For the treatment of hyperesthesia of hard tissues of the teeth is used. Hyperesthesia of the teeth: symptoms, varieties, therapy. Methods for treating hypersensitivity of teeth

Hyperesthesia of the teeth is a manifestation of increased sensitivity to temperature, chemical and mechanical stimuli, which is accompanied by sudden aching and sharp painful sensations. At the same time, various kinds of dental diseases and complications of caries are not the cause of hyperesthesia. This manifestation is caused by pathologies of the tissues of the teeth of a non-carious nature, as well as periodontal disease. Very often, hyperesthesia is observed with abrasion of the tooth tissues, when the enamel reaches the level of the dentin-enamel compound. This can provoke inflammation of the nerve and pulp of the tooth. In the absence of proper treatment, the increased sensitivity of the enamel of the teeth can lead to hyperesthesia of the hard tissues of the tooth. This dental disease has two forms of development: generalized and local. Generalized hyperesthesia of hard tooth tissues is caused by severe pain that spreads to all teeth at the same time. In turn, with a local form, pain occurs in one or more teeth. Treatment of hyperesthesia depends on the definition of the form and the cause of its manifestation. It is due to the correct differential diagnosis of the disease that the further treatment method and those measures are determined that will help to avoid the occurrence of a relapse.

Causes of hyperesthesia of teeth

As a rule, all forms of dental hypersensitivity occur during improper dental treatment or in violation of the rules of oral care, namely:

• violation of the technique of filling dental holes;
• non-professional caries treatment;
• traumatic damage to the tooth surface;
• the occurrence of splits, chips or cracks in the dental tissue;
• fractures of the crown of the tooth;
• mechanical trauma to the short frenulum of the lower and upper lip and tongue;
• wearing low-quality dentures or crowns;
• violation of the integrity of the enamel;
• improper use of dental floss;
• brushing your teeth with a hard toothbrush;
• violation of the rules for polishing teeth;
• improper performance of the teeth whitening procedure.

It is the frequent bleaching and irregular treatment of caries that lead to complications. Periodontal disease can also increase the sensitivity of the tooth. This disease is accompanied by exposure of the cervical zone of the tooth, which leads to gum recession.

Hypertension may appear or worsen from initial caries. In addition to the painful reaction due to external factors, dental hypertension can be associated with internal problems of the body. Such problems include diseases of the gastrointestinal tract, metabolic disorders, neuroses and age-related hormonal changes.

Clinical manifestations of dental hyperesthesia

Usually, patients experience increased sensitivity of teeth during or after taking sweet, sour, salty and spicy foods. Also, pain in patients with hyperesthesia can be caused by exposure to the teeth of low air temperature, hot or cold food, as well as touching the teeth. In this case, the nature of the pain can be both insignificant and manifested only by discomfort, and intense with significant pain syndrome. This is due to the fact that dental hyperesthesia has three stages of manifestation. At the first stage, the tooth tissues react only to a temperature stimulus, and at the second stage, the intensity of pain increases both from temperature changes and from chemical stimuli. The third stage is due to an acute, painful reaction to any of the above stimuli.

In addition to the appearance of pain, hyperesthesia is accompanied by symptoms such as:

• increased salivation;
• swelling of the face;
• soreness while talking and eating.

During this period, the patient is experiencing difficulties at the time of caring for the oral cavity. In some cases, due to severe pain, it is simply impossible to carry out hygiene procedures. This leads to the appearance of dental plaque, and later - caries, which is aggravated by inflammatory and destructive changes in the periodontal tissues. In the future, these factors can lead to recession or gingival hyperplasia, which further exacerbate the symptoms of dental hyperesthesia. Therefore, it is very important to timely diagnose and begin treatment of hypersensitivity of the teeth in order to prevent the occurrence of other diseases of the oral cavity.

Methods for the diagnosis of dental hyperesthesia

If a patient experiences pain in the tissues of the tooth, the doctor conducts a visual and instrumental examination of the patient's oral cavity. The dentist examines the teeth for cracks, enamel chips and other changes. In addition to the examination, the doctor asks the patient about the frequency of pain manifestations in order to find out the degree of sensitivity of the tooth enamel to various irritants. This allows the specialist to differentiate dental hyperesthesia from acute pulpitis, since the similarity lies in the presence of acute pain and difficulties in identifying a diseased tooth. If hypertension is provoked by injuries, then before starting treatment, the doctor makes a correction that will relieve the patient of painful symptoms. Also, a specialist can treat carious foci and professional oral hygiene. The method of treatment is prescribed depending on the stage of severity of hyperesthesia.

Methods for the treatment of dental hyperesthesia

Treatment of dental hyperesthesia is a rather complex and lengthy process. The method of treatment depends on the cause of the hypersensitivity and on the degree of development of hyperesthesia. As a rule, during treatment, therapeutic methods are used, less often they resort to surgical intervention.

With hyperesthesia of the teeth, treatment consists in influencing the development mechanism itself. Therefore, in order to eliminate the flow of tooth fluid and restore intracanal pressure, it is necessary to close the dentinal tubules. To do this, the patient is prescribed the intake of drugs that promote the binding of proteins of hard tissues with the active substance, which are deposited in the tubule, thereby strengthening it.

Also, one of the methods for eliminating hyperesthesia is teeth fluoridation. This procedure is aimed at eliminating the sensitivity of the teeth to irritants by applying cotton swabs made of fluoride and calcium salts to the diseased teeth. At the moment, fluorides block the dentin tubules, and fluoride ions interact with calcium ions and fill the dentinal tubules with an insoluble calcium fluoride compound. As a result, the rate of fluid flow in the dentinal tubule decreases, and the response to external stimuli becomes less pronounced.

