Why don't dental teams routinely discuss dentine hypersensitivity during consultations? A qualitative study informed by the Theoretical Domains Framework.

AIM: Although dentine hypersensitivity is widespread, can cause substantial pain and impact quality of life, it is not routinely discussed during dental consultations. This qualitative study aimed to develop an understanding of the barriers and facilitators to these discussions. MATERIALS AND METHODS: Using the Theoretical Domains Framework to shape the topic guide, N = 7 online focus groups were organized with a total N = 40 participants comprising experienced dentists, dental foundation trainees and dental care professionals. Inductive and deductive thematic analyses of the anonymized, transcribed focus group conversations were undertaken. RESULTS: An attitude-behaviour gap was observed in dental teams' accounts. Although they saw it as part of their professional role to routinely discuss sensitivity, and believed that such conversations were 'an easy win', in practice they experienced several behavioural barriers that hindered these conversations from taking place. These included competing priorities, a perceived lack of seriousness and assessment of dentine hypersensitivity and practical issues such as time. CONCLUSIONS: Systemic (e.g., lack of time and training, professional culture) and behavioural (e.g., dental teams' belief that conversations should take place only with patients likely to be adherent) barriers to dentine hypersensitivity conversations explain why these conversations do not routinely take place.

Dentists' education, knowledge, and professional behavior concerning the diagnosis and treatment of dentin hypersensitivity: An exploration.

OBJECTIVES: Dentin hypersensitivity (DH) affects patients' oral health-related quality of life, but is not always optimally treated in dental offices. The objectives were to assess dentists' DH-related education, knowledge, and professional behavior and explore relationships between education, knowledge, and behavior. METHODS: Survey data were collected from 220 ADA members in the United States. Descriptive and correlational analyses were performed. RESULTS: About half of the respondents agreed/strongly agreed that their dental school had educated them well about diagnosing DH in classroom-based (53.6%) and clinical settings (48.9%). Lower percentages agreed being well educated about treating DH (40.9%/37.3%). The majority self-educated themselves about DH after dental school by attending continuing education courses in person or online (60.6%/36.8%), reading articles (64.1%), or consulting with colleagues (59.6%). The majority knew that patients with DH describe their pain as stimulated (91.4%) and that recessed gingiva (89.6%), abrasion lesions (72.3%), tooth whitening (63.1%), erosion lesions (58.6%), and abfraction lesions (51.4%) are risk factors for DH. The majority diagnosed DH with patient self-reporting, confirmed by exams (81.8%), applying air blasts (53.7%), or cold-water (52.3%). They treated patients with DH often/very often with over-the-counter desensitizing agents (90%), and prescribing fluoride formulations toothpaste (82.8%) and/or potassium nitrate toothpastes (60.9%). In their offices, the majority (73.2%) educated their patients often/very often about DH and used fluoride dental varnish for treating DH (71.8%). The more recently respondents had graduated from dental school, the more positively they described their dental school education (r = 0.14; p < 0.05), the more ways to diagnose DH they used (r = 0.16; p < 0.05) and the more often they used fluoride dental varnish in their offices (r = 0.23; p < 0.001). The more dentists had educated themselves, the more methods for diagnosing DH they used (r = 0.23; p < 0.001) and the more often they used potassium oxalate products (r = 0.19; p < 0.01), Arginine/calcium products (r = 0.19; p < 0.01) and dentin bonding (r = 0.22; p < 0.001). CONCLUSIONS: More recently graduating from dental school correlates with more positive evaluations of DH-related dental school education. The finding that most dentists engage in self-education about DH after dental school should motivate dental educators to increase education about this topic not only in dental school, but also in continuing education courses.

Prevalence of dentin hypersensitivity after orthodontic treatment: A cross-sectional study.

INTRODUCTION: The prevalence of cervical dentin hypersensitivity in patients after corrective orthodontic treatment has been poorly studied, although such hypersensitivity is very common. This study aimed to assess the prevalence of dentin hypersensitivity in patients who received corrective orthodontic treatment, the impact of general oral problems on quality of life, and the impact of hypersensitivity on the quality of life of this population. METHODS: This observational, cross-sectional study evaluated 232 patients who finished orthodontic treatment between 2000 and 2020 for self-reported hypersensitivity and clinically diagnosed hypersensitivity. The following tests were used: tactile, evaporative (bellows), evaporative (triple syringe), and thermal. The patients were also evaluated regarding their quality of life using questionnaires (Oral Health Impact Profile-14 and Dentine Hypersensitivity Experience Questionnaire). We evaluated data with nonparametric statistics. RESULTS: The prevalence of hypersensitivity was higher in women and in those aged <30 years; the most affected teeth were the mandibular incisors and premolars; different diagnostic tests for hypersensitivity may indicate different prevalence values; patients with hypersensitivity had a lower quality of life in most of the domains of both of the tests that were used. CONCLUSIONS: The prevalence of hypersensitivity among patients after orthodontic treatment may be higher than in the general population. Further investigation is needed to indicate the possible factors associated with orthodontic tooth movement.

