The cause of postrestorative sensitivity and its prevention.
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By using a dentifrice or toothpaste for sensitive teeth, the brushing-induced effects on dentinal tubule occlusion and abrasion of human sound dentin were investigated with a scanning electron microscope and a scanning laser microscope. The dentifrice contained diatomaceous earth and silica as abrasives and strontium chloride hexahydrate as an active ingredient. Thirty dentin pieces of human premolar teeth with an average of 20% occluded dentinal tubules were attached to resin plates and exposed to the oral cavities of five adult subjects for 2, 4, and 8 weeks. Brushing with and without dentifrice was performed 1 min per day, respectively. Brushing with the dentifrice gradually decreased the mean average of occluded tubules from about 91 to 77% during 2 to 8 weeks, although there were no significant differences among the individual values. However, the mean abrasive loss of the dentin surfaces brushed with dentifrice significantly increased from about 52 to 143 microm in depth. The brushed surfaces of the dentin showed a rough topography with numerous toothbrush scratches but no organic pellicle was found. On the other hand, brushing without dentifrice caused about 99% of the dentinal tubules to occlude in 2 and 4 weeks and 100% in 8 weeks. The brushed dentin surfaces at 8 weeks were entirely covered with organic pellicle containing fine mineral granules derived from saliva, and the abrasive loss was about 1.4 microm in mean depth. Such results indicate that brushing with abrasive dentifrices for sensitive teeth remarkably erodes dentin, and suggest that the brushing should cause the dentinal tubules to open again for a certain period of time.
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This paper presents data from a mail survey on dental and facial pain. The survey was conducted in the City of Toronto in 1986. The aim of the study was to obtain estimates of the prevalence of such pain and its impact on daily life. A random sample of 1014 names was drawn from the voters' list, and, as a result of four mailings, information was obtained on 71.6% of the eligible sample. Of those returning questionnaires, 39.7% reported dental or facial pain in the previous four weeks. A psychological impact in the form of worry or concern was reported by 70.3% of those experiencing pain, while 58.0% reported one or more behavioral impacts. The most common behavioral impacts were consulting a dentist or doctor, avoiding certain foods, taking medication, and disturbance of sleep. Severe behavioral impacts such as work disability, need for bed rest, and reduced social contacts were also reported by some of those having pain. The results suggest that dental and facial pain imposes a significant burden on the community. Further research is indicated, with more sensitive impact measures being used.
Amelogenesis imperfecta is a hereditary disorder that affects enamel on primary and permanent teeth. It is a rare dental disease but represents a major restorative challenge for the dentist. A 14-year-old boy presented with sensitive, discolored, and mutilated teeth and a decreased vertical dimension of occlusion. The aim of treatment was to reduce dental sensitivity, to restore esthetics, and to correct the vertical dimension of occlusion. To modify the occlusion, and to protect the dentin from chemical and thermal attacks, nickel-chrome onlays were placed on the molars. To improve the esthetics of the incisors and premolars, resin composite restorations were applied. The patient was regularly recalled during the postoperative period. Radiographic and clinical examinations 10 months posttreatment revealed no evidence of disorders associated with the restored teeth or their supporting structures.
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The difficulty related to achieving a balance between wet and dry dentin makes the dentin bonding technique extremely sensitive. This study evaluated the effect of rewetting dried dentin with two commercial desensitizing agents (Protect and HurriSeal) on the dentin shear bond strength of three total-etch dentin bonding agents (Syntac Single-Component, OptiBond Solo Plus and Prime & Bond NT) and compared both to applying these same bonding agents to moist dentin and dry dentin. Each bonding agent was paired with an appropriate resin composite from the same manufacturer (Table 1). Recently extracted, formalin-treated caries-free human molars were used. The occlusal surface of each tooth was ground to create a flat dentin surface. Then, each tooth was mounted in acrylic. Twelve groups (n = 15) were prepared: 1) Syntac Single-Component with Heliomolar resin composite (SSC/H) to moist dentin; 2) SSC/H to dry dentin; 3) SSC/H to dried dentin rewet with Protect; 4) SSC/H to dried dentin rewet with HurriSeal; 5) OptiBond Solo Plus with Point 4 resin composite (OBS+/P4) to moist dentin; 6) OBS+/P4 to dry dentin; 7) OBS+/P4 to dried dentin rewet with Protect; 8) OBS+/P4 to dried dentin rewet with HurriSeal; 9) Prime & Bond NT with TPH Spectrum resin composite (PBNT/TPH) to moist dentin; 10) PBNT/TPH to dry dentin; 11) PBNT/THP to dried dentin rewet with Protect and 12) PBNT/TPH to dried dentin rewet with HurriSeal. Groups 1, 5 and 9 were placed according to manufacturers' instructions (moist dentin) as control groups. All the other groups received a 15-second air blast after etching and prior to applying the one bottle adhesive or desensitizer and one bottle adhesive. Resin composite cylinders [4 mm in diameter and 2 mm in height] were then placed. The specimens were stored in distilled water at 37 degrees C for 24 hours prior to thermocycling 2,500 times (at 8 degrees C and 48 degrees C). Shear bond strengths (SBSs) were measured one week after fabrication by using a circular knife-edge and crosshead speeds of 0.5 mm/minute. Failure modes of debonded specimens were determined under a stereomicroscope (30x). Failed specimens with the low and high shear bond strengths in each group were evaluated under a low vacuum Scanning Electron Microscope (SEM-LV). One-way ANOVA and Tukey's tests were used to compare the different conditions for each bonding system. In the Syntac Single-Component bonding agent groups, there was no significant difference in shear bond strength between the control (15.73 MPa), dry (18.11 MPa) and HurriSeal (16.18 MPa) specimens. Protect specimens showed significantly lower shear bond strength (6.39 MPa). In the OptiBond Solo Plus bonding agent groups, there was no significant difference between the control (20.79 MPa) and the HurriSeal (21.29 MPa) groups, and both groups had significantly greater bonds than the dry (14.13MPa) and Protect (9.57 MPa) groups. In the Prime & Bond NT bonding agent groups, the shear bond strength of the HurriSeal group (20.73 MPa) was significantly higher than the other groups: control (8.05 MPa), dry (5.73 MPa) and Protect (5.45 MPa).