Dentinal Hypersensitivity:A Review

Dentinal hypersensitivity is generally reported by the patient after experiencing a sharp pain caused by one of
several different stimuli. The pain response varies substantially from one person to another. The condition
generally involves the facial surfaces of teeth near the cervical aspect and is very common in premolars and
canines. The most widely accepted theory of how the pain occurs is Brannstrom’s hydrodynamic theory, fluid
movement within the dentinal tubules. The dental professional, using a variety of diagnostic techniques, will
discern the condition from other conditions that may cause sensitive teeth. Treatment of the condition can
be invasive or non-invasive in nature. The most inexpensive and efficacious first line of treatment for most
patients is a dentifrice containing a desensitizing active ingredient such as potassium nitrate and/or stannous
fluoride. This review will address the prevalence, diagnosis, and treatment of dentinal hypersensitivity. In
addition the home care recommendations will focus on desensitizing dentifrices.
Keywords: Dentinal hypersensitivity, hydrodynamic theory, stannous fluoride, potassium nitrate
Citation: Walters PA. Dentinal Hypersensitivity: A Review. J Contemp Dent Pract 2005 May;(6)2:107-117.

Introduction
Dentifrices and mouth rinses are routinely used
as a delivery system for therapeutic agents
such as antimicrobials and anti-sensitivity
agents. Therapeutic oral care products are
available to assist the patient in the control of
dental caries, calculus formation, and dentinal
hypersensitivity to name a few. The dental
practitioner makes recommendations regarding
selection of the appropriate therapeutic
dentifrice based on diagnosis of the disease or
condition. These recommendations are based
on extensive knowledge of the etiology of the
disease/condition, the mechanism of action of the
various active agents in the dentifrice and mouth
rinse, and the host’s
needs and response to
treatment.
This review will address
the etiology of the
condition commonly
referred to as “dentinal
hypersensitivity” or
“tooth sensitivity.” More specifically, this paper
will review the prevalence and diagnosis of the
condition as well as reviewing clinical evidence
behind popular home care recommendations.
Prevalence
Dentinal hypersensitivity is generally reported by
the patient after experiencing a sharp pain caused
by one of several different stimuli (Figure 1).
The prevalence of dentinal hypersensitivity
has been reported over the years in a variety
of ways: as greater than 40 million people
in the U.S. annually1, 14.3% of all dental
patients2, between 8% and 57% of adult dentate
population3, and up to 30% of adults at some time
during their lifetime.4
Dentinal hypersensitivity has been shown to
peak in 20 to 30 year olds and then rise again
when in their 50’s.4, 5 The condition generally
involves the facial surfaces of teeth near the
cervical aspect and is very common in premolars
and canines.4 Patients undergoing periodontal
treatment are particularly susceptible to this
condition because of the recession following
periodontal surgery or loss of cementum following
non-surgical periodontal therapy.6, 7 In addition
periodontal disease and improper brushing habits
can also result in gingival recession accompanied
by sensitive teeth. Dentinal hypersensitivity has
been researched extensively through the years
and many authors express an agreement that
dentinal hypersensitivity is either under-reported
by the dental patient population or misdiagnosed.
Theories
Several theories have been cited to
explain the mechanism involved in dentinal
hypersensitivity.8 The transducer theory, the
modulation theory, the “gate” control and vibration
theory, and the hydrodynamic theory have
all been presented and discussed throughout
Figure 1. Pictorial display of origin of pain
associated with sensitive teeth. Figure 2. Depiction of Brannstrom’s Theory.