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Making sense of dentine hypersensitivity
remineralisation by fluoride deposition,
Continued from page 10 but also help prevent root caries in an
have a higher prevalence than those example, for isolated problems, therapy adult population (Gillam et al, 1996;
who present with healthy mouths and is largely professionally delivered and Pereira and Chava, 2001; Jensen and
evidence of gingival recession. as such may be directed towards Kohout, 1988) (secondary benefits).
adhesives, resins, cervical restorations Furthermore, the incorporation of
Differential diagnosis (glass ionomer) and varnishes which essential oils (eg Listerine), triclosan or
One of the difficulties facing the may provide effective treatment of DH cetylpyridinium chloride (eg Colgate
clinician when confronted with a over one to three months (Ling and Plax) would have the added benefit of
patient complaining of tooth pain is Gillam, 1996); although in some reducing plaque bacteria that may
that there are a number of clinical situations pulpal extirpation or cause gingival inflammation/gingivitis
conditions such as “cracked tooth extraction of the offending tooth may (Ciancio, 1995), which in some
syndrome”, atypical facial odontalgia, be the treatment of choice. individuals could lead to breakdown of
fractured teeth and restorations, dental Soft tissue grafts, guided tissue the gingival tissue exposing the
caries, etc., that may elicit the same regeneration procedures, coronally underlying dentine.
clinical symptoms as DH and they have repositioned flaps, etc., have also been It would also be appropriate for the
to be eliminated before a correct recommended for treating areas of dental professional to recommend an
diagnosis of DH is made (Orchardson gingival recession with associated DH OTC product for the patient to use for
and Gillam, 2006). (Drisko, 2002). two to four weeks and then review the
The importance of the definition as Laser technology has been reported situation if the pain has not resolved 2001; Gillam and Orchardson, 2006;
suggested by Addy and co-workers to relieve DH through creating an sufficiently for the patient to enjoy Figure 1), but it is important that the
(1985, 1987 and from the Canadian altered surface layer on the root some “quality of life”. management of the condition should
Consensus document, 2003) is that it physically occluding the tubules (smear Subsequent treatment could be in fit in with the day-to-day running of
provides a very useful clinical layer creation). Further research is, the form of a more invasive therapy, eg the individual practice rather than
description of the condition and however, required before this restorations, etc. The advantages, cause an unnecessary burden on both
suggests the need to exclude other technique can be recognised as an however, of using an OTC product the dental professional and patient.
forms of tooth pain or sensitivity. acceptable treatment for this condition. readily available for the treatment of
More recently novel materials have DH by the consumer or patient Conclusion
Post-operative been developed from bioactive and compared to attending a dentist for From reviewing the available
hypersensitivity arising biocompatible glasses as well as casein treatment include ease of access, literature on the condition, it is
from dental treatment phosphopeptides (CPP) and expense, etc. One disadvantage is that apparent that the availability of a vast
It is important for the clinician to
It is important that the management of the
array of treatments would indicate
discriminate between the various
condition should fit in with the day-to-day
either that there is no one effective
sources of dental pain arising from
running of the individual practice rather than
desensitising agent for completely
treatment procedures such as
cause an unnecessary burden on both the dental
resolving the discomfort or that the
periodontal therapy, restorative
professional and patient.
condition due to its highly subjective
treatment and bleaching procedures as nature is difficult to treat irrespective
well as other potentially conflicting amorphous calcium phosphate (ACP) OTC desensitising products may take of the available treatment options.
conditions. combinations for use in the treatment up to four weeks to relieve symptoms The importance of implementing
There have been a number of recent of DH and sensitivity from bleaching whereas in theory a dental professional preventive strategies in identifying and
reviews on these topics which may be procedures (Gillam and Orchardson, applied therapy ideally may provide eliminating predisposing factors in
of benefit to the dental practitioner 2006 review). immediate relief of discomfort. particularly erosive factors (eg dietary
(Drisko, 2002; Van Haywood, 2002; It is important, however, for the acids) cannot be ignored if the dental
Orchardson and Gillam, 2006; Gillam Toothpastes and dental professional to have a professional is going to successfully
and Orchardson, 2006). mouthwashes management strategy that involves not treat this troublesome condition.
For generalised sensitivity involving only the removal of any aetiological
Management of dentine several teeth, the use of OTC and predisposing factors but also Acknowledgements
hypersensitivity toothpastes such as potassium nitrate careful monitoring of the condition This paper has been based on
Over-the-counter (OTC) or in-office and strontium acetate have been shown following initial treatment. reviews by Gillam, 2001; Orchardson
management of patients suffering from to be clinically effective in well A number of treatment paradigms and Gillam, 2006; and Gillam and
DH should be based on a correct controlled clinical studies and are have been suggested by investigators Orchardson, 2006.
diagnosis of the condition by the dental readily available to the consumer. (Canadian Consensus document, 2003; • A full list of references is available
professional who should be aware of According to Orchardson and Gillam Addy and Urquhart, 2002; Gillam, on request.
other clinical conditions which are (2000), formulations containing
similar in their presenting features potassium salts (either in toothpaste,
Dr David Gillam graduated as a dentist from
(Addy et al, 1985). Advice should be gels, solutions and mouthrinses) have
Edinburgh University in 1977 and worked as a
provided on correct brushing been widely used for treating DH
dentist in a variety of roles in general practice, armed
procedures (and type [texture] of although the effectiveness of these
forces and community dentistry before undertaking
brush) in order to prevent/minimise formulations (in toothpaste form) in
an MSc in Periodontology (1986-1988) in London
further damage to the exposed root reducing DH has been questioned
(Guy’s) and teaching dental hygienists and dental
surface. (Poulsen et al, 2001).
students at King’s College. He subsequently worked
The importance of counselling The adjunctive use of a pre- or post-
in the Periodontology Department at the Eastman
patients concerning their intake rinse mouthrinse following routine
Dental Institute (1989-1998) and during this time
(especially frequency) of acidic tooth brushing with a fluoride
completed a higher degree with Edinburgh
fruits and beverages with low pH, toothpaste may be more acceptable to
University (1992); in 1998 he was placed on the Specialist List in
particularly in relation to when the consumers and it is feasible that a
Periodontology. Since then he has held several clinical positions in industry.
teeth are brushed, should not be formulation containing potassium and
Currently he is a clinical lecturer in periodontology in the Centre for Adult
underestimated. fluoride may be beneficial not only for
Oral Health (The Dental School, Barts and the London School of Medicine
Management should also be based reducing symptoms of DH by nerve
and Dentistry). He has published over 40 peer-reviewed papers and book
on the severity of the condition. For desensitisation (primary benefit) and
chapters mainly on the topic of dentine sensitivity/hypersensitivity.
12
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