DentineHypersensitivity

David Gillam,

Richard Chesters, David Attrill, Paul Brunton, Mabel Slater, Peter Strand, Helen Whelton and David Bartlett

Dentine Hypersensitivity – Guidelines

for the Management of a Common
Oral Health Problem
Abstract: Dentine hypersensitivity (DHS) remains a worldwide under-reported and under-managed problem, despite making some dental
treatments more stressful than necessary and having a negative impact on the patient’s quality of life. This article is designed to build dental
professionals’ confidence and remove any confusion regarding the diagnosis, prevention and treatment of sensitive teeth caused by dentine
hypersensitivity in those patients known to be at risk. There is a need for simple guidelines, which can be readily applied in general practice.
However, it is also obvious that one strategy cannot suit all patients. This review describes a DHS management scheme for dental professionals
that is linked to management strategies targeted at three different groups of patient. These patient groups are: 1) patients with gingival
recession; 2) treatment patients with toothwear lesions; and 3) patients with periodontal disease and those receiving periodontal treatment.
The authors also acknowledge the role of industry as well as dental professionals in a continuing role in educating the public on the topic of
sensitive teeth. It is therefore important that educational activities and materials for both dental professionals and consumers use common
terminology in order to reduce the possibility for confusion.
Clinical Relevance: This review article provides practical, evidence-based guidance on the management of dentine hypersensitivity for dental
professionals covering diagnosis, prevention and treatment. Sensitivity associated with gingival recession, toothwear and periodontal disease
and periodontal treatment are specifically addressed in the article.
Dent Update 2013; 40: 514–524

Dentine hypersensitivity (DHS) is an oral prevention (both lesion localization and

David G Gillam, BA, BDS, MSc, DDS, FRSPH, FHEA,
health problem for 10–20% of adults that initiation) and its treatment.9
Clinical Lecturer in Restorative Dentistry, Centre
can affect their life style and quality of life.1-2 This article summarizes the
for Adult Oral Health, Institute of Dentistry, Queen
Recent research in the USA3 has confirmed outcome of the Expert Forum discussions on
Mary’s School of Medicine and Dentistry, London,
earlier research by Gillam et al4 that DHS the diagnosis, prevention and treatment of
Richard K Chesters, BSc, Independent Consultant,
is still inconsistently managed in many dentine hypersensitivity. The Forum Experts
Parkgate, David C Attrill, BDS, PhD, FDS RCS, FDS
dental surgeries, possibly because of a lack recognized that no single management
RCS(Rest Dent), FHEA, Senior Lecturer and Hon
of confidence to manage the condition strategy would be suitable for all patients.
Consultant in Restorative Dentistry, University of
effectively. It is therefore important to Thus management strategies for specific
Birmingham School of Dentistry, Paul Brunton, PhD,
recognize that new technologies5-8 may groups of patients have been developed
MSc, BChD, FDS RCS(Edin), Professor of Restorative
offer simple and effective relief for DHS, from the discussions of the Forum Group.
Dentistry, University of Leeds, Mabel Slater, MBE,
thereby reducing stress for both patient and These patient groups include patients with
MEd, RDH, Independent Consultant, Peter Strand,
dental professional. gingival recession, patients with toothwear
BDS, MSc, MRD, Specialist Periodontist, Ashford,
A group of eight experts lesions and, finally, periodontal diseases
Kent, Helen Whelton, PhD, BDS, MDPH, FFD, FFPH,
from different dental backgrounds were and those receiving periodontal treatments.
Director, Oral Health Services Research Centre,
assembled to form the UK and Ireland It is important to recognize that some
Professor of Dental Public Health and Preventive
Dentine Hypersensitivity Expert Forum. Their other dental treatments, such as crown
Dentistry, Dental School and Hospital, University
primary aim was to recommend simple, preparation10 and whitening procedures,11-12
College Cork, Ireland and David Bartlett, BDS, PhD,
evidence-based guidelines for the active can cause sensitivity and that this needs to
FDS(Rest) MRD, Head of Prosthodontics at King’s
management of DHS, taking account of the be addressed when providing treatment.
College London Dental Institute, UK.
need for a differential diagnosis of DHS, its However, as the aetiology of the sensitivity
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 DentineHypersensitivity

