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      Discussion: how can we improve diagnosis of dentin hypersensitivity in the dental office?

      Clinical Oral Investigations

      Springer-Verlag

      Dentin hypersensitivity, Diagnosis of DHS, Dentinal pain

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          Abstract

          What is known? Dentin hypersensitivity (DHS) is characterized by a sharp, short-lasting “dentinal” pain originating from pulpal tissues in a healthy pulp as a consequence of an external stimulus, which can be thermal (hot; cold, including air), electrical, mechanical, osmotic (sweet; sour), or chemical [19]. Its occurrence and intensity among individuals lies within a clinical spectrum that ranges from occasional stimulus-reliant moderate pain to frequent stimulus-dependent intense pain. What are the problems? A search in reveals that the number of publications related to the diagnosis of DHS is limited (Table 1). This may be an indication that the issue of making a diagnosis is either an easy or a difficult task. In fact, the latter is the case. Table 1 The results of a PubMed search reveal that many more publications focus on the therapy of dentin (hyper)sensitivity than on diagnostic aspects. Search date December 10, 2012 Search strategy Hits (“Dentin Sensitivity”[Mesh]) and “therapy” [Subheading] 1,348 (“Dentin Sensitivity”[Mesh] and “diagnosis” [Subheading]) 381 Time is needed to make a correct diagnosis because (a) a thorough patient history is required and (b) DHS is a diagnosis of exclusion: it is confirmed only after possible other conditions have been diagnostically eliminated. Unfortunately, a validated screening checklist of DHS-related predisposing, initiating, and perpetuating risk factors identified in clinical or epidemiological studies is not yet available. Since individuals may be affected by DHS in varying degree, mild forms may not be reported by the patient to the dentist. Conversely, in other patients, DHS may substantially impair oral health-related quality of life (OHRQoL), for instance during drinking, eating, and oral hygiene [5]. Not every patient who suffers from DHS may know where to seek help to alleviate the pain. What are the recommendations for daily practice? In every (new) patient, irrespective of a patient complaint of DHS, a verbal screening is recommended, during which she/he is asked the following questions: Do your teeth hurt when eating or drinking hot, cold, or acidic food or drinks? Do your teeth hurt when you brush your teeth? If patients answer with “yes” on at least one of these questions, specific pain characteristics should be recorded (e.g., character, severity, site, onset, etc.). Clinicians may ask or look for: Personal behavior (e.g., consumption of highly acidic drinks or food; overzealous dental hygiene); Previous dental procedures (e.g., scaling and other periodontal therapy; tooth bleaching; restorative procedures); Clinical signs (e.g., dental erosion; gingival recession; exposed cervical dentin; periodontitis; caries; tooth fractures). In patients with suspected DHS (due to positive findings in step 1 and, possibly, step 2), a thorough differential diagnosis is indispensable. Hence, other forms of orofacial pain, including pulpitis, periodontal pain, cracked tooth syndrome, and atypical odontalgia, must be excluded, before the diagnosis of DHS is made. A specific DHS-related clinical examination is obligatory in cases with positive findings in steps 1 and, possibly, 2, and negative findings in step 3: It is suggested to move a blunt exploratory probe in the mesiodistal (or distomesial) direction on the exposed dentin [12, 15]. In addition, a jet of air should be directed towards the affected tooth region [12, 15]. These tactile and thermal stimuli should provoke the DHS-associated pain. Pain intensity should be measured by using an 11-point numerical rating scale, a 100-mm visual analog scale, or a validated graphic pain scale, such as the Faces Pain Scale [6]. Pain quality should be characterized by verbal descriptors (“pain adjectives”), either according to the patient’s spontaneous report or by the use of a validated questionnaire [10, 11]. Since DHS may affect OHRQoL, it is recommended to include this pain-related dimension during the patient assessment. A suitable instrument for this purpose is the Oral Health Impact Profile [17], which needs to be completed by the patient. In addition to the original version of this questionnaire, validated translations are available in other languages, including Arabic [1], Chinese [21], Croatian [13], Dutch [20], French [2], German [8], Hungarian [18], Japanese [7, 22], Portuguese [14], Russian [4], Slovenian [16], Spanish [9], and Turkish [3]. Finally, education of the public should be fostered to ensure that individuals affected by and suffering from DHS know that dental practitioners may be able to alleviate their symptoms.

