Dentin Hypersensitivity: Diagnosis

Diagnosing dentin hypersensitivity

“A short sharp pain arising from exposed dentin in response to stimuli, which cannot be ascribed to any other form of dental defect or pathology”¹

Patient history

The Canadian Advisory Board Guidelines recommend screening all patients for dentin hypersensitivity to diagnose and help patients manage the condition effectively.² Patient-reported history should be obtained (in addition to objective measures) to support a diagnosis.^2,3 Certain individuals may be more susceptible to dentin hypersensitivity than the general population, for example:^2,3

People who brush their teeth aggressively
People who have had periodontal treatment
Frequent consumers of high-acid food/beverages
People with bulimia

Questions to ask patients as part of a patient history that may indicate dentin hypersensitivity²

Probing questions	What might indicate dentin hypersensitivity?
Can you describe the pain you experience? Is it dull, throbbing?	Pain described as: Short, sharp, twinge
What causes this pain? Is it a particular food or drink that triggers it?	Pain triggers: Thermal, osmotic and/or tactile
Can you describe your brushing habits to me?	Excessive brushing, poor oral hygiene
Can you describe your diet to me?	Excessive dietary acids: Wine, citrus fruits, fruit juices, pickles, etc.
Do you suffer from acid reflux or experience excessive vomiting?	Look for signs of: Gastric reflux or excessive vomiting

Read the Canadian Advisory Board consensus-based recommendations for the diagnosis and management of dentin hypersensitivity

Differential diagnosis of dentin hypersensitivity

There are a number of conditions with symptoms similar to dentin hypersensitivity.

These conditions should be excluded before confirming a dentin hypersensitivity diagnosis.³

Aetiology	Pain type	Pain-evoking stimulus	Associated features
Cracked tooth syndrome	Sharp, intermittent, short duration, resolves on removal of stimulus	Biting	Trauma, parafunction
Pulpitis	Sharp or dull, difficult to determine precise location in the mouth, spontaneous (may not need stimulus), possibly throbbing, longer duration, likely to keep patient awake at night	Thermal (heat stimulus more likely) Osmotic Tactile	Caries, restorations
Periapical periodontitis	Dull, spontaneous (may not need stimulus), possibly throbbing, longer duration, likely to keep patient awake at night	Biting	Possible periapical redness, swelling, mobility

Though often a conversation with the dentist is all that’s needed, dentin hypersensitivity can be a challenge for patients to describe, making it harder for clinicians to accurately diagnose.³

By nature, it is a diagnosis of exclusion, meaning conditions that can mimic symptoms of dentin hypersensitivity must be ruled out via a differential diagnosis.³

Other conditions to rule out which may be mistaken for dentin hypersensitivity include:⁴

Fractured restorations
Dental caries
Chipped teeth
Post-restorative sensitivity
Marginal leakage
Pulpitis
Palatogingival groove

Diagnostic tests: icons and descriptions

Useful diagnostic tests

Dentin hypersensitivity diagnosis can be confirmed by using a dental explorer to check response to tactile stimulus or air blast to check response to cold stimulus.^5,6

Assessing the pain of dentin hypersensitivity

Tests to confirm dentin hypersensitivity are aimed at evoking pain with a defined stimulus. In clinical trials, the intensity of the pain or level of discomfort caused can be quantified by the clinician or the patient.⁵ The Schiff scale allows the clinician to rate the degree of pain the patient is experiencing in reaction to cold air.⁵ The visual analogue scale (VAS) allows the patient to mark the degree of pain on a gradient scale.⁵

Schiff scale

The Schiff cold air sensitivity scale⁵

The degrees of the Schiff cold air sensitivity scale are:⁵

0. Subject does not respond to air stimulus

1. Subject responds to air stimulus but does not request discontinuation of stimulus

2. Subject responds to air stimulus and requests discontinuation of or moves from stimulus

3. Subject responds to air stimulus, considers stimulus to be painful, and requests discontinuation of the stimulus
VAS – a universally used medical tool to track pain
Visual analog scale (VAS)⁵

The two ends of the visual analogue scale represent:

0cm = minimum pain from external stimulus

10cm = maximum pain from external stimulus