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