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Dentin hypersensitivity: are you missing the opportunity to provide a treatment and follow-up plan?

Date: December 2020

Author: Louise Sinclair

When you diagnose your patient with dentin hypersensitivity, the work is only just beginning. Long-term success depends on a carefully planned treatment program with regular follow-ups. Missing out on this opportunity means missing the opportunity to enhance positive outcomes and strengthen patient relationships. In this article, we’ll discuss how to plan and implement an effective management strategy for dentin hypersensitivity.

Explain the problem and solution

Dentin hypersensitivity can have a serious impact on your patient’s quality and enjoyment of life. Further, if brushing and flossing become uncomfortable or painful, patients may be unwilling or unable to perform proper oral hygiene, which may well worsen their oral health.

Despite its prevalence and impact, dentin hypersensitivity is surprisingly simple to treat. After a diagnosis has been made by excluding other potential conditions that cause similar pain, mild-to-moderate cases can be managed at home with desensitizing toothpastes, which work in two ways.

The prevailing hydrodynamic theory states that dentin hypersensitivity occurs when an external stimulus makes contact with exposed dentin, triggering a change in the flow of fluids inside the open dentin tubules. Occlusive toothpastes use active ingredients to block open dentin tubules and prevent the fluid movement from stimulating a pain response.

One example is Colgate Total toothpaste. It includes stannous (tin) fluoride, which has been shown to effectively reduce sensitivity by occluding the open dentin tubules. It also helps to protect dental hard tissues from acid attacks.

The other option is a toothpaste that prevents a neural signal from being transmitted to the brain by depolarizing the nerve. Colgate Sensitive toothpaste achieves this with 5% potassium nitrate, and it also features sodium fluoride to help protect against dental caries.

Anti-sensitivity toothpastes are important for your patients' relief from dentin hypersensitivity with home care, but only if they use them as directed. We know that patients are more likely to comply with treatment recommendations when they understand the reason why, so we need to take the time to educate patients on exactly how these solutions will help to relieve their pain.

Provide immediate pain relief

While you have a long-term goal in mind for a treatment plan, your patient is likely most concerned with their immediate pain. It can take some days or weeks to feel the full benefits of desensitizing toothpastes, but you can help your patient right away prior to dental treatment by recommending a product like Colgate Anywhere, Anytime Sensitivity Relief Serum with exclusive Pro-Argin technology providing relief from hypersensitivity in just one minute. Patients can also take this home with them and use the remainder of the tube for sensitivity relief.

Pro-Argin technology uses an innovative arginine and calcium carbonate formula that works by quickly blocking and sealing the tubules. This combination accelerates the natural mechanisms of occlusion to create a mineral deposit within the tubules and a protective layer over the dentin.

You can also recommend that the patient switches to a toothbrush with ultra-soft bristles, like the Colgate Slim Soft, to effectively clean their teeth without causing any further discomfort.

Proactively monitor pain levels

During the initial assessment, you will have assessed your patient’s pain by replicating a stimulus, such as by using an air-water syringe, cold air blast, and/or dental explorer, and measuring their response. Depending on the stimulus, this can be achieved using a Visual Analog Scale (VAS) and/or the Schiff Cold Air Sensitivity Scale. You will have also enquired about the intensity, frequency and duration of their pain. This information will form a baseline by which you and your patient can measure the success of your treatment plan.

You can also replicate these investigations and gauge their progress at follow-up appointments. How have their VAS or Schiff responses changed? How have the intensity, frequency and duration changed?

Refine your approach

Hopefully, you will find during your follow-up appointments that your patient is achieving the desired relief from dentin hypersensitivity. However, sometimes you will find that you need to adjust the approach.

You may need to ask yourself if something needs to be added to the treatment plan, or if you need to re-think your approach altogether. For example, if your patient is not seeing satisfactory improvement from desensitizing toothpastes alone, you might add an in-office fluoride varnish like Colgate PreviDent Varnish. If your patient is at increased risk for caries, for instance with exposed root surfaces that are both sensitive and at risk, you may have already included a prescription-strength fluoride toothpaste like Colgate PreviDent 5000 Sensitive with 5000 ppm fluoride and 5% potassium nitrate.

Address underlying factors

During the initial examination, you will have identified any underlying factors contributing to exposed dentin and dentin hypersensitivity. While you can manage dentin hypersensitivity with desensitizing toothpastes and fluoride therapies, you may also need to address:

  • Gingival recession.
  • Clinical attachment loss due to periodontitis.
  • Dental erosion.
  • Abrasion.

Behavioral factors can indirectly play a role in dentin hypersensitivity by exposing dentin. These can include poor oral hygiene habits, aggressive toothbrushing, and consumption of acidic foods and drinks. In these situations, your patient may benefit from behavioral interventions, such as dietary counselling, oral health education, or guidance on proper toothbrushing technique. In the case of a contributing illness, such as bulimia nervosa or acid reflux, your treatment plan may involve referral and collaboration with an appropriate physician.

Adopt a team approach

Your dentin hypersensitivity management plan will be most effective when the whole dental team is involved. Brief your dental hygienist and other team members that are likely to be involved in the patient’s ongoing care so that everyone is working as a team towards the same goal.

With up to 57% of the population suffering, often in silence, we can create many more satisfied patients simply by opening up a dialogue about pain and taking a continued interest in its treatment. When we offer our patients real, lasting relief from the pain of dentin hypersensitivity, we ultimately create trust, mutually positive long-term relationships, and better oral health outcomes.