Despite its prevalence, dentin hypersensitivity often goes unreported and untreated. In this article, we highlight the challenges of diagnosing this common condition and share questions dental students should be asking their patients.
Dentin hypersensitivity
Dentin hypersensitivity can be defined as “a short, sharp pain that arises from exposed dentin in response to non-noxious stimuli, typically thermal, evaporative, tactile, osmotic or chemical, and that cannot be ascribed to any other form of dental defects or diseases.”
Dentin is normally protected from these stimuli by enamel or cementum, but factors like erosion or abrasion can compromise these outer layers, leading to the underlying dentin becoming exposed. According to the widely accepted hydrodynamic theory, these stimuli are then able to influence fluid movement within the exposed dentin tubules, leading to painful stimulation of the pulpal nerve fibers.
The diagnostic challenge
There are no objective tests for dentin hypersensitivity, so it is diagnosed based on the reporting of pain by the patient, and then by the systematic exclusion of all other possible causes. This presents two challenges when diagnosing this condition.
First, while an estimated one in eight adults in the United States were found to suffer from dentin hypersensitivity in a multi-office study, more than half of those reporting pain when evaluated had not self-reported pain in their medical history form prior to the evaluation. As the same time, this condition has a potentially serious impact on their quality of life. There’s a common misconception that it’s normal to experience some degree of sensitivity, especially as we age, so it may not be viewed as a pathological symptom. Since the pain is intermittent, people often simply learn to live with it by avoiding triggers.
Second, assuming that your patient reports their pain, you will then have to perform a rather extensive differential diagnosis. Confirming dentin hypersensitivity requires you to rule out the following alternative causes, such as:
Dental caries
Chipped/fractured teeth
Fractured restorations
Cracked tooth syndrome
Postoperative sensitivity
Pulpal issues
Palatogingival groove
Vital bleaching procedures
Acute hyperfunction of teeth
Asking the right questions
Given the various challenges of diagnosing dentin hypersensitivity, you may be wondering how best to help your patients. Ultimately, it’s up to us to proactively ask the right questions.
When starting a conversation about dentin hypersensitivity, the following tips may be helpful:
Start with broad questions and then zoom in on the specifics.
Dentin hypersensitivity pain is intermittent, so include a time frame to narrow their focus.
Offer prompts to help patients explain and characterize their symptoms.
Patients may use diverse vocabulary to describe subjective experiences, so be clear and unambiguous in your phrasing.
Pay special attention to anxious patients, who may be tempted to downplay symptoms.
With these tips in mind, here are some examples of effective questions to ask your patients.
1. Opening the conversation
“Have you been having any problems with your mouth or teeth recently?”
“Are there any problems you want to discuss today, like sensitivity or pain?"
“Have you noticed any pain or sensitivity in your teeth or gums at all?”
2. Gathering information
Next, you’ll want to get more specific about the nature of the pain, keeping in mind that dentin hypersensitivity pain is a short, sharp pain that happens intermittently.
“How often do you feel this pain? Is it daily, a couple of times a day, weekly, not very often?”
“When was the last time you felt this pain? Has it happened in the last week/two weeks/month?”
“How long does it usually last? Would you say a few seconds, minutes, hours?”
“Does the pain ever keep you awake?” (Hypersensitivity pain is transient and should not affect sleep.)
“What does the pain feel like? Is it sharp, dull, throbbing, stabbing, aching?”
3. Establishing triggers
Dentin sensitivity pain happens immediately in the presence of stimuli like hot or cold foods, cold air or pressure, while pain of other origins may occur without an obvious trigger.
“Is there anything in particular that brings on this pain? Chewing? Certain foods or drinks? Cold air? Brushing your teeth?”
“Do you experience any pain when you brush your teeth/chew/have certain foods and drinks?”
“Can you recall what you were doing the last time you felt this pain?”
“Is there anything that makes the pain worse?”
After ruling out other causes and identifying dentin hypersensitivity, dental professionals are in a position to offer advice, recommendations and treatment.
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