A Multifaceted Analysis of Dentin Hypersensitivity: A Comprehensive Clinical Review of Causes, Diagnosis, and Management Strategies

Chapter 1: The Fundamental Scientific Principles of Tooth Sensitivity

Tooth sensitivity, or dentin hypersensitivity, is more than just a simple discomfort; it is a significant symptom that reflects the complex physiological mechanisms of oral health. To accurately understand this symptom, a deep exploration of the micro-anatomical structure of the tooth and its pain transmission mechanisms must precede. This chapter aims to identify the core biological principles involved in the occurrence of dentin hypersensitivity and to present scientific theories on how various external stimuli are converted into sharp pain.

1.1. The Micro-Anatomy of the Symptom: Understanding the Dentin-Pulp Complex

The sensation in a tooth is determined by the sophisticated interaction of specific tissues. Tooth sensitivity occurs when the protective layer of the tooth is damaged, exposing the sensitive inner tissues to the external environment, which signifies a failure of the biological defense system. The key structures involved in this process are as follows:

• Enamel: The outermost layer covering the tooth, it is the hardest tissue in the human body. Composed of minerals, it has no nerves and thus feels no sensation.1 The primary function of enamel is to protect the delicate inner tissues from physical and chemical stimuli. The onset of tooth sensitivity usually begins when this enamel is damaged by abrasion, erosion, or fracture.3
• Dentin: Located directly beneath the enamel, this yellowish tissue constitutes the majority of the tooth's volume.1 It is softer and more elastic than enamel, and its structural characteristics are key to hypersensitivity. Within the dentin, there are millions of microscopic tubules, or dentinal tubules, that radiate from the pulp (the center of the tooth) to the enamel junction.2
• Dentinal Tubules: These are microscopic channels that make up the dentin, filled with a tissue fluid (dentinal fluid) and containing some nerve endings extending from the pulp.1 In a normal state, they are perfectly protected by enamel or the gums, but when these tubules are exposed to the outside, they act as a superhighway for external stimuli to reach the pulp nerves.3
• Pulp: The soft tissue located in the very center of the tooth, it is rich in nerves and blood vessels that supply nutrients and are responsible for sensation.1 All pain signals ultimately originate from this pulp and are transmitted to the brain.

In conclusion, the prerequisite for dentin hypersensitivity is the loss of the tooth's protective layers (enamel, cementum, gums) for any reason, leading to the direct exposure of the underlying dentin and dentinal tubules to the oral environment. This should be understood not just as a phenomenon of 'sensitive teeth' but as a structural problem of a 'breached tooth protective barrier,' which naturally leads to an inquiry into the causes of that breach.

1.2. The Hydrodynamic Theory: How External Stimuli Convert to Pain

How different types of stimuli, such as cold water, sweet foods, and brushing, can all trigger the same sharp, short pain is most convincingly explained by the 'Hydrodynamic Theory.' This theory is the standard academic model for explaining the pain mechanism of dentin hypersensitivity, and the process is as follows:

1. Stimulus Application: External stimuli such as cold air or water, sweet foods that cause osmotic pressure, or physical contact touch the exposed openings of the dentinal tubules.1
2. Fluid Movement: This stimulus causes a rapid movement of the tissue fluid within the dentinal tubules. For example, a cold stimulus causes the fluid to contract and move rapidly outward, while dry air evaporates moisture, causing movement in the same direction.1
3. Nerve Stimulation: The rapid flow of the tissue fluid mechanically stimulates or creates pressure changes on the nerve endings near the pulp. The nerves perceive this mechanical change as a pain signal.1
4. Pain Perception: This signal is transmitted to the central nervous system and interpreted by the brain as a short, sharp pain—the 'sensitive' feeling.

The Hydrodynamic Theory provides a unified explanation for why different types of stimuli cause the same pain response. The pulp nerves do not react directly to 'coldness' or 'sweetness' itself, but rather to the 'physical movement of the tissue fluid' induced by these stimuli. This theory is the foundation for the development of treatments for dentin hypersensitivity, which ultimately boil down to two approaches: 'blocking the dentinal tubules to prevent fluid movement' or 'desensitizing the nerve itself to inhibit signal transmission.'

Chapter 2: Analysis of the Multifactorial Causes of Dentin Hypersensitivity

Dentin hypersensitivity rarely arises from a single cause. Instead, it is the result of a complex interplay of physiological changes due to aging, genetic predispositions, and long-term lifestyle habits. This chapter systematically analyzes the various causes that lead to dentin exposure, providing an in-depth understanding of how tooth sensitivity begins and progresses.

2.1. Aging and Teeth: Inevitable Changes and Their Impact

As we age, the tissues in our oral cavity, like other parts of the body, undergo gradual changes. While these changes are not diseases in themselves, they create an environment conducive to the development of dentin hypersensitivity.

• Gingival Recession: This is one of the most representative changes that occur with increasing age. The gums gradually recede towards the root, exposing the part of the tooth root that was originally protected by the gum and alveolar bone.10 The tooth root is covered not by hard enamel, but by a relatively softer and thinner layer of cementum, which is easily worn away, exposing the underlying dentin.12
• Enamel Wear: Decades of chewing gradually wear down the enamel on the chewing and cutting surfaces of the teeth.6 This thinning of the enamel allows external stimuli to be more easily transmitted to the dentin.12
• Decreased Saliva Production (Xerostomia): Saliva production can decrease due to aging or as a side effect of medications commonly taken by the elderly, such as antihypertensives and antidepressants.12 Saliva plays a crucial role in washing away food debris and neutralizing acids. A decrease in saliva production makes it easier for an acidic environment to form in the mouth, accelerating tooth erosion and wear.14

While these age-related changes do not cause tooth sensitivity in all elderly individuals, they significantly reduce the teeth's defense against other risk factors.11

2.2. The Genetic Blueprint: The Role of Heredity in Tooth Susceptibility

While dentin hypersensitivity itself is not a hereditary disease, the 'susceptibility' to the underlying causes of tooth sensitivity can be influenced by genetics. This should be understood not as deterministic inheritance, but as a 'predisposition' that determines an individual's vulnerability to environmental factors.

