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Dentine hypersensitivity: New perspectives on an old problem

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Abstract

Dentine hypersensitivity is a prevalent, painful condition of the teeth. Despite the fact that the accuracy of the terminology is questionable and other terms have been proposed, 'dentine hypersensitivity' has been in long-term use and is, therefore, the preferred term. In dentine hypersensitiv-ity, lesions exhibit patent tubules at the exposed dentine surface and appropriate stimuli trigger pulpal nerves via a hydrodynamic mechanorecep-tor mechanism to produce a typically short, sharp, painful response. This accepted definition of the condition indicates the need to consider a differential diagnosis. This review will consider evidence that dentine hyper-sensitivity is a tooth-wear phenomenon characterised predominantly by erosion, which both exposes dentine and, more importantly, initiates the lesions. Abrasion caused by brushing teeth with toothpaste appears to be a secondary aggravating factor, which may even act in synergy with erosion. Gingival recession probably accounts for most dentine exposure at the gingival margin, but the process is poorly understood. Management strate-gies, which take into account aetiological and predisposing factors, rather than treatment alone, should be considered. There is little clinical research on many aspects of the aetiology and particularly on the management of the condition. In 1982, dentine hypersensitivity was described as an enigma, because it was frequently encountered yet poorly understood 1 . Some 20 years later, it is worthwhile reconsidering the statement, as the title of a recent article seems to suggest 2 . This review will discuss the terminology, definition, epidemiology, mecha-nisms, anatomy, aetiology and management of the condition. It is hoped that it will demonstrate that, although dentine hypersensitivity is not the enigma it once was, there is still much to be discovered about the condition, its prevention and its management.

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... There are several mechanisms for Odontalgia (dental pain), such as dentin sensitivity, pulpal inflammation, apical sensitization, peripheral sensitization, central sensitization, and psychological disorders [7]. Dentin hypersensitivity is a major mechanism of dental pain and originates from dentin response to varied stimuli, typically thermal, chemical, tactile, or osmotic [8][9][10][11][12]. Based on the morphological characteristics of teeth intradental sensory innervation, there are three main hypotheses concerning the mechanism of dental pain sensation induced by dentin hypersensitivity [4,7,12]: (1) The first is the theory of nerve conduction, which assumes that nerve endings extend through the dentin tubules to the dentin-enamel junction (DEJ). ...
... (3) The hydrodynamic hypothesis was first introduced by Alfred Gysi in 1900 [13], and subsequently developed by Brännström and his colleagues in the 1960s through a series of clinical and experimental studies [14]. This explanation is supported again in a number of later studies on fluid flow in dentin tubules and dental pain induced by stimuli [8]. The dentin tubule is connected to the pulpal chamber and is filled with tissue fluid. ...
... In addition to these three theories of direct innervation theory, hydrodynamic theory, and odontoblastic transducer theory above, there are also other explanations, such as neuroplasticity and sensitivity, and low-threshold algoneurons [7]. From a biological perspective, the explanation for dentin sensitivity ultimately lies in the ion channels on osteoblasts and nerve fibers [15], though today the hydrodynamic hypothesis is widely accepted [8,12]. ...
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Dental pain is a common ailment. With the development of oral anatomy and histology, the understanding of the neural circuit of dental pain sensation has become relatively comprehensive, and the corresponding methods for clinical diagnosis and therapy have become relatively well developed. The hydrodynamic hypothesis is a widely accepted theoretical explanation for dental pain induced by dentin hypersensitivity at present, but the corresponding quantitative mechanism is still lacking. In this work, in combination with the dynamics of neuronal excitability and experimental data, we select appropriate parameters and use the Hodgkin-Huxley equation to directly describe stress-induced neural discharge. This method simplifies the quantitative simulation scheme of the hydrodynamic hypothesis coupled with computational fluid dynamics and the membrane potential response of the nerve terminal. We plot the codimension-2 bifurcation diagrams between the stress sensitivity of mechano-gated ion channels and the maximum conductance of other ion channels. We further perform simulations with two dental pain scenarios under cold and hot stimulation. The simulated response behaviors of the pulp nerves are qualitatively consistent with the experimental results. The simplified description by the Hodgkin-Huxley equation is effective and reliable. It is helpful to further develop a quantitative simulation of the hydrodynamic theory of dentin hypersensitivity and to understand its dynamic response to thermal stimulation in dental practices.
... Dentin exposure is primarily caused by two processes, either by wear of tooth enamel or by exfoliation of the root surface due to the loss of cementum and periodontal tissues coating it. 1 The most generally accepted theory for this mechanism is the hydrodynamic theory. It focuses on dentinal tubules, which are open on the dentin surface, allowing a direct channel to the pulp. ...
... In the presence of any trigger element, the interstitial fluid in the tubules moves inward or outward and the displacement of fluid in the tubules is interpreted as pain fibers at the pulp wall. 2,3 Therefore, the method of controlling the hydrodynamic mechanism has led to the development of two types of products, namely (1) agents that reduce fluid flow in dentinal tubules and (2) agents or products that interfere with nerve impulse transmission. 4 Potassium oxalate, sodium fluoride, strontium salt, amorphous calcium phos phate containing casein phosphopeptide, and calcium glyc erophosphate are occluding agents which are widely used as desensitizers because they can seal dentinal tubules. ...
... Since premolars were the teeth most commonly affected by hypersensitivity (49%), followed by molars (34%) and canines (19%), this study was confined to upper first maxillary premolars. 1 The replication of the dentin substrate is not possible because of the natural variation in the number and diameter of dentinal tubules and the degree of mineralization as described by a previous study. 32 Nonetheless, attempts have been made to obtain dentin from the same area of root dentin and approximately the same thickness and dimensions. ...
Article
Introduction: There is an interest in developing materials with bioactive potential that could block exposed dentinal tubules. This study compared the effects of eggshell and seashell nanoparticles individually or combined with ND:YAG laser on dentinal tubules occlusion and remineralization. Methods: Fifty radicular dentin discs were prepared from freshly extracted human premolars. The smear layer created by cutting was removed using 37% phosphoric acid gel for 15 sec. The discs were divided into five groups according to the applied treatment(A) (n= 10 each): (A1) control, (A2); Nano eggshells, (A3); Nano seashells, (A4); Nano eggshells + Nd: YAG Laser, and (A5); Nano sea shell + Nd: YAG Laser. Each specimen was evaluated for tubular patency and mineral contents before and after each therapy using ESEM-EDXA energy dispersive spectroscopy for the assessment of tubule occlusion and remineralization. Results: ESEM results revealed a statistically significant decrease in the mean percent changes of the dentinal tubules number after the treatment of the experimental groups compared to the control. The greatest percent decrease was recorded in the seashell NPs + Nd: YAG laser, followed by the eggshell NPs + Nd: YAG laser, then Eggshell NPs only and then Seashell NPs only, while the lowest percentage decrease was recorded in the control group. EDXA revealed that the greatest percentage increase in Ca wt% was recorded in the Eggshell + Nd:YAG laser group, followed by Eggshell only, then Seashell only and then Seashell NPs + Nd: YAG laser, while the lowest percent increase was recorded in the control group. The post hoc test revealed no significant difference between the experimental groups. Conclusions: Both eggshell and seashell nanoparticles are effective in the occlusion and remineralization of dentinal tubules. The combined treatments with Nd: YAG laser had no benefits when compared to the effect of treatments alone.
... 12, 13 Other theories have been proposed as potential mechanisms by which pain transmission can occur, but these have largely been discounted. 1,14 The hydrodynamic theory suggests that dentin hypersensitivity is a result of inward or outward movement of fluid within the dentin tubules. This results in a pressure change across the dentin which activates intra-dental nerve fibers, via a mechanoreceptor response, to cause pain. ...
... 16,17 As the rate of fluid flow through dentin tubules is proportional to the fourth power of the tubule radius, it is highly likely that the difference in tubule diameter between "sensitive" and "non-sensitive" teeth is of clinical relevance to the treatment of dentin hypersensitivity. 1 Today, dozens of in-office sensitivity treatments and mass market sensitivity relief toothpastes are available worldwide. 15 Various chemical have been used for the ...
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creative common's attribution non-commercial License. Which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given, and the new creations are licensed under the identical terms. Abstract Background: Dentin hypersensitivity is characterized
... Según Martin Addy (2002), para que se produzca hipersensibilidad, se necesitan dos procesos: en primer lugar, que se exponga la dentina, lo que nos va a localizar la lesión, y, en segundo lugar, que los túbulos dentinarios estén abiertos hasta la pulpa, lo que nos va a provocar el inicio de la lesión. ...
... Se han identificado diferentes factores en la incidencia de HD, pero los que se consideran más importantes son los factores de tipo químico (erosión) y de tipo mecánico (abrasión y atricción). Según Addy (2002), en la exposición de la dentina, tienen mucho que ver los factores abrasivos y erosivos, mientras que en la apertura de los túbulos dentinarios van a ser sobre todo los factores erosivos los que van a jugar el papel fundamental. ...
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La hipersensibilidad dentinaria (HD) en pacientes periodontales suele ser un problema frecuente y en muchas ocasiones constituye un motivo de consulta antes y después del tratamiento periodontal, debido a la exposición dentinaria. Para que haya una exposición de la dentina, hace falta que se produzca una pérdida de esmalte o una pérdida de tejidos periodontales (recesión gingival). La hipersensibilidad dentinaria tiene una etiología multifactorial y uno de los factores etiológicos más importantes reside en los ácidos contenidos en la dieta. Objetivos: el objetivo de este artículo es revisar la relación existente entre la erosión provocada por los ácidos de la dieta y la apertura de los túbulos dentinarios, cuya consecuencia puede ser la aparición de hipersensibilidad dentinaria, y recomendar una serie de estrategias preventivas y terapéuticas para el manejo de los pacientes periodontales con estos problemas, entre las que incluiremos el consejo dietético. Conclusión: los ácidos contenidos en la dieta juegan un papel muy importante en la etiopatogenia de la hipersensibilidad dentinaria (HD). Por ello, es recomendable controlar los hábitos dietéticos del paciente y sus técnicas de higiene oral (frecuencia, fuerza y tiempo de cepillado), así como dar instrucciones y consejos dietéticos, tras tratamientos periodontales como el raspado y alisado radicular. Conocer y controlar los factores etiológicos de la hipersensibilidad dentinaria es esencial para prevenir, tratar y evitar la recurrencia de esta condición.
... 12, 13 Other theories have been proposed as potential mechanisms by which pain transmission can occur, but these have largely been discounted. 1,14 The hydrodynamic theory suggests that dentin hypersensitivity is a result of inward or outward movement of fluid within the dentin tubules. This results in a pressure change across the dentin which activates intra-dental nerve fibers, via a mechanoreceptor response, to cause pain. ...
... 16,17 As the rate of fluid flow through dentin tubules is proportional to the fourth power of the tubule radius, it is highly likely that the difference in tubule diameter between "sensitive" and "non-sensitive" teeth is of clinical relevance to the treatment of dentin hypersensitivity. 1 Today, dozens of in-office sensitivity treatments and mass market sensitivity relief toothpastes are available worldwide. 15 Various chemical have been used for the ...
... [1] DHS is generally characterized by short, sharp pain arising from exposed dentin, which cannot be ascribed to any other form of dental defect or disease. [2][3][4] Several authors [5,6] have reported the impact of this shocking sensation on the quality of life of an affected individual during eating, drinking, brushing and breathing. DHS may limit the dietary choices among affected individuals, which may further influence their effective oral hygiene and esthetics. ...
... Intragroup comparison of tactile stimuli showed statistically significant difference. 3 and graph no.3 shows comparison of sensitivity scores among group A and group B for tactile sensation. It shows that baseline score for group A was 6.6, after 7 days it was 5.33, after 14 days it was 4.8 and after 21 days it was 4.47. ...
Article
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Background: DHS is generally characterized by short, sharp pain arising from exposed dentin, which cannot be ascribed to any other form of dental defect or disease. Dentinal sensitivity reported in general dental practice population was 57.2%. Different materials and methods have been described to treat DHS. Recently there has been a growing interest in natural products, and herbal based toothpastes to treat dentinal hypersensitivity. So, we tried to formulate a novel herbal formulation to treat dentinal hypersensitivity. Aim: To make a new formulation using natural easily available ingredients for hypersensitivity and to check its efficacy against HIORA K tooth paste Materials and Methods: A randomised control trial was conducted on 30 patients with history of hypersensitivity aged 35 to 55 years. A Written and oral informed consent was taken from the patients prior to start of the study. They were randomly divided into two group one group received the novel herbal formulation and other received Hiora-K toothpaste. Baseline data and post response 7th day, 14th day, 21st day was recorded on a Visual analogue Scale. Results: Intragroup comparison of tactile stimuli showed statistically significant difference in both the groups. There was statistically significant difference in sensitivity scores for tactile sensation on 7 th day between Group A and Group B. Conclusion: There was gradual decrease in the hypersensitivity of the subjects seen who received the novel herbal formulation with periodic time interval. Hiora K toothpaste was found to be most effective than novel herbal formulation.
