Dentin Hypersensitivity

What is Dentin Hypersensitivity?

Dentin hypersensitivity is an oral condition characterized by a sharp pain in the affected tooth or teeth. The stimuli expose the dentin. It typically responds to thermal, evaporative, tactile, or chemical stimuli.

Dentin hypersensitivity is often described as the "common cold of dentistry" by some and "toothbrush disease" by others.

Prevalence of Dentin Hypersensitivity

Age: It is common in the age group of 20 to 40 years due to unmonitored dietary habits

Sex: It is more predominant in females than males

Region in the oral cavity: It can impact one or more teeth. This is especially true for canines and premolars in both upper and lower jaws

What is Dentin?

A tooth has the following layers:

• Enamel: The outer layer in the upper portion of the tooth. It is more transparent, so when it wears away, you might see the yellowish dentin underneath. It also shields your teeth from strong sensations and wear and tear
• Cementum: The outer layer in the lower portion of the tooth. This portion of the tooth is usually inside the bone
• Dentin: Layer present below enamel and cementum. Tooth dentin appears yellow, is hard in nature, and consists of minerals, collagen, and water.
• Pulp: The core layer lies below the dentin in the pulp chamber and contains an abundance of nerves and blood vessels.

Tiny channels called dentinal tubules connect the dentin to the pulp. Odontoblasts, cells that make dentin, line these channels.

Any tooth sensitivity, such as pain from temperature changes, goes through these channels to reach the nerves in the pulp. These nerves interpret this as the sensitivity of your dentin.

What are the Causes of Dentin Hypersensitivity?

Dentin hypersensitivity develops in stages, starting with local enamel erosion and progressing to dentin tubule exposure. Key factors include:

• Gum recession: This happens when gum tissue recedes from tooth roots due to poor oral hygiene. It's a form of periodontal disease known as receding gums. It often occurs due to improper or excessive tooth brushing.
• Plaque Build-up: When you do not maintain oral hygiene, plaque deposits on the tooth's surface. This makes the gum recede and exposes the root's surface, leading to the weakening of the tooth structure. It can also lead to gum disease.
• Brushing and Diet: Enamel can wear away due to overzealous brushing, abrasive toothpaste, hard foods, or acidic drinks.

• Grinding and Clenching: Teeth grinding or clenching harms enamel when teeth rub together. This is known as bruxism and can lead to tooth wear.
• Acid Exposure: Repeated or long-term exposure to acids from food or regurgitation damages teeth.
• Aging: Over time, enamel can wear down, but the body adds secondary dentin to repair teeth throughout life.

What are the Risk Factors of Dentin Hypersensitivity?

• People who eat or drink a lot of acidic things or snacks often are at risk of tooth enamel erosion.
• Drinking lots of carbonated beverages, canned juices, beer, flavored waters, machine-prepared tea or coffee, energy drinks, sour candies, and foods puts you at a high risk as there is exposure to primary dentin.
• People with a history of GERD (gastroesophageal reflux), gastritis, pregnant women, and people on chemotherapy are at high risk.
• People who don't produce enough saliva, known as dry mouth disorder, are at a greater risk. It is because a good environment for acid-producing microorganisms is created to grow in the mouth.
• Dental treatments like root canal treatment, and filling can lead to hypersensitivity(1^✔).

Dentin Hypersensitivity Symptoms

Symptoms and signs of Dentinal Hypersensitivity include:

• Feeling sensitive to hot or cold things
• Sharp, quick pain with hot or cold foods
• Aching and sensitivity if you touch the tooth area
• Not feeling good when using rough toothpaste or mouthwash
• The tooth is sensitive to sour or sweet foods(2^✔)

How is Dentin Hypersensitivity Diagnosed?

The dentist will take a detailed medical and dental history of the patient. This will include questions about the eating habits and oral hygiene practices that the patient follows.

After recording the history, the doctor performs a clinical examination. They may employ different techniques to diagnose dentinal hypersensitivity. These methods include:

• Response to pain on tapping the teeth to rule out inflammation of dental pulp tissue (pulpitis)
• Response to pain biting a hard surface, like a wooden stick to rule out a fracture
• Dental X-ray to diagnose fractures
• Exposing the tooth to a jet of air to evaluate the tooth's response(3^✔)

What is the Treatment for Dentin Hypersensitivity?

Dental hypersensitivity treatment includes:

Dentin Hypersensitivity Self-Care

If dentin hypersensitivity is in the initial stages, the doctor would recommend some self-care measures:

• Over-the-counter toothpaste available in the market is the most cost-effective way of dealing with dentin hypersensitivity.

• Employing the right methodology for brushing

• Maintaining oral hygiene

• Size and Shape of the Brush: The brush's size and shape matter. It should fit well in your mouth and reach all corners effectively. Soft-bristled brush should be preferred.

• Changing the Toothbrush: Change your toothbrush every 3-4 months. If bristles are worn out, replace them immediately.

• Fluoride Toothpaste: Use only toothpaste accepted by the American Dental Association, as it contains fluoride.

Brushing the Whole Mouth for Good Oral Health

• Brushing Technique: Hold the toothbrush at a 45-degree angle to your gums. Brush with short back-and-forth strokes
• Brush all surfaces of your teeth - outer, inner, and chewing surfaces
• Do not put excessive pressure on the mouth during brushing
• Do not excessively scrub the cervical part of the tooth
• Do not use excessive amounts of dentifrice during brushing
• Use desensitizing dentifrices with potassium salts as it helps in reducing tooth sensitivity
• Use toothpaste containing sodium fluoride and calcium phosphates. The most recommended ones are the kinds of toothpaste with potassium nitrate
• Use mouthwash containing potassium or sodium salts
• Reduce the quantity of acidic food intake
• Avoid brushing your teeth immediately after taking acidic food or drinks
• Keep a gap between food intake, and after every meal rinse your mouth with water(4^✔)

Dentin Hypersensitivity Medication and Therapy

The dentist might recommend the application of desensitizing agents or nerve desensitization therapies to reduce the pain(5^✔).

Occlusive Therapy:

• Protect exposed dentin with desensitizing agents.
• Examples: varnish, calcium compounds, fluoride compounds, etc.
• Reduces dentin permeability and sensitivity.

Laser Therapy:

• Erbium YAG or Er: YAG laser used.
• Reshapes dentin, closing tubules and reducing sensitivity.
• Also affects nerve activity, aiding protein coagulation.

Ozone Therapy:

• Ozone is applied to exposed tubules.
• Kills bacteria and supports mineralization.

Resin-Based Materials:

• Apply fluoride varnish or specific solutions to exposed dentin.
• Eases tooth hypersensitivity.

Oxalates:

• Apply oxalate particles to the dentin surface.
• Decreases pain perception from stimuli.

Iontophoresis:

• Use gentle current to close dentin tubules.
• Calcium and fluoride gels help block tubules.

Gum Grafts or Gingival Grafts:

• Treats gingival recession-causing sensitivity.
• Apply adhesive resin or glass ionomer to the affected area.

References:

1. Relationship between Food Habits and Tooth Erosion Occurrence in Malaysian University Students - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3431744/)
2. Dentin hypersensitivity: pain mechanisms and aetiology of exposed cervical dentin - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3585766/)
3. Dental records: An overview - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3009547/)
4. Brushing Your Teeth - (https://www.mouthhealthy.org/en/all-topics-a-z/brushing-your-teeth)
5. Treatment of Gingival Recession: When and How? - (https://pubmed.ncbi.nlm.nih.gov/34024328/)

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