Dentine hypersensitivity (DH) is a common, painful dental condition with a multi-factorial aetiology. The hydrodynamic mechanism theory to explain
dentine sensitivity also appears to fit DH: lesions exhibiting large numbers of open dentinal tubules at the surface and patent to the pulp. By definition, DH can only occur when dentine becomes exposed (lesion localisation) and tubules opened (lesion initiation), thus permitting increased fluid flow in tubules on stimulation. Erosion, particularly from dietary
acids appears to play a dominant role in both processes.
Toothbrushing with most
toothpaste products alone cause clinically insignificant wear of enamel but are additive, even synergistic, to erosive enamel loss. Additionally,
toothbrushing with
toothpaste is implicated in 'healthy'
gingival recession.
Toothbrushing with most
toothpastes removes the
smear layer to expose tubules and again can exacerbate erosive loss of dentine. These findings thereby implicate
toothbrushing with
toothpaste in the aetiology of DH. Management of the condition should have
secondary prevention at the core of treatment and therefore, must consider first and foremost the aetiology.
Fluoride toothpaste at present appears to provide little primary or secondary preventive benefits to DH; additional ingredients can provide therapeutic benefits.
Potassium-based products to block pulpal nerve response have caused much debate and are considered by many as unproven, which should not translate to ineffective. Several
toothpaste technologies formulated to block tubules are from studies in vitro, in situ and controlled clinical trials considered proven for the treatment of DH.