DENTIN HYPERSENSITIVITY: DIAGNOSIS AND TREATMENT METHODS

Abstract

Dentin hypersensitivity has been defined as the short, sharp and severe pain arising from exposed dentin in response to thermal, evaporative, tactile, electrical, chemical or osmotic stimuli. Various theories about pain mechanism of dentin hypersensitivity have been reported but none of the pain mechanisms has not been proved yet. The epidemiological research reported hypersensitivity and day after day it is increasing. The aetiology of dentin hypersensitivity is multifactorial. Diagnosis is difficult. Different materials and methods have been used for the treatment of dentin hypersensitivity but a gold standart for treatment has not been found yet. The definition, theories about pain mechanisms, aetiology and risk factors, diagnosis and treatment of dentin hypersensitivity will be discussed in this review

Keywords

• Pain Mechanism,Dentin Hypersensitivity,Aetiology,Treatment

DENTİN AŞIRI HASSASİYETİ: TANI VE TEDAVİ YÖNTEMLERİ

Abstract

Dentin aşırı hassasiyeti, açığa çıkmış dentinin termal, buharlaşma, dokunma, elektriksel, kimyasal veya osmotik uyaranlara karşı cevap olarak oluşturduğu kısa süreli, keskin ve şiddetli ağrı olarak tanımlanmaktadır. Ağrı mekanizması ile ilgili çeşitli teoriler ortaya atılmış ancak; dentin aşırı hassasiyetinin oluşturduğu ağrı mekanizması halen kesin olarak anlaşılamamıştır. Epidemiyolojik çalışmalar da çok farklı sonuçlar elde edilmiştir. Etyolojisi multifaktöri- yeldir. Görülme sıklığı gün geçtikçe artan dentin aşırı hassasiyeti diğer tüm patolojilerin elenmesi ile teşhis edilebildiği için teşhisi zor bir durumdur. Tedavisi amacıyla pek çok materyal ve yöntem denenmiştir ancak henüz altın standart olabilecek bir yöntem belirlenememiştir. Bu derlemede dentin aşırı hassas- iyetinin tanımı,  ağrı mekanizması ile ilgili teoriler, etiyoloji ve risk faktörleri, tanı ve teşhisi ile tedavide kullanılan materyal ve yöntemler tartışılacaktır.

Keywords

• Ağrı Mekanizması,Dentin Aşırı Hassasiyeti,Etiyoloji,Tedavi

References

1. Gernhardt CR. How valid and applicable are current diagnostic criteria and assesment methods for dentin hypersensitivity? An overview. Clin Oral Invest 2013;17:31-40.
2. Attar N, Korkmaz Y. Dentin aşırı hassasiyeti. Hacettepe Üniv Diş Hek Fak Derg 2006;30:83-91
3. Bamise CT, Olusile AO, Oginni AO, Dosumu OO. The prevalence of dentine hypersensitivity among adult patients attending a Nigerian teaching. Oral Health Prev Dent 2007;5:49-53.
4. Chabanski MB, Gillam DG, Bulman JS, Newman HN. Clinical evaluation of cervical dentine sensitivity in a population of patients referred to a specialist periodontology department: a pilot study. J Oral Rehabil 1997;24:666-72.
5. West XN, Sanz M, Lussi A, Bartlett D, Bouchard P, Bourgeois D. Prevelance of dentine hypersensitivity and study of associated factors: A European population-based cross-sectional study. J Dent 2013;41:841-51.
6. Ye W, Feng X-P, Li R. The prevalence of dentine hypersensitivity in Chinese adults. J Oral Rehabil 2012;39:182–7.
7. Gillam DG, Newman HN. Assessment of pain in cervical dentinal sensitivity studies. J Clin Periodontol1993;20:383-94.
8. Gernhardt CR. How valid and applicable are current diagnostic criteria and assesment methods for dentin hypersensitivity? An overview. Clin Oral İnvest 2013;17:31-40.

