Introduction

Dental hygienists frequently encounter clients with sensitive teeth and recognize ‘the look’ elicited when their sensitive teeth are stimulated. Many clients with sensitive teeth are clearly uncomfortable during dental hygiene procedures (Figure 1). In these instances, there is an added element of stress for the clinician who needs to provide a thorough debridement, yet seems to inflict pain with every stroke of the instrument. The client often looks to the dental hygienist to provide relief both during and after the procedure and is seeking information concerning the cause of the discomfort he or she is experiencing.

As with any disease or painful condition, it is essential to understand the etiology of tooth sensitivity to plan for effectively managing client discomfort and preventing subsequent painful episodes. However, hypersensitivity is a confounding condition because its development and expression is influenced by modifying and predisposing factors as well as by individual susceptibility. Additionally, an individual’s psychogenic pain response impacts the perception of the severity of the condition and the benefits of treatment.

Hypersensitivity has been referred to as an enigma1,2 for a variety of reasons, including difficulty in determining the etiology, the numerous treatment approaches, variability in pain relief, and because invivo objective clinical trials are difficult to conduct. A prerequisite for the occurrence of hypersensitivity is gingival recession and subsequent dentin exposure as a result of loss of cementum or enamel. Reasons for cementum and enamel loss are often difficult to determine.

There is no consensus in the literature concerning terminology used to describe the condition. The terms dentin hypersensitivity and tooth hypersensitivity or hypersensitivity have been questioned because the pulp response that is elicited by the stimulation of exposed dentin would be expected as a normal rather than a hyper-reaction.3 The terms dentinal, dentin, or tooth sensitivity frequently have been used. The condition has also been referred to as cervical dentin sensitivity4,5 and as cervical tooth sensitivity,6 adding a locationbased descriptor to differentiate it from other types of tooth pain.

For this continuing education course, the terms dentin hypersensitivity or hypersensitivity will be used.