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Clinical evaluation of cervical dentin sensitivity (CDS) in patients attending general dental clinics (GDC) and periodontal specialty clinics (PSC).

AIM: The objective of this study was to compare the prevalence, severity and distribution of CDS in patients attending general dental clinics (GDC) and periodontal specialty clinics (PSC) and to correlate them to possible causal factors. MATERIAL AND METHODS: 2 groups of patients aged 20-60 years recruited from GDC (144) and PSC (151) were evaluated for CDS by means of a questionnaire and intraoral clinical examinations. Furthermore, gingival recession and plaque scores were recorded at the same visit. RESULTS: The results showed that patients referred to PSC had a significantly higher prevalence of CDS (60.3%) than those examined at GDC (42.4%) (p<0.001). Also, mean plaque scores of PSC patients (1.87 +/- 0.88) was found to be significantly higher than that of GDC (1.44 +/- 0.7) (p<0.01). The occurrence and extent of gingival recession associated with hypersensitive teeth was significantly higher in PSC than GDC patients (p<0.01), with a 5% incidence of severe recession (5 mm) in PSC only. The association of periodontal disease and periodontal treatment to the high prevalence of CDS and gingival recession in PSC patients would suggest their role in predisposition to hypersensitivity. The distribution of CDS in tooth types revealed that upper molars and lower anteriors of PSC patients were mainly affected, and followed by, to a lesser extent, lower right canine and right first molars of GDC patients. CONCLUSION: The prevalence of CDS among our periodontal patients appears somewhat lower than that reported in periodontal specialty clinics of earlier studies but still higher than those reported in other dental populations. This indicates that periodontal disease and its treatments may increase the occurrence of hypersensitivity.

Adult↗

Dentin sensitivity, odontoblasts and nerves under desiccated or infected experimental cavities. A clinical, light microscopic and ultrastructural investigation.

Cavities were prepared in 35 pairs of young human premolars. One tooth in each pair served as a control. In one Series the test cavity was desiccated with compressed air for one minute. LM and TEM examination of the dentin and the adjacent pulp revealed an extensive aspiration of odontoblasts. Nerve fibers had moved 0.1 to 0.2 mm outward in the tubules. It is suggested that a streching or disruption of the nerve had occurred during desiccation. In a second Series, the test cavity was infected for 1 to 2 weeks. No nerve fibers were seen in the dentinal tubules under the cavities, only cellular remnants and some microorganisms. Despite the absence of nerves the dentin in the bottom of the infected cavities was highly sensitive to stimulation. It was concluded that the nociceptive nerves present in the adjacent inflamed pulp may be terminals, mechanosensitive in nature and that they activated by rapid outward movements of the tubules fluid.

Dental Pulp↗

Comparative efficacy of two dentifrices containing 5% potassium nitrate on dentinal sensitivity: a twelve-week clinical study.

The effect of a dentifrice containing 5.0% potassium nitrate, 1.3% soluble pyrophosphate, 1.5% PVM/MA copolymer, and 0.243% sodium fluoride in a silica base (Sensitive/Tartar Control) on dentinal hypersensitivity over a twelve-week period was compared to a commercially available dentifrice containing 5% potassium nitrate and 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base (Sensodyne-F). A total of ninety-seven subjects were entered into the study, and stratified into two balanced groups according to their baseline mean air sensitivity score and baseline mean tactile (Yeaple Probe) sensitivity score. The two groups were randomly assigned to use either the Sensitive/Tartar Control dentifrice or the commercially available hypersensitivity control dentifrice with potassium nitrate. The two groups were balanced with regard to their mean baseline air and tactile sensitivity scores, sex and age. Subjects were instructed to brush their teeth twice daily (morning and evening) for one minute with their assigned dentifrice and a commercially available soft-bristled toothbrush. Dentinal hypersensitivity examinations, which included tactile sensitivity, cold air blast, and a visual analog scale were conducted at baseline, six weeks, and twelve weeks. All examinations were conducted by the same dental examiner. After six weeks' use of the assigned dentifrices, there were no statistically significant differences between dentifrice groups in any of the parameters assessed (tactile, cold air blast and visual analog scale). After twelve weeks' use of the assigned products, there were no statistically significant differences between dentifrice groups in any of the parameters assessed (tactile, cold air blast and visual analog scale). Thus it can be concluded from this study that the use of a dentifrice containing 5.0% potassium nitrate, 1.3% soluble pyrophosphate, 1.5% PVM/MA copolymer, and 0.243% sodium fluoride in a silica base provides a clinically effective method of reducing dentinal hypersensitivity which is comparable in efficacy to a commercially available hypersensitivity control dentifrice containing 5% potassium nitrate and 0.76% sodium monofluorophosphate in a dicalcium phosphate dihydrate base.

Adult↗

Dentine hypersensitivity. A study of the patency of dentinal tubules in sensitive and non-sensitive cervical dentine.

