Hypersensitivity

(lectures by Dr/Amal Sakr)

 Definition
 Causes of preoperative and postoperative
hypersensitivity
 Theories of hypersensitivity
 Diagnosis
 Treatment of preoperative hypersensitivity
 Treatment of Postoperative hypersensitivity
It is an exaggerated response to a
sensory stimulus that usually
causes no response in normal
healthy teeth.
Affects eating, drinking, and
breathing.

Hypersensitive teeth are

characterized by transient pain in
response to:
• evaporative
• tactile
• thermal
• electrical

• chemo-osmotic stimulation of
exposed dentin
Bacterial
Chemical Osmotic
Mechanical
Abrasion
Cracked tooth syndrome
Fractured Tooth
Iatrogenic(during cavity
preparation)
Bur material
Bur design
Number of blades
Rake angle
End or lateral cutter
Hypersensitivity Theories
1. The odontoblast Transduction theory:

Pulp nerves are pain receptors: A dental stimulus

excites odontoblastic process which then transmits the
excitation to the adjacent nerve plexus (supported as
the odontoblasts are of neural crest origin).
2. Direct neural stimulation:

Odontoblastic processes are mechanoreceptors:

Dentin contains nerve endings which respond when
dentin is stimulated.
(no satisfactory evidence that there are nerves in
outer dentin which is the most sensitive region.)
The hydrodynamic theory:
(most widely accepted )
The perception occurs as a response to low intensity
stimulation of afferent A-delta nerve ends by sudden
inward / outward movement of tubular fluid on
application of non-noxious stimuli to exposed virgin
dentin surface
Diagnosis
History:
 onset, duration, stimuli, spontaneity, intensity and
factors that relief the pain.
Subjective Evaluation:(Symptoms)
 Verbal rating scale, which is a 4 scale
 grading pain as slight, moderate, severe and
agonizing,
 Visual analogue scale :is a line of 10cm in length
the extremes of the line represent the limits of pain
experienced by the patient from no pain and till the
most severe pain
 McGill word descriptors by answering a pre prepared
questionnaire
 Clinical and Radiographic examination:
 it is the objective evaluation of clinical signs using:
 Mechanical stimulus: Probe, scaler, constant pressure
probe and Yeaple pressure stimulators.
 Chemical (osmotic) stimulus: Sodium chloride,
sucrose, glucose and calcium chloride.
 Electric stimulus: Electrical pulp tester and dental
pulp stethoscope.
 Evaporative test: air blast, Air jet stimulator
 Thermal stimulus: Ethyl chloride, ice stick and heat
thermoelectric devices.
Techniques to Reduce
Preoperative Hypersensitivity
 Homecare
 In Office treatment
Homecare
 Desensitizing toothpastes / dentifrices
 Mouthwashes and chewing gums:
 Dietary Modifications:
 Management of parafunctional habits:
 Treating the cause as malocclusion

 Night guard and fluoride.

CaseinPhosphopeptides/ACP
Fluorides alone or with
iontophoresis
Potassium Nitrate
 Reduces hypersensitivity by decreasing nerve
transmition