9. Ernst E. Placebo: new insights into an old enigma. Drug Discov Today 2007;12:413–8.
10. McCarney R,Warner J, IIiffe S, van Haselen R, Griffin M, Fisher P. The Hawthorne Effect: a randomised, controlled trial. BMC Med Res Methodol 2007;7:30.
11. Markowitz K. A new treatment alternative for sensitive teeth: A desensitizing oral rinse. J Dent 2013;41:1-11.
12. Barsky AJ, Saintfort R, Rogers MP, Borus JF. Nonspecific medication side effects and the nocebo phenomenon.JAMA 2002;287:622-7.
13. West NX, Lussi A, Seong J, Hellwig E. Dentin hypersensitivity: pain mechanisms and aetiology of exposed cervical dentin. Clin Oral Invest 2013;17:9-19.
14. Dellow PG, Roberts ML. Bradykinin application to dentine: A study of a sensory receptor mechanism. Aust Dent J 1966;11:384-7 DH. 15. Pashley Smear layer physiological considerations. Oper Dent 1984;3:13-29.
15. Rugg-Gunn AJ, Macgregor IDM. A survey of toothbrushing behaviour in children and young adults. J Periodontal Res 1978;13:382-9.
16. Haywood VB. Dentine Hypersensitivity: bleaching and restorative considerations for successfull management. Int Dent J 2002;52:7-10.
17. Orbak R. Dentin Aşırı Duyarlılığı. Atatürk Üniv. Diş Hek. Fak. Derg. 1995;5:104-11.
18. Schiff T, Dotson M, Cohen S, De Vizio W, McCool J, Volpe A. Efficacy of a dentifrice containing potassium nitrate, soluble pyrophosphate, PVM/MA copolymer, and sodium fluoride on dentinal hypersensitivity: a twelve-week clinical study.J Clin Dent 1994;5:87-92.
19. Pereira R, Chava VK. Efficacy of a 3% potassium nitrate desensitizing mouthwash in the treatment of dentinal hypersensitivity. J Periodontol 2001; 72: 1720-5.
20. Pradeep AR, Agarwal E, Naik SB, Bajaj P, Kalra N. Comparison of efficacy of three commercially available dentifrices on dentinal hypersensitivity: a randomized clinical trial. Aust Dent J 2012;57:429– 34.
21. Wara-aswapati N, Krongnawakul D, Jiraviboon D, Adulyanon S, Karimbux N, Pitiphat W. The effect of a new toothpaste containing potassium nitrate and triclosan on gingival health, plaque formation and dentin hypersensitivity. J Clin Periodontol 2005; 32:53-8.
22. Guentsch A, Seidler K, Nietzsche S, Hefti AF, Preshaw PM, Watts DC, Klaus DJ, Bernd WS. Biomimetic mineralization: Long-term observations in patients with dentin sensitivity. Dent Mater 2012; 27: 457-64.
23. Minkoff S, Axelrod S. Efficacy of Strontium Chloride in Dental Hypersensitivity, J Periodontol 1987; 58: 470-4.
24. Mason S, Hughes N, Sufi F, Bannon L, Maggio B, North M, Holt J. A comparative clinical study investigating the efficacy of a dentifrice containing 8% strontium acetate and 1040 ppm fluoride in a silica base and a control dentifrice containing 1450 ppm fluoride in a silica base to provide immediate relief of dentin hypersensitivity. J Clin Dent 2010;21:42-8.
25. Parkinson CR, Willson RJ. An in vitro investigation of two currently marketed dentin tubule occlusion dentifrices. J Clin Dent 2011;22:6-10.
26. Ni LX, He T, Chang A, Sun L. The desensitizing efficacy of a novel stannous-containing sodium fluoride dentifrice: an 8-week randomized and controlled clinical trial. Am J Dent 2010;23:17B- 21B.
