A new perspective on dentine hypersensitivity – guidelines for general dental practice

Although dentine hypersensitivity (DH) has been extensively reported on in the published literature, there appear to be unresolved issues regarding its true prevalence. For example, it is clear from these studies that the patient's perspective on the condition is different from the clinician's perspective. According to Orchardson and Gillam,¹ patients who complain of the classic symptoms of DH, which are rapid in onset, sharp in character and of short duration, generally have lower prevalence values (15-30%) following a clinical examination compared to those values based on questionnaire studies, which tend to rely on the patients' perception of DH and which may, in turn, overestimate the extent of the problem (up to 74%).² However, a recent review on the burden of DH, by Cunha-Cruz and Wataha,³ would appear to suggest that the best overall estimate of the prevalence of DH in the population was 10%. There may, however, be an explanation for this apparent discrepancy, for example, the patient's difficulty in determining the type of dental pain they may be experiencing at the time when questioned. Another issue that has been recently addressed in the published literature was in regard to the extent of the impact of DH on the Quality of Life of those individuals who suffer with the condition.⁴ In this study, by Gibson et al, 28.2% of patients were unable to drink cold water without some discomfort, with 26.5% of patients also unable to eat ice-cream without discomfort; 8.7% of patients also reported that they were unable to brush their teeth without some discomfort.⁴ While several studies have suggested that DH may be a major problem in some patients, it would appear that it may be a relatively minor problem for the majority of the population, since the discomfort experienced by individuals has been reported to be transient (episodic) in nature.⁵ This observation may be one of the reasons why some patients either do not self-treat or fail to report the problem when seeing a dental professional.^6,7 It may also be a reason why the condition is often under-diagnosed by dental professionals in that, unless patients complain of the problem, there does not appear to be any screening undertaken by clinicians.⁷ There are undoubtedly a number of diagnostic challenges facing the dental professional when examining patients complaining of dental pain in general, and more specifically with DH. It is important, therefore, to recognize that the diagnosis of DH is essentially a diagnosis of exclusion.⁷ Several studies have also reported on the apparent lack of confidence by dental professionals when treating DH in daily practice, particularly with the vast array of commercially available In-office and over-the-counter (OTC) products that claim to be effective in reducing DH.^8,9 The question that arises is how does the clinician effectively screen, prevent, treat and monitor DH in a general dental practice, and are there simple and pragmatic guidelines that can help in the successful treatment or management of the condition when examining patients? The aim of this review is therefore to update dental professionals (dentists, dental therapists and hygienists) on the issues and challenges associated with the clinical management of DH and to provide simple guidelines based on the presenting clinical features that may help them successfully manage the condition in their day-to-day clinical practice.