from these procedures may not be the same that the prevalence and extent of gingival increase the risk of periodontal diseases and
as for classical DHS, these procedures have recession was reported to increase with sequelae (see ‘Aetiology’ below).
been excluded from these guidelines. age.18 There are limited data, however, on DHS may also be provoked
the association between gingival recession by some routine dental procedures such
and DHS. The presence of gingival recession as scaling and polishing, thereby making
Definition of dentine does not mean that DHS is inevitable. a regular dental visit unpleasant and
hypersensitivity For example, Kamal19 reported that only painful for the patient. This discomfort
Dentine hypersensitivity has 23.6% of individuals experienced DHS in may therefore add anxiety to an already
been defined as a short, sharp pain arising teeth with associated gingival recession. stressful experience. Preventive treatment
from exposed dentine in response to Information on the prevalence of toothwear for DHS before carrying out any potentially
stimuli, typically thermal, evaporative, and associated DHS is also limited and most painful, stress-provoking dental procedure
tactile, osmotic or chemical and which studies appear to report mainly on the is recommended in such cases as it creates
cannot be ascribed to any other dental presence or absence of occlusal, buccal and a calmer environment in subsequent
defect or disease.13 cervical wear rather than any prevalence treatment visits, for both the patient and
data on associated DHS per se.20-22 These the professional. In more severe cases, it
clinicans reported that most patients will may be more appropriate to complete the
Epidemiology have a degree of toothwear which may procedure under a local anaesthetic.
Dentine hypersensitivity is a increase throughout life. According to a
commonly occurring condition with a systematic review by Van’t Spijker et al,22 the
reported prevalence varying from as little predicted percentage of adults presenting Aetiology
as 4% to as high as 57%.6 This wide range with severe toothwear increases from 3%, Currently, the most widely
is thought to be because of differences in at the age of 20 years, to 17%, at the age accepted theory to explain the aetiology
the population, the setting and the clinical of 70 years. It is evident from six of the of the pain sensation caused by DHS is
methodology employed to assess DHS studies included in this review and a recent the ‘hydrodynamic theory’ advanced by
and also variations in patient perception. study by Cunha-Cruz et al,23 that males have Brännström and Aström.27 According to the
Canines and first premolars are most significantly more toothwear than females. hydrodynamic theory, DHS occurs when
frequently affected, followed by incisors However, it is also clear that some dental an external stimulus contacts exposed
and second premolars, with molars being procedures may also be associated with an dentine and triggers a change in the rate
least affected.14 The sites of those teeth elevated incidence of tooth sensitivity. For of flow of dentine fluid within the dentine
most commonly affected are the buccal example, several clinicians have reported tubule(s), and the resultant pressure change
cervical regions. In 1987, Orchardson that the prevalence of DHS associated with across the dentine activates intra-dental
and Collins15 reported that, in 90% of periodontal treatment was 9–23% before nerve fibres to cause immediate pain. DHS
cases, the hypersensitive area was at the treatment and 54–55% following treatment, is similar to any other condition involving
cervical margin. However, occlusal/buccal although this discomfort may be both mild/ subjective experiences, such as pain,
sites are now becoming more frequently moderate and transient (up to four weeks in that there is a difference in reported
affected in young adults, probably due to post treatment) in nature for the majority hypersensitivity of patients displaying
the combination of erosive and abrasive of patients.24-26 Overall, DHS cannot occur the same exposure to aetiologic factors.
toothwear.16 DHS can present at any age, without exposed dentine, but the inter- Thus the clinical observations are not
but the majority of individuals range from relationship with recession, toothwear and necessarily correlated with the degree of
20–50 years, with a peak in prevalence in erosion is complex. sensitivity reported by the patient. Such an
the age range 30–39 years.6 apparent mismatch between the clinical
Dentine may become exposed condition and the extent of discomfort
through either gingival recession or enamel Relevance experienced by the patient complicates
loss. Experts have concluded that gingival DHS is a painful experience that, the management of DHS. This disparity
recession, rather than cervical enamel loss, for the majority of sufferers, generates a may also raise the question ‘Why do some
is the key pre-disposing factor for exposing very unpleasant feeling, causing them to patients who have exposed roots suffer
the dentine surface. However, once the adapt and often modify their life styles. from dentine hypersensitivity yet others
dentine has been exposed, it is evident For example, patients may start guarding with exposed roots do not?’.
that erosion is a key factor in dentine the sensitive tooth with the tongue or The weight of evidence suggests
hypersensitivity initiation.13 Exposed drinking on the opposite side of the that this may occur not only because of
dentine is a common clinical finding. mouth, or even avoiding ice-cold food the subjective nature of pain, but also
Albandar and Kingman17 estimated that and drinks completely. However, for some because of the natural process of tubule
23.8 million individuals in the USA have one people, DHS can be so disturbing that it occlusion. Blocking of the dentine tubule
or more tooth surfaces with ≥3 mm gingival affects their quality of life.1-2 Additionally, can occur over extended time periods as a
recession. Kassab and Cohen also reported it has been reported that localized DHS result of precipitation of calcium phosphate
that 50% of those aged 18–64 years have at can lead to sensitive areas being avoided complexes triggered by proteins in saliva.6
least one or more sites with recession and during toothbrushing, which in turn can For a number of years it has been known
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 DentineHypersensitivity

