Dentinal Hypersensitivity

“Pain derived from exposed dentin in response to chemical, thermal tactile or osmotic stimuli which cannot be explained as arising from any other dental defect or disease.”104 Dentinal hypersensitivity is a common problem that may impact as many as 74% of adults at some point, and an even greater proportion of periodontitis patients.105,106 Exposed dentin can be the result of enamel loss (from physical or chemical sources), or from gingival recession that exposes the root.107 This exposure results in sharp, transitory pain commonly in response to thermal (e.g., cold air), chemical, and tactile triggers. The condition is uncomfortable and can cause sufferers to avoid thorough toothbrushing or professional dental care for fear of pain.

Desensitizing agents that can be delivered via the dentifrice vehicle are an excellent first-line strategy for anti-sensitivity treatment. The two most commonly used agents are stannous fluoride (a third therapeutic benefit of SnF2 beyond caries and gingivitis prevention) and potassium nitrate (KNO3). The former, SnF2, forms a smear layer that occludes dentinal tubes. Potassium nitrate acts by disrupting the nerve impulse transmission to the pulp.108 Two large meta-analyses of anti-sensitivity toothpastes with various agents have concluded that they provide significant benefits relative to a placebo, with the exception of strontium-based dentifrices.109,110

When choosing an anti-sensitivity toothpaste, in the US and Canada, clinicians and patients can select from stannous fluoride options found in stabilized SnF2 multi-benefit dentifrices. Examples include: Colgate Total, Crest Gum and Sensitivity, Parodontax, and Sensodyne Sensitivity and Gum. An advantage of the SnF2 paste choice for dentinal hypersensitivity is that SnF2 provides other concurrent benefits (e.g., anti-caries, anti-gingivitis, anti-erosion) in one product.

Per Figure 3, dentinal hypersensitivity sufferers also have the option of sodium fluoride-based toothpastes with 5% potassium nitrate; some marketed choices include: Sensodyne Fresh Mint; Colgate Sensitive, Crest 3D White Whitening Sensitivity Care, and Aquafresh Sensitive.