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PubMed2006

Managing dentin hypersensitivity.

BACKGROUND: The objective of this review is to inform practitioners about dentin hypersensitivity (DH) and its management. This clinical information is described in the context of the underlying biology. TYPES OF STUDIES REVIEWED: The authors used MEDLINE to find relevant English-language literature published in the period 1999 to 2005. They used combinations of the search terms "dentin*," "tooth," "teeth," "hypersensit*," "desensiti*" and "desensitiz*." They read abstracts and then full articles to identify studies describing etiology, prevalence, clinical features, controlled clinical trials of treatments and relevant laboratory research on mechanisms of action. RESULTS: The prevalence of DH varies widely, depending on the mode of investigation. Potassium-containing toothpastes are the most widely used at-home treatments. Most in-office treatments employ some form of "barrier," either a topical solution or gel or an adhesive restorative material. The reported efficacy of these treatments varies, with some having no better efficacy than the control treatments. Possible reasons for this variability are discussed. A flowchart summarizes the various treatment strategies. CLINICAL IMPLICATIONS: DH is diagnosed after elimination of other possible causes of the pain. Desensitizing treatment should be delivered systematically, beginning with prevention and at-home treatments. The latter may be supplemented with in-office modalities.

Adhesives↗
PubMed1998

Effects of desensitizing agents on human dentin permeability.

PURPOSE: To compare the in vitro effects of three desensitizing agents on hydraulic conductance of human dentin: Protect (n = 10), Gluma Desensitizer (n = 10), MS Coat (n = 10) (Pain-Free in the USA). MATERIALS AND METHODS: Dentin discs were prepared from 40 freshly extracted normal human third molars. The pulpal side of the dentin discs was etched with 37% phosphoric acid for 15 s and then rinsed under tap water. The coronal side was sequentially ground and the dentin discs were sonicated for 30 min. The hydraulic conductance was measured filtering 20% serum in phosphate buffered saline under a pressure of 15 cm H2O. The hydraulic conductance of each dentin specimen was measured before using the desensitizing agent and this value was designated as 100%. Thirty dentin discs were treated, the hydraulic conductance was remeasured and expressed as a percentage of the hydraulic conductance of that specimen before treatment. The teeth were stored for 1 month at 37 degrees C in deionized water and the hydraulic conductance of the 40 dentin discs was recorded again. Ten dentin discs were left untreated to serve as a control. RESULTS: No statistical difference was found between the immediate hydraulic conductance of the three groups after treatment. After 1-month storage, the control group showed a statistically higher hydraulic conductance than the three treated groups. There was no statistical difference between the three dentin desensitizing agents evaluated.

Acid Etching, Dental↗
PubMed1999

Biological basis for clinical success: pulp protection and the tooth-restoration interface.

This article provides biological and technological information that strengthens clinicians' understanding of cohesive hybridization and pulp therapy in order to support their routine use of bonding and resin systems. Utilizing cohesive systems, clinicians should experience several advantages over traditional water-soluble base and liner systems. When properly applied, cohesive hybridization of vital dentin prevents immediate postoperative hypersensitivity under all restorations and completely seals the entire tooth-restoration interface, which provides a reduction in recurrent caries.

Animals↗
PubMed2000

[Electroanalgesia: operating principles].

We are faced every day with the problem of dental pain arising from the concomitant action of the nerve fibres, the odontoblasts and the dentinal fluid. Its propagation is due to the triggering of the action potential from the resting potential. It can be reduced thanks to a reversible process of anelectrotonus in electro-analgesia.

Action Potentials↗
PubMedDate not supplied

Pulp-dentin biology in restorative dentistry. Part 5: Clinical management and tissue changes associated with wear and trauma.

Tooth wear occurs during normal mastication. Pathologic wear, including abrasion and erosion, may also take place. Formation of reactionary and reparative dentin and obturation of dentinal tubules are biologic responses that compensate for the loss of tissue. Physical trauma to teeth will affect the blood supply to the pulp. Extensive physical trauma may result in the formation of mineralized, often bonelike tissue in the pulp chamber. Minor trauma, such as that associated with orthodontic tooth movement, may exert transient effects on the pulp or it may result in permanent structural changes. No experimental data involving restorative work on traumatized teeth have been published, but available evidence suggests that special care may be necessary in the restoration of such teeth because their reaction patterns may differ from those in nontraumatized teeth.

