Self-Care Strategies

Professional interventions

Professional treatment methods are aimed at occluding or sclerosing the dentinal tubules. These methods include physically covering the dentinal tubules with varnishes and liners, precipitating ions into the tubules causing intratubular crystal formation, and placing glass ionomer or bonding agent restorations to physically block stimuli.

A variety of products and procedures are currently in use to seal the dentin tubules and are successful to varying degrees.

Fluorides—These are believed to act by precipitating fluoride ions at low concentrations to be available simultaneously with calcium and phosphate to produce fluorapitate or fluoridate hydroxyapatite. Fluoride actively enhances remineralization while fluoride precipitates are thought to occlude the dentin tubules.69 Although fluoride varnishes and burnishing fluoride into the tooth frequently result in reduced sensitivity, long term benefits have not been demonstrated because of the on-going tooth wear and daily occurring changes.70 Topical applications of stannous fluoride applied in a tray or burnished into the tooth surface have been shown to control dentin hypersensitivity.71 It can also be prescribed for home use utilizing a brush-on or tray technique.

Fluoride varnishes have been approved by the U.S. Food and Drug Administration (FDA) for use as a cavity liner and for the treatment of hypersensitive teeth.72 A 5% sodium fluoride varnish is an effective, convenient, and noninvasive method for desensitization.73-74 An advantage of this method is that teeth do not need to be dried prior to application and use of the air syringe, which can be painful, is not necessary. The varnish can be applied directly to the tooth with a brush or cotton pellet and sets on contact with the moisture of the oral cavity. The taste is not objectionable, and varnishes cause no interruption to the individual’s lifestyle or habits other than delaying the next brushing. The varnish acts as a reservoir for the fluoride, which is slowly released for remineralization to occur into the dentinal tubules, thereby blocking dentinal fluid flow.72

A new fluoride delivery method, an intraoral fluoride releasing device (IFRD), has been suggested and initially investigated. The device is bonded to the buccal surface of a maxillary molar and releases 0.04% mg of sodium fluoride per day. Although more comprehensive comprehensive evaluation is indicated, in initial testing a significant reduction in sensitivity was reported to be evident at four weeks.69

Oxalates—These compounds are composed of ions that react with calcium to form an insoluble calcium oxalate crystal that occludes the dentinal tubules. Ferric and potassium oxalate compounds when professionally applied can reduce hypersensitivity.75 Oxalates, although insoluble, do not penetrate far into the dentin tubules and may be readily dissolved or removed.76 Although, short term relief has been reported, long-term results are limited because of the ongoing mechanical wear of the affected tooth surface
and changes in the oral environment.70

Gluteraldehyde and hydroxyethylmethacrylate—This bonding agent system should be carefully applied to the tooth surface with a cotton tip applicator. Special precautions should be exercised to prevent the agent contacting gingival tissues.

Iontophoresis—Iontophoresis typically employs a low voltage charged electric current to drive a 2% sodium fluoride ion into the affected dentin. Use of iontophoresis has been shown to result in dentin incorporating two to six times more fluoride than dentin receiving only topically applied sodium fluoride.77

Composite resin or glass ionomer restorations—These resolve dentin sensitivity by sealing the surface and occluding the dentinal tubules. This long lasting, yet more invasive, procedure requires tooth surface preparation and is indicated when there is significant loss of tooth structure or the tooth doesn’t respond to other less invasive desensitizing treatment.

Periodontal surgery—A tissue grafting procedure can be used to cover the sensitive surface and protect the dentinal tubules from the oral environment. The outcomes of this procedure to relieve sensitivity is unpredictable.

Lasers—The Nd:YAG laser has been used in conjunction with sodium fluoride varnish with encouraging results. One study found that over 90% of the dentinal tubule openings were occluded through use of this combined therapy.78

In one long-term in vivo study utilizing CO2 laser irradiation and stannous fluoride gel, the tubule closure was observed by SEM for four to six months after treatment.79 Additionally tin ions were also seen, demonstrating integration of the fluoride into the dentin surface.Further in vivo studies are needed before long-term pain reduction with laser therapy can be confirmed. To date neither of these treatments has been approved by the FDA.