If the disease has arisen due to a carious process, then the patient is prepared to prepare the tooth, clean the cavity from the affected tissues and install a filling.

If the hypersensitivity manifested itself after whitening or brushing teeth, then in this case, electrophoresis and a solution of calcium glycerophosphate are used for dental hypertension (treatment). Also, the patient can be varnished with sodium and calcium fluorides.

When the gums descend, periodontal inflammation or the cervical area opens, the patient undergoes surgical treatment. During the operation, the dentist covers the neck of the tooth and lifts the gum.

If the patient has increased tooth wear, then he undergoes orthodontic treatment, during which the bite is corrected.

To reduce the excitability of nerve endings in the dentin tubules in a patient with hyperesthesia, potassium salts are used to allow the diffusion process of potassium ions into the channels. This method of treatment consists in creating a protective sheath in the dentinal tubules and blocking the transmission of nerve impulses.

Also, for the treatment of hyperesthesia, the patient can use traditional medicine. Such treatment involves the use of only herbal medicines. According to the doctor's recommendations, the patient can use folk remedies not only for treatment, but also for the prevention of a number of dental diseases.

Oral care for dental hyperesthesia

Prevention of dental hyperesthesia includes a number of therapeutic measures that are aimed at preventing hypersensitivity. There are special oral care products that, with regular use, help patients eliminate discomfort and prevent the development of hyperesthesia with a pronounced pain syndrome. These are toothpastes, gels, medicinal decoctions; the duration of their use is determined by the appointment of a specialist according to the patient's feelings. If hyperesthesia is caused by sensitivity to temperature stimuli, then the patient is advised to take funds that seal the dentinal canals and prevent painful sensations.

In addition, for the prevention of dental hyperesthesia, the patient must adhere to certain rules, namely:

1. observe the rules of oral hygiene. Carry out a systematic cleaning of teeth using toothpastes that contain:
   • nitrates;
   • potassium chlorides;
   • sodium fluoride;
   • strontium chlorides;
   • calcium;
   • quotes;
2. in order to increase efficiency and prevent addiction, experts recommend periodically changing toothpastes. In this regard, the patient should use toothpastes with a low level of abrasiveness or gel toothpastes;
3. do not use whitening toothpastes, as they contain chemical elements that damage the tooth enamel and wash out calcium from the teeth;
4. brush your teeth correctly. It is recommended that you use a small amount of toothpaste and brush your teeth effortlessly. After taking sour, sweet dishes, you need to rinse your mouth well;
5. use a medium hard or soft toothbrush that will not injure your gums and teeth. It is important to choose toothbrushes with rounded or smoothed bristle tips and an even cut;
6. using additional care items (such as dental floss or a toothpick);
7. use elixirs to rinse sensitive teeth;
8. eat right, or rather do not eat foods that contain calcium and phosphorus;
9. reduce the use of sour and sweet foods;
10. rinse the mouth with medicinal herbal decoctions;
11. regularly visit the dentist.

Dental hyperesthesia is a serious disease that can occur at any age. The prognosis of treatment depends on the cause of the disease and its stage. The most important thing in the early stages of the disease is to consult a dentist and follow the rules of dental care.

Hyperesthesia of teeth in dentistry is called an increased sensitivity of bone tissue to the effects of temperature, chemical, mechanical stimuli. This medical problem "declares itself" with sharp intense pains upon direct contact with an external agent (for example, hot drinks or sour, sweet foods), the discomfort disappears on its own after the "aggressor" stops acting.

Important! Dentists claim that hyperesthesia of the teeth can be triggered by erosion, mechanical damage, and thinning of the enamel. It is noteworthy that hypersensitivity, as a rule, is not associated with the course of other "local" diseases, although it is a common complication of caries and a consequence of insufficient care of the oral cavity.

Why the problem arises

• pathological abrasion of enamel;
• wedge-shaped lesions, erosion;
• any other injuries associated with a violation of the integrity of the enamel of the teeth, its thinning and exposure of dentin.

HZ often becomes a complication of cervical caries, leading to recession of the gums, demineralization (thinning) of the tooth enamel and "exposure" of dentin

Cervical caries also becomes the cause of hyperesthesia of hard dental tissues. This dental problem leads, first of all, to the demineralization of the tooth enamel (since it becomes thinner as a result of instability to the "attacks" of acids), and then to GB. Non-professional treatment of various diseases of the oral cavity can also provoke hypersensitivity of the teeth. Thus, the fight against caries, poor-quality filling (etching) of the canals are often "triggering levers" for the development of GB.

Damage to the integrity of the tooth in the form of splits, cracks, breaks of a part of the crown also results in an increase in the sensitivity of the enamel to "attacks" of stimuli.

Other factors contributing to PP:

• home or professional teeth whitening (leads to the loss of micro- and macronutrients by enamel, thinning the enamel) - with regular carrying out of such procedures, teeth begin to react even to minimal exposure to irritants;
• inflammatory and dystrophic pathological changes in the periodontium lead to exposure of the cervical zone of the teeth and to enamel hypersensitivity;
• the use of toothbrushes with stiff bristles, careless use of floss (threads), poor-quality prosthetics (filling) - all this turns into a recession (traumatic injury) of the gums and in the long term is fraught with HZ.