• Genes Related to Oral Diseases: Recent studies have identified 47 new genes associated with cavities and gum disease. These genes are known to affect the formation and strength of enamel, the protective function of saliva, and the composition of the oral microbiome.16 For example, certain genes like 'Axin2' are known to play an essential role in the normal development and hardness of teeth.17
• Congenital Structure and Form: The anatomical characteristics of teeth inherited from parents also play a role. Individuals born with congenitally thin or structurally weak enamel may experience enamel wear or erosion at a much faster rate than normal.18 Additionally, inheriting a molar shape with particularly deep and narrow fissures can make it easy for food to get trapped and difficult to remove, increasing the likelihood of cavities, which can eventually lead to dentin exposure.18
• Susceptibility to Gum Disease: The genetic predisposition to gum disease (periodontitis) is reported to be as high as 50%. This is a genetic risk factor that acts independently of environmental factors such as smoking or oral hygiene habits.19
• Interaction of Genetics and Environment: Experts emphasize that even with a genetic predisposition, its effects can be minimized or overcome through meticulous oral hygiene and healthy lifestyle habits.20 In other words, a person with a high genetic risk profile has less room for error in oral care. This suggests that genetic factors should be seen not as a destiny to be accepted, but as a motivation for more proactive preventive care.

2.3. Lifestyle and Behavioral Factors

Careless daily habits are the most direct and powerful factors that lead to the structural breakdown of teeth and cause dentin hypersensitivity.

2.3.1. Chemical Attack: A Detailed Analysis of the Acid Erosion Process

Acid erosion is the chemical dissolution of the hard tissues of the teeth by acidic substances, without the involvement of bacteria.

• Mechanism of Action: When the oral environment drops below a critical pH of 5.5, the hydroxyapatite crystals, the main component of enamel, begin to dissolve. This process is called demineralization.22
• Main Causes: Highly acidic beverages and foods such as carbonated drinks (pH 2-4), fruit juices, wine, and sports drinks are the primary culprits.3 Additionally, severe tooth erosion can occur when stomach acid flows back into the oral cavity due to gastroesophageal reflux disease (GERD).3
• Damage Process: Enamel exposed to acid temporarily softens. Brushing immediately in this state causes the softened enamel to be rapidly worn away by the abrasives in toothpaste and the physical force of the toothbrush.24 This demonstrates a 'Two-Hit' phenomenon where chemical damage (acid erosion) and physical damage (abrasion) combine to exponentially accelerate tooth damage. Therefore, it is recommended to rinse the mouth with water immediately after consuming acidic beverages and to wait at least 30 minutes before brushing.

2.3.2. Physical Forces: Improper Brushing, Occlusal Stress, and Bruxism

Excessive physical force can directly wear down or destroy teeth, exposing the dentin.

• Improper Brushing: One of the most common causes of tooth sensitivity is 'cervical abrasion.' This is caused by the habit of scrubbing the toothbrush back and forth with strong force, known as the 'horizontal scrubbing method.'5 The cervical area, the junction between the tooth and the gum, is an anatomically vulnerable point where the enamel is thinnest.1 Repetitive horizontal friction causes it to be notched in a V-shape, easily exposing the dentin.29 This phenomenon is exacerbated when using highly abrasive toothpaste.3
• Bruxism (Teeth Grinding) and Clenching: The habit of grinding or clenching teeth during sleep or unconsciously exerts a powerful force on the teeth, ranging from 2 to 10 times the normal chewing force.31 This excessive force causes attrition, the wearing down of the chewing surfaces of the teeth, and abfraction, where the enamel in the cervical area, where stress is concentrated, minutely fractures as the tooth flexes.5 Both attrition and abfraction are major causes of dentin exposure.27

The cervical area is a 'perfect storm' point where various damaging mechanisms converge, including age-related gum recession, abrasion from improper brushing, and abfraction from excessive occlusal forces. This is why cervical abrasion is often cited as the most representative diagnosis for dentin hypersensitivity.

2.4. The Mind-Oral Connection: How Stress Worsens Dental Condition

There is a clear physiological link between mental stress and oral health, with bruxism at its core.

• The Relationship Between Stress and Bruxism: Anxiety and stress are identified as the most significant factors that cause or worsen bruxism.31 In stressful situations, the central nervous system becomes overactive, leading to non-functional, unconscious contractions of the chewing muscles.35
• The Vicious Cycle: This process forms a clear causal relationship. A mental state (stress) triggers neuromuscular activity (bruxism), which in turn leads to physical tooth damage (wear, fracture), causing a physiological symptom (sensitivity). The resulting pain and discomfort can then add to the stress, creating a vicious cycle that intensifies the bruxism.33 Therefore, if unexplained tooth sensitivity persists, an evaluation for stress management and bruxism is essential.

Chapter 3: Interpreting the Signal: Tooth Sensitivity as a Diagnostic Warning

Tooth sensitivity should be interpreted not merely as an unpleasant sensation, but as an important warning sign of potential problems progressing within the oral cavity. In many cases, sensitivity can be the earliest noticeable symptom of a more serious dental condition. This chapter will analyze which underlying diseases sensitivity may indicate and discuss in depth the complex causal relationship with gum disease and the priority of treatment.