that both calcium and phosphate ions while there was considerable merit in terms because, once gingival recession occurs,
in saliva can remineralize tooth defects, of content, there was a need for a simplified the cementum covering the dentine
such as early carious lesions. Research into management scheme, which should be surface can be removed easily, thereby
the mechanism of natural desensitization easier to incorporate into clinical practice exposing the vulnerable underlying
suggests that calcium and phosphate ions, for the general dental setting. After careful dentine (lesion localization). This may
associated with salivary glycoproteins, consideration, the Forum proposed a subsequently be followed by the removal
can also facilitate tubule plugging.6 The simplified management scheme (Figure 1). of the smear layer through acid erosion
role of plaque in the aetiology of DHS is This scheme is elaborated in the following from dietary acids opening the dentine
controversial.28 Some clinicians25,29 report sections starting with a section on patient tubules (lesion initiation).9
that plaque is not a significant factor in DHS. screening.
However, other clinicians9 proposed that
plaque played an important role, possibly Screening Clinical examination
due to the production of acids, which may The clinical examination should
As suggested in the
affect the patency of the dentine tubules ideally include an assessment to identify
recommendations of the Canadian
by the dissolution of the smear layer. It may all sensitive teeth. This examination
Advisory Board of Dentin Hypersensitivity,13
also be possible that the importance of could involve triggers such as thermal
all dentate patients should be actively
plaque as a factor in DHS depends upon the and evaporative stimuli (eg a short blast
screened for dentine hypersensitivity by
patient type. For example, it is recognized of cold air from the 3-in-1 syringe), or
dental professionals at both the initial
that DHS is generally associated with good mechanical/tactile stimuli (eg running a
and subsequent check-ups (dental
oral hygiene practices in periodontally sharp explorer over the area of exposed
examinations), because DHS is frequently
healthy patients.25 Regardless of whether dentine).25 The application of a controlled
unreported by the patient. A simple but
plaque is a significant cause of lesion stimulus would be expected to result in
effective strategy is to ask patients whether
initiation, the importance of good plaque a short sharp pain that generally lasts
they have, or have had, any problems with
control is beyond dispute. However, there just for the duration of the stimulus.
sensitive teeth (discomfort) recently or
is also the possibility that a patient’s oral However, pain/discomfort may sometimes
since their last visit. This simple strategy
dental hygiene may be affected by the continue for a short time post stimulation,
should ’capture’ the vast majority of dentine
discomfort arising from DHS and this may, particularly if the patient has severe
hypersensitivity sufferers, thus enabling the
in turn, increase the risk for both caries and dentine hypersensitivity. This assessment
dental professional to manage the problem
periodontal diseases. There is therefore can also be used to assess the severity of
more thoroughly.
a compelling clinical reason for dental the patient’s DHS (see ‘Assessment of DHS
professionals not only to recognize, assess severity’).
and manage DHS, but to address a patient’s
comfort and quality of life during the History
management of the condition. Once the dental professional has Differential diagnosis
identified that the patient has a problem DHS can only be diagnosed by
with sensitive teeth, it is essential to let the exclusion of other potential causes for the
Management of dentine patient use his/her own words to describe patient’s sensitivity. Hence the information
hypersensitivity and both the symptoms and stimuli that trigger provided by the screening questions,
underlying conditions pain. At this stage, dental professionals patient history and clinical examination is
From the literature, it is should avoid putting words in the patient’s essential in order to exclude dental diseases
evident that a number of different mouth (leading the patient to a diagnosis). and dental defects, such as dental caries,
therapeutic approaches have been used Once the pain characteristics have been pulpitis, cracked tooth syndrome, fractured
for the treatment of DHS. Currently, these described by the patient, the dental restorations, gingival inflammation, chipped
therapeutic approaches include: professional can use ‘closed questions’ in teeth, fractured restoration and TMJ
 Desensitizing the nerves; order to confirm the diagnosis, for example: disorders.13,33,36
 Occlusion of open dentine tubules ‘Does the pain persist when you drink cold Other pain symptoms, such as
(tubular occlusion). drinks?’ or ‘Does the pain linger once you dull and throbbing pain, pain that persists
Monitoring is essential in any have stopped drinking your drink?’ after the stimulus has been removed,
management strategy and this may be It is important therefore to pain that may keep the patient awake at
the most important component of the obtain and record the patient’s dental and night, the need for pain relief (medication),
management strategy when implemented medical history. It is also advisable to check pain irradiating from other sites in the
in dental practices. The Expert Forum for any history of an excessive intake of mouth (referred pain), pain occurring at
considered a number of published acid food and drink (eg citrus juices and the chewing/biting surfaces, may be an
management paradigms, including Schuurs fruits, carbonated drinks, wines or ciders) in indication of other dental diseases or defects
et al.30, Addy and Urquhart31, Gillam et al4, the diet, as well as to consider evidence of that would warrant further investigation (for
Drisko32, Orchardson and Gillam33, Drisko34, gastric reflux and eating disorders prior to example, pulp vitality [sensibility] testing,
West35, Porto et al.36 It was decided that, considering a management strategy. This is diagnostic radiographs, etc).
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 DentineHypersensitivity

