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The importance of dental professionals dealing with a sensitive subject

Before diagnosing that a patient is suffering from dentine sensitivity, carrying out a differential diagnosis is essential1. In this article we consider this approach, as well as exploring the causes of sensitivity and the importance of effective treatments, recommended by dental professionals  to help patients overcome dentine sensitivity and the associated pain. Brought to you by Johnson & Johnson Ltd.

Recommend LISTERINE® Advanced Defence Sensitive for expert care when you’re not there

Sensitive teeth impact negatively on patients’ lives and their oral hygiene. Figures suggest that up to 69% of the population will experience sensitivity at some time2 and that when people have sensitive teeth3:

  • 42% find it painful at the dentist
  • 52% change their tooth brushing habits
  • 77% modify their eating
  • 85% are annoyed by the symptoms.

With 91% of sufferers believing that they have no other choice but to live with the painful condition3.

Differential diagnosis

Given the prevalence of dentine sensitivity, indeed up to 98% patients with periodontal disease and/ or its treatment claim to suffer with the condition4, Dental professionals may want to consider routinely screening for dentine sensitivity if the issue is not raised by patients.

Patients suffering from pain caused by dentine sensitivity may complain of problems when teeth come into contact with heat, cold, acids and sugar.

However, one of the difficulties when a patient complains of sensitivity is that the signs and symptoms associated with this condition are similar to some other clinical conditions, so ‘… it is important to distinguish between these in order to provide a correct diagnosis and successful management of the problem’4.

Some of the conditions that can present symptoms similar to those linked with dentine sensitivity, include4:

  • Dental caries
  • Cracked tooth syndrome
  • Improperly insulated metallic restorations
  • Post-operative sensitivity

Thus to correctly reach a diagnosis of dentine sensitivity, it is suggested that clinicians need to exclude the possibility that the pain is being caused by some other condition4.

Cause and effect

The most widely accepted mechanism of dentine sensitivity is the hydrodynamic theory proposed by Brännström, ‘whereby fluid flow within the dentinal tubules is altered (increased or changed directionally) by thermal, tactile or chemical stimuli near the exposed surface of the tubules’5.

This movement activates the nerves at the inner ends of the dentine tubules or the outer layers of the pulp4. Therefore, one of the greatest risk factors for sensitivity is exposed open dentine tubules.

Compared with non-sensitive teeth, dentine tubules in sensitive teeth are5:

  • 8x greater in number
  • 2x larger in diameter.

Combining these two factors, the fluid flow in teeth may be 100x greater.

In addition, the number and diameter of dentine tubules increase from the outer surface to the inner junction, increasing the likelihood of sensitivity worsening over time with loss of dentine5.

Products for lasting relief

According to this established theory, if the functional radius of opened dentinal tubules decreases, then the permeability is also decreased, reducing sensitivity.

“Thus, treatments for hypersensitivity should occlude dentinal tubules and prevent nerve sensitivity… However, superficial occlusion of tubules can be removed by daily tooth brushing, dissolution of the precipitate promoted by saliva or consumption of acidic beverages, leading to short-term desensitizing effects.” 6

To achieve effective long term effects intratubular deposition which reduces the fluid flow rate may be required 6.

Having established that effective and robust blocking of dentine tubules offers the greatest prospect for lasting relief of dentine sensitivity7, it seems prudent to consider some of the products clinically proven to do exactly that.

There are sensitivity toothpastes available that block tubules, however laboratory performance of some occluding toothpastes seems to indicate that these pastes leave a proportion of tubules unoccluded 8.

Also in existence are in surgery products based upon potassium oxalate. Potassium oxalate compounds have been in use as part of professionally applied sensitivity treatments such as varnishes, and now there is a mouthwash (LISTERINE® Advanced Defence Sensitive) proven to manage sensitivity effectively that patients can take home and use on an on-going basis 9.

The potassium oxalate compounds in this mouthwash bind to calcium in the saliva and crystals are formed. The crystals are deposited on the dentine and deep inside the exposed open tubules, and build with every rinse to provide deep, stable and comprehensive tubule occlusion.

The stability of the occlusion was put through a rigorous erosive and mechanical test and demonstrated that the mouthwash featuring patented potassium oxalate crystal technology withstands the daily challenges patients’ mouths may experience to provide lasting protection for sensitive teeth10in vitro*.Further, it blocks 92% of dentine tubules in just 6 rinses8 in vitro*.

The mouthwash from LISTERINE® can be used alone for lasting protection9 or in combination with the most recommended paste from the leading sensitivity brand, to significantly increase the number of tubules the paste blocks in vitro10,11,12.

On-going care

Once a diagnosis of dentine sensitivity has been made and the factors have been identified a treatment plan can be developed and outlined to the patient.  Depending on the severity of the condition, clinical management of dentine sensitivity may include both in-surgery and on-going use of an at-home sensitivity product. In most circumstances, the least invasive and most widely available treatment is the recommendation to use an effective at –home product such as a mouthwash.

*Based on percentage hydraulic conductance reduction

References:

  1. Cummins D et al. Am J Dent 2010; 23 Sp Is A: 3A-13A
  2. Gillam DG et al (2002) Journal of Oral Rehabilitation 29: 219-225
  3. Boiko  O V et al. J Clin Periodont 2010; 37: 937-80
  4. Gillam DG, Orchardson R. Endodont Topics 2006; 13: 13-33
  5. Canadian Advisory Board on Dentin Hypersensitivity, J Can Dent Assoc 2003; 69: 221-6
  6. Arrais C AG et al. Appl Oral Sci 2004; 12(2):144-8
  7. Cummins D. J Clin Dent 20 (Spec Iss):1–9, 2009
  8. Dentine Tubule Occlusion, DOF 1 – 2012
  9. Relief of Hypersensitivity, DOF 4 – 2012
  10. Tubule Occlusion Stability, DOF 3 – 2012
  11. Combination Tubule Occlusion, DOF 2 – 2012
  12. TNS – Sensitivity Market Research 1 – 2012

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