Pain with HZ is a response of the sensory receptors of dentin to contact with chemical, mechanical, temperature and even tactile stimuli. In addition to "local" reasons, hyperesthesia can be associated with malfunctions in the body as a whole. Such HPs in dentistry are called functional or systemic, including:

• endocrinopathies;
• psychoneuroses;
• acute and chronic diseases of the gastrointestinal tract (GIT);
• metabolic disorders (eg diabetes mellitus, obesity);
• hormonal changes (including age-related).

In modern dentistry, there are three main theories of the origin of HZ: receptor (pain is a response to irritation of nerve endings in the dentinal tubules), neuro-reflex (disruption of the ion exchange process in the tooth tissues, an overly acute reaction to "attacks" of stimuli of the receptor apparatus of dentin), hydrodynamic (change in the nature of fluid circulation in the dentinal tubules under the influence of external factors).

Experts have not established the final reason for the appearance of tooth hypersensitivity; this phenomenon is usually regarded as polyetiological (it occurs as a result of the simultaneous action of several factors).

Symptoms

HP occurs with food when a person eats foods that are sweet, sour, overly salty, or spicy. Hot, cold food and even air contact with teeth in such patients cause acute pain and discomfort. The severity of the pain syndrome can be different, depending on the characteristics of the organism as a whole and the degree of enamel thinning, in particular.

Deep fluoridation is the main technique for the treatment of dental hypersensitivity

At the initial stage of the development of the anomaly, the teeth "respond" exclusively to temperature stimuli. With deep lesions of the enamel, chemicals and even tactile sensations are included in the list of "aggressors". The appearance of pain while eating is accompanied by increased salivation, the very act of eating and talking becomes uncomfortable. Patients take a forced posture, trying to minimize contact between the cheeks and teeth.

Visually, the face of a person with HS looks puffy (swollen). Dental hypersensitivity (especially when severe) complicates daily oral care routines. Due to soreness, brushing your teeth becomes almost impossible, plaque accumulates - inflammatory and destructive periodontal diseases and, of course, caries develop. In the future, dental problems "joined" to HP (their list includes hyperplasia, gum recession) only exacerbate the symptoms of hyperesthesia.

Classification

GZ share:

• on generalized and limited (according to the prevalence of the abnormal process);
• with the loss of bone tissue as a result of preparation, dental diseases or as a result of systemic pathologies (by origin).

According to the clinical course, hypersensitivity of the teeth of 1, 2 and 3 degrees is distinguished. In the first case, bone tissues react exclusively to temperature stimuli, in the second, they begin to "respond" to chemicals (sour, salty, sweet foods). HP of the third degree is associated with painful sensations in contact with all "aggressors" (including tactile ones).

Diagnostics and treatment

A visual examination of the oral cavity and instrumental methods for assessing the condition of the teeth and gums help the dentist to detect HZ and choose the correct therapy for the disease. If the doctor discovers that the hypersensitivity of the bone tissue has arisen as a result of damage to the dental units, elimination of the root causes of the problem leads to the leveling of the symptoms of DH. Treatment of dental hyperesthesia depends on the degree of thinning, damage to the enamel and the severity of its reaction to external stimuli.

Refusal from hot, cold, and after - sour, salty, sweet food becomes an inevitable consequence of tooth hypersensitivity

The first thing a dentist should do is to eliminate all carious lesions and carry out professional oral hygiene.

The essence of one of the most common methods of dealing with the symptoms of HC is the direct elimination of the mechanism of the onset of a pain reaction to a stimulus. The dentinal tubules are closed to the patient - the flow of fluid in them stops, and the pressure is restored. For this purpose, special preparations are used based on citrates and fluorine ions, magnesium, which affect the structure of dentin (they compact, rebuild the soft tissue component of the tooth).

The same method of treating GZ involves the use of compounds that bind active substances with proteins of the hard tissues of the tooth - this measure allows you to strengthen the dentinal tubules. Patients are given gels, varnishes with a high fluoride content, and toothpastes based on the same active ingredient (for daily use) are prescribed. Thus, a deep, gradual fluoridation of the teeth is achieved.

The second direction in the therapy of GB is to reduce the excitability of the nerve endings of the tooth located in the dentinal tubules. To solve this medical problem, formulations with potassium salts are used. When active substances accumulate in the "problem focus", they create a protective sheath around the sensory fibers, blocking the transmission of nerve impulses. If dental problems such as malocclusion or excessive abrasion of the teeth have led to the appearance of hypersensitivity, orthodontic treatment is indicated for the patient.

How to prevent the problem

Prevention of hyperesthesia consists in the regular use of special products for the care of the oral cavity, which help to prevent pronounced pain in the teeth upon contact with irritants. When the pain subsides, medicated toothpastes are replaced with hygienic ones.

Competent home and professional oral care is the best prevention of hyperesthesia

Pastes, the action of which is aimed at preventing hypersensitivity, must necessarily contain the following active ingredients:

• sodium fluoride compounds;
• strontium chlorides;
• citrates;
• potassium compounds.

The complete list of active ingredients and their concentration depends on the manufacturer. It is better to change toothpastes from time to time in order to enhance the effectiveness of the use of these therapeutic and prophylactic agents. After leveling the symptoms of HS, preference should be given to toothpastes with a low content of abrasive particles or cleansing gels. Toothbrushes should be “equipped” with soft or very soft bristles (depending on the severity of the pain syndrome).

Traditional cleaning is complemented by the use of mouth rinses (elixirs) designed to care for sensitive teeth. Thorough home and professional hygiene can significantly reduce the symptoms of HS. It is recommended not to use a large amount of toothpaste in one brushing and not to exceed the brushing time indicated by the dentist. After eating foods that are sweet, sour, spicy, or other "irritating" foods, it is best to use mouthwash on your mouth.

