Dentine hypersensitivity: Causes and mechanisms

Scanning electron microscope image of exposed dentine tubules

Exploring the causes of dentine hypersensitivity

Dentine hypersensitivity is a common dental problem that can develop over time. Here we take a closer look at the aetiology of dentine hypersensitivity and most widely accepted theory of how it arises.

The hydrodynamic theory of dentine hypersensitivity

Brännström’s hydrodynamic theory is currently the most commonly accepted theory of how dentine hypersensitivity arises:1–4

  • Dentine hypersensitivity arises when tubules found within dentine become exposed, most commonly caused by gingival recession or enamel wear
  • Once exposed, these tubules may come into contact with stimuli, which can induce the movement of fluid within the tubules
  • Such movement can trigger nerves in the pulp, which may induce a short, sharp pain
  • Dentine exposure

    Causes of exposed dentine

    How dentine tubules become exposed

    Dentine tubules become exposed by gingival recession, due to:3,5

    • Periodontal diseases
    • An over-vigorous brushing technique

    Enamel wear exposes dentine tubules through one or more of the following:6

    • Erosion, commonly caused by acids or oesophageal reflux
    • Abrasion, i.e. enamel and dentine loss from excessive toothbrushing and/or other habits
    • Attrition (rarely), brought about by tooth grinding
  • Triggers

    Dentine hypersensitivity triggers

    Exposure of dentine tubules allows fluids within the tubules to move, which can be triggered by multiple types of stimuli.3,4

    Cold water; hot coffee

    1. Thermal stimuli

    Cold (more likely), hot

    Toothbrush with paste

    2. Tactile stimuli

    Toothbrushing

    Chocolate

    3. Osmotic stimuli

    Sugary foods and drinks

  • Nerve stimulation

    Tooth cross section

    Nerve stimulation and pain

    It is theorised that the rapid movement of fluid within dentine tubules triggered by external stimuli can stimulate the nerves within the dental pulp, causing pain.4

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