The Occlusal, Neurological, and Orthopedic Origins and Implications of the Hypersensitive Dentition

Abstract

In the dental literature, the association between the occlusion and hypersensitive teeth is poorly explained. Quantified occlusal contact force and timing parameters have been largely ignored in studies assessing hypersensitive teeth. This chapter introduces a novel occlusal concept, frictional dental hypersensitivity (FDH), after systemically simplifying the existing and often confusing terminology used in the literature to describe the variant clinical presentations of the hypersensitive dentition. Clinical evidence from combining computerized occlusal analysis and electromyography is presented linking opposing posterior tooth friction and muscular hyperactivity to FDH. This chapter will outline how occlusion, many muscular TMD symptoms, and FDH are all interrelated. Both a pilot study and a 100 subject cold ice water swish follow-up study are presented and used a numerical visual analog scale (NS/VAS) to quantify cold response dental hypersensitivity resolution observed in occlusally symptomatic patients that underwent the immediate complete anterior guidance development coronoplasty (ICAGD). This computer-guided occlusal adjustment procedure eliminated pretreatment FDH symptomatology, further supporting that dental hypersensitivity often has an occlusally-based, frictional etiology. Additionally, consideration for the orthopedic influences that may directly affect the occlusion and neurology of the system are outlined, as well as the medical concept of tooth allodynia. Furthermore, trigeminal neurological influences are compared and contrasted to autonomic sympathetic inputs in relation to the influence that they each have upon the hypersensitive dentition. Lastly, the greater auricular diagnostic nerve block is discussed, as is the influence that this nerve may have upon the hypersensitive mandibular posterior dentition.