Diagnosing Tooth Sensitivity

Diagnosing dentine hypersensitivity

“A short sharp pain arising from exposed dentine 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 dentine 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 dentine 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 dentine hypersensitivity²

Probing questions	What might indicate dentine hypersensitivity?
Can you describe the pain you experience?Is it dull, throbbing?	Pain described as:Short, sharp
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 dentine hypersensitivity.

Differential diagnosis of dentine hypersensitivity

There are a number of conditions with symptoms similar to dentine hypersensitivity. These conditions should be excluded before confirming a dentine 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

Useful diagnostic tests

Dentine 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.^4,5

Assessing the pain of dentine hypersensitivity

Tests to confirm dentine 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.⁴ The Schiff scale allows the clinician to rate the degree of pain the patient is experiencing in reaction to cold air.⁴ The visual analogue scale (VAS) allows the patient to mark the degree of pain on a gradient scale.⁴

Schiff scale

The Schiff cold air sensitivity scale⁴

The degrees of the Schiff cold air sensitivity scale are:⁴

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 analogue scale (VAS)⁴

The two ends of the visual analogue scale represent:⁴

0cm = minimum pain from external stimulus

10cm = maximum pain from external stimulus