Q U I N T E S S E N C E I N T E R N AT I O N A L
GENERAL DENTISTRY
Tooth hypersensitivity treatment trends
among dental professionals
Danielle Clark, BSc, RDH1/Liran Levin, DMD, FRCD(C)2
Objective: Tooth hypersensitivity is a common complaint of
patients who present to the dental office. The aim of this study
was to survey dental professionals in an effort to understand
the current treatment trends for tooth hypersensitivity.
Method and Materials: A questionnaire that addressed pos-
sible treatments for tooth hypersensitivity was developed and
validated. The survey included a case presentation in which the
responders were requested to list a first and second line of
treatment. The questionnaire was distributed to dental profes-
sionals and analyzed statistically. Results: A total of 106 ques-
tionnaires were collected. The most common first line
treatments for tooth hypersensitivity included sensitivity
toothpastes (38.7%) and desensitizers (40.6%). Referral for
patients with tooth hypersensitivity was indicated by 12.0% of
the responders. The most preferred products included sensitiv-
Key words: gingival graft, gingival health, plaque, prevention, root coverage
Tooth hypersensitivity, otherwise known as dentin
hypersensitivity (DH), can be caused by several factors
and is a common complaint among patients who pres-
ent to the dental office. DH normally occurs when there
is dentin exposure. This can be attributed to clinical
1
Clinical Instructor, Division of Periodontology, Faculty of Medicine and Dentistry,
University of Alberta, Canada.
2 Professor and Head, Division of Periodontology, Faculty of Medicine and Dentistry,
University of Alberta, Canada.
Correspondence: Professor Liran Levin, University of Alberta, School of
Dentistry, Faculty of Medicine and Dentistry, 5-468 Edmonton Clinic
Health Academy, 11405 – 87 Avenue NW, 5th Floor, Edmonton AB T6G
1C9, Canada. Email: liran@ualberta.ca
VOLUME 49 • NUMBER 2 • FEBRUARY 2018
Danielle Clark Liran Levin
ity toothpaste (34.9%) and fluoride varnish (19.8%). In regards
to the case presented in the survey, the most common first
treatment recommendations for patients were to use a sensi-
tivity toothpaste (37.7%), stop drinking cold water (13.2%),
and apply a desensitizing agent (23.6%). Of the 106 respond-
ers, 7.5% would opt to graft the recession area and 29.2%
would restore the area as the second line of treatment.
Conclusion: This study suggests that more invasive treat-
ment options such as grafting and restoring may be used too
early in the treatment plan for tooth hypersensitivity. Providing
continuing education programs that address simple and less
aggressive or invasive modes of treatment will benefit patients
and may also reduce the financial burden of the treatment.
(Quintessence Int 2018;49:147–151; doi: 10.3290/j.qi.a39510)
attachment loss caused by periodontal disease, bruxism,
abrasion, and acid exposure.1 The hydrodynamic theory
is the most widely accepted theory explaining DH.2 It
explains that the pain experienced from dentin expo-
sure is due to fluid movement within the dentinal
tubules.2 These tubules extend from the outside of the
tooth directly into the nerve of the tooth. Hot, cold, and
tactile stimuli cause fluid movement within these
tubules, ultimately stimulating the nerve, causing a
painful sensation.2
Dentinal tubules can be exposed due to gingival
recessions, periodontal treatment, whitening proced-
ures, etc. With the increasing popularity of bleaching
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Clark/Levin
Fig 1 Case study image of an area of recession with DH as
presented to the participants of the survey.
and tooth whitening, it is not surprising that the preva-
lence of DH ranges from 20.6% to 60% in recent
reports.3-6 As a result, DH is a prevalent and contempo-
rary complaint in dental offices. Sensitivity is triggered
by daily living activities, and therefore it is reasonable
for DH to be a chief complaint in dental patients. Tactile
stimuli such as brushing, consuming hot or cold drinks,
and even breathing cool air can stimulate DH. Several
studies have attempted to examine the relationship
between DH and Oral Health Related Quality of Life
(OHRQoL), and have shown that DH might have a seri-
ous influence on patients’ OHRQoL.7
Fortunately, several treatment options, from tooth-
pastes to restorations, exist for DH and it is important to
understand that these treatment options vary in their
level of invasiveness.8 A range of sensitivity toothpastes
is available. It is important to communicate to patients
that different toothpastes have different mechanisms
of action and may have different effectiveness based
on the individual.8 Other less-invasive treatment
options include in-office desensitizers such as fluoride
varnish. Within these categories of sensitivity tooth-
pastes and in-office desensitizers there is a variety of
available products.8 It may seem tempting, however,
for dental practitioners to jump to restorative or more
invasive options before exhausting the less-invasive
treatments.
148
The aim of the present study was to survey dental
professionals in an effort to understand the current treat-
ment trends being applied for tooth hypersensitivity.
METHOD AND MATERIALS
A ten-question survey was developed to collect infor-
mation about current treatments being used for DH.
The survey was validated with dental professionals
using the modified Delphi method. The survey
included demographic information as well as a case
study. The case study encompassed a short descrip-
tion of a patient with DH and a picture of an area of
recession (Fig 1). The responders were asked to sug-
gest the first- and second-line treatment options. The
survey was distributed between February 2016 and
April 2017 at continuing education seminars at the
University of Alberta to general dentists, specialists,
and dental hygienists. Data were input into Excel and
analyzed statistically using SPSS v24 (IBM). Ethical
approval was obtained from the University of Alberta
Ethics Board.
RESULTS
A total of 106 surveys were collected. Of the respond-
ers, 68.9% were female, 49.1% were dental hygienists
and 40.6% were general dentists. The remaining
respondents identified as specialists. Table 1 shows
their age ranges and experience. A total of 12% of the
responders indicated they would refer a patient to a
specialist for tooth hypersensitivity.
Popular first-line treatments for DH included sensitiv-
ity toothpastes (38.7%) and desensitizing agents (40.6%)
(Fig 2). Preferred products varied; however, the majority
of responders indicated they would recommend Senso-
dyne toothpaste (28.3%) while 6.6% would recommend
Colgate Pro-Relief (Fig 3). In response to the case study
presented in the questionnaire, 37.7% of responders
would recommend a sensitivity toothpaste to the patient
(Fig 4). Addressing brushing technique was indicated by
11.3% of responders. More invasive treatments such as a
restoration or gingival graft were recommended by 6.6%
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Table 1 Demographic information of the participants

