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04 December 2019

Dentin Hypersensitivity: Etiology, Mechanism and Prevention

Giulia Palandrani


Etiology  
Dentin hypersensitivity (DH) is defined as diminutive and sharp pain which arises from exposed dentin surface in reaction to a stimulus of thermal, evaporative, tactile, osmotic or chemical origin.   The prevalence has been reported at 8 to 35% of the population and affects more women than men.   Etiology of DH in not well understood. Various etiological and predisposing factors have been proposed to be associated with DH such as gingival recession, loss of enamel, abrasion, bruxism.   Gingival recession is seen in the population who usally have a high standard of oral hygiene or those who have poor standard of oral hygiene.   Acid erosion can be derived from many sources such as gastric, intrinsic, and extrinsic sources which are dietary in origin. Individual susceptibility results in the loss of enamel to acid erosion.   Abrasion of exposed dentin occurs due to improper oral hygiene practices.  

Mechanism  
Most widely accepted teory to explain DH is called hydrodynamic theory. It was proposed that application of external stimuli such as cold or hot, tactile or osmotic pressure will cause movement of dentinal fluid.The movement of the fluid will stimulate mechano-receptors and a pain response will be triggered.  

Prevention and treatment  
It has been suggested that brushing should be avoided for at least 1 to 3 hours after the consumption of acidic food or drink.   If the patient has a history of intrinsic erosion patient should be referred and treated by a physician.  
One of the logical conclusions to treat DH is to occlude the tubules by costituents of toothpaste. But the effectiveness of these products is dependent on their removal resistance.  Currently potassium salts are the most common active ingredient used to desesitize dentin. The synapse between the nerve cells is blocked by potassium ions, which will reduce the nerve excitation and the pain.   Calcium hydroxide can be used to block the tubules buti t has been reported that its presence can cause irritation of the gingiva. Other dentin sealer like composites and glass ionomer cements have a temporary effects because they can easly get washed away.  

Conclusions  
Dentin hypersensitivity is a widespread oral problem which affect people of variety of age groups. When a patient complains about DH causative or predisposing factor should be first identified by the  practitioner and then a treatment plan should be designed.

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