3.1. When Sensitivity Signals a Deeper Problem: Cavities, Cracks, and Periodontitis

Persistent or worsening tooth sensitivity often suggests the presence of an active disease that requires immediate professional intervention, going beyond non-pathological wear or recession.

• Dental Caries (Cavities): In the early stages of a cavity, only the enamel is damaged, and there are no particular symptoms. However, when the decay penetrates the enamel and reaches the dentin, sensitivity to cold or sweet foods is often the first symptom to appear.8 In particular, if sensitivity suddenly starts in a specific tooth, one should suspect an invisible interproximal cavity or a secondary cavity under an existing restoration and seek a dental examination immediately.8
• Cracked Tooth Syndrome: When a tooth has a microscopic crack, there may be no symptoms normally, but chewing or temperature changes can cause the crack to open, leading to sharp pain and sensitivity according to the hydrodynamic theory.6
• Restoration Failure: Over time, old amalgam, resin, or crown restorations can develop microscopic gaps at the margins, or the adhesive can dissolve. Bacteria and external stimuli can penetrate these gaps, irritating the underlying dentin and causing sensitivity.9
• Periodontal Disease (Gum Disease): Gum disease is the most common pathological cause of gum recession. Chronic inflammation due to bacterial plaque and tartar destroys the gums and alveolar bone, exposing the tooth roots, which leads to widespread sensitivity.29

Thus, tooth sensitivity has a dual nature as both a 'symptom' and a 'condition.' In cases of non-pathological causes like cervical abrasion, 'dentin hypersensitivity' itself can be the diagnosis. However, in the majority of cases, it appears as a 'symptom' of an active disease like cavities or periodontitis. Therefore, before attempting self-treatment with desensitizing toothpaste, it is crucial to visit a dentist to get an accurate diagnosis of the root cause. Masking the symptom without an accurate diagnosis can lead to neglecting the underlying disease, allowing it to worsen into a larger, more complex problem.28

3.2. The Symbiotic Relationship of Gum Disease and Sensitivity: Causality and Treatment Priority

Gum disease and tooth sensitivity are very closely linked in a causal relationship, and there is a clear priority in the treatment approach.

• Causal Relationship: Gum disease (periodontitis) is a clear cause of tooth sensitivity. Bacteria in the oral cavity, particularly in plaque and tartar, cause chronic inflammation of the gums and alveolar bone.37 This inflammatory response destroys the tissues that support the teeth, resulting in 'pathological gum recession,' where the gums recede towards the root. This exposes the tooth roots, which should be protected, to the oral environment, thereby causing dentin hypersensitivity.3 In short, gum disease is the cause, and sensitivity is the resulting symptom.
• Treatment Priority: Therefore, the order of treatment is clear. The underlying disease, gum disease, must be treated first. Using desensitizing agents or toothpaste to alleviate only the sensitivity is not a fundamental solution. This is like suppressing a symptom while leaving an active infection untreated, which over time will lead to continued bone destruction and eventual tooth loss.13
• The Paradox of Periodontal Treatment: An important point here is that the process of treating the root cause of gum disease can temporarily worsen the sensitivity. The basis of gum treatment is scaling and root planing to physically remove tartar and bacterial biofilm from the tooth roots.37 At this time, when the tartar that had been covering the root surface and acting as an 'insulator' against external stimuli is removed, the root surface is suddenly exposed to the external environment, which can temporarily make the sensitivity worse.37 This is not a sign that the treatment went wrong, but a normal and expected reaction in the healing process. During this period, using a desensitizing toothpaste for management will allow the tooth's own defense mechanisms (such as the formation of tertiary dentin) to take effect and adapt to external stimuli, gradually alleviating the symptoms.42 The patient must fully understand this 'paradox of treatment' beforehand to successfully complete the treatment without discontinuing it.

Chapter 4: Evidence-Based Management and Prevention Guidelines

The management of dentin hypersensitivity revolves around two main axes: symptom relief and cause elimination. This chapter presents effective management and prevention strategies based on scientific evidence. From the working principles of over-the-counter desensitizing toothpastes to the correct brushing methods to prevent tooth damage, and the management of temporary hypersensitivity after dental procedures, a multifaceted approach is taken to provide practical solutions.

4.1. Over-the-Counter Solutions: The Science of Desensitizing Toothpaste

Desensitizing toothpaste is widely used as a first-line management tool for dentin hypersensitivity. These products alleviate pain through two main mechanisms, and understanding these principles can help in choosing the right product. This can be likened to the strategies of 'cutting the wire' to block the nerve's pain signal transmission or 'plugging the pipe' to physically occlude the exposed dentinal tubules.

4.1.1. Comparative Analysis of Major Active Ingredients and Mechanisms of Action

The effectiveness of desensitizing toothpaste is determined by its active ingredients.

• Nerve Desensitization (Nerve Depolarization): This mechanism works by dulling the nerve that transmits pain signals.
  • Potassium Nitrate: This is the most representative nerve desensitizing agent. Potassium ions (K+) dissociated from potassium nitrate diffuse through the dentinal tubules to the vicinity of the nerve. The increased extracellular potassium concentration interferes with the repolarization of the nerve cell membrane, inhibiting the nerve from generating and transmitting pain signals.40 This is a method of controlling the pain 'signal' itself, not the cause of the pain.
• Tubule Occlusion: This mechanism works by physically blocking the openings of the exposed dentinal tubules, thereby preventing external stimuli from moving the internal fluid.
  • Stannous Fluoride, Arginine, Calcium Carbonate: These ingredients deposit on the tooth surface to form a mineral protective layer that covers the openings of the dentinal tubules.47
  • Tricalcium Phosphate, Hydroxyapatite (HAP): These are biocompatible materials that are identical or similar to the mineral components of teeth. They bind to the tooth surface, remineralize damaged areas, and effectively seal the dentinal tubules.2

The table below provides a comparative analysis of the mechanisms of action of major active ingredients.