[An integrated approach to reducing hyperesthesia of teeth in patients with underlying somatic pathology]. / Kompleksnyi podkhod v reabilitatsii patsientov s giperesteziei tverdykh tkanei zubov na fone somaticheskikh zabolevanii.

THE AIM OF THE STUDY: Was to analyze the effectiveness of therapeutic and preventive measures aimed at reducing hyperesthesia of hard dental tissues in patients with background somatic diseases. MATERIALS AND METHODS: The study involved 113 patients with increased tooth sensitivity and treated in the gastroenterological and endocrinological departments of the S.M. Kirov City Clinical Hospital No.3¼ in Astrakhan in the period from 2018 to 2021 at the age of 26-43 years. The main group included 52 patients with confirmed diagnoses of gastric and duodenal ulcer, pancreatitis and type II diabetes mellitus who were treated for dental hyperesthesia with an integrated approach. The control group included 61 patients with periodontal disease without background somatic pathologies in whom hyperesthesia was treated by remineralizing therapy. The effectiveness of the treatment was determined in dynamics on the 10th and 40th days of treatment using OHI-S, PMA indices, dental hypersensitivity prevalence (DHP), dental hypersensitivity intensity (DHI), Dental Sensitivity Index (DSI), Efficacy of Dental Sensitivity Index (EDSI). In addition, the pH of saliva, the activity of lysozyme and S-IgA, and the levels of cytokines IL-1ß, IL-4, IL-6, and IL-8 were determined. RESULTS: The average value of OHI-S in the main group on the 10th day of treatment decreased from 2.25±0.12 (poor level of hygiene) to 1.47±0.09 (satisfactory level). The PMA index in the main group also tended to decrease from 32.1±1.44% (moderate degree of gingivitis) to 20.5±2.08% (mild degree) on the 10th day of treatment. The average values of DPH, DPI, EDSI and DSI in the main group had a noticeable decrease already on the 10th day from the start of treatment (from 12.3±1.66% to 2.1±1.22%; from 2.5±0.48 to 1.2±0.16; from 48.3±1.14% to 40.8±1.71%; from 42.1±2.07% to 20.8±1, 65% respectively). In the main group on the 10th and 40th day of treatment the pH values of non-stimulated and stimulated saliva stabilized (from 4.61±0.12 to 6.94±0.07 and from 5.47±0.21 to 7.42±0.24, respectively), the activity of lysozyme increased (from 45.97±1.46% to 55.19±0.96%) alongside with secretory IgA (from 0.17±0.02 to 0.33±0.21 mg/ml). Also, indicators of cytokines IL-1ß, IL-4, IL-6, IL-8 tended to improve. The analysis of the control group revealed persistent mean values that did not yield to significant changes either in the course of treatment. CONCLUSION: Thus, in patients of the main group, the results obtained indicate an improvement in the dental status and activation of cytokine regulation, providing a combination of active components of the mineral complex. In controls the method of remineralizing therapy for tooth hyperesthesia alleviated dental hypersensitivity, but without significant improvement of the laboratory results.

Effect of silver diamine fluoride, potassium nitrate, and glutaraldehyde in reducing the post vital tooth preparation hypersensitivity: A randomized controlled trial.

Aim: Hypersensitivity is the most common clinical problem which is encountered by most of dental patients undergoing a vital tooth preparation for a fixed crown prosthesis. The aim of this study is to evaluate the effect of silver diamine fluoride, potassium nitrate, and glutaraldehyde in reducing dentinal hypersensitivity following vital tooth preparation. Settings and Design: This study is a randomized control trial performed on 119 teeth of 68 patients who are in need of fixed prosthesis treatment. Materials and Methods: After a thorough clinical examination, patients were allocated into any of the randomly assigned four groups (Control, silver diamine fluoride, potassium nitrate, and glutaraldehyde) and the level of hypersensitivity was measured by blasting air on the surface of tooth at five different intervals (before preparation, after preparation, after application of desensitizers, before cementation and after a follow up period of about 30 days) and is graded using Schiff 's cumulative hypersensitivity index. Statistical Analysis Used: Kruskal wallis test is used to compare the rate of sensitivity between the 4 groups. Friedman and Wilcoxon test is used to compare the rate of sensitivity at 5 different intervals. Results: All the desensitizers used in this study reduced the level of hypersensitivity. Among which, silver diamine fluoride was found to be more effective after application, before cementation, and after a follow up period of about 30 days followed by GLUMA and potassium nitrate. Conclusion: The results of this study suggest that silver diamine fluoride was found to be more effective after application, before cementation of the definitive prosthesis and after a follow up period of 30 days.