27. Schiff T, Bonta Y, Proskin HM, DeVizio W, Petrone M, Volpe AR. Desensitizing efficacy of a new dentifrice containing 5.0% potassium nitrate and 0.454% 2000;13:111-5. Am J Dent
28. Aparna S, Setty S, Thakur S. Comparative efficacy of two treatment modalities for dentinal hypersensitivity: A clinical trial. Indian J Dent Res 2010; 21:544-8.
29. Kern DA, McQuade MJ, Scheidt MJ, Hanson B Dyke TEV. Effectiveness of Sodium fluoride on tooth hypersensitivity with and without Iontophoresis. J Periodontol 1989;60:387-9.
30. Singal P, Gupta R, Pandit N. 2% Sodium fluoride- iontophoresis compared to a commercially available desensitizing agent. J Periodontol 2005;76:351-7.
31. Gillam DG, Mordan NJ, Sinodinou AD, Tang JY Knowles JC. The effects of oxalate-containing products on the exposed dentine surface: an SEM investigation. J Oral Rehabil 2001;28:1037-44.
32. Yiu CKY, King NM, Suh BI, Sharp LJ, Carvalho RM, Pashley DH, Tay FR. Incompatibility of oxalate desensitizers with acidic, fluoride-containing total- etch adhesives . J Dent Res 2005;84:730-5.
33. Vachiramon V, Vargas MA, Pashley DH, Tay FR, Geraldeli S, Qian F, Armstrong SR. Effects of oxalate on dentin bond after 3-month simulated pulpal pressure. J Dent 2008;36:178–85.
34. Lehmann N, Degrange M. Effect of four dentin desensitizer on the shear bond strength of three bonding systems. Eur Cell Mater 2005;9:52-3.
35. Huh JB, Kim J-H, Chung M-K, Lee H-Y,Choi Y-G, Shim J-S. The effect of several dentin desensitizers on shear bond strength of adhesive resin luting cement using self-etching primer. J Dent 2008;36:1025 –32.
36. Hamlin D, Williams KP, Delgado E, Zhang YP, Devizio W, Mateo LR. Clinical evaluation of the efficacy of a desensitizing paste containing 8% arginine and calcium carbonate for the in-office relief of dentin hypersensitivity associated with dental prophylaxis. Am J Dent 2009;22:16A-20A
37. Schiff T, Delgado E, Zhang YP, Cummins D, Devizio W, Matio LR. Clinical evaluation of the efficacy of an in-office desensitizing paste containing 8% arginine and calcium carbonate in providing instant and lasting relief of dentin hypersensitivity. Am J Dent 2009;22:8A-15A.
38. Mitchell JC, Musanje L, Ferracane JL. Biomimetic dentin desensitizer based on nano-structured bioactive glass. Dent Mater 2011;27:386-93.
39. Lynch E, Brauer DS, Karpukhina N, Gillam DG, Hill RG. Multi-component bioactive glasses of varying floride content for treating dentin hypersensitivity. Dent Mater 2012;28:168-78.
40. Chen WC & CS, Kung JC, Hsiao YC, Shih CJ, Chien CS. Effects of bioactive glass with and without mesoporous structures on desensitization in dentinal tubule occlusion. App Sur Sci 2013; 283: 833-42.
41. Tirapelli C, Panzeri H, Lara EHG, Soares RG, Peitl O, Zanotto ED. The effect of a novel crystallised bioactive glass ceramic powder on dentin hypersensitivity a long term clinical study. J Oral Rehabil 2011;38:253-62.
42. Ananthakrishna S, Raghu TN, Koshy S, Kumar N. Clinical evaluation of the efficacy of bioactive glass and strontium chloride for treatment of dentinal hypersensitivity. J Interdiscip Dentistry 2012;2:92- 7.
