There is often a confusion with the patients on terms dental pain and tooth hepersensitivity / sensitivity. Following points should help one understand the difference between tooth pain and tooth hypersenstivity:

  1. Patient can describe the location of pain well in tooth hypersensitivity while this is not possible with dentinal and pulpal pain. “Localization of Pain”.
  2. Dentinal hypersensitivity is a response from a non-noxious stimulus and a chronic condition with acute episodes whereas dentinal pain is a response from a noxious stimulus and usually an acute condition.

Dentinal Sensitivity – Non Pathogenic ----- Non Pathogenic (allodontia) ----- Loss of Enamel or cementum ----- Short intense exaggerated response to Normal sensory stimuli – e.g. cold, tactile, chemical ----- Acute cessation with dentinal tubule sealer, ferric oxalate, Potassium oxalate ----- Chronic cessation with strontium chloride Potassium nitrate, potassium chloride ----- No radiographic evidence of apical pathology

Differential Diagnosis

Conditions that produce symptoms namely those of dentinal hypersensitivity are:

  1. cracked tooth syndrome
  2. fractured restorations
  3. chipped teeth
  4. dental caries
  5. post restorative sensitivity
  6. teeth in acute hyper function
  7. palatogingival groove

Treatment of Hypersensitivity Dentin

The treatment of hypersensitive dentin may be deviated into

  1. The application of certain routine measures
  2. Desiccation of the exposed dentinal surfaces
  3. Use of caustics
  4. Use of local anodynes or anesthetics
  5. Use of general anesthetics

Routine procedures

  1. Use tact, encourages the patient, stimulate confidence in your ability and adopt a calm, cheerful, sympathetic manner. The power of suggestion is valuable, deflecting the thoughts of the patient in to other channels.
  2. Select the simple and less painful cases first if a series of operations are required, gradually lead up to the difficult ones.
  3. Use sharper instruments cut with light, but quick and decisive movements. Cut in a direction away from the pulp as far as possible. If burs are used, avoid production of heat from friction by frequently withdrawing them for a second. During the cutting process, diamond instruments and carborundum stones must be used under water to avoid heat.
  4. Exclude moisture through the application of the rubber dam in cavity preparation wherever possible.

Desiccation

Dry heat is applied by the use of electrically heated blasts of compressed air. The cavity may be moistened first with absolute alcohol or acetone. When the heat is applied until the cavity is thoroughly desiccated.

Use of Caustics

Three agents prevent the transmission of sensation by chemically destroying living tissue. They act

  1. by abstracting water from the tissues
  2. dissolution or precipitation of protein
  3. oxidation or substitution (e.g.) zinc chloride, absolute alcohol, trichloro acetic acid,
  4. 10 to 15% ammoniated solution of silver nitrate (contra indicated – property of producing discolorations).

Local anodynes or anesthetics

Cocaine hydrochloride, procaine hydrochloride, methanol clove oil, eugenol and phenol have been used with little success for treatment of hypersensitive conditions about the teeth.

Of various procedures the injection in to the surrounding tissues of procaine hydrochloride with adrenaline by either infiltration or the new blocks method is only one of great value.

Clove oil, Eugenol or phenol may be applied on a pellet of cotton and evaporated to dryness by means of hot air, the procedure being repeated several times if necessary as the operation progresses.

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Comments

  • Dr.Ritz

    Dr.Ritz 06 - April - 2012, at 19:19 PM

  • Shettima abba, There are many causes of sensation in teeth. It can be because of wearing of teeth or because of decay. Some times the gum problems also causes the sensitivity in teeth. The intrinsic staining can be because of some trauma, or after root canal treatment. Some times due to some meds like tetracycline, if consumed during the tooth development stages also causes the intrinsic staining.

  • Shettima abba

    Shettima abba 06 - April - 2012, at 13:45 PM

  • Causes of sensation in tooth and treatment of instrictic stain

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