professional with a way of monitoring the

SCREENING
No effectiveness of any management plan.
Any symptoms of DHS or tooth
These assessments also have the added
sensitivity following last dental
advantage of increasing the involvement
treatment? Ask patient to describe his/ NO TREATMENT REQUIRED
of the patient in the management of his/
her pain and any associated triggers
her condition. Since all assessment methods
are likely to cause pain or discomfort, only
one measure should usually be used (for
Yes example, an air blast from a triple syringe).
If, however, the patient’s DHS is seriously
CLINICAL EXAMINATION impacting a patient’s quality of life, then
CASE HISTORY multiple assessments may be justifiable,
Examine dentition to exclude other causes such as:
History of patient’s provided this provides essential additional
complaint  Cracked tooth syndrome  Post-restorative
information to manage the condition.
Review patient’s dental sensitivity
In general, the use of a well-
and medical history  Fractured restorations  Marginal leakage
controlled stimulus should help obtain a
 Chipped teeth  Pulpitis
more reproducible assessment. Whatever
 Dental caries  Palatogingival grooves
approach for monitoring sensitivity is
 Gingival inflammation
used, this should be addressed from the
Use either evaporative or tactile stimuli to identify patient’s perspective. Such an approach
sensitive areas. Record severity of DHS at sites could be as simple as asking the patients
following application of stimulus or overall whether they think that the pain/discomfort
sensitivity has ‘diminished’, ‘stayed the same’ or
‘increased since the last visit’. This can then
be broadened to encompass questions
Symptoms and case history consistent with DHS
aimed at whether any improvements have
allowed them to discontinue any of their
MANAGEMENT STRATEGY TO IDENTIFY and ADDRESS UNDERLYING avoidance strategies. More complex scales
MAINTAIN DHS TREATMENT CONDITIONS See section entitled – Dentine and Visual Analogue Scales (VAS) have been
PLAN AND MONITOR Hypersensitivity Management Strategies extensively used in clinical trials, however,
UNDERLYING CONDITION these require the patient to be trained in
FOLLOW-UP VISIT (APPOINTMENT) their use.37
Re-assessment of DHS and any relevant underlying
condition. Does patient’s DHS still persist?
Treatment planning
Yes As DHS is not a disease
No per se, but rather a symptom of one or
more underlying causes, it is essential
that all possible conditions potentially
RESOLUTION OF PATIENT’S COMPLAINT NO FURTHER
mimicking the symptoms of DHS should
TREATMENT OF DHS NECESSARY (at this time)
be identified and eliminated prior to
Continue to monitor any underlying conditions
deciding upon a management strategy.
and, if appropriate, to implement a suitable DHS
The management of DHS should identify
management in the form of professional or at-home
and aim to eliminate any underlying and
treatments, removal of any aetiological factors
predisposing factors, which could lead to
lesion localization (exposure of dentine)
Figure 1. Dentine Hypersensitivity Management Guidelines. and/or to lesion initiation (opening of
tubules). By identifying and treating the
underlying causes, it should be possible to
reduce both the frequency and intensity of
Once the dental professional Assessment of dentine DHS episodes.
has excluded other potential causes of hypersensitivity severity In the following sections, the
pain symptoms, typically associated with It is advisable to record most common predisposing factors have
DHS, a more definitive diagnosis of DHS the severity of DHS, even though such been reviewed and management strategies
can be reached. This will enable the dental measurements are notoriously problematic presented as guidance on how to manage
professional to manage the condition owing to the subjective nature of dentine hypersensitivity and any related
effectively.13,33,35-36 pain. Assessments provide the dental underlying conditions.
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 DentineHypersensitivity

