ISP Algorithms for managing dentinal hypersensitivity

DH is a rising cause of concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of a huge number of our patients.

The Indian Society of Periodontology has defined four distinct case categories viz A to D has been defined based on the presence /absence of hard and soft tissue loss in an individual case scenario of DH. Category codes have been assigned to indicate the extent and severity of DH and to provide appropriate guidance for the management of DH on case-to-case basis.

The approach considers a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance.

Management of Type A (no hard tissue loss + no soft tissue loss)
Category code names	Chronology of management (reevaluation for CCC after each phase)
ALMi	AH (mouthwash over dentifrice or a combination) - IO (appropriate periodontal therapy) - AH (mouthwash over dentifrice or a combination)
ALMo	IO (occlusive therapy and/or appropriate periodontal therapy) - AH (mouthwash over dentifrice or a combination) - IO (occlusive therapy and/or appropriate periodontal therapy) – AH (mouthwash over dentifrice or a combination) (occlusive therapy and/or)
ALSe	IO^a (occlusive therapy and/or appropriate periodontal therapy) - AH (mouthwash over dentifrice or a combination)
AGMi	AH (mouthwash over dentifrice or a combination) - IO (appropriate periodontal therapy) - AH (mouthwash over dentifrice or a combination)
AGMo	AH (mouthwash over dentifrice or a combination) - IO (appropriate periodontal therapy) - AH (mouthwash over dentifrice or acombination)
AGSe	IO (occlusive therapy and/or appropriate periodontal therapy) - AH (mouthwash over dentifrice or a combination)
^aEndodontic therapy in rare cases. A comprehensive periodontal assessment should be done. Occlusive therapy – Physical/chemical/laser occlusion of dentinal tubules. Cases under category A having no periodontal pockets could be probably due to gap CEJ (30% of cases with gap junction). Chronology of this type – AH (mild). IO – In-office management; AH – At home management; Mi – Mild; Mo – Moderate; Se – Severe; CEJ – Cementoenamel junction; CCC – triple C, or 3C’s approach

Management of Type B (hard tissue loss + no soft tissue loss)
Category code names	Chronology of management (reevaluation for CCC after each phase)
BLMi	TWES: 0–1 - AH (DS-dentifrice) - Review TWES: 2–4 - IO (occlusive/appropriate periodontal therapy) - Review - AH (DS-dentifrice)
BLMo	TWES: 0–1 - IO (appropriate occlusive therapy) - Review - AH (DS-dentifrice) TWES: 2–4 - IO (appropriate restorative therapy) - AH (DS-dentifrice)
BLSe	TWES: 0–1 - IO (appropriate occlusive therapy) - AH (DS-dentifrice) TWES: 2–4 - IO^a (appropriate restorative therapy) - AH (DS-dentifrice)
BGMi	TWES: 0–1 – AH (DS-dentifrice) - Review TWES: 2–4 – IO (appropriate restorative therapy) - AH (DS-dentifrice) - Review
BGMo	TWES: 0–1 - AH^b (DS-dentifrice) - IO (appropriate occlusive therapy) TWES: 2–4 - IO (appropriate restorative therapy) - AH (DS-dentifrice)
BGSe	TWES: 0–1 - IO (appropriate occlusive therapy) - AH (DS-dentifrice) TWES: 2–4 - IO (appropriate restorative therapy) - AH (DS-dentifrice) - Review
^aEndodontic therapy in rare cases; ^bThe idea of considering the AH preferred to lO initially is with bearing in mind that the severity might downgrade. Also, the review may also result in the change of case to a localized moderate. Though these cases have predominantlv a had tissue loss vet a comprehensive periodontal assessment is recommended for presence of periodontal pocket, in which case the management should be as per category A. Occlusive Therapy - Physical/ chemical/laser occlusion of dentinal tubules. TWES (citation) (0 - No wear; 1 - Wear confined to enamel; 2 - Wear with exposed dentins1/3 of crown height; 3 - Wear>1/3 but<2/3 of crown height; 4 - Wear ≥2/3 of crown height). According to TWES classification only preventive measures and monitoring should be advocated when grade 0 or 1 exists on the surfaces that are involved in occlusion/articulation, and/or grade 0 or 1 on the nonocclusal/nonincisal surfaces. Similarly, restorative treatment is to be considered when grade 3 or 4 exists on the surfaces that are involved in occlusion/articulation, and/or grade 2 on the nonocclusal/ nonincisal surfaces are diagnosed as well. I - In-office management; AH - At home management; TWES - Tooth wear evaluation system; DS - Dentin sensitivity; Mi - Mild; Mo - Moderate; Se - Severe; CCC - triple C

