A Clinico-Histological Study on the Hypersensitivity of Dentin

Ishikawa, Shota

doi:10.5357/koubyou.36.278

Cited by 29 publications

(19 citation statements)

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“…On the other hand, heat induces a slow retreat of dentin fluid, and the resultant pressure change activates the baroreceptors and nerve fibers in a less dramatic fashion, consistent with the observation that cold and evaporative stimuli are generally more painful to patients than heat [38]. The hydrodynamic theory of dentin hypersensitivity requires that dentin tubules are exposed at the dentin surface and patent to the pulp [39, 40]. Absi et al demonstrated that the number of tubules in clinically hypersensitive teeth was eight times higher, and the tubules were two times larger in diameter and were mostly open compared with nonsensitive teeth [40, 41].…”

Section: Discussionsupporting

confidence: 62%

How valid and applicable are current diagnostic criteria and assessment methods for dentin hypersensitivity? An overview

Gernhardt

2012

Clin Oral Invest

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ObjectivesAlthough dentin hypersensitivity is a common clinical condition and is generally reported by the patient after experiencing a sharp, short pain caused by one of several different external stimuli, it is often inadequately understood. The purpose of this paper is to discuss different available diagnostic approaches and assessment methods used in order to suggest a basis to diagnose, monitor, and measure these challenging painful conditions related to dentin hypersensitivity in daily practice and scientific projects properly.Material and methodsA PubMed literature search strategy including the following MeSH terms were used as follows: “dentin sensitivity”[MeSH Terms] OR “dentin”[All Fields] AND “sensitivity”[All Fields] OR “dentin sensitivity”[All Fields] OR “dentin”[All Fields] AND “hypersensitivity”[All Fields] OR “dentin hypersensitivity”[All Fields] AND “diagnosis”[Subheading] OR “diagnosis”[All Fields] OR “diagnosis”[MeSH Terms] AND “assessment”[All Fields] AND (“methods”[Subheading] OR “methods”[All Fields] OR “methods”[MeSH Terms]. Furthermore, alternative terms such as “validity,” “reliability,” “root,” “cervical,” “diagnostic criteria,” and “hypersensitivities” were additionally evaluated.ResultsThe literature search, also including the alternative terms and journals, revealed only a small number of specific papers related to valid diagnosis, diagnostic criteria, and assessment methods of dentin hypersensitivity. Outcomes from these publications showed that the response to different stimuli varies substantially from one person to another and is, due to individual factors, often difficult to assess correctly. Furthermore, the cause of the reported pain can vary, and the patient’s description of the history, symptoms, and discomfort might be different from one to another, not allowing a reliable and valid diagnosis.ConclusionsThe dental practitioner, using a variety of diagnostic and measurement techniques each day, will often have difficulties in differentiating dentin hypersensitivity from other painful conditions and in evaluating the success of a conducted therapy in a reliable way.Clinical relevanceCorrect diagnosis of dentin hypersensitivity including a patient’s history screening and a brief clinical examination in combination with the identification of etiologic and predisposing factors, particularly dietary and oral hygiene habits associated with erosion and abrasion, is essential. The relevant differential diagnosis should be considered to exclude all other dental conditions with similar pain symptoms.

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Section: Discussionsupporting

confidence: 62%

How valid and applicable are current diagnostic criteria and assessment methods for dentin hypersensitivity? An overview

Gernhardt

2012

Clin Oral Invest

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“…Evidence from extracted teeth indicates that this is indeed the case 43,44 . The question relevant to this debate is whether tooth brushing alone or with toothpaste is involved in either or both lesion localisation or initiation.…”

Section: Is Tooth Brushing Involved In Dentine Hypersensitivity?mentioning

confidence: 99%

Tooth brushing, tooth wear and dentine hypersensitivity — are they associated?

Addy

2005

International Dental Journal

210

186

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Evidence suggests that patients suffer the painful symptoms of dentine hypersensitivity when dentine is exposed and the dentinal tubule system is opened to the oral cavity to allow stimuli to trigger a neural response in the pulp via a hydrodynamic mechanism. The processes needed to localise lesions of dentine hypersensitivity include loss of enamel and/or gingival recession. Whilst tooth brushing with or without toothpaste appears to cause minimal wear to enamel (in the absence of acids), circumstantial evidence implicates tooth brushing with gingival recession and exposure of dentine. Other tooth wear processes notably attrition and acid erosion cause loss of enamel and can expose dentine. Therefore sensitivity may result. How lesions of dentine hypersensitivity are initiated is a matter of conjecture and based on extrapolating data from studies, mainly in vitro, to affect in vivo. Again this circumstantial type of evidence suggests that abrasion by some toothpastes and erosion by dietary acid could open the tubule system. Little is known about the actual effect of desensitising toothpastes on lesions of dentine hypersensitivity even though they are formulated to either occlude dentinal tubules or block the neural response in the pulp. Clinical studies have produced contradictory findings for the efficacy of products and there have been extremely few evidence based reviews. In conclusion, available evidence supports a probable link of tooth brushing, with or without toothpaste and an acidic diet to both tooth wear and dentine hypersensitivity, and suggests also that dentine hypersensitivity is a tooth wear phenomenon. Although there is a need for more direct clinical and scientific evidence for these associations, it is recommended that they be taken into consideration when planning management strategies for the dentine hypersensitivity sufferer. Martin Addy Bristol, UKMany aspects of dentine hypersensitivity are poorly understood by dental professionals and in particular the aetiology of the condition. This has lead to a great deal of conjecture on the subject of how best to treat, or more importantly manage the condition. Much confusion has been caused by conflicting views and opinions. Over recent decades much has been learned through research on dentine hypersensitivity and the former logical approach to the condition has been replaced by a biological strategy. Unfortunately, the next stage of an evidence based understanding of dentine hypersensitivity has not yet been achieved. Thus, many of the conclusions drawn on aspects of dentine hypersensitivity are based on studies in vitro, epidemiological surveys, case reports and even anecdote. Data drawn from such sources provide evidence that may be more circumstantial than factual. One notable and important area of debate, even argument, is the role of tooth brushing and toothpaste in the aetiology, and therefore the treatment of dentine hypersensitivity. Indeed, there was for some time, and may be still, diametrically opposed views on whether dentine hyperse...

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“…Clinical and laboratory studies have shown that patients with clinical sensitivity have lost the 'protective smear layer' and show many more wider dentinal tubules; these tubules are open at the external tooth surface and are patent to the pulp. [6][7][8] Patients who suffer from DS have been shown to consume a more erosive diet that contains food and drinks high in fruit acids, such as citric acid. 9 Foods and drinks that contain high levels of fruit acid have been shown in vitro to remove the protective smear layer, exposing the underlying dentinal tubules.…”

Section: Introductionmentioning

confidence: 99%