An underestimated problem: dentin hypersensitivity [Vol II]

23 Feb 2018

We talked about the problem of dentin hypersensitivity (DHS) in a former article (click here to read it) as it must be considered as a real issue in every branch of dentistry. We saw how to recognize signs and symptoms and how to perform quick and simple tests to diagnose DHS.

So, your patient came to your office with a problem, try to give him a quick solution! First of all, teach him how to properly brush: it seems to be a stupid thing, but many patients don’t know how to brush! They feel like they have to push with the toothbrush, and they often hurt their gums.

Then try to relieve their pain with a simple, quick and effective application of a fluoride varnish, and teach him how to use a desensitizing toothpaste non only to brush: it can be very helpful if used like an “emergency” treatment for DHS if patients apply it on the painful areas with a finger. It’s easy, cheap, fast and truly effective! You will for sure increase your patients’ confidence and trust in you and in themselves. Then, it will be easier to guide your patients through their own treatment path.

Fig. 1
Fig. 2
Fig. 3

Let’s see some clinical cases.

A 45 y.o. man is complaining about a strong DHS (VAS 9). He’s a strong bruxist, with GERD and a less than perfect plaque control. First of all we tried to relieve his DHS, in order to perform a professional hygiene and to design a restorative treatment plan.

Fig. 4

A fluoride varnish was applied, the correct brushing technique was explained with a desensitizing toothpaste.  At the control visit after 7 days the patient was really happy and much more confident and relaxed in the dental chair (VAS 4).

Fig. 5

A 55 y.o. woman is complaining about the aesthetics of her smile, tooth mobility and a strong DHS (VAS 9). She’s deeply scared, really odontophobic, but she decided to face her fears because she wanted a nice smile for her son’s marriage.

Fig. 6

In the first appointment teeth from 1.3 to 2.3 were splinted with a flexible composite fiber and diastemas were reduced, then a fluoride varnish was applied on every recession area. The aim was to give her some more confidence with more tooth stability, a little bit of aesthetic improvement and less DHS.

The correct brushing technique was deeply explained, and we suggested she gently massage the sensitive areas with a desensitizing toothpaste as an “emergency” treatment.

Fig. 7

The patient really appreciated our efforts, DHS decreased (VAS 4), she became step by step more self-confident and the odontophobia disappeared. So she was ready for a complete periodontal treatment plan.

Fig. 8

A 31 y.o. woman came to the office complaining about a strong DHS: she had pain drinking room temperature water, or sometimes even breathing (VAS 8).

Fig. 9

During the clinical examination it was really easy to find deep gingival recessions with abrasion of the dental structure. A lot of time was spent to illustrate a proper way to brush, with low pressure and without hurting the gums.

Fig. 10

Then a fluoride varnish was applied and after a week DHS test have been repeated (VAS 5).

Fig. 11

After the therapy with the varnish and a desensitizing toothpaste always remember to talk again to your patients, and to listen to them! Repeat the tests, and compare the results. If you’re not satisfied, maybe you just need to adjust the therapy, to increase the compliance of the patient or to reconsider your diagnosis.

Fig. 12

Air blast stimulation test after DHS treatment

Fig. 13

Tactile stimulation after DHS treatment

Fig. 14

Cold water stimulation after DHS treatment

Fig. 15

The interview after DHS treatment

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Fig. 17
 

Conclusions

The important thing is not to underestimate DHS, because it’s a real problem for a lot of patients; DHS therapy can be included in almost every branch of dentistry, and can help clinicians to lower the side effects of a lot of treatment plans.

Bibliography

Cummins D. J Clin Dent. 2009; 20 (spec iss): 1–9. Zapera. YouGov, 2009.

Brannstrom M, Astrom A. Int Dent J. 1972; 22: 219-27.

Canadian Advisory Board on Dentin Hypersensitivity. J Can Dent Assoc. 2003; 69: 221-6.

Susin C, Haas AN, Oppermann RV, Haugejorden O, Albandar JM. J Periodontol. 2004; 75: 1377–1386

Von Troil B, Needlemen I, Sanz M. J Clin Periodontol. 2002; 29 (supplement 3) :173-7.

Addy M. Int J Dent . 2002; 52: 367 – 375.

Van Haywood B. Inter Dent J. 2002; 52: 7–10.

Dowell P, Addy M. J Clin Periodontol. 1983; 4: 341-50.

Kleinberg I. Dent Today 2002; 21: 42-7.

Chesters R. J Clin Periodontol. 1992; 19: 256–261.

Vasconcelos A. Acta Odontologica Scandinavica. 2012; 70: 337–34.

NathooS J. Clin Dent 2009, 20 special issue: 123-130

Ayad F et al. J Clin Dent 2009. 20 special issue: 10-16