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Essentials for Managing Root Sensitivity

Posted: March 28, 2017

Root sensitivity near the gingival margin can make a person avoid effective plaque removing oral hygiene procedures. This results in increased plaque accumulation, a risk factor for carious lesion development as well as for gingival inflammation.

For teeth susceptible to gingival recession (see susceptibility factors on Gingival Recession Checklist), gingival inflammation is a major risk factor for continuing gingival recession. Therefore, reducing/eliminating clinically significant root sensitivity for these patients is a critical step in management and prevention of gingival recession.

 This issue of News2Use brings you a summary of essential tips for managing root sensitivity, a gingival recession risk factor covered in detail in the interactive seminar, Management and Prevention of Gingival Recession.

Essential Tips for Managing Clinically Significant Root Sensitivity Especially for Patients Susceptible to Gingival Recession

Preparation:

  1. Request your free copy of the article, “Management and Prevention of Gingival Recession”.
  2. Get your checklist cards and place one in each operatory.
  3. To help you focus your attention, briefly review the 14 Modifiable Conditions illustrated on Gingival Recession Checklist before patient exams and/or hygiene appointments.

Action Plan:

  1. Recommend low abrasive toothpastes. For example: Colgate Enamel Health, Colgate Sensitive, Colgate Sensitive Pro-Relief, Sensodyne Pronamel, Tom’s Simply White, Crest Cavity Protection, and Crest Sensi-namel.
  2. Recommend soft/low abrasive toothbrushes such as Colgate SlimSoft Ultra Compact Head and Oral B Sensi-Soft.
  3. Educate patients that small head tooth brushes are best for cervical plaque removal. We’ve found that tooth brush heads approximating these dimensions are best for most patients: bristle height 3/8”; bristle head width ~1/4”; bristle head length ≤ 7/8”; 3 or 4 bristle rows. Example: Colgate SlimSoft Ultra Compact Head.
  4. Train patients in the Modified Bass tooth brushing technique. Helpful suggestions:
    • Ask the patient to show you how she/he brushes and then, with positive feedback, modify techniques as needed
    • Encourage your patient to to brush while looking in a lighted magnified mirror. Multi-tasking, such as texting or watching TV while brushing, makes for less effective brushing
    • Advise and show the patient how to begin brushing on posterior palatal or lingual aspect; proceed to facial/buccal aspect but finish the brushing where recession/sensitivity is most advanced
  5. Advise patients to wet the tooth brush with warm-hot water before applying toothpaste to the brush.
  6. Train patients in safe and effective flossing technique. Helpful suggestions:
    • Ask the patient to show you how she/he flosses and then, with positive feedback, modify techniques as needed
    • Coach the “wrap-around” technique
    • Encourage your patient to floss while looking in a lighted magnified mirror. Multi-tasking, such as texting or watching TV while brushing, makes for less effective flossing
    • Especially for patients with delicate fragile tissue and short clinical crowns, avoid floss tapes
  7. If patient does home bleaching/whitening, advise her/him to discontinue it or to reduce frequency of use, especially if they ever notice tissue tingling or white patches. For those who must bleach/whiten, well-fitting trays, using less product, and less frequency are key factors.
  8. Educate patients on cervical erosion prevention measures. Excellent information is available online for patients regarding noncarious cervical lesions (NCCL’s) including mouthhealthy.org (American Dental Association) and the Australian Government Briefing Paper: “The potential of sugar-free beverages, sugar-free confectionery and sports drinks to cause dental erosion”.
  9. Advise patients to increase oral pH after meals, snacks.
    • Rinse with water (pH 7.0)
    • Stimulate saliva (pH 6.7-7.0) flow with sugar free chewing gum
    • Remove food particles from between teeth with tools such as wooden toothpicks; Stim-U-Dent Interdental Cleaners ; Sunstar GUM Soft-Picks
  10. Recommend low-abrasive fluoridated toothpaste with desensitizing agents such as Colgate Sensitive; Colgate Pro-Relief; Sensodyne; Crest Sensi-Relief.
  11. Prescribe low-abrasive high concentration fluoridated toothpastes such as Colgate PreviDent 5000; GC MI Paste Plus.
  12. Recommend fluoride varnish (e.g.: Colgate PreviDent, Duraphat) professional applications 2-4 times per year.
  13. Regarding professional prophylaxis: Decrease mechanical abrasion and protect against sensitivity:
    • Prophy cups (very soft and flexible).
    • Prophy polishing pastes: avoid conventional coarse/medium-coarse pastes. Use alternatives such as Colgate Sensitive Pre-Procedural Desensitizing Paste;  Proxyt (Ivoclar Vivadent); MI Paste (GC); MI Paste Plus (GC)
  14. For patients who choose to avoid fluoride, consider alternatives such as Colgate Sensitive Pre-Procedural Desensitizing Paste (8% Arginine-CaCO3); Colgate Perio-Guard chlorhexidine gluconate rinse; Non-alcohol based chlorhexidine gluconate rinse; MI Paste (GC);  Cervitec Plus chlorhexidine varnish (Ivoclar Vivadent).
  15. If you recommend xylitol gum, advise your pet owning patients to be careful: Xylitol, even in very small doses can be toxic or lethal to dogs (hyperinsulinemia, acute liver toxicity). If your dog eats a product containing xylitol, go to a veterinarian immediately.
  16. Selective occlusal adjustment: Especially for single tooth sensitivity, check occlusion for excessive contacts in maximum intercuspation position and in excursive movements. If needed, selectively and judiciously adjust occlusion but always implement above measures as well.
  17. Nightguard therapy: If all of the above has been implemented, root sensitivity persists and if grinding and/or clenching is suspected, a well-made custom nightguard can be very helpful (e.g.: laboratory processed hard acrylic maxillary full occlusal nightguard with minimum vertical dimension increase and custom adjusted occlusion).

We hope these tips help you improve your practice protocols for root sensitivity management and prevention. Implement the above tips before resorting to root coverage surgery, bonded restorations or other more involved measures. You and your patients will see incredible results.

See you at a future seminar! For more information and locations, visit http://merijohn.com/continuing-education/

 

George K. Merijohn, DDS

San Francisco periodontist George K. Merijohn practiced 28 years and is associate professor in postdoctoral periodontics at UC San Francisco and U Washington. He is appointed special expert to the California Dental Board; serves as a consultant to dental schools, clinicians, and the legal profession; and is on the editorial board of the Journal of Evidence-Based Dental Practice. Dr. Merijohn leads seminars and workshops at major dental conferences and is published in peer-reviewed journals with articles on mucogingival clinical decision-making, risk assessment, and the evidence-based approach. More about George >