Caracterización del tipo de sensibilidad dental de pacientes con periodontitis y su respuesta a los dentífricos / Characterization of the type of dental sensitivity of patients with periodontitis and their response to dentifrices

La hipersensibilidad de la dentina surge ante la exposición de esta y en respuesta a estímulos de diverso tipo, fundamentalmente de origen térmico, evaporativo, táctil, osmótico o químico. Se realizó una investigación abocada a caracterizar la hipersensibilidad dental de pacientes atendidos en consulta de odontología y la respuesta a determinado dentífrico utilizado. En el análisis de estimulación dental se tomaron 308 mediciones de la sensibilidad dental para todos los participantes (n=22), con 7 factores de tiempo (T0 antes del uso del producto, T3 días, T5 días, T8 días, T22 días y T29 días después del uso del dentífrico). Se realizó la prueba paramétrica regresión lineal simple para identificar la tendencia y el ajuste de los datos, al considerar dichas variables como una serie temporal. Se utilizaron 22 tratamientos. Casi el 91,0% expreso que el dentífrico había cumplido sus expectativas, fundamentalmente por la reducción de la hipersensibilidad a corto plazo, mientras que aproximadamente 91,0% de los casos afirmó que compraría el dentífrico (20 casos, IC 95%: 72,2% y 97,5%), respectivamente(AU)

Dentin hypersensitivity arises when exposed to it and in response to various types of stimuli, mainly of thermal, tactile evaporative, osmotic or chemical origin. An investigation was carried out aimed at characterizing the dental hypersensitivity of patients seen in the dental office and the response to a certain toothpaste used. In the dental stimulation analysis, 308 measurements of tooth sensitivity were taken for all participants (n = 22), with 7 time factors (T0 before use of the product, T3 days, T5 days, T8 days, T22 days and T29 days after using the toothpaste). The simple linear regression parametric test was performed to identify the trend and the fit of the data, considering these variables as a time series. 22 treatments were used. Almost 91.0% believed that the toothpaste had met their expectations, mainly due to the reduction in hypersensitivity in the short term, while approximately 91.0% of the cases stated that they would buy the toothpaste (20 cases, 95% CI: 72 , 2% and 97.5%), respectively(AU)

The prevalence, clinical features, and related factors of dentin hypersensitivity in the Turkish population.

OBJECTIVES: The purpose of this study was to identify the prevalence and predisposing and etiologic factors of dentin hypersensitivity (DH), as well as the demographic characteristics of patients. MATERIALS AND METHODS: The 1210 patients were examined. The research was based on a two-step investigation: questionnaire and clinical examination. DH was evaluated by the response of the patient to tactile and air-blast stimuli. Loss of attachment and gingival recession of sensitive teeth was measured on the buccal and lingual surfaces. Also, the tooth wear of sensitive teeth was graded on the buccal and lingual surfaces. Comparisons of nonnormally distributed continuous variables were performed using the Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance (ANOVA) and Dunn's post hoc test. Comparisons of categorical variables were performed using Pearson's chi-square, Fisher's exact chi-square, Yates's chi-square, and the Monte Carlo chi-square test. RESULTS: One hundred twenty-four patients reported DH, showing a prevalence for self-reported DH of 10.2%. Eight hundred forty teeth were diagnosed as having DH, giving a clinical diagnosis rate of DH of 29.4%. Females (76.8%), the 31-40 years age group (26%), housewives (36.8%), and high school education level (38%) had the highest prevalence of DH as demographic properties. A cold stimulus was the most common stimuli trigger for hypersensitivity (97.1%). Occasional pain (55.5%) showed the highest prevalence in terms of frequency of DH. A higher rate of DH was found with the use of medium brushes (47.4%) and brushing twice per day (59.4%) for 1-2 min (56.2%) with the circular method (33.8%) as oral hygiene habits. The buccal surface of the lower right central incisors (5.7%) had the highest prevalence. The most affected teeth by DH were incisors (38.4%). The buccal surfaces (86.3%) of teeth showed a higher high prevalence of DH compared with the lingual surface (52.7%), similar to gingival recession (40.9% vs. 15.7%) and loss of attachment (68.3% vs. 42.6%). CONCLUSIONS: Clinically diagnosed DH was more common than self-reported DH. Some factors related to patients such as sex (female), the 31-40 years age group, housewives, high school students, using medium brushes, brushing twice per day, and the circular brushing method were more likely to have a risk for DH. Also, buccal surfaces of teeth, gingival recession, and loss of attachment on the buccal surface of teeth should be considered as predisposing factors for DH. CLINICAL RELEVANCE: To control and prevent DH, clinicians should consider patients' demographics, predisposing factors, and etiologic factors.

