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Dentinal Sensitivity Issue in Winter : A Report

Dentinal sensitivity issue in winter or dentinal hypersensitivity is one of the most frequently occurring clinical problems. It is clinically outlined as an exaggerated response of a stimulus to exposed dentine, irrespective of the location.

Dentinal sensitivity issue in winter is characterized as short, sharp pain arising from exposed dentine in response to stimuli, typically thermal, evaporative, tactile, osmotic, or chemical.

Dentinal sensitivity issue in winter is a chronic condition that is becoming more prevalent in adults, and several research has been conducted to determine the etiologic factors in the condition’s causes, diagnosis, and treatment.

This condition is usually caused by the loss of enamel and cementum, or the exposure of dentinal tubules. The severity and degree of sensitivity are affected by a variety of factors and vary from person to person.

Many materials and methods have been proposed to reduce or eliminate sensitivity. They include the use of tooth pastes containing potassium salts, fluoride composites, resins, laser; bio-glass and so on. These substances usually work by sealing dentinal tubules or by interfering with nerve impulse transmission.

What Is Dentinal Hypersensitivity?

Dentinal Hypersensitivity is defined as “pain derived from the exposed dentin in response to chemical, thermal, tactile, or osmotic stimuli that cannot be attributed to any other dental defect or disease.”

Thousands of microscopic portals run through the dentine towards the central area of the tooth. External triggers (such as a cold drink) can stimulate the nerves within the tooth once the dentine is exposed, resulting in the characteristic short, sharp sensation of tooth sensitivity.

Epidemiology

It can affect people of any age, but those between the ages of 20 and 50 are more likely to be affected. Females are slightly more likely than males to develop dentin hypersensitivity.

The condition is most commonly associated with canine and bicuspid teeth on the facial (buccal) aspect of the maxillary and mandibular jaws, particularly in areas of periodontal attachment loss.

What Are The Various Theories Of The Mechanism Of Dentinal Sensitivity Issue in Winter?

According to various researches, there are three major theories of the mechanisms of dentinal sensitivity:

  • Direct Innervation Theory
  • Odontoblast Receptor Theory
  • Fluid Movement/Hydrodynamic Theory

Direct Innervation Theory

Direct innervation theory states that nerve endings penetrate dentine and extend to the dentino-enamel junction. An action potential is triggered by direct mechanical stimulation of these nerves. There are numerous flaws in this theory. There is no evidence that the outer dentin, which is typically the most sensitive, is innervated.

Odontoblast Receptor Theory

According to odontoblast receptor theory, odontoblasts act as receptors on their own and relay the signal to a nerve terminal. However, the majority of studies have shown that odontoblasts are matrix forming cells, not excitable cells, and no synapses have been demonstrated between odontoblasts and nerve terminals.

Fluid Movement Or Hydrodynamic Theory

According to Brannstrom (1964), Dentinal pain is caused by a hydrodynamic mechanism, i.e., fluid force. The presence of widely open dentinal tubules is revealed by scanning electron microscopic analysis of “hypersensitive” dentin.

The presence of large tubules in hypersensitive dentin supports the hydrodynamic theory. The existence and motion of fluid within the dentinal tubules is central to this theory.

This movement of centrifugal fluid activates nerve endings at the ends of dentinal tubules or at the pulp–dentine complex. This is analogous to touching or applying pressure to activate nerve fibres surrounding the hair.

What Factors Can Trigger Dentin Hypersensitivity?

