Dentinal Hypersensitivity:

As dental professionals one of the greatest dental concerns our patients report when they sit in our chair is experiencing sensitive teeth. Learning how to help our patients manage this condition ultimately helps us improve their dental health, well-being and quality of life. From my own clinical experience, I share my top tips to help you manage dentinal hypersensitivity in your patients.

Dentinal hypersensitivity occurs when the dentine is exposed either through the loss of enamel or exposure of root surfaces by gingival recession. The hydrodynamic theory of dentinal hypersensitivity posits that, any stimulus of the fluid within the dentinal tubules leads to activation of nociceptive (pain) fibres which are interpreted by the brain as sensitivity or pain.¹ These stimuli are sourced from temperature changes (hot or cold), certain foods (sweet, sour or spicy), or tactile changes during toothbrushing or touching the exposed area with a finger. 

The first risk factor for  dentinal hypersensitivity is exposure of the root surface of the tooth caused by gingival recession or periodontal disease. Given the root surfaces of teeth are not covered by protective enamel, these exposed dentinal tubules can become vulnerable to stimuli and therefore sensitivity. The second way dentinal hypersensitivity can be caused is from the loss of the enamel surface that protects the dentine. This can be a consequence of acid erosion, toothbrush abrasion or abfraction of the cervical surface of the tooth.²

Understanding the aetiology and causes of dentinal hypersensitivity is only part of the challenge as the main challenge is managing our patients who all have individual thresholds of pain/sensitivity. Here are some top tips to navigate these clinical challenges:

• Switch the patient to a soft manual toothbrush or electric toothbrush - brushing with too much pressure during toothbrushing combined with the micro-abrasive particles in toothpastes which facilitate mechanical removal of plaque can lead to loss of cervical enamel over time leading to exposed dentinal tubules and sensitivity. Some models of electric toothbrushes come with pressure sensors that flash a red light when brushing with too much force and can be a great tool to prevent further abrasion. If patients are already experiencing some sensitivity, instruct them this will not stop the sensitivity but will prevent further damage from exacerbating the dentine hypersensitivity.³

• Apply a fluoride varnish layer to the sensitive areas in chair - when patients present for a routine hygiene appointment or other dental procedure it can be helpful to apply a fluoride varnish layer to sensitive areas of teeth to provide some short term relief but also aim to strengthen the existing enamel and dentine surfaces.3

• Apply a desensitising bonding agent layer to sensitive areas in chair - for patients who get persistent or frequent sensitivity to exposed dentinal tubules where there is no obvious defect of tooth surface, a desensitising bonding layer can be applied to the dried surface and cured to provide a barrier which prevents further stimulation of dentinal tubules thus reducing sensitivity.3

• Switch the patient to using a sensitive toothpaste twice daily -some patients benefit from switching to a sensitive toothpaste (e.g. Colgate Sensitive Pro-Relief*) which has been specially formulated to provide a barrier between the dentinal tubules and oral environment, relieving dentinal hypersensitivity.3

• Switch the patient to higher strength fluoridated toothpaste twice daily - patients who experience dentinal hypersensitivity and have a higher risk of dental caries can use a 5000ppm fluoridated toothpaste which aims to strengthen the existing tooth structure by increasing the likelihood of fluorapatite crystals on the enamel surfaces and dentinal tubules making them more acid resistant.3

• Restore the defective tooth surfaces - Some patients have Non-Carious Cervical Lesions (NCCLs) on the cervical surface of teeth or eroded occlusal surfaces of teeth which can lead to frequent dentinal hypersensitivity and can be relieved permanently by restoring the defective surfaces with composite resin, providing a permanent barrier between the dentinal tubules and oral environment.3

• Suggest gingival grafting to cover exposed root surfaces - for patients who have root surfaces of teeth exposed from gingival recession subsequent to periodontal disease or significant NCCLs may qualify in some cases for a gingival graft which covers the exposed surfaces with grafted gum tissue and thus provides soft tissue coverage of dentinal tubules relieving dentinal hypersensitivity. This procedure can be complex and may require treatment by a specialist periodontist.3  

• Educate the patient on the long term management of this condition - this is the most important factor as patients need to be aware that once enamel has been lost it cannot be replaced and so the condition must be managed in the long term. Any of the management tips suggested above do not guarantee complete cessation of dentinal hypersensitivity permanently but will relieve it and thus improve the quality of life for the patient.3