Dentin hypersensitivity

Lore & Background

The real cause of dentine hypersensitivity is controversial, with several theories proposed, including the odontoblastic transduction theory, the neural theory, and the hydrodynamic theory. The most commonly accepted model is the hydrodynamic or fluid movement theory proposed by Brannstrom in 1964, which states that when exposed dentine is subjected to stimuli, fluid flow within the tubules increases, triggering mechanoreceptors on nerves at the pulpal aspect and eliciting pain. Research indicates that triggers causing dentinal fluid to move away from the pulp elicit more painful responses than those moving toward it.

Reader's Guide

Dentin hypersensitivity is significant as a common dental complaint that requires diagnosis of exclusion, ruling out other causes such as pulpitis. Its prevalence is linked to gingival recession and tooth wear from factors like forceful toothbrushing, abrasive toothpaste, chronic periodontitis, acid erosion from diet or gastric reflux, and dental bleaching. Prevention focuses on non-traumatic brushing techniques, non-abrasive fluoride toothpaste, limiting acidic foods, and avoiding immediate brushing after acid exposure. Treatment lacks a gold standard, with options ranging from over-the-counter products for generalized mild cases to in-office procedures for localized severe hypersensitivity, often aiming to occlude dentinal tubules or desensitize nerves.

Did You Know?

• The most common trigger for dentin hypersensitivity is cold, with 75% of people reporting pain upon application of a cold stimulus.
• The hydrodynamic theory, proposed by Brannstrom in 1964, is the most accepted explanation for the pain mechanism.
• Dentin hypersensitivity is a diagnosis of exclusion, reached only after all other possible causes of dental pain are ruled out.
• Not all exposed dentin surfaces cause hypersensitivity, and some experts consider the pain a normal physiologic response rather than true allodynia.