Radiographic Evaluation

Three digital photographs (Figure 8.4.1), one horizontal bitewing of the left side (Figure 8.4.2).

Dental Hygiene Diagnosis

Planned Interventions

Discussion

Dentinal hypersensitivity is a prevalent clinical condition that is experienced by 10–20% of the population (Argawahl et al. 2016; Zhong et al. 2015; Kunam et al. 2016; Pathan et al. 2016). Kachalia (2016) suggests that 50% of the population suffers from dentinal hypersensitivity. Dentinal hypersensitivity is characterized by short, often sharp pain originating from exposed dentin in response to stimuli (Argawahl et al. 2016; Zhong et al. 2015; Kunam et al. 2016; Pathan et al. 2016). These stimuli can present as thermal, evaporative, tactile, osmotic, or chemical and cannot be attributed to any other form of dental defect or pathology (Argawahl et al. 2016; Zhong et al. 2015; Kunam et al. 2016; Pathan et al. 2016). Correct diagnosis of dentinal hypersensitivity is crucial for dental professionals. Assessment begins with a differential investigation to exclude some dental defects such as a fractured tooth, dental caries, and periodontal diseases in order to administer the correct form of treatment (Argawahl et al. 2016; Zhong et al. 2015; Kunam et al. 2016; Pathan et al. 2016). Dentinal hypersensitivity is related to exposed dentinal tubules, and the most common clinical cause of exposed dentinal tubules is gingival recession (Argawahl et al. 2016; Zhong et al. 2015; Kunam et al. 2016; Pathan et al. 2016). See intraoral images (Figure 8.4.1) for gingival recession on tooth #19. Aggressive brushing habits, high acidic or sugar intake in the diet, all types of tobacco use, and some other illnesses including gastroesophageal reflux may also cause dentin hypersensitivity (Argawahl et al. 2016; Zhong et al. 2015; Kunam et al. 2016; Pathan et al. 2016). It also results from abfraction, abrasion, or erosion and denudation of the root surface. See Figure 8.4.2 for excessive wear facets on mesial cusp. It has also been indicated as a result of nonsurgical and surgical periodontal treatment (Argawahl et al. 2016; Zhong et al. 2015; Kunam et al. 2016; Pathan et al. 2016).

The treatment for dentinal hypersensitivity has been classified by mode of delivery as at‐home (patient‐applied) therapy and in‐office (professional) therapy (Argawahl et al. 2016; Zhong et al. 2015; Kunam et al. 2016; Pathan et al. 2016). There are many products available on the market that claim to reduce dental hypersensitivity effectively. It is a dental hygienist’s responsibility to use evidence‐based literature as a guide to making clinical decisions regarding what to recommend to patients. Numerous researchers have provided a concise overview of various approaches to occlude the dentinal tubules (Argawahl et al. 2016; Zhong et al. 2015; Kunam et al. 2016; Pathan et al. 2016). Researchers have determined that there are two ways of reducing hypersensitivity: one is that the occlusion of dentinal tubules occurs by natural mineralization in situ and two by the blockage of tubules by fine particle layers (Argawahl et al. 2016). In other words, products either reduce the fluid flow within the dentin tubules by occluding the tubules, while others interrupt the neural response to stimuli (Jena and Shashirekha 2015). Most products are intended to control the hydrodynamic mechanisms of pain (Jena and Shashirekha 2015).

According to Bae et al. (2016) meta‐analysis indicated that there is sufficient evidence to support the use of potassium, stannous fluoride, calcium sodium phosphosilicate, and arginine‐containing desensitizing toothpaste for dentin hypersensitivity, but not the use of strontium‐containing desensitizing toothpaste (Bae et al. 2016). The clinical relevance of meta‐analysis provides support for dental professionals and best‐practice decision making for recommending a desensitizing toothpaste to patients (Bae et al. 2016). Many of these potassium, stannous fluoride, calcium sodium phosphosilicate, and arginine products in toothpaste offer only short‐term relief to patients by means of dentinal hypersensitivity reduction (Kachalia 2016). In fact, other at‐home products such as oxylates, in strips, have been determined to have no effect on dentine hypersensitivity in a single treatment when compared to placebos (Arnold et al. 2015). However, dental professionals have products available that can be applied to the teeth that resolve sensitivity for a longer period. These products are considered in‐office varnishes. Pathan et al. (2016) suggests reduced dentinal hypersensitivity can last one month after one treatment with in‐office products, as opposed to brushing with a sensitive toothpaste whereby reduction of dentinal hypersensitivity begins after two weeks of twice daily use. In‐office desensitizing agents provide immediate, provisional relief from symptoms of dentinal hypersensitivity (Pathan et al. 2016). Currently, there is no “gold standard” for dentinal hypersensitivity treatment (Jena and Shashirekha 2015). A consultation with a dental professional regarding best treatment options along with a recommended home‐care regimen and regularly scheduled dental recare appointments are highly recommended.