... A study by Addy et al. [8] demonstrated that horizontal brushing with excessive force significantly increased cervical wear compared to circular and vertical techniques. ...
Article
Background: The adoption of Artificial Intelligence (AI) in healthcare continues to grow, promising more accurate diagnoses, greater efficiency and fewer human errors. Despite this trend, a critical gap remains in understanding how healthcare students-who represent the future workforce-perceive and accept these emerging technologies, including issues related to ethics, data security and the potential impact on patient care, particularly within the context of Saudi Arabia’s rapidly evolving healthcare sector. Objective: This study explores how health sciences students at the University of Hail view the integration of AI in clinical contexts, focusing on their willingness to adopt such tools-referred to as their “acceptance level”-and on how ethical and privacy concerns shape their attitudes. Methods: A qualitative case study design was adopted. Semi-structured individual interviews were conducted via Zoom from June to August 2024 with 18 participants, recruited from diverse health sciences programs (medicine, nursing, pharmacy, dentistry, public health and health informatics). The interview guide addressed students’ understanding of AI, perceived benefits and challenges, ethical considerations and the potential effects on their future professional roles. Data were analyzed using Braun and Clarke’s six-phase thematic analysis framework. Trustworthiness was ensured via member checking, an audit trail and reflexive journaling. Results: Participants generally recognized AI’s capacity to enhance efficiency and precision in healthcare tasks. Most conveyed optimism about the technology’s benefits, emphasizing improvements in workload management and diagnostic accuracy. Nevertheless, concerns about data privacy and over-reliance on algorithms emerged as major reservations, particularly given students’ limited clinical experience. Ethical considerations ranged from protecting patient confidentiality to ensuring that AI complements, rather than displaces, clinicians. Several interviewees also expressed a desire for AI-focused training in their academic curriculum. Conclusion: Health sciences students at the University of Hail anticipate AI’s transformative potential in healthcare but remain cautious about privacy breaches and diminished human oversight. These findings highlight the necessity for targeted education that addresses technical, ethical and practical challenges. By adopting a measured approach to AI implementation, future healthcare professionals may be equipped to leverage technology while maintaining high standards of patient care.
... This heterogeneity has been attributed to the population screened, recruitment process, study setting, and the different diagnostic criteria used to collect data [5]. This rate is higher in individuals with periodontal disease, reported to be approximately 72-98% [6]. DH is commonly observed between the ages of 20 and 50, but it can also affect individuals up to their 70s [7]. ...
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Background The short form of the Dentin Hypersensitivity Experience Questionnaire (DHEQ-15) is a valid and reliable tool for Oral Health-Related Quality of Life (OHRQoL) studies. The aim of this study was cross-culturally adapt and validate the English version of DHEQ-15 for the Turkish language. Methods The Turkish version of the DHEQ-15 was developed using the forward-backward translation method. Two independent translators translated it from English to Turkish, followed by back-translation into English. A pilot study was conducted with 30 patients with dentin hypersensitivity (DH). The sample consisted of 150 individuals with DH and 150 without. DH was assessed using the Schiff Sensitivity Scale by applying air to the cervical area of the tooth for 1 s from a distance of 1 cm. A total of 300 individuals completed the Turkish DHEQ-15 in the waiting room. Subsequently, 30 randomly selected individuals with DH completed the questionnaire again after 7–10 days to assess test-retest reliability. Participants provided an overall oral health rating assessment on a 6-point scale. The reliability of the DHEQ-15 was assessed using internal consistency and test-retest methods. Exploratory Factor Analysis (EFA) identified its domains, while construct validity was evaluated through cross-cultural (Confirmatory Factor Analysis- CFA), discriminative (Mann-Whitney test) and convergent (Spearman correlation) validity. Results The demographic characteristics of the sample included 137 men and 163 women, with an average age of 36. The Turkish DHEQ-15 demonstrated excellent internal consistency (α = 0.970) and outstanding test-retest reliability (r = 0.920, p < 0.001), indicating an excellent correlation. Confirmatory factor analysis confirmed the unidimensional scale structure of the Turkish DHEQ-15 (p = 0.000). A statistically significant negative correlation was found between the DHEQ-15 score and the overall oral health rating assessment (p < 0.05). Participants with DH had a significantly higher DHEQ-15 score compared to those without DH (p < 0.001). Conclusions This study provides evidence supporting the cross-cultural validity and reliability of the Turkish DHEQ-15.
... Dentin hypersensitivity occurs when the dentin surface is exposed and dentin tubules are accessible from the pulp to the oral environment. This exposure can be caused by various factors, including gingival recession, attrition, and erosive lesions [1,2]. The prevalence of dentin hypersensitivity ranges from 3% to 98%; it is slightly higher for women and peaks at 30-40 years [3]. ...
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This study aimed to assess the antibiofilm effects of dentin desensitizers using a modified Robbins device flow cell system. The test desensitizers were Saforide, Caredyne Shield, and Clinpro White Varnish. Standardized dentin specimens were prepared from human single-rooted premolars, treated with one of the materials, and mounted on the modified Robbins device flow cell system. Streptococcus mutans biofilms were developed for 24 h at 37 °C under anaerobic conditions. Scanning electron microscopy, fluorescence confocal laser scanning microscopy, viable and total cell counts, acid production, and gene expression analyses were performed. A wavelength-dispersive X-ray spectroscopy electron probe microanalyzer was used to analyze the ion incorporations. Clinpro White Varnish showed the greatest inhibition, suggesting its suppression of bacterial adherence and transcription of genes related to biofilm formation. Saforide reduced only the number of viable bacteria, but other results showed no significant difference. The antibiofilm effects of Caredyne Shield were limited. The uptake of ions released from a material into dentin varies depending on the element. Clinpro White Varnish is effective for the short-term treatment of tooth sensitivity due to dentin demineralization. It prioritizes remineralization by supplying calcium and fluoride ions while resisting biofilm formation.
... Dentin hypersensitivity (DH) is a short, sharp pain caused by exposed dentin in response to thermal, evaporative, tactile, osmotic, or chemical stimuli that can't be caused by any other dental disease. 1 According to the studies that have been done on the subject, many experts agree that there may be more cases of dentin hypersensitivity than have been recorded. 2,3 The etiology of DH has been the subject of a number of reviews. Some of the causes have been linked to long-term damage from brushing, an acidic environment, stomach reflux or dietary changes, structural factors, and periodontal disease-related gingival recession caused by periodontitis or periodontal surgery. ...
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The aim of this study was to investigate and compare the influence of two desensitizing agents in reducing dentine permeability. A 6-week study was conducted on 30 adult patients with hypersensitivity to two or more teeth. Patients were divided into two groups using a spilt-mouth study design; each patient received two different desensitizing agents (Gluma Desensitizer ,Heraeus Germany , and Clinpro™ XT Varnish 3M ESPE, USA) in each side. The sensitivity was assessed at baseline, immediately after application, and after 1 week, 3 weeks, and 6 weeks. The tactile stimulus were applied with an explorer prob response using a visual analog scale and a standard cold air blast were used to compare the efficacy of desensitizing agents after a single application. The data were analysed using Wilcoxon test with a Bonferroni correction for non parametric data. Based on desansitizing agent, Gluma Desensitizer resulted in a significant reduction in pain scale compared to Clinpro™ XT Varnish using an air blast (P = 0.007) and a tactile test (P = 0.008) immediately post-treatment. All two desensitizing agents were effective in relieving dentin hypersensitivity (DH) up to 6 weeks, independent of their application procedures. There was, however, a significant reduction in mean sensitivity scores of teeth that had been treated with Gluma Desensitizer.
... A common dental issue known as dentin hypersensitivity is characterised by brief, intense pain in reaction to thermal, tactile, chemical, or osmotic stimuli. This discomfort cannot be attributed to any other type of dental pathology or defect (Addy, 2002). The disorder develops when the tubules inside the dentin, which are normally shielded from the oral environment by the gums or enamel, become visible (Canadian Advisory Board on Dentin Hypersensitivity, 2003). ...
Article
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The older population is especially susceptible to dentin hypersensitivity, hence this paper examines the many facets of treating this tooth issue in this demographic. Due to conditions including gum recession and enamel wear, dentin hypersensitivity-which is characterised by brief, acute pain that arises from exposed dentin in reaction to stimuli-is becoming more common in older individuals. The paper starts by describing the physiological alterations that lead to increased oral sensitivity in older individuals. This is followed by a critical analysis of existing therapeutic approaches. These consist of dental restorations, fluoride therapy, and the use of desensitising chemicals. Innovative dental materials and new therapies like laser therapy are given special consideration because they have great potential for this population. The paper's main focus is on the particular difficulties in treating older people, including concurrent medical issues, cognitive deficits, and the requirement that carers participate in dental care. An analysis of the efficacy of different therapies is conducted, emphasising the necessity of gentle and customised care methods. The article also stresses the value of patient education and preventative strategies in the treatment of dentin hypersensitivity in elderly patients. The results imply that even though the current treatments work, there is a strong need to modify them to better fit the needs of the elderly population. This involves a wholistic approach that takes into account the general state of health as well as the unique requirements of senior citizens. The need of developing geriatric dental care to improve the quality of life for senior patients is emphasised by the paper's conclusions, which offer recommendations for clinical practise and identify areas for further research.
... A common dental issue known as dentin hypersensitivity is characterised by brief, intense pain in reaction to thermal, tactile, chemical, or osmotic stimuli. This discomfort cannot be attributed to any other type of dental pathology or defect (Addy, 2002). The disorder develops when the tubules inside the dentin, which are normally shielded from the oral environment by the gums or enamel, become visible (Canadian Advisory Board on Dentin Hypersensitivity, 2003). ...
... Dentin hypersensitivity (DH) is a prevalent clinical manifestation characterized by acute and short-lasting pain without association with any pathology [1][2][3]. Its etiology can be associated with dentin exposure, resulting from the loss of dental enamel or exposure of root surfaces [4,5]. ...
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Objectives: This study aimed to establish a single-session associative protocol for non-restorative management of dentin hypersensitivity (DH). Materials and methods: Twenty-four individuals with DH and a minimum sensitivity level of 4 on the visual analog scale (VAS) were selected. The study was conducted in a split-mouth design, with each participant (n = 20) having at least 1 affected tooth in all quadrants. The management protocols consisted of control group: universal adhesive, Neural Desensitizing Protocol group: 5% potassium nitrate, Mixed Desensitizing Protocol (PAM) group: 5% sodium fluoride and 5% potassium nitrate, Remineralizing Desensitizing Protocol (PDR) group: surface-partially reacted glass technology photopolymerizable varnish. Evaluations were performed immediately after application, at 1 week, 1 month, 2 months, and 12 months using the VAS sensitivity test. Results: The scores were subjected to statistical analysis using the Friedman test (p < 0.05), Durbin-Conover test (p < 0.05), and Wilcoxon test (p < 0.05). At the 12-month evaluation, all groups showed statistically significant differences compared to the initial assessment. For the evaluation after 12 months, there was a statistically significant difference between the PAM group, the control group, and the PDR group. Conclusions: It can be concluded that all groups were effective in controlling DH, but there were significant results in the control group and PDR group. The clinical relevance of this study is to demonstrate that the application of single-session desensitizing protocols can be effective in controlling DH for up to 12 months. Trial registration: Brazilian Clinical Trials Registry Identifier: RBR-4r63d7s.
... In the present study, almost 51% of patients were sensitive to cold stimuli; the result parallels the study conducted in Karachi in 2016, reporting 71% sensitivity to cold [20]. This observation is corroborated by other studies, such as Rees and Addy (2002), who found that cold stimuli are the most frequently reported trigger for dentinal hypersensitivity [34,35]. ...
Article
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Background Dentin hypersensitivity (DH) is one of the most challenging and persistent dental complaints characterized by transient, intense pain triggered by various stimuli. It affects a significant portion of the global population, predominantly those aged 20–40. This study aims to evaluate the desensitizing efficacy of seventh-generation dentin bonding agents (Single Bond Universal by 3 M ESPE and Xeno-V + by Dentsply) against a control group using Bifluorid 12 by Voco in mitigating DH within a month of the follow-up period. Methods This was a single-center, parallel-group, double-blind, controlled randomized clinical trial conducted at Dow University of Health Sciences, Karachi, Pakistan. A total of 105 patients with DH were allocated into three groups for this study. The patients were divided into three groups (Single Bond Universal by 3 M ESPE and Xeno-V + by Dentsply) and the control group containing fluoride varnish (Bifluorid 12 by Voco). Discomfort Interval Scale scores and Schiff Cold Air Sensitivity Scale scores were recorded at baseline, immediately after the intervention, after 01 weeks, and after 01 month. Results All the materials demonstrated a statistically significant reduction in discomfort and sensitivity (DIS scores p-value 0.01) immediately after 01 week and over a period of 01 month after treatment compared with the baseline scores before application, with no single material proving superior over the one-month observation period. The study also provided insights into dental hygiene practices, with a significant majority using a toothbrush and sensitivity patterns, with cold stimuli being the most common cause of sensitivity. Conclusion The study demonstrates that Single Bond Universal, Xeno V+, and Bifluorid 12 are equally effective in reducing dentin hypersensitivity, with no distinct superiority observed over a one-month period. The findings highlight the potential of fluoride varnishes as a less technique-sensitive and cost-effective option for treating DH, offering valuable insights for future research and clinical practice. Trial registration NCT04225247 (https://clinicaltrials.gov/study/NCT04225247), Date of Registration: 13/01/2020. (Retrospectively registered).