Active Ingredient	Primary Mechanism of Action	Detailed Mechanism	Clinical Considerations
Potassium Nitrate	Nerve Desensitization (Nerve Depolarization)	Increases extracellular potassium (K+) ion concentration, interfering with nerve repolarization and inhibiting pain signal transmission.	Takes 2-4 weeks for effect to manifest. Effective at blocking the pain signal itself.
Stannous Fluoride	Tubule Occlusion	Forms a stable, acid-resistant protective layer on the dentin surface, physically occluding the dentinal tubules.	Also provides cavity prevention and gum inflammation relief. Has an immediate occlusive effect.
Arginine & Calcium Carbonate	Tubule Occlusion	Arginine attracts calcium and phosphate from saliva to the dentin surface, forming a protective layer that blocks the tubules.	Shows relatively rapid pain relief; known as Pro-Argin technology.
Tricalcium Phosphate & Hydroxyapatite	Tubule Occlusion & Remineralization	Similar to tooth components, they bind to the exposed dentin surface and remineralize damaged enamel, strengthening the underlying structure.	Biocompatible and helps to enhance the tooth's natural defense mechanisms.

4.1.2. Considerations for Long-Term Use and Potential Side Effects

Desensitizing toothpastes are generally designed with low abrasive content to minimize tooth wear, making them considered safe for long-term use.2 However, there are a few important points to be aware of when using them.

• Time to Effect: For potassium nitrate-based toothpastes, consistent use for at least 2 to 4 weeks is necessary for the effect to appear.50 One should use it with patience rather than expecting immediate results.
• The Greatest Risk: The risk of delaying diagnosis is greater than the pharmacological side effects of desensitizing toothpaste. As mentioned earlier, sensitivity can be an early symptom of serious conditions like cavities or gum disease. If the pain is temporarily relieved by using toothpaste, one might not realize there is an underlying condition and neglect it.2 Therefore, if symptoms persist or worsen after using the toothpaste for 2-4 weeks, it is essential to visit a dentist to find the exact cause.40
• Effective Usage: To maximize effectiveness, after regular brushing, applying a small amount of the toothpaste directly to the most sensitive area with a finger, like an ointment, and not rinsing it out can be helpful.50

4.2. The Gold Standard of Oral Hygiene: Mastering the Modified Bass Brushing Technique

Improper brushing is one of the most common causes of tooth sensitivity, so learning the correct brushing method is as good as a therapeutic act for prevention and management. The 'Modified Bass Technique,' recommended as the standard by organizations like the Korean Dental Health Association, is the most ideal method for minimizing cervical abrasion and promoting gum health.

• The Problem: Horizontal Scrubbing: Brushing back and forth with force is clearly identified as the main culprit for causing cervical abrasion and gum recession.25
• The Solution: Detailed Steps of the Modified Bass Technique
  1. Bristle Angle: Angle the toothbrush bristles at 45 degrees to the long axis of the tooth, with the bristle tips pointing towards the gums.53
  2. Bristle Insertion: Apply gentle pressure so that some of the bristles enter slightly into the small gap between the tooth and the gum (the gingival sulcus).53 This is where the bacterial plaque that causes gum disease accumulates the most.
  3. Micro-Vibrations: Keeping the bristle tips in the gingival sulcus, relax your wrist and apply short, gentle back-and-forth vibrations of about 2-3mm for about 10 seconds.53 This is more like a trembling motion than scrubbing.
  4. Sweeping Motion (Rolling): After the micro-vibrations, rotate your wrist to gently sweep the bristles from the gum line towards the chewing surface of the tooth—upwards for the lower teeth and downwards for the upper teeth.53
• Additional Recommendations: Always use a 'soft' bristle toothbrush 30 and hold it lightly with your fingertips rather than gripping it tightly in your fist to avoid applying excessive force.9

The Modified Bass Technique is more than just a skill for cleaning teeth. It is a therapeutic approach that effectively removes the bacterial plaque in the gingival sulcus, the cause of gum disease, while avoiding the destructive horizontal forces that cause cervical abrasion, thereby simultaneously preventing and managing the two main causes of dentin hypersensitivity (gum disease and mechanical wear).

4.3. Post-Dental Treatment Sensitivity: Understanding and Preventing Iatrogenic Hypersensitivity

It is very common to experience temporary sensitivity after professional dental treatments like scaling or whitening. This does not mean the treatment was done incorrectly, and understanding the cause can help manage it effectively.