Mean Median SD Range

Age (y) 40.1 35.5 13.5 21–70
Years in practice 15.2 13.5 10.0 0–47
Patients with DH seen per week 8.3 6.7 7.0 0–40

Sensodyne toothpaste Fluoride varnish

Other
Gluma Colgate Pro-Relief toothpaste

Assess/modify habits MI paste None

Other
Oraquix 5.7%

MI paste
28.3%
Desensitizer
26.4%

Sensitivity toothpaste
5.7% 19.8%
0% 10% 20% 30% 40% 50% 6.6%
7.5%
Distribution of study participants

Fig 2 Distribution of first-line treatments for DH as reported by Fig 3 Preferred products for DH treatment as reported by the
the study participants. study participants.

and 0.9% of dental professionals, respectively, as the
first line of treatment.
Popular second-line treatments included a restor-
ation (29.2%), desensitizer (22.6%), and sensitivity
toothpaste (10.4%). More invasive second-line treat-
ments were also recommended, such as gingival graft
(7.5%) and endodontic treatment (1.9%). There were no
significant correlations between the type of provider
(dental hygienist, general dentist, etc) and the recom-
mended treatment.
DISCUSSION
DH is undoubtedly a common complaint among
patients who present to the dental office. On average,
the dental professionals who participated in this study
saw 8.3 ± 7.0 patients per week with DH. It is therefore
important that dental professionals are aware of all the
existing treatment options for DH. Furthermore, it is crit-
ical that dental professionals understand and appreciate
the different levels of invasiveness each treatment offers.
The case study in the questionnaire asked dental
professionals to describe their first- and second-line
treatments for the area with DH. Invasive treatments
such as gingival grafts and restorations were reported
as first-line treatment options by some of the respond-
ers. There was also a relatively high number of invasive
treatment options suggested as the second step, such
as endodontic treatment, restoration, and laser treat-
ment. Not only do these treatments involve more risk
and morbidity for the patient, but they may also not be
the most appropriate.8
Gingival recession can be attributed to orthodon-
tics, aggressive tooth brushing, and bruxism. Patients
who have poor oral hygiene are also at a high risk for
the progression of periodontal disease and, as a result,
developing gingival recession.9 Therefore, it is import-
ant for dental professionals to obtain a detailed medi-

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First-line Tx Second-line Tx
40%
35%
30%
Distribution of study participants

