Dentin Hassasiyetinin Tanısı ve Tedavisinde Güncel Yaklaşımlar
Özet
Dentin hassasiyeti (DH), dentin yüzeyinin çeşitli dış uyaranlara maruz kalmasıyla oluşan, kısa süreli ve keskin ağrılarla karakterize yaygın bir halk sağlığı problemidir. Toplumda prevalansı %4-74 arasında değişen bu durum, yaşla birlikte azalma eğilimi gösterir ve genellikle 20-40 yaş aralığındaki bireylerde, özellikle kadınlarda ve premolar ile kanin dişlerin bukkal servikal bölgelerinde daha sık gözlenir. Etiyolojisinde hatalı diş fırçalama, asidik diyet, diş eti çekilmesi ve mekanik travmalar gibi faktörlere bağlı olarak mine veya sement tabakasının kaybı yer alır. Mekanizması en yaygın şekilde, tübül içindeki sıvı hareketinin sinir liflerini uyarmasını temel alan hidrodinamik teori ile açıklanmaktadır. Teşhiste hava spreyi ve sond yardımıyla yapılan klinik muayene ile ayırıcı tanı önem taşırken, ağrı şiddeti VAS ve VRS gibi skalalarla değerlendirilir. Tedavi yaklaşımları, etiyolojik faktörlerin ortadan kaldırılmasıyla başlar ve evde hastalar tarafından kullanılan potasyum tuzları veya florür içerikli ajanlar ile klinikte hekimlerce uygulanan protein çökelticiler, lazerler (Er,Cr:YSGG, Nd:YAG vb.), adeziv sistemler veya yumuşak doku greftleri gibi tübülleri tıkamayı ya da sinir iletimini bloke etmeyi amaçlayan yöntemleri kapsar.
Dentine hypersensitivity (DH) is a common public health issue characterized by short-term, sharp pain resulting from the exposure of the dentin surface to various external stimuli. With a prevalence ranging from 4% to 74% in the population, this condition tends to decrease with age and is mostly observed in individuals aged 20-40, particularly in women and on the buccal cervical regions of premolar and canine teeth. Its etiology involves the loss of enamel or cementum due to factors such as improper toothbrushing habits, acidic diet, gingival recession, and mechanical traumas. The mechanism is most widely explained by the hydrodynamic theory, which is based on the movement of fluid within the tubules stimulating the nerve fibers. In diagnosis, clinical examination utilizing an air spray and a probe, along with differential diagnosis, is crucial, while pain severity is evaluated using scales like VAS and VRS. Treatment approaches begin with eliminating etiological factors and encompass home-use agents containing potassium salts or fluorides, as well as in-office professional applications including protein precipitants, lasers (such as Er,Cr:YSGG, Nd:YAG), adhesive systems, or soft tissue grafts aimed at occluding tubules or blocking neural transmission.
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