Dental Deposits↗
PubMed2002

Efficiency and cytotoxicity of resin-based desensitizing agents.

PURPOSE: To compare in vitro the efficacy of five resin-based desensitizing agents at reducing human dentin permeability and to compare their cytotoxicity. The tested hypothesis was that their different curing techniques cause variations in efficiency and cytotoxicity. MATERIALS AND METHODS: Dentin slices (0.5 +/- 0.05 mm thick) were prepared from human third molars (10 per group) and their hydraulic conductance was recorded before and after application of one of the desensitizing agents with a Flodec device. Six desensitizing agents were studied: one light curing agent (Seal and Protect); one self-curing agent (Pain Free); the resin-based agents without any polymerization initiator (Health-Dent, Gluma Desensitizer, Isodan); one oxalate-based agent served as a control (Protect). A MTT assay on L 929 fibroblasts was performed to measure the cytotoxicity of the six desensitizing agents applied onto additional dentin slices (10 per group). RESULTS: All the desensitizing agents resulted in a large decrease in dentin permeability. The best results were obtained with Gluma Desensitizer, Isodan, Pain Free and Protect. A statistically significant difference was found among the materials (P = 0.001). All the materials were non-cytotoxic. Cell viability ranged from 88% for Seal and Protect to 100% for Isodan. No difference was found among their cytotoxicity.

Analysis of Variance↗
PubMed2003

Consensus-based recommendations for the diagnosis and management of dentin hypersensitivity.

These consensus recommendations for the diagnosis and management of dentin hypersensitivity were developed by a broadly constituted board of dentists and dental hygienists drawn from general dental practice, specialist practice, academia and research from across Canada, joined by 2 international dentists with subject matter expertise. The need for consensus recommendations was made evident by the lack of clear and robust evidence in the dental literature, as well as confusion about diagnosis and management demonstrated by an educational needs assessment survey. High prevalence of the condition, underdiagnosis and widespread availability of noninvasive, efficacious and inexpensive preventive treatment further underscored the need for direction. This paper outlines the key elements of the scientific basis for the causes, diagnosis and management of dentin hypersensitivity; where such evidence is deficient, the document relies on the compound experience of the board. A simple algorithm was developed to guide clinicians through the diagnostic process and assist them in determining appropriate case management. Finally, the board makes a series of recommendations to raise awareness, to improve dental education, to develop symbols for charting, to develop an index for case assessment and for further research.

Algorithms↗
PubMed2003

Dentin permeability and eugenol diffusion after full crown preparation.

PURPOSE: To compare teeth prepared to receive a metallic versus a metal-ceramic crown with respect to (1) in vitro dentin permeability before and after using a desensitizing agent and (2) pulpal eugenol concentration after sealing a temporary crown with a zinc oxide-eugenol based cement. MATERIALS AND METHODS: The roots of 20 human mandibular molars were separated and the crowns were prepared to receive a metallic crown. The hydraulic conductance was recorded before and after using Protect dentin desensitizer. The crowns were then further reduced to receive a metal-ceramic crown and the hydraulic conductance was recorded under the same conditions, on deeper dentin, before and after using the desensitizing agent. Twenty additional teeth were prepared: 10 to receive a metallic crown and 10 teeth to receive a metal-ceramic crown. A tube filled with 1 mL phosphate buffered saline (PBS) was sealed to the cementoenamel junction. A temporary crown was sealed onto the preparation with Temp Bond. The amount of eugenol that diffused across dentin into PBS was spectrofluorimetrically measured at Day 1 and Day 7. The crown preparations were vertically sectioned and the dentin remaining thickness was recorded. RESULTS: The hydraulic conductance of teeth prepared for a metal-ceramic crown was twice as high as teeth prepared for a metallic crown (P < 0.001). The desensitizing agent reduced the hydraulic conductance in both groups (P< 0.001). The two groups showed the same hydraulic conductance after using Protect (ns). No significant difference was found in the amount of eugenol diffusion between the two groups of teeth although eugenol diffusion decreased with time (P < 0.01). No correlation was found between eugenol diffusion and remaining dentin thickness.

