Dental Pain: Dentine Sensitivity, Hypersensitivity and Cracked Tooth Syndrome

Abstract

Dentine hypersensitivity is a frequently encountered patient complaint that can present with a number of associated factors including erosion and abrasion. The hydrodynamic mechanism responsible for dentine hypersensitivity is intimately related to the anatomical and physiological composition of teeth. Alterations to the integrity of the enamel and dentine through processes of trauma, decay and toothwear can increase dentine permeability. This gives rise to symptoms of sensitivity as dentinal fluid movement in response to thermal, chemical and mechanical cues stimulate the pulpal Aδ fibres. Restorative procedures can also rapidly change the architecture of the protective enamel and dentine layers leading to pulpal inflammation and increased thermal sensitivity of the tooth. Patient-reported symptoms of dentine hypersensitivity can be attributed to a number of possible causes and a definitive diagnosis can therefore be difficult. A full history including social and medical factors such as occupation, diet and/or medication is likely to provide significant information to aid a diagnosis. Consideration of occlusal factors should not be overlooked as these may contribute to symptoms arising from a cracked tooth. Management strategies are linked to the diagnosis – from topically applied desensitising pastes and resin bonding agents to direct restorations and possibly more advanced restorative procedures such as root canal treatment. Management should, however, be staged to enable more conservative strategies to prevail prior to considering irreversible dental interventions.