quiz 2 study guide

dentinal hypersensitivity definitive characteristic

pain upon stimulus and alleviated upon its removal

sharp, short, transient

mechanisms of dentin exposure

gingival recession and root exposure

loss of enamel and cementum

attrition, abrasion, and erosion

abfraction

hydrodynamic theory

fluid movement within the dentinal tubules → pressure changes → pain

involves open and partially occluded dentin tubules (less sensitivity)

natural desensitization

sclerosis of dentin- a thicker, highly mineralized layer of intratubular dentin (from traumatic stimuli like attrition or caries) → a smaller diameter tubule that is less able to transmit stimuli

secondary dentin- “walling off” dentinal tubules after formation of primary dentin, increases with age

smear layer- debris that covers the dentinal surface and the tubules (forms a plug that blocks stimuli)

calculus- a protective coating that shields exposed dentin from stimuli

prevalence of hypersensitivity

most common among 30-40 y/o (more wear and tear, diseases)

declines with elders (natural desensitization)

also more common in women, primarily at cervical facials on premolars and md anteriors

differential diagnosis of tooth pain

(determines where the pain is coming from)

pain of hypersensitivity subsides when stimulus is removed

ex: chewing pain (occlusal pressure) can be indicative of pulpal pathology

utilize data collection by interview (ask trigger questions) and diagnostic techniques (marking paper, rads, percussion, mobility, transillumination)

hypersensitivity management

assessment components (subjective pain, analyze self-care)

educational considerations

treatment hierarchy- two basic goals (pain relief and modification or elimination of contributing factors)

reassessment (evaluate treatment interventions. if pain persists, explore different options)

factors contributing to gingival recession and subsequent root exposure

hard and aggressive toothbrushing

anatomically narrow zone of attached gingiva

tight/short frenum attachments

mechanisms of densensitization

potassium-based products- prevent nerve depolarization that interrupts the neural transmission to the pulp

prevent a stimulus from moving the tubule fluid by occlusion of dentin tubule orifices or reduction in tubule lumen diameter

dietary modifications for hypersensitivity

acidic foods may incite pain from dissolution of the smear layer

do not brush after consuming acidic foods/bevs, as erosion and abrasion occur together

avoid extremes of hot and cold beverages

effects of dental biofilm

w/ biofilm, dentinal tubule orifices increase

the presence of biofilm on exposed root surfaces does not directly correlate with sensitivity, so biofilm composition may be a factor

potassium salts- desensitizing agents

ex: potassium nitrate

reduce depolarization of the nerve cell membrane and transmission of the nerve impulse

widely used OTC

fluorides- desensitizing agents

precipitate calcium fluoride crystals within the dentinal tubule to decrease the lumen diameter (blocks open dental tubules)

calcium phosphate technology

increase remineralization by releasing calcium and phosphate ions into saliva for deposition of new tooth mineral (hydroxyapatite)

can compromise the bioavailability of fluorides- better for patients w poor salivary flow (deficient in calcium phosphate)

self-applied desensitizing agents

OTC dentrifices (potassium nitrate + fluoride)

fluoride gels and mouthrinses

professionally applied desensitiizng agents

fluoride tray, varnish, resins, detin-bonding agents, glass ionomer, etc.

components of pain

pain perception (little variability)

pain reaction (interpretation + response), highly variable

pain threshold (varies, may be altered by drugs and anesthesia)

pain control mechanisms

remove the painful stimulus

block the pathway of the pain message

prevent pain reaction by raising pain reaction threshold

depress the CNS

use psychosedation methods (iatrosedation)

nonopioid analgesics

drugs like NSAIDS block prostaglandin synthesis

for mild to mod pain during treatment and postprocedure healing

characteristics of nitrous oxide-oxygen

analgesia + anxiolytic (sedative) + anesthetic effects

not biotransformed in the body, enters and eliminated through the lungs rapidly

non allergenic

insoluble in blood, primary saturation within 3-5 mins

diffusion hypoxia can occur at completion

indications for nitrous oxide

mild to mod anxiety

medically compromised and would benefit from anziety reduction (CVD, stress asthma)

contraindications for nitrous oxide

absolute- chronic respiratory disease, upper respiratory tract infection, pregnancy (first trimester)

relative- antidepressants, phobias, (must weigh risks and benefits)

advantages of nitrous oxide

mild analgesic and sedative, increases relaxation and cooperation

nonallergenic and safe w little risk

rapid onset and recovery

disadvantages of nitrous oxide

low potency (may need to be coupled with anesthesia)

technique sensitive, expensive

ester local anesthesia

topical, causes vasodilation of blood vessels

high incidence of allergic reactions

hydrolyzed in blood plasma

eliminated by the kidneys

one “i” in name

amide local anesthesia

causes vasodilation of blood vessels

low incidence of allergic reactions

metabolized by the liver and excreted by the kidneys

short, intermediate, and long acting

“ii” in name

contents of a local anesthetic cartridge

amide anesthetic

vasoconstrictor- offsets vasodilation caused by anesthetic

antioxidant- preservative

sterile water

sodium chloride- creates biocompatibility

indications for local anesthesia

pain relief and reducing stress/discomfort

non-surgical treatment of periodontitis

extensive instrumentation

advantages of local anesthesia

no pain or discomfort during procedure

completely reversible without residual side effects

rapid onset

disadvantages of local anesthesia

potential for toxicity, systemic side effects, and soft-tissue injury post injection

anticipating injections may cause further anxiety

noninjectable anesthesia

applied to surface (form of topical)

formulations include gels, creams, liquids, and sprays

blunt-tipped applicator in pd pocket (?)

topical anesthesia

applied directly to surface

to reduce discomfort for an injection, prevent gagging

desensitize the mucous membrane by numbing the terminal nerve endings