State-of-the-Art Diagnostic and Treatment Methods for the Successful Management of Hypersensitive Teeth

Abstract

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.