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(6) Dentine Sensitivity (Pain theories (Hydrodynamic Theory (Most…

- - - - Infraorbital
        
        Anterior superior alveolar
        
        Maxillary Sinus
        
        Incisors & Canines
        
        Middle superior alveolar
        
        Maxillary sinus
        
        Premolars possibly the mesiobuccal root of 1st molar
      - Ganlionic
      - Posterior Superior Alveolar
        
        Maxillary sinus
        
        Molars (maybe except mesiobuccal root of 1st molar)
      - Zygomatic
  - - - Inferior Alveolar
  - - - Non-myelinated
      - Core to cell free zone
      - Slow burning ache
      - High threshold (tissue injury)
    - - Delta 90%
        
        Myelinated
        
        Pulp-dentine junction
        
        Sharp
        
        Relatively low threshold
      - Beta
        
        Myelinated
        
        Pulp-dentine junction
        
        Pre-pain
        
        Low threshold
- - - - Allodynia (Previously non noxious perceived as noxious (sunburn)
      - Hyperalgesia (Increase response to suprathreshold stim)
      - Reversible
      - Stage 1: Mediators
      - Stage 2: Intracellular signalling
      - Stage 3: Modulation of ion channels
      - Sensitization of CNS: 1) Decrease threshold of mechano receptors 2) Phantom pain on wrong site 3) Pain persist even after inflammation
      - Sensitization of PNS: 1) Localized to site of injury 2) Dec threshold of heat receptors
    - - 1) Biocorrosion (Chemical) Important
        
        Diet
        
        Acid reflex (Gerd/Bulima)
        
        Medication
      - 2) Abrasion / Friction
        
        Tooth-tooth
        
        Smoker's tooth paste
        
        Root planing
        
        Toothbrush
        
        Dentine abrade 25x faster, Cementum 35x faster
      - 3) Attrition / Grinding
        
        Diet
        
        Bruxism
      - 4) Stress / Abfraction / NCCL
        
        Stress from cusp flexure caused by excessive cyclic non-axial tooth loading
        
        Only a factor with erosion
  - - - Air blast evaporation
      - Hypertonic Solution (Sweet / Sour)
      - Cold
      - Toothbrushing
  - - - Amorphous Smear
      - Intratubular Crystal Deposits
      - Adsorption of plasma proteins to inner surface of tubule
    - - Modify/Block nerve response
        
        5% Potassium Nitrate toothpaste reduce excitability of Adelta nerves
      - Tubule occlusion
        
        Protein precipitations
        
        Plugging (Fluoride varnish)
        
        Surface Barrier (Restoration)
      - Natural (Decrease in dentine permeability - protective mechanism)