Treatments

Classifications of Desensitizing Agents based on:

1. Mode of administration

   At home treatment

   In-office treatment

2. Mechanism of action

   Nerve desensitization

   1. Potassium nitrate

   Protein precipitation

   1. Gluteraldehyde

   2. Silver nitrate

   3. Zinc chloride

   4. Strontium chloride hexahydrate

   Plugging dentinal tubules

   1. Sodium fluoride

   2. Stannous fluoride

   3. Strontium chloride

   4. Potassium oxalate

   5. Calcium phosphate

   6. Calcium carbonate

   7. Bio active glasses (SiO₂–P₂O₅–CaO–Na₂O)

   8. Cyanoacrylate adhesive

   Dentine adhesive sealers

   1. Fluoride varnishes

   2. Oxalic acid and resin

   3. Glass ionomer cements

   4. Composites

   5. Dentin bonding agents

   Lasers

   1. Neodymium:yttrium aluminum garnet (Nd-YAG) laser

   2. GaAlAs (galium-aluminium-arsenide laser)

   3. Erbium-YAG laser

   Homeopathic medication

   1. Propolis

Treating dentinal hypersensitivity can be challenging for the dental professional because of the difficulty related to measuring the pain response as the response can often vary from patient to patient. In addition, if the dentin exposure is due to personal habits, it may be difficult for patients to change their behavior.

In 1935, Grossman addressed the requirements for an ideal desensitizing agent as: rapidly acting with long-term effects, non-irritating to the pulp, painless and easy to apply without staining the tooth surface. These requirements still exist today when considering an ideal solution to dentinal hypersensitivity.¹⁹ There are two common approaches to treating dentinal hypersensitivity, nerve depolarization and tubule occlusion. Furthermore, treatment options can be classified as either invasive or non-invasive in nature. Examples of invasive procedures administered in-office include gingival surgery, application of resin adhesive materials such as dentin bonding agents, or a pulpectomy. Dentifrices and other products for home use are non-invasive. Finally, treatments can be categorized based on whether they can be applied by the patient (over-the-counter) or require professional application. For the purposes of this CE course, the focus is on those treatments that disturb the neural response to pain stimulus and those that block/occlude the dentinal tubules. The multitude of treatments available decrease the patient’s DH, but none are a gold-standard agent.