dentists' views on cervical hypersensitivity and their knowledge of its treatment

8/3/2019 Dentists' Views on Cervical Hypersensitivity and Their Knowledge of Its Treatment

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Endod Dent Traumatot 1995: II: 240 244Printed in Denmark . Alt rights reserved

Copyright Munksgaard Endodon tics &Dental T raumatol

ISSN 0109-2502

D e n t is t s ' v i e w s o n c e r v ic a i h y p e r s e n s i t iv i t ya n d t h e i r k n o w le d g e o f i t s t r e a t m e n tSchuurs AHB, Wessel ink PR. Ei ikman MA], Duivevmoorden HI .Dentists" \ ie\ \s on cen ica l h\pe rsensit i \ i t \ and their knowledge ofits t reatme nt. End od Dent Tra um atol 1995: 1 1: 240 244. Munksgaard , 1995.Abstract - A rand om sample ol ' 400 Du tch general practi t ionerswas asked to complete a questionnaire dealing with the pre\si-lence, condit ions and therapies of ce nic al h \persen sit i \ i ty of theirpatients . According to the 259 responding dentists an a\erage of10() of their patients suffered from moderate cer\ical pain. Theestimated mode for se\ere pain was l*'o. More than two thirds ofthe dentists reported inadequate brushing of the teeth to cause theh\persensit i \ i ty, about one half acknowledged periodontal causes,well o\ er one q uarter men tioned the in\o l\ eme nt of dietary acids,and about one sixth implicated psychosomatic factors. Other causalfactors were mentioned less often. Of the therapies a\ailable. ihehome-care methods appeared to be promoted mo.st often, i .e .brus hing with ther ape utic toothpaste.s 77**o. im pr o\e nic nt oi oralhygien e 51*^0 a nd local self-application with finger of a the ra-peutic tooth paste o r fluoride prep ara tion s before the night 4r'(> .Well o\er 50" o reported to apply occasionnally bonclings/x aniish-es and 28" o .said to make sometimes cenical fiUinos. Other thera-peutic possibilities were not. or \er\- seldom, used.

A . H . B . S c i iu u r s \ P . R . W e s s e i inM . A . J . E ij k m a n ^ ,H . J . D u i v e n v o o r d e n ^Departments of ^Cariology and Endodontolog^Social Dentistry and Dental Health EducatioACTA, University of Amsterdam, ^MedicalPsychology and Psychotherapy. ErasmusUniversity, Rotterdam. The Netherlands

Key words: dental hypersensitivity; dental papulpai painA. H. B. Schuurs. ACTA. Louwesweg 1,1066 EA Amsterdam, the NetherlandsAccepted September 13. 1994

CJer\ical hyper sen siti\ity i.s a pof)rly u nd ers too d con-ditio n. There fore, co m m on a.s it m a\ be . h\per.seiisit-i\it\' may pose a therapeutic and even a diagno.sticproblem to general practi t ioners 1 .

Cenical hyper.sensiti\it\" is a painful but othcnsiseharmless reaction to external thermal, tact i le, electro-chemical and osmotic stimuli lo dentine of iceih with\ia bl e pulp.s. Usu ally th e pai n i.s sho rt-li\'ed. lastingfrom secon ds lo min utes after provo cation 2 5i. Ifthe pulp is inflamed, h\persensili\ity is IIKHX' casiKprovo ked, more severe, and of longer duratio n 6 1, .1 he main pathogenic condition is loss of cementumafter denudation of the root dentine as a result (Agingival recession 8 . Mo st likelv the ex tern al, in prin -ciple non-noxious, stimuli cause abrupt shifts ormov enients of the fluid in those den tinal tubules thatare open and patent to the pulp, thus exciting pulpalnerve endings 12 3, 9;. However, other theories exist.

the s t imulu s appl ie d 4. K) 12 . Co ld seem s lo i)eflecl ive si imii lus and vxould ("vokc most of the pla in t s 13; . Xf)i a ll pa i ic nis wi th den ud ed d en t inefer pa in because the ora l aper tures of t l i c dentubules may l)( 'c