Dentine hypersensitivity DIAGNOSIS FOLLOW-UP

management strategies  Primary underlying cause of dentine exposure  Regular assessment
Gingival recession from mechanical trauma leading to DHS identified as mechanical of patient’s oral hygiene
Gingival recession is a multi-  Patients exhibit good standard of plaque control regimen including brushing
factorial condition rendered more complex frequency and force
by predisposing and precipitating  Assess severity and
factors.18,38 Over-zealous toothbrushing and frequency of DHS
improper toothbrushing techniques have
PATIENT EDUCATION
been associated with gingival damage and
 Show patient the affected site(s)
loss of gingival tissue through mechanical
 Explain probable cause for recession
trauma. Once gingival recession occurs, the AT HOME ORAL HYGIENE
 Explain factors triggering sensitive teeth episodes
cementum covering the dentine surface can ROUTINE
 Encourage patients to modify their oral hygiene
be removed easily, thereby exposing the  Brushing with a
regimen in order to reduce damage to gingivae
vulnerable underlying dentine, which is at desensitizing toothpaste
 Reduce excessive consumption of acid foods
increased risk of DHS.9 and an appropriate
and drinks
A treatment strategy for patients toothbrush twice daily
where mechanical trauma is primarily  Use of a clinically
responsible for the gingival recession is proven desensitizing
summarized in Figure 2, based on the DHS mouthwash between twice
Management Scheme (Figure 1). This group MANAGEMENT
daily brushing may be
of patients normally exhibits good plaque  In-surgery desensitizing treatment to
recommended if necessary
control with minimal gingivitis and no provide instant pain relief
to reduce the risk of further
evidence of periodontitis.  Check patient’s periodontal health
gingival tissue trauma due
Initiate the patient’s education to over-zealous (excessive)
by showing him/her the sites with toothbrushing
gingival recession and check what type of
toothbrush (soft, medium, hard texture) the Figure 2. Dentine hypersensitivity management strategy options for patients with gingival recession
patient normally uses. If possible, assess caused by mechanical trauma.
the patient’s toothbrushing technique to
see if this is likely to be responsible for the
gingival recession or whether there are
anatomical features, such as prominent Check the patient’s periodontal health, if abrasion or attrition can significantly
canines or premolars or thin gingival tissue this has not been previously been checked, accelerate toothwear. Detailed in vitro and
biotypes38 which predispose the patient and then work with the patient to agree in situ studies have demonstrated that the
to gingival trauma. Where there is an an effective oral hygiene regimen. Keep mechanical process of brushing with a
indication to modify the patient’s manual in mind that this group of patients usually toothbrush alone has no measurable effect
or powered toothbrushing technique, exhibits a good standard of plaque control. on enamel, and that toothbrushing with
this should be implemented at this However, it may be useful to point out to toothpaste contributes little, if anything, to
stage, together with a discussion on the the patient that good brushing technique the loss of enamel over a lifetime of use.39
importance of the role of any supplemental rather than use of excessive force is critical However, studies have demonstrated that
hygiene measures (eg floss, interdental to good plaque control. It is often useful acidic foods and drinks can soften enamel,
brushes) with the patient (Figure 2). to demonstrate the ideal brushing force leading to significant toothwear, particularly
Explain the cause of sensitive (pressure) required. Finally, record the when combined with mechanical cleaning.28
teeth and check that the patient essential details on the patient’s records Ultimately, toothwear can lead to exposure
understands what can trigger episodes of and check at follow-up appointments about of dentine, thus patients showing evidence
DHS. In particular, explain that frequent DHS and compliance with the previously of erosion/abrasion are at risk of suffering
consumption of acidic food and/or drink agreed oral hygiene regimen. from dentine hypersensitivity.
may remove the protective smear layer The outline treatment strategy
and hence cause teeth to become more of DHS for patients with toothwear lesions
sensitive. Dentine hypersensitivity and is shown in Figure 3, following directly from
The use of a professional toothwear lesions the DHS Management Scheme (Figure 1).
desensitizing treatment to provide instant Toothwear refers to loss of tooth Patient education plays a critical part of
relief for any sensitive site is recommended, substance caused by abrasion, attrition, the management strategy for this group
as this may not only reduce the stress erosion and possibly abfraction.29 In of patients as it is essential to prevent, or
associated with the dental check-up, but recent years, investigators have suggested at least reduce, the rate of toothwear and
can also improve overall patient satisfaction. that acid erosion combined with either hence lesion localization. The probable

