Krauser J T
J Prosthet Dent. 1986 Sep;56(3):307-11. doi: 10.1016/0022-3913(86)90009-0.
If the hydrodynamic theory for pain transmission were accepted, occlusion of the patent dentinal tubules would appear to be essential for treatment efficacy. There are many compounds with seemingly varied chemical forms that have been shown to be effective. Their exact mode of action however, is not clearly defined because well-designed, nonbiased, and controlled comparison studies between agents are lacking. The various toothpastes may have ingredients that actually occlude patent tubules or they may cause secondary desensitization by irrational or abrasive action. In any pain study, the nature of the placebo effect and other psychogenic factors play a significant role. Fluoride preparation with and without iontophoresis has been shown to alter tubule structure and form microprecipitates. The natural desensitization process, although slow, is nature's protection, allowing dentinal sclerosis of secondary dentin formation. Although the resin-adhesive systems, especially the new light-cured dentin bonding agents, appear immediately to be effective, the effect on the pulp remains unknown. Perhaps a combination of iontophoresis with sodium fluoride and light-cured dentin bonding material may yield protection and desensitization at a high level of predictability. With the population trends toward a more geriatric society, further research, knowledge, and understanding of dentinal hypersensitivity is of paramount importance. The expected increase in longevity of the dentition suggests that dentin exposure and sensitivity will increase as a clinical problem. There is a clear time-age relationship involved in gingival recession, erosion and attrition of the teeth, and the need for periodontal surgical therapy. For total comprehensive care, patient comfort is important and should be provided along with sound periodontal health and ideal restorative function.
如果疼痛传导的流体动力学理论被接受，那么封闭开放的牙本质小管对于治疗效果似乎至关重要。有许多化学形式看似各异的化合物已被证明是有效的。然而，由于缺乏精心设计、无偏差且受控的药物间对比研究，它们的确切作用方式尚不清楚。各种牙膏可能含有能实际封闭开放小管的成分，也可能通过不合理或研磨作用导致继发性脱敏。在任何疼痛研究中，安慰剂效应的本质和其他心理因素都起着重要作用。已表明有或无离子导入的氟化物制剂会改变小管结构并形成微沉淀物。自然脱敏过程虽然缓慢，但却是自然的保护机制，可使继发性牙本质形成牙本质硬化。尽管树脂黏结系统，尤其是新型光固化牙本质黏结剂似乎能立即产生效果，但其对牙髓的影响仍不明确。或许将氟化钠离子导入与光固化牙本质黏结材料相结合，可能会在高度可预测性的情况下实现保护和脱敏。随着人口向老龄化社会发展的趋势，对牙本质过敏进行进一步的研究、了解和认识至关重要。牙列预期寿命的增加表明，牙本质暴露和敏感作为一个临床问题将会增多。牙龈退缩、牙齿侵蚀和磨损以及牙周手术治疗的需求之间存在明显的时间 - 年龄关系。对于全面的综合护理而言，患者舒适度很重要，应在保证良好的牙周健康和理想的修复功能的同时予以提供。
