Interview: Dentine hypersensitivity—“A sizeable problem”

Dental Tribune Online: Dentine hypersensitivity still seems to be an underrated condition in the majority of practices. How prevalent is it according to the latest data and are there demographics that are more affected than others?
Dr David Gillam: Dentine hypersensitivity affects any age group from 18 onwards, but the peak is probably in people in their thirties and forties. There is some evidence that sensitivity decreases with age owing to more dentine being laid down. That does not mean that one cannot develop hypersensitivity at age 60 and above. However, there is a higher possibility of the condition affecting younger people owing to their lifestyle and dietary choices, which can lead to the erosion of dentine.

With people keeping their teeth longer, they are potentially more exposed to erosive patterns and behaviour. A different profile may yet emerge, but this is not the case at the moment. From studies, we estimate that nowadays the condition occurs on average in one in ten patients, indicating a sizeable problem.

Does hypersensitivity result solely from erosion?
In scientific data from the US, recession is considered the main cause, but this is a predisposing feature. To my mind, once the dentine is exposed, erosion facilitates hypersensitivity because it opens the tubules. There are actually two stages, the uncovering of the dentine layer and the widening of the tubules, as set out in the hydrodynamic theory.

What makes the treatment of dentine hypersensitivity particularly challenging?
Dentine hypersensitivity is one of those nuisance conditions that may have more than one cause. It also takes a great deal of diagnostic time, unfortunately. From the patient’s point of view, it is often considered a minor problem that he or she believes he or she can deal with in everyday life. That makes it difficult to identify sometimes.

I recommend that practitioners consider the guidelines and the presenting features and manage the patient accordingly. There is a large amount of valuable information available in the literature and in the industry, but most of this is product-related. However, one cannot just wave a magic wand with one solution and expect the condition to go away. Part of what I do now is to educate and raise awareness among members of the dental profession. Therapists, particularly, are a key target group for education. There needs to be higher awareness in general.

What are the key recommendations for dental professionals with patients showing signs of hypersensitivity?
Practitioners should ask the patients the right questions. Key to this is linking the problem with lifestyle and how it affects the patient on a day-to-day basis. Also, dentists should do a differential diagnosis to exclude other causes of dental pain. A large number of dental professionals do not seem to do that. They should not simply recommend a once-off solution, but one that is based on managing the presenting clinical features. This will help to diversify the clinician’s management plan.

If the dentist provides treatment, he or she should incorporate a preventative philosophy that will involve changing certain habits. The patient should be monitored within the practice’s time frame. It is not necessary to see him or her every week. Finally, the clinician should research the pain presentation and not use any specific technique just because it is endorsed by a particular manufacturer.

Thank you very much for the interview.