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          Most cited references 23

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          The McGill Pain Questionnaire: major properties and scoring methods.

           R Melzack (1975)
          The McGill Pain Questionnaire consists primarily of 3 major classes of word descriptors--sensory, affective and evaluative--that are used by patients to specify subjective pain experience. It also contains an intensity scale and other items to determine the properties of pain experience. The questionnaire was designed to provide quantitative measures of clinical pain that can be treated statistically. This paper describes the procedures for administration of the questionnaire and the various measures that can be derived from it. The 3 major measures are: (1) the pain rating index, based on two types of numerical values that can be assigned to each word descriptor, (2) the number of words chosen; and (3) the present pain intensity based on a 1-5 intensity scale. Correlation coefficients among these measures, based on data obtained with 297 patients suffering several kinds of pain, are presented. In addition, an experimental study which utilized the questionnaire is analyzed in order to describe the nature of the information that is obtained. The data, taken together, indicate that the McGill Pain Questionnaire provides quantitative information that can be treated statistically, and is sufficiently sensitive to detect differences among different methods to relieve pain.
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            The short-form McGill Pain Questionnaire.

             R Melzack (1987)
            A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. The SF-MPQ also includes the Present Pain Intensity (PPI) index of the standard MPQ and a visual analogue scale (VAS). The SF-MPQ scores obtained from patients in post-surgical and obstetrical wards and physiotherapy and dental departments were compared to the scores obtained with the standard MPQ. The correlations were consistently high and significant. The SF-MPQ was also shown to be sufficiently sensitive to demonstrate differences due to treatment at statistical levels comparable to those obtained with the standard form. The SF-MPQ shows promise as a useful tool in situations in which the standard MPQ takes too long to administer, yet qualitative information is desired and the PPI and VAS are inadequate.
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              • Record: found
              • Abstract: found
              • Article: not found

              The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement.

              The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self-report measure used to assess the intensity of children's pain. Three studies were carried out to revise the original scale and validate the adapted version. In the first phase, the FPS was revised from its original seven faces to six, while maintaining its desirable psychometric properties, in order to make it compatible in scoring with other self-rating and observational scales which use a common metric (0-5 or 0-10). Using a computer-animated version of the FPS developed by Champion and colleagues (Sydney Animated Facial Expressions Scale), psychophysical methods were applied to identify four faces representing equal intervals between the scale values representing least pain and most pain. In the second phase, children used the new six-face Faces Pain Scale-Revised (FPS-R) to rate the intensity of pain from ear piercing. Its validity is supported by a strong positive correlation (r=0.93, N=76) with a visual analogue scale (VAS) measure in children aged 5-12 years. In the third phase, a clinical sample of pediatric inpatients aged 4-12 years used the FPS-R and a VAS or the colored analogue scale (CAS) to rate pain during hospitalization for surgical and non-surgical painful conditions. The validity of the FPS-R was further supported by strong positive correlations with the VAS (r=0.92, N=45) and the CAS (r=0.84, N=45) in this clinical sample. Most children in all age groups including the youngest were able to use the FPS-R in a manner that was consistent with the other measures. There were no significant differences between the means on the FPS-R and either of the analogue scales. The FPS-R is shown to be appropriate for use in assessment of the intensity of children's acute pain from age 4 or 5 onward. It has the advantage of being suitable for use with the most widely used metric for scoring (0-10), and conforms closely to a linear interval scale.
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                Author and article information

                Contributors
                jens.tuerp@unibas.ch
                Journal
                Clin Oral Investig
                Clin Oral Investig
                Clinical Oral Investigations
                Springer-Verlag (Berlin/Heidelberg )
                1432-6981
                1436-3771
                28 December 2012
                28 December 2012
                March 2013
                : 17
                : Suppl 1
                : 53-54
                Affiliations
                Clinic for Reconstructive Dentistry and Temporomandibular Disorders, Dental School, University of Basel, Basel, Switzerland
                Article
                913
                10.1007/s00784-012-0913-z
                3585981
                23269545
                © The Author(s) 2012

                Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

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                Review
                Custom metadata
                © Springer-Verlag Berlin Heidelberg 2013

                Dentistry

                dentinal pain, diagnosis of dhs, dentin hypersensitivity

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