Root Dentine Sensitivity

Transcription

1 Indian Medical Gazette JULY Original Study Root Dentine Sensitivity Jyoti Ajay Khade, Associate Professor, Dept. of Dentistry, Rajiv Gandhi Institute of Medical Sciences (RIMS) Adilabad, A.P. Satish Doiphode, Professor and Head, Dept. of Periodontics, CSMSS, Aurangabad, Maharashtra. Abstract Background: Dentine hypersensitivity is one of the most painful, ubiquitous and least satisfactorily treated of all the chronic oral problems involving the teeth. Active Periodontal treatment appears to be one of the significant causes of hypersensitivity. Also, the role of plaque control in treatment of hypersensitivity is controversial. Thus the present study is aimed to study the degree to which a sample of patient developed Root Dentine Sensitivity (RDS) following nonsurgical periodontal treatment. Material & Methods: A total of 60 dental patients were evaluated for plaque scores and pain scoring using Scratch test and Air blast test. Visual Analogue Scale (VAS) was used for pain scoring. Oral hygiene instructions were given and non- surgical periodontal treatment was done quadrant wise over a period of 4 weeks. Results: The intensity of RDS given by VAS score and the percentage of teeth sensitive to both the test increased after scaling and root planing but gradually decreased when meticulous plaque control was maintained. Conclusion: Non- surgical periodontal treatment i.e. SRP and Oral hygiene maintenance may temporarily increase RDS, which reduces subsequently over a period of time with meticulous plaque control. Keywords root dentine sensitivity, non-surgical periodontal treatment Introduction The successful treatment of periodontal disease depends on the effective removal of bacterial deposits from the tooth surface accomplished through daily oral hygiene measures achieved by the patient and by professionally performed mechanical debridement. However, active periodontal treatment may result in undesired side effects like gingival recession, removal of cementum layer, denudation of root dentin and increased sensitivity of exposed root surfaces 8. Dentine hypersensitivity is characterized by short, sharp pain arising from exposed dentine in response to stimuli, typically thermal, evaporative, tactile, osmotic or chemical and which cannot be ascribed to any other dental defect or pathology 5. Dentine Hypersensitivity (DH) affects about one out of every seven dental patients. Its prevalence has been reported to vary between 8% to 84% depending on the patient population examined 3, 4, 5, 6, 9. It being a frequent and distressing sequelae to scaling, root planing and surgical procedures, presents a nagging nightmare for the patient 1, 2, 7. But, due to inconclusive data available, neither the incidence nor the severity of DH, subsequent to periodontal therapy is well established. Furthermore, there are disagreeing opinions about the role of plaque control in the etiology of dentine hypersensitivity. Also, it is not clear whether already sensitive teeth are at risk to become more sensitive after scaling and root planning (SRP). Thus, keeping this inconclusive data about DH in mind, the present clinical trial was aimed to study the degree to which a sample of patients requiring non-surgical periodontal treatment develops root dentine sensitivity (RDS). Address for correspondence: Dr Jyoti Ajay Khade, Quarter No.5, Staff Quarters, RIMS Adilabad, A.P wjyots@yahoo.co.in