The use of floss and toothpicks should not be associated with injury to the gingival papillae. Modern scientific research is aimed at creating a material that would fill holes in injured dentin that are open to irritants. Recently, British scientists have succeeded in developing coated silicon nanoparticles. In the future, they will be used for the prevention of caries and restorative therapy of hypersensitive teeth.

Patients with sensitive teeth should give preference to soft bristled brushes

So, hyperesthesia is called the increased sensitivity of dental units in contact with various stimuli. This problem can have both a "local" origin (complication of caries, dystrophic, inflammatory processes in the periodontium), and also be the result of hormonal, metabolic disorders in the body. The fight against GZ is complex, it involves the use of fluorinating compounds (gels, applications), careful, gentle care for sensitive teeth at home. With the secondary nature of tooth hypersensitivity, therapy should be aimed primarily at eliminating the root cause of the problem.

Hyperesthesia is an increased sensitivity of the teeth to the effects of various irritating factors: sour and sweet, cold, hot or spicy. The pain occurs when the irritant hits the surface of the teeth and quickly passes. This distinguishes hyperesthesia from an acute inflammatory disease of the pulp (nerve), in which the pain does not go away for a long time (several minutes). A common symptom of hypersensitivity may be pain while brushing your teeth or going outside and breathing in cold air. This problem occurs in both adults and children, especially during puberty, when the hormonal background of the child changes. Hyperesthesia can manifest itself as an independent syndrome not associated with the development of another disease, or stand out as a sign of the underlying disease (periodontitis, periodontal disease, infectious diseases, endocrine disorders, etc.).

Reasons for a sensitive tooth reaction

Exposure of the tooth enamel to fruit acids leads to an increase in its sensitivity.

Non-systemic factors:

• the effect of acids (citrus juices, fruits, soda) on tooth enamel;
• the use of whitening toothpaste and a hard brush (you can compare the time of the onset of pain with the beginning of the use of new items and hygiene products, sometimes manifestations occur after a few days);
• pathological abrasion of dental tissues (the initial manifestations of pain are along the cutting edges of the crowns of the teeth);
• erosion of enamel;
• wedge-shaped defects (localized in the cervical areas of the teeth);
• initial (softening of the surface layer of enamel);
• periodontal disease (periodontitis);
• after turning teeth under a crown;
• after removing tartar (the enamel closed by it has a less dense structure and after removing deposits for several days it remains susceptible to irritants);
• after a chemical procedure (the outer layer of enamel is damaged);
• microtrauma, enamel cracks, chipped crown corners (bad habits are important - gnawing seeds, biting off wire or threads with your teeth, etc.).

Systemic factors:

• lack of minerals (calcium, phosphorus, etc.);
• toxicosis of pregnant women;
• infections and viruses;
• endocrine disorders;
• mental illness, stress;
• the effect of ionizing radiation;
• taking hormonal contraceptives;
• chemical production, occupational hazards.

Classification of hyperesthesia

1. Limited form (pain in the area of ​​one or more teeth)
2. Systemic form (pain in the area of ​​all teeth of one jaw or side)

By clinical manifestations:

• 1 degree - painful reaction to cold, warmth.
• 2 degree - pain from temperature irritants plus from sweet, sour, salty, spicy.
• Grade 3 - tooth tissues react to all types of stimuli.

Why do teeth become sensitive?

The main tissues are enamel, which protects the teeth from the outside, and dentin, located closer to the nerve (pulp). In structure, dentin is similar to bone tissue; it contains microscopic dentinal tubules with fluid. They stretch from nerve cells in the pulp to the tooth enamel. Processes of nerve cells are located in the tubules, and they transmit a pain impulse when stimulated by stimuli. This happens when the enamel becomes thinner as a result of various reasons.

Tooth sensitivity treatment

Treatment should begin with adherence to certain dietary rules. With an increase in the reaction of tooth enamel to sour, sweet, cold, such foods should be avoided. Citrus fruits, fresh juices and sodas contain acids that can attack the teeth. Avoid sudden temperature changes such as hot coffee with ice cream. Croutons, nuts, seeds can cause the appearance of microcracks and chips on the surface of the teeth. Foods rich in calcium, phosphorus, potassium, magnesium, iron (sea fish, seafood, milk, cheese, cottage cheese, liver) are very useful for strengthening teeth.

Various means are used to reduce the sensitivity of enamel and dentin. It can be special toothpastes, elixirs, gels and foams, varnishes, solutions and preparations for oral administration. Treatment of hypersensitivity should be comprehensive, including not only local effects on dental tissues. It is necessary to find out the cause of the appearance of pain, and if hyperesthesia is a symptom of another disease, it must first be treated.

Desensitizing toothpastes

A patient complaining of tooth sensitivity will probably be advised to clean the forelocks with a special paste.

The use of pastes at home is convenient for the patient. Every day, while brushing your teeth, not only oral hygiene is carried out, but also a therapeutic effect on dental tissues. Examples of such pastes:

• Oral-B Sensitive Original (contains 17% hydroxyapatite, similar in structure to the structural elements of enamel);
• MEXIDOL dent Sensitive;
• Sensodyne-F ​​(contains a potassium compound, ions of which block the transmission of nerve impulses);
• "Rembrandt Sensitive" (forms a protective film on the teeth, must be used after each meal, has an additional whitening effect).