... Dentin hypersensitivity (DH) is defined as a short sharp pain that originates from exposed dentin due to enamel wear or gingival recession in response to external stimuli such as tactile stimuli or thermal evaporative [1,2]. DH is a clinical oral health issue that affects adults, and it was shown that 20-40% of the general population has this type of sensitivity [3][4][5]. ...
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Objective Bioactive glass and hydroxyapatite are biocompatible materials used as an adjunct to various dental materials. The present study aimed to evaluate the occlusion effects of bioactive glasses and hydroxyapatite on dental tubules. Materials and methods We searched the PubMed/Medline, Embase, and Web of Science databases for the relevant records. The methodological quality of the studies was assessed by an accepted quality assessment tool. Results From the electronic databases, 372 articles were retrieved. After evaluating the records, 35 in vitro studies were included. The studies revealed a low risk of bias. The primary outcomes from bioactive glass studies demonstrated the potential efficacy of both bioactive glass and hydroxyapatite in dentin tubule occlusion compared to the control. Conclusion The current systematic review showed that bioactive glass and hydroxyapatite could effectively occlude the dentinal tubules. Thus, desensitizing agents containing bioactive glass and hydroxyapatite can be used to manage dentin hypersensitivity (DH). However, long-term follow-up clinical trials are required in the future before definitive recommendations can be made. Clinical relevance This work achieved a satisfactorily systematic review for assessing desensitizing agents containing bioactive glass and hydroxyapatite in dentine hypersensitivity treatments recommended for clinical practice and research.
... Dentin hypersensitivity has been defined as a "short, sharp pain arising from exposed dentin in reaction to stimuli that can be thermal, evaporative, tactile, osmotic or chemical and which cannot be attributed to something related to any other dental defect or pathology". [1][2][3][4] This pain ranges from slight to severe, can lead to physical, psychological, and social disability and may significantly impact patients' quality of life. 5,6 Patients may report changes in eating habits, oral hygiene neglect or modification, sensitivity while consuming cold food or drinks, or require local anaesthetic for routine dental appointments. ...
Article
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Dental Hypersensitivity (DH) is a common clinical condition yet an annoying disease. Most of the time, clinicians fail to diagnose, leading to improper management and unsatisfied patients, negatively impacting their quality of life. The management involves various self-applied and in-office management modalities. This review briefly discusses several treatment options available for dentinal hypersensitivity and recommends Silver Diamine Fluoride (SDF) as a newer and more effective treatment option for dentinal hypersensitivity based on the available literature.
... Dentin hypersensitivity is one of the most common problems in dentistry, the management of dentin hypersensitivity always presented a challenge for clinicians (63) . The most common age of onset is between 30 and 40 but women experience a higher incidence of dentin hypersensitivity at a younger age than men (1) . ...
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Introduction: from how to diagnose hypersensitivity to causes and ending by the treatment
... Detergents in toothpastes (e.g. sodium lauryl sulfate) and their pH values are also thought to affect the surface properties of restorative materials [27]. Some studies have shown that optical whitening toothpastes have a greater effect on discoloration than conventional toothpastes [28]. ...
Article
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Objective: The aim of this study was to evaluate the color stability of smart monochromatic composite resin after coloring with coffee solution, thermal aging and brushing with four different kinds of toothpaste. Materials and methods: According to the manufacturer's instructions, 40 smart monochromatic composite resin (Omnichroma, Tokuyama Dental, Japan) specimens were prepared with a thickness of 2 mm and a diameter of 10 mm. The samples were divided into four groups. The first group (SFM) was brushed with Sensodyne Fresh Mint (Sensodyne GSK, UK), the second group (CW) with Colgate 2 in 1 Whitening (Colgate Palmolive, USA), the third group (OW) with Opalescence Whitening (Ultradent Products, Inc., USA), the fourth group (COW) with Colgate Optic White With Charcoal (Colgate Palmolive, USA). At time point t0, no brushing and thermal cycles were performed. For time point t1, simulations corresponding to 10 days of staining, thermal aging and brushing were performed. For time point t2, simulations corresponding to one year of staining, thermal aging and brushing were performed. The color of all specimens was measured at t0, t1 and t2 with a spectrophotometer. To examine the color change, ΔE00 values were calculated with the CIEDE 2000 color system. Shapiro Wilk, Kolmogorov Smirnov, Wilcoxon Signed Rank, Kruskal Wallis, and Mann-Whitney U tests were used to analyze the data. Results: According to the results of the intergroup comparison, there is no statistically significant difference between the groups in ΔE00(t0-t1) values in terms of t0-t1 time period measurement (p>0.05). There is a statistically significant difference between the groups in ΔE00(t1-t2)values in terms of t1-t2 time period measurement (p<0.05). The COW group had the lowest ΔE00(t1-t2) value and the OW group had the highest ΔE00(t1-t2) value. There is a statistically significant difference between the groups in ΔE00 (t0-t2) values in terms of t0-t2 time period measurement (p<0.05). The COW group had the lowest ΔE00(t0-t2) value and the OW group had the highest ΔE00(t0-t2) value. Conclusion: The whitening efficacy of different kinds of toothpaste whitening mechanisms may differ from each other. Toothpastes also show whitening on composite resins. The lowest discoloration was observed in the group brushed with toothpaste containing activated charcoal and blue covarine. The efficacy of whitening toothpastes should be supported by in vivo studies.
... Dentin hypersensitivity (DH) is defined as a short and acute pain that appears from exposure to open dentin tubules [1]. It has been agreed that it is generated by chemical, thermal, tactile, or osmotic stimuli once it is not related to any other dental condition [2]. ...
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Objective: To compare the effectiveness of cyanoacrylate to other treatments or placebo in the management of dentin hypersensitivity (DH). Materials and methods: The present review was organized based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. The search aimed to answer the following question: is cyanoacrylate effective in the treatment of DH when compared to other treatments or placebo? The following databases were used: PubMed/MEDLINE, Scopus, BVS, Web of Science, Cochrane, Clinicaltrials.gov, Portal Periódicos Capes, Google Scholar, and manual search. The evaluation process started with the information collected from the selected articles according to the Consolidated Standards of Reporting Trials (CONSORT). Results: Two randomized and five nonrandomized clinical trials were analyzed in the qualitative synthesis. The studies presented different cyanoacrylate formulations, different scales for evaluating pain, and different methods for provoking a painful stimulus. Cyanoacrylate-based products reduce DH in shorter follow-up periods and this reduction persisted throughout the study. The results varied according to the methods used to stimulate the pain. Only two articles showed a low risk of bias and a high level of scientific evidence. Conclusion: Although there is a limited number of studies in the scientific literature with appropriate methodological quality, the available evidence proves the effectiveness of cyanoacrylate in the treatment of DH. Clinical Relevance. Cyanoacrylate is easy to access, effective, easily applicable, and a low-cost product with satisfactory results.
... The Colgate Sensitive Pro-Relief Toothpaste, providing statistically significant improvements after four weeks of twice-daily brushing (32.8667 ±1.53644, 4.8000±.44934). This finding was in agreement with that reported by researcher in patients from Rome and Italy (25,26). Desensitizing dentifrices represent a treatment option that, given regimen compliance, may be efficacious for most individuals (2,12,13,42). ...
Article
The aim of this research is to evaluate clinically the effect of Colgate sensitive pro-relief tooth paste containing 8% arginine-calcium carbonate on Dentin hypersensitivity in group of Iraqi patient. Material and Method: Fifty volunteered subjects male and female with mean age between 20-40 years suffering from dentin hypersensitivity from at least two teeth on cold and hot stimuli and not due to dental caries were agreed to participate in this study. At home brushing instruction consisted of brushing their teeth for one minute, twice daily using only the tooth paste provided and to refrain from any other oral hygiene products and procedures throughout the duration of the study. Assessment of the dentin hypersensitivity were carried out with air blast and repeated by the same examiner using the same methods. Record was taken according to Colgate sensitivity visual analog scale graduated from 0 to 10. Records were taken on day zero and after four weeks for each patient on the same visual scale. Results Statistical analysis of the total sample demonstrated a highly significant difference between before (32.8667 ±1.53644) and after four weeks (4.8000±.44934) of twice daily use of the product (p =0.001), The percentage of changes was slightly higher in males (6l7.12%) than females (66.12%). Conclusion: Colgate sensitive pro-relief tooth paste contains 8% arginine and calcium carbonate used twice daily for four weeks significantly reduces dentin hypersensitivity. It offers significant relief of dentin hypersensitivity in Iraqi patients. [Nidhal A. Ali, Mohammed Q. Mahmood Fahmi, Fouad H. Al-Bayaty. Effect of long lasting self-applied colgate sensitive pro-relief tooth paste in dentin hypersensitivity in group of Iraqi patients. Life Sci J 2014;11(9):747-751]. (ISSN:1097-8135). http://www.lifesciencesite.com. 113
... 5 Pressure changes in the exposed dentinal tubules in response to thermal, chemical, tactile, and osmotic changes are believed to excite nerves and cause pain. 1 Various physiological factors like attrition, erosion of enamel and cementum, abrasion, occlusal pressure, gingival recession, and faulty tooth brushing can cause DH. 6,7 Iatrogenic factors such as periodontal treatment, tooth whitening, and tooth preparation may also play a part in developing DH. 8,9 Dentin hypersensitivity can impact a patient's quality of life, trigger the development of chronic pain and become a source of consistent frustration, inducing psychological and emotional distress. 10,11 It can impact a patient's physical, emotional, and cognitive functioning along with social and family life. ...
Article
Objective: Dentin hypersensitivity (DH) is characterized by a short, sharp pain in response to a thermal or tactile stimulus. The application of desensitizing agents such as GLUMA and laser is a non-invasive and safe approach to decrease sensitivity. The evidence for the efficacy of GLUMA desensitizer compared to laser desensitization in patients with DH was evaluated for 6 months. Design: In March 2022, an electronic search of PubMed, Scopus, and Web of Science databases was conducted. Articles published in English that compared GLUMA and laser in the treatment of DH with a follow-up of 6 months or more were included. Randomized, non-randomized controlled trials, and clinical trials were included. Risk of bias assessment tools developed by the Cochrane collaboration ROB 2 and ROBINS-I were used to assess the quality of studies. The GRADE assessment method was used to assess the certainty of evidence. Results: About 36 studies were identified in the search results. After applying the predefined eligibility criteria, eight studies with 205 participants and 894 sites were included in this review. Of the eight studies, four were judged to be at high risk of bias, three had some concerns, and one had a serious risk of bias. The certainty of the evidence was graded as low. Conclusion: Based on limited evidence, GLUMA and laser appear to be equally effective in providing relief from DH. GLUMA showed an immediate effect and provided pain relief. Over the course of a week, laser showed long-term stable results. GLUMA is effective in providing immediate relief.
... A frequent complaint presented by patients visiting the dental office is pain and discomfort related to tooth wear and dentine hypersensitivity [1,2]. Despite significant progress being made in regards to dental materials and treatment techniques, these two pathological terms are prevalent in the world of dentistry and are closely associated with each other. ...
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The aim of this work was to prepare a new hydrogel based on nanohydroxyapatite (nFAP, 10% w/w) and fluorides (4% w/w), both of which are used as sources of fluoride ions in the treatment of dentin hypersensitivity, and to characterize its physicochemical properties. The release of fluoride ions from 3 gels (G-F, G-F-nFAP, and G-nFAP gel) was controlled in Fusayama–Meyer artificial saliva at pH 4.5, 6.6, and 8.0. The properties of the formulations were determined by an analysis of viscosity, a shear rate test, a swelling study, and gel aging. Various methods, i.e., FT-IR spectroscopy, UV-VIS spectroscopy, and thermogravimetric, electrochemical, and rheological analysis, were used for the experiment. The profiles of fluoride release indicate that the amount of fluoride ions released increases with a decrease in the pH value. The low pH value facilitated water absorption by the hydrogel, which was also confirmed by the swelling test, and it promoted the exchange of ions with the surrounding environment. Under conditions similar to physiological conditions (at pH 6.6), the amounts of fluorides released into artificial saliva were approximately 250 µg/cm² and 300 µg/cm² for the G-F-nFAP hydrogel and G-F hydrogel, respectively. The aging study and properties of the gels showed a loosening of the gel network structure. The Casson rheological model was used to assess the rheological properties of the non-Newtonian fluids. Hydrogels consisting of nanohydroxyapatite and sodium fluoride are promising biomaterials in the prevention and management of the dentin hypersensitivity.
