Dentine hypersensitivity: new perspectives on an old problem

Dentine hypersensitivity is a prevalent, painful condition of the teeth. Despite the fact that the accuracy of the terminology is questionable and other terms have been proposed, 'dentine hypersensitivity' has been in long-term use and is, therefore, the preferred term. In dentine hypersensitivity, lesions exhibit patent tubules at the exposed dentine surface and appropriate stimuli trigger pulpal nerves via a hydrodynamic mechanoreceptor mechanism to produce a typically short, sharp, painful response. This accepted definition of the condition indicates the need to consider a differential diagnosis. This review will consider evidence that dentine hypersensitivity is a tooth-wear phenomenon characterised predominantly by erosion, which both exposes dentine and, more importantly, initiates the lesions. Abrasion caused by brushing teeth with toothpaste appears to be a secondary aggravating factor, which may even act in synergy with erosion. Gingival recession probably accounts for most dentine exposure at the gingival margin, but the process is poorly understood. Management strategies, which take into account aetiological and predisposing factors, rather than treatment alone, should be considered. There is little clinical research on many aspects of the aetiology and particularly on the management of the condition.