A person’s susceptibility to dentin hypersensitivity can be influenced by a number of factors, including:

  • Abrasive Tooth Brushing – Brushing the teeth too hard can wear off of the defensive enamel covering the tooth. Dentin hypersensitivity occurs when the enamel is damaged, exposing the dentin.
  • Gum Recession – Periodontal (gum) diseases are one of the leading causes of gum recession. Gum disease can cause the gums to recede from the gum line, exposing the dentin beneath, resulting in dentin sensitivity.
  • Broken Teeth – Broken teeth may permit bacteria to enter the pulp of the teeth, causing inflammation and tooth sensitivity.
  • Grinding Of The Teeth – As it is with bruxism, regular clenching or grinding of the teeth can lead to deterioration of the protective enamel, resulting in dentin sensitivity.
  • Overuse of abrasive agents for tooth whitening, such as hydrogen peroxide or baking soda, may result in tooth enamel damage and exposure of deeper tooth layers, resulting in tooth sensitivity.
  • Plaque accumulation on the tooth surface may also contribute to tooth sensitivity.
  • Excessive use of mouthwashes may also increase the likelihood of tooth sensitivity, especially if the dentin is exposed. Acids in mouthwash may exaggerate tooth sensitivity even more.
  • Dentin sensitivity can be caused by enamel erosion, especially that is caused by the consumption of highly acidic foods such as pickles, tomatoes, and tea.
  • Dentin sensitivity can be caused by dental procedures such as tooth scaling, crowning, and fillings. However, the sensitivity caused by these procedures usually resolves within 4 to 6 weeks.
Dentinal Sensitivity During The Winter Season: A Prevalent Dental Condition

What Are The Signs And Symptoms Of Dentinal Sensitivity?

People who have sensitive teeth may feel pain or discomfort in response to certain triggers. This pain may be felt at the roots of the affected teeth. The following are the most common triggers:

  • Hot foods and drinks
  • Cold foods and beverages
  • Sweet foods and beverages
  • Cold air
  • Acidic foods and beverages
  • Cold water, especially during routine dental cleanings
  • Tooth brushing or flossing
  • Alcohol-based mouth washes

The symptoms may come and go for no apparent reason over time. They can range from mild to severe. The severity and frequency with which the pain occurs vary.

In response to an external stimulus, the pain is sharp and sudden. Cold is the most common trigger, with 75% of people with hypersensitivity reporting pain when exposed to a cold stimulus. Other types of stimuli that may cause pain in dentin hypersensitivity include:

  • Thermal – Hot and cold drinks and foods, cold air, coolant water jet from a dental instrument.
  • Electrical – While using electric pulp testers.
  • Mechanical-Tactile – while using probe during dental examination, periodontal scaling and curettage, toothbrushing.
  • Osmotic – Hypertonic solutions such as sugars.
  • Evaporation – Air blast from a dental device.
  • Chemical – Acids, such as dietary, gastric, and acid etching during dental procedures.

How Are Sensitive Teeth Diagnosed?

Diagnosis Of Dentinal Sensitivity

Before initiating treatment for Dentinal Sensitivity, as with any other clinical condition, an accurate diagnosis is crucial.

Dentinal Sensitivity shares characteristics with other conditions such as caries, fractured or chipped enamel/dentine, pain from reversible pulpitis, and post-bleaching sensitivity. A thorough clinical history and examination are required to make a diagnosis of dentinal sensitivity.

Before a definite diagnosis of dentinal sensitivity is made, all other causes of dental pain should be ruled out. Other causes must be excluded, some of these techniques are:

  • Pain reaction to tapping teeth (to indicate pulpitis/periodontal involvement).
  • Pain when biting a stick (tends to suggest fracture).
  • Use of transilluminating light or dyes (to diagnose fractures).
  • Pain associated with recent restorations.

A simple clinical method for diagnosing DH involves using a jet of air or an exploratory probe on the exposed dentin in a mesiodistal direction, inspecting all of the teeth in the region where the patient complains of pain.

The intensity or degree of pain can be assessed either according to categorical scale (i.e., mild, moderate or severe pain) or using a visual analogue scale.

Prevention Of Dentinal Sensitivity

To avert sensitive teeth from occurring again in the future, teeth at least twice a day with a soft-bristled toothbrush and fluoride toothpaste and floss daily. Instead of intense or harsh scrubbing, use gentle strokes, and avoid using abrasive toothpaste. If individuals grind their teeth, speak with the dentist about getting a mouth guard. Tooth grinding can cause tooth fractures and sensitivity.

