Most patients think they have to “just live with” dentinal hypersensitivity. That’s why most patients don’t even tell you if they have it. Now you can provide your patients with predictable, long-lasting protection from dentinal hypersensitivity, quickly and inexpensively.
About one out of every four adults under the age of 45 has some degree of dentinal hypersensitivity. If you’re like most dentists, you don’t bother asking your patients, and you don’t even treat hypersensitivity. This is because you’ve never found an easy treatment that works virtually every time.
Just think about all the situations that deal with sensitivity. There is the typical encounter with a new patient who can’t take cold foods or liquids, or who may even react painfully to cold air. There is the postoperative periodontal patient who has acute sensitivity after root planing or periodontal surgery. There is the patient who experiences postoperative dentinal sensitivity after a class V composite restoration, and of course, postoperative sensitivities after other direct or indirect bonded restorations. And the list goes on.
It has been shown that acid etchants remove the smear plugs from the dentinal tubules, and even enlarge the orifices of these tubules. After rinsing off the acid, bonding agent is applied. It has also been shown that a significant percentage of these “opened” dentinal tubules are not sealed when the bonding agent is applied, even after repeated applications. It makes sense that cleansing and sealing dentinal tubules responsible for dentinal hypersensitivity may eliminate the sensitivity.
TECHNIQUE
We have found that Touch&Bond (Parkell) self-etching bonding agent eliminates postoperative sensitivity under all direct and indirect bonded restorations.
Touch&Bond is a self-etching product. The 4-META molecule not only acts as the acid etchant, but is also the bonding agent molecule. Therefore, it is impossible to open a tubule without sealing it at the same time. The result is “no sensitivity.”
The technique for treating dentinal hypersensitivity begins with cleaning the exposed dentin/cementum surface as best you can. An antimicrobial rinse may also help prepare the dentinal surface. Often, if the surfaces are not visually unclean, we simply scrub the surface gently with a cotton pellet. The slightly abrasive cotton will cleanse the surface. The acidic nature of Touch&Bond will also aid in cleansing the dentinal surface.
Gently dry the area to be desensitized. Of course, air from a syringe is out of the question (a warm-air dryer may be used). These patients are very sensitive. Touch&Bond does not require an impeccably dry surface. Dab the area dry with cotton and/or gauze. Apply the soaked Touch&Bond applicator pellet to the exposed/sensitive surfaces. Take it easy at first—the “cold” from the soaked pledget will often cause a mild response from the patient. However, the Touch&Bond starts soaking in and plugging up the dentinal tubules right away, so the very slight initial sensitivity subsides very quickly. We agitate the soaked pledget against the sensitive surface for 1 minute. This is longer than the directions call for when Touch&Bond is used as a bonding agent on fresh-cut dentin. It is assumed that there will be more microscopic surface debris, therefore the pledgets are “rubbed” onto the surface in a scrubbing manner.
After application of the Touch&Bond, a gentle spray of air is applied to the areas. Since the dentinal tubules are now occluded with Touch&Bond, the patients have very little, or most often, no sensitivity to the air. The Touch&Bond is then light cured 5 to 10 seconds on each treated surface. If you use other than a halogen curing light, check with the manufacturer to confirm a wavelength compatible with Touch&Bond. After curing, a composite surface sealer is applied. We have used both Fortify (Bisco) and PermaSeal (Ultradent). After application of this very thin layer of composite, the areas are again light cured for 10 seconds.
Any “flash” or composite debris is left untouched. The patient is advised that they may feel these areas very slightly for a day or two, and that these areas may initially catch dental floss. We do not recommend “cleaning” these areas of flash because the act of removing debris may again expose sensitive tooth structure. Applying the coating of composite surface sealer may provide two benefits. Curing composite and bonding agents will leave an external oxygen-inhibited surface. This means that there is uncured composite on the surface. This is good, because it allows an excellent bond between layers of applied composite. However, the problem with the oxygen-inhibited surface is that it wears off very quickly. We assume that by applying an additional surface layer of composite surface sealant, the entire layer of the Touch &Bond will be allowed to fully cure, and the deeper portion of the composite surface sealer layer will also cure. Additionally, we feel adding the layer of composite surface sealer may extend the life of the desensitization procedure.
We have been utilizing this technique for 2 years (at the time of writing this article). We are not aware of any reappearance of sensitivity in any of the cases we have treated.
TREATING DIFFERENT TYPES OF SENSITIVITY
Treatment of Typical Dentinal Hypersensitivity
Areas of exposed root surface are isolated with cotton rolls, dri-angles, etc. The areas are cleansed and treated per the previously described protocol.
Treatment of Periodontal Postoperative Sensitivity
Because of the possibility of “creeping [epithelial] attachment” and minimal interproximal re-growth of gingival tissue after periodontal therapy, desensitization procedures are not accomplished until full healing. We do not want a composite layer on the surface of the root to prevent anticipated gingival re-adherence (epithelial “attachment”). Once full healing is established, the above treatment protocol may be accomplished. A cotton pliers may be used to insert the Touch&Bond-soaked pledget interproximally. If you prefer, you may place the Touch&Bond pledget into the mixing well with the Touch&Bond liquid, and then mix the pledget/liquid with a microbrush and apply to the teeth with the microbrush. “Scrubbing” of the root surface is advisable interproximally, as discussed previously. However, access to all exposed interproximal surfaces may be impossible. Nonetheless, the authors have not experienced difficulty desensitizing interproximally, probably due to the initial acidic nature of the Touch&Bond, which likely aids in cleansing the root surface.
Prevention of Postoperative Sensitivity of Class V Restorations
You’ve probably seen it. You place a beautiful class V composite, polish it, and proudly bring out the hand mirror to show the patient your handiwork. But to your surprise, the patient calls the next week complaining of acute sensitivity in the area of the restoration. What went wrong?