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Dent ists on cervicai i iypersensi t ivsidered (22). With d esensitizing agents and pro ced uresit is tried to seal the copen apertures, to alter the con-tents of the dentinal tubuli or to occlude them. CJolla-crt & Fischer (1990) have reviewed the c urrently usedageiils, among which fluorides, strontium chloride,sodium citrate, potassium nitrate and oxalate, andfind the repo rted results to be am bigo us ^23/. Exceptfor a genera l placebo-effect (24) the abr asive silicaparticles in therapeutic dentifrices rather than the ac-tive agents, such as strontium and fluoride, have beenconcluded to occlude the tubules (24 26). Althoughthe benefits of Sensod yne'^ withou t fluoride andI'^mofbrm'' j arc found significantly less than those oftoothp astes w ith a silica abrasive 26 . the formerbrand is still on the market and is widelv' promotedas a therapeutic agent against hypersensitive teeth.(Jther thcrapcail ic methods and procedures includeva rnis he s/bo nd ing s/ resins 27 29 . occlusal grinding30 , class \ ' restora tion 3f 32 or even crow ns, ion-to]^ho rcsis of" floride 18. 33 35 , hy]3nc)sis 36 . in du c-tion of rep ara tive de nti ne 3() and sclerosis bv cal-cium hy drox ide 37 39 or gluco cortico ids 37 . soft40: or liard laser ilicrapv- 41 41 :. an d cndoc iontictre atm en t. The efficacy of most of" these the rap iesseems not v\cil established and unpredictable.

It is not kiiovMi v\iictlicr geiicial practitioners areav\arc of the scoj^c, the conditions anci the possiblethcra]:)ic-s of" livpc rscnsitiv ity. The aim of the pre se ntinvestigation was therefore to siudv": 1 ihc generalden ial pia clilio iicrs 's j^cicc ptioii of th e ]3rcv alen ce. se-verity, and duration of cervical dciitinal hyperseiisitiv-ltv. 2 their knowledge of its conditions, i.e. etiology,and 3; to establish liov\ dcniists deal witfi ihc^ clinicalpro ble m an d if" they ne ed a leaflet for the p atie nts .

iViater iai and met i iodsFrom the alphabetical lisiccl Duuii active generalciciuisis a rand om sain])lc of" 400 abo ut 2.5" o v\asdraw n. O ne third 35,4" o ofllu^ dcinisis lo v\ hom ihcC|iicsiioniiairc v\as sent did not respond. Due to mov-ing and uukiiovvii address, no data WCM'C collectedfrom 2f de m ist s. 'I"hrcc ckMiiists rc])ortccl to be rc -iirccl. three had CIUTL one ctppcarcd to have an ortho-doti i ic piaclue and 1 13 did not rcspoiici, in spite of asecon d m ailing . Ilius data wcnv cc^ltHtcd from 259()-!.()" o dentists.

1 he c|uc\siionnairc^ was rather staightforvsard andcoiisisU'd of" nin e prccoclcel an d two o ])cii-ciid qu es-tions. 1 he opcn-ciicl c|U(\stions asked for the con-diiions an d the ilic^apics of" cervical hvpcrscn sitivitv.1 he pic-coclcd questions coiucriicd the prevalence of

lnp crsc usit iv ily of" c(M-vic al ro ot de nt in e an d the pe r-centage of ])aticiits suffering sc^vcrc pain, its rdation-shij) v\ith strc^ss in dailv life, tlic frcc|uency of patients'

the data. Correlations were used to find relationshbetween the data.ResuitsAccording to the dentists ' reports, an average 9.i sd9 .6 % ; mode = 5"''o; range 0-75"o of their tients suffered from cervical hypersensitivitv" and 2.!sd3.13"/(): m od c= l" 'o ; range 0 25"'o from sevcenical pain. The dentists thought the complaintspersevere for one week or less, to 12 weeks and mTable 1 . Abo ut on e half of them reported that tients ' 'sometimes"" ask questions concerning h\psensitive teeth, and more than one third acknoedgcci to be co nsu lted "often"" Ta ble 2 .

