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Dentine contains many thousands of microscopic tubular structures that radiate outwards from the pulp; these dentinal tubules are typically 0.5-2 microns in diameter. Changes in the flow of the plasma-like biological fluid present in the dentinal tubules can trigger mechanoreceptors present on nerves located at the pulpal aspect thereby eliciting a pain response. This hydrodynamic flow can be increased by cold, air pressure, drying, sugar, sour (dehydrating chemicals), or forces acting onto the tooth. Hot or cold food or drinks, and physical pressure are typical triggers in those individuals with teeth sensitivity.
Treatment can consist of amorphous calcium and phosphate, NovaMin, potassium nitrate, strontium chloride, gluma, fluoride therapy, or calcium sodium phosphosilicate.
Potassium nitrate is commonly used in toothpastes such as Sensodyne or Crest Sensitive as a remedy and is approved as a monographed drug by the FDA. Nonetheless, there remains some dispute about its effectiveness. Strontium chloride and strontium acetate are used in Sensodyne Original and Sensodyne Mint toothpastes. The mode of action is linked to their ability to form mineralised deposits within the tubule lumen and on the surface of the exposed dentine that help prevent transmission of the applied stimulus.
One cause of sensitive teeth can be traced to nocturnal gastroesophageal reflux disease (acid reflux). Stomach acid can reach the teeth and cause enamel loss and prevent re-mineralization.
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Prevalence :
A study conducted at Queen's University, Belfast, determined that the prevalence of reported sensitivity was 57.2%. In most cases the incidence occurred in the 30-39 year age group. Although the majority of individuals reported that cold was the major stimulus for pain, other causes such as toothbrushing, hot, and sweet stimuli were reported as well. This study found the prevalence of dentine sensitivity to be much higher than in previous reports. These results suggest an increase in the levels of sensitivity within the general population.
Prevention :
Before the proper treatment for a patient is defined, it is important to first prevent, modify, eliminate or control etiologic factors such as plaque, improper toothbrushing, and a diet high in fermentable carbohydrates and/or acidic foods.
Some examples of acidic foods are fruits, fruit juices and wine whose acids can remove smear layers and open dentinal tubules. Toothbrushing with abrasive toothpaste may abrade the dentin surface which may open up dentinal tubules if combined with erosive agents. One recommendation for patients is to avoid toothbrushing for at least two to three hours after consuming the above mentioned acidic foods or drinks.
Treatments :
There are different options to treat dentine hypersensitivity that can be divided in at-home treatments, those the patient can apply, and in-office treatments, those applied by the dentist
At Home Treatments :
** Desensitizing toothpastes/dentifrices : Tooth-pastes are the most widely used dentifrices for delivering over-the-counter desensitizing agents. The first desensitizing toothpastes to appear on the market claimed either to occlude dentinal tubules (those that contained strontium salts and fluorides) or destroy vital elements within the tubules (those that contained formaldehyde). Now, most desensitizing toothpastes contain a potassium salt such as potassium nitrate, potassium chloride or potassium citrate, though one study reported that a remineralizing toothpaste containing sodium fluoride and calcium phosphates reduced DH.
** Potassium Salts : Toothpastes containing potassium nitrate have been used since 1980. Since then, pastes containing potassium chloride or potassium citrate have been made available. Potassium ions are thought to diffuse along dentinal tubules and decrease the excitability of intradental nerves by altering their membrane potential. The efficacy of potassium nitrate to reduce DH, however, is not supported strongly by the literature, according to Poulsen and colleagues. These authors undertook a meta-analysis of clinical trials on potassium nitrate toothpastes published up to 1998. Eight studies satisfied their inclusion criteria, but only four studies provided sufficient information to be included in their final meta-analysis.
Since 2000, several trial results of potassium-containing toothpastes have been published. Some of these studies compared different tooth-paste formulations. For instance, six studies found that pastes containing 5 percent potassium nitrate or 3.75 percent potassium chloride significantly decreased DH when compared with baseline or negative controls. A product containing 5 percent potassium nitrate and 0.454 percent stannous fluoride in a silica base produced significantly greater reduction in DH than did a tooth-paste containing 5 percent potassium nitrate and 0.243 percent sodium fluoride in a silica base or than did an alternative formulation containing 5 percent potassium nitrate and 0.76 percent sodium monofluorophosphate in a dicalcium phosphate base.
An in vitro study of hydraulic conductance in dentin disks confirmed the findings of these clinical trials. The product containing 5 percent potassium nitrate and 0.454 percent stannous fluoride in a silica base, which caused significantly greater reduction in DH, also demonstrated the lowest hydraulic conductance (permeability) and greatest inward potassium ion flux in dentin disks.
Two studies support the desensitizing effectiveness of pastes containing potassium citrate. Many toothpastes contain other ingredients such as fluorides (for example, sodium monofluoro-phosphate, sodium fluoride, stannous fluoride) and antiplaque agents in conjunction with desensitizing and abrasive agents. Further studies are needed to determine that these various ingredients do not interfere with each other. Two studies found that the antiplaque ingredients triclosan or zinc citrate did not compromise the desensitizing efficacy of potassium nitrate or citrate.
** Toothpaste Applications : Practitioners should educate patients on how to use dentifrices and monitor their toothbrushing techniques. Dentifrices should be applied by toothbrushing. There is no evidence to suggest that finger application of the paste increases effectiveness. Many patients habitually rinse their mouths with water after toothbrushing. Rinsing with water may cause the active agent to be diluted and cleared from the mouth and, thus, reduce the efficacy of the caries-reducing effect of fluoride toothpastes.
** Mouthwashes and Chewing Gums : Studies have found that mouthwashes containing potassium nitrate and sodium fluoride, potassium citrate or sodium fluoride or a mixture of fluorides can reduce DH. In only one of these studies, however, was the effect of the active mouthwash significantly greater than that of the control product. Another study concluded that a chewing gum containing potassium chloride significantly reduced DH, but the study did not include a control group.
DH severity should be reassessed two to four weeks after commencement of treatment to determine the effectiveness of the first level of desensitizing treatment . If at-home care fails to reduce DH compared with baseline levels, the next level of treatment, an in-office method , should be started.
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You've pretty much given the list of things that people should avoid whenever they start to feel irritable about their teeth. I'll be listing down those food categories that you've mentioned. Thanks for the home remedies, by the way.
ReplyDelete@Loretta John thanks for your comment.
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