Sensitivity: Diagnosis

Patient with dentist for assessment

Diagnosing dentine hypersensitivity

“A short sharp pain arising from exposed dentine in response to stimuli, which cannot be ascribed to any other form of dental defect or pathology.”1

Patient history

The Canadian Advisory Board guidelines recommend screening all patients for dentine 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 dentine 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 dentine hypersensitivity2

Probing questions What might indicate dentine hypersensitivity?
Can you describe the pain you experience? Is it dull, throbbing? Pain described as: Short, sharp
What causes this pain? Is it a particular food or drink that triggers it?   Pain triggers: 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 dentine hypersensitivity

There are a number of conditions with symptoms similar to dentine hypersensitivity. These conditions should be excluded before confirming a dentine hypersensitivity diagnosis.3

Aetiology Pain type Pain-evoking stimulus Associated features
Cracked tooth syndrome Sharp, intermittent, short duration, resolves on removal of stimulus Biting

Trauma, parafunction

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
more likely)
Osmotic
Tactile
Caries, restorations
Periapical periodontitis Dull, spontaneous (may not need stimulus), possibly throbbing, longer duration, likely to keep patient awake
at night
Biting Possible periapical redness, swelling, mobility
Diagnostic tests: icons and descriptions

Useful diagnostic tests

Dentine 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.4,5

Assessing the pain of dentine hypersensitivity

Tests to confirm dentine 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.4 The Schiff scale allows the clinician to rate the degree of pain the patient is experiencing in reaction to cold air.4 The visual analogue scale (VAS) allows the patient to mark the degree of pain on a gradient scale.4

  • Schiff cold air sensitivity scale

    The Schiff cold air sensitivity scale4

    The degrees of the Schiff cold air sensitivity scale are:4

    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 analogue scale

    Visual analogue scale (VAS)4

    The two ends of the visual analogue scale represent:4

    • 0cm = minimum pain from external stimulus
    • 10cm = maximum pain from external stimulus

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