Management and Prevention of Dentin Hypersensitivity

Differential diagnosis
When clients present with complaints of sensitive teeth, the first consideration should be to determine the etiology of the pain, since it may be difficult to differentiate between dentinal hypersensitivity and a variety of other tooth and/or pulp-associated reasons for discomfort. Clients often have a difficult time describing the pain and may not be able to localize it to any specific tooth or teeth, although they are usually more accurate in localizing hypersensitivity (caused by a non-noxious agent) than dentinal or pulpal pain. The character of the pain is similar when comparing dentin pain to hypersensitivity pain from exposed dentin. Dentin pain (caused by a noxious agent, i.e. dental caries) can be intensified by thermal change, sweet, and sour, all of which could elicit a hypersensitivity reaction as well. Additionally, pain from both is usually within the mild to moderate range. Pulpal pain can be differentiated from dentin pain since it is often described as severe, intermittent, and throbbing. However, both can be elicited by hot and/or cold stimuli. Pulpal pain may also manifest during chewing, which would distinguish it from hypersensitivity.

Pulpal inflammation or pulpitis can be difficult to assess, since there is no way to be certain of the diagnosis, short of tooth extraction combined with histologic examination. Adiagnosis of pulpitis is based upon a combination of clinical findings and symptomology. Diagnostic aids include history of pain, percussion and palpation tests, inspection of the teeth and surrounding tissues, thermal and electric pulp tests, and radiographic examination. The dental history should include chronology, nature, location, and aggravating and alleviating factors that influence pain.43 The pain of pulpitis often occurs without provocation, and particularly after thermal tests, may persist after the stimulus has been removed. This would differentiate pulpitis from dentin hypersensitivity pain, which subsides after removal of the stimulus. Additional tests for pulpitis could include painful response to percussion and tooth mobility.

A differential diagnosis to rule out other conditions must be established before treating for hypersensitivity. Dentists vary in the techniques used to arrive at a differential diagnosis. Some of these include pain response upon the pressure of tapping teeth to indicate pulpitis; having the client bite on a stick to evoke pain that is suggestive of tooth fracture; use of lights or dyes to aid in the diagnosis of a fracture line in the tooth; fractured restorations visualized by careful examination of the restoration, perhaps aided by magnification; pain associated with a recent restoration as determined by dental history; and adjusting the occlusion to produce relief from the hyperfunction created by placement of a new restoration or crown.