-Surabhi desai

[Fourth year]

Guided by-Dr.Ashish Jain sir.

HOD of conservative and endodontics department

DENTINAL HYPERSENSITIVITY

INTRODUCTION

THERMAL STIMULUS

No

icecream

No tea

WHAT TO DO?

What is

it??????????

INTRODUCTION

DEFINITION

ETIOLOGY

MECHANISM

CLINICAL FEATURES

DISTRIBUTION

DIAGNOSIS

PREVENTION

TREATMENT

DIFFRENTIAL DIAGNOSIS

CONTENTS

Pain is short and sharp.

caused by exposed dentin.

In response of stimulus:

1.thermal

2.Tactile

3.Chemical/osmotic

4.evaporative

INTRODUCTION

STIMULUS

Pain

on???

??

“Dentin hypersensitivity is characterisedby short , sharp pain arising from exposed

dentin in response to stimuli typically thermal, evaporative ,tactile , osmotic or

chemical and which cannot be ascribed to any other form of dental defect or

pathology.”HOLLAND ET AL 1997

DEFINITION:

ETIOLOGY

ETIOLOGY

ENAMEL

LOSS

ETIOLOGY

CEMENTAL

LOSS

The history and nature of pain.Describe the pain.

The number and location of sensitive teeth.

The stimuli which initiate the sensitivity.

Tooth brushing method.

If he has undergone periodontal surgery.

Obtain detailed dietary history.

Probe for gastric acid reflux and vomiting.

DIAGNOSIS

THEORIES OF PAIN

DIRECT

INNERVATION

THEORY

ODONTOLAST

DEFORMATION

THEORY

HYDRODYNAMIC

THEORY

DISTRIBUTION

FEMALE CANINE

PREMOLARPERIODONTITIS

Affects the

buccal aspect

of cervical

area

Age group

25-50

AN OUNCE OF PREVENTION IS

WORTH A POUND OF CURE

How to

prevent???

????????

desensitizationAT HOMEIN OFFICE

by occluding the Dentinal tubules

by blocking the pulpal Sensory nerve

MANAGEMENT:

MECHANISM

DESENSITISATION BY OCCLUDING DENTINAL TUBULES

A)FORMATION OF SMEAR LAYER OVER EXPOSED DENTIN

B)USE OF TOPICAL AGENTS TO OCCLUDE EXPOSED TUBULES

CALCIUM HYDROXIDE PASTE

SILVER NITRATE

FLUORIDE

VARNISHES

DENTIN ADHESIVES

PROTEIN PRECIPITATION

GLUTERALDEHYDE

STRONTIUM CHLORIDE

CLASSIFICATION

C)PLACEMENT OF RESTORATIONS

GLASS IONOMER CEMENTS

COMPOSITE RESINS

D)USE OF LASERS

2. DESENSITIZING BY BLOCKING PULPAL SENSORY

NERVES

A)POTASSIUM NITRATE TOOTHPASTE

OTHERS

CORTICOSTEROID

CLASSIFICATION

Use of topical agents to occlude the dentinal tubules

•Calcium hydroxide- calcium hydroxide powder can be mixed with distilled water to

form paste. This is then applied on the exposed dentin . It increases peritubular

dentin formation.

COMMERCIALLY AVAILABLE

PRODUCT – GC TOOTH MOUSSE.

SILVER NITRATE• It reduces the fluid movement by precipitating the protein within the

dentinal tubules.DISADVANTAGE: this agents is not popularly used nowadays as it stains dentin and is also damaging to the pulp and gingiva.

Strontium chloride •It acts by penetrating the tubules and forming strontium apatite which occludes the exposed dentinal tubules•It is incorporated in desensitizing toothpastes.

Fluorides:

Agents such as sodium fluoride , stannous fluoride, or acidulated phosphate fluoride may be used for a few minutes as mouth

rinses, toothpastes or as topical applications over exposed dentin.

They act by forming fluorapatite within the tubules which blocks fluid movement within

the dentin.

Varnishes:

•Varnishes act by forming a barrier over the exposed dentin.

•This lowers hypersensitivity as it reduces dentin permeability.

Placement of restorations:

•Whenever a considerable amount of dentin is lost,, a glass ionomer or a composite resin restoration may be

placed to replace the lost tooth structure and seal the exposed dentin.

It reducing the excitability of the sensory nerves in response to stimuli.

Potassium nitrate toothpastes: Potassium ions from potassium nitrate toothpastes can easily pass

through the dentin to the pulp .Here they depolarizes of the sensory nerve endings present

close to the odontoblasts BY ALTERING THEIR

MEMBRANE POTENTIAL thus preventing the transmission of impulses to brain.

DESENSITIZATION BY BLOCKING PULPAL SENSORY NERVES:

Nd-YAG) laser

Neodymium:yttrium aluminum garnet

GaAlAs (galium-aluminium-arsenide laser)

Erbium-YAG laser

USE OF LASERS

THEY OCCLUDE THE DENTINAL TUBULES.

The CO2 laser belongs

to the group of the middle-output power lasers.

LASERS

Direct

method

Indirect

method

DIFFERENTIAL DIAGNOSIS

THANK YOU