... As reported, adults between the ages of 20 to 50 are frequently diagnosed with dentine hypersensitivity at a prevalence rate of up to 98% 2,3 . In addition, the prevalence distribution of patients with chronic periodontal diseases has been recognized to be above 72% 2,4 . Dentin hypersensitivity is defined as a sharp and localized pain for a short period, typically associated with a stimulus of thermal, osmotic, or chemical source to the exposed dentin tubules 5 , but not responsible for any other tooth defects or diseases 6 . ...
Article
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The occlusion of dentinal tubules has become a rapid and effective method for treating dentin hypersensitivity. Accurate evaluation of dentin occlusion is critical to illustrate the efficacy of oral care products and to optimize dental therapy in the clinics, which is limited by the conventional two-dimensional (2-D) characterization methods. Here, we demonstrate the visualization of the dentin occlusion via three-dimensional (3-D) characterization using a focused ion beam-scanning electron microscopy (FIB-SEM) tomography. Using the “Slice and View” approach, the material used for occluding dentin tubules is imaged with a very high-resolution voxel (10 nm × 10 nm × 20 nm) from 2-D SEM images and then reconstructed into a 3-D volume, which presents the mode of action of toothpaste for treating dentin hypersensitivity. Meanwhile, quantitative analysis of the depth of occlusion is successfully obtained. This work validates the feasibility of FIB-SEM tomography in the analysis of dentin occlusion within the complicated networks of dentine tubules at the nanoscale, and provides a novel approach to facilitate the research and development of oral care products.
Article
Background Dentin hypersensitivity (DH) is common, particularly among periodontal patients. This trial evaluated magnitude of desensitizing benefit, onset of action, and complete relief of three dentifrices with distinct desensitizing technologies. Methods Healthy adults with DH were enrolled and randomized to one of four dentifrices in this randomized, controlled, double‐blind trial: marketed potassium nitrate (KNO 3 ), marketed stannous fluoride (SnF 2 ), experimental 1.5% oxalate, or negative control (NC) monofluorophosphate. Participants brushed with their assigned dentifrice twice daily for 8 weeks, followed by 3 weeks during which all participants used the NC. DH was measured by thermal challenge (Schiff Index) and tactile challenge (Yeaple Probe) at baseline, Day 3, and Weeks 2, 4, 8, and 11. Results A total of 120 participants were randomized to treatment, and 118 completed the study. Thermal challenge (Schiff) : All treatments provided greater relief than NC at all timepoints ( p ≤ 0.004). The SnF 2 dentifrice had greater thermal improvements than KNO 3 dentifrice at Week 2 ( p = 0.021) and in a random coefficients model across all timepoints ( p = 0.015). The percentage of participants showing complete relief in at least one test tooth was greater for SnF 2 versus KNO 3 through Week 8 (all p ≤ 0.044). Tactile challenge ( Yeaple Probe) : All treatments provided greater tactile sensitivity relief than NC at all timepoints ( p ≤ 0.019), except KNO 3 at Day 3 ( p = 0.197). The SnF 2 dentifrice had greater improvements in tactile scores versus the KNO 3 dentifrice at Day 3 ( p = 0.020). Conclusion SnF 2 , KNO 3 , and oxalate dentifrices significantly reduced DH over 8 weeks. SnF 2 dentifrice showed the greatest benefits for onset of relief, magnitude of benefit, and complete relief. Trial Registration NCT03965039 Plain Language Summary This study tested four toothpastes for sensitivity relief, including speed and completeness of relief, among approximately 120 adults with sensitive teeth. They were randomly assigned to use one of four toothpastes: commercial toothpaste with potassium nitrate, commercial toothpaste with stannous fluoride, experimental toothpaste with oxalate, or standard fluoride toothpaste (control) with no antisensitivity ingredient. Participants used their toothpaste twice daily for 8 weeks, and then everyone used the control toothpaste for 3 weeks. Sensitivity was measured at the beginning of the study, after 3 days, and after 2, 4, 8, and 11 weeks by blowing cold air on sensitive teeth and moving a probe across the sensitive area (tactile assessment). The potassium nitrate, stannous fluoride, and oxalate toothpastes reduced sensitivity better than the control toothpaste at all times, except potassium nitrate toothpaste at Day 3 for tactile sensitivity. Stannous fluoride toothpaste reduced cold air sensitivity better than potassium nitrate toothpaste at Week 2 and across all times combined. More participants showed complete relief from cold air sensitivity for stannous fluoride toothpaste than potassium nitrate toothpaste through Week 8. Stannous fluoride toothpaste had greater improvements in tactile sensitivity versus potassium nitrate toothpaste at Day 3. Overall, stannous fluoride toothpaste was superior at relieving sensitivity.
Article
The possibility of conducting remineralizing therapy simultaneously with orthodontic treatment is an undeniable advantage of using removable orthodontic appliances — aligners. A product with remineralizing properties should have a pleasant taste, be moderately fluid and colorless, and not irritate the oral mucosa. Gel-based personal hygiene products best meet these characteristics. Today, dentists have a very large range of gel-based remineralizing products at their disposal, which is why the problem of rationally choosing the most effective and suitable product is relevant. The aim of the work is to substantiate the use of R.O.C.S. PRO Brackets & Ortho toothpaste and R.O.C.S. Medical Minerals remineralizing gel in patients undergoing orthodontic treatment with aligners. Materials and methods. Seventy patients aged 18 to 44 years who were treated with aligners were observed for 12 months. Group I included 32 people who used their usual oral hygiene products. Patients of Group II (38 people) were recommended a remineralizing complex of personal oral hygiene products consisting of R.O.C.S. PRO Brackets & Ortho toothpaste and R.O.C.S. Medical Minerals remineralizing gel one month before wearing the aligners and throughout the study period. The level of oral hygiene was assessed using the Quigley-Heine plaque index (1962) and the Okushko-Kosareva TER test (1983). The anti-inflammatory effect was assessed using the PMA index (Parma, 1960). The examination and measurement of the specified indicators were carried out 1 month before the installation of the aligners and 1, 3 and 12 months after their installation. Results. In Group II, the Quigley-Hein plaque index improved to 1.16 points after 1 month, to 1.32 points after 3 months, and remained at a high level (1.41 points) throughout the study. The TER test in Group II demonstrated an increase in enamel acid resistance and was 3.3 after 1 month of observation, 2.6 after 3 months, and 2.9 after 12 months, which corresponds to an increase in remineralizing efficiency by 39% after 1 month, 52% after 3 months, and 46% after 12 months from the initial value. The dynamics of the PMA index change in Group II was 5% after 1 month of using the recommended R.O.C.S. PRO Brackets & Ortho toothpaste and R.O.C.S. Medical Minerals remineralizing gel 9% after 3 months of the study and 15% after 12 months from the start of the observation. Conclusion. The combination of R.O.C.S. PRO Brackets & Ortho toothpaste and R.O.C.S. Medical Minerals remineralizing gel demonstrated reliably high efficiency in patients undergoing orthodontic treatment with aligners. It can be recommended for use throughout the entire period of orthodontic treatment.
Chapter
This chapter provides an introduction to this book by briefly describing and discussing the current knowledge on specific aspects of dentine hypersensitivity (DH). Prevalence and distribution data are summarised. An internationally agreed definition is presented together with discussion on alternative terminology. The hydrodynamic mechanism of dentine sensitivity as applying to DH is described and what probable aetiological factors involved in the development of the problem and any subsequent activation of the mechanism is discussed. A secondary preventive-based management programme is proffered, and treatment approaches are discussed. Finally, some present-day deficiencies in knowledge of the condition are identified, and suggestions for future research are made.
Chapter
Dentine hypersensitivity (DH) is a common oral condition, which is typically a short lasting, intense pain located around teeth and often associated with cold stimuli. An innate problem with dentine hypersensitivity (DH) is that its clinical features are transient, and patients do not always present with DH at examination, even though they may suffer from it regularly. Indeed, the nature of DH appears to be cyclic, and most sufferers self-medicate and/or use desensitising toothpastes to control the condition, which often returns. There are increasing suggestions from the published literature that support the transient nature of the condition (Gillam 2013; West 2006; West et al. 2013b; Olley et al. 2015, Song and West 2015). The reasons for this trend, historically, have been unclear. Indeed, the cause/s of DH have been poorly understood and have resulted in DH being termed an enigma decades ago, and this concept has been re-visited on a number of occasions since (Johnson et al. 1982; Dababneh et al. 1999; Addy 2002; Markowitz and Pashley 2008). The apparent historical lack in the understanding of the aetiological processes in particular tooth wear often resulted in elusive treatment and preventive strategies which focused on the symptoms of DH rather than its cause/s in practice (Markowitz and Pashley 2008). Nevertheless, our understanding of the condition is somewhat clearer today. This chapter therefore focuses attention on the clinical features of DH and in detail on the causes of DH and the associated clinical presentation.
Chapter
In dental literature, the clinically confounding association between the occlusion and hypersensitive teeth is poorly explained. Quantified occlusal contact force and timing parameters have been largely ignored in studies assessing hypersensitive teeth. This chapter introduces a novel occlusal concept; frictional dental hypersensitivity (FDH), after systemically simplifying the existing and often confusing terminology used in the literature over the past decades to describe the variant clinical presentations of the hypersensitive dentition. Clinical evidence from combining computerized occlusal analysis and electromyography is presented linking opposing posterior tooth friction and muscular hyperactivity to FDH. This chapter will outline how occlusion, many muscular TMD symptoms, and FDH are all interrelated. After the differences between dentinal hypersensitivity, cervical dentinal hypersensitivity, and frictional dental hypersensitivity and the myriad of etiologies and modern treatments available are explained, an effective treatment regimen combining the usage of Nd:YAG and Er:YAG lasers coupled with medical grade ozone as a first line diagnostic and treatment protocol for hypersensitive teeth of non-occlusal origins is discussed. Afterwards, both the original FDH Pilot Study and a 100 subject Cold Ice Water Swish follow-up FDH study are then presented that used a numerical Visual Analog Scale (NS/VAS) to quantify cold response dental hypersensitivity resolution observed in occlusally symptomatic patients that underwent the immediate complete anterior guidance development coronoplasty (ICAGD). This computer-guided occlusal adjustment procedure eliminated pretreatment FDH cold symptomatology, further supporting that dental hypersensitivity often has an occlusally-based, frictional etiology. Recent clinical research studies challenging the FDH theory are then presented, including a recent study that compared air indexing protocols to the cold ice water swish and the statistical correlation that was found between these two initiators of dental hypersensitivity following the ICAGD occlusal adjustment procedure. Additionally, consideration for the orthopedic influences that may directly affect the occlusion and neurology of the system are outlined, as is the medical concept of dental allodynia which most dental practitioners are unaware of. Furthermore, trigeminal neurological influences are compared to autonomic sympathetic inputs in relation to the influence that they each have upon the hypersensitive dentition, because after all, pulpal neurology consists of not only trigeminal nerve fibers, but cervical sensory and sympathetic nerve fibers as well. Lastly, the greater auricular diagnostic nerve block is discussed, as is the influence that this nerve may have upon the hypersensitive mandibular posterior dentition.
Article
Background: In recent years, there has been a gradual increase in cases of dentin hypersensitivity, often related to gingival recession, enamel abrasion from brushing, and wear of root cementum. This condition can affect patients of all ages but is more common between 20 and 40 years of age, especially in females and individuals with periodontal disease. The study aimed to evaluate and compare the efficacy over time of a product for at-home treatment of dentin hypersensitivity. Methods: One hundred five patients aged between 28 and 65 years were recruited, each with at least two hypersensitive teeth due to erosions, abrasions, gingival recessions, and/or periodontal diseases. Participants were selected through the Schiff Test and anamnestic evaluations, with compilation of periodontal records. Patients are instructed to use the product three times a day, to be applied with a soft-bristled toothbrush and/or topically as a gel on teeth with strong sensitivity and deep cervical lesions and gingival recessions. Results: There were no statistically significant differences between measurements at baseline and after scaling. However, significant differences were observed in follow-ups from the 1st to the 8th week, with a progressive decrease in values. The average trend of product efficacy increases over time according to the Schiff Test, with a significant improvement observed at follow-ups conducted after four and eight weeks. Conclusions: The results indicate that the product enriched with biomimetic hydroxyapatite and lactoferrin is effective in reducing the painful symptoms of dentin hypersensitivity and in counteracting the inflammatory state of the supporting tissues.