Healing pastes to reduce hyperesthesia contain alkalis (sodium bicarbonate, potassium and sodium carbonates), which, by binding with water in the dentinal tubules, cause dehydration and, as a result, reduce the susceptibility to irritation. It is necessary to use such pastes in courses several times a year, the frequency of which depends on the degree of sensitivity of the teeth.

Healing gels, varnishes, foams

Various companies have developed complementary treatments for hyperesthesia. Gels, foams and mousses can be used with mouth guards by wearing them over your teeth before bed. It is especially effective for systemic hyperesthesia. The solutions are used in the form of rinsing several times a day or they are moistened with cotton turundas, balls, with which the agent is applied to the teeth. Varnishes form a protective film on the teeth after application, after which it is not recommended to eat for 30-40 minutes. All funds must be used regularly, only after a few days or even weeks their therapeutic effect becomes noticeable.

• Bifluoride 12 (varnish based on sodium and calcium fluoride);
• Fluocal - gel or solution (the latter can be used in conjunction with electrophoresis);
• Fluoride varnish (forms a yellow film on the teeth);
• Remodent is a powder that is used as a 3% solution (for rinsing or leaving it on cotton balls for 15–20 minutes, a course of at least 10 applications). It contains elements such as zinc, iron, sodium, calcium, magnesium, phosphorus, manganese;
• Strontium chloride paste 75% (for application to teeth) or 25% aqueous solution (rinse);
• 10% calcium gluconate solution (apply on teeth for 15–20 minutes);
• Professional dental gel Tooth Mousse. Due to its special composition, it reacts with the saliva of the oral cavity to form a protective film. Apply the product to the teeth with cotton swabs or a finger, leave for 3 minutes. Can be used in children from 1 year old;
• MI Paste Plus (dental cream with fluoride, applied to teeth for 3 minutes, contraindicated in children under 12 years of age).

Drugs for the treatment of hyperesthesia can be used in the prevention of caries in children with weak enamel.

Electrophoresis (iontophoresis)

This is a method of electrotherapy, in which the patient's body is exposed to a constant galvanic or pulse current together with a medicinal substance. The following agents are used to treat hyperesthesia:

• 5% solution (for children) or 10% solution for calcium gluconate (for adults) with a course of at least 10 procedures, 10-15 minutes each;
• 1% sodium fluoride;
• Vitamin B1 with trimecaine;
• Fluocal (solution).

Folk remedies for the treatment of tooth sensitivity

• Tea tree oil (3 drops in a glass of warm water, rinse your mouth several times a day).
• Decoction of oak bark (1 tablespoon of dry matter in a glass of boiled water, keep on fire or leave for 5-10 minutes).
• A decoction or infusion of chamomile and burdock (pour a glass of boiling water over 1 teaspoon of dry herb, leave for an hour and rinse your mouth).
• Hold warm cow's milk in your mouth (for short-term relief in case of pain).

Treatment of dental hyperesthesia should be carried out systematically and regularly. When the first symptoms appear, you need to immediately start using pastes or other means, follow a diet. It is difficult to treat hyperesthesia by the presence of chronic diseases, against the background of which soreness of the enamel manifested itself, or taking medications. In such cases, you can act on the tooth tissue with local preparations or remove the nerves in those teeth where the pain is very severe and local treatment does not help. One option is to cover the teeth with crowns.

Increased sensitivity of the teeth is expressed in painful sensations when eating cold and hot foods, as well as sweet and sour foods.

In dentistry, this phenomenon is called tooth hypersensitivity or hyperesthesia. The problem not only causes discomfort, it can be the first signal of serious dental abnormalities, so it is important to find out the cause of its occurrence and only then figure out what to do and how to reduce the sensitivity of the teeth.

Causes of hyperesthesia

The main cause of tooth hypersensitivity is damage to the enamel. The protective layer reveals the dentin, which contains the nerve endings. With a sharp change in temperature or acidity in the mouth, they begin to react, causing pain. Most often this is due to the following factors:

All of the above reasons are associated with a change in the structure of the teeth, their appearance. These conditions are problematic and require specific treatment. There are situations when hyperesthesia occurs in the absence of apparent reasons. Then it could be due to:

Dentist treatment

When the first signs of tooth sensitivity appear, it is better to consult a dentist who will identify the true cause of the problem and prescribe the correct therapy. Before treating, sometimes it is necessary to eliminate the cause, and only then proceed to the restoration of the enamel.

Remineralization and fluoridation

Remineralizing therapy involves the saturation of the enamel with calcium. For this, special preparations are used that are applied to the surface of the teeth. It is important to accompany this procedure with fluoridation. So, the effect will be many times better. This is due to the fact that calcium, when it gets into the enamel, turns into hydroxyapatite. The substance strengthens the protective layer, but it is quickly washed out under the influence of acids.

By resorting to fluorination immediately after the remineralization procedure, hydroxyapatite is transformed into fluoro-hydroxyapatite, which is more resistant to acids. This method is ineffective in the presence of caries or wedge-shaped defects.

One of the most popular means for enamel sensitivity enhancement is “ Enamel-sealing liquid Tiefenfluorid". The German preparation consists of two ampoules: the first is applied a substance rich in calcium hydroxide, the second - containing fluorine. After two procedures, the enamel will be restored, which is why the hyperesthesia of the hard tissues of the tooth will cease to bother.

Iontophoresis

In severe cases, the dentist may prescribe iontophoresis. The method involves the use of drugs under the influence of a galvanic current. Due to the impulse, salts penetrate deeper into the surface tissue and form denser compounds. Most often, the following medicines are used during the procedure:

After the procedure at the dentist, the remaining course can be carried out at home, using special mouth guards soaked in the drug.

