By Tina Beck, DDS, MS
What do you do when a patient complains about root sensitivity? Do you have a desensitizing protocol? Here are some tips. First, it is important to recognize the cause of root sensitivity: Exposure of dentinal tubules allowing cold temperatures to stimulate the pupal nerve. The treatment of sensitivity involves either filling or blocking the open tubules. For moderate to severe recession, root coverage procedures including connective tissue grafting, coronal repositioning, and the Pinhole® Surgical Technique may be performed to cover the exposed area or if symptoms persist after the following desensitizing therapy.
Temporary relief can be achieved with the use of a dentin desensitizing product such as HurriSeal, which physically occludes the exposed area with a clear resin. For more permanent relief or mild-moderate discomfort, I recommend the use of a sensitivity toothpaste such as Sensodyne or Colgate Sensitive. There are many similar products currently available, and any dentifrice (toothpaste) with potassium nitrate will result in blockage of the dentinal tubules and offer relief from sensitivity. Concurrently, prescribe a prescription-strength fluoride toothpaste and alternate the use of both. Using a potassium-based dentifrice in the morning and a fluoride-based dentifrice in the evening will encourage both methods of tubule closure. Remind the patient to avoid drinking or eating for 30 minutes after use.
The second line of defense is the use of a soft-bristled electric toothbrush, such as Sonicare or Oral-B, to discourage further abrasion via aggressive scrubbing. However, it is important to instruct the patient on its proper use; with very light pressure and no scrubbing. In-office fluoride treatments can also be attempted. A fluoride tray with gel or foam is recommended for generalized sensitivity and a viscous fluoride varnish application if the sensitivity can be localized.
Other more recent treatmentsinclude a paste by Colgate called Pro-Relief toothpaste. It is applied with a prophy cup and has impressive results for relief of sensitivity for approximately four to six weeks. It is particularly useful when applied immediately prior to a prophy to provide immediate relief for those patients who have such severe sensitivity that it interferes with treatment. Crest also came out with a product called “Sensi-Stop Strips” that are applied onto the sensitive area at home. Although they claim to produce immediate results for up to a month, my paients have reported minimal improvement using this product. Sorry, Crest. Some studies suggest that certain types of lasers can also reduce dentinal sensitivity, but there is limited research to support this claim.
Home care can further be amplified with the use of either an OTC or prescription-strength fluoride mouthrinse. These products are very useful for maintaining results achieved after active therapy.
Finally, be sure to check for any occlusal imbalances that may be causing microscopic abfractions. Be sure to explain to the patient that any type of desensitizing therapy may require several weeks to months to take effect and results may vary. Emphasize that the goal of treatment is to reduce — not eliminate — the sensitivity. Good luck!
Case Studies
Case 1: Preoperative and eight-week postoperative connective tissue grafts Nos. 12 and 21. Patient complained of severe sensitivity to cold. He was diagnosed with gingival recession, inadequate atttached gingiva, localized gingivitis, and frenum pull. A connective tissue graft was done to increase keratinized tissue, achieve root coverage, and resolve his sensitivity.
Case 2: Preoperative and two-month postoperative connective tissue grafts Nos. 23-26. Patient complained of severe sensitivity to cold as well as tactile sensitivity. She was diagnosed with gingival recession and inadequate attached gingiva. A connective tissue graft achieved root coverage and resolved her symptoms.
Case 3: Preoperative and 8-week postoperative Pinhole® Surgical Technique #28-30. Patient complained of sensitivity to cold and sweets. Hhe was diagnosed with gingival recession, inadequate attached gingiva, root caries, and failing cervical restorations.. A Pinhole® Surgical Technique was performed to icover the exposed root surfaces, affected dentin, and minimize the sensitivity. All symptoms resolved.