43. Bakry AS, Tamuro Y, Otsuki M, Kasugai S, Ohya K, Tagami J. Ctotoxicity of 45S5 bioglass paste used for dentine hypersensitivity treatment. J Dent 2011;39:599-603.
44. Forsback A. & P, Areva S, Salonen JI. Mineralization of dentin induced by treatment with bioactive glass S53P4 in vitro. Acta Odontol Scand 2004; 62:14-20.
45. Polderman RN, Frencken JE. Comparison between effectiveness of a low-viscosity glass ionomer and a resin-based glutaraldehyde containing primer in treating dentine hypersensitivity—a 25.2-month evaluation . J Dent 2007;35:144-9.
46. Ünlü İ, Bala O. Dentin duyarlılığı tedavisinde değişik materyallerin etkinliğinin klinik olarak değerlendirilmesi. GÜ Diş Hek Fak Derg 2008; 25: 13-8.
47. Akca AE, Gökce S, Kürkçü M, Özdemir A. Clinical assessment of bond and fluoride in dentin hypersensitivity. Hacettepe Üniv. Diş Hek Fak Derg 2006; 30:92-100.
48. Yu X, Liang B, Jin X, Fu B, Hanning M. Comparative in vivo study on the desensitizing efficacy of dentin desensitizers and one-bottle self- etching adhesives. Oper Dent 2010;35:279-86.
49. Birang R, Poursamimi J, Gutknecht N, Lampert F, Mir M. Comparative evaluation of the effects of Nd:YAG and Er:YAG laser in dentin hypersensitivity treatment. Lasers Med Sci 2007;22:21–4.
50. Schwarz F, Arweiler N, Georg T, Reich E. Desensitizing effects of an Er:YAG laser on hypersensitive dentine. A controlled, prospective clinical study. J Clin Periodontol2002;29:211–5.
51. Yılmaz HG, Cengiz E, Kurtulmuş-Yılmaz S, Leblebicioğlu B. Effectiveness of Er,Cr:YSGG laser on dentine hypersensitivity: a controlled clinical trial. J Clin Periodontol 2011;38:341-6.
52. Yılmaz HG, Kurtulmuş-Yılmaz S, Cengiz E. Clinical evaluation of Er,Cr:YSGG and GaAlAs laser therapy for treating dentine hypersensitivity: A randomized controlled clinical trial. J Dent 2011;39:249-54.
53. Akca AE, Gökce S, Kürkçü M, Özdemir A. A clinical investigation of low level laser irradiation on hypersensitive dentine. Hacettepe Diş Hek Fak Derg 2006;30:92-9.
54. Yılmaz HG, Kurtulmuş-Yılmaz S, Cengiz E. Long- term effect of diode laser irradiation compared to sodium flouride varnish in the treatment of dentine hypersensitivity in peirodontal maintenance patients: A randomized controlled clinical study. Photomed Laser Surg 2011;29:721-5.
55. Lopes AO, Aranha ACC. Comparative evaluation of the effects of Nd:YAG laser and a desensitizer agent on the treatment of dentin hypersensitivity: A clinical. Photomed Laser Surg 2013;31:132-8.
56. Yılmaz HG, Bayındır H, Cengiz E, Berberoğlu A. Dentin Cumhuriyet Dent J 2012;15:71-82. tedavi yöntemleri.
57. Orchardson R, Gillam DG. The efficacy of potassium salts as agents for treating dentin hypersensitivity. J Orofac Pain 2000;14:9-19.
58. Bozok Y. Dentin hassasiyeti tedavisinde diş hekimi tarafından uygulanan desensitize edici ajanlar. ADO Klinik Bilimler Dergisi 2011;5:867-74.
59. Schüpbach P, Lutz F, Finger WJ. Closing of dentinal tubules by Gluma desensitizer. Eur J Oral Sci 1997;105:414-21.
60. Jain P, Vargas MA, Denehy GE, Boyer DB. Dentin desensitizing agents: SEM and X-ray microanalysis assessment. Am J Dent 1997;10:21-6.
