Treatment of Dentinal Hypersensitivity
Date: 22nd Sept., 2016
In the last post we looked at some aspects of diagnosing dentinal hypersensitivity (DH). To recap, it is characterized by a short sharp pain arising from exposed dentine in response to stimuli; typically thermal, evaporative, tactile, osmotic or chemical. Importantly, this pain cannot be ascribed to any other form of dental defect or pathology (1)
The hypersensitivity response varies to a great extent from one person to another. Most commonly involved teeth are canines and premolars. Generally, the facial surfaces of teeth near the cervical aspect are involved. Patients undergoing periodontal treatment are also particularly susceptible to this condition because of the recession following periodontal surgery or loss of cementum following non-surgical periodontal therapy.
The most widely accepted theory of how the pain occurs is hydrodynamic theory i.e. because of fluid movement within the dentinal tubules. The dental professional, using a variety of diagnostic techniques, discerns DH from other conditions that may cause sensitive teeth.
Once diagnosis confirms dentinal hypersensitivity in the absence of underlying diseases or structural problems, then the following steps can be initiated:
- Remove the risk factors by educating the patient about dietary acids and other oral care habits
- Recommend appropriate tooth-brushing methods
- Initiate treatment by recommending a desensitizing agent like RA- Thermoseal for home use
- Applying topical desensitizing agents professionally if required.
There are various options for treatment of hypersensitivity. The most inexpensive and efficacious first line of treatment for most patients is a dentifrice containing a desensitizing active ingredient such as potassium nitrate and /or stannous fluoride. RA- Thermoseal is a desensitizing toothpaste containing potassium nitrate as chief ingredient and is effective against dentinal hypersensitivity.
Mode of Action
Use of topical agents and dentifrices that contain a desensitizing active ingredient are the first line of action against sensitivity. These are considered to be the simplest, cost-effective, and efficacious treatment for most patients.According to the literature, the most widely available desensitizing toothpaste ingredient is potassium nitrate. The potassium ions are thought to block the synapses between nerve cells, reducing nerve excitation and the associated pain. Another active ingredient that exhibits a similar mechanism is potassium chloride.(2,3,4,5,6)
Other treatments are designed to reduce flow into the dentin tubules by occluding or sclerosing the tubules. Active ingredients include stannous fluoride, strontium chloride hexahydrate, and aluminum, potassium orferric oxalates and fluorides
A number of studies, published since the early seventies, have investigated the use of potassium nitrate (KNO3) as an effective active ingredient in treating dentinal hypersensitivity.The conclusions for studies assessed in the Cochrane review indicate toothpaste containing 5% KNO3 significantly reduced dentinal hypersensitivity to both tactile and air blast stimuli as well as subjective response.(5,6,7,8)
RA – Thermoseal, which contains potassium nitrate is a commonly available medicated toothpaste readily available in most of the chemists and is an effective tool to manage dentinal hypersensitivity.
Dentinal hypersensitivity is a problem that plagues many patients and choice of medicated toothpaste often confuses dentists. Based on current scientific evidence, potassium nitrate and strontium chloride are the most effective ingredients available in toothpaste. RA- Thermoseal, a potassium nitrate containing toothpaste is an effective dentifrice to treat dentinal hypersensitivity.
- Dowell P, Addy M (1983) Dentine hypersensitivity–a review. Aetiology, symptoms and theories of pain production. J ClinPeriodontol 10, 341-350.
- Tarbet WJ, Buckner A, Stark MM, et al. The pulpal effects of brushing with a 5 percent potassium nitrate paste used for desensitization. OralSurg1981;600-602.
- Knight NN, Tryggve L,ClarkSM, et al. Hypersensitive Dentin: Testing of procedures for mechanical and chemical obliteration of dentinal tubuli. J Periodontol 1993;64:366-373.
- PoulsenS, Errboe M, HovgaardO, et al. Potassium nitrate toothpaste for dentine hypersensitivity (Review). The CochraneCollaboration 2004, Issue 4, Wiley Publisher. 1-11.
- Nagata T, Ishida H, Shinohara H, et al. Clinical evaluation of a potassium nitrate dentifrice for the treatment of dentinal hypersensitivity. JClinPeridontol 1994;21 (3):217-21.
- Schiff T, Dotson M, CohenS, et al. Efficacy of a dentifrice containing potassium nitrate, soluble pyrophosphate, PVM/MA copolymer, and sodium fluoride on dentinal hypersensitivity: a twelve-week clinical study. JClin Dent 1994;5Spec No: 87-92.
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