The condit ions/causes reported to underl ie hvpsensitivit) v\crc categorised and arc summarisedFable 3. Fhe majoritv- mentioned more than cause, above all inadequate toc3th brushing, retractof the gingiva due to different causes and cen iabrasion, either f"urthered bv' erosion or not. p.sychosomatic aspect was reported spontaneous!)-one sixth of the dentists, but when a.skcd explicone cjuartcr stated that h)pcrsensitivity depends stress, especiall)- manifest in bruxism. Other factamong vxhich the condition of the pulp and iatroge

Table 1. Duration of complaints due to hypersensitivity. as perceived by nbers of dentists

Duration of complaints12 weeks or more

8 weeks4 weeks3 weeks2 weeks1 week or less

Do not knowNot reportedTotal

n8047243238141212

259

(%)(30.9)(18.1)

(9.3)(12.4)(14.7)

(5.4)(4.7)(4.7)

(100.2)*Rounding off error.

Table 2. Frequency of patients asking questions about hypersensititivitperceivea by numbers of dentists

Very oftenOftenSometimesRarelyNeverDo not knowNot reported

n10

10012422

01CNJ

(%)(3.9)

(38.6)(47.9)

(8.5)(0.0)(0.4)(0.8)


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Sci iuurs e t a i .Table 3. Conditions for hypersensitivity, as perceived by numbers of dentists Table 4. Reported treatmen ts of hypersensitivity by number of dentists

n1. Brushing

Hard toothbrushAbrasive paste ( +brush)

2. Gingival retractionPlaquePeriodontal surgeryScalingPocketsAgeImproved cleaning

3. Diet (erosive abrasion)4. Psychosomatic factors

Bruxism/occlusal interferenceStress

5. General health factorsMinor resistanceAnatomical/geneticalHormonal

6. MiscellaneousIatrogenic factors^Temperature/climateExcitation pulpDrugs

7. Not reported

1825828

1292924191498

76473021291112

5502422

33

20

(69.9)

(49.8)

(30.1)(17.8)

(11.6)

(19.3)

(7.7)Valid percentages.For instance a crown not covering totally the cutt surfaces.

factors were mentioned cither b)' onh- a fcv\" dentistsor not at all.In Table 4 the clinical treatment modalities arcrankordered. It can be seen that a majorit)- of thegeneral dentists used several approaches, the averagenumber being 2.6. Home-care with a therapeutictoothpaste was first choice of all and man)- mentioneddentifr ices b) brand name. Sensodyne' ' v\ i thoutffuoride being b) far the most popular. In descendingorder w ere used the applicat ion of" var nish es/b ond -

ings. instruction to improve the oral h)gicne. self-ap-plication of ffuoride and therapeutic tootfipastcs. res-torat ions, endodontic treatment, diet counseling andocclusal correction. Other treatments, such as ion-tophoresis, v\crc reported once each.

A large majorit)- of the dentists 86.5 "o assessedtheir treatment methods to be eflectivx-. but 47 ofthem remarked that the results were not always posi-tiv-c. Most of the interviewees ;79.6"/o: wished to re-ceive a scicntificall) approveci brochure on h)-pcrscns-itivit) for their patients.

A matrix with correlation coefficients between thevariables revealed some significant values. Fhe corre-lation between the 'by the dentists estimated) frc-qucnc)- distributions of mild and severe cervical pain

1. Prescription therapeutic toothpaste^Sensodyne^DarosenseEmoformOthers (among which Elmex gel")

2. Varnishes/bondingsDuraphat"Others (Tresiolan ", tenure, copalite)

3. Improvement hygieneWay of brushing^Other (softer) toothbrushA less abrasive toothpaste

4. Applications by patientFluorideOthers (therapeutic toothpastes)

5. Restorations''GiassionomerComposite

6. Endodontic treatment^7. Diet counseling8. Occlusai correctionNot reported

n196141

482

181366536

131107

5016

1059215731931181694

(%)*(76.9)

