歯の痛み：象牙質知覚過敏症、知覚過敏症、ひび割れ歯症候群

Dental Pain: Dentine Sensitivity, Hypersensitivity and Cracked Tooth Syndrome.

抄録

象牙質知覚過敏症は頻繁に遭遇する患者の訴えであり、びらんや摩耗を含む多くの関連因子を呈する可能性がある。象牙質知覚過敏症の原因となる流体力学的メカニズムは、歯の解剖学的および生理学的組成と密接に関連している。外傷、虫歯、歯の磨耗などのプロセスを通じてエナメル質と象牙質の完全性が変化すると、象牙質の透過性が増加する。これは、熱的、化学的、機械的な合図に反応した象牙質液の移動が歯髄Aδ線維を刺激するためで、知覚過敏の症状を引き起こす。<br/>患者が訴える象牙質知覚過敏の症状は、多くの原因が考えられるため、確定診断は困難である。職業、食事および/または投薬などの社会的および医学的要因を含む十分な病歴は、診断を助ける重要な情報を提供する可能性が高い。<br/>管理戦略は、局所的に塗布する減感作ペーストやレジンボンディング剤から、直接修復、場合によっては根管治療のようなより高度な修復処置まで、診断と関連している。しかし、不可逆的な歯科的介入を考慮する前に、より保存的な戦略を優先できるよう、管理は段階的に行うべきである。

Dentine hypersensitivity is a frequently encountered patient complaint that can present with a number of associated factors including erosion and abrasion. the hydrodynamic mechanism responsible for dentine hypersensitivity is intimately related to the anatomical and physiological composition of teeth. Alterations to the integrity of the enamel and dentine through processes of trauma, decay and toothwear can increase dentine permeability. This gives rise to symptoms of sensitivity as dentinal fluid movement in response to thermal, chemical and mechanical cues stimulate the pulpal Aδ fibres. Restorative procedures can also rapidly change the architecture of the protective enamel and dentine layers leading to pulpal inflammation and increased thermal sensitivity of the tooth.<br/> Patient-reported symptoms of dentine hypersensitivity can be attributed to a number of possible causes and a definitive diagnosis can therefore be difficult. A full history including social and medical factors such as occupation, diet and/or medication is likely to provide significant information to aid a diagnosis. Consideration of occlusal factors should not be overlooked as these may contribute to symptoms arising from a cracked tooth.<br/> Management strategies are linked to the diagnosis - from topically applied desensitising pastes and resin bonding agents to direct restorations and possibly more advanced restorative procedures such as root canal treatment. Management should, however, be staged to enable more conservative strategies to prevail prior to considering irreversible dental interventions.