Clinical Oral Investigations

, Volume 17, Supplement 1, pp 53–54 | Cite as

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

  • Jens C. TürpEmail author
Open Access


Dentin hypersensitivity Diagnosis of DHS Dentinal pain 

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


(“Dentin Sensitivity”[Mesh]) and “therapy” [Subheading]


(“Dentin Sensitivity”[Mesh] and “diagnosis” [Subheading])


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?

  1. 1.
    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:
    1. (a)

      Do your teeth hurt when eating or drinking hot, cold, or acidic food or drinks?

    2. (b)

      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.).

  2. 2.
    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).

  3. 3.

    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.

  4. 4.

    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].

  5. 5.

    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].

  6. 6.

    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.



  1. 1.
    Al-Jundi MA, Szentpétery A, John MT (2007) An Arabic version of the Oral Health Impact Profile: translation and psychometric properties. Int Dent J 57:84–92PubMedCrossRefGoogle Scholar
  2. 2.
    Allison P, Locker D, Jokovic A et al (1999) A cross-cultural study of oral health values. J Dent Res 78:643–649PubMedCrossRefGoogle Scholar
  3. 3.
    Baran I, Nalcaci R (2011) Self-reported problems before and after prosthodontic treatments according to newly created Turkish version of Oral Health Impact Profile. Arch Gerontol Geriatr 53:e99–e105PubMedCrossRefGoogle Scholar
  4. 4.
    Barer GM, Gurevich KG, Smirniagina VV et al (2007) [Validation of Oral Health Impact Profile (OHIP) quality of life questionnaire in Russian patients with evidence of chronic generalized periodontitis]. Stomatologiia (Mosk) 86:27–30Google Scholar
  5. 5.
    Bekes K, John MT, Schaller HG et al (2009) Oral health-related quality of life in patients seeking care for dentin hypersensitivity. J Oral Rehabil 36:45–51PubMedCrossRefGoogle Scholar
  6. 6.
    Hicks CL, von Baeyer CL, Spafford PA et al (2001) The faces pain scale—revised: toward a common metric in pediatric pain measurement. Pain 93:173–183PubMedCrossRefGoogle Scholar
  7. 7.
    Ide R, Yamamoto R, Mizoue T (2006) The Japanese version of the Oral Health Impact Profile (OHIP)—validation among young and middle-aged adults. Community Dent Health 23:158–163PubMedGoogle Scholar
  8. 8.
    John MT, Patrick DL, Slade GD (2002) The German version of the Oral Health Impact Profile—translation and psychometric properties. Eur J Oral Sci 110:425–433PubMedCrossRefGoogle Scholar
  9. 9.
    Lopez R, Baelum V (2006) Spanish version of the Oral Health Impact Profile (OHIP-Sp). BMC Oral Health 6:11PubMedCrossRefGoogle Scholar
  10. 10.
    Melzack R (1975) The McGill Pain Questionnaire: major properties and scoring methods. Pain 1:277–299PubMedCrossRefGoogle Scholar
  11. 11.
    Melzack R (1987) The short-form McGill pain questionnaire. Pain 30:191–197PubMedCrossRefGoogle Scholar
  12. 12.
    Miglani S, Aggarwal V, Ahuja B (2010) Dentin hypersensitivity: recent trends in management. J Conserv Dent 13:218–224PubMedCrossRefGoogle Scholar
  13. 13.
    Petricevic N, Celebic A, Papic M et al (2009) The Croatian version of the Oral Health Impact Profile questionnaire. Coll Antropol 33:841–847PubMedGoogle Scholar
  14. 14.
    Pires CP, Ferraz MB, de Abreu MH (2006) Translation into Brazilian Portuguese, cultural adaptation and validation of the Oral Health Impact Profile (OHIP-49). Braz Oral Res 20:263–268PubMedCrossRefGoogle Scholar
  15. 15.
    Porto ICCM, Andrade AKM, Montes MAJR (2009) Diagnosis and treatment of dentinal hypersensitivity. J Oral Sci 51:323–332PubMedCrossRefGoogle Scholar
  16. 16.
    Rener-Sitar K, Celebic A, Petricevic N et al (2009) The Slovenian version of the Oral Health Impact Profile questionnaire (OHIP-SVN): translation and psychometric properties. Coll Antropol 33:1177–1183PubMedGoogle Scholar
  17. 17.
    Slade GD, Spencer AJ (1994) Development and evaluation of the Oral Health Impact Profile. Community Dent Health 11:3–11PubMedGoogle Scholar
  18. 18.
    Szentpétery A, Szabo G, Marada G et al (2006) The Hungarian version of the Oral Health Impact Profile. Eur J Oral Sci 114:197–203PubMedCrossRefGoogle Scholar
  19. 19.
    Türp JC, Hugger A, Löst C et al (2009) Vorschlag einer Klassifikation der Odontalgien. Schmerz 23:448–460PubMedCrossRefGoogle Scholar
  20. 20.
    van der Meulen MJ, John MT, Naeije M et al (2008) The Dutch version of the Oral Health Impact Profile (OHIP-NL): translation, reliability and construct validity. BMC Oral Health 8:11PubMedCrossRefGoogle Scholar
  21. 21.
    Wong MC, Lo EC, McMillan AS (2002) Validation of a Chinese version of the Oral Health Impact Profile (OHIP). Community Dent Oral Epidemiol 30:423–430PubMedCrossRefGoogle Scholar
  22. 22.
    Yamazaki M, Inukai M, Baba K et al (2007) Japanese version of the Oral Health Impact Profile (OHIP-J). J Oral Rehabil 34:159–168PubMedCrossRefGoogle Scholar

Copyright information

© 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.

Authors and Affiliations

  1. 1.Clinic for Reconstructive Dentistry and Temporomandibular Disorders, Dental School, University of BaselBaselSwitzerland

Personalised recommendations