(53.3)

(51.4)

(41.2)

(28.6)

(7.1)(6.3)(3.5)(1.5)

* Valid percentages.^ Fifteen dentists limited themselves to prescription of such a tooth

Some did not mention specific tooth pastes, others more than one.' Eleven specified Sensodyne with F: a few expressed doubts about the 2 A combination of brushing method. Bass' methods for one. with

toothbrush (n=30) and other combinations (n = 14). Four dentists lthemselves to improving the oral hygiene.

^ Inclusive crowns, mentioned by some.^ Specifically mentioned as" . . . a last resort".

all other correlation cocfficic^nts appcarcci to smaller.DiscussionFhe noii-respoiisc in the present investigation have been due to, among others, a lack of knowleon the subject and may therefore have caused a l)demanding caution in generalising- the results.Ih c repo rted av erage frccjucncy of cervical h)pscnsitivit)- was about 1 ()"(). 'Fhis ])crcciitag-c was lthan the 15 30" o scc> Iiitroduc tion: prcscntccl inliterature, yet indicated that tlic dentists were rawell aware- of" the m ag nit ud e of the pro bl em . scjm cwhat low fiecjuc ncy figure migh t bc clue to ticnts not bothering to consult a dentist l"or tlic j^1cm, if m ino r. A lternativ ely, the recollec tions of"den tists m ay not be re liable i nd ica tor s of" the qu cn cy of" ccnic :al h ypersen sitivity, unless the y kcareful patient records. A dentist 's judgement


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Dentists on cervical hypersensitiresults. The same may be t rue for the est imated num-ber of patients sufFerins; from severe pain.With regard to durat ion ol" hypersensiti\ity twothirds of the dentists reported the pain to last shorterthan tweK e weeks. D ata on the persistenc e of hyper-sensitivity often coneerned anti-sensitivit) ' treatmenttrials, but they made it clear that the pain mii^ht lastfor even years. O th er studies Intro due tion; point toa })ossible shorter duration. The dentists' perceptionol the pain duration may be inl lueneed by either theirunreliable recollections or the bel ia \ ior of the pa-tients, that is to say, patients who accept the presenceof a m ild pain do probal)ly not visit a dentist. Patients.w ho are advised to deal v\ith the hypersensiti\it\- l)yhome-ca re , ma\- be less inclined to consult the dentistagain in case of minor pain. Moreover, patients ma\ha\e become accus tomed to the discomfort and ma\ha\e learned not to trigger the ]3ain, by avoiding thecontact ( f cold foo d/d rink s \\ ith the sensitiv e areas.

Man\" dentists appeared to ment ion onh' a few ofthe condit ions w hu h the literature associates with hy-])ersensiti\ it)\ In \ iew of the hardK know n causes ofh\persensiti\ it\; this lack in re]3ort is not amazing. In-correct brushing of the leeth was ment ioned by twothirds, but retraction of the gingixa due lo ])enodontaldisease, surgical t reatment and/or improved homecleaning were reported l)y less than half of the inter-vicn\('es. Ihe tÎect ol dietary acids on denuded den-tine and the relationship v\ith otlier factors, such asocclusal problems and iatrogenic causes, were re-porte d c on side iab K less ollen. Itie retrospectivecharacter of the study mav ha\e alfected the dentists"viev\s and answers.Many dentists said to ircâi the com|)laiius in sev-eral ways. As it is not established which thera])y oi'hvpersensitivitv' is lêst. it makc-s sense to choose ini-tially the most simple and cheapest method oi treat-ment, unless the pain is severe. The theiapv mostoitcMi instituted was presc ri})tion oi iherapcuiic tooth-pastes and improvement oi~ the oral hvgicne. Of thether ape utic tooth pastes , presc ribed bv three cjuariersol the dentists, mainlv' Sensodync' ' without lluoridev\as rc-commended. In caseoi severe ]xun and in caseoi lack ol success oi a simple tluM'aj)v\ one has to selectanotluM- trcatmciU m etho d. A bout haliO f the dentistsrc])()rted to do so by applic ation ol a bonding/v arnishand/or seir-a])plic alion bv the patients oi in [)articulai'llnoridc. Oilier therapies appecuxxi to be used rela-tivc'lv seldom. Althougli almost one third stated dic-tarv acids as a cause of hyjHMsensitiv itv, considerablylewcM" ap])ecUC'd to warn tlieir paticnits. or forgot torc^port so. 1 he su|)CM"lic ial obtu ra ti on oi the tubulesby the smear laver {4'Si and the mineralisation oi theaper tures is counterac ted by l)C)th strong and v\eakdicHan ac ids, tliat w ould also dim inish or nulliiy the

