Table 1 Diseases or Conditions to be excluded for the diagnosis of dentin hypersensitivity
Dental caries: | Severe sensitivity experienced when dental caries passes the dentin-enamel junction and affects the pulp |
Cracked tooth syndrome | Sharp intermittent pain elicited on biting as the occlusal force increases, and relief of pain occurs once the pressure is withdrawn using bite test, a Tooth Slooth, or tapping of an individual cusp |
Traumatized or chipped tooth | a. Enamel fracture: with superficial, rough edges that may cause tongue or lip irritation, but no sensitivity or pain b. Enamel and dentin fracture: with rough edges that usually accompanied with tooth sensitivity or pain |
Pulpitis | a. Reversible pulpitis: with sharp pain that is provoked by hot, cold, or sweet stimulus. The pain last less than 20s after stimuli withdrawal b. Irreversible pulpitis: with severe, sharp, throbbing, intermittent or continuous pain that may keep the patient awake at night. Pain is provoked by cold, hot, chewing, lying flat and persists after stimuli withdrawal, and pain irradiating from other sites in the mouth (referred pain). |
Periodontal abscess | Continuous dull pain that is aggravated on biting, often associated with deep periodontal pockets and alveolar bone loss |
Periapical periodontitis | Continuous dull pain that is aggravated on biting, often associated with deep caries and a necrotic pulp |
Pericoronitis | Continuous dull pain that is aggravated on biting, often associated with swollen pericoronal tissues |
Bleaching sensitivity: | Pain resembles that of reversible pulpitis due to penetration of the bleaching agent into pulp chamber. |
Tooth grinding (bruxism) | Pain and sensitivity to cold and hot stimuli due to occlusal wear, with dentin exposure associated with reflexive and repetitive chewing actions. May be accompanied by facial pain, tension headaches, stiffness and pain in the temporomandibular joint. Enamel micro-fractures and broken or chipped tooth may also occur. |
Post-operative sensitivity | a. Cavity preparation phase: • Heat generation due to inadequate cooling during cutting • Exerting excessive pressure during cutting • Vibration due to eccentricity of the bur • Dentin desiccation which contributes to sensitivity of vital dentin to any subsequent irritant. b. Restorative phase: • For composite resin restoration, post-restorative hypersensitivity may be related to leakage, improper bonding procedure, cuspal strain, or a fractured restoration • For amalgam restoration, post-restorative hypersensitivity may be associated with lack of effective dentin insulation, leakage, hairline cracks, fractured restorations, premature contacts or galvanic stimuli. • Post-operative sensitivity associated with resin cements used for cementation of indirect restorations |