Potassium nitrate-fluoride reduces bleaching sensitivity, report says.
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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 effect 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 de-sensitising 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 also suggests 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.
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OBJECTIVES: The objective of this work was to determine if there were differences in the distribution of tube-like structures within the tubules of biopsies from hypersensitive versus non-sensitive human cervical radicular dentine. METHOD: Ten pairs of dentine were made from the exposed sensitive and non-sensitive radicular dentine of nine adult patients complaining of dentine sensitivity. The biopsies were made with a small hollow diamond bur. The specimens were submitted to HCl-collagenase treatment to partially digest the surface to permit visualization of subsurface structures. Half of the specimens were embedded in resin to facilitate longitudinal sectioning, and the other half were processed with embedding for SEM and EDS observation. RESULTS: Biopsies from hypersensitive regions exhibited hollow, tube-like structures within the lumina of dentinal tubules in 75.8 +/- 9.4%) ( mean +/- S.D.) of the tubules. In biopsies of non-sensitive areas of the same teeth, these tube-like structures were only seen in 20.4 +/- 8.5% of the tubules. In specimens that were embedded prior to treatment with HCl-collagenase, resin tags penetrated many of the tubules from hypersensitive dentine but few of the tubules from non-sensitive dentine. CONCLUSION: It is speculated that tube-like structures found in hypersensitive dentine play a role in maintaining the patency of the tubules which may prevent physicochemical processes from spontaneously occluding the tubules, thereby maintaining dentine sensitivity.
In an era when many clinicians are confused or almost overwhelmed by the rapidity of change in the field of conservative dentistry, the purpose of this presentation/paper is to identify briefly, with 'bottom line' statements, the research evidence in many topics within this field. The fields to be covered are glass ionomer restorations, 'compomer' restorations, composite resins, 'posterior composites', post-restoration sensitivity, direct pulp therapy, resin bonding to enamel and to dentine.
2 new methods are described for measuring the sensitivity of dentine to mechanical (probe) and cold-air stimulation. The methods are suitable for clinical use and could be used in the evaluation of desensitising treatments. In addition to qualitative differences in the pattern of sensitivity of teeth to these stimuli, considerable variation was observed in the distribution of pain thresholds to probe and air stimulation. Thresholds were not significantly affected by the age or sex of the subjects, but mean thresholds of teeth sensitive to only one stimulus were significantly greater than thresholds of teeth sensitive to both stimuli; these differences were most marked in female subjects. Factors such as the qualitative differences in sensitivity to various stimuli and quantitative differences in the degree of sensitivity to the stimuli require to be considered in clinical evaluation of desensitizing treatments.
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The correlation between thermal sensitivity and the microorganisms present in 29 deep carious lesions was studied. The numbers of lactobacilli and total Gram-positive rods in the carious lesions were found to be negatively related to the length of pain triggered by cold and heat stimulants. The presence of Gram-positive cocci and non-black-pigmented Bacteroides were positively associated with both cold and heat sensitivities. Black-pigmented Bacteroides, Streptococcus mutans, and total anaerobic colony counts were positively related to the heat sensitivity. Recovery of Fusobacterium nucleatum, Actinomyces viscosus, and enterics on the selective plates was associated with cold sensitivity. Total counts of Gram-positive cocci and Gram-negative rods on the anaerobic nonselective medium were positively related to the cold sensitivity. It appeared that teeth with low numbers of lactobacilli in the carious lesions usually responded to thermal tests with longer duration of pain. Conversely, teeth with high numbers of lactobacilli in the carious lesions usually responded with shorter duration of pain.
Irritation of human teeth can evoke pain sensations of varying qualities depending on the type and intensity of the stimuli used. For example, drilling or air drying of dentin typically induces sharp, piercing pain, while intense heating of the tooth can cause dull, aching pain sensation. The dental pulp is richly innervated by both myelinated (A-fibers, mostly A delta-type) and unmyelinated (C-fibers) axons. A-fibers seem to be responsible for the sensitivity of dentin. They respond to stimuli that induce sharp pain in human teeth, for example, drilling of dentin and drying of dentin with air blasts. C-fibers are activated only when the stimuli used reach the pulp proper. They respond to intense heating. In human teeth, dull pain is induced at a temperature level corresponding to the heat thresholds of intradental C-fibers. The other functional characteristics of C-fibers indicate that they may play a role in the mediation of the dull pain connected with pulpal inflammation. Accordingly, activation of intradental nerve fibers of A- and C-type may contribute to the varying qualities of pain sensations induced by stimulation of human teeth.