Diplen films

Not so long ago, a wide range of dental films has appeared, which normalize the sensitivity of the teeth by enriching and strengthening the enamel. The thin strips are impregnated with a medicinal substance on the inside. They are very flexible and malleable and fit comfortably on the teeth. Apply the film for half an hour or longer, it is almost imperceptible on the teeth. Already after the first procedure, a noticeable decrease in sensitivity is felt.

What can you do at home?

You can also reduce hyperesthesia at home. To do this, use remineralizing gels and toothpastes for sensitive teeth. Also, a lot of recipes are offered by traditional medicine.

Remineralizing gels

In case of a problem with increased sensitivity of the teeth, it is recommended, in addition to dental procedures, to carry out remineralization at home. For this, there are gels saturated with calcium, which contribute to the accelerated restoration of enamel. The most popular home remedies for sensitive teeth are R.O.C.S. Medical Minerals and Elmex gel.

A small amount of the agent is applied to the surface of the teeth and left on 30-45 minutes... Some consumers complain that the gels are unstable due to increased salivation during use. This problem can be solved with caps. It is enough to apply a thin layer of gel on the inside and do the necessary things. The effect of such a procedure is noticeable, but in severe forms of hyperesthesia, this method has to be resorted to daily.

Sensitive Tooth Paste

A prerequisite for hypersensitivity of teeth is the observance of the rules of hygiene, and the choice should be given exclusively in favor of toothpastes for sensitive teeth. They are enriched with minerals, in particular potassium, calcium, fluorine, strontium. The following pastes are very popular:

There are also special hygiene products based on bischofite. Their main task is to block the emerging cracks and tubules that expose dentin. Often these pastes are resorted to when.

Folk remedies

Traditional medicine cannot cure the problem, but it can help reduce pain.

Do not forget about proper nutrition, rich in vitamins and minerals. Particular attention should be paid to foods containing calcium: milk, cottage cheese, sour cream. The substance is well absorbed only in combination with vitamin D, therefore it is better to include it in the complex of medications taken. Vitamins C and E are of great importance; they are found in abundance in fruits, berries and vegetables.

People with sensitive teeth should monitor their oral health and adhere to a number of rules. These include:

Increased sensitivity of teeth can cause a lot of discomfort and become the beginning of dental problems caused by thinning of the enamel. To prevent this from happening, you need to consult a specialist and identify the cause, as well as undergo a course of medical procedures. Preventive measures and a correct lifestyle will preserve the integrity of the enamel for a long time.

Hypersensitivity of the hard tissues of the tooth.

