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ORIGINAL ARTICLE
Year : 2014  |  Volume : 5  |  Issue : 1  |  Page : 21-24  

Dentin hypersensitivity following tooth preparation: A clinical study in the spectrum of gender


1 Department of Prosthodontics, PGIMER, Rohtak, Punjab, India
2 Department of Prosthodontics, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
3 Department of Public Health Dentistry, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India
4 Department of Pedodontics and Preventive Dentistry, Gian Sagar Dental College and Hospital, Rajpura, Punjab, India

Date of Web Publication18-Feb-2014

Correspondence Address:
Ramandeep Singh Gambhir
Gian Sagar Dental College, Rajpura, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-9668.127277

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   Abstract 

Objective: The objective of this study was to estimate and compare the incidence of dentin hypersensitivity among men and women in an adult population who required replacement of missing tooth/teeth with a fixed partial prosthesis (FPD). Materials and Methods: The study population included 124 subjects (62 men and 62 women), who visited the out-patient department in need of FPD for replacement of missing teeth. After conducting routine examinations, each abutment tooth received two stimuli: Tactile and thermal to assess the sensitivity. The measurement of sensitivity was carried out by using a 10 cm visual analog scale before preparation and after preparation. The results were analyzed statistically using the Mann-Whitney U test. Results: The results showed that women reported more dentin hypersensitivity than men before and after tooth preparation. Conclusion: The results of the present study demonstrated that women reported more dentin hypersensitivity than men before and after tooth preparation. More studies are needed to explore this nature on gender basis.

Keywords: Dentin hypersensitivity, gender differences, pain, tactile stimulus, tooth preparation, visual analog scale


How to cite this article:
Yadav K, Sofat A, Gambhir RS, Galhotra V. Dentin hypersensitivity following tooth preparation: A clinical study in the spectrum of gender. J Nat Sc Biol Med 2014;5:21-4

How to cite this URL:
Yadav K, Sofat A, Gambhir RS, Galhotra V. Dentin hypersensitivity following tooth preparation: A clinical study in the spectrum of gender. J Nat Sc Biol Med [serial online] 2014 [cited 2019 Nov 15];5:21-4. Available from: http://www.jnsbm.org/text.asp?2014/5/1/21/127277


   Introduction Top


Dentin hypersensitivity following tooth preparation is a frequently encountered oral health problem. Dentin hypersensitivity is a "short, sharp pain arising from exposed dentin in response to stimuli typically thermal, evaporative, tactile, osmotic or chemical and which cannot be ascribed to any other form of dental defect or pathology." [1] The first part of the definition provides a clinical description of dentin hypersensitivity, whereas the second part aids in its differential diagnosis.

Dentin hypersensitivity typically afflicts individuals in the age range of 20-49 years, especially 30-39 years. [2],[3] Numerous studies, which have included clinical evaluations by trained examiners through patient-based surveys, have reported prevalence figures in the range of 15-20%. [4],[5] However, higher levels, of up to 57% for individuals in general dental practice settings, and up to 98% in patients following periodontal therapy, have been reported. [1],[2],[6],[7] Women are more frequently affected, and at a younger mean age. [8] Dentin hypersensitivity is most commonly observed in the buccal-cervical regions of the canine and pre-molar teeth, sites, which are also most susceptible to gingival recession. [1],[2]

Although, dentin hypersensitivity following tooth preparation is a frequent problem in dentistry yet very rarely documented and limited epidemiological data have been collected so far. Dentin is a tissue traversed by tubules 0.6-2.0 mm in diameter. [9] When a full crown preparation is performed, approximately, 1-2 million dentin tubules (30,000-40,000 dentin tubules/mm 2 ) are exposed, [10] that can lead to increased dentin permeability and subsequent pulpal irritation. The risk of pulpal damage during and after preparation depends on various factors: Heat generated by bur attrition, amount of remaining dentin, dentin permeability, procedures used in the construction of the provisional crowns, quality of the cements used for temporary and final cementation and degree of marginal infiltration. [9]

The hydrodynamic theory suggests that dentin hypersensitivity occurs when an external stimulus, such as cold air, induces a change in fluid flow within the dentin tubules. This, in turn, results in a pressure change across the dentin, which activates the nerve response, causing a painful sensation. For the hydrodynamic mechanism to induce pain, the dentin tubules must become exposed, be open at the exposed surface, and patent at the pulp. Ex vivo studies have shown that sensitivity is strongly correlated with the number and diameter of exposed and open dentin tubules. [11]

Gender differences in the awareness of experimentally induced pain are well-known. [12] In contrast, studies on gender differences in dentin hypersensitivity are sparse in the peer-reviewed literature. The present study was designed to estimate and compare the incidence of dentin hypersensitivity among men and women in an adult population sample who required replacement of missing tooth/teeth with a fixed partial prosthesis (FPD).


