Desensitizing Effect of Sodium Bicarbonate Mouthwash in Patients with Dentinal Hypersensitivity–A Clinical Trial| Stephy Publishers

 



Introduction

Dentin Hypersensitivity (DH) is a major complaint of the general population. Reports have indicated the incidence of DH is 4 to 74 percent of the population.1 It poses a challenge for clinicians because its presentation is ambiguous with no specific signs.2 Dentists rely on the patient’s clinical and dietary history and a thorough intraoral examination using thermal and tactile stimuli. Dentin receptors have a unique feature of eliciting pain as a response to any environmental stimulus. The sensory response in the pulp cannot differentiate between heat, touch, pressure or chemicals, because they lack specificity. Irrespective of the type of stimulus, the patient perceives any stimulus as a pain.3 Hence careful examination should be performed to rule out other condition s which present in a similar manner to DH. These include cervical caries, leakage around and fractured restorations, cracked tooth and palatogingival grooves.4 Continual research takes place to check the efficacy of desensitizing agents to treat DH as no treatment modality is widely accepted as the gold standard.

Various terminologies have been used for this condition including dentin sensitivity, tooth sensitivity, cervical dentin sensitivity, cemental sensitivity or hypersensitivity and tooth hypersensitivity. The term hypersensitivity represents a pathological situation in which treatment of DH is essential.5 The incidence of DH in most of the population groups ranges from 10 to 30 percent of the general population with an age range of 20 to 50 years. The peak prevalence is reported at the end of the third decade of life and decreas es during the fourth and fifth decades. This may be explained by the decrease in the permeability of dentin and neural sensitivity, natural desensitization due to sclerosis and secondary dentin formation with increasing age. Even the prolonged use of fluoridated dentifrices may cause occlusion of dentinal tubules resulting in decreased sensitivity.4 The higher incidence of DH as seen in females than males can be attributed to hormonal influences and dietary habits, although the results are statistically insignificant. DH may involve a single tooth, group of teeth, area of the mouth or it can be generalized. The most commonly affected teeth are premolars and canine of both arches, followed by maxillary first molars and incisors reported being the least sensitive. Cervical regions on the facial aspect are the most commonly involved areas.4

Various theories and mechanisms responsible for DH have been proposed for over a century. Gysiin 1900 attempted to explain the hypersensitivity of teeth and described fluid movement in the dentinal tubules.6 The hydrodynamic theory was proposed by Brännström in 1963.7 This is the most widely accepted theory which is based on fluid movement inside the dentinal tubules as a response to various stimuli. Any change in temperature or physical or chemical changes create a disturbance in the fluid which is present inside the dentinal tubules. This movement of the fluid acts as a stimulus for baroreceptors causing neural discharge which is ultimately perceived as a DH or pain by the patient. Stimuli like cold, drying, hypertonic chemicals and evaporation cause outward movement of the dentinal fluid (i.e. away from the dentin-pulp complex) whereas heat or mechanical stimulation causes fluid to flow towards the pulp.


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