Dentine hypersensitivity is a frequently encountered patient complaint that can present with a number of associated factors including erosion and abrasion. The hydrodynamic mechanism responsible for dentine hypersensitivity is intimately related to the anatomical and physiological composition of teeth. Alterations to the integrity of the enamel and dentine through processes of trauma, decay and toothwear can increase dentine permeability. This gives rise to symptoms of sensitivity as dentinal fluid movement in response to thermal, chemical and mechanical cues stimulate the pulpal Aδ fibres. Restorative procedures can also rapidly change the architecture of the protective enamel and dentine layers leading to pulpal inflammation and increased thermal sensitivity of the tooth. Patient-reported symptoms of dentine hypersensitivity can be attributed to a number of possible causes and a definitive diagnosis can therefore be difficult. A full history including social and medical factors such as occupation, diet and/or medication is likely to provide significant information to aid a diagnosis. Consideration of occlusal factors should not be overlooked as these may contribute to symptoms arising from a cracked tooth. Management strategies are linked to the diagnosis – from topically applied desensitising pastes and resin bonding agents to direct restorations and possibly more advanced restorative procedures such as root canal treatment. Management should, however, be staged to enable more conservative strategies to prevail prior to considering irreversible dental interventions.
This case reinforces the importance of careful investigation and planning in ensuring an optimal outcome when addressing multiple dental anomalies. Extensive consideration of the initial treatment strategy is required, coupled with evaluation of the outcome and longevity of any potential treatment modality to be employed. The consideration of inevitable future restorative treatment is fundamental, highlighting the importance of multidisciplinary planning at diagnosis. Moreover, orthodontic, aesthetic, behavioural and/or social factors may further complicate management in adolescents.
Highlights the broad capabilities and potential contributions of design.Discusses barriers and drivers to the adoption of inclusive and human-centred design in oral health.
Oxford Assess and Progress: Clinical Dentistry features over 270 Single Best Answer questions. Written and peer-reviewed by clinicians working within each specialty and mapped to dental school curricula, this is an authoritative guide for dental students providing a wealth of revision. Organised by specialties, chapter introductions unlock difficult subjects with hints and tips. Each question is accompanied by detailed answers explaining the rationale behind right and wrong answers. Cross-references to the Oxford Handbook of Clinical Dentistry and further reading resources, expand your revision further. A four star rating system indicating question difficulty to monitor your progress as you learn. Key words also help highlight specific clues or words that can assist with recall. Oxford Assess and Progress: Clinical Dentistry is your prescription for exam succcess.
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