Chapter
In the dental literature, the association between the occlusion and hypersensitive teeth is poorly explained. Quantified occlusal contact force and timing parameters have been largely ignored in studies assessing hypersensitive teeth. This chapter introduces a novel occlusal concept, frictional dental hypersensitivity (FDH), after systemically simplifying the existing and often confusing terminology used in the literature to describe the variant clinical presentations of the hypersensitive dentition. Clinical evidence from combining computerized occlusal analysis and electromyography is presented linking opposing posterior tooth friction and muscular hyperactivity to FDH. This chapter will outline how occlusion, many muscular TMD symptoms, and FDH are all interrelated. Both a pilot study and a 100 subject cold ice water swish follow-up study are presented and used a numerical visual analog scale (NS/VAS) to quantify cold response dental hypersensitivity resolution observed in occlusally symptomatic patients that underwent the immediate complete anterior guidance development coronoplasty (ICAGD). This computer-guided occlusal adjustment procedure eliminated pretreatment FDH symptomatology, further supporting that dental hypersensitivity often has an occlusally-based, frictional etiology. Additionally, consideration for the orthopedic influences that may directly affect the occlusion and neurology of the system are outlined, as well as the medical concept of tooth allodynia. Furthermore, trigeminal neurological influences are compared and contrasted to autonomic sympathetic inputs in relation to the influence that they each have upon the hypersensitive dentition. Lastly, the greater auricular diagnostic nerve block is discussed, as is the influence that this nerve may have upon the hypersensitive mandibular posterior dentition.
Article
Aim The aim of this study was to assess customer satisfaction premarket launch of the newly developed mouthwash; the present survey has been conducted to evaluate the taste, texture, their effectiveness in treating sensitivity, and bad breath. Materials and Methods The survey was conducted for a sample size of 480. Participants received a questionnaire consisting of questions on oral health, sensitivity, bleeding gums, and bad breath. Results Eighty-two percentage of the population found the clove mouthwash to be effective and claimed that their sensitivity was significantly reduced. Conclusion Since the clove mouthwash gained acceptance from the majority of the population as evidently supported by the results of our current survey, it is stated that within the confines of the survey, clove mouthwash can be launched in the market.
Article
A person's teeth are not just there to look attractive in pictures. Teeth allow you to follow a healthy diet and stay well nourished by preparing the food you eat for swallowing and digestion. Dantaharsha is characterized by inability to tolerate the Shita Pravata (cold air), Shita Bhakshya (cold food particles), Amla Rasa (Sour substance), pain and unable to do mastication or grinding of food due to vitiation of Vata. Dantaharsha can be correlated to Dental hypersensitivity in modern science. DH (Dentine hypersensitivity) is a condition with an incidence ranging from 4 to 74%. The clinical study was conducted on 30 patients’ assessment has been done before, after and completion of follow up of treatment. The patients for the study were selected from RKM Ayurveda Medical College Hospital & PG Research centre, Vijayapur, Karnataka. The statistical data of study shows, Tilayasthimadhu Kshira Gandusha in management of Dantaharsha shown significance results p value < 0.05. Interpretation & Conclusion: Tila is best among vata shamaka and its Vyavayi guna spreading throughout the body quickly, Yasthimadhu is having naturally occurring steroids, it does anti-inflammatory action, Milk is a most valuable food for the formation of bone. Phosphorus contents of cow’s milk, Combination of all these drugs gives a layer of coating on the surface of the tooth and gingival thus protecting the dentine from exposure. Tilayasthimadhu Kshira Gandusha is proved to be cost effective, adoptive, safe and better drug of choice in the management of Dantaharsha. Key words: Dantaharsha, Gandusha, Dentine Hypersensitivity, Tilayasthimadhu Kshira
Article
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This split-mouth blinded randomized controlled study compared the efficacy of a desensitizing agent with oxalate/resin polymer and a universal adhesive containing mesoporous bioactive glass (MBG) for dentin hypersensitivity (DH) relief, using Schiff sensitivity score (SSS) and visual analog scale (VAS). Split quadrants containing teeth with DH were treated with either MS Coat ONE or Hi-Bond Universal with MBG as the functional additive. Assessments at baseline, immediately post-application, and at 1- and 2-week follow-ups used standardized stimulus protocols (air, cold, and acid). The SSS difference was the primary outcome, while the VAS difference was the secondary outcome. A mixed linear effect model performed statistical analysis. Immediate DH reduction occurred in response to air stimuli, with a significant decrease in Group HB than in Group MS (p = 0.0178). Cold stimulus reduction exhibited a gradual cumulative effect, with consistently greater reductions in Group HB than in Group MS (p ≤ 0.0377). Both groups effectively managed acidic stimuli, with no significant differences (p > 0.05). The VAS scores decreased gradually over the follow-up period (p < 0.0001). This study highlights the differential efficacy of treatments for various DH triggers and recommends specific approaches based on different stimulus types. The universal adhesive containing MBG demonstrated DH relief potential, promising efficacy identical to or superior to that of a dedicated desensitizing agent. Further research exploring the long-term efficacy and underlying mechanisms is warranted. The universal adhesive containing MBG can be adopted as an in-office desensitizing agent for DH relief. The desensitizing efficacy of universal adhesive matches or surpasses dedicated agents for air and cold stimuli.
Article
Background Dentinal hypersensitivity is a sharp pricking pain occurring on exposure of the dentinal surface to the external stimuli such as hot, cold, air, tactile, and chemical. This study was conducted to compare the effectiveness of two herbal desensitizing pastes in the relief of dentinal hypersensitivity at different time intervals. Materials and Methods Forty subjects (with two teeth per patient) were considered for this study and randomly divided into two groups: Group 1: Hiora K, herbal desensitizing toothpaste and Group 2: Dant Kanti medicated desensitizing toothpaste. Using tactile stimulus and air stimulus, the sensitivity scores were recorded on visual analog scale immediately, then at 2 weeks, and then at the end of 4 weeks and compared. Results There was no significant difference in the distribution of tactile sensitivity score and air blast sensitivity score at baseline, immediately after application, after 2 weeks, and after 4 weeks between Groups 1 and 2. Statistical Analysis Chi-square test was used for statistical analysis. Conclusion Desensitizing pastes can be used as a safe, economical, and effective option in the management of dentinal hypersensitivity.
Article
Мета справжнього дослідження полягала у оцінці стану твердих тканин зубів після їх вибілювання із застосуванням пероксиду. Матеріали і методи дослідження. У дослідження погодилися взяти участь 44 особи у віці від 19 до 27 років ‒ 37 жінок і 7 чоловіків, які при опитуванні підтвердили, що раніше проводили вибілювання зубів, причому в попередній опитуванню рік. Вибілювання зубів проводилося з використанням пероксидов. Були поставлені наступні завдання: 1. Визначити поширеність гіперестезії зубів, що розвинулася після хімічного вибілювання у осіб, яким проводили вибілювання в діапазоні 6-7 місяців тому. 2. Вивчити мінералізуючий потенціал ротової рідини і міру розвитку де мінералізації зубів. Результати дослідження. Перший етап досліджень торкався оцінки стоматологічного статусу пацієнтів перед вибілюванням зубів. Аналіз результатів вказував на високу поширеність поразки твердих тканин у обстежених пацієнтів, з них у 91 % ‒ каріозного походження і у 18,2 % ‒ некаріозного походження. І це було ризиком для погіршення ситуації, дотично збільшенню проникності емалі, і, як наслідок, розвитку гіперчутливості зубів після їх вибілювання. Результати оцінки резистентності емалі відповідали помірній кислотостійкості емалі. При оцінці мінералізуючого потенціалу ротової рідини за типом кристалізації слини було встановлено, що найменша кількість осіб (21 %) мала найбільш сприятливий, 1 тип. І 3-й тип, найбільш несприятливий, при якому спостерігається повна відсутність кристалів в полі зору, виявлений у більшості осіб. Після оцінки стоматологічного статусу пацієнтів були проведені основні дослідження, що стосуються вивчення впливу вибілювання зубів на їх стан в постблічинговий період. Щоб оцінити стан емалі у осіб з гіперестезією зубів використали спеціальні клінічні тести, а саме тест на її резистентність, а також визначали минерализующий потенціал ротової рідини. За допомогою останнього побічно можна оцінити чи досить міститься в ротовій рідині основних мінералів для здійснення процесу мінералізації і ремінералізації. Результати оцінки резистентності емалі показали, що середньостатистичний показник відповідав помірній кислотостійкості емалі. При цьому понад усе було осіб з високою і помірною резистентністю (14 осіб); низька і дуже низька резистентність виявлена у 10 осіб. Вказане свідчило про те, що, попри те, що дослідження проводилися не відразу після вибілювання, резистентність емалі була понижена.
Article
Relevance . The retention period is the most important stage during which the structural and functional state of the organs and tissues of the mouth must be fully restored after long-term orthodontic treatment. An increase in the time spent by orthodontic equipment in the oral cavity associated with the use of retention devices also increases the risk of developing complications from the hard tissues of teeth and periodontal tissue, while the problem of preventing these complications is not fully addressed. Purpose . Based on a multi-level study of the condition of the organs and tissues of the mouth, to evaluate the effectiveness of the use of modern domestic means of intraoral hygiene in the retention period of orthodontic treatment. Materials and methods . 84 patients aged 18 to 45 years during the retention period of orthodontic treatment were examined. The control group consisted of 32 people using usual hygiene products. Patients of the second group (28 people) were prescribed anti-inflammatory hygiene products for the first 7 days after removal of the equipment; then using a combination of anti-inflammatory and remineralizing intraoral agents based on hydroxyapatite. In the third group (24 people), a rinse aid based on benzydamine (0.15%) and chlorhexidine (0.05%) was prescribed for the first 7 days after removal of the equipment; then use your usual hygiene products and any means to remineralize the enamel at night. The condition of periodontal tissues was assessed using the PMA index and the CPITN index. Enamel caries resistance was determined using the TER test. The desensitivity effect was studied using the dental sensitivity index of L.Yu. Orekhova - S.B. Ulitovsky. Examinations of patients were carried out on the day of removal of fixed orthodontic equipment, after 7 days, after a month and after 3 months from the start of the study. Results . The dynamics of changes in the CPITN index in the second group were 9.1% after 7 days of use, 35.6% after a month of study and 46.2% after 3 months from the start of observation. The dynamics of changes in the PMA index were 13.6% after 7 days of use, 39.7% after a month of study and 47.7% after 3 months from the start of observation. Remineralizing efficiency in the second group improved by 13.1% after 7 days, after a month of use to 36.1%, and after 3 months it increased to 57.4%. In patients of the second group, the desensitizing effectiveness was 27%, after 1 month -47%, after three months -56%. Conclusions . The data obtained allow us to recommend proven oral care products during the retention period of orthodontic treatment for the purpose of primary and secondary prevention of diseases of the hard tissues of teeth and periodontal tissue after removal of fixed orthodontic equipment (brackets).
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Full-text available
This book is intended to provide clinicians and patients with valuable information about the benefits and safety of using nightguard vital bleaching, a dentist-prescribed home whitening treatment using a 10% carbamide peroxide solution applied in a custom-fitted tray. The following topics are addressed to help clinicians educate their patients and treat their esthetic needs using nightguard vital bleaching: • Overview of the nightguard vital bleaching technique • Importance of a proper examination • Diagnosis of the discoloration • Treatment of naturally yellow teeth • Treatment of brown or white partial discolorations • Extended treatment of nicotine and tetracycline stains • Treatment options for single dark teeth • Combined bleaching and restorative treatments • Design and fabrication of a custom-fitted tray • Treatment of sensitivity • Caries control The book serves as a resource the clinician can use to demonstrate case studies of patients who presented with one or more of these esthetic problems. In this way, post-treatment photographs provide concrete examples of both the efficacy and limitations of bleaching treatment for patients in similar clinical situations. The book is best viewed on an iPad or chairside monitor. Quintessence International Book (152 pages). This book is shared by permission of Quintessence International. It is not for republication or reproduction. It was published also as an e-book in 2013.
Article
Relevance. The average time of orthodontic treatment in children is often several years. However, the final mineralization of erupted permanent teeth occurs during this period. The skills developed at this age rarely guarantee a high level of individual oral hygiene. Thus, modern removable appliances (aligners) in children with mixed dentition have several advantages. Remineralization therapy performed simultaneously with orthodontic treatment is one of the essential advantages of using aligners. Purpose . The study aimed to conduct a comparative clinical assessment of changes in the enamel acid resistance and remineralization effectiveness in patients undergoing orthodontic treatment with removable appliances (aligners). Material and methods. Orthodontic follow-up observation involved 59 patients aged 8 to 14 years for six months. They made up three observation groups. The first (control) group included 17 people who visited the orthodontist for a check-up. The second (21 people) and third (21 people) groups comprised patients undergoing orthodontic treatment with aligners. Patients of the second group added ASEPTA TEENS paste to their daily oral care complex. Patients of the third group used ASEPTA remineralizing gel for children besides ASEPTA TEENS paste. The TER test assessed enamel acid resistance, and remineralization effectiveness was determined throughout the study. Results . The comparative analysis revealed that the enamel acid resistance increased in patients of the third group who had followed our recommended scheme of oral care product use with a complex of ASEPTA TEENS paste and ASEPTA remineralizing gel for children. The group showed a remineralization effectiveness of 39.5% after six months. Patients of the second group who used ASEPTA TEENS paste without gel applications for six months also showed an increase in remineralization effectiveness of 19.5% compared to the baseline. Conclusion . The results obtained during the study allow us to recommend ASEPTA remineralizing gel for children for oral care during orthodontic treatment with removable appliances (aligners) in patients with mixed dentition. Removable aligners allow you to combine orthodontic treatment and the preventive use of mineralizing agents for forming strong enamel and protecting it from demineralization.
