Dentinal Hypersensitivity: Etiology, Diagnosis, and Management

Dentinal hypersensitivity has been referred to as one of the most painful and chronic dental conditions, with a reported prevalence of between 4% and 57% in the general population and a higher prevalence in periodontal patients. It may also occur as a result of, or during, dental treatment. Clinicians must screen for dentinal hypersensitivity and diagnose by exclusion, determine appropriate treatment, and provide treatment and preventive recommendations. Consideration should also be given to treating dentinal hypersensitivity associated with dental treatment. Traditional treatments have included adhesive resins, fluoride varnishes, HEMA, iontophoresis, gingival grafts and desensitizing dentifrices. Other technologies include the use of bioglass particles, ACP, as well as 8% arginine and calcium carbonate paste. Introduction During routine dental examinations, our patients frequently inquire about dentinal hypersensitivity that was one episode or is chronic and recurring due to a given action, e.g., drinking cold beverages, eating hot foods, breathing in and out. This common complaint is defined as dentinal hypersensitivity, but it is also known as root sensitivity, or just sensitivity. Patients describe this phenomenon as sharp, short-lasting tooth pain, irrespective of the stimulus.1 Holland et al. described dentinal hypersensitivity as “characterized by short, sharp pain arising from exposed dentin in response to stimuli typically thermal, evaporative, tactile, osmotic or chemical and which cannot be ascribed to any other form of dental defect or pathology.”2 The prevalence of dentinal hypersensitivity has been reported to be between 4% and 57% in the general population.3-10 Among periodontal patients, its frequency is considerably higher (60%–98%).11,12 This hypersensitivity may be due to cementum removal during root instrumentation. Dentinal hypersensitivity has been described as generally occurring in patients 30 to 40 years old,13 but it can occur in patients significantly younger or older. Women may be affected more often than men.14 Dentinal hypersensitivity affects incisors, canines, premolars and molars, with canines and premolars reported to be affected most often.15,16 Patients with dentinal hypersensitivity may not specifically seek treatment, because they do not view it as a significant dental health problem, but will mention it at a routine dental appointment.17 At other times, patients will seek treatment recommendations from their dental professionals. Some patients are concerned whenever there is dental pain,18 and for some the first time they experience dentinal hypersensitivity creates fear that there is something more serious occurring. The authors of this course have had patients report sensitivity who believe that it may be a toothache that requires immediate attention so that the pain does not get worse. Patients can identify areas of dentinal hypersensitivity before a clinical exam is performed. This may be chronic, or unpredictable and cause intermittent discomfort that is difficult to pinpoint.19,20 Other patients cannot distinguish between dentinal sensitivity and gingival sensitivity. Patients may also experience dentinal hypersensitivity as a result of treatment such as scaling and root planing or during routine and normal actions associated with treatment, such as when a tooth is dried using an air spray or scratched with the tip of an explorer. Dental treatment can also exacerbate pre-existing sensitivity. Dentinal hypersensitivity has all the criteria to be considered a true pain syndrome.21 It is important to distinguish sensitivity pain, that of short duration, from pain of longer duration not treatable with desensitizing agents. A painful response that lingers or that wakens the person from a sound sleep may be the result of pulpal inflammation. A diagnosis by the dentist is necessary to establish a cause and effect, and a diagnosis by exclusion must be made for dentinal hypersensitivity, ruling out other conditions requiring different treatment. After the diagnosis of dentinal hypersensitivity has been made, depending on the etiology, recommendations can be made for effective treatment. Calvo noted in 1884: “There is great need of a medicament, which while lessening the sensitivity of dentin, will not impair the vitality of the pulp.”22 Recommendations can include in-office, at-home professionally dispensed or over-the counter treatments.23-26 Regardless of which treatment recommendations are made and provided, it is important to follow up with the patient to evaluate the therapeutic results. Etiology and Physiology of Dentinal Hypersensitivity Dentinal hypersensitivity can have multiple etiologies. It is important that the patient’s medical and social history, lifestyle, medications and supplements being taken, diet and food habits, and oral hygiene be thoroughly reviewed. Before making a diagnosis of dentinal hypersensitivity, other oral conditions must be ruled out, including occlusal trauma, caries, defective restorations, fractured or cracked