The terms "hyperesthesia", "hypersensitivity of dental hard tissues", "hypersensitivity of teeth", "hypersensitivity of dentin" are synonyms for the same condition, which is characterized by the sudden onset of aching or acute, rapidly passing pain under the influence of temperature, chemical and mechanical irritants (provided that this pain cannot be explained by other dental diseases, for example, complications of caries). Patients often go to the dentist with complaints of a feeling of soreness and pain that occurs after eating sour, sweet or salty foods, carbonated drinks, pain with a sharp change in temperature - taking cold and hot food and liquids, pain when brushing teeth and eating hard food ... According to the literature, up to 50-60% of the adult population of different countries suffers from this pathology, and it is more pronounced at the age of 30-60 years. In children and young people, the dental integument is not yet severely damaged, and in the elderly, the dentin is sclerotic and old, and for this reason its reactions are less pronounced. Women suffer more than men. Classification of hyperesthesia. I.G. Lukomsky, and then Yu.A. Fedorov (1981) proposed the following classification of hyperesthesia: According to the clinical course 1 degree of severity- pain occurs under the influence of a temperature stimulus (more or less 37 degrees C), while the EDI = 3-8 μA 2 severity- pain arises from temperature and chemical stimuli, EDI = 3-5 μA 3 severity- pain arises from temperature, chemical and tactile stimuli, EDI = 1.5-3.5 μA By prevalence 1) Limited form(1 or more teeth are sensitive) - single carious cavities, wedge-shaped defects, single erosion, teeth after preparation, etc. 2) Generalized form(in the area of ​​most or all of the teeth - with exposure of the necks of the teeth, pathological abrasion, multiple caries, multiple and progressive form of erosion) By origin 1. Hyperesthesia associated with the loss of hard tooth tissues a) in the area of ​​carious cavities b) after preparation c) pathological abrasion and wedge-shaped defects d) enamel erosion 2. Hyperesthesia not associated with the loss of hard tooth tissues a) when the necks of the teeth and roots are exposed with periodontal diseases b) hyperesthesia of intact teeth, accompanying general disorders in the body (functional or systemic hyperesthesia). Most often, hypersensitivity is observed in diseases of non-carious origin (abrasion, pathological abrasion, erosion, less often with wedge-shaped defects), in which there is a significant loss of enamel and dentin is exposed. With carious defects, as well as with initial caries, especially when it is localized in the cervical region, pain may occur, which is associated with the demineralization of the enamel under the action of acids and an increase in its permeability. Hyperesthesia can also occur after the treatment of carious lesions if the technique of filling and etching the enamel is not followed. Hyperesthesia is observed in traumatic injuries of the hard tissues of the teeth: split, chip, crack, fracture of the tooth crown. Enamel sensitivity, as a complication, can be considered after teeth whitening. Studies by N.I. Krikheli (2001) convincingly proved that during teeth whitening, in particular professional, there is a release of macro- and microelements from the enamel, which leads to an increase in the permeability of the enamel and, as a result, the emergence of sensitivity, and the less stable the enamel , i.e. in persons with a high level of caries intensity, the higher the risk of this complication. With recession of the gums, exposure of the necks of the teeth, which are found in various conditions and especially in periodontal diseases, both inflammatory and dystrophic in nature, the symptom of sensitivity is observed quite often. Recession of the gums, in addition to periodontal diseases, can occur with its mechanical injury, the presence of a short frenum of the upper and lower lips, tongue, a shallow vestibule of the oral cavity, occlusion disorders, poor-quality manufacturing of dentures and crowns, the use of a toothbrush with stiff bristles, as well as incorrect (horizontal ) and aggressive movements when brushing teeth, traumatic and improper use of floss, lack of gum isolation during whitening. Hypersensitivity of the teeth can also occur after traumatic professional hygiene (damage to the enamel with tools, excessive polishing, especially in the area of ​​the neck and root of the tooth). In addition to the pain reaction resulting from local causes and irritants, this kind of pain can also occur in connection with certain pathological conditions of the body (the so-called systemic or functional hyperesthesia): psychoneuroses, endocrinopathies, diseases of the gastrointestinal tract, metabolic disorders, age-related hormonal changes and disorders, infectious and other concomitant diseases. The mechanism of development of hypersensitivity of the hard tissues of the tooth. First, let's clarify that tooth enamel is an insensitive tissue. The dentin of the tooth is sensitive, and to be more precise, the nerve structures in the dentinal tubules react to stimuli. At the same time, the condition of the enamel, changes in its physical and chemical properties (loss of enamel, increase in its permeability, damage) can contribute to the emergence of sensitivity. Normally, the dentin is tightly covered with enamel, and the cement of the tooth is gum. This protects the dentin from environmental irritants. The enamel in the cervical region is less mineralized and thinner, therefore hypersensitivity is most common in these areas. Dentin consists of a basic substance permeated by many thin dentinal tubules or tubules containing processes of odontoblast cells, the bodies of which are located in the pulp. Dentinal tubules diverge from the pulp of the tooth to the periphery in a radial direction. The sensory mechanism of dentin is not well understood, but it is believed that there are nerve endings in the dentinal tubules and the outer layers of the pulp. There are several theories of tooth sensitivity: odontoblast receptor theory, theory of straight nerve endings, hydrodynamic theory. Currently, the overwhelming majority of researchers adhere to the hydrodynamic theory of the onset of dental hypersensitivity. According to this theory, in the cavity of the tooth, in the pulp there is a fluid that is under pressure determined by capillary blood pressure. Normally, dental fluid moves centrifugally at a certain very low speed. According to M. Branstrom, the founder of this theory, any hydrodynamic effect that changes the intratubular pressure causes a change in the rate of flow of dental fluid in the dentinal tubules, which in turn mechanically irritates the nerve endings of the fibers, causing pain. In the clinic, this manifests itself as follows: as a result of the thinning of the enamel layer or its disappearance, dentin is exposed, the dentinal tubules open, the intratubular pressure changes, and the outflow of dental fluid from the external openings of the dentinal tubules occurs at an increased rate, which causes irritation of the nerve fibers. Further, dehydration of the tubules occurs and the unprotected nerve endings react with a sharp manifestation of pain to any external influence. Restoration of intratubular pressure (when the dentinal tubules are closed) leads to a rapid elimination of pain sensitivity. The most common and severe irritant to these teeth is cold. A less pronounced reaction is noted to an increased temperature, since hot stimuli stimulate a relatively slow internal movement of fluid in dentin. Studies using electronic scanning and dye penetrating into dentin showed that with increased sensitivity, there is a greater number (approximately 8 times compared to the norm) of open dentinal tubules, and their diameter is 2 times the diameter of the tubules of intact dentin. Thus, the difference in the number and diameter of dentinal tubules results in a 16-fold increase in dental fluid flow rate. Patients with hypersensitive teeth have problems with dental care, as they may experience pain when brushing. This leads to a