The Decision Tree for Clinical Management of Dentin Hypersensitivity. A Consensus Report.

PURPOSE: To reach a consensus on a consistent strategy to adopt when screening patients for the clinical management of dentin hypersensitivity. MATERIALS AND METHODS: A panel consisting of members of the Advanced Technology in Oral Hygiene Sciences Academy (ATASIO) was formed to start a review process on dentin hypersensitivity (DH) and subsequently elaborate a decision tree to manage DH, from diagnosis to prognosis. The panel employed the RAND in their deliberations. After an initial systematic literature review, it became evident that a consensually validated protocol for the management of patients affected by dentin hypersensitivity has to be considered mandatory by all dental professionals. However, the outcome of the systematic review made it evident that the treatment options to be provided, as well as their prognosis and timing, had never been defined. The panel produced documents that addressed the topic and were subsequently used to generate a questionnaire. A workshop of expert dental professionals was organised to reach consensus on the main steps of the decision tree. Each member completed the questionnaire independently, and then a panel discussion was held to reach a consensus. RESULTS: A high level of agreement was reached regarding all the items on the questionnaire, and each of the clinical questions formulated was answered. A clinical decision threshold was created. CONCLUSIONS: The dissemination of the information to a wide dental audience should commence upon publication of this consensus document. The authors hope that this consensus will become a model for the development of a dedicated protocol to manage DH.

Laser therapy for dentinal hypersensitivity.

BACKGROUND: Dentinal hypersensitivity is characterized by short, sharp pain from exposed dentine that occurs in response to external stimuli such as cold, heat, osmotic, tactile or chemicals, and cannot be explained by any other form of dental defect or pathology. Laser therapy has become a commonly used intervention and might be effective for dentinal hypersensitivity. OBJECTIVES: To assess the effects of in-office employed lasers versus placebo laser, placebo agents or no treatment for relieving pain of dentinal hypersensitivity. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 20 October 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2020, Issue 9), MEDLINE Ovid (1946 to 20 October 2020), Embase Ovid (1980 to 20 October 2020), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 20 October 2020), and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; from 1982 to 20 October 2020). Conference proceedings were searched via the ISI Web of Science and ZETOC, and OpenGrey was searched for grey literature. The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomized controlled trials (RCTs) in which in-office lasers were compared to placebo or no treatment on patients aged above 12 years with tooth hypersensitivity. DATA COLLECTION AND ANALYSIS: Two review authors independently and in duplicate screened the search results, extracted data, and assessed the risk of bias of the included studies. Disagreement was resolved by discussion. For continuous outcomes, we used mean differences (MD) and 95% confidence intervals (CI). We conducted meta-analyses only with studies of similar comparisons reporting the same outcome measures. We assessed the overall certainty of the evidence using GRADE. MAIN RESULTS: We included a total of 23 studies with 936 participants and 2296 teeth. We assessed five studies at overall low risk of bias, 13 at unclear, and five at high risk of bias. 17 studies contributed data to the meta-analyses. We divided the studies into six subgroups based on the type of laser and the primary outcome measure. We assessed the change in intensity of pain using quantitative pain scale (visual analogue scale (VAS) of 0 to 10 (no pain to worst possible pain)) when tested through air blast and tactile stimuli in three categories of short (0 to 24 hours), medium (more than 24 hours to 2 months), and long term (more than 2 months). Results demonstrated that compared to placebo or no treatment the application of all types of lasers combined may reduce pain intensity when tested through air blast stimuli at short term (MD -2.24, 95% CI -3.55 to -0.93; P = 0.0008; 13 studies, 978 teeth; low-certainty evidence), medium term (MD -2.46, 95% CI -3.57 to -1.35; P < 0.0001; 11 studies, 1007 teeth; very low-certainty evidence), and long term (MD -2.60, 95% CI -4.47 to -0.73; P = 0.006; 5 studies, 564 teeth; very low-certainty evidence). Similarly, compared to placebo or no treatment the application of all types of lasers combined may reduce pain intensity when tested through tactile stimuli at short term (MD -0.67, 95% CI -1.31 to -0.03; P = 0.04; 8 studies, 506 teeth; low-certainty evidence) and medium term (MD -1.73, 95% CI -3.17 to -0.30; P = 0.02; 9 studies, 591 teeth; very low-certainty evidence). However, there was insufficient evidence of a difference in pain intensity for all types of lasers when tested through tactile stimuli in the long term (MD -3.52, 95% CI -10.37 to 3.33; P = 0.31; 2 studies, 184 teeth; very low-certainty evidence). Most included studies assessed adverse events and reported that no obvious adverse events were observed during the trials. No studies investigated the impact of laser treatment on participants' quality of life. AUTHORS' CONCLUSIONS: Limited and uncertain evidence from meta-analyses suggests that the application of laser overall may improve pain intensity when tested through air blast or tactile stimuli at short, medium, or long term when compared to placebo/no treatment. Overall, laser therapy appears to be safe. Future studies including well-designed double-blinded RCTs are necessary to further investigate the clinical efficacy of lasers as well as their cost-effectiveness.

