Diagnosis
Diagnosis of exclusion: first rule out dental caries, cracked tooth syndrome, reversible pulpitis, and fractured restorations — all of which can cause similar symptoms but require different treatment.
History: onset, duration, precipitating stimuli, previous dental treatment. History of recent periodontal treatment, whitening, or aggressive brushing.
Clinical examination: visual inspection for gingival recession, exposed root surfaces, cervical abrasion/erosion defects, tooth wear, and caries.
Stimulus tests: cold and air blast tests to confirm and localize sensitivity. Positive response (immediate sharp pain resolving quickly) confirms DH if other pathology excluded.
Intraoral periapical radiographs to exclude periapical pathology and assess bone levels.