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Pain origining from the teeth is a common problem in older animals. Not always it is due to infected roots or loose teeth. This excellent article from one of the most famous veterinary dentists gives an overview how to handle dentinal pain.
The hydrodynamic theory states that to remove hypersensitivity in dentin we must reduce dentinal permeability and fluid flow. The two major ways of accomplishing this concern are to reduce bacterial contamination at the exposure sites and seal the dentinal tubules.
The body attempts to `fix` the open dentin site by initiating a process of repair with tertiary or peritubular dentin formation. This forced mineralization of the open tubules decreases sensitivity. If the damage to the site is continuous or the repair cannot keep up with the trauma, the dentinal tubules remain open and the patient is uncomfortable.
The question to be pondered concerns dentinal hypersensitivity in animal patients. For years, I have queried many experts in veterinary dentistry about this problem and have gotten mixed responses. I have come to the realization that we do not really know how significant this type of pain is in animal patients. I have also reached a conclusion after speaking to human dentists and human restoration specialists that it should not be ignored.
Specifically, dentinal hypersensitivity in all vital teeth must be addressed. Whether placing restorations, completing crown coverage or treating enamel hypocalcification, in these patients, dentin desensitization must be accomplished.
Dr. Harald Heymann, DDS, MEd, professor and chair of Operative Dentistry of the School of Dentistry at the University of North Carolina has recently reported on a specific `one bottle desensitizer` and how it works.
He describes Gluma® desensitizer by Heraeus Kulzer. Gluma is 5% glutaraldehyde and 35% HEMA(hydroxyethyl methacrylate) and water. He describes the glutaraldehyde as being antibacterial and an effective disinfectant. It forms a `coagulation plug` by coagulating the plasma proteins within the dentinal fluids. The HEMA component is also considered to be an important factor in tubular occlusion.
The Gluma desensitizer can be used under restorations of vital teeth. He even describes using it under amalgam restorations. In composite restorations it does not interfere with the bonding of the adhesive systems to dentin. The desensitizer is an excellent `rewetting` agent after acid etching and drying, and, therefore, enhances bond strength. Prior to crown cementation in vital teeth Gluma desensitizer can be used.
Dr. Heymann describes a 30-second `scrubbing` prior to placement to assure saturation of the product through the smear layer.
Gluma desensitizer is only one of a number of agents used to reduce and eliminate dentinal hypersensitivity.
Source: Donald H. DeForge (2001): Take steps to control dentinal hypersensitivity in your patients. In: DVM Newsmagazine February 1, 2001
www.dvmnewsmagazine.com/dvm/
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