The identification and treatment of the dentinal sensitivity causative factors is a frequently overlooked phase of clinical management of DH. The condition can even be prevented from occurring or recurring if the etiological factors are removed.

Various etiological factors which can be corrected to prevent sensitivity include:

  • Faulty tooth brushing
  • Poor oral hygiene
  • Premature contacts
  • Gingival recession due to periodontal therapy or physiological reasons
  • Exogenous/endogenous non-bacterial acids

Faulty tooth brushing includes hard brushes, extreme forces, excessive scrubbing at the cervical areas or even lack of brushing which causes plaque accumulation and gingival recession. A model should be used to teach the patient the proper way to brush teeth.

Tooth powders and pastes with high abrasives should be spared. In addition, patients should be instructed not to brush their teeth for at least 2 hours after consuming acidic beverages in order to avoid the agonist effect of acidic erosion on tooth brush abrasion.

Erosive agents play an important role in the initiation and progression of DH. They have a tendency to remove the enamel or to open up the dentinal tubules.

Exogenous dietary acids or endogenous acids can be used as erosive agents. The exogenous dietary acids usually include carbonated drinks, citrus fruits, wines, yoghurt, and professional hazards (workers in battery manufacturing, wine tasters).

Acid-containing foods should be consumed in smaller quantities and on a less frequent basis. After acidic drinks, the patient should be advised to drink something alkaline (milk) or at least neutral (water), and to sip the drink rather than swishing it around the teeth.

Endogenous acid is produced as a result of gastroesophageal reflux or regurgitation. It is also common in patients suffering from eating disorders. The condition is distinguished by widespread erosion of the palatal surfaces of the maxillary anterior teeth. A patient in this situation should be referred to a medical practitioner for expert management of the underlying pathology.

An occlusal splint can be fabricated to cover the affected regions, to prevent any contact with the acids.

When To See A Dentist?

A dental examination may be required to determine the source of severe tooth sensitivity.

If individuals seem to have a continuous or severe tooth sensitivity and pain, they should consult their dentist.

A dentist may recommend the following treatments, depending on the cause and severity of the sensitivity:

  • Using a fluoride gel
  • Desensitizing agents
  • Filling
  • A Crown
  • An Inlay or Onlay
  • Surgical gum grafts
  • A root canal treatment
Dentinal Sensitivity During The Winter Season: A Prevalent Dental Condition

Management And Treatment For Dentinal Sensitivity

Management Strategy Includes

  • Obtain a thorough clinical and dietary history.
  • Distinguish the condition from other causes of dental pain.
  • Determine and monitor etiological and risk factors.
  • In the case of mild-to-moderate sensitivity, at-home desensitizing therapy is recommended.
  • If there is no relief or if the sensitivity is severe, proceed with in-office treatment.
  • Endodontic therapy can be initiated in extreme cases if the patient does not respond to the therapy and there are individual teeth exhibiting the symptoms.
  • A regular review should be performed, with a strong focus on disease prevention.

Treatment Methods for Dentinal Sensitivity

Because there is no universally accepted, gold-standard treatment that reliably relieves the pain of dental hypersensitivity over time, many treatments have been proposed with varying degrees of efficacy when scientifically studied.

These treatments’ presumed mechanism of action is either occlusion of dentin tubules (e.g., resins, varnishes, toothpastes) or desensitization of nerve fibers/blocking neural transmission (e.g., potassium chloride, potassium citrate, potassium nitrate).

In general, they can be divided into the following:

In-office treatment (i.e., intended to be applied by a dentist or dental therapist)

At-home treatment (i.e., available over-the-counter or by prescription)

OTC products are better suited for generalized, mild to moderate dentin hypersensitivity associated with multiple teeth, whereas in-office treatments are better suited for localized, severe sensitivity associated with one or two teeth.