Book
This book is intended to provide clinicians and patients with valuable information about the benefits and safety of using nightguard vital bleaching, a dentist-prescribed home whitening treatment using a 10% carbamide peroxide solution applied in a custom-fitted tray. The following topics are addressed to help clinicians educate their patients and treat their esthetic needs using nightguard vital bleaching: • Overview of the nightguard vital bleaching technique • Importance of a proper examination • Diagnosis of the discoloration • Treatment of naturally yellow teeth • Treatment of brown or white partial discolorations • Extended treatment of nicotine and tetracycline stains • Treatment options for single dark teeth • Combined bleaching and restorative treatments • Design and fabrication of a custom-fitted tray • Treatment of sensitivity • Caries control The book serves as a resource the clinician can use to demonstrate case studies of patients who presented with one or more of these esthetic problems. In this way, post-treatment photographs provide concrete examples of both the efficacy and limitations of bleaching treatment for patients in similar clinical situations.
Article
Background: Evidence on the efficacy of calcium sodium phosphosilicate (CSPS) and arginine dentifrices on reducing root sensitivity (RS) following non-surgical periodontal therapy (NSPT) is limited. The aim of the study was to compare the efficacy of these dentifrices in reducing RS during daily activities in patients undergoing NSPT. Methods: Using a double-blind randomized controlled trial, CSPS, arginine or control dentifrices were randomly assigned to forty-five RS individuals following NSPT. The participants used the dentifrices 2x/day for 8 weeks. A self-reported visual analog scale (VAS) was assessed during daily activities. Results: Self-reported VAS scores were similar among the three groups at each time point. The with-in group analysis revealed that the arginine dentifrice reduced RS from week 1-8 compared with baseline in response to cold. Similarly, the CSPS dentifrice reduced RS at week 4 and 8. The CSPS and arginine dentifrices exhibited RS relief resulting from toothbrushing starting at week 4 and 2, respectively. In response to air, RS relief was observed from week 4 in the arginine group. The number of patients with VAS>2 in response to cold declined at week 2 and 4 in the CSPS and arginine groups, respectively. In response to toothbrushing, only 10% in the test groups still had RS at week 8. In response to air, the number of RS patients only in the arginine group decreased at week 4. Conclusion: The CSPS and arginine dentifrices provided comparable RS relief during daily activities within 2-4 weeks and remained effective up to 8 weeks. This article is protected by copyright. All rights reserved.
Article
Objectives: This systematic review with network meta-analysis synthesises available randomised controlled trials evidence concerning efficacy of self-administered dentifrices for management of dentine hypersensitivity (DH) pain. Study selection: Following systematic review registration (CRD42019154064), three data bases (MEDLINE, Embase, CENTRAL) were searched to December 2022 for parallel randomised controlled trials conducted in adults diagnosed with DH, using at least two recognised stimuli, assessing the short-term efficacy of home-use dentifrice treatment in reducing pain. Thirty-two studies and 4,638 participants were included. A Network meta-analysis (NMA) approach was used to compare relative effectiveness between interventions. Conclusions: Twice daily application of self-applied dentifrice containing formulations of stannous, potassium +/- stannous, or arginine can be recommended for the reduction of dentine hypersensitivity pain. There is a need for standardised methodology guideline development to improve the conduct, analysis and reporting of DH clinical studies. Clinical relevance: This is the first comprehensive NMA to be performed, that follows guidelines for conduct of DH trials to determine the efficacy of self-applied dentifrices for the management of dentine hypersensitivity. Indirect comparisons can be made between formulations that have not been compared to one another in randomised controlled trials.
Article
Full-text available
Pathological tooth wear is an increasing problem affecting a significant proportion of the population. Although different wear mechanisms have been described, most reports in the literature concentrate on cases in which the predominant mechanisms were erosion and attrition. This article presents an unusual case of abrasive tooth wear caused by a sand eating habit which the patient had adopted as a child. Different causes of "abrasive" wear are discussed and the difficulties in management of this case are also presented.
Article
In conclusion, if dentine hypersensitivity is to be prevented or more effectively managed, greater consideration must be given to the etiology of the condition than has been the norm to date. In established cases of dentine hypersensitivity, exclusion of other possible causes of pain is essential by considering a differential diagnosis. Management requires the determination of etiologic factors and predisposing influences, and where possible, their control or modification. In particular, the presence of erosive elements should be identified and separated from abrasive influences such as tooth-brushing. To ensure the successful management of the clinical implications of dentine hypersensitivity, a careful assessment of the etiologic factors must be considered in evaluating the dental patient presenting with these symptoms.
Article
Objectives: To review current knowledge with respect to the epidemiology of abrasive lesions and the evidence for the role of toothpastes and toothbrushes in their aetiology. Materials and methods: ‘Medline’ databases for the period 1966 to the present day were searched electronically, while the dental literature prior to 1966 was searched manually. In both cases, the key words: tooth abrasion, toothpaste and toothbrush were used. Conclusions: Studies in vitro demonstrate that tooth brushing with abrasive toothpastes produces wear to dentine. Extrapolation of these data to effects in vivo is difficult, but suggests that, under normal use, tooth brushing with toothpaste will cause limited wear of dentine in a lifetime's use. Negligible damage to dentine occurs with a toothbrush alone. Most toothpastes have low relative enamel abrasivity values and, alone, have little or no effect on enamel. Abuse and/or interaction with erosion can increase wear of dentine to pathological levels. Enamel softened by erosive agents is easily removed by any mechanical action.
Article
Abstract The reported prevalence of cervical dentine sensitivity (CDS) ranges from 8 to 35%. Detailed epidemiology of the condition, particularly with regard to possible causal factors, is lacking. In particular, no published data appear to exist on its prevalence in periodontal patients. The aim of the present study was therefore to determine the prevalence, distribution and severity of CDS in a population of patients referred to a Periodontology Department of a specialist postgraduate hospital. 507 patients (181 M: 326F, mean age 44.2 (SD 10.31) years) attending a periodontal clinic were assessed for CDS by a questionnaire. The results demonstrated a prevalence of CDS of 84% with no significant gender difference. 71.1% of patients perceived cold as the most common cause of discomfort. A higher prevalence of self-reported discomfort was observed between 40 and 49 years. Of the patients with a reported history of periodontal surgery (34.7%), those treated within 6 months prior to assessment appeared to be more at risk to CDS. Of the patients who received hygienist treatment (88.2%). only 10.5% reported discomfort persisting ≥3 days after treatment. Generally, patients who complained of varying degrees of discomfort over time (84.5%) did not perceive the condition as severe and consequently did not seek treatment. The prevalence of CDS in these referred patients was very high, suggesting that periodontal diseases and/or treatment effects play a role in its aetiology.
Article
Due to the stresses resulting from biomechanical loading forces exerted on the teeth (static, as in swallowing and clenching or cyclic, as in chewing), both enamel and dentin can chip or break away. This loss of tooth substance, which shall be termed Abfraction, is dependent on the magnitude, duration, direction, frequency, and location of the forces. These abfractive lesions are caused by flexure and ultimate material fatigue of susceptible teeth at locations away from the point of loading. Clinical observation of a variety of enamel and dentin lesions due to the shapes, sizes, loci, and frequency warrants a new and distinct classification.
Article
One hundred teeth, experimentally treated with Class V amalgam and silicate restorations and extracted 7 days later, were used to study the correlation between clinical symptoms of thermal sensitivity and histologic signs of pulpal hyperemia and inflammation. The number of teeth sensitive to both cold and heat increased significantly in the presence of hyperemia. As pulpal inflammation increased in severity, the number of teeth sensitive to heat also increased. No correlation was found between the degree of inflammation and sensitivity to cold. These results are discussed in the light of current knowledge concerning the meaning of clinical symptoms and histologic changes in the pulp.
Article
The clinical data indicate that Thermodent toothpaste is of considerable value as an aid in treating sensitive teeth. Local areas of hypersensitivity caused by erosions, abrasions, or attrition have responded most favorably. Although excellent symptomatic relief is provided, it is important that every effort be made to identify and correct the basic causes of the hypersensitivity.
Article
The clinical aspects, epidemiology, etiology and pathogenesis of dental erosions in man and experimental animals are reviewed. Abrasion of enamel, softened in orange juice for 3 minutes and brushed with various dentifrices, was studied with Knoop hardness measurements and scanning electron microscopy. Knoop indentations made on softened enamel surfaces were almost totally removed by 2-minute brushings with highly abrasive tooth pastes. Brushing without dentifrices only slightly changed the distinctness of the indentation outlines. Recommendations for primary and secondary prevention of erosions are given.
Article
The prevalence, distribution and possible causal factors of cervical dentine hypersensitivity were studied in a population from a Marine Dental Clinic in the city of Rio de Janeiro, Brazil. A total of 635 patients were examined for the presence of cervical dentine hypersensitivity by means of a questionnaire and intraoral tests (air and probe stimuli). There were 157 patients (25%) reporting to have hypersensitive teeth, but only 108 patients (17%) were diagnosed as having cervical dentine hypersensitivity. The prevalence of hypersensitivity was higher among females than males, but this difference was not statistically significant. Most females with hypersensitivity were aged 20-49 and most males were aged 40-59. Incisors and premolars had the highest prevalence of dentine hypersensitivity to air and probe stimuli, while molars had the lowest. The presence and history of dentine hypersensitivity were positively correlated with previous exposure to periodontal treatment. Only a few of the patients who claimed to have dentine hypersensitivity had tried treatment with desensitizing toothpastes or sought professional help.
Article
Dentine hypersensitivity occurs when dentinal tubules are open on the dentine surface and patent to a vital pulp. There has been limited interest in the aetiology of dentine hypersensitivity. In particular, little is known about agents that remove the dentine smear layer to expose tubules. Toothbrushing certainly may expose dentine, but whether a toothbrush per se has the effect of opening tubules has not been established. The aim of this study in vitro was to determine whether a toothbrush could remove or create a smear layer. In addition, the combined effects of toothbrushing with dietary fluids on dentine was assessed. Toothbrushing was observed, by scanning electron microscopy, both to remove and to recreate a smear layer on dentine specimens. However, the processes took a considerable time, and under conditions of normal toothbrushing it is unlikely that the latter plays a direct aetiological role in opening tubules. Indeed, together with toothpaste it is more likely that brushing has a therapeutic action by mechanically forming a smear layer. Conversely, and importantly, toothbrushing in the presence of dietary acids enhanced smear layer removal. This finding raises the question of whether the dental profession should be advising that teeth be brushed before meals rather than after, as is often the case.
Article
Dentine hypersensitivity is caused by a change in fluid flow in the dentinal tubules, which excites nerve endings located in the dentinal tubules and at the pulp-dentine border area. Traumatic oral hygiene procedures, excessive use of acid containing dietary fluids and certain dental treatments have been implicated in the occurrence of dentine hypersensitivity. Initial treatment relies on a positive doctor-patient relationship and the use of a desensitizing toothpaste containing strontium chloride, potassium nitrate or sodium citrate. If no relief is obtained, further treatment attempts need to be undertaken by the dentist--application of fluoride varnishes, potassium oxalate, resins or adhesives.
Article
The effect of cement and stone dust on teeth was explored in a cross-sectional study, using blind dental examinations. The sample consisted of 36 workers who had been exposed to to the dust and 62 control workers. Tooth surface loss was observed in 72.2 per cent of the exposed workers and in 48.4 per cent of the controls (P less than 0.03). In both the maxillae (P less than 0.001) and the mandible (P less than 0.02) the amount of tooth surface loss was greater in the exposed workers than in the controls. Both anterior and posterior teeth were affected. These findings indicate that tooth surface loss caused by work-related dust should be considered an occupational hazard.
