Dentine sensitivity
Management of dentine sensitivity following PMPR
Around 50% of patients may experience increased dentine sensitivity following professional mechanical plaque removal (PMPR), especially those with sensitive teeth prior to treatment.81
Key recommendation
For patients who experience post-PMPR dentine sensitivity, consider the use of a desensitising agent.
- At-home treatments (e.g. desensitising toothpaste) should be tried initially, with professionally-applied desensitising agents used for persistent sensitivity.
(Conditional recommendation; low certainty evidence)
There are a large number of over-the-counter products available to patients that claim to reduce dentine sensitivity, such as toothpastes containing arginine, stannous fluoride, calcium sodium phosphosilicate, strontium, potassium salts and hydroxyapatite, and there is some low to moderate quality evidence that these are effective in the treatment of general dentine sensitivity.82-85 However, the applicability of this evidence to patients with increased dentine sensitivity following PMPR is unclear.
Additionally, there are various treatments that can be provided by the dental team, such as dentine bonding agents, fluoride varnish, glass ionomer cements and the use of lasers. Again, the efficacy of these agents in treating dentine sensitivity induced by PMPR is unclear, although there is some evidence of a benefit for patients with general dentine sensitivity.83, 84, 86, 87 The evidence is considered to be of low to moderate certainty due to the limited number of relevant studies, small study size, risk of bias and the variation in both the agents tested and study design.
Further details on the development of the recommendations in this guidance can be found in Methodology.
Prior to carrying out periodontal therapy, explain to the patient that their teeth may become sensitive. They may also experience gingival recession following healing.
Check that the patient uses a low-abrasive, fluoride-containing toothpaste and toothbrush and has an atraumatic brushing technique.
- A pressure-controlled electric toothbrush may be useful if the patient’s current brushing technique is too abrasive.
During PMPR, use techniques that aim to avoid root surface damage and over-instrumentation.
Where a patient complains of sensitivity, assess whether this is a post-PMPR effect or is related to another cause (e.g. caries, pulpitis, dental abscess, dental erosion, other post-treatment pain).
Advise the patient that proprietary desensitising fluoride-containing toothpastes can be used to treat particular areas of sensitivity.
- A small amount of toothpaste should be applied to the affected area with a finger after toothbrushing.
- Alternatively, a desensitising mouthwash may be of benefit.
- Emphasise to the patient the importance of having plaque-free dentine for the desensitising agent to be effective.
- Patients may have to try different desensitising toothpaste or mouthwash formulations to find one that works for them.
Advise the patient to reduce their intake of acidic food and drinks.
Where a patient complains of acute sensitivity, consider other topical therapies in addition to desensitising toothpaste (e.g. apply fluoride varnish or a dentine bonding agent).