2 270 Indian Medical Gazette JULY 2012 Materials and Methods A sample of 60 subjects (32 males and 28 females) aged 18 to 48 yrs, requiring periodontal treatment were recruited for the study. Inclusion Criteria 1. Need for non-surgical periodontal treatment in at least two quadrants, each comprising a minimum of 4 teeth in the incisor- premolar region. 2. No open carious lesions in the past 3 months. 3. No treatment received for periodontal disease in the past 3 months. 4. No orthodontic treatment in the past 3 months. 5. No ongoing treatment for DH, and 6. Patient should not be on medications affecting the responsiveness of the pulp sensory organ, including analgesics, anti-inflammatory or mind-altering drugs. Clinical Examination All the tentative experimental teeth were tested for pulp vitality by cold test employing cotton pellet soaked in ethylchloride. Prior to the initiation of the trial and during the study period, patients were subjected to a comprehensive periodontal examination involving Plaque Index (Turesky et al modification of Quigley and Hein Plaque Index, 1970) after disclosure with a solution of erythrosine on all facial and lingual surfaces of all teeth excluding 3rd molars. Pain scoring Tests for painful responses were carried out on the buccal surfaces of each tooth excluding molars using a scratch test and air blast stimulus 7. Scratch test was performed using a True Pressure Sensitive probe (TPS probe) with a probing force of 20gm and a blunt tip diameter of 0.5mm. During testing, the probe was held perpendicular to the root surface and was run vertically and horizontally in order to cover the entire buccal surface. After stimulation, the patient was asked to score the discomfort according to a Visual Analogue Scale (VAS). Following the scratch test, a rest period of approximately 20 min was allowed before the test with air-blast pain stimulus. An air-blast (60 psi, 22 C) derived from a dental syringe was directed to the root surface for 1 sec, with the syringe held perpendicularly, 2-3mm from the root surface. During testing the dentist s gloved fingers shielded the neighboring teeth. After this stimulation the patient was asked again to score the discomfort. Visual Analogue Scale (VAS) The perceived discomfort for each tooth was graded for each of the two stimuli by using a 10cm VAS, labelled at the two extremes with no pain at the zero extreme and with unbearable pain at the 100mm extreme. Data from the VAS was recorded by measuring in millimeter the distance between the zero point and the sign marked by the patient on the 10 cm line.! ! ! 0 50mm 100mm No pain Moderate Unbearable pain pain Study Design The study was extended to include a total of 4 weeks of observation. After baseline recordings the subjects received oral hygiene instructions (OHI) including the use of soft toothbrush and interdental teeth cleaning devices. Subsequently, SRP of the right side of maxillary arch was done using hand and / or ultrasonic instrumentation at the baseline (i.e. at 0 week). Polishing was then performed with a rubber cup and polishing paste. At the subsequent week (i.e., at 1st week), treatment (including SRP and polishing) of the left side of maxillary arch was done after repeating the clinical examination and pain scoring. At 2nd week right side of mandibular arch was treated and left side of mandibular arch was treated at 3rd week following clinical examination and pain scoring (Table 1). Results The results of this clinical trial are based on data comprising 60 patients in the age range between 18 to 48 years, having a total number of 1792 teeth. Out of these only 1188 teeth were included for pain scoring. The mean age of the patients was 27.27yrs with an equal gender representation (28 females and 32 males).

3 Indian Medical Gazette JULY Baseline data At the baseline examination, a total of 232 (19.53%) teeth (112 in maxillary arch and 120 in mandibular arch) responded positively to one or both of the two stimuli used for pain scoring. Of the responding teeth, 108 were sensitive to scratch test done by probe, 232 to air blast and 108 to both probing and air blast. Thus, all those teeth which were sensitive to probing were also sensitive for air blast. But, 124 teeth were only sensitive to air blast. The comparison between genders revealed that in males 25.16% of teeth were reported to respond positively, while in females the proportion of responding teeth were 13.04%. Plaque Scoring The mean plaque index at the baseline examination for the total sample of patients was Following oral hygiene instructions and subsequent to periodontal treatment, the mean plaque scores showed decreasing trend with mean plaque index of 1.82 at 1st week, 1.69 at 2nd week,1.11 at 3rd week and 0.70 at 4th week (Table 2). Root Dentine Sensitivity Changes The percentage of sensitive teeth in the right side of upper arch, increased at the 1st week observation (i.e. 1 week post SRP and OHI) but it showed a decreasing trend in subsequent weeks of observation (Table 2). Conversely, for the left side of maxillary arch, the percentage of sensitive teeth decreased at the 1st week observation (i.e. 1 week after OHI), but it subsequently increased at the 2nd week observation (i.e. 1 week post SRP and 2 weeks after OHI). Again in the 3rd and 4th weeks the percentage of sensitive teeth gradually decreased. For right side mandibular teeth, percentage of sensitive teeth decreased from baseline till 2nd week but in the 3rd week this increased (i.e, 1 week post SRP and 3 weeks after OHI). At the 4th week observation there was a slight decrease in percentage of