Before undergoing in-office procedures, non-invasive, simple treatments that can be performed at home should be tried.

Home Remedies For Sensitive Teeth

Oil Pulling

Oil pulling may aid in the prevention of gum disease and tooth sensitivity. Teeth sensitivity may be reduced by oil pulling with sesame or coconut oil.

Oil pulling is an Ayurvedic practice that originated in India that involves swishing oil around the mouth for several minutes before spitting it out.

According to the findings of a study, sesame oil pulling may help to alleviate the symptoms of gum disease, also known as gingivitis by dentists. This practice was also supported by a pilot study, which found that daily coconut oil pulling may reduce plaque formation and gingivitis markers.

Oil pulling’s potential benefits for gingivitis may, in turn, reduce tooth sensitivity. According to research, people with gingivitis-induced gum recession are more prone to tooth sensitivity.

Guava Leaves

Chewing guava leaves or applying a topical gel containing guava leaf extract to the affected area may help reduce tooth pain and sensitivity.

According to an analysis of the health benefits of guava leaves, extracts rich in guava flavonoids have the potential to relieve toothache because of their pain-relieving, anti-inflammatory, and antimicrobial properties.

Clove Oil

Clove oil has long been used as a folk remedy for toothache. According to research, there is more to this than just tradition.

In a study, clove gel was compared to topical benzocaine, a gel that dentists frequently use to numb a person’s gums before inserting needles. The findings suggested that clove gel may be as effective as benzocaine gel in relieving needle pain.

Clove gel or oil applied to the gums may help reduce tooth sensitivity and pain. However, more research into the use of clove gel is needed to confirm its benefits.

Garlic

Garlic is a traditional remedy for a variety of health issues. Garlic is used in folk medicine to treat toothaches. Chewing on a piece of garlic produces a compound called allicin for a short period of time.

A study concluded that allicin has antimicrobial properties and may aid in the killing of bacteria that cause oral diseases, such as Streptococcus mutans.

S. mutans buildup around the teeth and gums can cause tooth decay, which can exacerbate tooth sensitivity. Combating these bacteria may slow the process and reduce tooth sensitivity.

Warm Rinse With Saltwater

Another way to fight bacteria in the mouth and improve oral hygiene is to use a warm saltwater rinse as a mouthwash.

According to one study, a saltwater rinse may be as effective as a chlorhexidine mouthwash in reducing dental plaque.

Add half a teaspoon of salt to 8 ounces of warm water to make a saltwater rinse. Then, before spitting out the salt water, swish it around your mouth several times.

Capsaicin Gel

Capsaicin is a spicy compound found naturally in chili peppers. Although capsaicin can cause burning when applied to the skin or gums, it may also help to relieve pain.

According to a study, topical application of capsaicin can help relieve some types of pain. Scientists aren’t sure how this works, but they believe capsaicin numbs nerve fibres, making them less capable of delivering pain.

Capsaicin gel applied to the gums may help relieve pain from sensitive teeth.

Turmeric

Turmeric is a yellow spice that is used in Ayurvedic medicine to cure inflammation. Turmeric contains curcumin, which may help with pain relief.

In a small study, a turmeric plant extract was found to be just as effective as ibuprofen in relieving pain from knee osteoarthritis.

To help reduce tooth pain and sensitivity, a person can make a paste by combining turmeric and water and rubbing it into their gums. However, there is no scientific evidence to back up this use of turmeric.

Fluoride

Using fluoride-containing dental products can help reduce the risk of cavities while also reducing tooth sensitivity.

According to one study, most fluoride preparations reduce tooth sensitivity when used in conjunction with desensitizing treatments.

There are numerous fluoride treatment options available for daily use, including:

  • Toothpaste
  • Gel
  • Mouthwash
Dentinal Sensitivity During The Winter Season: A Prevalent Dental Condition

Desensitizing Agents

Desensitizing toothpaste contains agents that reduce the permeability of dentin. Dentin is a hard, porous tissue found beneath the enamel layer in all teeth.

