Dentin hypersensitivity: Diagnosis
Diagnosing dentin hypersensitivity
“A short sharp pain arising from exposed dentin in response to stimuli, which cannot be ascribed to any other form of dental defect or pathology”1
The Canadian Advisory Board Guidelines recommend screening all patients for dentin hypersensitivity to diagnose and help patients manage the condition effectively.2 Patient-reported history should be obtained (in addition to objective measures) to support a diagnosis.2,3 Certain individuals may be more susceptible to dentin hypersensitivity than the general population, for example:2,3
- People who brush their teeth aggressively
- People who have had periodontal treatment
- Frequent consumers of high-acid food/beverages
- People with bulimia
Questions to ask patients as part of a patient history that may indicate dentin hypersensitivity2
|Probing questions||What might indicate dentin hypersensitivity?|
|Can you describe the pain you experience?
Is it dull, throbbing?
|Pain described as:
Short, sharp, twinge
|What causes this pain?
Is it a particular food or drink that triggers it?
Thermal, osmotic and/or tactile
|Can you describe your brushing habits to me?||Excessive brushing, poor oral hygiene|
|Can you describe your diet to me?||Excessive dietary acids:
Wine, citrus fruits, fruit juices, pickles, etc.
|Do you suffer from acid reflux or experience excessive vomiting?
||Look for signs of: Gastric reflux or excessive vomiting
Differential diagnosis of dentin hypersensitivity
There are a number of conditions with symptoms similar to dentin hypersensitivity.
These conditions should be excluded before confirming a dentin hypersensitivity diagnosis.3
|Aetiology||Pain type||Pain-evoking stimulus||Associated features|
|Cracked tooth syndrome||Sharp, intermittent, short duration, resolves on removal of stimulus||Biting||
|Pulpitis||Sharp or dull, difficult to determine precise location in the mouth, spontaneous (may not need stimulus), possibly throbbing, longer duration, likely to keep patient awake at night||Thermal (heat stimulus
|Periapical periodontitis||Dull, spontaneous (may not need stimulus), possibly throbbing, longer duration, likely to keep patient awake
|Biting||Possible periapical redness, swelling, mobility|
Though often a conversation with the dentist is all that’s needed, dentin hypersensitivity can be a challenge for patients to describe, making it harder for clinicians to accurately diagnose.3
By nature, it is a diagnosis of exclusion, meaning conditions that can mimic symptoms of dentin hypersensitivity must be ruled out via a differential diagnosis.3
Other conditions to rule out which may be mistaken for dentin hypersensitivity include:4
- Fractured restorations
- Dental caries
- Chipped teeth
- Post-restorative sensitivity
- Marginal leakage
- Palatogingival groove
Useful diagnostic tests
Dentin hypersensitivity diagnosis can be confirmed by using a dental explorer to check response to tactile stimulus or air blast to check response to cold stimulus.5,6
Assessing the pain of dentin hypersensitivity
Tests to confirm dentin hypersensitivity are aimed at evoking pain with a defined stimulus. In clinical trials, the intensity of the pain or level of discomfort caused can be quantified by the clinician or the patient.5 The Schiff scale allows the clinician to rate the degree of pain the patient is experiencing in reaction to cold air.5 The visual analogue scale (VAS) allows the patient to mark the degree of pain on a gradient scale.5
The Schiff cold air sensitivity scale5
The degrees of the Schiff cold air sensitivity scale are:5
0. Subject does not respond to air stimulus
1. Subject responds to air stimulus but does not request discontinuation of stimulus
2. Subject responds to air stimulus and requests discontinuation of or moves from stimulus
3. Subject responds to air stimulus, considers stimulus to be painful, and requests discontinuation of the stimulus
Visual analog scale (VAS)5
The two ends of the visual analogue scale represent:
- 0cm = minimum pain from external stimulus
- 10cm = maximum pain from external stimulus