• Sensitivity After Scaling: The main reason is the removal of tartar that was covering the tooth roots. Thick tartar acted as an 'insulator,' blocking external stimuli from the tooth roots. When this tartar is removed through scaling, the cleaned root surface is suddenly exposed to temperature changes in the mouth, causing temporary sensitivity.37 This is a sign that the cleaning was effective and usually disappears naturally within a few days to a few weeks.43
• Sensitivity After Teeth Whitening: The hydrogen peroxide-based agents used for whitening penetrate through the microscopic pores of the enamel and dentin to break down staining substances. In this process, the agent can temporarily irritate the pulp nerve and increase the porosity of the tooth, making it more sensitive to external stimuli.41 Temporary demineralization can also occur during the whitening process.59
• Prevention and Management Strategies:
  • Pre-treatment Management: If you usually have sensitive teeth, inform your dentist before undergoing scaling or whitening treatment. Using a desensitizing toothpaste for a few weeks before the treatment can help prevent or reduce symptoms.60
  • In-treatment Adjustment: The dentist can adjust the concentration of the whitening agent or apply a desensitizing agent during the procedure to reduce discomfort.
  • Post-treatment Care: Use a desensitizing toothpaste consistently after the treatment. Potassium nitrate can help calm the nerves, while hydroxyapatite or calcium phosphate can help fill the increased porosity from whitening and remineralize the teeth.41 It is also advisable to avoid very hot or cold foods for a few days after the treatment.61

Chapter 5: Evaluation of Alternative and Traditional Therapies

There are several folk remedies passed down to alleviate dentin hypersensitivity. This chapter critically evaluates representative folk remedies, including the user-queried saltwater rinse, from a scientific perspective to clarify the validity and limitations of their effects.

5.1. The Scientific Basis and Limitations of Saltwater Rinses

Saltwater rinses have been used as a folk remedy for oral health for a long time, and their effects have a certain scientific principle. However, their direct therapeutic effect on tooth sensitivity is limited.

• Scientific Principle: Saltwater works through the principle of osmosis. A saltwater solution with a higher concentration than the oral cavity draws moisture out of bacterial cells and swollen gum tissue from inflammation.62 This can temporarily inhibit bacterial activity and reduce gum swelling, exhibiting a mild antibacterial and anti-inflammatory effect.63 It can also partially help in neutralizing the acidic environment created by bacteria.64
• Efficacy and Application: Due to these mechanisms, saltwater rinses can be useful as an adjunctive measure for disinfecting wounds after tooth extraction or alleviating mild gum inflammation (gingivitis).64
• Limitations for Tooth Sensitivity: The key distinction here is that saltwater rinses primarily act on soft tissues like the gums. In contrast, dentin hypersensitivity is a structural problem of the hard tissue, namely exposed dentinal tubules. There is no mechanism in saltwater rinses to physically block the exposed dentinal tubules or to directly desensitize the pulp nerve.66 Therefore, a saltwater rinse cannot be a direct treatment for tooth sensitivity. However, it can indirectly help in 'preventing' sensitivity caused by gum recession by promoting gum health.
• Proper Usage: To see effects while avoiding side effects, it is important to maintain the proper concentration. Using about half a teaspoon (approx. 2-3g) of salt dissolved in a cup of warm water (approx. 200ml) is safe.65 A concentration that is too high can irritate and dry out the oral mucosa.62 It is also important to remember that saltwater rinses are an adjunctive therapy and can never replace physical cleaning like brushing and flossing.62

5.2. Efficacy Evaluation of Other Folk Remedies

• Corncobs: There is a folk remedy that suggests gargling with water boiled with corncobs can alleviate sensitivity. The scientific basis for this is the presence of a compound called 'beta-sitosterol' in corncobs.67 This compound is actually used as the main ingredient in some gum medications and is known to have effects in strengthening periodontal tissues and reducing inflammation.67 Like saltwater rinses, this has some validity in that it can help prevent gum recession in the long term by improving gum health. However, there is still a lack of strong clinical evidence that it directly and immediately alleviates the sensitivity of already exposed dentin. It is appropriate to understand it as one of the unverified adjunctive therapies.

Chapter 6: Synthesis and Final Recommendations

This report has provided a comprehensive analysis from the fundamental scientific principles of dentin hypersensitivity to its multifaceted causes, diagnostic significance, and evidence-based management strategies. Based on this, practical guidelines for the long-term prevention and management of tooth sensitivity are presented.

6.1. Summary of Key Findings

Dentin hypersensitivity is a symptom that occurs when the protective layer of the tooth is damaged, exposing the sensitive inner dentin. Its causes are a complex result of aging, genetic predisposition, and lifestyle habits (consumption of acidic foods, improper brushing, bruxism). Tooth sensitivity is more than just a discomfort; it can be the first sign of serious underlying conditions such as cavities, tooth cracks, and periodontal disease. Therefore, an accurate diagnosis by a professional should precede any self-diagnosis. Treatment and management should involve a two-pronged approach: a symptomatic approach to block exposed dentinal tubules or desensitize the nerve, and a causal approach to correct lifestyle habits and treat underlying diseases.

6.2. Action Plan for the Prevention and Long-Term Management of Dentin Hypersensitivity

The following is a step-by-step action plan for effectively managing and preventing dentin hypersensitivity.

• Step 1: The Principle of Diagnosis - Professional Diagnosis First
  • When symptoms of sensitivity appear, the first step in all management is to visit a dentist for an accurate diagnosis of the cause. If underlying diseases such as cavities or gum disease are found, treatment of those conditions should be the top priority.
• Step 2: The Prevention Triangle - Lifestyle Modification
  1. Dietary Control: Reduce the frequency and contact time of acidic foods like carbonated drinks and fruit juices with the teeth. After consumption, immediately rinse the mouth with water, and brush at least 30 minutes later to prevent enamel abrasion.
  2. Non-Traumatic Oral Hygiene: Internalize the habit of brushing with a soft-bristled toothbrush using the 'Modified Bass Technique.' This is the most effective way to prevent cervical abrasion and gum recession.
  3. Stress and Bruxism Management: If bruxism is suspected, get a diagnosis from a dentist and, if necessary, wear a custom-made occlusal splint to protect the teeth. Finding your own stress-relief methods, such as meditation or exercise, is also important.
• Step 3: A Stepwise Approach to Symptom Management
  1. First-Line Management (Self-Care): Under the diagnosis that there is no underlying disease, consistently use a desensitizing toothpaste for at least one month. Consider choosing or combining products with nerve-desensitizing and tubule-occluding ingredients based on your symptoms.
  2. Second-Line Management (Professional Treatment): If symptoms do not improve sufficiently with toothpaste, receive treatment at the dentist, such as the application of a professional desensitizing agent (e.g., fluoride varnish) or restoring the exposed cervical area with resin.
  3. Third-Line Management (Invasive Treatment): If severe pain persists despite all the above methods, a crown to cover the entire tooth or root canal therapy to remove the nerve, the source of the pain, may be considered as a last resort.