Hipersensibilidade dentinária: etiologia, diagnóstico e tratamento / Dentin hypersensitivity: etiology, diagnosis and treatment

Introdução: A hipersensibilidade dentinária (HD) consiste em uma condição clínica caracterizada por dor localizada, curta e aguda, resultante de estímulos exógenos. Objetivo: Esse estudo objetivou realizar uma revisão da literatura sobre os aspectos relevantes vinculados à HD, como etiologia, diagnóstico, mecanismos biológicos, medidas preventivas e terapêuticas. Metodologia: Foi realizada a busca eletrônica de publicações nas bases de dados Scielo, PubMed, Periódicos Capes, Lilacs e Medline, utilizando os seguintes descritores: "dentin", "dentin sensitivy", "treatment". Os estudos foram publicados no período de 2010 a 2020. Resultados: Observou-se que a HD acomete cerca de 9-55% da população, principalmente indivíduos entre a terceira e quarta décadas de vida, apresentando maior prevalência no sexo feminino, afetando especialmente as regiões vestibulares dos caninos, pré-molares superiores e sequencialmente os incisivos e molares inferiores. O diagnóstico é determinado a partir de testes de sensibilidade, como o mecânico ou a desidratação. O tratamento dispõe de inúmeras propostas baseadas na obliteração dos túbulos dentinários como forma de impossibilitar a movimentação líquida intratubular ou restrição neural dos mecanorreceptores pulpares. Conclusão: Embora os aspectos clínicos sejam bem estabelecidos na literatura, a importância de um correto diagnóstico é essencial para um plano de tratamento adequado, por se tratar de uma condição de etiologia multifatorial... (AU)

Introduction: Dentin hypersensitivity (DH) consists of a clinical condition characterized by localized, hort and acute pain, resulting from exogenous stimulus. Objective: This study aimed to conduct a narrative literature review on the relevant aspects linked to DH, such as etiology, diagnosis, biological mechanisms, preventive and therapeutic approaches. Methodology: The electronic search for publications was carried out in the Scielo, PubMed, Capes, Lilacs and Medline databases, using the following descriptors: "dentin", "dentin sensitivy", "treatment". The studies were published in the period from 2010 to 2020. Results: It was observed that DH affects about 9-55% of the population, mainly belonging to the third and fourth decade of life, with higher prevalence in females, especially affecting the vestibular regions of the canines, upper premolars and sequentially the incisors and molars lower. The diagnosis is determined based on sensitivity tests, such as mechanical or dehydration. The treatment has numerous proposals based on the obliteration of the dentinal tubules as a way of preventing the intratubular liquid movement or neural restriction of the pulp mechanoreceptors. Conclusion: Although the clinical aspects are well established in the literature, the importance of a correct diagnosis is essential for an adequate treatment plan, as it is a multifactorial condition... (AU)

Levels of matrix metalloproteinase-8 and cold test in reversible and irreversible pulpitis.

ABSTRACT: Researchers have reported false positive/negative results of the cold test in the diagnosis of pulpitis. Knowledge of the correlation between results of the cold test and proteins could aid in decreasing the frequency of incorrect diagnosis. To associate the levels of matrix metalloproteinase-8 (MMP-8) with the responses (in seconds) to the cold test in teeth diagnosed with reversible and irreversible pulpitis.A cross-sectional study was performed. A total of 150 subjects were evaluated, of which 60 subjects met the selection criteria. The participants were divided into 3 groups: Group 1, healthy pulps, 20 subjects with 20 posterior teeth (premolars) with clinically normal pulp tissue; Group 2, reversible pulpitis, 20 patients with 20 teeth diagnosed with reversible pulpitis; and Group 3, irreversible pulpitis, 20 subjects with 20 teeth diagnosed with irreversible pulpitis. All participants were evaluated based on the following variables: medical and dental history, cold test, and expression of MMP-8 by enzyme-linked immunosorbent assay in dentin samples.Responses to the cold test between 4 to 5 seconds (second evaluation; P < .0001) were associated with high levels of MMP-8 (mean, 0.36 ng/mL) in the reversible pulpitis group. In the irreversible pulpitis group, the responses from 6 to ≥10 seconds (second evaluation; P < .0001) were associated with a higher average of MMP-8 levels (mean, 1.97 ng/mL).We determined that an increase in the duration of response to the cold test was associated with an increase in MMP-8 levels (Rho = 0.81, P < .0001) in teeth with pulpitis. The above correlations can be considered an adjunct to the clinical diagnosis of pulpitis.

