Dentinal Over-sensitiveness

Definition

The dentinal over-sensitiveness is characterized by a short and acute pain emanating of the exposed Dentine in reaction to stimuli of thermal nature, related to evaporation, tactile, osmotic or chemical and that one can charge to no other form of defect or dental pathology. (1983, international work group)

Possible stimuli: mechanics (brushes with tooth, nail); thermics (cold drink, air); chemical (acid); osmotic (sugar). The most frequent stimuli is the cold .

Prevalence

4 to 57% (72 to 98% among patients having a disease parodontale). Indeed the Maladie parodontale very often involves a gingival recession, which strips the root partially. However the root is protected only by the Cément, very end. The dentine is thus more sensitive.

One lives longer by preserving more teeth, therefore the prevalence increases.

The most touched zones: vestibular zone (= collet), in particular Canine S and Premolar S jawbones then the Incisor S and Molar S.

Clinical diagnosis

Over-sensitiveness is highlighted by the interrogation associated with the anamnèse.

Signs: pain of appearance and disappearance rapids.

A clinical examination and radiographic meticulous allow the elimination of the other causes of pain of dental origin (decays, fracture, crack, Pulpite) or gingival.

Differential diagnosis

  • decays

  • exhausted teeth; syndrome of the fractured teeth; furrows palatine and vestibular
  • fractured restorations, defect of marginal sealing of the restorations, certain materials of restoration

Mechanisms

  • dentinal Permeability (crucial factor)

  • hydrodynamic Phenomena = hydrodynamic theory of inflammatory Brännström
  • Reaction
Fibers AD are stimulated by movements of fluid in the channels under the effect of the cold of the air or of sweetened; thus the sensitivity increases (Variable most important: difference in diameter of the tubuli).

According to the repairing potential of pulp (tertiary affixing of dentine) and speed of mineralization of the canaliculi, this sensitivity disappears or persists (the elimination of pulp = Pulpectomie can require)

Etiology

2 processes are necessary: the exposed dentine (localization of the lesion) more the open tubuli dentinal (starting point of the lesion)

Probable assumption: association erosion and abrasion (the essential cause, the erosion , involve the exposure of the dentine; the worsening factor is the abrasion by brushing)

  • noncarieuse cervical Lésion = mylolyse (due to the abfraction)
  • the lesions strip the permeable canaliculi of the exposed dentine, and of the stimuli the nerves of pulp via hydrodynamic mechanisms excite. An acute painful reaction is thus obtained.
  • Exposure of the dentine following an enamel loss and erosion, attrition, abrasion, or denudation root and gingival recession or treatment parodontal

  • the correlation with the dental plaque is about null

  • the bleaching very often involves a more or less transitory and more or less important sensitivity
  • a brushing too vigorous with a toothpaste " anti-tartre" or " " blancheur" , too abrasives, accelerate over-sensitiveness

- Over-sensitiveness in the disease parodontale : it can be due to pathology or the treatment (too aggressive descaling and surfacing)

- post-operative Over-sensitiveness after coronary obturation : it can be due to a marginal infiltration, in particular so of the canaliculi were open, for example following the healthy size of dentine or with a chromate finishing (acid treatment) When a tooth undergoes a parodontal treatment or a prosthetic preparation before the installation of a crown, the dentinal canaliculi are exposed to the environment.

  • an over-sensitiveness of the teeth to the differences in temperature, sugar, the acids and the pressure is very frequent after microtraumatisms which had with the Bruxisme within the framework d´un Syndrome Algo-Dysfonctionnel of the Apparatus Manducateur (SADAM).

Therapeutic

Objective of the treatments: to close the canaliculi to prevent the movements of dentinal fluid.

The Councils:

  • If hygiene is failing: motivation with hygiene more possibly descaling/surfacing
  • If hygiene is excessive: method of brushing more adapted: brush soft, technical adequate (in roller), nonabrasive toothpaste (special sensitive teeth).
  • If the dietary habits are harmful: dietetic councils: to decrease the acid mets and drinks; not to immediately brush the teeth after having eaten.

Principle of the desensitizing toothpastes : they contain Fluor and potassium.

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