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How valid and applicable are current diagnostic criteria and assessment methods for dentin hypersensitivity? An overview.

Gernhardt CR - Clin Oral Investig (2012)

Bottom Line: Furthermore, the cause of the reported pain can vary, and the patient's description of the history, symptoms, and discomfort might be different from one to another, not allowing a reliable and valid diagnosis.Correct diagnosis of dentin hypersensitivity including a patient's history screening and a brief clinical examination in combination with the identification of etiologic and predisposing factors, particularly dietary and oral hygiene habits associated with erosion and abrasion, is essential.The relevant differential diagnosis should be considered to exclude all other dental conditions with similar pain symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Operative Dentistry and Periodontology, University School of Dental Medicine, Martin-Luther-University Halle-Wittenberg, Grosse Steinstrasse 19, 06108, Halle, Germany. christian.gernhardt@medizin.uni-halle.de

ABSTRACT

Objectives: Although dentin hypersensitivity is a common clinical condition and is generally reported by the patient after experiencing a sharp, short pain caused by one of several different external stimuli, it is often inadequately understood. The purpose of this paper is to discuss different available diagnostic approaches and assessment methods used in order to suggest a basis to diagnose, monitor, and measure these challenging painful conditions related to dentin hypersensitivity in daily practice and scientific projects properly.

Material and methods: A PubMed literature search strategy including the following MeSH terms were used as follows: "dentin sensitivity"[MeSH Terms] OR "dentin"[All Fields] AND "sensitivity"[All Fields] OR "dentin sensitivity"[All Fields] OR "dentin"[All Fields] AND "hypersensitivity"[All Fields] OR "dentin hypersensitivity"[All Fields] AND "diagnosis"[Subheading] OR "diagnosis"[All Fields] OR "diagnosis"[MeSH Terms] AND "assessment"[All Fields] AND ("methods"[Subheading] OR "methods"[All Fields] OR "methods"[MeSH Terms]. Furthermore, alternative terms such as "validity," "reliability," "root," "cervical," "diagnostic criteria," and "hypersensitivities" were additionally evaluated.

Results: The literature search, also including the alternative terms and journals, revealed only a small number of specific papers related to valid diagnosis, diagnostic criteria, and assessment methods of dentin hypersensitivity. Outcomes from these publications showed that the response to different stimuli varies substantially from one person to another and is, due to individual factors, often difficult to assess correctly. Furthermore, the cause of the reported pain can vary, and the patient's description of the history, symptoms, and discomfort might be different from one to another, not allowing a reliable and valid diagnosis.

Conclusions: The dental practitioner, using a variety of diagnostic and measurement techniques each day, will often have difficulties in differentiating dentin hypersensitivity from other painful conditions and in evaluating the success of a conducted therapy in a reliable way.

Clinical relevance: Correct diagnosis of dentin hypersensitivity including a patient's history screening and a brief clinical examination in combination with the identification of etiologic and predisposing factors, particularly dietary and oral hygiene habits associated with erosion and abrasion, is essential. The relevant differential diagnosis should be considered to exclude all other dental conditions with similar pain symptoms.

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Patient with painful teeth after experiencing cold. Exposed dentin surfaces and signs of erosive lesions could explain the presence of dentin hypersensitivity
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Fig1: Patient with painful teeth after experiencing cold. Exposed dentin surfaces and signs of erosive lesions could explain the presence of dentin hypersensitivity

Mentions: Previously, dentin hypersensitivity (DHS) was described as “an enigma being frequently encountered yet poorly understood” [1]. More recently, an internationally accepted and widely used definition in the international literature for dentin hypersensitivity is available [2]. Dentin hypersensitivity is characterized by distinctive short, sharp pain arising from exposed cervical dentin in response to various external stimuli that are typically thermal, evaporative, tactile, electrical, osmotic, or chemical, which cannot be ascribed to any other form of dental pathology, defect, or disease (Fig. 1) [3–5]. The definition provides a clinical description of the condition and identifies dentin hypersensitivity as a special clinical entity [6]. The most frequently experienced pain from dentin hypersensitivity is characterized by a rapid onset, sharp burst of pain of short duration strongly assigned to the application time and site of the used stimuli. Since several oral conditions may cause dental pain, such as untreated caries, a cracked tooth or marginal leakage around insufficient restorations, the diagnosis of dentin hypersensitivity can be very difficult [2, 7, 8]. Although there are numerous publications on all topics related to dentin hypersensitivity, a relatively high number of dental professionals are confused about the diagnosis, etiology, predisposing factors, and mechanism of this clinical condition [4, 9–12]. Time is needed to make a correct diagnosis, because dentin hypersensitivity is always a diagnosis of exclusion; it could only definitely be confirmed after all possible other conditions have been diagnostically eliminated. Therefore, the correct attribution of dental pain to dentin hypersensitivity is essential for dentists to develop and implement appropriate treatment options to help suffering patients effectively [4, 13]. However, despite an enormous number of products that are available for dental professionals and patients, a conclusive evidence of a successful treatment is still missing [14]. Although most of these agents have been proposed and developed to treat dentin hypersensitivity successfully, many clinical studies have shown contradictory results [15]. One explanation might be that in all pain studies, it is notoriously difficult to assess the subjective and individual different nature and complexity of pain [16]. Therefore, the correct and reliable diagnosis with valid measurement and assessment of dentin hypersensitivity is also a key factor in monitoring patients and judging therapeutic approaches in clinical trials.Fig. 1


How valid and applicable are current diagnostic criteria and assessment methods for dentin hypersensitivity? An overview.

