Addy Martin
Bristol Dental School, Lower Maudlin St, Bristol, BS1 2LY, UK.
Int Dent J. 2005;55(4 Suppl 1):261-7. doi: 10.1111/j.1875-595x.2005.tb00063.x.
Evidence suggests that patients suffer the painful symptoms of dentine hypersensitivity when dentine is exposed and the dentinal tubule system is opened to the oral cavity to allow stimuli to trigger a neural response in the pulp via a hydrodynamic mechanism. The processes needed to localise lesions of dentine hypersensitivity include loss of enamel and/or gingival recession. Whilst tooth brushing with or without toothpaste appears to cause minimal wear to enamel (in the absence of acids), circumstantial evidence implicates tooth brushing with gingival recession and exposure of dentine. Other tooth wear processes notably attrition and acid erosion cause loss of enamel and can expose dentine. Therefore sensitivity may result. How lesions of dentine hypersensitivity are initiated is a matter of conjecture and based on extrapolating data from studies, mainly in vitro, to affect in vivo. Again this circumstantial type of evidence suggests that abrasion by some toothpastes and erosion by dietary acid could open the tubule system. Little is known about the actual effect of desensitising toothpastes on lesions of dentine hypersensitivity even though they are formulated to either occlude dentinal tubules or block the neural response in the pulp. Clinical studies have produced contradictory findings for the efficacy of products and there have been extremely few evidence based reviews. In conclusion, available evidence supports a probable link of tooth brushing, with or without toothpaste and an acidic diet to both tooth wear and dentine hypersensitivity, and suggests also that dentine hypersensitivity is a tooth wear phenomenon. Although there is a need for more direct clinical and scientific evidence for these associations, it is recommended that they be taken into consideration when planning management strategies for the dentine hypersensitivity sufferer.
有证据表明，当牙本质暴露且牙本质小管系统向口腔开放，使刺激通过流体动力机制触发牙髓中的神经反应时，患者会出现牙本质过敏的疼痛症状。定位牙本质过敏病变所需的过程包括牙釉质丧失和/或牙龈退缩。虽然无论有无牙膏刷牙似乎对牙釉质造成的磨损最小（在没有酸的情况下），但间接证据表明刷牙与牙龈退缩和牙本质暴露有关。其他牙齿磨损过程，尤其是磨耗和酸蚀，会导致牙釉质丧失并暴露牙本质。因此可能会产生敏感症状。牙本质过敏病变是如何引发的只是一种推测，是基于从主要是体外研究的数据推断到体内情况。同样，这种间接证据表明某些牙膏的磨损和饮食酸的侵蚀可能会打开小管系统。尽管脱敏牙膏的配方旨在封闭牙本质小管或阻断牙髓中的神经反应，但对于其对牙本质过敏病变的实际效果知之甚少。临床研究对产品疗效得出了相互矛盾的结果，而且基于证据的综述极少。总之，现有证据支持无论有无牙膏刷牙以及酸性饮食与牙齿磨损和牙本质过敏之间可能存在的联系，并且还表明牙本质过敏是一种牙齿磨损现象。虽然需要更多关于这些关联的直接临床和科学证据，但建议在为牙本质过敏患者制定管理策略时考虑这些因素。
