Definition:

• Dentine hypersensitivity is characterised by short sharp pain arising from exposed dentine in response to stimuli typically thermal, evaporative, tactile, osmotic or chemical and which cannot be ascribed to any other form of dental defect or disease.

Epidemiology:

• Variable and depends on whether self reported or measured at chair side.
• Recent study in Europe reported 42% self reported sensitivity and 57% responded to cold air stimulation in the surgery.
• Prevalence ranges from 4 to 74%
• Patients with periodontitis 60-98%
• Peaks between 30-40 years old
• Patients reluctant to divulge symptoms because of fear of cost of care and dentistry.

 Aetiology:

• Clinical findings are not always correlated to the degree of pain and there are clear differences in subjective pain experience.
• Two phases development: lesion localisation (exposure of dentine) and lesion initiation (opening of tubules – role of acids).
• Lesion localisation can be due to loss of enamel (abrasion, attrition, erosion) or gingival recession (over-zealous tooth-brushing or flossing, periodontitis, gingival trauma and crown preparation). 

Management:

• Dentine sensitivity is an underdiagnosed and undertreated, painful condition.
• Screening is important at regular dental check-up.
• Identification and modification of all predisposing factors is prerequisite for controlling sensitivity.
• When considering acidic foods and drinks, you need to look at both the pH and strength (titratable acidity).
• Dentine sensitivity is common among perio, whitening, restorative and molar-incisor hypomineralisation patients.
• Dentine sensitivity treatment should be considered within the management of perio patients.
• Patients undergoing tooth whitening treatment should be offered dentine senstivity treatment.
• Principles of de-sensitising dentine:
  1. Desensitising the nerves (K+ ions)
  2. Block the hydrodynamic mechanism and occlusion of open tubules (smear layer).
• Complete range of desensitising products that can address different patient needs and enable a targeted dentine senstivity treatment considering the underlying cause
• In surgery or home use products
• Treat with a step-by-step approach e.g. with over-the-counter products following by in surgery treatment (e.g. fluoride varnish, bonding agent, restoration).

General Dental