What Works Best?
February 1, 2024
Volume 0, Issue 0, February 2024
Page(s): p. 8
It can throw a wrench in almost any procedure, for almost any patient—pediatric, adult, or geriatric.1 Everything can be going well clinically, until the patient feels a sharp, short-lasting pain on exposed dentin,2 typically in the canines and premolars.1 Clinicians see it as an exaggerated response to routine stimuli, and it causes no direct harm to the tooth, dentin, or pulp,2 but it can derail a treatment nonetheless.
As a dental hygienist, I've seen firsthand how debilitating dentinal hypersensitivity can be. I often recommend an over-the-counter toothpaste that patients can use that is specially formulated for sensitive teeth. Patients are reminded to make sure that the toothpaste contains potassium nitrate or stannous fluoride, which helps to depolarize the nerve endings.
Dentinal hypersensitivity is a serious consequence of gingival recession that can impact patients' overall wellbeing. An often-overlooked solution involves addressing the underlying etiologies for gingival recession and performing root coverage procedures. Such surgical treatments can be combined with other treatments, including desensitizing medicaments and/or restorative care, particularly for cases when enamel has been lost or where loss of interdental hard and soft tissues makes achieving complete root coverage unpredictable.
My preferred method for addressing dentinal hypersensitivity involves the use of potassium nitrate-based products. I find these options to be accessible, practical, and highly beneficial. Potassium nitrate toothpaste products are readily available and often come at a reasonable cost, making them a practical choice for many patients. In public health patient care, it is crucial to recommend practical solutions that are within the general population's reach. While other solutions I might recommend are available through dental practices, I appreciate potassium nitrate products (such as Pronamel® from Sensodyne) because of their accessibility. This aligns with my commitment to ensuring that individuals can access affordable solutions for their oral health concerns.
My focus of care surrounds medically compromised patients—mainly cancer patients and survivors. I believe that silver diamine fluoride (SDF) is an extremely valuable tool that tends to be underutilized, including for the treatment of dentinal hypersensitivity. According to the American Dental Association, "SDF has been cleared by the FDA as a dentin desensitizing agent, and various studies support the effectiveness of SDF in treating tooth sensitivity." Of course, esthetic concerns should be considered, as staining will occur in caries and areas of hypomineralization.
For patients who experience hypersensitivity, my recommendations may include home and/or in-office applications. At home, patients can use such topical treatments as an over-the-counter toothpaste containing potassium nitrate (I prefer Colgate Sensitive, due to taste), a prescription-strength toothpaste formulated for sensitive teeth (I like PreviDent® 5000 from Colgate), or a remineralizing toothpaste (I recommend MI Paste® from GC America because it uses a milk-derived protein known as RECALDENT®). At a minimum, I advise the patient experiencing hypersensitivity to discontinue using toothpastes containing baking soda or those advertising whitening or tartar-control properties. In the office, the most economical treatment is to polish prior to any scaling with a fluoride-containing prophy paste (I use Nupro® Extra Care from Dentsply Sirona, with its calcium sodium phosphosilicate ingredient called NovaMin®). This can help significantly with the procedure of the day and also offers up to 28 days of extra relief. For general hypersensitivity, I apply a 5% neutral sodium fluoride varnish pre-scaling (if scaling bothers the patient) or post-polishing. Going further, I will use laser desensitization following the fluoride varnish application for localized sites of hypersensitivity. One other in-office option for a localized area is to apply a thin layer of liquid-based desensitizer (I prefer GLUMA® from Kulzer) and light-cure.
For dentinal hypersensitivity I like to use a product that utilizes calcium and phosphate in the form of hydroxyapatite (I prefer Predicta® Bioactive Desensitizer by Parkell). The ingredients penetrate the dentinal tubules on contact and continue to penetrate deeper over several weeks. It is very easy to apply. Students learn and incorporate the technique quickly: You simply remove the calculus and plaque and apply the gel to the surface. Use a microbrush (which comes with the kit) to massage the material into the surface. Patients report sensitivity relief for 6 weeks or longer. There is no tissue irritation, and we have not had a negative reaction of any kind since implementing the product over 2 years ago.
Leveraging my experience as a dental hygienist, I've developed a systematic approach to manage dentinal hypersensitivity, which includes diagnosing the root cause, biofilm control through education and routine recare visits, and remineralization via fluoride treatments or remineralizing dentifrices. Fluoride varnish, despite being highly effective, is often underappreciated. However, there's an emergence of new varnishes that are non-rosin based and do not include alcohol in their composition. These innovative solutions provide the full benefits of fluoride therapy in less time. Stay alert to these advancements in dental care.
Addressing dentinal hypersensitivity during visits is an often-overlooked tool for patient success. Think of it this way: When patients are out of discomfort, they are more present to move forward with other needs because they aren't worried about being in pain. If the pain is experienced only during the hygiene visit, an electronic dental anesthesia device (I like the Dental Pain Eraser from Synapse) is a great tool to block the pain response so that you don't need to skip a tooth. If the pain happens with cold drinks or sweets, then chairside light-cured desensitizers (I prefer Admira Protect by VOCO) coupled with daily use of a sensitivity toothpaste (I recommend Remin Pro from VOCO or Rapid Relief Sensitive from Tom's of Maine) are a great way to keep those zaps away. I also like hydroxyapatite toothpastes and putting adjuncts into trays.
Because there are many products for dentinal hypersensitivity and all patients are different with varying etiologies, there can be several options. Mild hypersensitivity can often be reduced by desensitizing toothpastes, used regularly. It doesn't happen overnight. Flouride varnish can also be applied to an area for relief. For immediate help, in-office options include products containing glutaraldehyde with HEMA, hydroxyapatite, glass ionomer cements, and even laser therapy. I tend to go with the least invasive option first (toothpastes, fluorides), and if no relief is achieved I then move on to some of the in-office treatments. There are various ones to choose from, and it might take some trial and error to obtain a product that works for that particular patient.
Dentinal hypersensitivity can be managed effectively, but it should not be approached with a one-size-fits-all mentality. I like to look at clinical signs—recession, clenching/grinding, and abfractions-and what can be done to prevent sensitivity from getting worse. The simple route is an application of fluoride varnish every 4 to 6 months, along with at-home prescription toothpaste (I like FluoriMax® 5000 from Elevate Oral Care) that has higher levels of potassium nitrate. If a patient has clinical signs of clenching and/or grinding (abfractions, wear, recession), I would also recommend a night guard to help prevent further damage. Now, my favorite and most effective way of treating dentinal hypersensitivity is with a laser, which is effective at sealing off the tubules, reducing the transmission, or completely blocking the sensitivity.
Dentinal hypersensitivity is common for many, as there are several contributing factors to the condition. Often, a combination of solutions that include both take-home products and in-office procedures can help tackle the problem. Popular take-home products with ingredients that contain potassium nitrate, bioglass, and various fluorides can help to seal the tubules. In-office treatments may include the clinician applying varnishes to the areas of discomfort, use of laser therapy, or restorative treatment. Communication is key to determine what methods might work best for each specific case.
References
1. Miglani S, Aggarwal V, Ahuja B. Dentin hypersensitivity: recent trends in management. J Conserv Dent. 2010;13(4):218-224.
2. Strassler HE, Serio F. Managing dentin hypersensitivity. Inside Dentistry. 2008;4(7):82-86.
