Dentin hypersensitivity: prevalence, etiology, pathogenesis, and management
Dentin hypersensitivity is simply defined as a short sharply painful reaction of the exposed and innervated pulp dentin complex in response to stimuli being typically thermal, evaporative, tactile, osmotic, or chemical and which reaction cannot be attributed to any dental defect or pathology. To be hypersensitive, dentin must be exposed and the exposed tubules must be open and patent to both the oral cavity and the pulp. Exposure of dentin through the loss of gingival and periodontal tissue may be caused by either too meticulous or by neglected oral hygiene. Exposure of dentin by the loss of the protecting enamel is mainly caused by erosion, abrasion, and abfraction or a combination thereof. Clinical examination for dentin hypersensitivity would include a pain provocation test by a tactile stimulus, an evaporative air stimulus, or a cold stimulus. A number of other dental conditions can give rise to pain symptoms, which may mimic those of dentin hypersensitivity. Therefore, careful examination is necessary to exclude the conditions, which need different treatment options. When the patients do suffer from dentin hypersensitivity, there is broad range of treatment options comprising home use and professional approaches. It is advised to start with the less invasive home use therapies and only expand to professional in office treatments when the home use treatments are not effective. When decided to continue with in office treatments, again one should start with the least invasive ones. The working mechanisms fall under two basic categories being nerve desensitization (potassium salts and guanethidine) and occlusion of exposed dental tubules (chemically: strontium, fluoride, stannous, oxalate, calcium phospho silicate, arginine calcium carbonate, nano hydroxyapatite, and glutaraldehyde; mechanically: pumice paste, glassionomers, dentin bondings, and resins; laser therapy) Regenerative mucogingival therapy also remains an alternative, where hard and soft tissue conditions allow.