently introduced self-adhesive resin cement to dentin.
MATERIALS AND METHODS
Thirty-five human molars' occlusal surfaces were ground to expose dentin; and were randomly grouped as (n=5); 1) Gluma-(Glutaraldehyde/HEMA) 2) Aqua-Prep F-(Fluoride), 3) Bisblock-(Oxalate), 4) Cervitec Plus-(Clorhexidine), 5) Smart protect-(Triclosan), 6) Nd:YAG laser, 7) No treatment (control). After applying the selected agent, RelyX U200 self-adhesive resin cement was used to bond composite resin blocks to dentin. All groups were subjected to thermocycling for 1000 cycles between 5-55℃. Each bonded specimen was sectioned to microbars (6 mm × 1 mm × 1 mm) (n=20). Specimens were submitted to microtensile bond strength test at a crosshead speed of 0.5 mm/min. Kolmogorov-Smirnov, Levene's test, Kruskal-Wallis One-way Analysis of Variance, and Conover's nonparametric statistical analysis were used (P<.05).
Gluma, Smart Protect and Nd:YAG laser treatments showed comparable microtensile bond strengths compared with the control group (P>.05). The microtensile bond strengths of Aqua-Prep F, and Cervitec Plus were similar to each other but significantly lower than the control group (P<.05). Bisblock showed the lowest microtensile bond strength among all groups (P<.001). Most groups showed adhesive failure.
Within the limitation of this study, it is not recommended to use Aqua-prep F, Cervitec Plus and Bisblock on dentin when used with a self-adhesive resin cement due to the decrease they cause in bond strength. Beside, pre-treatment of dentin with Gluma, Smart protect, and Nd:YAG laser do not have a negative effect.
The journal of advanced prosthodontics 04/2014; 6(2):88-95. DOI:10.4047/jap.2014.6.2.88 · 0.64 Impact Factor
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