   Materials and Methods Top


Subjects

Study population consisted of 124 subjects, 62 men and 62 women, who visited the outpatient department for replacement of missing tooth/teeth with a FPD. The informed consent of all the subjects who participated in this clinical investigation was obtained.

Clinical assessments

All subjects were given an oral examination to ensure good general health except for the symptoms of dentin hypersensitivity. Detailed clinical and radiographic investigations were performed on all subjects to exclude conditions of teeth, which might have caused pain similar to dentin hypersensitivity. There was at least one vital abutment tooth in each FPD. If an FPD had two vital abutments, only one was chosen, randomly. Each abutment tooth received two stimuli: Tactile stimulus and thermal stimulus (water jet at room temperature, 15°C and 45°C). Sensitive teeth were identified with an explorer passed cervically over the abutment tooth. Ten minutes following tactile stimulation, dentin hypersensitivity was elicited using a jet of water to approximately the same anatomical feature of the tooth as had received the tactile stimulus.

Assessment of sensitivity

Immediately following stimulation, the subjects were asked to grade their overall sensitivity using a 10 cm visual analog scale (VAS), [4],[5] labeled at the extremes with "no pain," at the 0 cm end of the scale, and "severe pain," at the 10 cm end of the scale. The VAS is considered reliable because the amount of pain in one patient can be measured multiple times (at least twice) and results of each test for that individual compare favorably. [13] Measurements from the scale were made in millimeters giving a scoring range of 0-10. After the VAS was recorded before tooth preparation, the subjects underwent tooth preparation of the abutment teeth for the fixed partial denture. The VAS was recorded immediately after tooth preparation. The data were compiled and subjected to statistical analysis.

Statistical analysis

Data were analyzed on an intention-to-treat basis with the subject and teeth as the unit of statistical analysis. In our study, we expressed the descriptive statistics as mean ± standard deviation, based on the 10-cm VAS. We used the Mann-Whitney U test to conduct pairwise comparisons. In addition, we used the Wilcoxan signed rank test to determine the differences between participant's responses to before and after tooth preparation in response to tactile and thermal stimuli.


   Results Top


Comparison between men and women showed that women reported more dentin hypersensitivity than men based on the VAS scale [Table 1]. Statistically significant results were obtained before (P = 0.880) and after tooth preparation (P = 0.520) in both men and women although using the Mann-Whitney test [Table 2]. Comparisons between men and women before and after tooth preparation showed statistically highly significant differences (P = 0.001) indicating that women were more sensitive than men both before and after tooth preparation based on the Wilcoxan signed rank [Table 3].
Table 1: Descriptive statistics of comparison of dentin hypersensitivity between men and women before and after tooth preparation, based on the VAS scale

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Table 2: Mann-Whitney test, to pairwise compare differences in dentin hypersensitivity between men and women before and after tooth preparation, based on the VAS scale

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Table 3: Wilcoxon signed ranks test– determination of participants' responses to before and after tooth preparation in response to tactile and thermal stimuli

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   Discussion Top


Much has been written on the subject of dentin hypersensitivity; yet it would seem justifiable to agree that the condition is "an enigma being frequently encountered, but poorly understood." Not many studies are available in literature that have evaluated the incidence of dentin hypersensitivity following tooth preparation. The present study evaluated the hypersensitivity among men and women following tooth preparation.

Epidemiological studies and pain and sensitivity research have shown that women and men experience and cope with pain and sensitivity differently. [14] The search for a mechanistic understanding of observed sex and gender differences in sensitivity is still in its infancy. There are clear indications that multiple factors individually and collectively play a role, yet our recognition and understanding of the individual factors and their complex interaction is minimal at present. These factors include, but are not limited to, genetic, hormonal, social roles, exercise, and information processing in the brain.

Women may experience and report pain differently than men. [4] Although, with any medical condition, more women tend to present more pain than men. [8] Hormonal variation, puberty, reproductive status, and menstrual cycle have all been shown to affect pain threshold and perception. In general, women have lower pain thresholds and less tolerance to noxious stimuli. [15],[16]

Sex-related differences in blood pressure are emerging as one potential biological explanation of sex-related differences in pain. Many studies report a continuous, inverse relationship between resting blood pressure and pain sensitivity, [17],[18] and women generally have lower resting blood pressure than men. Stereotypical gender roles and expectations affect pain perception. Men report less pain and have higher thresholds in the presence of a female examiner and pain threshold is increased in the presence of an attractive female. [19] The exact opposite was present in women who reported more pain and had lower thresholds with attractive male examiners. [9] Thus, the individual performing the test may produce dramatically different test results without any overt attempt to introduce bias. Differences between men and women have also been attributed to maladaptive coping strategies, like catastrophizing.

