Dentin hypersensitivity (DH) is common, but “sensitive teeth” is not a diagnosis in itself.
For dental professionals, effective management of dentinal hypersensitivity begins with three questions:
- Is this really dentin hypersensitivity?
- What caused or is perpetuating the dentin exposure?
- Which intervention is appropriate for this patient, at this stage?
Let’s look at current protocols for effective management of dentinal hypersensitivity.
Is it really dentinal hypersensitivity? Start with the Diagnosis
CHECK → TEST → EXCLUDE → DIAGNOSE
- Identify exposed dentin
- Record location and extent
- Elicit pain with controlled stimuli
- Assess pain duration and characteristics
- Check restorations and occlusion
- Evaluate periodontal tissues
- Consider radiographs when indicated
- Exclude caries, cracked tooth, pulpitis, periodontal/periapical disease and other causes
Classic Presentation of Dentinal Hypersensitivity
Persistent, spontaneous, lingering or poorly localised pain should prompt reconsideration of the diagnosis rather than simply escalating desensitising therapy.
Common triggers include:
- Cold
- Air blast
- Touch
- Heat
- Sweet or acidic foods and drinks
Identify the Cause
Dentin exposure often results from multiple factors. Common predisposing factors are:1
- Gingival recession
- Periodontal disease or periodontal treatment
- Erosion from dietary acids
- Abrasion from aggressive toothbrushing
- Attrition and tooth wear
- Bruxism
- Acid reflux or repeated vomiting (as seen in bulimia)
- Combined erosive–abrasive challenges
Why Does Cold Hurt?
The hydrodynamic theory remains the most widely accepted explanation for DH.2
When dentin is exposed and dentinal tubules are patent:
External stimulus
↓
Movement of fluid within dentinal tubules
↓
Stimulation of pulpal nerve fibres (Aδ)
↓
Short, sharp pain
This explains why treatments generally aim to either occlude dentinal tubules or reduce neural excitability/pain transmission.
How to Manage Dental Hypersensitivity?
The Indian Society of Periodontology's 2022 Good Clinical Practice Recommendations advocate a hierarchical approach, beginning with simpler, non-invasive at-home measures and progressing according to severity, tissue loss and treatment response.1
You can take ‘Two Routes to Relief’
Route 1: Tubule Occlusion
- Reduce fluid movement
- Reduce stimulus transmission
Arginine-containing formulations are designed primarily around an occlusive mechanism.
In Pro-Argin® technology, arginine and calcium carbonate interact at the dentin surface to promote formation of a calcium-rich deposit that occludes exposed dentinal tubules.
ARGININE + CALCIUM
↓
Interaction with exposed dentin
↓
Tubule occlusion
↓
Reduced dentinal fluid movement
↓
Reduced sensitivity
Clinical trials of an 8% arginine/calcium carbonate dentifrice have demonstrated significant reductions in tactile and air-blast sensitivity. Following 2 weeks of applying 8% arginine/calcium carbonate dentifrice twice daily, there was a 317.8% reduction in tactile sensitivity and a 90.1% reduction in air-blast sensitivity from baseline.3
Route 2: Neural Desensitisation1
- Reduce nerve excitability
- Reduce pain signalling
Potassium nitrate-based formulations work on the neural component of dentinal hypersensitivity. Potassium reduces the excitability of pulpal nerves, decreasing pain sensation3
Clinical takeaway: The choice of desensitising agent should be matched to the clinical situation, patient preference, severity and response—not based on familiar brands seen on television or advertisements.
Stepwise Management of Dentinal Hypersensitivity
Three major strategies for the management of dentinal hypersensitivity include:1
- Patient education and behavior modification
- Non-invasive treatments for occluding dentin tubules and relieving pain associated with DH
- Restorative or surgical treatments for the management of DH, along with restoration of associated tooth structure and soft tissue loss.
STEP 1: Identify and Control the Cause
- Modify brushing technique
- Use an appropriately soft toothbrush
- Reduce frequent acidic exposures
- Address erosive dietary habits
- Manage contributing periodontal factors
- Assess and manage bruxism where appropriate
STEP 2: At-Home Desensitisation
Recommend desensitising dentifrice to be used twice a day. Reinforce adherence and technique.
STEP 3: In-Office Management
Consider this step when symptoms are moderate to severe, root sensitivity is noted, home therapy has been inadequate, and immediate relief is needed.
In-office management of dentinal hypersensitivity involves application of desensitising agent on the cervical part of the tooth and the exposed root surfaces.
STEP 4: Restorative or Periodontal Intervention
This step is considered when there is significant hard-tissue loss, structural defects that require treatment, periodontal disease/recession requires intervention or if conservative measures do not adequately control symptoms.
Give your patients a pain-free smile. Don’t let them settle for less. Recommend
Colgate Sensitive Pro Relief
It uses Pro-Argin technology – an arginine and calcium carbonate-based occlusive approach that has been designed to block exposed dentinal tubules.
It provides:
- Instant relief: 48.9% hypersensitivity reduction immediately after fingertip application.
- Long-lasting effect: 90.1% hypersensitivity reduction after two weeks of use
Why consider Colgate Sensitive Pro Relief in your DH protocol?
- Superior blocking of dentinal tubules for instant relief
- Promotes formation of a durable calcium-rich protective layer
- Designed for effective at-home care for ongoing dentinal sensitivity management
References:
- Grover, V., Kumar, A., Jain, A., Chatterjee, A., Grover, H. S., Pandit, N., Satpathy, A., Pillai, B. R. M., Melath, A., Dhruvakumar, D., Thakur, R., Joshi, N. V., Deshpande, N., Dadlani, H., Meenakshi, A. A., Ashok, K. P., Reddy, K. V., Bhasin, M. T., Salaria, S. K., et al. (2022). ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity. Journal of Indian Society of Periodontology, 26(4), 307–333. https://doi.org/10.4103/jisp.jisp_233_22
- Liu, X., Tenenbaum, H. C., Wilder, R. S., Quock, R., Hewlett, E. R., & Ren, Y. (2020). Pathogenesis, diagnosis and management of dentin hypersensitivity: an evidence-based overview for dental practitioners. BMC Oral Health, 20(1), 220. https://doi.org/10.1186/s12903-020-01199-z
- Ayad, F., Ayad, N., Vazquez, J., Zhang, Y. P., Mateo, L. R., & Cummins, D. (2018). Use of a toothpaste containing 8% arginine and calcium carbonate for immediate and lasting relief of dentin hypersensitivity: A simple and effective in-office procedure. American Journal of Dentistry, 31(3), 135–140. PMID: 30028931. PMID: 30028931