Skip to main content
SpringerLink
Log in

Dental Pain: Dentine Sensitivity, Hypersensitivity and Cracked Tooth Syndrome

  • Chapter
  • First Online:
Optimal Pain Management for the Dental Team

Part of the book series: BDJ Clinician’s Guides ((BDJCG))

  • 672 Accesses

Abstract

Dentine hypersensitivity is a frequently encountered patient complaint that can present with a number of associated factors including erosion and abrasion. The hydrodynamic mechanism responsible for dentine hypersensitivity is intimately related to the anatomical and physiological composition of teeth. Alterations to the integrity of the enamel and dentine through processes of trauma, decay and tooth wear can increase dentine permeability. This gives rise to symptoms of sensitivity as the dentinal fluid movement in response to thermal, chemical and mechanical cues stimulates the pulpal Aδ fibres. Restorative procedures can also rapidly change the architecture of the protective enamel and dentine layers leading to pulpal inflammation and increased thermal sensitivity of the tooth.

Patient-reported symptoms of dentine hypersensitivity can be attributed to a number of possible causes and a definitive diagnosis can therefore be difficult. A full history including social and medical factors such as occupation, diet and/or medication is likely to provide significant information to aid a diagnosis. Consideration of occlusal factors should not be overlooked as these may contribute to symptoms arising from a cracked tooth.

Management strategies are linked to the diagnosis—from topically applied desensitising pastes and resin bonding agents to direct restorations and possibly more advanced restorative procedures such as root canal treatment. Management should, however, be staged to enable more conservative strategies to prevail prior to considering irreversible dental interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 69.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 89.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 119.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. West NX, Sanz M, Lussi A, Bartlett D, Bouchard P, Bourgeois D. Prevalence of dentine hypersensitivity and study of associated factors: a European population-based cross-sectional study. J Dent. 2013;41:841–51.

    Article  PubMed  Google Scholar 

  2. Gysi A. An attempt to explain the sensitiveness of dentine. Br J Dent Sci. 1900;XLIII:865–8.

    Google Scholar 

  3. Brännström M. Sensitivity of dentine. Oral Surg Oral Med Oral Pathol. 1966;21:517–26.

    Article  PubMed  Google Scholar 

  4. Orchardson R, Cadden SW. An update on the physiology of the dentine-pulp complex. Dent Update. 2001;28:200–9.

    Article  PubMed  Google Scholar 

  5. Seong J, Davies M, Macdonald E, Claydon N, West N. Randomized clinical trial to determine if changes in dentine tubule occlusion visualized by SEM of replica impressions correlate with in vivo assessment of tubule occlusion. Am J Dent. 2018;31:189–94.

    PubMed  Google Scholar 

  6. Mitsiadis TA, Graf D. Cell fate determination during tooth development and regeneration. Birth Defect Res. 2009;7:199–211.

    Article  Google Scholar 

  7. Nanci A. Development of the tooth and its supporting tissues. In: Nanci A, editor. Ten Cate’s oral histology: development, structure, and function. 9th ed. Amsterdam: Elsevier; 2017.

    Google Scholar 

  8. Pashley DH. Dynamics of the pulpo-dentin complex. Crit Rev Oral Biol. 1996;7:104–33.

    Article  Google Scholar 

  9. Fristad I, Bergreen E. Structure and functions of the dentin-pulp complex. In: Hargreaves KM, editor. Cohen’s pathways of the pulp expert consult. 11th ed. Amsterdam: Elsevier; 2017.

    Google Scholar 

  10. Berggreen E, Bletsa A, Heyeras KJ. Circulation in normal and inflamed dental pulp. Endod Topics. 2010;17:2–11.

    Article  Google Scholar 

  11. Pashley DH. Dentin: a dynamic substrate - a review. Scan Microsc. 1989;3:161–76.

    Google Scholar 

  12. Vongasavan N, Matthews B. Fluid flow through cat dentine in vivo. Arch Oral Biol. 1992;37:175–85.

    Google Scholar 

  13. Seow WK. Developmental defects of enamel and dentine: challenges for basic science research and clinical management. Aust Dent J. 2014;59:143–54.

    Article  PubMed  Google Scholar 

  14. Chaoenlarp P, Wanachantararak S, Vongsavan N, Matthews B. Pain and the rate of dentinal fluid flow produced by hydrostatic pressure stimulation of exposed dentine in man. Arch Oral Biol. 2007;52:625–31.

