Before they ask ...

Dec. 1, 2006
Background noise in a typical exam room includes electric toothbrushes humming, plaque being scraped, soft music, and occasional chattering between you and your patient.
Patients hesitate before bringing up sensitivity; shouldn’t you ask about the unpleasant condition first?

Background noise in a typical exam room includes electric toothbrushes humming, plaque being scraped, soft music, and occasional chattering between you and your patient. It is usually you doing the talking - an open-mouthed patient isn’t an ideal conversationalist. But did you know that talking with your patients might significantly improve their oral health? By proactively questioning patients to identify specific oral health concerns, you have the opportunity to dispense professional guidance that can help them live more comfortably.

Dental professionals routinely look for plaque build-up, gingivitis and signs of tooth decay. Less visible oral health issues, such as dentin hypersensitivity, are equally serious, yet may not be addressed or resolved. Dentin hypersensitivity is clinically defined as a short, sharp pain arising from exposed dentin in response to stimuli, which cannot be ascribed to any other form of dental defect or pathology.1 Though frequently left unaddressed by dental professionals, the condition is highly prevalent, affecting nearly one in five people, or about 22 percent of adults.

Under-mentioned and under-treated

Although dentin hypersensitivity affects people of all ages, those between 20 and 50, and specifically 20 to 30, report it more often.2 Women, too, are more likely to report the condition.3 Despite the surprisingly high incidence of sensitivity among Americans, many patients avoid telling their dental professional about their suffering.4 Data indicates that up to 42 percent of patients with dentin hypersensitivity do not mention their discomfort. Why do they hesitate? Some might consider sensitivity a mild annoyance not worthy of their dentist’s attention.5 Others believe that treatment will be more unpleasant than the condition itself, or fear a serious underlying problem. Asking patients detailed, proactive questions about tooth sensitivity will often coax reluctant ones to mention their concerns.

By understanding the triggers of tooth sensitivity and how treatment options have improved, professionals can recommend solutions that will help patients live more comfortably and enjoy foods and beverages they have had to avoid. Dentin hypersensitivity can result from numerous stimulants. For this reason, sufferers must often alter their lifestyle to avoid discomfort. Hot, cold, sweet or sour foods and beverages, cold air, and aggressive brushing or flossing can all result in painful tooth sensitivity.5 Some patients may adopt poor oral hygiene habits, and avoid certain areas of the mouth when brushing and flossing.

As explained by the hydrodynamic theory, dentin hypersensitivity occurs when sensitivity-inducing stimuli make contact with open dental tubules on the tooth surface. The rapid flow of fluid into the open tubules causes a pressure change across the dentin, which is perceived as pain by the patient. The more tubules exposed, the greater degree of sensitivity a patient will experience. The amount of exposed dentin and tubule system is a direct indicator of the degree of sensitivity.

Even after a patient’s dentin hypersensitivity has been identified, dental professionals should remain proactive by providing guidance and alleviating discomfort. While the condition is easily treated with over-the-counter products such as desensitizing toothpaste, some patients may be hesitant to switch from their regular toothpaste due to misconceptions about safety or taste. Others believe the desensitizers are abrasive and should be alternated with regular toothpaste. In fact, modern desensitizing toothpastes are non-abrasive and designed for everyday use. By telling patients that today’s desensitizers have neither an unpleasant taste nor a gritty texture, chances increase that they will become everyday users.

Sensitivity protection for whitening patients

Professional whitening procedures now account for a large percentage of business in many general practices. The number of patients whitening their teeth at home using OTC products also is rising significantly.4 As popularity in whitening grows, patients may not be aware that dentin hypersensitivity is the primary side effect, with up to 75 percent experiencing sensitivity from repeated bleach applications.4 By asking each patient if they plan to pursue whitening, then dispensing professional recommendations prior to treatment, you can increase their chances of achieving a positive, pain-free outcome.

Whitening-related sensitivity typically begins early in the treatment process, and may not disappear until one or two days after completion.5 Patients who experience discomfort often discontinue the whitening process early, which results in a less-than-satisfactory outcome. Research indicates that up to 41 percent of dentists and hygienists recommend patients stop whitening prematurely to alleviate related sensitivity.6 This is not the ideal solution, as patient dissatisfaction with whitening can reflect negatively on the dentist and his/her practice.

You can identify patients with the greatest potential for whitening-related sensitivity by initiating a discussion about their sensitivity to cold, heat, and other triggers. Patients with preexisting sensitivity are more likely to experience discomfort from whitening; however, even patients with no history of sensitivity may be at risk. For this reason, dental professionals should recommend that patients interested in whitening brush with a desensitizing toothpaste two times a day, two weeks before and two weeks during whitening treatment.

