Hipersensibilidade Dentinária
Prevalence: Affects 8-57% of the adult dentate population depending on the study methodology; peak prevalence in the 20-40 age group; approximately 1 in 8 adults experience clinically significant dentinal hypersensitivity
Overview
Dor aguda e transitória da dentina exposta em resposta a estímulos térmicos, evaporativos, táteis ou osmóticos
Etiology and Risk Factors
Dentin exposure occurs through: (1) enamel loss — erosion (dietary acid, GERD), abrasion (toothbrush abrasion), attrition (bruxism), abfraction (non-carious cervical lesions from tooth flexure); (2) cementum loss — gingival recession exposing root surface, periodontal scaling and root planing removing cementum.
Tubule patency — why not all exposed dentin is sensitive: Normally, dentinal tubules at the tooth surface are occluded by the smear layer, mineral deposits, or sclerosis (tertiary dentine). Sensitivity occurs when tubules become patent, allowing fluid movement.
Risk factors for developing DH: aggressive toothbrushing (hard bristles, high force), high frequency of acidic food/drink consumption, untreated GERD, periodontal disease and treatment (scaling opens tubules), bleaching treatment (temporarily sensitizing).
The paradox of sensitivity: not all exposed dentin is sensitive, and sensitivity can fluctuate over time. This reflects the dynamic status of tubule patency.
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Pathogenesis
The hydrodynamic theory (Brännström, 1966): dentinal tubules are fluid-filled. When an external stimulus (cold, air, sweet, pressure) is applied to exposed dentin, it causes rapid fluid movement WITHIN the tubules — either inward or outward depending on the stimulus.
Classification
Mild Hypersensitivity
Discomfort that does not interfere with daily activities.
Moderate Hypersensitivity
Pain that interferes with eating and oral hygiene.
Clinical Manifestations
Chief complaint: sharp, shooting pain to cold (most common), air, sweet foods, acidic foods, or touch. Pain onset is immediate upon stimulus application and resolves within seconds to minutes of stimulus removal.
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.
Treatment Protocol
At-Home Desensitizing Toothpastes
First-line management; requires regular, continued use
Prognosis
Prognosis is generally good — DH tends to improve over time as tertiary dentin is deposited and tubules sclerose naturally.
Prevention
- Correct tooth brushing technique — use soft-bristled brush, gentle circular/horizontal scrubbing at the cervical area, not sawing motion
- Wait 30-60 minutes before brushing after consuming acidic food or beverages
Interactive Quiz
Test your understanding of Hipersensibilidade Dentinária.
Q1.
3D Pathology Description
Show a tooth with exposed root dentin and open dentinal tubules at the cervical area, with fluid movement arrows within tubules in response to cold stimulus, A-delta fiber location at the pulp-dentin border, and comparison of patent vs. occluded tubules demonstrating the hydrodynamic mechanism.