In human studies, there is an enhanced ability to gain a direct verbal report of sensitivity as well as assess other components such as suffering, memory, expectation, and fear. The stimuli used to evaluate sensitivity were tactile evaluation (where an explorer is passed over the sensitive lesion), and thermal evaluation, that is a response to water at the water at room temperature and 15°C and 45°C, as thermal tests and cold test in particular have a good correlation to the hypersensitivity symptoms encountered in daily life. The temperatures of 45°C and 15°C had been selected as these were the temperatures at which food and beverages were likely to be frequently consumed.


   Conclusion Top


Clinical experiments show the preparation of vital teeth for full coverage crowns can cause sharp, transient pain as a result of dentinal hypersensitivity in the majority of cases. It was observed that women reported more dentin hypersensitivity than men before and after tooth preparation. Still this multifaceted nature needs to be explored.

 
   References Top

1.Holland GR, Narhi MN, Addy M, Gangarosa L, Orchardson R. Guidelines for the design and conduct of clinical trials on dentine hypersensitivity. J Clin Periodontol 1997;24:808-13.  Back to cited text no. 1
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2.Addy M. Dentine hypersensitivity: New perspectives on an old problem. Int Dent J 2002;52:367-75.  Back to cited text no. 2
    
3.Pashley DH, Tay FR, Haywood VB, Collins MC, Drisko CL. Dentin hypersensitivity: Consensus-based recommendations for the diagnosis and management of dentin hypersensitivity. Inside Dent 2008;4:1-35.  Back to cited text no. 3
    
4.Fillingim RB. Sex, gender, and pain: Women and men really are different. Curr Rev Pain 2000;4:24-30.  Back to cited text no. 4
    
5.Murray LE, Roberts AJ. The prevalence of self-reported hypersensitive teeth. Arch Oral Biol 1994;39:1295.  Back to cited text no. 5
    
6.Dababneh RH, Khouri AT, Addy M. Dentine hypersensitivity-an enigma? A review of terminology, mechanisms, aetiology and management. Br Dent J 1999;187:606-11.  Back to cited text no. 6
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7.Drisko CH. Dentine hypersensitivity-Dental hygiene and periodontal considerations. Int Dent J 2002;52:385-93.  Back to cited text no. 7
    
8.West NX. Dentine hypersensitivity: Preventive and therapeutic approaches to treatment. Periodontol 2000 2008;48:31-41.  Back to cited text no. 8
    
9.Gijsbers K, Nicholson F. Experimental pain thresholds influenced by sex of experimenter. Percept Mot Skills 2005;101:803-7.  Back to cited text no. 9
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10.Richardson D, Tao L, Pashley DH. Dentin permeability: Effects of crown preparation. Int J Prosthodont 1991;4:219-25.  Back to cited text no. 10
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11.Cummins D. The efficacy of a new dentifrice containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride in delivering instant and lasting relief of dentin hypersensitivity. J Clin Dent 2009;20:109-14.  Back to cited text no. 11
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12.Riley JL 3 rd , Robinson ME, Wise EA, Myers CD, Fillingim RB. Sex differences in the perception of noxious experimental stimuli: A meta-analysis. Pain 1998;74:181-7.  Back to cited text no. 12
    
13.Bodian CA, Freedman G, Hossain S, Eisenkraft JB, Beilin Y. The visual analog scale for pain: Clinical significance in postoperative patients. Anesthesiology 2001;95:1356-61.  Back to cited text no. 13
    
14.Keogh E, Herdenfeldt M. Gender, coping and the perception of pain. Pain 2002;97:195-201.  Back to cited text no. 14
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15.Rosseland LA, Stubhaug A. Gender is a confounding factor in pain trials: Women report more pain than men after arthroscopic surgery. Pain 2004;112:248-53.  Back to cited text no. 15
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16.West NX. The dentin hypersensitivity patient-a total management package. Int Dent J 2007;57:411-9.  Back to cited text no. 16
    
17.Bruehl S, Carlson CR, McCubbin JA. The relationship between pain sensitivity and blood pressure in normotensives. Pain 1992;48:463-7.  Back to cited text no. 17
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18.France CR. Decreased pain perception and risk for hypertension: Considering a common physiological mechanism. Psychophysiology 1999;36:683-92.  Back to cited text no. 18
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19.Levine FM, De Simone LL. The effects of experimenter gender on pain report in male and female subjects. Pain 1991;44:69-72.  Back to cited text no. 19
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    Tables

  [Table 1], [Table 2], [Table 3]


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