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 DentineHypersensitivity

DIAGNOSIS occurs, the cementum covering the

 Toothwear primary cause of dentine exposure and exposed dentine surface may be easily
subsequent DHS FOLLOW-UP removed by either physical and/or
 Identify cause of toothwear (enamel loss) and record  Regular assessment of chemical forces, thereby exposing the
severity of lesions, if possible, using a recognized index* toothwear and review potential underlying dentine tubules and increasing
causes for enamel loss the risk of DHS.9
 Assess severity and Patients suffering from DHS
frequency of DHS as a result of periodontal disease or its
PATIENT EDUCATION treatment should receive a multi-phase
 Show patient the site(s) and explain probable treatment and prevention plan that
cause of the toothwear lesion(s) addresses both periodontal health and
AT HOME ORAL HYGIENE DHS. Patient education is of paramount
 Recommend an oral hygiene regimen to minimize
ROUTINE importance and should cover at least the
risk of further toothwear
 Brushing with a points shown in Figure 4. It is vital that the
 Where appropriate, recommend reducing
desensitizing toothpaste patient understands the absolutely critical
frequency of consumption of acidic food and drink
and an appropriate role played by at home oral hygiene, as
toothbrush twice daily well as the need to reduce periodontal
 Recommend use risk factors by maintaining good control
of a clinically proven of systemic disease conditions such
densensitizing mouthwash as diabetes and the need for smoking
MANAGEMENT
between twice daily cessation.
 Provide high fluoride remineralizing
toothbrushing in order The initial phase of
treatment
to help reduce the risk management should include a periodontal
 Provide professional desensitizing treatment
of toothwear caused by assessment in order to assess what
to relieve DHS
over- zealous (excessive) treatment, usually non-surgical, is required.
 Encourage patient to seek advice from
toothbrushing Where appropriate, the possibility that the
medical practitioner, if toothwear caused
by working environment or reflux/excessive treatment may invoke temporary post-
vomiting therapeutic sensitivity should be explained
to the patient and consent obtained.
Figure 3. Dentine hypersensitivity management strategy options for patients with toothwear lesions. The re-evaluation after the initial therapy
*For example: Basic Erosive Wear Examination Bartlett et al40 or Smith & Knight.41 phase should indicate whether there is a
need to plan for a corrective phase based
on the expected outcome of periodontal
treatment.42 The corrective phase would
cause of the toothwear should be explained In some cases, it may also be advisable
typically involve the use of surgical
to the patient as well as the location of any to change toothbrushing practice (eg
periodontal therapy.42 Again, consideration
toothwear lesions. brushing before rather than after meals).28
should be given to relief of any pain
The management strategy The adjunctive use of a clinically proven
associated with the treatment therapy.
should involve pre-emptive treatment desensitizing mouthwash between twice
Any DHS associated with
with a high fluoride professional product daily toothbrushing may be recommended
exposed dentine or periodontal treatment
(eg varnish) to remineralize any softened for patients who report excessive
may be managed by using a chairside
enamel and dentine. However, this alone toothbrushing frequency. Patients should
desensitizing product applied by the
is unlikely to be effective, so instruction also be advised to seek medical advice,
dental professional. The application of
should be given to slow or prevent any where the primary cause of toothwear is
desensitizing products, such as polishing
subsequent future toothwear. Clearly, the either environmental or medical.
pastes, prior to, during and after treatment,
measures to prevent further toothwear
can be recommended, particularly
depend upon its probable cause. The main
for patients with a previous history of
sources of acids are dietary (the frequency Dentine hypersensitivity discomfort during such treatments. Such
of consumption of acidic foods or drinks) and periodontal disease and pre-emptive desensitization can improve
or gastric (ie gastric reflux or excessive treatment patient satisfaction by making it less
vomiting) and very rarely environmental Periodontal disease results uncomfortable and stressful. It may also
(enamel loss caused by the patient’s work in tissue damage, loss of gingival tissue help remove a potential barrier to the
environment). and alveolar bone through biological patient achieving effective plaque control
Where the patient’s diet is the breakdown processes and can result in measures at home following periodontal
probable cause, then the patient should gingival recession.24 Gingival recession is treatment.
be encouraged to reduce the frequency of also a common side-effect of periodontal Experience has shown
consumption of acidic foods and drinks. treatment.25 Once gingival recession that an evolutionary approach to
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 DentineHypersensitivity

