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Dental Tribune Middle East & Africa Edition | 4/2016 HYGIENE TRIBUNE 5 whitening products should be given instruction on how to modify the whitening process to avoid or man- age the sensitivity associated with toothwhitening. Treatments for hypersensitive den- tin can be self applied by the patient at home or be applied in-office by a dental professional, and work by ei- ther occluding the dentinal tubules or blocking nerve conduction by depolarizing the nerve. As patient- applied treatments tend to be sim- ple and inexpensive and can treat generalized hypersensitivity affect- ing many teeth,4 they should be pre- scribedasthefirstlineoftreatment. The effectiveness of over-the-coun- ter desensitizing fluoride tooth- pastesthatcontain5percentpotassi- umnitrateasthedesensitizingagent iswellestablished. The level of potassium at the dentin surface will increase following each use of potassium nitrate toothpaste. This localized increase in concentra- tion is hypothesized to lead to a dif- fusion of potassium ions through the tubules, toward the pulp, where itcouldinterruptnerveconduction. Twice-dailytoothbrushingwithapo- tassium nitrate toothpaste provides theregulardosesofpotassiumtothe dentin surface necessary to build up and then maintain the depolarizing activity of the potassium ions. A sig- nificant reduction in sensitivity can occur within as little as two weeks withtwice-dailyapplication.8,9 Continual use of the desensitizing dentifrice is necessary for ongoing protection, so to favor patient com- pliance, sensitivity dentifrices are availableinavarietyofformulations to meet the patients’ needs and de- sires, such as tartar control, whiten- ing and sodium lauryl sulphate-free formulations. If the patient’s dentin hypersensitiv- ity persists after four weeks usage of the OTC desensitizing toothpaste, a further dental examination should be carried out, and a professional treatment should be considered as thesecondlineoftreatment. Recently developed calcium phos- phate technologies have also dem- onstrated effectiveness in tubule occlusion, including ACP, CPP-ACP, and NovaMin®, a calcium sodium phosphosilicate. The effectiveness of NovaMin in occluding dentinal tubules is attributed to its unique mechanisms of action. Not only do the NovaMin particles immediately bind to exposed dentin and fill open tubules, the subsequent release and surface reaction of calcium and phosphate ions forms a protective hydroxyl carbonate apatite-like layer that provides tubule occlusion, whichisresistanttothechallengesof acidicenvironments.10,11 Treatment for dentin hypersensitiv- ityshouldalsobeincludedinroutine preventive and periodontal thera- pies. The instrumentation used dur- ing adult prophylaxis, perio mainte- nance and periodontal debridement (SRP) procedures can cause pain at pre-existinghypersensitivesitesand may result in new sites of transient hypersensitivity. To manage hypersensitivity stimu- latedduringandfollowingperiodon- tal instrumentation, the continuous care treatment strategy can include usage of NUPRO® Sensodyne® prophylaxis paste with NovaMin. As detailed previously, the incorpora- tion of NovaMin particles into the prophy paste provides immediate tubule occlusion and formation of anacid-resistanthydroxylcarbonate apatite-likelayer.14 NUPRO Sensodyne prophy paste withNovaMin,availableinpolishing and stain-removal grits, can be used for the immediate relief of tooth sensitivity and for lasting sensitivity relief for up to 28 days after just one application.12,13 A thin, white residue might remain visible after rinsing. This is inherent in the product for- mulationandisconsiderednormal. For localized hypersensitive sites that do not respond to the first or second lines of treatment, in-office treatments that are more complex and/or more potent may be indi- cated. Such treatments involve use of adhesives, including varnishes, bonding agents and restorative ma- terials: iontophoresis, lasers or gin- gival grafting. One option, NUPRO White Varnish (Fig. 1), is a uniquely formulated varnish for hypersensi- tivity relief; another option is Seal & Protect™, a protective light-cured sealant indicated for use in the treat- ment of hypersensitive cervical ar- eas(Fig.2).15 Effective prevention and manage- ment of dentin hypersensitivity re- quiresacontinuouscareapproach. The continuum of care starts with a screening assessment for hypersen- sitivity, followed by identification and modification of causative fac- tors to help prevent hypersensitiv- ity. A combination of at-home and in- office therapies (available from Sen- sodyne and NUPRO) are next in the continuum of care, with the treat- ment regimen adopted being de- pendentupontheperceivedseverity ofthediscomfortandthenumberof teethinvolved.4 Asthefirstlineoftreatment,patient- applied OTC desensitizing denti- frices containing potassium nitrate, such as Sensodyne brand tooth- pastes, provide an easy, inexpensive, andeffectivetherapyforgeneralized hypersensitivity. When a second line of treatment is indicated, a professional treatment should be considered. The con- tinuum of care can be maintained chairsideatroutineprophylacticand perio maintenance appointments by using NUPRO Sensodyne prophy paste with NovaMin to reduce hy- persensitivity resulting from peri- odontalinstrumentation.16 References 1.StrasslerHE,DriskoCL,andAlexan- der DC. Dentin Hypersensitivity: Its inter-relationship to gingival reces- sion and acid erosion. Compendium of Continuing Education in Dentist- rySupp2008:29(5). 2.ChabanskiMB,GillamDG,Bulman JS, Newman HN. Prevalence of cervi- cal dentine sensitivity in a popula- tion of patients referred to a special- ist periodontology department. J ClinPeriodontol1996;23:989–992. 3. Holland GR, Narhi MN, Addy M et al. Guidelines for the design and conduct of clinical trials on dentine hypersensitivity. J Clin Periodontol 1997;24:808–813. 4. Orchardson R and Gillam DG. Managing dentin hypersensitivity. JADA2006;137:990–998. 