© Springer International Publishing Switzerland 2015
David G. Gillam (ed.)Dentine Hypersensitivity10.1007/978-3-319-14577-8_12
12. Closing Remarks Quo Vadis?
Centre for Adult Oral Health, Barts and The London School of Medicine and Dentistry QMUL, Turner Street, London, E1 2AD, UK
David G. Gillam
There’s no end to the publishing of books, and constant study wears you out so you’re no good for anything else. (Ecclesiastes 12:12) 1
The main purpose of the book was to provide an overview on DH in order to both educate and update readers on the latest research results regarding the development of new products and any advances in clinical management strategies and perhaps more importantly for clinicians the implications for everyday clinical practice. There is no doubt, however, that for both the hard-pressed researcher and the busy clinician, dentine hypersensitivity (DH) is somewhat enigmatic in nature and the condition has consistently challenged both the clinician and the researcher to develop new strategies and new products in order to treat the condition. As Gottfried Schmalz indicated in the foreword of the book, the topic of DH has attracted considerable interest in recent years as demonstrated by the number of publications listed in the published literature. This observation concurs with the earlier concerns of Emling (1982) who indicted that:
There may well be no single phenomenon in all of science which has occupied so much attention over so much time and yielded so few results as dentin hypersensitivity. Its causes have remained obscured throughout the existence of mankind. (Emling 1982)
The question may, however, arise: why write another book on DH? Perhaps the reader will have some sympathy with the exhortation expressed by Solomon in the book of Ecclesiastes regarding the need of researchers to constantly study and publish the outcomes of their labours. There is no doubt, however, that previously, as indicated in Chap. 1, there were concerns expressed by both researchers and clinicians with regard to the apparent lack of knowledge and understanding of the condition and in particular the terminology used to define DH (Emling 1982; Johnson et al. 1982; Dababneh et al. 1997). Nevertheless as Martin Addy indicated, there have been considerable advances in both the knowledge and understanding regarding DH in recent years and yet, as expressed by the various contributors in this book, there are still areas of research and clinical practice that need to be addressed. For example, the question of the role of pulpal inflammation in DH is still relatively unclear and somewhat controversial (Dababneh et al. 1997), and there are questions relating to whether the hydrodynamic theory can explain all aspects of stimulus transfer to the pulp (see Chap. 2). The role of the odontoblast in DH is also enigmatic; generally speaking, most published texts have consigned its role to the past and yet as Markowitz and Pashley (2008) have indicated that, following more recent evidence, this requires a reappraisal of its role (see Chap. 2). Furthermore according to Markowitz and Pashley (2008), although there was evidence to suggest that by increasing dentine permeability teeth become more sensitive, what is uncertain however is the degree to which dentine permeability needs to be reduced in order to effectively desensitise teeth.
The question as to whether the true prevalence of DH is reported in the published literature has also been addressed (see Chap. 3), and there appears to be some confusion with what is exactly being reported. For example, there are a wide range of values from the questionnaire and clinically based studies and where the studies were conducted (e.g. general or private practice, university/hospital, patients with or without periodontal disease, consumer based, etc.). Furthermore the methodology used when conducting these studies also varies and therefore there appears a need for more consistent and reproducible methodology when reporting the prevalence of DH. One of the problems that has also caused controversy has been the redefining of DH and root sensitivity (RS) (Sanz and Addy 2002), although to date there does not appear to be any published studies that have separated the precise prevalence values based on the treatment history of these individuals in order to distinguish the two clinical aspects of tooth sensitivity.
Undoubtedly there are a number of diagnostic challenges facing the busy clinician when examining patients complaining of dental pain in general and more specifically with DH (Gillam 2013). For example, (1) are clinicians under- or overestimating the problem, (2) is the condition being adequately diagnosed and successfully managed by clinicians in daily practice, (3) are clinicians aware of the impact (real or imagined) on the quality of life (QoL) in patients complaining with DH and (4) is the condition adequately monitored by clinicians in daily practice? It would appear that according to Gillam (2013) clinicians do not routinely screen/examine their patients for DH unless the patient prompts them, and this practice therefore needs to be reconsidered.