Dentine Hypersensitivity












Management ofDental Emergencies inChildren andAdolescents, First Edition.
Editedby Klaus W.Neuhaus andAdrianLussi.
© 2019 John Wiley & Sons Ltd. Published 2019 by John Wiley & Sons Ltd.
Companion website: www.wiley.com/go/neuhaus/dental_emergencies
269
What is Dentine
Hypersensitivity?
Pain is a very common problem in the daily
dental practice. It leads to anxiety and stress
in patients, eventually causing a negative
impact on their quality of life. Since pain is
a subjective condition, it can be difficult to
assess its precise state and intensity, espe-
cially when dealing with children, who are
still learning to express themselves.
Amongst the different kinds of oral pain,
we most commonly find in the clinic those
related to dental caries, pulpitis, fractured
teeth and restorations, cracked tooth syn-
drome (CTS), molar–incisor hypominerali-
sation (MIH), post‐restorative sensitivity,
marginal leakage, vital bleaching and gingival
inflammation. If a particular pain cannot be
assigned to any of these conditions, it might
be related to dentine hypersensitivity (DH).
By definition, DH is a diagnosis of exclusion,
and it is characterised as a sharp pain, with
short duration, arising from different stimuli
on exposed dentine, occurring when no
other form of dental defect or disease is
identified (Holland et al., 1997; Canadian
Advisory Board, 2003).
How Does DH Occur?
The most common factors leading to DH are
gingival recession and loss of dental hard
tissue. Gingival recession is a change of the
gingival position from the cement–enamel
junction to a more apical location. It may
occur due to the use of orthodontic devices,
traumatic toothbrushing or periodontitis
and its treatment, amongst other causes
(Smith, 1997). Loss of dental hard tissue
(known as erosive tooth wear, ETW) occurs
when erosion and abrasive forces continually
impact the tooth surface, which can com-
pletely wear away the enamel, expose the
underlying dentine and leave the dentine
tubules patent to the oral environment (Lussi
and Carvalho, 2014; Carvalho et al., 2015).
Figure 7.2.1 shows a deciduous molar with
ETW lesions, exposed dentine and patent
tubules. If the erosive and abrasive forces
occur in an area of gingival recession, it can
lead to a wedge‐shaped defect on the cervical
area of the tooth and expose the underlying
dentine.
The feeling of pain in DH arises because
the dentinal tubules are open to the oral
environment and the dental pulp. The fluid
7.2
Dentine Hypersensitivity
Thiago Saads Carvalho and Samira Helena JoãoSouza
Department of Restorative, Preventive and Pediatric Dentistry, School for Dental Medicine, University of Bern, Bern, Switzerland

7.2 Dentine Hypersensitivity
270
within the tubules is free to move through-
out the whole extent of the dentine. This
movement changes the flow direction and
pressure of the dentinal fluid, resulting in a
shift in the pulpal pressure, which stimulates
the pulpal nerves and causes a sharp pain
sensation (Brännström et al., 1967). This
means that any number of stimuli occurring
in the exposed tubules will trigger a sharp
movement of the dentinal fluid and cause
pain. These stimuli can be thermal, evapora-
tive, tactile, osmotic or chemical, but epide-
miological data show that cold (thermal) is
the main trigger for DH (Brännström etal.,
1967; Amarasena etal., 2011).
Prevalence ofDH in
Children andAdolescents
ETW is an important factor in DH, especially
in young adults, whose chances of experienc-
ing pain from DH increase at least threefold
when ETW is present (West etal., 2013). In
children and adolescents, the prevalence of
ETW can reach 79–100%, whilst the preva-
lence of DH varies in the range 4.7–45.2%
(Table7.2.1). Amongst studies reporting DH
in children and adolescents (Table 7.2.1),
practically none shows specific prevalence
data for children, but most present some for
adolescents. In general, premolars and inci-
sors are the most commonly affected teeth,
and patients typically complain that the pain
is triggered by a cold stimulus or that tooth-
brushing causes DH discomfort.
Given the scarce epidemiological evidence
on this condition in children, it is difficult
to pinpoint specific prevalence values in this
age group or to describe how the condition
shifts as a function of age. However, studies
show that DH is already a concern for some
adolescent patients.
Clinical Aspects ofDH in
Children andAdolescents
When a patient complains of pain, dental
professionals should meticulously analyse
his or her dental history and carry out a
thorough clinical examination to identify its
source and location, and all possible factors
that could be driving the process of dentine
exposure.