deterioration in the hygienic state of the oral cavity, excessive plaque deposition, which, in turn, can cause the occurrence of multiple carious lesions, inflammation and destruction of periodontal tissues or their aggravation. Further, pathological changes in the periodontium lead to gum recession or its enlargement, resulting in increased hypersensitivity. Thus, a kind of vicious circle arises. More complex is the mechanism of the appearance of pain sensitivity in macroscopically intact enamel, which is most often observed in general concomitant pathology of the body. In all likelihood, in some cases, there are still microcracks in the enamel, through which irritants can penetrate deeply. What matters is the number and diameter of the lumen of the dentinal tubules, which depend on the individual characteristics of the organism. An important role in this process is played by the threshold of pain sensitivity of a person. If the pain threshold is lowered, then the sensitivity to physical, chemical and mechanical stimuli increases. In this case, pain can be felt even by those whose enamel and dentin do not have macroscopically visible lesions. Prevention and treatment of dental hypersensitivity. Treatment of hypersensitivity can be pathogenic, i.e. aimed at treating those conditions and diseases in which this symptom is observed, and symptomatic, aimed at eliminating or reducing pain sensitivity itself. In accordance with the mechanism of the emergence and development of sensitivity, the reduction of hyperesthesia can be achieved in two ways: 1. By closing the dentinal tubules, thereby achieving the cessation of the flow of dental fluid at an increased rate and restoration of intratubular pressure. For this purpose, drugs are used that rebuild and compact the structure of dentin, form compounds that clog the dentinal tubules, as well as agents that bind to proteins of the hard tissues of the tooth and are deposited in the tubules. In this regard, the use of preparations of calcium, fluorine, strontium, citrates is relevant. There is evidence of a positive effect on the sensitivity of fluoride ions. A fairly large number of methods and means have been proposed: fluoride-containing varnishes and gels, fluoride-containing toothpastes, the "deep fluoridation" method, etc. The effect of fluorides is largely associated with physical blockade of dentin tubules. Fluoride ions react with calcium ions in the fluid filling the dentinal tubules to form insoluble calcium fluoride. These precipitates are deposited in the tubules, gradually decreasing their diameter. The result of a decrease in the flow of fluid in the dentinal tubule is a decrease in the response to external stimuli. Strontium salts, in particular strontium chloride, obturate the dentinal tubules by binding it to the protein matrix of dentin and precipitating this complex. In addition, strontium stimulates the formation of dentin replacement. Also, when strontium compounds are used, the dentin structure is rearranged and compacted by replacing calcium enamel in hydroxyapatite crystals with the formation of calcium-strontium-hydroxyapatite crystals. Calcium compounds rebuild and compact the dentin structure, are able to fill and tightly clog the entrance openings of the dentinal tubules. Obturation of dentinal tubules with the use of citrates occurs due to the formation of complexes with dentin calcium. 2. Another direction of reducing sensitivity is to reduce the excitability of the nerve endings themselves in the dentinal tubules, and for this purpose, potassium salts (nitrate, chloride) are effectively used. Potassium ions diffuse into the dentinal tubules, accumulate in them, surround the sensory nerve endings in the pulpal sections of the tubules, creating a semblance of a protective sheath, and thus block the transmission of nerve impulses. Oral cavity care products for teeth hypersensitivity. Special toothpastes are used to help patients control tooth sensitivity throughout most of their lives. The use of these pastes is mainly a long-term indication for the continued use of the paste is the subjective feeling of the patient. It is recommended to change the paste from time to time. Pastes contain biologically active components: - potassium salts (nitrate, chloride), - fluorides (sodium fluoride, aminofluoride, sodium monofluorophosphate) - strontium salts (chloride) - calcium compounds (calcium glycerophosphate, hydroxyapatite) - citrates (zinc) Necessary it should be noted that pastes for reducing the sensitivity of teeth are pastes with a low degree of abrasiveness (dentin abrasiveness index - RDA is 30-50) or they can be gel-based. The mechanism for reducing the sensitivity of the hard tissues of the teeth is carried out by the ingredients included in the toothpaste and is described above. The most widespread and effective pastes on the Russian market are: Sensodine Pastes Sensodine C contains active ingredients: 10% strontium chloride Sensodine P contains active ingredients: potassium chloride, zinc citrate and sodium fluoride. The desensitizing effect of these pastes appears quickly - after 2-3 days from the start of application. Oral-B series pastes Oral-B contains active ingredients: sodium fluoride and potassium nitrate. The dentin abrasiveness index (DDA) is 37. Improvement occurs within 3-5 days of application with 2-fold brushing of the teeth. After 1 month, sensitivity disappears in 90% of patients. "Oral-B" contains an active component - hydroxyapatite (17%), which fills the tubules, tightly blocking the inlets and restoring intratubular pressure. RDA 30. Elimination of pain occurs on the 4-9th day of use. Prophylactic gel toothpaste "Elgifluor" (France) contains active ingredients: fluorinol, chlorhexidine. "President" paste contains active ingredients: potassium nitrate, sodium fluoride, in addition, linden and chamomile extracts. Recommended to apply 2-3 times a day. As desensitizing toothpastes of domestic production, we can recommend the following pastes: "Parodontol" containing hydroxyapatite. "Pardontol sensitive" containing strontium chloride, zinc citrate, vitamin PP "Pearl" with 2.5% calcium glycerophosphate, "New Pearl" with calcium glycerophosphate, etc. Brushes for sensitive teeth should be soft or very soft, depending on the severity of manifestations hypersensitivity, the tips of the bristles are rounded. The shape of the trimming of the brush field is preferably even. An example of such a brush would be a special Oral-B “super-soft bristled toothbrush for sensitive teeth. In the arsenal of care products for sensitive teeth, it is advisable to use rinses for sensitive teeth, for example, "Sensodine" containing sodium fluoride and potassium chloride, "Oral-B" containing active components sodium fluoride and potassium nitrate. Recommendations for professionals and patients. In order to prevent the occurrence and development of hypersensitivity of dental hard tissues, dentists should - when examining patients, pay attention to the initial signs of diseases leading to hypersensitivity: these are periodontal diseases, enamel erosion, enamel abrasion, wedge-shaped defects - to correctly use tools for processing the root in the time of removing tartar and polishing the tooth surface - avoid excessive polishing of the exposed root during the removal of stains used to control the effectiveness of cleaning - isolate the gum during professional whitening - make high-quality and competently dentures and crowns To prevent the occurrence and development of hypersensitivity of hard tissues patients should - maintain oral hygiene by following the correct brushing technique - use a small amount of toothpaste while brushing - brush your teeth effortlessly and without longer than the recommended time - do not use brushes with stiff bristles - use brushes with rounded bristle ends - rinse your mouth with water immediately after taking acidified foods and carbonated drinks - brush your teeth no earlier than 30 minutes after taking acidified foods and drinks - avoid excessive or improper using floss and other substances to clean the contact surfaces of the teeth - when using toothpicks, do not damage the gums.