When dentin is less permeable, liquid has a more difficult time passing through it. Reduced permeability protects the nerve beneath, reducing tooth sensitivity and pain.

Dental Desensitizing Agents Include

  • Metal ions
  • Potassium
  • Oxalates

For people with sensitive teeth, one option is to use a desensitizing toothpaste containing potassium.

In an in vitro study, researchers applied rhubarb and spinach oxalate extracts to dentine discs extracted from human molars. The findings suggested that these extracts could aid in the reduction of tooth sensitivity.

In-Office Therapy

In-clinic treatments may include the placement of materials to seal dental tubules or the use of night-time appliances if the sensitivity is caused by night-time grinding.

Teeth that are sensitive can be treated. The type of treatment will be determined by the cause of the sensitivity. The dentist may recommend one of the following treatments:

Fissure Sealants, Resin, Or Glass Ionomer Materials

Fissure sealants, resin, or glass ionomer materials can be applied to sensitive areas of the tooth to penetrate the exposed tubules and seal them against the external environment.

An in-office procedure that strengthens tooth enamel and reduces sensation transmission.

Fluoride Application

Fluoride may be applied to the sensitive areas of the teeth by a dentist to strengthen tooth enamel and reduce pain. Duraphat varnish, a high concentration fluoride varnish, can be applied at regular intervals to alleviate the severity of dentine hypersensitivity symptoms.

The dentist may also advise using prescription fluoride at home via a custom tray.

Desensitizing Or Bonding

Exposed root surfaces can occasionally be treated by applying bonding resin to the sensitive root surfaces. A local anesthetic may be required.

Surgical Gum Graft

If the tooth root has lost gum tissue, a small amount of gum tissue from another part of one’s mouth can be taken and attached to the affected site. This can help to protect exposed roots while also reducing sensitivity.

A Crown, Inlay Or Onlay

A crown, inlay, or onlay is a type of dental restoration. These can be used to fix a flaw or decay that causes sensitivity.

The Root Canal Procedure

If one’s sensitive teeth are causing severe pain and other treatments aren’t working, the dentist may recommend a root canal which is a procedure used to treat problems in the soft core of the tooth (dental pulp). While this may appear to be a significant treatment, it is widely regarded as the most effective method for removing tooth sensitivity.

Prognosis

Individuals’ quality of life may be influenced by dentin hypersensitivity. The dentin-pulp complex may modify to the reduced insulation by laying down tertiary dentin, increasing the thickness between the pulp and the exposed dentin surface and alleviating hypersensitivity symptoms.

Formation of a smear layer (e.g., from toothbrushing) and dentin sclerosis are both examples of similar processes. These physiologic repair mechanisms, which occur naturally at a slow pace, are likely to occur with or without treatment.

Dentinal Sensitivity During The Winter Season: A Prevalent Dental Condition

Read Also: Baby Teeth : Know About The Importance And Functions Of Milk Teeth/Baby Teeth From A Dentist

Summary

Dentinal Sensitivity is a common oral pain condition that affects a large number of people. The etiology is multifactorial; however, the impact of erosion has become more apparent in recent years.

To cause dentinal sensitivity, a lesion must first be located on the tooth surface and then spread to exposed dentine tubules that are patent to the pulp. The short, sharp pain symptom is believed to be derived from the hydrodynamic pain theory and, while transient, is arresting and has an impact on quality of life.

Because of the rise in dentition longevity and tooth wear, especially among young adults, this episodic pain condition is likely to become a more common dental complaint in the future. Many effective treatment regimens, including a number of over-the-counter home use products, are now available.

The basic principles of treatment are simply changing or chemically blocking the pulpal nerve or altering fluid flow in the dentinal tubules with tubule occlusion.

If sensitivity is severe and persisting despite the precautionary efforts, visit a dentist for an evaluation. Only a visit to the dentist can determine the most likely cause of the tooth sensitivity and the best solution for one’s specific situation.

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