61. Shiau HJ. Dentin hypersensitivity. J Evid Base Dent Pract 2012;12:220-8.
62. Banfield N, Addy M. Dentine hypersensitivity: development and evaluation of a model in situ to study tubule patency. J Clin Periodontol 2004;31:325-35.
63. Pinto SCS, Silveria CMM, Pochapski MT, Pilatti GL, Santos FA. Effect of desensitizing toothpastes on dentin. Braz Oral Res 2012;26:410-7.
64. Rölla G, Saxeguard E. Critical evaluation of the composition and use of topical fluorides, with emphasis on the role of calcium fluoride in caries inhibition. J Dent Res 1990;69:780-5.
65. Ripa LW. A critique of topical fluoride methods (dentifrices, mouthrinses, operator-, and self- applied gels) in an era of decreased caries and increased fluorosis prevalence. J Public Health Dent 1991;51:23-41. 70. Bozok
66. Y. Dentin hassasiyeti, etiyolojisi ve
67. tedavisinde güncel yaklaşımlar: Hassasiyet giderici
68. diş macunları. ADO Klinik Bilimler Dergisi 2011;5:859-66.
69. Cunha-Cruz J, Stout JR, Heaton LJ, Wataha JC. Dentin hypersensitivity and oxalates: a systematic review. J Dent Res 2011;90:304-3
70. Sezgin B, Tarım B. Dentin hassasiyeti ve tedavisi. İstanbul Üniversitesi Diş Hekimliği Fakültesi Dergisi 2012;46:88-100.
71. Panagakos F, Schiff T, Guignon A. Dentin hypersensitivity: Effective treatment with an in- office desensitizing paste containing 8% arginine and calcium carbonate. Am J Dent 2009;22:3A-7A. 74. Cummins
72. D. Dentin hypersensitivity: from
73. diagnosis to a breakthrough therapy for everyday
74. sensitivity relief. J Clin Dent 2009;20:1-9.
75. Petrou I, Heu R, Stranick M, Lavender S, Zaidel L, Cummins D, Sullivan RJ, Hsueh C, Gimzewski JK. A breakthrough therapy for dentin hypersensitivity: how dental products containing 8% arginine and calcium carbonate work to deliver effective relief of sensitive teeth. J Clin Dent 2009; 20: 23-31.
76. Sharif MO, Iram S, Brunton PA. Effectiveness of arginine containing toothpastes in treating dentin hypersensitivity: A systematic review. J Dent 2013; 41:483-92.
77. Oliveira DWD, Oliveira-Ferreira F, Flecha OD, Gonçalves PF. Is surgical root coverage effective for the treatment of cervical dentin hypersensiti- vity? A systematic review. J Periodontol 2013;84: 295-306.
78. Kimura Y, Wilder-Smith P, Yonaga K, Matsumoto K. Treatment of dentine hypersensitivity by lasers: a review. J Clin Periodontol 2000;27:715–21.
79. Myers TD, McDaniel JD. The pulsed Nd:YAG dental laser: review of clinical applications. J Can Dent Assoc 1991;19:25-30.
80. Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A. Lasers for treatment of dentin hypersensitivity: A meta-analysis. J Dent Res 2013;92:492-9.
81. Yonaga K, Kimura Y, Matsumoto K. Treatment of cervical dentin hypersensitivity by various methods using pulsed Nd:YAG laser. J Clin Laser Med Surg 1999;17:205-10. 82. Yılmaz
82. D, Güncü GN. Dentin hassasiyeti:
83. mekanizmalar, etiyoloji ve tedavi yaklaşımları. ADO
84. Klinik Bilimler Dergisi 2011;5:833-40.
85. Toker H, Özan F, Özdemir H, Değer O. Dentin hassasiyetinin tedavisinde propolisin etkisi. GÜ Diş Hek Fak Derg 2008;25:1-6.