Dentin hypersensitivity can be a chronic condition that requires lifelong management. However, by accurately understanding its scientific principles, applying evidence-based preventive habits in daily life, and seeking professional help when necessary, it can be sufficiently controlled to maintain a healthy oral state.

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8. 충치, 치통과 꼭 비례할까?…지나쳐선 안 되는 위험신호 - 뉴시스, 8월 28, 2025에 액세스, https://mobile.newsis.com/view/NISX20230814_0002413690
9. 치아가 시린 이유와 치료 방법 - 참조은치과, 8월 28, 2025에 액세스, http://cjdental.co.kr/%EC%B9%98%EC%95%84%EA%B0%80-%EC%8B%9C%EB%A6%B0-%EC%9D%B4%EC%9C%A0%EC%99%80-%EC%B9%98%EB%A3%8C-%EB%B0%A9%EB%B2%95/
10. 이가 시린 이유와 치료 방법 - 해운대 센텀오딧세이치과의원, 8월 28, 2025에 액세스, http://odental.co.kr/home/bbs/board.php?bo_table=sub6_6&wr_id=34
11. 이 더위에도 찬물 못 마시는 이유 '시린이' [자가진단 시리즈] - Hinews / 하이뉴스, 8월 28, 2025에 액세스, https://www.healthinnews.co.kr/news/articleView.html?idxno=39411
12. 노화가 구강과 치아에 미치는 영향 - 구강 및 치아 장애 - MSD 매뉴얼 ..., 8월 28, 2025에 액세스, https://www.msdmanuals.com/ko/home/%EA%B5%AC%EA%B0%95-%EB%B0%8F-%EC%B9%98%EC%95%84-%EC%9E%A5%EC%95%A0/%EA%B5%AC%EA%B0%95-%EB%B0%8F-%EC%B9%98%EC%95%84-%EC%83%9D%EB%AC%BC%ED%95%99/%EB%85%B8%ED%99%94%EA%B0%80-%EA%B5%AC%EA%B0%95%EA%B3%BC-%EC%B9%98%EC%95%84%EC%97%90-%EB%AF%B8%EC%B9%98%EB%8A%94-%EC%98%81%ED%96%A5
13. 찬물에 치아가 찌릿~ '시린이' 관리 핵심 잇몸 건강 - 힐팁, 8월 28, 2025에 액세스, http://www.healtip.co.kr/news/articleView.html?idxno=3423
14. 동안을 좌우하는 한 끗 차이! 치아도 안티에이징 치아 역시 시간이 지나면 자연스럽게 노화 증상이 나타난다. 얼굴이나 몸처럼 눈으로 바로 확인할 수 없으니 모르고 지나갈 뿐. 생활 속에서 - 라이나전성기재단, 8월 28, 2025에 액세스, https://www.junsungki.com/magazine/post-detail.do?id=2977
15. 노인의 구강건강과 전신질환, 8월 28, 2025에 액세스, https://www.ekjcg.org/journal/download_pdf.php?doi=10.15656/kjcg.2020.21.2.39
16. "충치·잇몸질환, 유전적 영향 받아" - 헬스조선, 8월 28, 2025에 액세스, https://m.health.chosun.com/svc/news_view.html?contid=2019070501806
17. 치아 성장 저해하는 '유전적 원인' 첫 규명 - 데일리메디, 8월 28, 2025에 액세스, https://www.dailymedi.com/news/news_view.php?wr_id=928170
18. 충치 잘 생기는 것도 유전? - 헬스중앙, 8월 28, 2025에 액세스, https://jhealthmedia.joins.com/news/articleView.html?idxno=20032
19. 잇몸 질환의 유전 요소들 - 잇몸 유전 알아보아요 - 구강 매거진 by 리브러쉬, 8월 28, 2025에 액세스, https://rebrush.co.kr/article/%EA%B5%AC%EA%B0%95-%EB%A7%A4%EA%B1%B0%EC%A7%84/5/4566/
20. 관리 잘해도 생기는 '충치' 혹시 유전은 아닐까? - 헬스경향, 8월 28, 2025에 액세스, https://www.k-health.com/news/articleView.html?idxno=22511
21. "원래 이가 안 좋아서…" 충치도 유전 될까? - 헬스조선, 8월 28, 2025에 액세스, https://m.health.chosun.com/svc/news_view.html?contid=2016051602271
22. [DR. 최일묵의 덴탈스토리] 치아 건강에 '독'… 탄산음료 - 대한급식신문, 8월 28, 2025에 액세스, https://fsnews.co.kr/news/articleView.html?idxno=46137
23. 에너지음료가 치아부식에 미치는 영향, 8월 28, 2025에 액세스, http://www.kjcdh.org/view/kjcdh_03_01_03.pdf
24. 치아부식 예방하려면?...산성식품 피해야 - 현대건강신문, 8월 28, 2025에 액세스, https://www.hnews.kr/news/view.php?no=11824
25. 5년 넘게 수평방향으로 칫솔질하면 '시린이' 발생한다 - 헬스조선, 8월 28, 2025에 액세스, https://m.health.chosun.com/svc/news_view.html?contid=2011081901199
