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Some examples of stimuli that can cause
• hot, cold, sweet, salty, sour or
• blast of cold air from the wind, or
a dentist’s equipment blowing air
• brushing of teeth
• tooth scaling or deep cleaning by
• teeth bleaching.
The dentine can become exposed
from several causes. The enamel
and cementum which protects the
dentine can become removed or
stripped by processes such as attrition
(tooth grinding), abrasion (loss of
tooth structure by mechanical forces),
or erosion (loss of enamel via chemical
dissolution).6,9 These processes can occur
from the following causes6,10
• vigorous tooth brushing
• food acids (cause dental erosion)
• gingival recession
• developmental anomaly (where
enamel and cementum don’t meet)
• bruxism or teeth grinding
• teeth bleaching (this can cause DH as
well be a stimulus).
Theories on how DH occurs
The exact mechanism of how DH
occurs is not fully understood, however,
a few theories have been proposed.
CONTINUING PROFESSIONAL DEVELOPMENT
Currently, the most widely accepted
theory is the hydrodynamic theory
proposed by Brannstrom.
11,12 This theory
suggests that when the exposed dentine
comes into contact with a stimulus,
there is an increased flow of dentinal
fluid in the exposed dentine tubules.
This causes a change in pressure (sensed
by baroreceptors), which excites some
pressure-sensitive nerves in the tooth’s
pulp. This sends pain signals to the
brain which the person feels as tooth
sensitivity. Any stimulus that causes
movement in the dentinal fluid will cause
pain (see Figure 2).
An accurate diagnosis by a dentist is
important before starting management
of DH to rule out other causes of pain
such as a fractured or chipped tooth,
or oral and gum diseases. Dentists may
recommend the person continue with
in-home use of DH products, or they may
use special oral treatments in the dental
surgery. Dentists can also recommend
higher strength fluoride preparations
A person with mild-to-moderate DH
may benefit from using some self-care
strategies and DH toothpastes available
from a pharmacy.
Dentine hypersensitivity products
Several DH products are available, some
available over-the-counter (OTC) and
some via a dentist. They have variations
in ingredients and formulations.
The majority of DH products sold OTC for
in-home use are available as toothpastes.
Figure 1. Tooth cross section
Figure 2. Hydrodynamic theory of dentine
DH products work in two main ways:
• nerve stabilisation, or
• dentine tubule occlusion.
There are a limited number of
head-to-head clinical trials comparing
the variety of DH products for in-home
use that are available on the market.
Authors of review articles state that
it can be difficult to directly compare
studies due to the differing manner
in which the studies were designed,
conducted and evaluated. However,
these studies do provide some guidance
for further research, and allow for
recommendations to be made for
over-the-counter DH products.
A variety of products and methods of
application can be used by dentists to
treat DH. These products will generally
contain higher concentration of active
agents. It does not seem however,
that there is any gold standard
treatment for in-home use of DH
Consumers may trial a
product recommended to them, but
need to move to a different agent if their
DH is still not resolved.
Counselling tips for consumers
• Avoid vigorous tooth brushing and
use a soft toothbrush.
• Avoid abrasive toothpastes.
Use desensitising toothpaste twice
daily. Advise that they may still
experience some DH if using a product
for the first time or changing between
products with different agents.
• Reduce frequency of acidic foods
and drinks (e.g. fruit juice, wine,
soft drinks). Rinse the mouth out after
• Use a straw to drink acidic drinks.
• Avoid brushing teeth within half
an hour of consuming acidic foods
or drinks, as this can weaken the
• Brush teeth twice daily and floss daily.
• Have regular check-ups at the dentist.
• See a dentist if you grind your teeth
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