Case Study - Tooth Sensitivity Teenager |
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The other areas of her dentition were unaffected and appeared clinically normal. Her general health was good, however she suffered from moderately severe asthma requiring daily use of a number of maintenance medicine. She had a moderate intake of caffeine (140mg/day) from cola soft drinks.
Her daily water intake was low, and she avoided drinking any sizeable volumes of cold water, since this caused a stomach upset. Careful questioning revealed Emma had suffered for some years from gastro-oesophageal reflux, a condition frequently associated with asthma. She noticed that her reflux was less severe on days when she had no cola soft drinks.
Emma's saliva test revealed a low resting flow rate and acidic pH, but normal stimulated parameters. The low pH was explained partly by a negative fluid balance (from diuretic effects of the caffeine) and by the hyposalivatory effects of her medications. She was advised to eliminate cola soft drinks, since caffeine stimulates gastric acid production and could exacerbate gastric reflux.
Emma was also advised to drink warm water slowly, to minimise the stimulation of gastric acid secretion caused by stomach distension. She was referred to her medical practitioner who considered the value of using a H-2 receptor antagonist medication to suppress gastric acid production. Emma was advised to apply Tooth Mousse directly onto the eroded palatal surfaces and rapidly obtained relief from sensitivity. After 2 weeks, the eroded dentine was covered with a thin layer of sealant for further protection.
Case Study - Tooth Sensitivity Adult |
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This problem began six months ago but has become more severe over time. She has also noticed small cavitations appearing on some of the root surfaces. Coincidentally, Helen has noticed an increase in dryness in both her mouth and eyes. Her general health is good and she has no other health problems.
Clinical examination revealed that the exposed root surfaces of the maxillary anterior teeth are affected by erosion and are extremely sensitive to air and thermal stimuli. Toot surface caries lesions are present on the lower anterior teeth.
Saliva testing revealed an acidic salivary pH, both at rest and when stimulated. She also had depressed salivary buffer capacity. A lifestyle analysis revealed that Helen did not consume either caffeine or alcohol, and had a water intake of more than 2 litres per day. The combination of depressed salivary parameters and ocular dryness in a female patient of this age is suggestive of primary Sjogrens Syndrome. Serological testing and a labial salivary gland biopsy confirmed this presumptive clinical diagnosis.
In the light of her ongoing caries and erosion problems, Helen's home care program included GC Tooth Mousse Plus with Fluoride twice daily, a saliva substitute, and intermittent Dry Mouth Gel Therapy. After restoring her cavitated areas with dental sealant, Helen was then enrolled in a three-monthly maintenance program to ensure regular review of her status and to provide ongoing fluoride varnish applications to the at-risk tooth surfaces.
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