DIAGNOSIS by mechanical trauma;

 Periodontal disease or periodontal treatment primary  Patients with toothwear lesions; and
cause of exposure of dentine and hence DHS  Patients with periodontal disease and
those receiving periodontal treatment.
The DHS Expert Forum
acknowledges the role of industry as well
PATIENT EDUCATION as dental professionals in a continuing
 Reinforce need for good oral hygiene role in educating the public on the topic
 Show patient the site(s) affected by periodontal of sensitive teeth. It is therefore important
disease and explain probable cause of the exposed that any educational activities and
dentine materials use common terminology for
 Guide patient to improve at home oral hygiene both dental professionals and consumers
regimen in order to reduce the possibility for
 Instruction on ways of reducing periodontal risk confusion.
factors
Membership of DHS Expert Forum and
Acknowledgements
MANAGEMENT Membership: David Atrill
(University of Birmingham), David Bartlett
INITIAL PHASE (King’s College, London), Paul Brunton
 Non-surgical periodontal procedure(s) (University of Leeds), David Gillam (Queen
 DHS Treatment Mary, University of London), Mabel
RE-EVALUATION Slater (Consultant), Peter Strand (Private
Follow-up assessment on periodontal status Practitioner and Lecturer at King’s College
AT HOME ORAL HYGIENE
and dentine hypersensitivity Dental Institute, London), Helen Whelton
ROUTINE
(University College Cork) and Richard
CORRECTIVE PHASE  Regular brushing with an
Chesters (Consultant).
 Surgical periodontal procedure(s) antibacterial toothpaste to
The DHS Expert Forum would
 DHS Treatment aid plaque control
also like to recognize the financial support
 Use of clinically proven
provided by Colgate-Palmolive (UK) Ltd.
desensitizing mouthrinse
twice daily for dentine
FOLLOW-UP MANAGEMENT hypersensitivity control
MAINTENANCE PHASE  Short period, the use of a References
 Supportive periodontal therapy 0.2% chlorhexidine solution 1. Bekes K, John MT, Schaller H-G, Hirsch
 Ongoing monitoring of periodontal for plaque control C. Oral health-related quality of life
health in patients seeking care for dentin
 Dentine hypersensitivity treatment hypersensitivity J Oral Rehabil 2008;
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