Therapeutic Strategies for Erosive Tooth Wear Related to Dentine Hypersensitivity.

Abstract

European and Chinese data suggest that dentine hypersensitivity (DH) is an ever increasing, significant oral pain condition, with adult population prevalence figures reaching 50%. Aetiology is multifactorial, with erosive tooth wear (ETW) becoming more important due to increased frequency of dietary acidic food and beverage challenges in younger adults. In older cohorts, DH prevalence increase is driven by population longevity, healthier lifestyles and higher vital tooth retention enduring a lifetime of tooth wear. DH negatively affects quality of life. For DH to occur, the lesion is localized on tooth crown and/or root surface, followed by initiation, exposing dentine tubules which are patent to the pulp, the key component to DH aetiology being ETW. Therapeutic strategies commence with risk assessment and instigation of preventive measures. Peer-reviewed, evidenced-based, efficacious dentifrice treatment regimens are now available, particularly over-the-counter home-use products, including arginine, stannous and potassium, with or without stannous, and resistant to acid challenge. Dentifrices should be regarded as the first-line treatment in conjunction with ETW preventive therapy. Professional treatment is the second-line approach, and although a plethora of agents have been advocated, there is weak evidence base for a preferred strategy. The ideal treatment should demonstrate immediate and long-lasting pain relief, with efficacious dentifrices showing variable degrees of pain relief commencing immediately to up to 2 weeks. The basic principles of treatment involve altering dentinal tubule fluid flow with dentine tubule occlusion or surface coverage and are designed to withstand ETW or chemically blocking pulpal nerve response.