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Closed Loop Care for Dentinal Hypersensitivity Sheri B. Doniger, DDS

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Approximately 45 million Americans suffer from dentinal hypersensitivity. It appears that the ages of 25 to 50 are most affected, and there is a slight predilection for women. With age, there is an increase in reparative dentin; hence sensitivity might decrease over time. A reaction might be elicited from cold or hot temperatures, or change in oral pH. Sweets might also be the culprit. Another reason for dentin hypersensitivity is lost cementum due to either the toothpaste used with aggressive toothbrushing or recession. One of the most common causes of tooth sensitivity today is post-operative teeth whitening. Post-periodontal therapy tends to increase tooth sensitivity, as well.

Dentin is not normally exposed to the oral cavity. Enamel, although it is the hardest tissue in the human body with its hydroxyapatite formation and lack of nerve cells, is fairly impervious, but not immune to many types of chemical and tactile attacks. Enamel is primarily hydroxyapatite and crystalline, while dentin contains more organic components and water. Dentin is usually covered by enamel and cementum. It is composed of tubules that extend from the enamel/cementum, traversing through the core of the tooth, with the cell bodies located in the pulp. Dentinal sensitivity occurs primarily due to tubules open to the oral cavity. Thermal, tactile or osmotic changes in the mouth might elicit the sharp, momentary pain that is not due to a frank carious lesion, but rather changes within the dentinal tubules.

As professionals, decreasing a patient's dentinal sensitivity can be accomplished by occluding the tubules to prevent the fluid shift and hence, eliminate the pain of sensitivity. There are several treatment modalities available, ranging from topical applications of fluoride, varnishes, various dental restorative materials and lasers to periodontal grafting procedures. Plaque control is paramount in decreasing the acid environment and maintaining a healthy oral flora.

A new combination of an in-office treatment and an at-home regimen shows promise in relieving dentinal hypersensitivity. The therapy begins with an in-office treatment utilizing a fluoride prophy paste containing NovaMin. This is followed with home use of a therapeutic toothpaste also containing NovaMin and 5,000ppm fluoride.

NovaMin is a calcium sodium phosphosilicate bioactive glass, originally created as a bone regenerative material. It has the capacity, when it interacts with saliva, to release calcium and phosphate ions, which remineralize the enamel matrix by forming hydroxyapatite. Sodium ions in the bioactive glass react with hydrogen ions, causing an increase in salivary pH. This allows rapid release of calcium and phosphate ions into the saliva. Nupro prophy paste has been available for more than 25 years and was extensively used for stain removal and selective polishing. Dentsply has now added Novamin to Nupro prophy paste to occlude the dentinal tubules and reduce hypersensitivity while polishing the teeth.

GSK has created a brand of Sensodyne toothpaste which contains 5,000ppm fluoride toothpaste plus NovaMin. This will further continue the therapeutic levels of available NovaMin at home daily, providing continuous benefits to both occlude the tubules and rebuild the tooth. Proper recall and maintenance are recommended to ensure patients' continued health.

Combining Nupro prophy paste containing NovaMin and Sensodyne 5,000ppm fluoride toothpaste with NovaMin offers a dual-therapeutic treatment for continuous care of dentinal hypersensitivity, both at the office and at home, providing a closed loop of care for patients suffering with dentinal hypersensitivity.
Author’s Bio
Sheri B. Doniger, DDS is a leading dental clinician, author, educator and consultant who currently practices dentistry in Lincolnwood, Illinois. Dr. Doniger has authored numerous articles and has presented many lectures with a focus on women in the dental industry.
Dentaltown Magazine
April 2024
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