Gernhardt CR - Clin Oral Investig (2012)

Patient with painful teeth after experiencing cold. Exposed dentin surfaces and signs of erosive lesions could explain the presence of dentin hypersensitivity
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3585843&req=5

Fig1: Patient with painful teeth after experiencing cold. Exposed dentin surfaces and signs of erosive lesions could explain the presence of dentin hypersensitivity
Mentions: Previously, dentin hypersensitivity (DHS) was described as “an enigma being frequently encountered yet poorly understood” [1]. More recently, an internationally accepted and widely used definition in the international literature for dentin hypersensitivity is available [2]. Dentin hypersensitivity is characterized by distinctive short, sharp pain arising from exposed cervical dentin in response to various external stimuli that are typically thermal, evaporative, tactile, electrical, osmotic, or chemical, which cannot be ascribed to any other form of dental pathology, defect, or disease (Fig. 1) [3–5]. The definition provides a clinical description of the condition and identifies dentin hypersensitivity as a special clinical entity [6]. The most frequently experienced pain from dentin hypersensitivity is characterized by a rapid onset, sharp burst of pain of short duration strongly assigned to the application time and site of the used stimuli. Since several oral conditions may cause dental pain, such as untreated caries, a cracked tooth or marginal leakage around insufficient restorations, the diagnosis of dentin hypersensitivity can be very difficult [2, 7, 8]. Although there are numerous publications on all topics related to dentin hypersensitivity, a relatively high number of dental professionals are confused about the diagnosis, etiology, predisposing factors, and mechanism of this clinical condition [4, 9–12]. Time is needed to make a correct diagnosis, because dentin hypersensitivity is always a diagnosis of exclusion; it could only definitely be confirmed after all possible other conditions have been diagnostically eliminated. Therefore, the correct attribution of dental pain to dentin hypersensitivity is essential for dentists to develop and implement appropriate treatment options to help suffering patients effectively [4, 13]. However, despite an enormous number of products that are available for dental professionals and patients, a conclusive evidence of a successful treatment is still missing [14]. Although most of these agents have been proposed and developed to treat dentin hypersensitivity successfully, many clinical studies have shown contradictory results [15]. One explanation might be that in all pain studies, it is notoriously difficult to assess the subjective and individual different nature and complexity of pain [16]. Therefore, the correct and reliable diagnosis with valid measurement and assessment of dentin hypersensitivity is also a key factor in monitoring patients and judging therapeutic approaches in clinical trials.Fig. 1

Bottom Line: Furthermore, the cause of the reported pain can vary, and the patient's description of the history, symptoms, and discomfort might be different from one to another, not allowing a reliable and valid diagnosis.Correct diagnosis of dentin hypersensitivity including a patient's history screening and a brief clinical examination in combination with the identification of etiologic and predisposing factors, particularly dietary and oral hygiene habits associated with erosion and abrasion, is essential.The relevant differential diagnosis should be considered to exclude all other dental conditions with similar pain symptoms.

View Article: PubMed Central - PubMed

Affiliation: Department of Operative Dentistry and Periodontology, University School of Dental Medicine, Martin-Luther-University Halle-Wittenberg, Grosse Steinstrasse 19, 06108, Halle, Germany. christian.gernhardt@medizin.uni-halle.de

ABSTRACT

Objectives: Although dentin hypersensitivity is a common clinical condition and is generally reported by the patient after experiencing a sharp, short pain caused by one of several different external stimuli, it is often inadequately understood. The purpose of this paper is to discuss different available diagnostic approaches and assessment methods used in order to suggest a basis to diagnose, monitor, and measure these challenging painful conditions related to dentin hypersensitivity in daily practice and scientific projects properly.

Material and methods: A PubMed literature search strategy including the following MeSH terms were used as follows: "dentin sensitivity"[MeSH Terms] OR "dentin"[All Fields] AND "sensitivity"[All Fields] OR "dentin sensitivity"[All Fields] OR "dentin"[All Fields] AND "hypersensitivity"[All Fields] OR "dentin hypersensitivity"[All Fields] AND "diagnosis"[Subheading] OR "diagnosis"[All Fields] OR "diagnosis"[MeSH Terms] AND "assessment"[All Fields] AND ("methods"[Subheading] OR "methods"[All Fields] OR "methods"[MeSH Terms]. Furthermore, alternative terms such as "validity," "reliability," "root," "cervical," "diagnostic criteria," and "hypersensitivities" were additionally evaluated.

Results: The literature search, also including the alternative terms and journals, revealed only a small number of specific papers related to valid diagnosis, diagnostic criteria, and assessment methods of dentin hypersensitivity. Outcomes from these publications showed that the response to different stimuli varies substantially from one person to another and is, due to individual factors, often difficult to assess correctly. Furthermore, the cause of the reported pain can vary, and the patient's description of the history, symptoms, and discomfort might be different from one to another, not allowing a reliable and valid diagnosis.

Conclusions: The dental practitioner, using a variety of diagnostic and measurement techniques each day, will often have difficulties in differentiating dentin hypersensitivity from other painful conditions and in evaluating the success of a conducted therapy in a reliable way.

Clinical relevance: Correct diagnosis of dentin hypersensitivity including a patient's history screening and a brief clinical examination in combination with the identification of etiologic and predisposing factors, particularly dietary and oral hygiene habits associated with erosion and abrasion, is essential. The relevant differential diagnosis should be considered to exclude all other dental conditions with similar pain symptoms.

Show MeSH
Related in: MedlinePlus