In the clinic, the assessment of pain is com-
monly made with an air blast or tactile stimu-
lus, but the patient’s perception of pain and
their reported history are also important
sources of information (Canadian Advisory
Board, 2003). In general, the assessment of
DH‐related pain is not easy, given the subjec-
tive nature of the pain. Whilst older children
and adolescents can communicate and
express themselves without extreme influ-
ence of any cognitive, emotional or situa-
tional factors (von Baeyer and Spagrud,
2007), younger children have difficulty in
precisely expressing their sensations. They
are highly influenced by previous unpleasant
dental experiences, and they may present
an anxious response to clinical tests. Proper
(a) (b) (c)
b
Figure7.2.1 Deciduous molar with (a) ETW lesions on the occlusal surface, exhibiting (b) exposed dentine.
(c)Scanning electron microscopy (SEM) image showing the patent dentine tubules.

Clinical Aspects ofDH in Children andAdolescents
271
assessment of pain location and intensity in
these young patients is thus challenging.
Once the location and source of pain are
established, the dental professional should
determine which factors are associated with
the DH in their patient. Gingival recession is
one of the most common factors in DH, and
it is frequently observed in adolescents. Its
prevalence increases with age, and it is most
commonly observed in buccal surfaces of
canines, premolars and first molars (Ainamo
etal., 1986). Most of the prevalence studies in
Table7.2.1 associate DH with gingival reces-
sion. Its causes are mainly soft‐tissue trauma
(e.g. from toothbrushing) and orthodontic
therapy.
In addition to gingival recession, dental
professionals should also bear in mind the
factors related to ETW (Shitsuka etal., 2015).
Frequent consumption of acidic foods or
drinks is highly associated to ETW (Carvalho
etal., 2014; Lussi and Carvalho, 2014). The
constant presence of acids in the oral cavity is
not only related to the loss of dental hard tis-
sue and dentine exposure, but also maintains
the dentinal tubules constantly open, thus
sustaining the conditions for pain related to
DH. For this reason, dental professionals
should assess the daily diet of their patients
(and their families, in case of children). This
can be done using a food diary, where the
patient must take note of any food or beverage
Table7.2.1 Studies reporting theprevalence ofDH inchildren andadolescents.
Study Study type
Number of
volunteers
Age group
(years)
Prevalence
ofDH (%)
Fischer etal. (1992) Clinical and
questionnaire
635 13–87 17.0
a
25.0
b
Rees (2000) Clinical 3593 15–83 3.8
Clayton etal. (2002) Questionnaire 228 17–58 45.2
c
Rees and Addy (2002) Clinical 4841 16–82 4.1
Rees etal. (2003) Clinical 226 12–82 <25.0
c
Rees and Addy (2004) Clinical 5477 15–80 2.8
Chi and Milgrom (2008) Questionnaire 45 14–28 52.6
Bamise etal. (2010) Questionnaire 1019 14–41 4.7
c
Amarasena etal. (2011)
d
Clinical 12 692 <20 to >60 4.7
c
Oderinu etal. (2011) Questionnaire 382 17–37 40.9
c
Bahsi etal. (2012) Clinical 1368 13–71 1.6
Çolak etal. (2012) Questionnaire 1463 17–33 8.4
Shitsuka etal. (2015) Case–control 48 4–9 41.0
c
Haneet and Vandana
(2016)
Clinical 404 16–55 39.2
c
a
Prevalence value obtained from the clinical assessment.
b
Prevalence value obtained from the questionnaires.
c
Prevalence values specific for children and adolescents (<20 years old).
d
Reference found after searching for (dentin OR dentine) AND (sensitivity OR hypersensitivity) AND (prevalence).
A literature search was performed on PubMed using the terms (dentin OR dentine) AND (sensitivity OR
hypersensitivity) AND (child OR children OR adolescent OR adolescents OR teenager OR teenagers) AND
(prevalence). The search resulted in a total of 83 studies, amongst which only 13 involved children or adolescents
(<20 years old), one of which (Shitsuka etal., 2015) was specifically on children. Another study (Amarasena etal.,
2011) was later added after using a broader search term.
