Current diagnosis of dentin hypersensitivity in the dental office: an overview

Abstract

ObjectivesThe aim of this overview is to consider the problems that may be associated with making a diagnosis of dentin hypersensitivity (DHS) and to provide a basis for clinicians to effectively diagnose and manage this troublesome clinical condition.Materials and methodsA PUBMED literature research was conducted by the author using the following MESH terms: (‘diagnosis’[Subheading] OR ‘diagnosis’[All Fields] OR ‘diagnosis’[MeSH Terms]) AND (‘therapy’[Subheading] OR ‘therapy’[All Fields] OR ‘treatment’[All Fields] OR ‘therapeutics’[MeSH Terms] OR ‘therapeutics’[All Fields]) AND (‘dentin Sensitivity’[MeSH Terms] OR (‘dentin’[All Fields] AND ‘sensitivity’[All Fields]) OR ‘dentin sensitivity’[All Fields]). Variations to the above MeSH terms using terms such as ‘cervical’, ‘dentine’ and ‘hypersensitivity’ as substitutes were also explored, but these searches failed to add any further information.ResultsThe literature search provided only limited data on specific papers relating to the clinical diagnosis of DHS by dental professionals. Evidence from these published studies would therefore indicate that clinicians are not routinely examining their patients for DHS or eliminating other possible causes of dental pain (differential diagnosis) prior to subsequent management and may rely on their patients’ self-reporting of the problem. Furthermore, the findings of the Canadian Consensus Document (2003) would also suggest that clinicians are not confident of successfully treating DHS.ConclusionsIt is apparent from reviewing the published literature on the diagnosis of DHS that there are a number of outstanding issues that need to be resolved, for example, (1) is the condition under- or overestimated by dentists, (2) is the condition adequately diagnosed and successfully managed by dentists in daily practice, (3) is the impact of DHS on the quality of life of sufferers adequately diagnosed and treated and (4) is the condition adequately monitored by clinicians in daily practice. These and other questions arising from the workshop forum should be addressed in well-conducted epidemiological and clinical studies in order for clinicians to be confident in both identifying and diagnosing DHS and subsequent management that will either reduce or eliminate the impact of DHS on their patients’ quality of life.Clinical relevanceClinicians should be made aware not only of the importance of identifying patients with DHS but also of the relevance of a correct diagnosis that may exclude any confounding factors from other oro-facial pain conditions prior to the successful management of the condition.

Original Articles

“…This is defined as an acute, sharp pain initiated in a dentin exposed area of the tooth in response to chemical, thermal, tactile or osmotic stimuli. This pain cannot be attributed to any other form of dental pathology (3) . As exposed by Brännström (4) fluid movement inside dentinal tubules triggered by external stimuli (as cold, hot or pressure) reaches nerve receptors at the pulp-dentin complex generating pain (hydrodynamic theory of dentinal pain).…”

“…Dental adhesive materials attempt to occlude dentinal tubules mechanically blocking extrinsic stimulus, and so decreasing sensitivity (3) . In our study all treated groups showed dentin permeability, expressed as hydraulic conductance, although all were adhesively treated.…”

Preventive dentistry 3. Prevalence, aetiology and diagnosis of dentine (hyper)sensitivity

“…Een handige tip voor de diagnostiek is de applicatie van een fl uoridelak op blootliggend worteloppervlak, waarbij de clinicus voor en na applicatie de ernst van het probleem evalueert met een luchtstoot waarbij na de applicatie de klachten minder zouden moeten zijn. Voorgeschiedenis van restauratieve procedures kan ook helpen bij het elimineren van andere mogelijke oorzaken van de pijn (Gillam, 2013).…”

Clinical presentation and physiological mechanisms of dentine hypersensitivity

“…A number of clinical conditions may elicit the short, sharp tooth sensitivity that is characteristic of DH (summarized in Table 2.1). 9,10,12,15,16 These conditions require treatment options that are usually quite different from those used for DH. Therefore, it is necessary to take the proper time to make a correct diagnosis, because DH is always a diagnosis of exclusion; it can only be definitively confirmed after all other possible conditions have been diagnostically eliminated.…”

“…24 Several studies indicate that even though high percentages of a population may report having sensitive teeth, a much smaller proportion actually has DH diagnosed on the basis of defined clinical diagnostic criteria. 2,16,17 Another factor that may explain the huge range in self-reported prevalence figures is the subjective nature of pain. The experience of a sensory event is highly subjective, can vary substantially between individuals, and is related to individual tolerance of pain as well as to physical and emotional factors.…”