**4. Clinical management of dentine hypersensitivity**

Once a definitive diagnosis has been determined, the clinician can then formulate a management strategy to treat the condition. The complexity of this treatment plan will depend on (1) on the extent and severity of the problem, (2) the willingness of the patient to comply with the recommendations provided by the clinician, and (3) the ability of the clinician to successfully diagnose the problem and provide the appropriate treatment including preventative strategies. Broadly speaking, the initial treatment will be either (1) professionally applied (in-office treatment) such as a fluoride varnish or more invasive strategy (composite, laser, periodontal surgery) for localized severe DH, or (2) patient applied/at home [over the counter treatment (OTC)] such as an OTC toothpaste for a mild-moderate discomfort (see **Table 2** for examples). The clinician should also be aware of the impact of DH on the QoL of the patient and it is important for the clinician to monitor whether the recommended treatment has improved the patient's QoL. For example, can the patient continue their daily routine of eating, drinking and oral hygiene practices without any interruption to their daily activities.

Several investigators have recommended treatment algorithms to help the clinician mange DH successfully [6, 8, 10]. An example of one of these algorithms is displayed in **Figure 3** based on the recommendations from a UK Guidelines workshop, London, UK [10]. An important aspect of these guidelines was the recognition that



**Table 2.**

*Overall management strategy options for treating DH (Acknowledgement Gillam et al. [10] modified).*

*Management and Prevention Strategies for Treating Dentine Hypersensitivity DOI: http://dx.doi.org/10.5772/intechopen.101495*

#### **Figure 3.**

*Selected responses from participants on what other dental conditions should be excluded when determining a differential diagnosis (Acknowledgement Exarchou et al. [18]).*

the management of DH should be based on the presenting features of the problem rather than simply providing a blanket treatment plan to cover all aspects of DH. For example, three categories were presented for the clinician to consider: (1) patients with gingival recession in a well-maintained mouth, (2) patients with a tooth wear problem, and (3) patients with a periodontal problem (**Table 2**) [10]. This concept was utilized and developed by Gillam and Koyi [21] covering six clinical case scenarios in dealing with oro-facial pain with specific clinical presentations.

The management of DH can therefore involve both simple and complex cases to treat and it is important that the clinician is aware of both their expectations of success and the patient's expectation of resolving their pain. There may be times when this aspiration can only be partially met to the satisfaction of both parties. The clinician should avoid simply handing out or recommending a treatment or technique without identifying the aetiological factors that initiated the problem in the first place. One of the concerns from the Canadian Advisory Board on Dentin Hypersensitivity [6] was whether clinicians had the confidence in the products that they recommended for treatment. This concern has also been highlighted by several investigators and it appears that this issue is still a matter of concern [7, 19].

Depending on the severity of the problem, the following products and techniques can be suggested (see **Table 2**). The question as to whether these products or techniques are effective in the treatment of DH has been the subject of several systematic reviews and meta-analysis [22–25].

### **5. Preventive strategies**

The importance of a preventive strategy for minimizing further episodes of DH cannot be overstated. It is not enough to simply provide a patient with a treatment such as a toothpaste or composite restoration without first eliminating or at least minimizing the aetiological or predisposing features that initiated the problem in the first place. This aspect will involve reviewing the clinical features implicated with the condition such as patients with a healthy mouth or patients with a periodontal or

restorative problems. For example, patients with a healthy, plaque-free mouth may be over-zealous, or an enthusiastic brusher with a healthy diet that may include acidic drinks will need advice on modifying their tooth brushing technique and minimizing the effects of dietary acids. The patient with a periodontal or restorative problem will require more extensive and prolonged treatment and perhaps one way of initially alleviating post-operative pain following this treatment would be to apply a desensitizing polishing paste or dental varnish [16].

Traditionally, clinicians expect their patients to change their health behavior, which is a philosophy based on a top-down approach (clinician directed) where the patient was provided information that was considered beneficial to them by the clinician. This philosophy, however, not only failed to empower the patient but was also ineffective in motivating the patient to initiate any behavior changes to improve their health and well-being. It is, therefore, important for the clinician to adopt management strategies and goals that will effectively encourage the patient to take individual responsibility to initiate these behavioral changes in the lifestyle of their patients. According to Gillam and Ramseier [26], the introduction of patient-centred approaches such as Motivational Interviewing is ideal for motivating patients in dental practice. It is acknowledged, however, that for many clinicians, this approach may be difficult to implement, due to time constraints, although the process could be continued over several visits as in the periodontal maintenance phase [27]. There are several factors to consider when developing a strategy using this approach, for example, (1) the extent and severity of the patient's problem, (2) acquiring the patient's permission to discuss any proposed changes, (3) the availability of the patient and their willingness to engage with the consultation process, (4) the rapport between the patient and clinician, (5) the willingness of the patient to reflect on the proposed changes and to weigh up the advantages/disadvantages and decide whether to accept or reject these proposals, (6) the patient's motivation to initiate these changes and subsequently adhere (comply) to the recommended changes to their behavior, and (7) the frequency of monitoring during the maintenance phase and subsequent reinforcement strategy in monitoring the patient's progress [26, 27].
