Exposed cervical dentin and dentin hypersensitivity summary of the discussion and recommendations.

Abstract

Keywords Exposedcervicaldentin .Dentinhypersensitivity .Oralhealth-relatedqualityoflifeGeneral discussionFirst, the question was addressed whether exposed cervicaldentin deserves attention irrespective if the individual suffersfrom dentin hypersensitivity. All presentations had, however,discussed dentin hypersensitivity implicitly suggesting thatsymptom-free exposed cervical dentin does not warrant spe-cial treatment although these areas are at risk for dentinhypersensitivity but also for cervical caries. These risks wererecognized by the forum, and in the final managementscheme, it is advised that exposed cervical dentin is furtherinvestigated for hypersensitivity and that in absence of dentinhypersensitivity the patient is advised on the possible futurepresentationofit[1].Theforum,however,recognizedtheriskof creating patients, which should not be encouraged.All presentations adhered to a similar definition of dentinhypersensitivity: Dentin hypersensitivity is characterized bydistinctive short sharp pain arising from exposed cervicaldentin in response to various external stimuli that are typi-cally thermal, evaporative, tactile, electrical, osmotic, orchemical and which cannot be ascribed to any other formof dental pathology defect or disease [2]. Several aspects ofthis definition were discussed. It was questioned why thedefinition mention hypersensitivity. There is no evidencethat there are any biological changes making the tooth moresensitive than other teeth neither that pulp pathology isinvolved [3]. The difference between sensitive and non-sensitive dentin relates primarily to the number and size ofpatent dentin tubules [3]. Perhaps it would be better to usethe term dentin sensitivity. Coronal exposed dentin may alsopresent (hyper)sensitivity. Probably, the mechanisms are thesame as for cervical dentin (hyper)sensitivity and differen-ces in the degree of sensitivity are related to the number andshape of the dentinal tubules [3].A third point of discussion in relation to the definition isthe cause of exposureof the dentin. The forum agreed ontherole of gingival recession and that the exposure should benon-caries related. The exposure could be caused by eitherabrasion, erosion, attrition, or abfraction, or clinically morerelevant a combination of these. Finally, it was remarkedthat not the dentin but pulp is sensitive. In spite of all thesecomments on the definition, the forum suggested for clarityreason to stay in line with the common use and to continueto use the term dentin hypersensitivity.EpidemiologyIt became clear that there is only limited epidemiologicaldata available on the prevalence and the natural course ofdentin hypersensitivity [4]. The reported prevalence datavaries enormously depending on the selected population. Itis clear that it is prevalent after periodontal treatment but thelarger part of dentin hypersensitivity after periodontal treat-ment will faint out in 2 to 3 weeks [5]. It was estimated that2 to 6 % of periodontitis patients develop continuous dentinhypersensitivity, but there are no studies substantiating thesefigures. The suggestion to conclude each scaling and rootplaning procedure routinely by a preventive (desensitizing)treatment, e.g., fluoride application or prescription of adesensitizing toothpaste was not endorsed by the forum.The peak prevalence of dentin hypersensitivity is inindividuals aged between 30 and 40 years [4]. A problem