hygiene the international C.E. magazine of dental hygiene

18 I I C.E. article_ hypersensitivity hygiene 1_2013 persensitivity and the reluctance of patients to seek treatment, it is increasingly important for the dental professional to screen for hypersensitivity as part of a routine dental assessment. The prophylaxis or perio maintenance appointment provides the dental hygienist an ideal opportunity to identify areas of gingival recession and then to evaluate those re- cessed areas for hypersensitivity during the course of the visit as various stimuli are experienced by the patient—instrumentation(tactile),air(evaporative), and water (thermal). Sites of sensitivity can be documented, including duration, onset and the nature of the stimuli initiat- ing the hypersensitive reaction. All contributory and predisposing factors and conditions should be explored, such as gingival recession, tooth wear, oral hygiene and any harmful habits.7 Once sites of recession and hypersensitivity are noted, the dentist can make a differential diagnosis, ruling out other causative factors for the sensitivity (cracked tooth syndrome, caries, etc.) to confirm the diagnosis of dentin hypersensitivity. With a confirmed diagnosis, whether generalized or localized, a treatment plan can be designed to manage the discomfort of hypersensitive dentin, as well as the contributing or causative factors identi- fied for each individual patient. Prevention of hypersensitivity is the most cost- effective treatment option for patients.7 By identify- ing the factors contributing to the hypersensitivity, patients can be educated to modify their behaviors to minimize or prevent the occurrence of pain. Be- havioral modifications may include changing the technique used when brushing teeth and avoiding brushing immediately after ingesting acidic foods and drinks. Patients at risk of acid wear may be advised to modify dietary habits when consuming acidicfoodsandbeveragesthatcontributetoerosion and exposure of the tubules. Patients utilizing whit- eningproductsshouldbegiveninstructiononhowto modifythewhiteningprocesstoavoidormanagethe sensitivity associated with tooth whitening. Treatments for hypersensitive dentin can be self appliedbythepatientathomeorbeappliedin-office byadentalprofessional,andworkbyeitheroccluding the dentinal tubules or blocking nerve conduction by depolarizing the nerve. As patient-applied treat- ments tend to be simple and inexpensive and can treat generalized hypersensitivity affecting many teeth,4 they should be prescribed as the first line of treatment. Theeffectivenessofover-the-counterdesensitiz- ing fluoride toothpastes that contain 5 percent po- tassium nitrate as the desensitizing agent is well es- tablished.Thelevelofpotassiumatthedentinsurface willincreasefollowingeachuseofpotassiumnitrate toothpaste.Thislocalizedincreaseinconcentrationis hypothesizedtoleadtoadiffusionofpotassiumions through the tubules, toward the pulp, where it could interrupt nerve conduction. Twice-daily toothbrushing with a potassium ni- tratetoothpasteprovidestheregulardosesofpotas- sium to the dentin surface necessary to build up and thenmaintainthedepolarizingactivityofthepotas- sium ions. A significant reduction in sensitivity can occur within as little as two weeks with twice-daily application.8,9 Continual use of the desensitizing dentifrice is Fig. 1_NUPRO White Varnish is uniquely formulated for hypersensitivity relief. (Photos/ Provided by DENTSPLY Professional) Fig. 1 ‘Surprisingly, a majority of patients do not seek treatment to relieve their dentin hypersensitivity pain. The subtle onset of the sensitivity allows for the unconscious development of coping strategies to minimize the discomfort.’