lations betVA een the reported condit ions of hypersitivity and the rejDorted treatment modalities mpoint to gaps in knowledge of the practi t ioners. Hoe\er . as long as scientific data in the- area of hvsensitivity are scarce and conflicting, it is not faisay that the dentists under studv' v\ere "unav\are"its etiologv- and treatment modalities. Other rc^seareveals that, generalK^ speaking, dentists lack knoedge in several dental fields 45 49 .I t appeared irom the | )resent study that mosthe dentists treated hvpersensitivitv; v\hich cc^ntrav\ith a ]:>revious finding that almost three quarterthe patients in anotlier stuck- said nev er to be t reibr cervical pain 4 . Altogether, many of the denin this studv' resiricted themselves to home-careommenda t ions , and 85" o reported the methods uto be eilectivc. The finding that a majority of th e dtists under studv- ex])ressed a need for guidelinestheir patients, might indicate that the practi t io

either regarded the t rea tment of hvpersensitivitvpose a problem or vvere not sure hov\" to infbrm tpatients adequatelv-.

References1. (JIF' I MC'. i c c hn i ) l ( ) t i ' ' \ t r a ns l c r nt pn and l i s s i i i ' c s c a l a i u>

I ' r o c c f d i n s ^ x ol a c o n r c r r n c c , Pii and f i s s u r e s e a l a n t s : \\h\l i m i u - d u s a o r ? Ma\- i !. 19 1. A D A. C h i c a g o . II. I'MU:i.").

_'. B R . W X S I R O M M . I hf c l i c i t a i i o n ( i f j ) a i n in h u m a n d t - n i i n clûlp l)\" c h e m i c a l a i i m u l i . . l/ v /; On;! iJinl l. i-)R.\. \siR()M M . . \ s i R ( i M A. .\ s t u c k o n i l i e m e c h a n i s m ofe l i e i t e d i r o m t he d e i u i n . 7 l^


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Schuurs et a l .

18

. \c)SHnA.MA A I, AIAS.AD.A. J, L CHiD.-v ^. et ai. Sc ann ing electro nmicro.scopic cha rac teriz atio ti oi sensitive \.s. insensitive h um anrad tcul ar dent in. J/>/A'1: 35: \ 'm 32.Fi'^'ASA.vtA 1. htiolooA and treatment of sensitive teeth. Qjiin!In! 1988: I'J: 921 3.I HOV! G. f)ie Beh andltm g der /ah nha lsln per sen sibi li tat dttrc h

Okklttstonskorrektur und Beseitifruni;- von Paraiunktioneti.Stonuuol DDR 1 9 8 9 : 3'J: 1 )8 7 9 1 .PovvFLt. L \ . CioRDcjx CjE.JoHXSDX CJH. Setisitivitv resiored oi'class \ abr asio n/er osio n lesions. J Am Den! A.wot 1990: 12 :()94 7.\\FtJ? i RV R R . AlfRRAV JJ . A clinical trial ol 'tlie t;iass-ionomc-rcem ent -co mp osit e resin ""sandw ich" tec hniq ue in class II cavi-ties in pc'nnanent piemolar and molar teetl i . Ouud In! 1990::V.-307 12.