d

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Management ofDental Emergencies inChildren andAdolescents, First Edition. Editedby Klaus W.Neuhaus andAdrianLussi. © 2019 John Wiley & Sons Ltd. Published 2019 by John Wiley & Sons Ltd. Companion website: www.wiley.com/go/neuhaus/dental_emergencies269 What is Dentine Hypersensitivity?Pain is a very common problem in the daily dental practice. It leads to anxiety and stress in patients, eventually causing a negative impact on their quality of life. Since pain is a subjective condition, it can be difficult to assess its precise state and intensity, espe-cially when dealing with children, who are still learning to express themselves.Amongst the different kinds of oral pain, we most commonly find in the clinic those related to dental caries, pulpitis, fractured teeth and restorations, cracked tooth syn-drome (CTS), molar–incisor hypominerali-sation (MIH), post‐restorative sensitivity, marginal leakage, vital bleaching and gingival inflammation. If a particular pain cannot be assigned to any of these conditions, it might be related to dentine hypersensitivity (DH). By definition, DH is a diagnosis of exclusion, and it is characterised as a sharp pain, with short duration, arising from different stimuli on exposed dentine, occurring when no other form of dental defect or disease is identified (Holland et al., 1997; Canadian Advisory Board, 2003). How Does DH Occur?The most common factors leading to DH are gingival recession and loss of dental hard tissue. Gingival recession is a change of the gingival position from the cement–enamel junction to a more apical location. It may occur due to the use of orthodontic devices, traumatic toothbrushing or periodontitis and its treatment, amongst other causes (Smith, 1997). Loss of dental hard tissue (known as erosive tooth wear, ETW) occurs when erosion and abrasive forces continually impact the tooth surface, which can com-pletely wear away the enamel, expose the underlying dentine and leave the dentine tubules patent to the oral environment (Lussi and Carvalho, 2014; Carvalho et al., 2015). Figure 7.2.1 shows a deciduous molar with ETW lesions, exposed dentine and patent tubules. If the erosive and abrasive forces occur in an area of gingival recession, it can lead to a wedge‐shaped defect on the cervical area of the tooth and expose the underlying dentine.The feeling of pain in DH arises because the dentinal tubules are open to the oral environment and the dental pulp. The fluid 7.2Dentine HypersensitivityThiago Saads Carvalho and Samira Helena JoãoSouzaDepartment of Restorative, Preventive and Pediatric Dentistry, School for Dental Medicine, University of Bern, Bern, Switzerland 7.2 Dentine Hypersensitivity270within the tubules is free to move through-out the whole extent of the dentine. This movement changes the flow direction and pressure of the dentinal fluid, resulting in a shift in the pulpal pressure, which stimulates the pulpal nerves and causes a sharp pain sensation (Brännström et al., 1967). This means that any number of stimuli occurring in the exposed tubules will trigger a sharp movement of the dentinal fluid and cause pain. These stimuli can be thermal, evapora-tive, tactile, osmotic or chemical, but epide-miological data show that cold (thermal) is the main trigger for DH (Brännström etal., 1967; Amarasena etal., 2011). Prevalence ofDH in Children andAdolescentsETW is an important factor in DH, especially in young adults, whose chances of experienc-ing pain from DH increase at least threefold when ETW is present (West etal., 2013). In children and adolescents, the prevalence of ETW can reach 79–100%, whilst the preva-lence of DH varies in the range 4.7–45.2% (Table7.2.1). Amongst studies reporting DH in children and adolescents (Table 7.2.1), practically none shows specific prevalence data for children, but most present some for adolescents. In general, premolars and inci-sors are the most commonly affected teeth, and patients typically complain that the pain is triggered by a cold stimulus or that tooth-brushing causes DH discomfort.Given the scarce epidemiological evidence on this condition in children, it is difficult to pinpoint specific prevalence values in this age group or to describe how the condition shifts as a function of age. However, studies show that DH is already a concern for some adolescent patients. Clinical Aspects ofDH in Children andAdolescentsWhen a patient complains of pain, dental professionals should meticulously analyse his or her dental history and carry out a thorough clinical examination to identify its source and location, and all possible factors that could be driving the process of dentine exposure.In the clinic, the assessment of pain is com-monly made with an air blast or tactile stimu-lus, but the patient’s perception of pain and their reported history are also important sources of information (Canadian Advisory Board, 2003). In general, the assessment of DH‐related pain