25%
20%
15%
10%
5%
0%
Sensitivity toothpaste

Bonding

Restoration

Home fluoride trays

Stop drinking cold water

Night guard

Denstitizer

MI paste

Address brushing technique

Endodontic Tx

Drink through straw

Other
Gingival graft

Fig 4 Distribution of first- and second-

line treatments (Tx) for DH case study.

cal and dental history from the patient to first deter- office desensitizing agents. A popular desensitizing
mine the etiology of the DH. Only then can the patient agent, according to the present study, is the application
be directed toward the appropriate treatment options. of fluoride varnish. Fluoride varnish works by occluding
To illustrate, if a patient presents with generalized the dentinal tubules and may be even more effective
plaque at the gingival gum line, it is unnecessary and than low-level laser treatment.16 Other in-office desen-
might even be contraindicated to treat the area with a sitizers include Gluma products (Heraeus Kulzer), Sen-
gingival graft. As the patient has poor oral hygiene, the sodyne prophylaxis paste (GlaxoSmithKline), Bifluorid
gingival graft will likely become inflamed and will fail. (Voco), and D/Sense Crystal (Centrix).17 These in-office
Oral hygiene has a significant impact on the success of desensitizers have been reported to significantly
guided tissue regeneration10 and is one of the most reduce DH.17 Other in-office desensitizers that promote
important considerations for gingival graft success.11 tubule occlusion are NanoSeal (Brilliant Smile), MS Coat
Once the etiology of the DH has been established, ONE (Sun Medical), and Saforide (Morita).18 When sensi-
there are a variety of effective sensitivity toothpastes tivity toothpastes do not eliminate DH, there are several
available. Sensitivity toothpastes are unique, and differ- options for in-office desensitization that can be utilized
ent types use different ingredients to treat DH. Some as second-line treatment options.
sensitivity toothpastes contain arginine, an ingredient Several other noninvasive treatment options exist
that has been demonstrated to efficiently occlude den- for DH. However, according to the present study, almost
tinal tubules, thereby eliminating DH.12-14 Other tooth- 30% of dental professionals would opt for a restoration
pastes use potassium nitrate or increased concentra- as a second-line treatment. Due to the relatively high
tions of sodium fluoride.15 The variety of sensitivity incidence of DH, this may result in an unnecessarily high
toothpastes makes it important to encourage patients number of restorations being performed. Restorative
to try several different kinds before moving on to a treatment often involves removing tooth structure in
second-line treatment. order for the restorative material to adhere, and is there-
Once patients have exhausted their use of sensitiv- fore more invasive than a sensitivity toothpaste or in-of-
ity toothpastes, other treatment options involve in- fice desensitization. Gingival grafts are even more inva-

150 VOLUME 49 • NUMBER 2 • FEBRUARY 2018


sive and were recommended by 7.5% as a second-line
treatment. Furthermore, 12% of responders indicated
they would refer patients to a specialist. This often is for
root coverage procedures which, as any surgery, pres-
ent some risk to the patient.19,20 Gingival grafts and res-
torations are more invasive and costly procedures for
patients and it is therefore important to exhaust the use
of the noninvasive treatments that are available.
Limitations to this study involve sampling, as a con-
venience sample of individuals attending continuing
education seminars was used. Interpretation of the
results is also limited as a questionnaire is subject to bias
and responders may have interpreted questions differ-
ently, influencing their answers. Despite the limitations
to the study, the majority of the surveyed dental profes-
sionals recommended sensitivity toothpastes and desen-
sitizers as first-line treatments. However, a relatively high
number of these dental professionals would recommend
invasive procedures as either first- or second-line treat-
ments for DH. Therefore, it may be necessary to promote
continuing education programs on DH treatment.
CONCLUSION
Despite the availability of noninvasive treatments for
DH, dental professionals may opt for more invasive
treatments too early. The first step in DH should be
eliminating the etiology. The second step in DH treat-
ment should involve utilizing sensitivity toothpastes
and in-office desensitizers to the fullest extent before
restorations and gingival grafts are recommended. Con-
tinuing education programs may be useful in conveying
current treatment modalities for DH to practicing dental
professionals. Continuing education programs, as well
as better coverage in dental schools, may also increase
more conservative treatment by practitioners, ulti-
mately decreasing risk and financial burden for patients.
ACKNOWLEDGMENT
The study was supported by the Northern Alberta Clinical Trials and
Research Center Summer Student Award to Danielle Clark.
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