Management of Type C (no hard tissue loss + no soft tissue loss)
Management of Type C (no hard tissue loss+soft tissue loss)
code	Chronology of management(reevaluation for CCC after each phase)
CLMi	AH (mouthwash over dentifrice or a combination) - Review - IO (appropriate periodontal therapy and/or occlusive therapy)
CLMo	IO (occlusive therapy) - AH (mouthwash over dentifrice or a combination) - Review - IO (appropriate periodontal therapy/occlusive therapy)
CLSe	IO (occlusive therapy)^a - AH (mouthwash over dentifrice or a combination) - Review - IO (appropriate periodontal therapy
CGMi	AH (mouthwash over dentifrice or a combination) - Review - IO (appropriate periodontal therapy and/or occlusive therapy)
CGMo	IO (occlusive therapy) – AH (mouthwash over dentifrice or a combination) - Review - IO (appropriate periodontal therapy)
CGSe	IO (occlusive therapy) - AH (mouthwash over dentifrice or a combination) - Review - IO (appropriate periodontal therapy)
^aEndodontic therapy in rare cases; Case selection is vital. A comprehensive periodontal assessment should be done. Occlusive therapy – Physical/chemical/ laser occlusion of dentinal tubules. IO – In-office management*; AH – At home management; TWES – Tooth wear evaluation system; DS – Dentin sensitivity; Mi – Mild; Mo – Moderate; Se – Severe; CCC – triple C, or 3C’s approach

Management of Type D (hard tissue loss + no soft tissue loss)
Management of Type D (hard tissue loss+soft tissue loss)
code	Chronology of management(reevaluation for CCC after each phase)
DLMi	TWES: 0–1 - AH (DS-dentifrice) - Review - IO (appropriate periodontal therapy and/or occlusive therapy) TWES: 2–4 - IO (restorative) - AH (DS-dentifrice) - Review - IO (appropriate periodontal therapy)
DLMo	TWES: 0–1 - IO (appropriate occlusive therapy) - AH (DS-dentifrice) - Review - IO (appropriate periodontal therapy) TWES: 2–4 - IO (appropriate restorative therapy) - AH (DS-dentifrice) - Review - IO (appropriate periodontal therapy)
DLSe	TWES: 0–1 - IO (occlusive therapy/appropriate periodontal therapy) - AH (DS-dentifrice) - Review TWES: 2–4 - IO (appropriate restorative therapy/appropriate periodontal therapy) - AH (DS-dentifrice)
DGMi	TWES: 0–1 - AH (DS-dentifrice) Review - IO (appropriate periodontal therapy and/or occlusive therapy) TWES: 2–4 - IO (restorative) - AH (DS-dentifrice) - Review - IO (appropriate periodontal therapy)
DGMo	TWES: 0–1 – IO (appropriate occlusive therapy) - AH - Review – IO (appropriate periodontal therapy) TWES: 2–4 - IO (appropriate restorative therapy) – AH - Review - IO (restorative therapy - appropriate periodontal therapy*) - Review
DGSe	TWES: 0–1 - IO (occlusive therapy/appropriate periodontal therapy) - AH - Review TWES: 2–4 - IO (appropriate restorative therapy/appropriate periodontal therapy*) - AH (DS-dentifrice)
^aEndodontic therapy in rare cases. A comprehensive periodontal assessment should be done. Occlusive therapy – Physical/chemical/laser occlusion of dentinal tubules. IO – In-office management; AH – At home management; Mi – Mild; Mo – Moderate; Se – Severe; CCC – triple C, or 3C’s approach

GGI-CO-A1-AQS-300032384-ELC-L24-0923
Reference:
Grover V, Kumar A, Jain A, et al. ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity. J Indian Soc Periodontol. 2022;26(4):307-333. doi:10.4103/jisp.jisp_233_22

Vantej Long Lasting Relief

Dental & Oral Health

Dentinal Hypersensitivity

Vantej Long Lasting Relief

Vantej, enriched with the Calcium Sodium Phosphosilicate (CSPS) molecule, is a highly effective occluding desensitizer. It provides relief from dentinal hypersensitivity caused by enamel damage due to attrition, abrasion, and erosion.

Know more

ISP Algorithms for managing dentinal hypersensitivity

Related Articles

Login to continue