33. C'tANCîo SCi. Delivery sv stems and clinical significanc e of able agents for dentinal hypersensitivitv. Endod Dent Irau1986: 2: 130 52.

34 . CiANCi.VROSA LP, BrFiFTNKR A L, B.vKER W P, et a l. D ou bl e-evaluation ol ditration ol dentin sensitivity reduction by lide iontophotesis. Gen Den! 1989: 37 : 316 9.

33. AIc;BRtDF AfA, CJn,p.vi"Rtc;K R O , FOVVLFR WL. Fhe eifecliess ol sodium lluot"ide iontophoresis in patients with sensteeth. Oîin! In ! 1991: 22 : 637 40.

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37. M|C)R IA. Histologic studies ol human cx)t"onal dc-ntine follng the tnsertion oi var'ious mateitals m ex})enmeiUally pared cav"ities. Arch Oral Biol 1967: 12 : 441-32 .

38 . JoRKjF.XD L. T R O X S I AD L. Treatti ient of hvpersensitive stttiaces bv c-a!cititii hvclroxide. Srand J Dent Res 1972264 6.

39 . L A N D R Y RCi, \C)V"FR R . Le I 'raitement de fhypersensibdentin ait"e: u ne c'-tude tx'-trospec tive et com pa ta tiv e d e approches thc'-rapeutiqttes. / (('>' Den! Assoc 1990: 56 :4 1 .

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41 . R F X I O X - H A R P F R P , A II D DA M . XdA'ACi laser treatment otinal hypet"sc-nsitivity. Bn ! Den! J 1991: 172: 13 fi.

42. CTFI.SKFY SC:. W ntT FjA l, PRUTtit \ 'K . l l i e eiTeetiveness oXd:'\ACJ laser tn the treatment ofdental hy])ei"sensitivity. /Den! Assoc 1993: 59 : 377 8 & 38:! (i.

43 . A D D Y Al, A B S I V.G. ADAVts 1). Den titie liy])ersensitivitv. eilec ts /// vi!ro of acids and dietatA subs tance s on toot-j^latid bitrted dentit ie. 7 C7/H /\ 'nodon!ol 1987: 14 : 274 9.

44. C:i.ARK DC :, W o o Ci, Sit v"FR J G , et al. 'f he inlltienc e oicjuent inyestion oi acids in the diet on treatment for dsensitivitv. 7 ('m Den! Assoc 19!)0: 56 : 1101 3.

43 . FjjK.vt.vx AIAJ, I ) F W I T H C : . Atiswers from dentists, dentalgienists and dental assistants to cjuestions asked by jjatconcern ing prevent ive dental mat ters . (.(immii?i/!r Den! Oraeniud 19 80 : //. 3: 9 46 .

46. I RAZiFR PJ. In: C:ohen C:K, Bry ant PS eds . Social sciencden!is!n vol. II. Public a nd f)ro/i'\\njnal ada/>!a !ion oJ selcded me!o preven! denial dtacy. L o nd on : Cû in tessence P t ib l . C:on ip . , p . 128 .

4 7 . H A M I F ' I O X f A , C I R A XI A . \ . W o T n i i x r i i o x H \ ' . D e n t a l c a r eek ie r lv pc -ople by gene ra l dc -n ta l p ra c t i t ion e rs . Bn! Den! 'j 1168: 108 12. '

4 8 . RovtBKRc: 1'., CioHFX LA. L A 1 ) I I , I . F A l ) . K n o w l e d g e , a t t i tand ou t look toward den t i s t rv : the i r a l fcc t on sea lan t t i se othc-r te latc-d varia!)les . Clin Prer Den! 1 9 8 9 : 11(5): 3 9 .

4 9 . D() \L SB, C:c) i'F ()XF J .A. Kn ow led ge an d a t t i tu des o i ' Td e n t i s t s c o n c c - r n i n g A I D S . Am J Den! 1 9 9 0 : 3: 3 8,


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dentists' views on cervical hypersensitivity and their knowledge of its treatment

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