DENTIN HYPERSENSITIVITY

DEFINITION

•   the international workshop on dentin hypersensitivity(1983) has proposed the following definition for this condition: “ it is characterised by 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 form of dental defect or pathology”

ETIOLOGY

•enamel loss

•occlusal wear

•tooth brush abrasion

•dietary erosion

•abfraction

•parafunctional habits

•cemental loss

•gingival recession

•periodontal disease

•root planing

•periodontal surgery

THEORIES OF DENTIN HYPERSENSITIVITY

1. Direct innervation theory 

 - first theory to be put forward

 - nerve fibers present within dentinal tubules intiate impulses when they are injured

2. Odontoblast deformation theory/transducer theory

 - nerve fibers are present only in the predentin and inner dentinal zones

 - when pain inducing substances like pottasium chloride,acetylcholine are applied to exposed dentin,they fail to elicit painful response.

3. Hydrodynamic theory

 - the most widely accepted mechanism of action of dentin hypersensitivty , the hydrodynamic theory which was proposed by gysi in 1900 and validated by brannstrom in 1996

DIAGNOSIS

1. Complete history	2. Clinical examination	3. Radiographic examination
signs and symptoms	visual assesment	rule out peri apical lesion
intensity	physical assesment
frequency and duration	depth of periodontal pocket depth
dietary changes	percussion testing
	response to cold air

DIFFERENTIAL DIAGNOSIS

1.fractured restorations

2.fractured enamel exposing dentin

3.dental caries

4.post restoration sensitivity

5.cracked tooth syndrome

6.bleaching sensitivity

PREVENTION

1.diet counselling regarding consumption of acidic fruits and beverages

2.correction of brushing technique

3.care during operative procedures

4.care during periodontal procedures

MANAGEMENT

1.Desensitisation by occluding dentinal tubules

a ) formation of smear layer over exposed dentin

b ) use of topical agents to occlude exposed tubules

•  calcium hydroxide paste

•  calcium phosphate paste

•  silver nitrate

•  fluorides

•  fluoride iontophresis

•  potassium nitrate

•  varnishes

•  dentin adhesives

c) placement of restorations

•  glass ionomer cements

•  composite resins 

d) use of lasers  

•  co2 laser

• nd:yag,er:yag laser

• he:ne laser

2. Desensitizing by blocking pulpal sensory nerves

a) potassium nitrate toothpaste

CALCIUM HYDROXIDE

- it increases the remineralisation of the exposed dentin thus reducing dentin permiability

- disadvantage : it causes temporary occlusion of tubules

CALCIUM PHOSPHATE PASTE

• it reduces dentin hypersensitivity by blocking tubules and dentin permeability is reduced

• available product – gc tooth mousse

• it  contains amorphous calcium phosphate and caesin phosphopeptide 

SILVER NITRATE

• it reduses fluid movement by precipitating protein or silver  chloride within the dentinal tubules

• it is not used nowadays as it stains dentin and also damages pulp and gingiva

STRONTIUM CHLORIDE

- The mode of action is linked to their ability to form mineralised deposits within the tubule lumen

and on the surface of the exposed dentine that help prevent transmission of the applied stimulus

FLUORIDES

•agents-sodium fluoride,stannous fluoride or acidulated phosphate fluoride.

•used as mouth rinses,toothpastes or topical application on exposed dentin.

•action is by forming fluorapatite within tubules which block fluid movement within dentin.

FLUORIDE IONTOPHORESIS

• iontophoresis- it is a procedure in which ions of chosen medicament are driven into specific

tissues by means of electric current.

•flouride iontophoresis transfers fluoride ions into dentin for desensitizing it. unit has

•  -positive electrode is placed on patients face or arm

•  -negative electrode is plastic tip placed around the tooth

• 2% sodium fluoride is applied on the  exposed dentin and is transferred deep into the dentin on

  activation of the unit.

•it is reported to provide long-term relief from hypersensitive dentin.

MANAGEMENT

varnishes

• they act by forming a barrier over exposed dentin. This reduces hypersensitivity as it reduces

dentin permeability. they provide only temporary relief.

use of lasers

•they occlude the dentinal tubules by producing local changes around the exposed dentin

•they also produce changes in central pulp neuron.

