Introduction

Dentin hypersensitivity is a common condition of transient tooth pain caused by a variety of exogenous stimuli.  The condition affects more than 40 million people in the United States annually.¹   The exogenous stimuli include thermal (cold), tactile (touch), or osmotic changes (sweets or drying the surface).²  While extreme stimuli can make all teeth hurt, the "hyper" sensitivity means painful response to stimuli not normally associated with pain.  The response to a stimulus varies from person to person due to differences in pain tolerance, environmental factors, and emotional state.³

Although most people can tolerate a wide range of oral changes, some patients experience discomfort to the extent that it interferes with their eating patterns and oral hygiene habits.  For these hypersensitive patients, it is appropriate to evaluate the cause and to prescribe a treatment.

The primary underlying clinical cause for dentin hypersensitivity is exposed dentinal tubules.  This clinical condition allows for fluid flow within the tubules (the hydrodynamic theory), creating pain.  The only hypersensitivity not associated with this etiology is the transient spontaneously resolving hypersensitivity associated with the dental bleaching process.

The most common clinical cause for exposed dentinal tubules is gingival recession.⁴   The recession may or may not be associated with bone loss.  If bone loss occurs, then more dentinal tubules can be exposed.  A wide range of mechanisms has been proposed as causes of recession.  (See Table 1)  When gingival recession occurs, cementum is exposed.  Cementum, being a very thin outer protective layer on dentin, is easily abraded or eroded away.  This leaves the underlying dentin, which consists of tubules which contain the protoplasmic projections (little arms) of the cells (odontoblasts) within the tooth pulp chamber.  These cells contain nerve endings and when disturbed, depolarize (fire off).^5,6  This neural discharge is interpreted as pain.  The pain has a rapid onset and is usually of short duration, but it can persist as a dull ache.²

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