An Update on Dentinal Hypersensitivity - Aetiology to Management – A Review

Abstract

BACKGROUND Dentinal hypersensitivity is a common clinical disease that occurs as a result of dentin exposure. Though the term dentin hypersensitivity and dentin sensitivity is used interchangeably, dentin hypersensitivity is an exaggerated form of dentinal sensitivity which arises due to localized pulpal inflammation, pulpal nerve sprouting, and development of inflammatory sodium channels. It is characterised by short sharp pain emerging from exposed dentinal tubules in reaction to various stimuli. Such dentin exposure could be due to either enamel loss or cemental loss. This is followed by removal of smear layer by mechanical or chemical means. At present, the hydrodynamic theory, which describes fluid movement in response to stimuli within exposed dentinal tubules, is a commonly recognized explanation for dentin hypersensitivity. It is more common in premolars and canines, and it affects the facial surfaces of the teeth towards the cervical aspect. Studies suggested microscopic changes in the structure of sensitive dentin compared with normal dentin. The diagnosis of dentinal hypersensitivity requires careful clinical examination and eliciting the response using various stimuli. Dentinal hypersensitivity is usually managed by the use of physical or chemical agents. They work either by disturbing the neural response to pain stimulus or block fluid flow by occluding the tubule. The desirable features of a desensitising agent include the ability to give instant and longlasting pain relief, being simple to use, well accepted, not harmful to the pulp. It is recommended that the desensitizing agent is used for at least two weeks. Some of the newer agents used for management includes CPP-ACP, proarginine, nanomaterials, herbal products, propolis etc. In cases where there is tooth structure loss, appropriate restorative material is used to cover the exposed dentin. Root canal therapy is considered the last resort for pain relief after all other options have failed to provide relief. The present article outlines the etiopathogenesis, risk factors, diagnosis, prevention and treatment of dentinal hypersensitivity. KEY WORDS Dentinal Hypersensitivity; Dentin Sensitivity; Desensitizing Agents; Iontophoresis