5. Pashley DH, Tay FR. Dentin hyper- sensitivity: Current state of the art and science. Dentin Hypersensitiv- ity Consensus Monograph 2008;4(9 SpecialIssue). 6. Gillam DG, Seo HS, Bulman JS, Newman HN. Perceptions of den- tine hypersensitivity in a general practice population. J Oral Rehabil 1999;26:710–714. 7. Collins MA. The role of the den- tal hygienist in the management of dentin hypersensitivity. Dentin Hypersensitivty Consensus Mono- graph2008;4(9SpecialIssue). 8. Tavss EA, Fisher SW, Campbell S et al. The scientific rationale and development of an optimized den- tifrice for the treatment of dentin hypersensitivity. Am J Dent 2004 Feb;17(1):61–70. 9. Kanapka JA. Over-the-counter dentifrices in the treatment of tooth hypersensitivity. Review of clinical studies. Dent Clin North Am 1990;34(3):545–560. 10. Burwell A, Jennings D, Muscle D, and Greenspan DC. NovaMin and dentin hypersensitivity- in vitro evidence of efficacy. J Clin Dent 2010;21(SpecIss):66–71. 11.Dataonfile 12. Neuhaus KW, Milleman JL, Mil- leman KR, Mongiello KA, Simonton TC, Clark CE, Proskin HM, Seemann R. Effectiveness of a calcium sodium phosphosilicate containing prophy- laxis paste in reducing dentine hypersensitivity immediately and 4 weeks after a single application: a double-blind randomized con- trolled trial. J Clin Periodontol 2013; .doi:10.1111/jcpe.12057. 13. Milleman JL, Milleman KR, Clark CE, Mongiello KA, Simonton TC, Proskin HM. NUPRO sensodyne prophylaxis paste with Novamin for the treatment of dentin hypersensi- tivity: a 4 week clinical study. Am J Dent2012Oct;25(5):262–268. 14.Dataonfile 15.Dataonfile 16.Dataonfile Fig. 2a, b: Seal & Protect, shown with silo and applicator stick,isaprotectivelight-curedsealantindicatedforusein the treatment ofhypersensitivecervicalareas. Gail Malone, RDH, BS is a clinical edu- catorforDENTSPLY Professional, serv- ing the northeast region of the United States. She received her dental hygiene de- gree from Mont- gomery County Community College in Blue Bell, Pa., and received a bachelor’s degree in dental hy- giene from Thomas Jefferson University in Philadelphia, where she also served as adjunct faculty. Malone’s more than 20 yearsofexperienceinthefieldofdentistry includes experience in clinical practice, dental hygiene education, dental practice management anddentaldistribution. She has lectured internationally, nation- ally and at the state and local level on ul- trasonics,localanesthesiaandavarietyof other topics. Her aim is to provide dental professionals with current scientific re- search and information to assist them in implementing effective and efficient evi- dence-based treatment protocols in their clinical practices. You may contact her at gail.malone@dentsply.com. "Thecontinuumofcarestarts withascreeningassessmentfor hypersensitivity,followed byidentificationandmodification ofsativefactorstohelpprevent hypersensitivity." and the increasing consumption of acidicfoodsandbeverages(e.g.,fresh fruits, juices, carbonated beverages), which promotes acid erosion of the toothstructure,aseachisrecognized as a contributing or causative factor fordentinhypersensitivity.1 Dentin hypersensitivity is charac- terized by short, sharp pain arising from exposed dentin in response to stimuli — typically thermal, evapo- rative (movement of air over the tooth), tactile, osmotic or chemical – which cannot be attributed to any other dental defect or disease.3 For hypersensitivity to be experienced, twoprocessesmusthaveoccurred:1) exposure of the dentin, typically re- sulting from gingival recession and 2) opening of the dentinal tubules, usually through loss of the smear layer, predominantly from acid chal- lenges.4 Any tooth may be affected, but the most common sites for dentin hypersensitivity are the buc- cal cervical areas of the cuspids and premolars.5 Surprisingly, a majority of patients donotseektreatmenttorelievetheir dentin hypersensitivity pain.5 The subtle onset of the sensitivity allows for the unconscious development of coping strategies to minimize the discomfort, such as avoidance of ice, drinking through straws and brush- ing with warm water.7 Additionally, patients may not perceive the sensi- tivity to be a severe problem, or con- versely, they may fear it is a sign of a more severe problem and choose to tolerate it rather than seek invasive treatment.6 Given the increase in prevalence of dentin hypersensitivity and the reluctance of patients to seek treat- ment,itisincreasinglyimportantfor 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 idealopportunitytoidentifyareasof gingival recession and then to evalu- ate those recessed areas for hyper- sensitivity during the course of the visit as various stimuli are experi- enced by the patient — instrumen- tation (tactile), air (evaporative), and water(thermal). Sites of sensitivity can be document- ed,includingduration,onsetandthe nature of the stimuli initiating the hypersensitive reaction. All contrib- utory and predisposing factors and conditions should be explored, such asgingivalrecession,toothwear,oral hygieneandanyharmfulhabits.7 Once sites of recession and hyper- sensitivity 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 confirmeddiagnosis,whethergener- alized or localized, a treatment plan can be designed to manage the dis- comfort of hypersensitive dentin, as well as the contributing or causative factors identified for each individual patient. Prevention of hypersensitivity is the mostcosteffectivetreatmentoption for patients.7 By identifying the fac- tors contributing to the hypersen- sitivity, patients can be educated to modify their behaviors to minimize or prevent the occurrence of pain. Behavioral modifications may in- clude changing the technique used when brushing teeth and avoiding brushing immediately after ingest- ing acidic foods and drinks. Patients at risk of acid wear may be advised to modify dietary habits when con- suming acidic foods and beverages that contribute to erosion and expo- sure of the tubules. Patients utilizing