Article
Exposed dentine may be sensitive to stimuli depending on the patency of the dentinal tubules. Most abrasive elements tend to produce a smear layer which obturates the dentinal tubules. This layer is easily removed by a number of erosive agents, particularly dietary acids. Mouthwashes are increasingly used and largely investigated for possible benefits to dental health. Rarely do studies assess potential detrimental activity. The aim of the present study was to examine effects of mouthwashes on dentine. Smear layers artificially produced on dentine sections were exposed, for time periods ranging from 3 to 300 min, to mouthrinses alone, or with subsequent brushing for 2 min using water or a fluoride toothpaste. Assessments were made by scanning electron microscopy. Of the nine rinses tested, six produced no consistently observable changes compared to water treated controls at any time period with or without brushing. A hexetidine rinse and a fluoride/antiseptic rinse both exposed tubules after exposure times of 2 h and longer, an effect enhanced by post-treatment brushing. A phenolic antiseptic rinse consistently removed the smear layer from specimens, an effect enhanced by brushing such that after 10 min exposure and 2 min brushing many tubules were open at the surface. The results indicate that the use of some mouthrinses could predispose to excessive tooth substance loss and dentine hypersensitivity, particularly if used prior to toothbrushing. There is a need to determine whether the intermittent use of some mouthrinses produces cumulative effects on dentine.
Article
Reported toothbrushing frequency and the effect of toothbrushing frequency, toothbrushing hand, sex and social class on the incidence of plaque and periodontal disease in a group of 720 adolescents examined at age 11-12 years and again at 15-16 years is presented. At 11-12 years, the mean toothbrushing frequency was 11.5 times per week. By age 15-16 years, it had risen to 13.3 times per week. Children from social class I were less likely to brush once per day or less and more likely to brush twice daily than those from social class V. At both examinations, consistently low negative correlations were seen between reported toothbrushing frequency and the mean scores for buccal and lingual plaque, buccal, mesial and total bleeding. Few significant differences were seen between left- and right-handed toothbrushers at age 11-12 years. These were almost entirely due to differences between the boys. By age 15-16 years, no significant differences existed between the two groups. At both examinations, the boys had higher plaque, bleeding and pocketing scores than did the girls. At 15-16 years of age, all social classes exhibited lower mean total pocketing scores than at age 11-12 years. At 11-12 years of age, the social class differences were mainly contributed by the girls, while at re-examination plaque and bleeding scores for both sexes showed an overall trend to increase from social class I through to social class V. At 11-12 years of age, the boys showed a trend for pocketing to increase from social class I through to social class V. This was absent at 15-16 years of age. The girls showed no such trend at 11-12, but it had emerged by age 15-16. The results again demonstrate the influence of social class and sex rather than toothbrushing frequency and handedness on oral hygiene and gingival health. However, in view of the high number of statistical tests employed, some caution must be exercised in the interpretation of differences significant at the 5 per cent level.
Article
In conclusion, if dentine hypersensitivity is to be prevented or more effectively managed, greater consideration must be given to the etiology of the condition than has been the norm to date. In established cases of dentine hypersensitivity, exclusion of other possible causes of pain is essential by considering a differential diagnosis. Management requires the determination of etiologic factors and predisposing influences, and where possible, their control or modification. In particular, the presence of erosive elements should be identified and separated from abrasive influences such as toothbrushing. To ensure the successful management of the clinical implications of dentine hypersensitivity, a careful assessment of the etiologic factors must be considered in evaluating the dental patient presenting with these symptoms.
Article
This article reviews dentin sensitivity from a mechanistic perspective beginning with short treatments of pulpal innervation, the hydrodynamic considerations of dentin, and how various stimuli may cause pain. Speculation is raised about the contribution of bacteria and their products on dentin sensitivity and how dentin might become truly hypersensitive, especially following periodontal therapy. Wherever possible, the clinical considerations of basic research is stressed.
Article
The aim of the study was to introduce an individual tooth wear index and to use this index to investigate factors correlated to occlusal wear. The material consisted of 585 randomly selected dentate individuals from the community of Jönköping, Sweden, who in 1983 reached the age of 20, 30, 40, 50, 60, 70, or 80 years. The degree of incisal and occlusal wear was evaluated for each single tooth in accordance with criteria presented earlier. An individual tooth wear index, which made it possible to rank individuals in accordance with incisal and occlusal wear, was used as dependent variable to investigate factors related to incisal and occlusal wear. Of all factors analyzed, the following were found to correlate significantly with increased incisal and occlusal wear: number of existing teeth, age, sex, occurrence of bruxism, use of snuff, and saliva buffer capacity. Stepwise multiple regression analysis gave a total explanation factor of R2 = 0.41. It was also possible to distinguish well between groups of individuals with and without tooth wear by means of these factors.
Article
Studies of extracted teeth have shown that teeth exhibiting dentine hypersensitivity have larger numbers of widened dentinal tubules at the dentine surface compared to non-sensitive teeth. Many compounds used in the treatment of dentine hypersensitivity are thought to achieve therapeutic benefit by tubule occlusion, but there has been almost no attempt to prove such action in vivo. These studies systematically determined whether the dentine surface could be evaluated non-invasively, by a scanning electron microscopic replica technique. Employing a silicone rubber impression method in vitro, the surface detail of dentine could be accurately replicated, with surface scratches, tubules and intratubular structures on the original reproduced on the replica. With attention to method, similar accuracy was achieved in vivo, particularly when tubules were open on the dentine surfaces of the original. The method would appear useful for the study of the dentine surface in cases of dentine hypersensitivity and could prove the first objective method of studying the effects of treatment agents used in the treatment of this painful condition.
Article
The clinician must frequently make treatment decisions with limited knowledge of the appropriateness and consequences of the different options. Patients have specific expectations: that the treatment they receive is the usual one, that they have been informed of the alternatives and the consequences, and most importantly that the treatment has a reasonable chance of success. In TMJ therapy, as with most treatments, the patient's improvement is closely connected to a proper diagnosis based on sound physiologic principles. This investigation will review four basic splint types and discuss their success in the resolution of various temporomandibular disorders. Since the position of the condyle-disc-fossa, the occlusal contact pattern and the masticatory muscle dynamics are interrelated, this study will focus on the physiologic changes splints may cause with modification of this tooth, joint and muscle relationship. Hopefully, selection of a specific splint design appropriate to the patient's disorder will be facilitated by better understanding of its physiologic and therapeutic effects.
Article
In this study the viability and the distribution of bacteria within the radicular dentin and pulp of periodontally diseased caries-free teeth were studied. Healthy teeth served as controls. Samples were obtained from the pulp tissue and from the radicular dentin. Dentin samples were taken from the interdental surfaces in the subgingival area. Starting from the pulpal side, three to five successive dentin layers of approximately 1 mm thickness were sampled. The samples were processed and cultured using an anaerobic technique. Bacterial growth was detected in 87% of the periodontally diseased teeth. In 83% of the teeth, bacteria were present in at least one of the dentin layers. Fifty-nine percent of the diseased teeth, from which the pulp tissue was cultured, contained bacteria in the pulp samples. The mean bacterial concentrations in the pulp and dentin layers ranged from 1,399 to 16,537 colony-forming units (CFU) per mg of tissue. These concentrations were 259 to 7,190 times greater than concentrations found in healthy teeth. It is suggested that the roots of periodontally diseased teeth could act as bacterial reservoirs from which recolonization of mechanically treated root surfaces can occur, as well as infection of the dental pulp. These findings might change current concepts concerning root surface debridement in periodontal therapy.
Article
Evidence indicates that teeth exhibiting cervical dentine hypersensitivity have open dentinal tubules at the dentine surface. The identification of factors which render dentine exposed and tubules open is important both to the prevention and management of dentine hypersensitivity. In this study, recently extracted teeth were root planed or burred to expose the root dentine. Specimens were horizontally sectioned and then using the apical portion as control, the coronal portions placed in a variety of strong and weak acids and dietary fluids. Examination under the scanning electron microscope revealed a smear layer covering completely underlying tubules on the control root planed or burred portions. Test portions exposed to strong and weak acids showed loss of the smear layer and exposure of large numbers of tubules. Formic and tannic acids produced no changes. Some dietary fluids, in particular red and white wine, citrus fruit juices, apple juice and yogurt produced similar etching effects to the acids. The low pH carbonated drink, coca-cola, and a blackcurrent cordial produced no effects. The results of this study in vitro cannot necessarily be extrapolated to the clinical situation, but suggest that certain dietary factors could play a rôle in the aetiology of dentine hypersensitivity. Dietary advice to patients may prove important in the management of this often recurrent condition.
Article
Based on the hydrodynamic theory for stimulus transmission across dentine, it would be logical to conclude that teeth exhibiting the clinical symptoms referred to as dentine hypersensitivity should have dentinal tubules open at the root surface and patent to the pulp. With the exception of studies on cut dentine, there is little direct evidence to support this conclusion. In this study, caries-free teeth with exposed cervical root areas scheduled for extraction which were classified as non-sensitive or hypersensitive after suitable stimulation were examined by scanning electron microscopy. Hypersensitive teeth showed highly significantly increased numbers of tubules per unit area (approximately 8 X) compared with non-sensitive teeth. Tubule diameters were significantly wider (approximately 2 X) in hypersensitive compared to non-sensitive teeth. The number of teeth showing the penetration of methylene blue through the zone of exposed cervical dentine was larger and the depth of penetration greater in hypersensitive teeth compared to non-sensitive teeth. The results provide further evidence that stimulus transmission across dentine in hypersensitive teeth is mediated by a hydrodynamic mechanism. An understanding of factors which open dentinal tubules would seem important if attempts to prevent or treat dentine hypersensitivity are to be successful.
Article
Numerous factors may affect the distribution of plaque and gingivitis in any individuals mouth. Of considerable importance must be the oral hygiene habits of each person, which will be influenced by compliance and dexterity with tooth cleaning methods. The pattern of gingivitis seen at a young age may, with time, reflect the eventual distribution of attachment loss. This in part, could explain the considerable variation in chronic periodontal disease seen between individuals and at different sites within the same mouth. This study reports the baseline data for the distribution of plaque and gingivitis in 1105, 11-12-year-old children in South Wales. The children were selected by disproportionate stratified random sampling and examined by a multidisciplinary group with the long-term aim of evaluating the importance of malocclusion to dental health and psychosocial variables. Toothbrushing frequency had a very low but significant correlation with the distribution of plaque and gingivitis, accounting therefore for only a small % of the variance in the group. For the total group and right-handed toothbrushers, buccal plaque and gingivitis was significantly increased on right contralateral teeth. No specific pattern for plaque and gingivitis distribution by side was seen for 100 left-handed toothbrushers. Plaque and gingivitis also showed significant differences dependent upon arch, tooth number, and surface. The population is being followed at 4-year intervals to monitor the pattern of periodontal disease with time and correlate changes with these baseline findings.
Article
The features of dentine hypersensitivity have been presented largely in descriptive form and there is only limited information on the intraoral distribution of the condition. Additionally, there have been conflicting reports of both high and low plaque accumulation at sites of hypersensitivity. This study investigates the distribution of recession, sensitivity and plaque in a group of 92 patients diagnosed as suffering moderate to severe dentine hypersensitivity affecting several teeth. The group was relatively homogeneous and there was no significant variation in recession, sensitivity or plaque scores between subjects. Tooth number (1–28) highly significantly influenced all parameters. In three-way analyses of variance to identify the effects of jaw, side and tooth number in a segment (1–7) almost all parameters were significantly influenced, however: 1.1. The dominant factors affecting degree of recession were side and tooth number.2.2. The dominant factor affecting sensitivity was side.3.3. The dominant factors affecting buccal plaque were side and tooth number.4.4. The dominant factor affecting lingual plaque was jaw.Two- and three-way interactions were, for the most part, also significant. The correlation matrix revealed significant positive correlations for recession with sensitivity and significant negative correlations for recession and sensitivity with buccal plaque. The findings indicate that the intraoral distribution of recession, sensitivity and plaque in this selected population is complex, being partly fitted by a main-effects model, and suggest that tooth cleaning is one of several major factors which influence the occurrence and distribution of dentine hypersensitivity.
Article
The incidence of ‘hypersensitive’ teeth was investigated in 369 patients by means of a questionnaire and intraoral testing with a cold-water mouthrinse (CWMR) and a sharp probe. Patients' subjective evaluations were found to be unreliable. Of the 103 patients who thought they had ‘sensitive’ teeth, only 62 responded positively to the intraoral tests. Around 29 per cent of patients reported discomfort with the CWMR, but when those with obvious causes for the pain (e.g., caries, cracked enamel) were excluded, the incidence of sensitivity to the CWMR was found to be 18 per cent. The incidence of sensitivity to CWMR and probing was 8·7 per cent. More females than males had sensitive teeth, but the differences were not statistically significant.
