Hygienists’ corner

Hygienists’ corner

For hygienists, by hygienists. Deborah Lynne offers advice on the management and prevention of dentinal hypersensitivity.

Sensitive teeth is one of the most common oral complaints I receive from patients.

Dentinal hypersensitivity is characterised as a sharp and transitory pain arising from exposed dentine, in response to an external stimulus in the oral environment.

Up to 30% of adults have dentine hypersensitivity at some period in their lives (Trushkowsky, Oquendo, 2011), with a high prevalence in the 18-40-year-old age group (Canadian Advisory Board on Dentin Hypersensitivity, 2003).

Over the years, an increase has been noted in younger generations due to an excessive consumption of acidogenic beverages and the imperceptive use of whitening products. If left untreated, it can prompt the onset of other oral conditions such as dental decay, gingivitis and periodontitis.

Sensitivity origins

Dentine consists of microscopic tubules filled with nerve endings. The outer enamel layer protects the dentine within the crown section of the tooth, and the dentine extending down the root is protected by a
layer of cementum.

Sensitivity occurs when dentine loses its protective layer of enamel or cementum, exposes the nerve endings to the elements.

It can originate from worn enamel, exposing dentine due to aggressive over- brushing with a hard toothbrush, which can also lead to gum recession leading to exposed root surfaces.

It can also be caused by over-consumption of acidic food and beverages, caries, broken teeth, worn or leaky fillings, attrition, or even during and after dental treatment.

Preventative measures

A dental expert diagnosis is firstly needed to determine that the tooth pain is a definite result of dentinal sensitivity. Once the cause is identified, the hygienist can advise on the appropriate home care and in-surgery
solutions. Hygienists can advise dietary adjustments, such as avoiding acidic foods and drinks. I demonstrate proper brushing techniques with a soft toothbrush and a non-abrasive toothpaste. Poor habits such as bruxism can be avoided with the use of a nightguard.

Desensitising the nerve by occluding the dentinal tubules reduces sensitivity – this can be achieved by using active ingredients such as potassium salts (potassium nitrate, potassium chloride), strontium, Pro-Argin
technology – combining arginine and insoluble calcium carbonate and sodium fluoride.

These ingredients help occlude the tubules and promote remineralisation. They can be found in various desensitising dentifrices, which are most effective when used twice daily to build and maintain a
protective barrier or applied directly to the problem area. Patient compliance is necessary for results.
In surgery, I apply fluoride varnishes where applicable, which form calcium globules occluding the tubules, and light-activated sealants that infiltrate and seal the dentinal tubules.

Once the patient understands the causes, a preventative treatment plan can be put in place. Management of sensitivity generally involves a combination of at-home and in-surgery therapies.

References
Canadian Advisory Board on Dentin
Hypersensitivity (2003) Consensus-based
recommendations for the diagnosis and
management of dentin hypersensitivity. J
Can Dent Assoc 69(4):221-6
Trushkowsky RD, Oquendo A (2011)
Treatment of dentin hypersensitivity.
Dental Clinics of North America.
55(3):599-608

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