Pathogenesis, diagnosis and management of dentin hypersensitivity: an evidence-based overview for dental practitioners.

Though dentin hypersensitivity (DHS) is one of the most common complaints from patients in dental clinics, there are no universally accepted guidelines for differential diagnosis as well as selection of reliable treatment modalities for this condition. The neurosensory mechanisms underlying DHS remain unclear, but fluid movements within exposed dentinal tubules, i.e., the hydrodynamic theory, has been a widely accepted explanation for DHS pain. As several dental conditions have symptoms that mimic DHS at different stages of their progression, diagnosis and treatment of DHS are often confusing, especially for inexperienced dental practitioners. In this paper we provide an up-to-date review on risk factors that play a role in the development and chronicity of DHS and summarize the current principles and strategies for differential diagnosis and management of DHS in dental practices. We will outline the etiology, predisposing factors and the underlying putative mechanisms of DHS, and provide principles and indications for its diagnosis and management. Though desensitization remains to be the first choice for DHS for many dental practitioners and most of desensitizing agents reduce the symptoms of DHS by occluding patent dentinal tubules, the long-term outcome of such treatment is uncertain. With improved understanding of the underlying nociceptive mechanisms of DHS, it is expected that promising novel therapies will emerge and provide more effective relief for patients with DHS.

A novel cervical tooth wear and recession index, the cervical localisation code, and its application in the prevention and management of dentine hypersensitivity.

OBJECTIVES: To design and validate a new index to assess tooth wear (TW) in the cervical region and its association with gingival recession (GR), for use both in research studies and as resource in General Dental Practice, with focused prevention and management strategiesparticularly related to aetiology of dentine hypersensitivity provided for each Code score. METHODS: Codes to reflect clinical presentations of the cervical region in health and disease recording both TW and GR were defined. Validation of the Code was undertaken by 3 trained examiners who scored buccal and lingual surfaces of eligible teeth in 42 adult healthy volunteers. Each volunteer underwent 4 identical clinical examinations, being assessed twice by the examiner who performed the first and last exam. RESULTS: Cervical Localisation Code definitions were A: no GR, no coronal TW, B: no GR, distinct coronal TW, C: GR but no coronal TW, D: GR with distinct coronal and root TW. For validation 2073 eligible tooth surfaces were scored. There were only 57 within and 201 between examiner disagreements, the most common being between scores C and D. CONCLUSIONS: The Cervical Localisation Code was used reproducibly by three independent examiners. It will provide focussed data on the cervical region in research studies allowing the association of patient reported dietary and lifestyle factors with specific lesion types, and a tool to aid the management of clinical scenarios, specifically those that lead to dentine hypersensitivity in general dental practice. CLINICAL SIGNIFICANCE: Exposure of dentine at the cervical margin by TW and/or GR often results in dentine hypersensitivity, however current TW indices do not record TW location or GR presence. The Cervical Localisation Code captures both parameters and suggests likely aetiology for dentine hypersensitivity and guide clinical management of the cervical region.

Sensitivity and specificity of assessment scales of dentin hypersensitivity - an accuracy study.

The aim of the present study was to compare the sensitivity and specificity of pain scales used to assess dentin hypersensitivity (DH). The preferred scale, and toothbrushing habits of participants were also investigated. This cross-sectional study was conducted with students and employees of a Brazilian Federal University who presented DH. The participants answered a questionnaire about their toothbrushing and drinking habits. Hypersensitive and non-sensitive teeth were submitted to tactile and ice stick stimuli. Then, the subjects marked their pain level in the visual analogue (VAS), numeric scale (NS), faces pain scale (FPS) and verbal evaluation scale (VES). DH was also assessed by Schiff scale (SS). The data were analyzed by Wilcoxon and Chi-Square tests, as well as by ROC curve. The mean age of the sample (56 women, 16 men) was 27.8 years. The most prevalent acidic beverage was coffee (36.0%) and the most preferred scale was the NS (47.2%). The pain level was statistically higher in teeth with DH compared to teeth without DH (p < 0.05). The accuracy ranged from 0.729 (SS) to 0.750 (NS). The highest sensitivity value was 81.9% for NS. The SS presented the highest specificity (91%). The visual analog, numerical, verbal evaluation, faces pain, and Schiff scales were accurate for DH diagnosis. The Schiff scale was the preferred scale for DH assessment.