Article
It has been established that there is a relationship between osmotic pressure and pain-producing power when CaCl2 solutions in the range 200-2800 atm are applied to dentine (Anderson and Ronning, 1962). Experiments have been performed in an attempt to explain previous failure to confirm this relationship with other solutions. The experiments fell into two groups: those with solutions in the range 25-700 atm and those in the range 200-2800 atm. A decline in sensitivity during an experiment was observed as previously but was found to be caused only by solutions in the high range of osmotic pressure. Because of this decline in sensitivity, only the first results of every sequence of stimulations with the high range of osmotic pressures is comparable with results from the low range of osmotic pressures. Comparable data over the entire range of osmotic pressures 25-2800 atm was obtained by selecting only the first results of every series in the high range and using all the results in the low range of osmotic pressures. When this selection was made, the points on a graph of pain-producing power and log osmotic pressure fell on a sigmoid curve. This curve can be considered to represent the distribution of pain thresholds within the group of subjects, defined in units of log osmotic pressures. Probit transformation has shown that this distribution is normal (Gaussian). Osmotic pressure can therefore be taken as the effective stimulus common to all the solutions used in evoking pain from dentine.
Article
Hydrostatic pressures were applied to human teeth to investigate the development across the dentin of electric potentials which might be involved in excitation of sensory receptors. Electric potentials were measured, and an attempt was made to explain the phenomenon on the basis of the Helmholtz-Smoluchowski equation.
Article
象牙質知覚過敏症は, 日常の臨床でしばしば遭遇する疾患であり, しかもその病理ならびに処置法はまだ十分に明らかにされていない為, 著者は, 知覚過敏症の本態を知り, 同時に適確な処置法を知る目的で, その特徴的症状 (自発痛の欠如と誘発痛の持続性が短いこと) を中心に臨床的ならびに組織学的検索を行なった。その結果, 知覚過敏状態は露出象牙質全面に起るものでなく, 知覚過敏部は点状または小帯状 (Spot or Area) をなして局在することを知った。その知覚過敏部と歯髄・口腔粘膜の電気抵抗値を測定すると多くの場合15kΩから50kΩであり, 知覚過敏の訴えのない象牙質露出部の800kΩとに明かな差がみられた。象牙質知覚過敏を訴えるin situの歯牙の象牙質露出面に銀イオン導入を行うと, 銀イオンが歯髄面まで運ばれている所, 象牙質壁の途中までで輸送が留まっている所, 全く導入が起らない所がみられた。銀イオンの輸送は, その部位を流れる電流の大きさに比例し, 象牙質の抵抗に反比例するので, 銀イオンが歯髄面まで運ばれている所は, 電気抵抗値の小さい所, すなわち, 知覚の鋭敏な場所にあたる。この知覚過敏部位と連なる歯髄面の象牙芽細胞には減数, 消失がみられ, 知覚過敏の訴えのない部位には第2象牙質の添加があった。知覚過敏の特徴的痛みは, この変化した象牙細管を介して速やかに外来刺激が歯髄内の知覚神経に伝わることにより惹起されるものと考えられた。
Article
The exposure of cervical dentine has a multifactorial aetiology and pain may frequently be elicited by a number of stimuli. Management of the condition, dentine hypersensitivity, tends to be empirical because of the lack of knowledge concerning the mechanism of pain transmission through dentine. The pulpal changes associated with the condition and any modulating effect on symptoms are by no means clearly established. Evidence suggests that exposed dentine which is sensitive exhibits patent tubules. The question of how pain is initiated across the dentine has received considerable attention but still remains somewhat debatable. The literature reviewed indicates that, at most, nerve fibres only penetrate a limited distance along some dentinal tubules. The theories that either the odontoblasts and their processes act as dentinal receptors or the nerves in the pulp are the pain receptors, are discussed. Evidence for the stimulation of pulp nerve fibres by a hydrodynamic mechanism would appear the most likely mechanism. Nevertheless, whichever theory proves to be correct, occlusion of dentinal tubules would appear an essential prerequisite for an effective desensitising agent.
Article
This paper reviews the factors, anatomical, pathological and physiological, which have been implicated in the aetiology of gingival recession. Changes in the root surface when exposed to the oral fluids are also reviewed, a possible mechanism for the perpetuation of recession with increase in age is suggested.
Article
The object of the investigation was to test the value of the 3M Brand Electro-Ionizing Toothbrush in the treatment of dentinal hypersensitivity. Eighty-eight volunteers were divided into three groups, each using different methods: (I) stannous fluoride dentifrice and 3M brush without a battery; (II) stannous fluoride dentifrice and 3M brush with a 1 1/2 volt battery; and (III) strontium chloride dentifrice and 3M brush without a battery. The volunteers brushed their teeth for 3 minutes twice a day for 12 weeks using one of the three test agents. The subjects were tested at weeks 0, 2, 4, 8 and 12 by means of a cold water spray quantitated by a temperature probe. All three groups experienced improvement and by week 12 Groups II and III displayed much less sensitivity than did Group I. At the end of the 12 weeks the subjects were questioned as to benefit of treatment. The questionnaire revealed that stannous fluoride with the ionizing brush provided significantly greater relief than did the stannous fluoride alone.
Article
Evidence is presented that the rate of inward diffusion of chemicals through exposed dentine is affected by the rate of outward flow of fluid through the dentinal tubules. Such a flow has been demonstrated in cats. The flow rate appears to depend upon the pulpal tissue-fluid pressure; flow increased during pulp vasodilatation and decreased, even reversing in direction, during vasoconstriction. Pulp vasodilatation can be produced by stimulating intradental afferent nerves, including some of those that seem to be excited by displacement of tubule contents (i.e. by a hydrodynamic mechanism). Thus, when dentine is exposed and these afferents are stimulated they will help to protect the pulp by producing reflex vasodilatation, which will decrease the rate of diffusion of toxins from the mouth into the pulp. The relation between the rate of flow through dentine and the discharge evoked in intradental nerves was investigated in cats. Single fibres were more sensitive to outward than to inward flow. The flow rates required to excite the pulp afferents were greater than those observed during even maximal pulpal vasodilatation.
Article
The buccal surfaces of premolar teeth are common sites of gingival recession, generally attributed to overzealous oral hygiene. Scanning electron microscopy (SEM) of replicas made from dental impressions was applied to document the micromorphology of the buccocervical region of all premolar teeth in 27 dentally healthy, young adults. The SEM observations were correlated with clinical examination. Of the 216 sites, one-third, predominantly the maxillary first premolars, had gingival recession, but fewer than 50% were clinically discernible. The exposed roots were devoid of cementum, and the dentinal surface was smear-like or dotted with tubular apertures from which droplets of fluid extruded. SEM of replicas of gingiva, recorded as clinically healthy, frequently showed signs of inflammation: fluid exudate and distortion of gingival contour by swelling. The cervical enamel of healthy and affected sites showed characteristic periodic fissure-like cracks, probably enamel tufts. The high frequency of subclinical gingival recession, exposed cervical dentin, and gingival inflammation in dentally healthy young adults, in the absence of abrasion of hard or soft tissues, indicates the need to review conventional concepts of initiation of buccal recession and root exposure.
Article
Stimulus transmission across dentine, in conditions such as dentine hypersensitivity, is considered to occur via a hydrodynamic mechanism. This fluid flow in dentine may then induce a mechanoreceptor response in pulpal nerves. However, when fluid flows through a porous structure electrical potentials are also generated. The aim of this study was to develop a reproducible model system to measure streaming potential across dentine and hydroxyapatite and determine the influence of pressure. Using an acrylic cell, with silver electrodes, streaming potentials were recorded across dimensionally standardized dentine and hydroxyapatite specimens, over a pressure range of 1-6 atmospheres. Streaming potentials were found to be directly proportional to pressure and dependent on the electrical conductivity of the saline used in the cell. The results confirm the limited existing data on streaming potentials across dentine and indicate that at these low pressures excitation of pulpal nerves would not occur. However, if, as may be the case, stimuli applied to dentine create very high pressures, the resultant potentials generated could indeed evoke a neural response. The model system is worthy of further use to study this phenomenon and the factors which may influence it.
Article
Gingival recession (GR) is an intriguing condition. This brief communication, after proposing a definition for GR, considers the possible relevance of anatomical, physiological, pathological and traumatic factors in its etiology. It is probable that no one factor in isolation leads to the development of GR. Because of the possible influence of several factors, not necessarily acting synchronously, the occurrence of GR at a given site may be difficult to explain fully, and any subsequent changes may be hard to predict. The importance of the CEJ (or other fixed point) in assessment of GR severity is discussed. A new two-figure Index of Recession (IR) (e.g., F2-4asterisk) is also described, in which the 1st digit relates to the proportional evaluation of the horizontal extent of GR at the level of CEJ, and the 2nd digit is the vertical extent of GR from CEJ in millimetres; the asterisk denotes involvement of the MGJ. The prefixed F (or L) denotes whether GR is facial (or lingual) to the involved root.
Article
Clinical trials on dentine hypersensitivity have been numerous and protocols varied. To date there is little consensus as to the conduct of studies on this poorly-understood yet common and painful dental condition. A committee of interested persons from academia and industry was convened to discuss the subject of clinical trials on dentine hypersensitivity and a consensus report is presented. A double-blind randomized parallel groups design is recommended, although cross-over designs may be used for the preliminary screening of agents. Subjects may have multiple sites scored. Sample size will be determined by estimating the variability in the study population, the effect to be detected and the power of the statistical test to be used. Subject selection is based on a clinical diagnosis of dentine hypersensitivity, excluding those with conflicting characteristics such as currently-active medical or dental therapy. The vestibular surfaces of incisors, cuspids and bicuspids are preferred as sites to be tested. A range of sensitivity levels should be included. Tactile, cold and evaporative air stimuli should be applied. Negative and benchmark controls should be incorporated. Most trials should last 8 weeks. Sensitivity may be assessed either in terms of the stimulus intensity required to evoke pain or the subjective evaluation of pain produced by a stimulus using a visual analog or other appropriate scale. The subject's overall assessment may be determined by questionnaire. Outcomes should be expressed in terms of clinically significant changes in symptoms. Follow-up evaluation is required to determine the persistence of changes. At least 2 independent trials should be conducted before a product receives approval.
Article
The prevalence, distribution, and possible causal factors of cervical dentin hypersensitivity were studied in a population attending the Health Examination Center of National Taiwan University Hospital. A total of 780 patients were examined for the presence of cervical dentin hypersensitivity by means of a questionnaire and intraoral tests. There were 253 patients (32%) who claimed to have hypersensitive teeth at present and 90 patients (12%) who reported a history of hypersensitive teeth. The intraoral distribution of hypersensitivity showed that premolars and molars were the most common teeth sensitive to the air and probe stimuli, while the incisors were the least sensitive ones. The presence and history of dentin hypersensitivity were positively correlated with previous tooth-brushing and periodontal disease. Only a few of the patients who claimed to have dentin hypersensitivity had tried treatment with desensitizing tooth-pastes (11%) or sought professional help (5%).
Article
The aim of this study was to determine, by questionnaire, the reported levels of dentine hypersensitivity in adult patients attending general dental practice. A total of 250 subjects (88 males, aged 40 +/- 14.3 years; 162 females aged 37 +/- 11.6 years), were recruited to the study in 5 dental practices. The prevalence of reported sensitivity was 57.2%, most frequently occurring in the 30-39 year age group. In the vast majority of cases (89.3%) cold was the major stimulus for pain, other commonly reported causes being toothbrushing (38.6%), hot (37.9%) and sweet (25%) stimuli. Desensitising toothpastes were used by 67.9% of those reporting sensitivity, the majority of these (72.6%) reporting a beneficial effect. Professional treatment had been sought by 32% of subjects, almost all (91%) reporting an improvement post-treatment. There was no significant correlation in the level of reported sensitivity and previous periodontal treatment. The majority of subjects with sensitivity also smoked (67.6%), although this relationship did not reach statistical significance (p = 0.07). Visual analogue scales indicated that perceived pain levels with dentine sensitivity were relatively low. It was concluded that the prevalence of dentine sensitivity found in this study was much higher than previously reported, suggesting an increase in the levels of sensitivity within the general population.
Article
Acidic soft drinks are frequently implicated in dental erosion, but there are limited supporting data. Research is problematic due to the insidious nature of erosion and accuracy in assessing tissue loss. The aim of this study was to develop and validate, using a negative control, a model to accurately measure erosion in situ due to a single aetiological agent over a relatively short time period. An intra-oral appliance capable of retaining an enamel sample was designed in order to assess the effect of orange juice consumption on enamel. The study was a single centre, randomized, placebo controlled, blind, crossover design. Ten subjects, each consuming 11 of orange juice per day for 15 days, showed significantly more erosion on the enamel specimens than the same subjects consuming 11 of water per day over the same time period, measurements undertaken with surfometry. The same investigation was performed in vitro. Again, orange juice was significantly more erosive; indeed, it was in the order of 10 times that produced in situ. Surface microhardness testing in situ and in vitro demonstrated statistically significant differences between exposed and unexposed areas after orange juice treatment. Changes produced by water either in situ or in vitro were always well within the baseline measurement parameters (+/- 0.3 micron) set down for the method and hence validated the clinical model in terms of reproducibility and accuracy in measurement. It is concluded that this method has confirmed the erosive potential of orange juice in situ. The method could have many applications to study dental erosion under highly controlled conditions and over realistic time periods.