POTASSIUM NITRATE

• potassium ion may depolarize the nerve and prevent it from repolarizing, thereby, preventing it

  from sending pain signals to the brain.

• potassium ions are thought to diffuse along dentinal tubules and decrease the excitability of

  intradental nerves by altering their membrane potential reducing nerve excitation, and the

associated pain.

AIIMS MAY 2014

   Book by Dr. Gaurav Ramchandani and Dr. Kapil Singhal by DAMS is available now on site for preparation of AIIMS MAY MDS ENTRANCE EXAM 2014. This book consists of questions came in aiims november 2013 exam.

PATTERN OF EXAM 
In november exam, question pattern is completely different and consists of new topics and questions. Students with their clear concepts can easily go thruogh the questions and can attempt them but if we compare november aaims from may aiims, then may aiims is far much easier to crrack.

Just follow few tricks :

• revise everypaper of AIPG MDS in last 7 years
• revise everypaper of AIIMS MDS in last 10 years
• in last few years, they are giving questions from PGI CHANDIGARH also, So don't forget about them
• revise amit ashish of last 5 years
• revise mudit khanna of last 5 years
• GET AIIMS SRSHIP EXAM PAPERS. They are very important.

MANAGING DENTAL EMERGENCIES

Objectives

•Basic dental anatomy

•Diagnosis and treatment planning

•Pulpitis

•Dental abscess and cellulitis

•Trauma

•Anesthesia for dental procedures

•Extraction

•Drugs in dentistry

•Emergency dental kit

Introduction

• Dental disease is evident in all patient populations regardless of medical conditions.
• Most commonly occurs because of dental neglect, however, certain populations have unique oral health issues.
• Dental care consistently ranks in the top 5 of unmet needs in Statewide Statement of HIV/AIDS needs Survey.

Lymphatic Drainage

•Lymphatic drainage is to the submental, submandibular and deep cervical nodes.

DIAGNOSIS &TREATMENT PLANNING

Emergency vs Urgency

•Emergencies interrupt normal eating, working and sleeping.

•Emergencies occur within 2 days.

•Pain medications for emergencies are usually ineffective.

What is a true dental emergency?

•The presence of pain does not necessarily constitute a dental emergency.

•An acute dental emergency requires the presence of :

–Swelling

–Fever

–Pus

–Bleeding

Ludwig’s Angina

Cellulitis involving bilateral sublingual, submandibular and submental spaces
Tongue is elevated toward palate
Rapid spread of infection into lateral and retropharyngeal spaces leading to airway obstruction

When to Admit?

Deep fascial space threatening the airway
Patient is dehydrated and requires IV fluids
General anesthesia needed for surgical procedure

Aims &Objectives

At the end of the session the students will be able to:

identify medical emergencies 

Understand resuscitation procedures

provide immediate management of anaphylactic reaction, hypoglycaemia, upper respiratory

obstruction, cardiac arrest, fits, vasovagalattack, inhalation or ingestion of foreign bodies

apply the principles of first aid

Asthma

Clinical features of acute severe asthma include:

• Inability to complete sentences in one breath.

• Raised respiratory rate 

• Increased heart rate

Management of Acute asthma

• Most attacks will respond to a few ‘activations’ of the patient’s own inhaler such as salbutamol

• Repeat doses may be necessary.

• Reassure and calm patient Reassure and calm patient Severe / life threatening 

• Call emergency service 

• Call for help and when available give oxygen

• 4–6 activations from the salbutamolinhaler should be given using a large-volume spacer device and repeated every 10 minutes if necessary until an ambulance arrives.

Common medical emergencies in dental practice Signs and symptoms 

Anaphylaxis

• Urticaria, erythema, rhinitis, conjunctivitis.

• Abdominal pain, vomiting, diarrhoea.

• Difficulty in breathing

• Vasodilation leading to low blood pressure and collapse. vomiting, diarrhoea.

• Flushing  and swelling of the face, especially of the eyelids and lips.

collapse. 

• Respiratory arrest 

• Cardiac arrest.

Common medical emergencies in dental practice Management Anaphylaxis

• Call for emergency service

• Lay the patient flat & raise the feet (restoration of blood pressure)

• administer oxygen (10 litres per minute). Severe reactions

• adrenaline should be given