    Article  Google Scholar 

  15. Yu CY, Abbott PV. Pulp microenvironment and mechanisms of pain arising from the dental pulp: from an endodontic perspective. Aust Endod J. 2018;44:82–98.

    Article  Google Scholar 

  16. Närhi M, Yamamoto H, Ngassapa D, Hirvonen T. The neurophysiological basis and the role of inflammatory reactions in dentine hypersensitivity. Arch Oral Biol. 1994;39(Suppl):23S–30S.

    Article  PubMed  Google Scholar 

  17. Ricucci D, Loghin S, Siqueira J Jr. Correlation between clinical and histologic pulp diagnoses. J Endod. 2014;40:1932–9.

    Article  PubMed  Google Scholar 

  18. Hashem D, Mannocci F, Patel S, Manoharan A, Brown JE, Watson TF, et al. A clinical and radiographic assessment of the efficacy of calcium silicate indirect pulp capping: a randomized controlled clinical trial. J Dent Res. 2017;94:562–8.

    Article  Google Scholar 

  19. Wolters WJ, Duncan HF, Tomson PL, Karim IE, McKenna G, Dorri M, et al. Minimally invasive endodontics: a new diagnostic system for assessing pulpitis and subsequent treatment needs. Int Endod J. 2017;50:825–9.

    Article  PubMed  Google Scholar 

  20. Duncan HF, Cooper PR, Smith AJ. Dissecting dentine - pulp injury and wound healing responses: consequences for regenerative endodontics. Int Endod J. 2019;52:261–6.

    Article  PubMed  Google Scholar 

  21. Närhi M, Virtanen A, Kuhta J, Huopaniemi T. Electrical stimulation of teeth with a pulp tester in the cat. Scand J Dent Res. 1979;87:52–8.

    Google Scholar 

  22. England MC, Pellis EG, Michanowicz AE. Histopathogic study of the effect of pulpal disease upon nerve fibres of the human dental pulp. Oral Surg Oral Med Oral Pathol Oral Radiol. 1974;38:783–90.

    Article  Google Scholar 

  23. Matthews B, Andrews D, Wanachantararak S. Biology of the dental pulp with special reference to its vasculature and innervation. In: Addy M, Embery G, Edgar WM, Orchardson R, editors. Tooth wear and sensitivity. London: Martin Dunitz; 2000.

    Google Scholar 

  24. Ciucchi B, Bouillaguet S, Holz J, Pashley DH. Dentinal fluid dynamics in human teeth, in vivo. J Endod. 1995;21:191–4.

    Article  PubMed  Google Scholar 

  25. Heyeras KJ, Bergreen E. Interstitial fluid pressure in normal and inflamed pulp. Crit Rev Oral Biol Med. 1999;10:328–36.

    Article  Google Scholar 

  26. Schellenberg U, Krey G, Boshardt D, Nair P. Numerical density of dentinal tubules at the pulpal wall of human permanent premolars and third molars. J Endod. 1992;18:104–9.

    Article  PubMed  Google Scholar 

  27. Gaberoglio R, Brännström M. Scanning electron microscopic investigation of human dentinal tubules. Arch Oral Biol. 1976;21:355–62.

    Article  Google Scholar 

  28. Williams C, Wu Y, Bowers DF. ImageJ analysis of dentin tubule distribution in human teeth. Tissue Cell. 2015;47:343–8.

    Article  PubMed  Google Scholar 

  29. Pashley DH, Michelich V, Kehl T. Dentin permeability: effects of smear layer removal. J Prosthet Dent. 1981;46:531–7.

    Article  PubMed  Google Scholar 

  30. Michelich V, Pashley DH, Whitford GM. Dentin permeability: a comparison of functional versus anatomical tubular radii. J Dent Res. 1978;57:1019–24.

    Article  PubMed  Google Scholar 

  31. Anderson DG, Chiego DJ, Glickman GN, McCauley LK. A clinical assessment of 10% carbamide peroxide gel on human pulp tissue. J Endod. 1999;25:247–50.

    Article  PubMed  Google Scholar 

  32. Soares DG, Basso FG, Scheffel DS, Hebling J, De Souza Costa C. Responses of human dental pulp cells after application of a low concentration bleaching gel to enamel. Arch Oral Biol. 2015;60:1428–36.

