Giving the gift of comfort

Dec. 1, 2009
I used to cringe every time a patient said, "Don't touch that spot" or "That hurts!" This indicated that the next 45 to 60 minutes were going to be tough for both of us.

by Anne Nugent Guignon, RDH,

I used to cringe every time a patient said, "Don't touch that spot" or "That hurts!" This indicated that the next 45 to 60 minutes were going to be tough for both of us.

Tense patients are hard to manage emotionally and physically. Patients rigid with fear are an ergonomic nightmare. It's hard to work with someone as rigid as a 2x4, anticipating the hygienist's every move. Dentinal hypersensitivity can take even the sanest person into incomprehensible dread.

Research indicates that close to 60% of adults suffer periodic or constant discomfort from dentinal hypersensitivity. The reasons for sensitivity vary greatly, but patients who experience sensitivity dread every touch of an instrument, every drop of cold water, and every blast of air. In most cases, an ultrasonic scaler sends them over the edge.

For years all we had to fight this were a handful of fluoride compounds and some potassium nitrate solutions. Most products were applied at the end of the appointment, which always seemed like poor timing. Why did we make a patient suffer and treat the sensitivity problem afterwards? The success of these treatments was limited at best.

Dentinal hypersensitivity is the direct result of exposed roots being damaged by a constant barrage of dietary acids, aggressive home care, gingival recession, and many other factors. Sensitivity arises from sensations traveling through open dentinal tubules subjected to a host of stimuli.

Well aware of the millions who suffer from sensitivity, scientists are devising more effective ways to treat it. Creating a solution that will plug open dentinal tubules and prevent annoying sensations from reaching the nerve is the most obvious challenge. Products need to be cost effective and easy to apply, deliver immediate relief, not irritate soft tissue, and provide real and long–lasting tubule occlusion. From a clinical standpoint, the simpler this is, the better.

Novel chemistries have emerged that meet these requirements, and treat dentinal hypersensitivity immediately and effectively. Several new polish or paste products are now on the market that accomplish these goals. While there is no one perfect product that will work on every single patient, these three have a very high success rate at the chair.

Colgate's new Sensitive Pro–Relief desensitizing paste, an arginine bicarbonate compound, is applied to sensitive areas like a prophy paste. The Pro–Argin formula raises the pH close to neutral, which enhances the immediate deposition of calcium and phosphorus into the open tubules.

If the problem is truly hypersensitivity, then the patient will experience immediate relief that has been shown in research to last at least a month. My clinical experience with the original product over the years has been amazing, and the effects typically last much longer than a month.

This product has transformed my ability to care for patients. The state where I live does not allow hygienists to give anesthesia, so a quick preprocedural polish solves any discomfort, and a second application at the end of the appointment reinforces the desensitizing treatment while serving as a mild polish. Don't expect great stain removal with Sensitive Pro–Relief, but get ready for patients to feel amazing relief.

Polishing products that contain NovaMin also occlude dentinal tubules. When the calcium phosphosilicate compound NovaMin comes in contact with water or saliva, the calcium and phosphorus ions are released and form a layer of hydroxyapatite, occluding the open dentinal tubules. Dentsply's NuSolutions prophy paste is made with this ingredient and comes in several grits and flavors that provide immediate relief as well as stain removal.

The British company OSspray developed a novel air polishing powder called Sylc that is 100% NovaMin. Once in contact with the tooth, Sylc particles form a protective hydroxyapatite layer on the tooth surface. Those that prefer air polishing can provide desensitizing benefits with Sylc while removing light deposits of stain. The product's composition reduces overall aerosol production.

Reducing or eliminating hypersensitivity has been a top clinical priority of mine for four decades. Eliminating hypersensitivity is a gift that keeps on giving all year long.