Doctors Revision

Oral & Dental Health

Dentin Hypersensitivity

Short, sharp pain arising from exposed dentin in response to stimuli, typically thermal, evaporative, tactile, osmotic or chemical, and which cannot be ascribed to any other dental defect or disease.

Also known as: Tooth Sensitivity

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Referral and warning signs

When to refer

Refer to Dentist (HC4/RR) if symptoms are severe, persistent despite desensitizing toothpaste, or if underlying cause needs professional treatment (e.g., fillings, root canal).

Red flags

  • Pain that lingers after stimulus removed (suggests pulpitis).
  • Spontaneous pain (suggests pulpitis).
  • Visible cavity or fracture.

Signs and symptoms

  • Sensitivity or pain triggered by hot, cold, sweet, or acidic foods/drinks.
  • Sensitivity to breathing in cold air.
  • Pain is typically sharp and short-lived upon stimulus exposure.

Risk factors

  • Gum recession (due to age, periodontal disease, improper brushing).
  • Enamel erosion (due to acidic beverages, vomiting e.g., bulimia/anorexia, GERD).
  • Tooth grinding (bruxism).
  • Chipped or fractured teeth exposing dentin.
  • Abrasion from aggressive brushing.
  • Following dental procedures (scaling, whitening).

Diagnosis

Clinical assessment

Based on patient history of characteristic stimulus-provoked pain. Examination to identify exposed dentin, rule out other causes like caries, cracked tooth, pulpitis.

Investigations

  • Dental examination.
  • Tactile stimulus (e.g., probe) or air blast may provoke pain.
  • Rule out other pathology.

Diagnostic criteria

Characteristic pain on stimulation with exposed dentin identified and other causes excluded.

Management

Non-pharmacological management

  • Use soft-bristled toothbrush and non-abrasive technique.
  • Avoid highly acidic foods and drinks.
  • Use night guard if bruxism present.

Pharmacological treatment

  • Topical Application: Use toothpaste specifically formulated for sensitive teeth (containing potassium nitrate, strontium chloride, stannous fluoride, etc.). (LOC: HC2)
  • Topical fluoride application (varnish, gel) by dental professional. (LOC: HC4)

Surgical/Procedural Management

  • Referral for professional cleaning (scaling). (LOC: HC4)
  • Referral for consideration of bonding agents, fillings over exposed areas, gum grafts, or root canal therapy in severe, refractory cases. (LOC: HC4/RR)

Monitoring

Monitor symptom relief with desensitizing toothpaste and professional treatment.

Complications

  • Pain and discomfort affecting eating/drinking.
  • Avoidance of oral hygiene due to pain.

Prevention

  • Proper brushing technique with soft brush.
  • Limit acidic food/drink intake.
  • Use fluoride toothpaste.
  • Regular dental check-ups.
  • Manage bruxism.

Patient education

  • Explanation of the cause (exposed dentin).
  • Proper oral hygiene technique.
  • Use of desensitizing toothpaste.
  • Dietary advice (limit acids).
  • Need for dental assessment if persistent.

Uganda-specific notes

Management at lower levels focuses on recommending desensitizing toothpaste and referral if severe.

References

  • Uganda Clinical Guidelines (UCG) 2023

    Chapter 23, Section 23.1.2

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