final exams 2010

  1. Dentinal Hypersensitivity
    characterized by a short, sharp pain arising in response to thermal, evaporative, tactile, osmotic or chemical stimuli applied to the teeth either in normal function or in the dental office

    can occur in single of multiple teeth which may effect mode of treatment

    can occur in virgin teeth or after restorative work
  2. Before definitive diagnosis of DH is made, other causes must be ruled out: (7)
    • caries / leaky restoration
    • chipped/fractured teeth / trauma / occlusal problems
    • palatoginigval grooves
    • periodontal disease
  3. Diagnosis of DH
    • pt history
    • rule out other etiological factors (examination, radiographs, pulp testing)
  4. Etiology: 3 Theories
    • 1) nerve in dentin: dentin contains nerve endings that respond when it is stimulated
    • 2) odontoblastic process: the odontoblasts serve as receptors & are coupled to nerves in the pulp
    • 3) hydrodyanmic theory*: the tubular nature of the dentin permits fluid mvt to occur w/in the tubule when a stimulus is applied--a mvt registered by pulpal free nerve endings close to the dentin
  5. Hydrodyanmic Theory
    Stimuli create hydrodynamic movement in fluid-filled tubules that stimulate nerve endings by activating mechanoreceptors in intra tubular nerves or the superficial pulp. Thus, the true physiologic stimulus is inward or outward fluid shift. Tubal configuration and diameter as well as the number of open tubules affects the flow of fluidThermal, evaporative, tactile, osmotic or chemical stimuli can cause responsePulpal sensory nerves include myelinated A-Beta and A-Delta fibers as well as C-Fibers. When stimulated, the resulting sensation is pain
  6. DH not related to restorations
  7. Statistics of DH
    60 – 98 % of patients with periodontitis have DHMain Cause of DH is gingival recession leading to loss of enamel or cementum Many do not seek treatment for it as it is not perceived as a major problemIn one survey, dentists stated that 10-25 % of their patients are diagnosed with DH while it is a severe problem in only 1%DH occurs most commonly in pts. between 30-40 yrs. old and women more often than menCanines and Premolars are teeth most effected
  8. More than 90% of DH surfaces are at the cervical margin on the buccal or labial aspects of the teethIt is believed DH lesions develop in two phases:First, lesion localization by exposure of dentin; either by loss of enamel or gingival recessionSecond, lesion initiation by loss of smear layer.AbrasionErosion (acid erosion is predominate)
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final exams 2010
final exams 2010