Analysis of Variance↗
PubMed2004

Occlusion of dentin tubules by desensitizing agents.

PURPOSE: To evaluate the occluding effect of five desensitizing agents on human dentin tubules. METHODS: 30 buccal and lingual surfaces were prepared from 15 extracted intact third molars. Each surface was polished with aluminum oxide abrasive papers to remove enamel and to expose the underlying dentin in cervical area. The flat dentin surfaces were treated with 0.5 M EDTA for 2 minutes to expose dentin tubule orifices. The samples were randomly divided into six groups: AS - immersed in artificial saliva at 37 degrees C for 2 weeks (control); OX - Oxagel (monopotassium oxalate), DU - Duraphat (sodium fluoride), DE - Desensibilize (strontium chloride), OD - Odahcam (acidulated phosphate fluoride) and SE - Sensodyne (strontium chloride + calcium carbonate abrasive). Dentin desensitizers were applied during 2 weeks and after each application the samples were kept in artificial saliva at 37 degrees C. The samples were prepared according to the scanning electron microscope procedures and were examined at x2000 magnification. RESULTS: The results were expressed in percent (%) of tubule occlusion and analyzed by ANOVA and Duncan's multiple range test (P < 0.05): AS- 45.41 +/- 11.65a; OX- 42.65 +/- 11.79a; DU- 47.25 +/- 8.59ab; DE- 49.36 +/- 18.27ab; OD- 64.43 +/- 15.55b and SE- 65.44 +/- 10.93b. Results suggest that the dentin surfaces treated with OD and SE showed higher tubule occlusion when compared to AS and OX, but were not different compared to DU and DE treatments.

Acidulated Phosphate Fluoride↗
PubMed2005

[Neurophysiological background of pain in the orofacial area: review of the literature].

The article presents an overview on the peripheral and central neural mechanisms underlying pain in the orofacial area. First a definition of pain and a description of general aspects of orofacial pain are presented. Characteristics of acute and chronic pain are also described. The study highlights the sense organs, the molecular mechanisms and categories of primary afferents involved in peripheral events of orofacial pain. After describing the brain-stem nuclei participating in trigeminal pain and their functional role, primary afferents involved in nociceptive sensation from the tooth pulp, explanations of dentinal sensitivity and differences between the brain-stem endings of primary afferents among different species are discussed in details. The role of higher brain centres, with a special emphasis on the thalamus and somatosensory cortex in the development of orofacial pain sensation is considered. The last section provides a review about how the activities of nociceptive neurons are controlled by higher brain centres and neurochemicals involved in pain transmission.

Acute Disease↗
PubMed1990

[Microleakage: evaluation and treatment].

Microleakage is a biological phenomenon with several implications. The affective component patient hyperalgesia (pain/hypersensitivity) of dentin which is a function of episodic hydrodynan (fluid) movement. The effective component is the disease process which signals the dentin-pulp complex to respond by disposition of sclerotic and/or reparative dentin. Vital dentin is an extension the pulp, presenting the first line of response to the consequences of microleakage. Recent data has demonstrated a correlation between pulp response and material biocompatibility when microleakage is prevented. Dentin-pulp healing is ensured when a proper hermetic seal is provided to control prevent microleakage. A critical evaluation of various clinical procedures is discussed.

Dental Leakage↗
PubMedDate not supplied

[Clinical evaluation of a posterior photopolymerizing composite: results 4 years after application].

The aim of this study was to examine clinical results of class I and class II composite restorations of forty two posterior teeth, considering pulpal vitality, dentinal sensitivity, marginal integrity, contact areas, color, gingival irritation and secondary decay. The restorations were evaluated over a four-year period. The results are considered satisfactory both from a chemical-physical and biological point of view. The Authors wish to outline the importance to improve the operative technique to minimize the disadvantages of these materials and to obtain better results. The Authors propose to carry out a later control to confirm these results.

Adolescent↗