Based on the hydrodynamic theory for stimulus transmission across dentine, it would be logical to conclude that teeth exhibiting the clinical symptoms referred to as dentine hypersensitivity should have dentinal tubules open at the root surface and patent to the pulp. With the exception of studies on cut dentine, there is little direct evidence to support this conclusion. In this study, caries-free teeth with exposed cervical root areas scheduled for extraction which were classified as non-sensitive or hypersensitive after suitable stimulation were examined by scanning electron microscopy. Hypersensitive teeth showed highly significantly increased numbers of tubules per unit area (approximately 8 X) compared with non-sensitive teeth. Tubule diameters were significantly wider (approximately 2 X) in hypersensitive compared to non-sensitive teeth. The number of teeth showing the penetration of methylene blue through the zone of exposed cervical dentine was larger and the depth of penetration greater in hypersensitive teeth compared to non-sensitive teeth. The results provide further evidence that stimulus transmission across dentine in hypersensitive teeth is mediated by a hydrodynamic mechanism. An understanding of factors which open dentinal tubules would seem important if attempts to prevent or treat dentine hypersensitivity are to be successful.

Dentin↗

The effects of primers on the sensitivity of dentin.

The effects of dentin primers on the sensitivity of dentin were examined by measurement of the repetitive firing observed when a class V cavity prepared in the dentin of the lower jaw of a rabbit was irritated by a blast of compressed air. It was possible to conclude that the combined application of an aqueous solution of 35% hydroxyethyl methacrylate and a commercially available dentin bonding agent was effective for reducing the repetitive firing and for maintaining such a "sedative " effect. Although the dentin tubules were sealed mechanically by the resin material, it was impossible to explain the mechanism by which the dentin primer application reduced firing.

Aminosalicylic Acids↗

Clinical evaluation of two adhesive composite cements for the suppression of dentinal cold sensitivity.

STATEMENT OF PROBLEMS: Postoperative cold sensitivity after the cementation of indirect restorations with composite cements has been reported frequently but not scientifically documented. PURPOSE: This controlled clinical study was designed to simulate the dentin/composite cement interface immediately after cementation of a cast restoration. The desensitizing capabilities of a composite cement that contains a self-etching, dual-polymerizing resin adhesive system were compared with those of a composite cement that use phosphoric acid etching followed by a single-bottle, light-activated primer/resin-based adhesive. MATERIAL AND METHODS: The hypersensitive root surfaces of selected teeth were randomized to receive 1 of 3 treatments: coating with a self-etching adhesive (Linkmax) and its respective cement, coating with a conventionally etched adhesive (RelyX ARC) and its cement, or no treatment (negative control). The sample size was 22. Dentin sensitivity was ascertained with an accurate cold testing device that slowly decreased in temperature. Tooth sensitivity was measured both immediately and at 7 days after placement. Two-way analysis of variance and Fisher's least significant difference test (P<.05) were used to determine whether significant differences existed as a function of treatment type or time. RESULTS: Immediately after placement, the self-etching adhesive and its respective cement resulted in more suppression of cold sensitivity than no treatment (control); with Linkmax treatment, the temperature at which teeth responded was reduced by 8.4 degrees C. The conventionally etched adhesive and its cement reduced the temperature at which teeth responded by 9.4 degrees C. After 1 week, these temperature reductions were 7.0 degrees C and 4.3 degrees C, respectively. Untreated controls at the 2 intervals showed a mean decrease in sensitivity to cold of 3.6 degrees C and 4.1 degrees C. Statistical analysis showed type of composite cement to be a significant factor. CONCLUSION: Within the limitations of this study and in comparison to untreated control teeth, Linkmax treatment resulted in a significant reduction in tooth root sensitivity over 1 week (P=.02), whereas RelyX ARC did not (P=.066).

Acid Etching, Dental↗

Dentine hypersensitivity. The development and evaluation of a replica technique to study sensitive and non-sensitive cervical dentine.

Studies of extracted teeth have shown that teeth exhibiting dentine hypersensitivity have larger numbers of widened dentinal tubules at the dentine surface compared to non-sensitive teeth. Many compounds used in the treatment of dentine hypersensitivity are thought to achieve therapeutic benefit by tubule occlusion, but there has been almost no attempt to prove such action in vivo. These studies systematically determined whether the dentine surface could be evaluated non-invasively, by a scanning electron microscopic replica technique. Employing a silicone rubber impression method in vitro, the surface detail of dentine could be accurately replicated, with surface scratches, tubules and intratubular structures on the original reproduced on the replica. With attention to method, similar accuracy was achieved in vivo, particularly when tubules were open on the dentine surfaces of the original. The method would appear useful for the study of the dentine surface in cases of dentine hypersensitivity and could prove the first objective method of studying the effects of treatment agents used in the treatment of this painful condition.

Acid Etching, Dental↗