    Article  PubMed  Google Scholar 

  33. Caviedes-Bucheli J, Azuero-Holguin MM, Correa-Ortiz JA, Aguilar-Mora MV, Pedroza-Florez JD, Ulate E, et al. Effect of experimentally induced occlusal trauma on substance P expression in human dental pulp and periodontal ligament. J Endod. 2011;37:627–30.

    Article  PubMed  Google Scholar 

  34. Kalyva M, Padadimitriou S, Tziafas D. Transdentinal stimulation of tertiary dentine formation and intratubular mineralization by growth factors. Int Endod J. 2010;43:382–92.

    Article  PubMed  Google Scholar 

  35. O’Toole S, Bartlett D. The relationship between dentine hypersensitivity, dietary acid and erosive tooth wear. J Dent. 2017;67:84–7.

    Article  PubMed  Google Scholar 

  36. West NX, Seong J, Davies M. Management of dentine hypersensitivity: efficacy of professionally and self-administered agents. J Clin Periodontol. 2015;42(Suppl):S256–302.

    Article  PubMed  Google Scholar 

  37. Markowitz K, Bilotto G, Kim S. Decreasing intradental nerve activity in the cat with potassium and divalent cations. Arch Oral Biol. 1991;36:1–7.

    Article  PubMed  Google Scholar 

  38. Arnold WH, Prange M, Naumova EA. Effectiveness of various toothpastes on dentine tubule occlusion. J Dent. 2015;43:440–9.

    Article  PubMed  Google Scholar 

  39. Gibbs JW. Cuspal fracture odontolgia. Dent Digest. 1954;60:158–60.

    Google Scholar 

  40. Guertsen W. The cracked-tooth syndrome: clinical features and case reports. Int J Periodontol Rest Dent. 1992;12:395–405.

    Google Scholar 

  41. Fox K, Youngson C. Diagnosis and treatment of the cracked tooth. Prim Dent Care. 1997;4:109–13.

    PubMed  Google Scholar 

  42. Lynch CD, McConnell RJ. The cracked tooth syndrome. J Can Dent Assoc. 2002;68:470–5.

    PubMed  Google Scholar 

  43. Lubisich EB, Hilton TJ, Ferracane J. Cracked teeth: a review of the literature. J Esthet Restor Dent. 2010;22:1–13.

    Article  Google Scholar 

  44. Lloyd BA, McGinley MB, Brown WS. Thermal stress in teeth. J Dent Res. 1978;57:571–82.

    Article  PubMed  Google Scholar 

  45. Reeh ES, Messer HH, Douglas WH. Reduction in tooth stiffness as a result of endodontic and restorative procedures. J Endod. 1989;15:512–6.

    Article  PubMed  Google Scholar 

  46. Talim ST, Gohil KS. Management of coronal fractures of permanent posterior teeth. J Prosthet Dent. 1974;31:172–83.

    Article  PubMed  Google Scholar 

  47. Opdam NJ, Roeterrs JJ, Loomans BA, Bronkhorst EM. Seven-year clinical evaluation of painful cracked teeth restored with a direct composite resin restoration. J Endod. 2008;34:808–11.

    Article  PubMed  Google Scholar 

  48. Krell SKV, Rivera EM. A six-year evaluation of cracked teeth diagnosed with reversible pulpitis: treatment and prognosis. J Endod. 2007;33:1405–27.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Liverpool and The Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK

    Nicholas Neil Longridge & Callum Cormack Youngson

  2. Liverpool Health Partners, Liverpool, UK

    Nicholas Neil Longridge & Callum Cormack Youngson

Authors
  1. Nicholas Neil Longridge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Callum Cormack Youngson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Callum Cormack Youngson .

Editor information

Editors and Affiliations

  1. Department of Oral Surgery, King’s College London, London, UK

    Tara Renton

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Longridge, N.N., Youngson, C.C. (2022). Dental Pain: Dentine Sensitivity, Hypersensitivity and Cracked Tooth Syndrome. In: Renton, T. (eds) Optimal Pain Management for the Dental Team. BDJ Clinician’s Guides. Springer, Cham. https://doi.org/10.1007/978-3-030-86634-1_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-86634-1_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-86633-4

  • Online ISBN: 978-3-030-86634-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation