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Clark D, Levin L. Int Dent J 2016;66: 249–256

It is stated in this narrative review, that tooth sensitivity is experienced by up to one third of the population, it occurs mainly in females and affects canine and premolar teeth because of their position within the arches. But many of the studies reporting these findings are riddled with bias.

The authors state the obvious in that management should be focussed on addressing the aetiology. Invasive interventions, such as placing restorations, should only be carried out if less invasive approaches do not resolve the symptoms.

When the authors described the causes of tooth sensitivity, again little is new. But, they do refer to the Relative Dentin Abrasivity (RDA) score for measuring this property in toothpastes. Several websites give the RDA for a range of different toothpastes (for example see www.williamsonperio.com/wp-content/uploads/2014/07/Toothpaste-Abrasiveness-Ranked-by-RDA.pdf). Most of the regular toothpastes demonstrate low abrasion, whereas the whitening and some tartar control toothpastes are categorised as 'harmful'. When considering home oral care, a study has shown that teeth covered with plaque are less sensitive. However, this should be qualified in that gingival recession, induced by plaque, is associated with tooth sensitivity. Contrary to anecdote, scaling and root planing would not seem to exacerbate tooth sensitivity.

The following ingredients have been added to toothpastes which purportedly manage tooth sensitivity: potassium nitrate, strontium (acetate and chloride), arginine and calcium carbonate, calcium sodium phosphosilicate and high fluoride concentration toothpastes. When considering potassium nitrate [SENSODYNE® PRONAMEL® and Toms of Maine strength® SENSITIVE maximum (parent company Colgate-Palmolive)] it is suggested that this agent depolarises the nerves within the dentinal tubules. The efficacy of potassium nitrate, however, is disputed. Strontium (Sensodyne® 24/7 Protection* Original) facilitates the occlusion of dentinal tubules with strontium acetate but only to the depth of 5 μm. The combination of arginine and calcium carbonate (for example Colgate® Sensitive Pro-Relief™ from a stable of toothpastes containing these ingredients) also occlude the dentinal tubules by forming a positive complex with the negatively charged dentinal surface. It has been reported that toothpastes containing arginine and calcium carbonate are more effective than those containing strontium salts.

Despite the title of this paper, the authors describe the placement of cervical restorations and even root canal treatment in order to manage tooth sensitivity.