Evaluation of postoperative sensitivity in restorations with self-adhesive resin: a randomized split-mouth design controlled study.

OBJECTIVES: To evaluate the postoperative sensitivity of restorations with self-adhesive resin composite (SAC) (Vertise Flow (VER)/Kerr) compared with conventional resin composite with self-etching adhesive (Filtek Z250 (Z250)/3M ESPE; Clearfil SE Bond (CSEB)/Kuraray). MATERIALS AND METHODS: A randomized, controlled, double-blind, split-mouth, two-arm clinical trial was conducted. Twenty-seven volunteers with third molars indicated for extraction received two deep class I restorations, one with each material. Postoperative sensitivity was measured at 24 h and 15 or 30 days after the restorative procedures using a visual analog scale (VAS). When present, information on the characteristics of the pain was also collected. The data were submitted to the McNemar test (α = 0.05). RESULTS: Regardless of the time intervals, the postoperative sensitivity was observed in 52% and 48% of the CSEB and VERT groups, respectively (p = 1.000). When the evaluation periods were analyzed, the 15-day evaluation presented the highest occurrence of pain, but of mild intensity, in both groups. All patients with sensitivity reported that the pain was localized and of short duration. CONCLUSION: Self-adhesive resin composite Vertise Flow and conventional resin composite with a self-etching bonding agent promoted similar response regarding postoperative sensitivity in deep class I cavities. When postoperative sensitivity was present, mild pain was observed, especially after 15 days of the restorative procedure, which decreased over time. CLINICAL RELEVANCE: Postoperative sensitivity to self-adhesive resin composite (SAC) restorations in deep cavities was comparable with that of conventional restorations with a self-etching bonding agent.

Sensitivity and specificity of assessment scales of dentin hypersensitivity - an accuracy study

Abstract The aim of the present study was to compare the sensitivity and specificity of pain scales used to assess dentin hypersensitivity (DH). The preferred scale, and toothbrushing habits of participants were also investigated. This cross-sectional study was conducted with students and employees of a Brazilian Federal University who presented DH. The participants answered a questionnaire about their toothbrushing and drinking habits. Hypersensitive and non-sensitive teeth were submitted to tactile and ice stick stimuli. Then, the subjects marked their pain level in the visual analogue (VAS), numeric scale (NS), faces pain scale (FPS) and verbal evaluation scale (VES). DH was also assessed by Schiff scale (SS). The data were analyzed by Wilcoxon and Chi-Square tests, as well as by ROC curve. The mean age of the sample (56 women, 16 men) was 27.8 years. The most prevalent acidic beverage was coffee (36.0%) and the most preferred scale was the NS (47.2%). The pain level was statistically higher in teeth with DH compared to teeth without DH (p < 0.05). The accuracy ranged from 0.729 (SS) to 0.750 (NS). The highest sensitivity value was 81.9% for NS. The SS presented the highest specificity (91%). The visual analog, numerical, verbal evaluation, faces pain, and Schiff scales were accurate for DH diagnosis. The Schiff scale was the preferred scale for DH assessment.

Effect of the casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) and photobiomodulation (PBM) on dental hypersensitivity: A randomized controlled clinical trial.

OBJECTIVE: This randomized controlled clinical trial aimed to evaluate the effect of the casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) and photobiomodulation (PBM) in the treatment of dentin hypersensitivity (DH), and the impact of this on the health-related quality of life (HRQL). METHODS: Eighty teeth with DH were randomized into four groups and received three treatment sessions: PLACEBO = placebo + LASER application mimicking; CPP-ACPF = CPP-ACPF + LASER application mimicking; PBM = placebo + LASER active application; CPP-ACPF+PBM = CPP-ACPF + LASER active application. Tactile (exploratory probe) and evaporative (triple syringe) stimuli were used to measure DH and were recorded with the aid of a visual analogue scale (VAS) after the 1st, 2nd and 3rd treatment sessions and one-month follow-up. The HRQL was recorded in the DH experience questionnaire (DHEQ). RESULTS: The intragroup comparison showed a significant reduction in DH (p < 0.05) with both stimuli after one-month follow-up. The intergroup comparison with the evaporative stimulus showed that CPP-ACPF+PBM significantly reduced DH when compared to the rest of treatments, after one-month follow-up. CPP-ACPF+PBM group statistically differed from the other treatment groups in the DHEQ evaluation after one-month follow-up. CONCLUSION: After one-month follow-up, the association of CPP-ACPF with PBM was effective in the reduction of DH and promoted a positive impact on the HRQL of the participants of this study.

