‘Each clinician must assess whether a problem is mild or moderate generalised sensitivity, or moderate to severe localised sensitivity, and the severity of the problem will determine whether the treatment is more invasive. It’s not just giving the treatment or procedure, it’s altering the patient’s behaviour and modifying what they do in their day to day lifestyle.’ So said Dr David Gillam, speaking at BioMin’s recent expert panel discussion, entitled ‘Combatting Dentine Hypersensitivity’.
The discussion took place at the hugely innovative and successful Online Dentistry Show, mounted in response to the COVID-19 pandemic, where the dental profession and industry came together in a live online version of a real dental conference and exhibition. At BioMin’s expert panel conversation, key opinion leaders in their field looked at the problem of dentine hypersensitivity (DH) and gave their perspectives on its management, and how to work with patients to ensure the treatment plan worked.
Renowned expert on DH, Clinical Reader in Periodontology and Clinical Consultant to BioMin Technologies Ltd, Dr Gillam observed that many clinicians underestimated the impact that DH can have on patients’ quality of life, and were not confident in managing and monitoring the condition. Often they did not routinely screen for DH unless the patient asked about it. Patients tended to self-treat or find coping mechanisms, rarely consulting dentists about the problem. However, a number did suffer a significant impact on the quality of their daily life, he argued.
Running through the options to treat DH, particularly minimally invasive solutions, Dr Gillam introduced BioMin F, in which a lower level of fluoride is contained within a bioactive glass, dissolving slowly over 12 hours to release fluoride, calcium and phosphate to combat DH and to effect remineralisation of damaged tooth enamel.
Not only is the slow, sustained release action combined with a low level of fluoride more effective at blocking dentinal tubules and reducing the fluid flow that causes DH, BioMin F also forms fluorapatite, which is more acid resistant than the hydroxyapatite formed by previous generations of bioactive glass.
He warned, however, ‘Simply giving the patient a toothpaste without modifying and advising patients on other factors that caused the problem in the first place, would be wrong’.
He outlined a diagnostic test for DH, using a cold air blast and asking the patient to rate the discomfort on a scale of 0-10; then applying a varnish or paste, and then testing again. If the pain has been reduced, it’s likely to be DH.
Moving on to the treatment path, Dr Gillam said that depending on the severity of the problem the clinician should either treat it in surgery or give the patient a toothpaste to use at home, and monitor any improvement either with a return visit or a pain diary.
If the sensitivity continued, he recommended a stepwise approach to treatment, involving advice on diet and brushing, and toothpaste, then moving up as needed to topical agents, restorative materials or even periodontal surgery. He insisted that these principles were to be used only as guidance, and adapted to fit with the demands of each clinician’s own practice and time constraints. Finally, he said that clinicians had to manage their expectations and those of their patients. ‘We have to acknowledge that we might not get pain down to zero,’ he said.
‘To my mind, if we can reduce the level of discomfort to a level where they can cope with their day to day practices, I think that’s still a benefit.’
Next up: A team approach to DH management