4 272 Indian Medical Gazette JULY 2012 sensitive teeth. For left side mandibular teeth, the percentage of sensitive teeth decreased from baseline till 3rd week observation. But at 4th week observation, there was an increase in percentage of sensitive teeth (i.e, 1 week post SRP and 4 weeks after OHI). These observations were seen for both the stimuli used for pain scoring (Table 2). The mean VAS scores were recorded for each quadrant separately, by both the stimuli used for pain scoring, at baseline, 1st week, 2nd week, 3rd week and 4th week observation period. Upper arch: The mean VAS scores by scratch test and air blast stimuli at baseline were 1.23 and 2.3 for right side and for left side they were 1.29 and 2.4 respectively. After recording the baseline scores, the patients were given OHI and SRP was done for the right side maxillary teeth at the same appointment. Following one week of OHI and SRP, right side maxillary teeth showed an increase in the mean VAS scores for both the stimuli (i.e for scratch test and 3.47 for air blast stimuli). But the sensitivity gradually reduced in subsequent weeks (Table 3). For the left side maxillary teeth VAS scores reduced from baseline till the first week. But in the second week VAS scores increased (i.e. one week post SRP). In the 3rd and 4th week observations, VAS scores gradually reduced for both the stimuli. Lower Arch The mean VAS scores by scratch test and air blast stimulus at baseline were 1.07 and 2.79 respectively for right side and for left side they were 1.6 and 2.96 respectively. After recording the baseline scores the patients were given oral hygiene instructions only. SRP was done at the 2nd week observation following repeat measurements of VAS scores for right side and at the 3rd week observation for left side. At the 1st week observation (i.e. following 1 week of OHI) and 2nd week observation (i.e. following 2 weeks of OHI ), the mean VAS scores were reduced for both stimuli in both sides. But, at the 3rd week observation, the mean VAS scores increased following 1 week of SRP for both the stimuli in right side mandibular teeth (Table 3). Whereas, left side mandibular teeth showed reduced VAS scores in the 3rd week as well. At the 4th week observation VAS scores were reduced for the right side but increased for the left side mandibular teeth (Table 3). Discussion The results of the present clinical trial, demonstrated that the intensity of root dentine sensitivity (RDS) as well as the frequency of teeth that were sensitive to both the stimuli decreased when no root instrumentation had yet been performed and where meticulous plaque control was maintained. This observation is in contrast to the findings of few studies that plaque control results in an increase of RDS 7. However, similar results have been demonstrated by few authors 8. In the present study, dentine sensitivity increased

5 Indian Medical Gazette JULY following SRP. This applied to the intensity of RDS (as given by mean VAS scores), the number of patients reporting sensitivity as well as the frequency of sensitive teeth. These findings are in line with many prevalence studies observing RDS to be a particularly prevalent complication in patients previously exposed to either non-surgical or surgical periodontal therapy 1, 2, 3, 7, 8. The present study demonstrated that SRP was accompanied by an increased intensity, as well as incidence of RDS. This observation lends support to the clinical impression that SRP is often associated with RDS, at least temporarily. During the later phase of the follow-up period, there was a reduction in the intensity of RDS and percentage of sensitive teeth. These observations can be explained by the fact that after periodontal instrumentation, opened dentinal tubules may subject to hydrodynamic forces in response to externally applied stimuli. The gradual decrease in RDS in the later phase of follow-up period, may be related to a peripheral occlusion of the exposed dentinal tubules by the plaque control methods 1, 3, 7, 8. Conclusion Thus, the results of the present clinical trial demonstrate that scaling and root planing procedures result in an increase in intensity of RDS and percentage of sensitive teeth. This decreases with time when no instrumentation is performed and meticulous plaque control is maintained. The findings of the present study should be kept in mind by both the practitioner and the patient before and after non-surgical periodontal treatment. In clinical practice, it may be recommended that patients should be made aware of the potential for root sensitivity prior to treatment. References 1. Addy M. Clinical aspects of dentine hypersensitivity. Proc Finn Dent Soc. 88(Suppl 1): , Addy M. Etiology and implications of dentine hypersensitivity. Dent Clin No Amer. 34: , Berman L.H. Dentinal sensation and hypersensitivity. A review of mechanism and treatment alternatives. J Periodontol. 56: , Chopra P. Comprehensive review article Dentine hypersensitivity. JIDA. 60(5): 85-91, Dababneh R.H., Khouri A.T., Addy M. Dentine Hypersensitivity an enigma? A review of terminology, epidemiology, mechanisms, etiology and management. B Dent J. 187(11): , Dowell P., Addy M. Dentine Hypersenstivity- A Review. J Clin Periodontol , Jul Gillam D.G., Newman H.N. Assessment of pain in cervical dentine sensitivity studies- A review. J Clin Periodontol. 20: , Tammaro S., Wennstrom J.L., Bergenholtz G. Root dentine sensitivity following non-surgical treatment. J Clin Periodontol. 27: , Walters P.A. Dental Hypersenstivity- A Review. J Contemp Sent Pract. 6 (2): , May 2005.