Discussion leads to diagnosis, treatment

The affordability of desensitizers, along with significant improvements in taste and function, make them an effective and convenient solution for dentin hypersensitivity. Dental professionals play a critical role in identifying and managing this painful condition. Adopting a proactive diagnosis strategy can help increase patient awareness of the condition, and dispel any concerns that it is untreatable or a symptom of a larger oral problem. Patients with these concerns may benefit from a discussion of symptoms and solutions with their dental professional.

By talking to patients about sensitivity and potential triggers, dental professionals can more easily identify patients who are suffering. Including desensitizing toothpaste options in this discussion means patients leave the office confident that their sensitivity can be easily managed. Whether achieving a whiter smile or simply eating their favorite foods, patients’ comfort level and quality of life will be improved with your professional guidance. This benefits you through improved relationships with patients and their heightened satisfaction and loyalty. RDH


1 Holland GR, Narhi MN, Addy M, et al. Guidelines for the design and conduct of clinical trials on dentine hypersensitivity. J Clin Periodontal 1997, 24:808-813.

2 Gillam DG, Aris A, Bulman JS, Newman HN, Ley F. Dentine hypersensitivity in subjects recruited for clinical trials: clinical evaluation, prevalence and intraoral distribution J Oral Rehabil. 2002: 29:226-231.

3 Addy M. Dentine hypersensitivity: New perspectives on an old problem. Int Dent J. 2002; 52: 375-376.

4 Data on file, GlaxoSmithKline.

5 Swift E. Tooth Whitening and Sensitivity. Compendium. 2005. Vol. 26, No. 9 (Suppl 3).

7 Haywood VB. Contemporary Esthetics and Restorative Practice. 1993; 3 (suppl.): 2-11.

8 Haywood VB. Dentine hypersensitivity: bleaching and restorative considerations for successful management. Int Dent J. 2002; 52:376-385.

Kathleen H. Alvarez, RDH, MS, received her RDH certification from Los Angeles City College. She has a master’s in Health Science Professional Studies and Education from California State University Dominguez Hills. Kathy is currently an assistant professor and junior clinic coordinator in the Department of Dental Hygiene at Cypress College in Cypress, Calif. She also holds an adjunct faculty position in West Los Angeles College’s Department of Dental Hygiene. Kathy has acted as president of the American Dental Hygienists’ Association, California Dental Hygienists’ Association, South Bay Dental Hygienists’ Society and the Hispanic Dental Association. She is a recipient of the Pfizer/ADHA Award for Excellence in Dental Hygiene (2005), Phi Kappa Phi Honor Society (2004), the Hispanic Dental Association’s Appreciation Award (2002) and American Dental Hygienists’ Association Outstanding Leadership and Achievement Award (2001). In addition, Kathy is the immediate past president of the California State University Dominguez Hills Alumni Association and a founding member of the California State University Dominguez Hills’ Hispanic Scholarship Fund, supporting Latino higher educational achievement.

Choosing a desensitizer

Not all desensitizing toothpastes are created equal. It is important for patients to select a desensitizer that contains ingredients clinically proven to relieve painful sensitivity. Patients may not know that they can alleviate discomfort simply by switching to a toothpaste that contains five percent potassium nitrate and fluoride, such as Sensodyne® (GlaxoSmithKline Consumer Healthcare), Colgate® Sensitive Plus Whitening (Colgate-Palmolive) or Crest® Sensitivity Protection (Procter & Gamble).7 Potassium nitrate penetrates the tooth enamel and dentin to slow the transmission of nerve impulses, thus alleviating painful sensitivity to external stimuli. Toothpastes containing this key ingredient have demonstrated reduced hypersensitivity symptoms within two weeks when incorporated into a patient’s daily oral hygiene routine.7

Use of desensitizing toothpaste will reduce the likelihood that patients will discontinue treatment due to sensitivity. A recent study found that patients who brushed with a desensitizer were more sensitivity free during the first three days of their whitening treatment, which is usually when the worst whitening-related sensitivity is felt.7 The same study revealed that these patients were more satisfied with their whitening experience, and would be more willing to repeat treatment.

For patients with severe dentin hypersensitivity, daily use of desensitizing toothpaste may be more effective for long-term management than an in-office treatment. Though designed to provide immediate relief from painful sensitivity by occluding dentinal tubules, in-office treatment can be brushed off within weeks, and result in exposed tubules and the return of sensitivity.4 Because the potassium nitrate in desensitizers penetrates rather than occludes tubules, relief is long-term and cannot be brushed away. Patients should be encouraged to first brush with desensitizing toothpaste for four to six weeks before determining if an in-office treatment is necessary. If sensitivity persists, an in-office procedure, followed by continued use of desensitizing toothpaste, is the best option.