Dentinal Hypersensitivity Stimuli
Dentinal hypersensitivity is characterized by a short, sharp pain in response to stimuli. Dentinal hypersensitivity, which is more commonly seen in adults in the 20 – 40 – year old age group, has several etiological factors. Gingival recession and enamel loss both contribute to the prevalence of this condition, resulting in the exposure of dentin.
Dentinal hypersensitivity is believed to occur due to the movement of fluid within the dentinal tubules occurring in response to:
Tactile: Contact with a toothbrush and other oral hygiene devices, eating utensils, periodontal and dental instruments, and friction from prosthetic devices.
Thermal: Temperature changes caused by hot and cold food and beverages and cold air as it contacts the teeth. Cold air is the most common stimulus for pain.
Evaporative: Dehydration of oral fluids as from high volume evacuation or applying air to dry the teeth during intraoral procedures.
Osmotic: Alteration of osmotic pressure I dentinal tubules due to isotonic solutions of sugar and salt.
Chemical: Acids in foods and beverages such as citrus fruits, spices, wines and carbonated beverages; acids produced by acidogenic bacteria following carbohydrate exposure; acids from gastric regulation. (Wilkins, BS, RDH, DMD, 2013)
stimuli, according to Brannstroms Hydrodynamic Theory. Anatomically, the areas of the tubules closer to the pulp activates the nerves associated with the odontoblasts at the end of the tubule, resulting in pain response.
Tooth brushing techniques causing gingival trauma are a significant factor for gingival recession. The frequency, duration and force of brushing all contribute to recession. Excessive force and improper technique may lead to ...
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..., as well as erosion, abrasion and abfraction. Females tend to be prone to hypersensitivity and it has been hypothesized that this is because females tend to be more frequent attenders for treatment and perform more extensive home care oral hygiene in comparison to males. Hypersensitivity tends to be most prevalent on the buccal and cervical regions of the teeth. The most common sites for dentinal hypersensitivity are the cervical margins of the buccal and labial surface of the teeth. These areas of the teeth are a common site for recession and the enamel is also thinner in these areas. Canines and first premolars, followed by incisors, second pre-molars and molars are commonly affected by recession. Lastly, patients with moderate to severe sensitivity tend to have gingival recession more prevalent on one side of their mouth compared to the contralateral side.