26. 찬물만 닿아도 부르르…'시린 이', 나이 탓만 할 게 아니다? - 헬스경향, 8월 28, 2025에 액세스, https://www.k-health.com/news/articleView.html?idxno=48134
27. "요즘 이가 시리다면?" 이시림 원인부터 관리 및 예방법에 관하여 - 닥터나우, 8월 28, 2025에 액세스, https://doctornow.co.kr/content/magazine/8509d7708da611ed95e206ef18b6ac0c
28. '아아' 못 마시는 시린이...방치하면 당뇨까지 이어진다 [알고 먹자 영양소] > 건강정보, 8월 28, 2025에 액세스, https://www.stcarollo.or.kr/0401/2068
29. “아, 이시려…” 단순히 찬바람 불어서일까? - 헬스조선, 8월 28, 2025에 액세스, https://m.health.chosun.com/svc/news_view.html?contid=2023110901634
30. 시린 이, 잘못된 양치질 탓… 좌우로 문지르면 안 돼 - 헬스조선, 8월 28, 2025에 액세스, https://m.health.chosun.com/svc/news_view.html?contid=2015102002402
31. 잠 방해하는 '뿌득뿌득' 소리… 원인 뭐길래? - 헬스조선, 8월 28, 2025에 액세스, https://m.health.chosun.com/svc/news_view.html?contid=2022120602034
32. 지끈지끈 두통까지? '이갈이습관' 제대로 알기 - 헬스경향, 8월 28, 2025에 액세스, https://www.k-health.com/news/articleView.html?idxno=30787
33. 이를 갈지 마세요: 시린이의 원인이 됩니다 - 리스테린 세균억제 구강청결제, 8월 28, 2025에 액세스, https://www.listerine.kr/tooth-sensitivity/teeth-grinding
34. N의학정보 | 서울대학교병원, 8월 28, 2025에 액세스, https://www.snuh.org/health/nMedInfo/nView.do?category=SYM&medid=AC000113
35. 스트레스ㆍ잘못된 칫솔질도 시린 이 원인 - 매경헬스, 8월 28, 2025에 액세스, http://www.mkhealth.co.kr/news/articleView.html?idxno=21510
36. 이갈이 - 서울뿌리튼튼치과, 8월 28, 2025에 액세스, https://rootdental.co.kr/www/contents.php?inc=bruxism.html
37. 시린니는 치아•잇몸에 문제 있다는 신호 - 메디포뉴스, 8월 28, 2025에 액세스, https://medifonews.com/news/article.html?no=124131
38. 시린니 방치했다가 젊은 나이에도 틀니 할 수 있어... 주의 - 복지로, 8월 28, 2025에 액세스, https://www.bokjiro.go.kr/ssis-tbu/cms/pc/news/news/6103140.html
39. 센소다인 - 나무위키, 8월 28, 2025에 액세스, https://namu.wiki/w/%EC%84%BC%EC%86%8C%EB%8B%A4%EC%9D%B8
40. 시린이 증상 완화에 좋은 질산칼륨 - 구강 매거진 by 리브러쉬, 8월 28, 2025에 액세스, https://rebrush.co.kr/article/%EA%B5%AC%EA%B0%95-%EB%A7%A4%EA%B1%B0%EC%A7%84/5/15846/
41. 스케일링, 치아 미백 후 이가 시리다면?...치과 정명진 원장 [인터뷰 ..., 8월 28, 2025에 액세스, https://news.hidoc.co.kr/news/articleView.html?idxno=27670
42. '스케일링'하면 이가 더 시린 이유 - 매경헬스, 8월 28, 2025에 액세스, https://www.mkhealth.co.kr/news/articleView.html?idxno=70970
43. 스케일링 후 치아가 시린 이유 (The reason my teeth are cold after scaling) - YouTube, 8월 28, 2025에 액세스, https://www.youtube.com/watch?v=s6WF8xBxmZo
44. 스케일링하면 이가 시리다? 그래도 해야하는 이유 - 중앙일보, 8월 28, 2025에 액세스, https://www.joongang.co.kr/article/23579245
45. 시린이 치약, 정말 효과 있을까요? : 덴탈피디아 정보, 8월 28, 2025에 액세스, https://dentalpedia.kr/dentalpedia/?bmode=view&idx=33142052
46. 이 시린 사람은 ' 색' 치약 쓰세요 - 헬스조선, 8월 28, 2025에 액세스, https://m.health.chosun.com/svc/news_view.html?contid=2021112201023
47. 시린이 치약의 세대별 기전과 효과에 대한 이해 - 메디칼업저버, 8월 28, 2025에 액세스, https://www.monews.co.kr/news/articleView.html?idxno=327504
48. [SUB] Best Toothpaste for Sensitive Teeth - Here's What You Need - YouTube, 8월 28, 2025에 액세스, https://www.youtube.com/watch?v=QMRln8I3KD8