Concordance between practitioner questionnaire responses and observed clinical treatment recommendations for treatment of dentin hypersensitivity: findings from the National Dental Practice-Based Research Network.

BACKGROUND: Few published reports have presented concordance between treatment choices selected by dentists in hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice. The aim of the current cross-sectional study, conducted within the Management of Dental Hypersensitivity (MDH) study, was to assess the potential value of practitioners' questionnaire responses regarding their typical treatment provided for management of dentin hypersensitivity (DH), by evaluating agreement between these responses and subsequently-observed recommendations recorded during actual clinical examinations. METHODS: A total of 171 practitioners enrolled in the National Dental Practice-Based Research Network completed both a questionnaire and a clinical study regarding methods they use to treat dental hypersensitivity. The questionnaire solicited first-, second- and third-choice products when prescribing or recommending management of dentin hypersensitivity. Agreement was calculated for first-choice products/recommendations and for inclusion in the top three choices, as identified by the practitioners, from 11 listed treatment options. Overall percent agreement and Cohen's kappa statistic were calculated, with associated 95% confidence intervals (CI). Associations between practitioner characteristics and agreement were also evaluated. RESULTS: For individual treatment modalities, percentage agreement ranged from 63 to 99%, depending on the specific item. Percentage agreement between typical treatment and actual treatment for each practitioner's top three treatment modalities, as a combined grouping, ranged from 61 to 100%. When these same agreement pairings were quantified to account for agreement above that expected by chance, kappa values were poor to low. CONCLUSIONS: Concordance between hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice showed moderate to high levels of percentage agreement, but Cohen's kappa values suggested relatively low levels of agreement beyond that expected by chance. This analysis adds to the larger work of the network which has now observed a wide range of agreement between hypothetical and actual care, depending upon the specific diagnosis or treatment under consideration. Questionnaire data for DH might serve as a useful adjunct to clinical data regarding treatment recommendations, but agreement was not sufficiently high to justify use of questionnaires alone to characterize patterns of treatment for this particular condition.

[Guideline for diagnosis, prevention and treatment of dentin hypersensitivity].

Dentin hypersensitivity is a common oral condition with a high prevalence rate. As part of the Chinese dental clinicians have some uncertainties on the prevention, diagnosis and treatment of dentin hypersensitivity, a task force was formed under the supervision of the Section of Preventive Dentistry, Chinese Association of Stomatology to develop the present clinical guide on diagnosis and management of dentin hypersensitivity according to the evidence-based dentistry. The evidence is based on systematic and narrative reviews published during the past 10 years (2009-2018) in the Medline database. The present guildlines consist of the definition, epidemiology, etiology and mechanisms, contributing factors, diagnosis and prevention of dentin hypersensitivity, the clinical treatment of dentin hypersensitivity was also recommened.

Prevalence of self-reported versus diagnosed dentinal hypersensitivity: a cross-sectional study and ROC curve analysis.

OBJECTIVE: This study aimed to identify and compare the self-reported and diagnosed prevalence of dentinal hypersensitivity (DH) in an University population; and to verify accuracy, sensitivity and specificity of DH stimuli tests. MATERIAL AND METHODS: Three hundred and eighty patients (67.2% women and 32.8% men) were assessed by questionnaire, clinical exam, tactile and cold water tests. The intensity of DH was assessed using a visual analogue scale, and a calibrated examiner measured the scores using a caliper. The ICC for intra-examiner was 0.990. Scores above 5 mm were considered sensitive teeth. The association between variables was assessed by Chi-square test. ROC curve analysis determined accuracy, sensitivity and specificity of the tests (p < .05). RESULTS: The mean age of participants was 24.08 years. 158 (41.7%) volunteers self-reported the presence of DH, while, 88.7% of the participants were clinically diagnosed (p = .023). In total, 8958 teeth were evaluated, of those 3367 (37.6%) were diagnosed sensitive. The most prevalent teeth with DH were incisors and premolars. The accuracy of the tests with cold water and tactile were 99%. The sensitivity and specificity for cold water and tactile tests were 99.9%, 99.7%, 99.1% and 87.6%, respectively. CONCLUSION: The self-reported prevalence of DH was significantly lower than that clinically diagnosed. The cold test proved to be a highly accurate stimulus for the diagnosis of DH.