Why So Sensitive?
Have you ever had a patient jump so suddenly and wildly while you were scaling a tooth that you were lucky the scaler did not puncture the lip or cheek? Have you experienced this same reaction to rinsing or drying a tooth? What causes this reaction? More important, what should be done to prevent this reaction?
In a normal tooth/gingiva relationship the gingiva covers the root surface. As years go by, gingiva recedes, exposing root surfaces. Some causes of recession are toothbrush abrasion, periodontal surgery and compromised occlusion. Initially when gingiva recedes there is not much sensitivity because cementum is intact on the newly uncovered root. It may not be long, however, until cementum disappears. Cementum is a thin protective layer over the dentin that erodes easily from exposure to external substances. It can also be mechanically abraded, usually by a toothbrush. Once cementum has disappeared, dentinal tubules are open to the elements in the oral cavity. Herein lays the cause of sensitivity. Fluid movement within the tubules is caused by temperature change or physical pressure change and is detectable by the nerve in the tooth. This translates to a feeling of pain in the absence of protective cementum.
So what is the cure? Either the nerve needs to be desensitized to make it less responsive to stimulation, or dentinal tubules need to be plugged to prevent fluid flow. Potassium nitrate claims to desensitize the nerve. It is theorized that potassium nitrate penetrates through the tubules to the nerve and depolarizes it, resulting in no pain impulse being sent to the brain. There are products on the market that contain potassium nitrate that are approved by the ADA. These products are found in the form of a paste.
When considering blocking the tubules, there are many products that can be considered. Many clinicians recommend stannous fluoride. Though this substance has been found to be somewhat successful, no over-the-counter, ADA-approved sensitivity toothpaste contains this product. Strontium chloride, which also has the ability to occlude tubules, is no longer available in over-the-counter toothpastes either.
SensiStat has proven very effective in sealing open tubules. SensiStat contains an arginine bicarbonate/calcium carbonate complex and is applied to tubules at a professional cleaning appointment to plug and seal open dentinal tubules during a routine polishing. The procedure is painless and the reduction of tooth sensitivity is usually immediate. Patients report the ability to eat ice cream or drink cold drinks after one treatment. Treatment can be followed up by dispensing a toothpaste containing SensiStat for home use.
Novamin (calcium sodium phosphosilicate) is also able to occlude open tubules. When Novamin is added to toothpaste and exposed to saliva, particles are deposited onto the dentin surfaces and mechanically seal the tubules. Although Novamin is not a specific product, it can be found in several products and is gaining popularity.
ReCaldent is also on the scene. ReCaldent is a complex of casein phosphopeptite (CPP) and amorphous calcium phosphate (ACP). ReCaldent can assist with sensitivity by delivering calcium and phosphate to cover dentinal tubules. It also helps to buffer the acidity of plaque that increases sensitivity.
Clinicians have many options to consider when it comes to combating sensitive teeth. It is far more complex than just offering a patient a tube of gel or paste containing stannous fluoride. There are many choices, but no single agent or form of treatment has been found effective for all patients. It is important to realize that even though some agents/treatments may work quite well for some patients, they may not work at all for others. It is the responsibility of the dental professional to understand the etiology of sensitivity, existing treatments and products available to assist in the reduction of sensitivity. If one agent does not work, different products should be recommended until an agent that reduces the patient’s sensitivity is discovered. When sensitivity has been arrested, the worry of misplacing an instrument due to a jumpy patient will be greatly reduced. Patient and hygienist will be elated with this result.
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