49. 3 set 닥터치카 고불소 시린이 치약 불소 함유 1450 잇몸 관리 케어 질산칼륨 1426ppm, 8월 28, 2025에 액세스, https://drchika.co.kr/product/3-set-%EB%8B%A5%ED%84%B0%EC%B9%98%EC%B9%B4-%EA%B3%A0%EB%B6%88%EC%86%8C-%EC%8B%9C%EB%A6%B0%EC%9D%B4-%EC%B9%98%EC%95%BD-%EB%B6%88%EC%86%8C-%ED%95%A8%EC%9C%A0-1450-%EC%9E%87%EB%AA%B8-%EA%B4%80%EB%A6%AC-%EC%BC%80%EC%96%B4-%EC%A7%88%EC%82%B0%EC%B9%BC%EB%A5%A8-1426ppm/441/
50. 시린 증상이 있다면? 치아가 시린 것과 시큰한 것을 구분해야 합니다 - YouTube, 8월 28, 2025에 액세스, https://www.youtube.com/watch?v=hMekbZAVPDE
51. 이가 시린 이유, '시린이 치약' 쓰면 좋아질까? - 하이닥, 8월 28, 2025에 액세스, https://news.hidoc.co.kr/news/articleView.html?idxno=15772
52. 치아에 번개 치는 '시린이' 주요 원인 & 치료‧예방법 - 힐팁, 8월 28, 2025에 액세스, http://www.healtip.co.kr/news/articleView.html?idxno=3406
53. 올바른 양치질 하는 방법 - 바스법! 치주염 잇몸염증 증상에 좋은 칫솔질 - YouTube, 8월 28, 2025에 액세스, https://www.youtube.com/watch?v=bCF7M10ey2o
54. 치과의사들이 추천하는 올바른 잇몸 양치질 법. (변형 바스법) #매직박 #양치질 #칫솔질 #바스법 - YouTube, 8월 28, 2025에 액세스, https://www.youtube.com/shorts/_7eFF66fZWY
55. 부산대학교 치과병원 > 나눔소통 > 건강정보 > 건강정보, 8월 28, 2025에 액세스, https://pnudh.co.kr/pnudh/board/view.do?cmnx=46&page=1&idx=7
56. 잇몸이 튼튼해지는 올바른 이 닦기- 잇몸질환 환자를 위한 바스법 칫솔질, 8월 28, 2025에 액세스, https://athanvit.co.kr/%EC%9E%87%EB%AA%B8%EC%9D%B4-%ED%8A%BC%ED%8A%BC%ED%95%B4%EC%A7%80%EB%8A%94-%EC%98%AC%EB%B0%94%EB%A5%B8-%EC%9D%B4-%EB%8B%A6%EA%B8%B0-%EC%9E%87%EB%AA%B8%EC%A7%88%ED%99%98-%ED%99%98%EC%9E%90%EB%A5%BC/
57. 언제까지 '3·3·3'만?…내게 맞는 칫솔질 골라 닦아야 - 중앙일보, 8월 28, 2025에 액세스, https://www.joongang.co.kr/article/21566137
58. "스케일링을 하고나서 잇몸이 다 파였어요. 치아가 깎여서 더 시리고 아파요 " - 왜 그런지 진짜 이유를 알려드릴게요. - 노원 디자인치과, 8월 28, 2025에 액세스, https://design-dental-clinic.com/blog/?bmode=view&idx=15522416
59. 치아 미백 시림 증상 원인 및 해결 방법 - 구강 매거진 by 리브러쉬, 8월 28, 2025에 액세스, https://rebrush.co.kr/article/%EA%B5%AC%EA%B0%95-%EB%A7%A4%EA%B1%B0%EC%A7%84/5/15850/
60. 치아변색 - 창원메트로병원, 8월 28, 2025에 액세스, http://www.metrohosp.com/sub05/healthguide_contents.php?idx=5410&sub=6
61. 스케일링 (Dental Scaling) 스케일링은 치과치료에서 가장 기본적인 치료이며 예방적인 치료입니다. 1년 혹은 6개월에 한번씩은 정기검진과 함께 스케일링을 받는 것이 꼭 필요합니다. - 정성을 다하는 구미로덴치과, 8월 28, 2025에 액세스, https://www.bestroden.com/%EC%8A%A4%EC%BC%80%EC%9D%BC%EB%A7%81
62. 김포치과에서 알려드리는 "소금물 가글의 효과와 올바른 사용법" : 의료 ..., 8월 28, 2025에 액세스, https://www.kdent.co.kr/column/?bmode=view&idx=132673515
63. 잇몸이 붓거나 충치가 있을 때, 소금물 가글은 효과적일까? 치과의사가 알려드립니다., 8월 28, 2025에 액세스, https://www.youtube.com/watch?v=9Tu8idl_J3Q&pp=0gcJCRsBo7VqN5tD
64. 잇몸 건강, 소금물 가글 효과는? - 자투리경제, 8월 28, 2025에 액세스, https://www.jaturi.kr/news/articleView.html?idxno=21560
65. 소금물 가글과 칼슘, 잇몸 건강을 지키는 자연의 비밀 - Marah Natural America - 마라내츄럴 아메리카, 8월 28, 2025에 액세스, https://marahnaturalamerica.com/%E2%9C%94%EF%B8%8F-%EC%86%8C%EA%B8%88%EB%AC%BC-%EA%B0%80%EA%B8%80%EA%B3%BC-%EC%B9%BC%EC%8A%98-%EC%9E%87%EB%AA%B8-%EA%B1%B4%EA%B0%95%EC%9D%84-%EC%A7%80%ED%82%A4%EB%8A%94-%EC%9E%90%EC%97%B0%EC%9D%98/
66. [HOT튜버] 소금물가글, 잇몸 염증 효과 있을까?, 8월 28, 2025에 액세스, https://www.mkhealth.co.kr/news/articleView.html?idxno=52306
67. [엑스파일 02.] 시린이치약, 치약으로 좋아진 시린이 증상 정말 괜찮아 ..., 8월 28, 2025에 액세스, https://m.health.chosun.com/svc/news_view.html?contid=2014111002923