One common reason is the opening of dentinal tubules near the margin of the restoration as a result of polishing procedures. Many dentists, after polishing composite restorations, apply a composite surface sealant. Yes, these very low-tension products do seem to seal tiny aberrations in the surface of your finished composite. But will they actually seal the dentinal tubules as well as the self-etching bonding agent? Most likely not. Therefore, after the final polishing of the class V composite restoration (or any restoration that has the potential to expose dentin or cementum), we recommend the typical desensitizing protocol described above. You will be pleased to find that the unwanted complaint telephone calls from patients will disappear—a win-win situation!
Prevention of Typical Postoperative Composite Sensitivity After Placement of Direct and Indirect Bonded Restorations
It is our experience that complaints by dentists of a high percentage of postoperative discomfort are quite common after placement of direct and indirect bonded restorations. In communication with numerous dentists now using the self-etching Touch&Bond bonding agent prior to these restorations, there is an overwhelming report of elimination or near elimination of this postoperative problem. Dentists also report a greatly decreased incidence of postoperative discomfort after placement of crowns when they have applied Touch&Bond to the crown preparation prior to crown cementation with a resin/resin-reinforced glass ionomer cement. Touch&Bond film thickness is reported to be in the order of only 3 microns. Therefore, treatment of the crown preparation with Touch&Bond, followed by curing of Touch&Bond prior to crown cementation, will not adversely affect the seating of the crown.
BENEFITS FOR THE DENTIST
Effective desensitizing treatment is an absolute gold mine for dental office promotion.
When new patients come in, do you specifically ask them if they have any teeth that are sensitive to cold or sweets? Note that I didn’t say, “ask them if they have any sensitive teeth.” There’s a difference. Many patients have dentinal hypersensitivity, but many dentists do not offer treatment, or if they have, often it has not been successful. So these patients think hypersensitivity is “normal” for them. When you ask them if they have any sensitive teeth, they may think you are talking about something new that may be related to “a cavity.” So, ask your patients if they have any teeth that are sensitive to cold or sweets. You’ll really start hearing all about it. They’ll tell you that they can’t eat ice cream, they order their soft drinks with no ice, they can’t eat sweets, etc. They may even tell you that the touch of the toothbrush sends them through the roof. Also, don’t forget to ask them if any family members have teeth that are sensitive to cold, etc. Start asking even your existing patients. You’ll be amazed at what you find.
Do you want to know how to wow a new patient who has dentinal hypersensitivity? Try this: After the patient answers your question and tells you about her sensitivity, ask her to take a sip of ice water. She’ll look at you as if you’re a devil! She’ll take a very timid sip—and then comes the facial wince. Now perform the quick and easy desensitization of all her sensitive teeth. Sit the patient up and again ask her to take a sip of ice water. Again she’ll grimace at the thought. She’ll take a very small, very careful sip. A surprised look will come to her face, and she’ll look at you in a questioning manner. Next she’ll take a bigger sip, then a large gulp, and then the big grin—and sometimes a big hug!! Congratulations, you have just totally wowed a new patient who’ll now think you are a dental god. If you then hand her a few of your business cards and tell her, “If anyone you know has sensitive teeth, we can help them too,” what do you think her response is going to be? Any treatment you recommend will be agreed to and scheduled immediately. And just wait for the phone calls from her friends whom she’ll refer to you. Now, what is all that worth?
However, if you want to charge for this service, that is well within your right. The proper insurance reporting code is D9911—Application of desensitizing resin for cervical and/or root surface, per tooth. This code is not to be used when resin is applied under a restoration. This could also be billed as “palliative treatment.”
Given the incidence of dentinal hypersensitivity, many households have at least one family member with sensitive teeth. Do you think Mom knows about this sensitivity involving one of her children, her husband, or herself? You bet she knows. And is Mom concerned about the sensitivity of a family member? Of course she is. After all, she’s “Mom.” And guess who, in particular, we are marketing to when we market our services to the public? That’s right—Mom! Mom usually makes the decision regarding which dentist the family is going to see. So, adding a blurb about tooth sensitivity to your marketing can really boost your credibility, your emotional appeal, and your response rate.
CONCLUSION
The desensitization technique described is quick, easy, and effective. Incorporating it into your treatment regimen will provide significant benefits to patients as well as your practice.
Dr. Kurthy is the author of a new book, The No-Coupon Marketable Dentist, (available at newpatientsinc.com) and maintains a full-time practice in Mission Viejo, Calif. He has been involved in clinical research for 25 years. Dr. Kurthy is the recipient of numerous awards and honors, including the Mosby Publishers Scholarship award, Fairleigh Dickinson University Prosthodontic and Pediatric Dentistry Awards, the Omicron Kappa Upsilon Gold Key Award and membership, and a Commendation from the Chief Attorney of the United States Department of Defense for his role in supporting patients’ rights in disputes with insurance carriers. He has appeared numerous times in various media, including television, radio, and magazines. He was also the personal dentist of the 1994 United States World Cup Soccer Team. Dr. Kurthy may be contacted at (949) 588-1600 or drrodger@cox.net.
Dr. Weigand maintains a full-time practice in Spokane, Wash. He is a member of the American Academy of Cosmetic Dentistry, a fellow of the Academy of General Dentistry, and has achieved certification from both the Las Vegas Institute for Advanced Dental Studies and the Pacific Aesthetic Continuum. Dr. Weigand has been interviewed and has authored articles in various media regarding new trends in dentistry.
Most patients think they have to “just live with” dentinal hypersensitivity. That’s why most patients don’t even tell you if they have it. Now you can provide your patients with predictable, long-lasting protection from dentinal hypersensitivity, quickly and inexpensively.
