Know pain and gain results: hypersensitivity and anxiety

Interestingly, 85 percent of anxiety is from past experiences with a dental professional.

Fortunately, we have the products to treat either “pain.” This article will review the causes of gingival recession, symptoms of dental anxiety and products to consider for our patients’ comfort.

Hypersensitivity

Hypersensitivity occurs when fluids within the tubule are disturbed by certain stimuli: thermal, evaporative, tactile, osmotic. The most common clinical cause for exposed dentinal tubules is gingival recession.

All too often, documentation of gingival recession is missed during either periodontal charting or a comprehensive exam.

In addition, some of your patients may be mislead by associating dentinal hypersensitivity with their whitening sensitivity. Whitening sensitivity will depend on length of exposure, how the tray fits and the concentration of the material used. Although some patients may not know this information, your established patients will have the documentation in their chart.

The causes for gingival recession include:

• toothbrush abrasion
• prominent roots
• inadequately attached gingiva
• oral habits
• crown preparation
• pocket reduction/periodontal therapy
• cervical decay

Many times, hypersensitivity may be in conjunction with the following:

• cracked tooth
• xerostomia
• occlusion
• erosion
• decay
• sinusitis
• recent dental treatment
• nutritional choices

One approach for determining whether your patients’ pain is hypersensitivity or another cause of sensitivity is to ask detective-like questions beginning with a thorough health history. For example, ask which stimuli trigger the sensitivity.

On a scale from 1 to 10 — with 1 being least sensitive and 10 the most — which number describes your sensitivity? Does it ache, throb or is it tender to biting?

Have you used an over-the-counter (OTC) product for sensitivity? If so, did you use the product according to its recommendations? For example, sensitive toothpastes propose a daily use plus two-week timeframe to notice results.

As for clinical assessments, document recession, occlusion, abfraction, attrition, erosion and inflammation. Continue your clinical assessment with intra-oral photos; digital x-rays, complete periodontal recording and caries risk evaluation.

Choosing the product

Once hypersensitivity has been diagnosed, product selection is the next task. Two types of treatment options are to desensitize the nerve inhibiting the stimuli’s effect or occlude or block dentinal tubules.

Selecting a product will depend upon your patients’ habits, whether they are willing to change them, their currant oral health and understanding of product use.

Those whose hypersensitivity is minimal may best benefit from OTC toothpaste containing 5 percent potassium nitrate. Potassium nitrate will not excite the nerves, thus lessening the sensation to stimuli. Some brands to seek out are Sensodyne by GlaxoSmithKline, Colgate Sensitive by Colgate-Palmolive and Crest Sensitivity by Procter & Gamble.

Professional treatment selections range from toothpaste, liquid, light cured to paint on. Depending on the intensity of the pain, you may opt to professionally apply a treatment before your preventative service.

Colgate’s Pro-Relief with Pro-Argin, NuPro’s NUsolutions with Novamin and GC America’s MI Paste with ReCaldent may be applied with a slow-speed handpiece. Each will occlude dentinal tubules before preventative treatment and establish comfort for your patient.

Post treatment options for hypersensitivity may include reapplying the previously mentioned products; custom trays for take home use of professionally dispensed products; or paint on products such as, fluoride varnish or an aqueous solution containing glutaraldehyde and ions/salts.

Note that soft tissue may become irritated if solution overflows from the root surface upon placement. Additional options are the use of lasers, gingival grafts and resins.

Symptoms of anxiety may challenge our diagnosis of true dentin hypersensitivity. You may begin by asking your patients what their past dental experiences were and what made them uncomfortable. Next, it’s helpful to observe both general symptoms and underlying conditions that contribute to your patients’ anxiety.

General symptoms include sweating, difficulty concentrating; a fast breathing pattern or sighing often; restlessness; choking; gagging; anticipating a certain smell, taste or feeling. Underlying conditions of anxiety are depression, stress, heart disease, cancer, medications, dementia and substance/physical/emotional abuse.

As you already know, medications and health ailments contribute to xerostomia. When treating anxiety coupled with dentin hypersensitivity, product selections may be narrowed.

Dental anxiety treatment options

When selecting a topical anesthetic, know the onset and duration. This information will be imperative for your patients’ comfort during the appointment. Topical anesthetics that contain 20 percent benzocaine will have an onset in 30 seconds and duration of 5 to 15 minutes.

Oraqix, lidocaine/prilocaine, is a thermal setting agent where fluid becomes a gel at body temperature. It is easy to apply, onset occurs within 30 seconds and it lasts 20 to 30 minutes.

If you are providing periodontal therapy and your patients require local anesthetic, you may offer OraVerse. A reverse soft-tissue anesthetic, your patient will have feeling return in 30 to 90 minutes vs. residual numbness of 3 to 5 hours.

Finally, oral conscious sedation may be considered for patients who have dental anxiety no matter what treatment they are visiting your office for. Once ingested, onset is 30 minutes and lasts 1.7 to 3 hours.

Conclusion

Whether your patient is experiencing dentin hypersensitivity and/or dental anxiety, the options for gaining comfort are many. Three ways to monitor your patient’s comfort for either scenario are: assess, plan and eliminate.

Assess by viewing previous documentation, current symptoms, medical history and asking the patient to describe his or her pain level on a scale from 1 to 10. Plan for patient comfort during the appointment. Based on your research, decide what desensitizing and anxiety-reducing products you believe would best fit for success.

Determine which professionally dispensed products to supply your patient for the daily home care regimen. Address habits such as lifestyle, nutrition, occlusion or home care for oral health that the patient may be willing to change.

Eliminate what isn’t working and document it for obtaining future comfort. Our goal is to accurately diagnose dentin hypersensitivity, which may co-exist with anxiety.

What may have seemed a daunting task a few years ago, holds much promise in gaining comfort for many patients today and in the future.

About the author

Anastasia L. Turchetta, RDH, has written for several dental industry publications and is a recognized source for oral health information for numerous online consumer-based websites. Her weekly video blog on YouTube, Anastasia’s Hump Day Happenings, answers questions from the general public on oral health topics. Turchetta also spends time as an independent consultant working with several companies to develop website content, continuing education programs and in-office training for dental hygiene departments. Her memberships include the American Dental Hygienist Association and the National Speakers Association. You may visit her online at www.anastasiardh.com.