is not easy, given the subjec-tive nature of the pain. Whilst older children and adolescents can communicate and express themselves without extreme influ-ence of any cognitive, emotional or situa-tional factors (von Baeyer and Spagrud, 2007), younger children have difficulty in precisely expressing their sensations. They are highly influenced by previous unpleasant dental experiences, and they may present an anxious response to clinical tests. Proper (a) (b) (c)bFigure7.2.1 Deciduous molar with (a) ETW lesions on the occlusal surface, exhibiting (b) exposed dentine. (c)Scanning electron microscopy (SEM) image showing the patent dentine tubules. Clinical Aspects ofDH in Children andAdolescents271assessment of pain location and intensity in these young patients is thus challenging.Once the location and source of pain are established, the dental professional should determine which factors are associated with the DH in their patient. Gingival recession is one of the most common factors in DH, and it is frequently observed in adolescents. Its prevalence increases with age, and it is most commonly observed in buccal surfaces of canines, premolars and first molars (Ainamo etal., 1986). Most of the prevalence studies in Table7.2.1 associate DH with gingival reces-sion. Its causes are mainly soft‐tissue trauma (e.g. from toothbrushing) and orthodontic therapy.In addition to gingival recession, dental professionals should also bear in mind the factors related to ETW (Shitsuka etal., 2015). Frequent consumption of acidic foods or drinks is highly associated to ETW (Carvalho etal., 2014; Lussi and Carvalho, 2014). The constant presence of acids in the oral cavity is not only related to the loss of dental hard tis-sue and dentine exposure, but also maintains the dentinal tubules constantly open, thus sustaining the conditions for pain related to DH. For this reason, dental professionals should assess the daily diet of their patients (and their families, in case of children). This can be done using a food diary, where the patient must take note of any food or beverage Table7.2.1 Studies reporting theprevalence ofDH inchildren andadolescents.Study Study typeNumber of volunteersAge group (years)Prevalence ofDH (%)Fischer etal. (1992) Clinical and questionnaire635 13–87 17.0a25.0bRees (2000) Clinical 3593 15–83 3.8Clayton etal. (2002) Questionnaire 228 17–58 45.2cRees and Addy (2002) Clinical 4841 16–82 4.1Rees etal. (2003) Clinical 226 12–82 <25.0cRees and Addy (2004) Clinical 5477 15–80 2.8Chi and Milgrom (2008) Questionnaire 45 14–28 52.6Bamise etal. (2010) Questionnaire 1019 14–41 4.7cAmarasena etal. (2011)dClinical 12 692 <20 to >60 4.7cOderinu etal. (2011) Questionnaire 382 17–37 40.9cBahsi etal. (2012) Clinical 1368 13–71 1.6Çolak etal. (2012) Questionnaire 1463 17–33 8.4Shitsuka etal. (2015) Case–control 48 4–9 41.0cHaneet and Vandana (2016)Clinical 404 16–55 39.2caPrevalence value obtained from the clinical assessment.bPrevalence value obtained from the questionnaires.cPrevalence values specific for children and adolescents (<20 years old).dReference found after searching for (dentin OR dentine) AND (sensitivity OR hypersensitivity) AND (prevalence).A literature search was performed on PubMed using the terms (dentin OR dentine) AND (sensitivity OR hypersensitivity) AND (child OR children OR adolescent OR adolescents OR teenager OR teenagers) AND (prevalence). The search resulted in a total of 83 studies, amongst which only 13 involved children or adolescents (<20 years old), one of which (Shitsuka etal., 2015) was specifically on children. Another study (Amarasena etal., 2011) was later added after using a broader search term.d 7.2 Dentine Hypersensitivity272consumed over the course of 4 days, includ-ing one weekend day. Using this diary, dental professionals can identify the substances related to ETW and establish individual‐tailored advice for their patients on reducing the frequency of acid intake.Acids from gastro-esophageal reflux dis-ease (GERD) are important factors for this condition, too. Children as young as 3–4 years who reportedly suffer from GERD present higher rates of ETW with dentine exposure on deciduous teeth (Murakami etal., 2011). Patients reporting GERD should be referred to their medical doctor or gastroenterologist for check‐up. Occasionally, a patient may present ETW lesions and have no apparent GERD symptoms. Such patients may be suffering from silent reflux, and they should also be referred to their doctor. Silent reflux occurs when a patient is not aware that they suffer from reflux, but still present some sub-tle clinical signs of ETW related to GERD, such as asymmetric ETW lesions. These lesions are slightly more discernible in one side of the mouth than the other. If GERD is not treated, the condition can persist into the teenage years and adulthood, sustaining the ETW and possibly act as the driving force for DH on permanent teeth. Furthermore, eating disorders such as anorexia and bulimia can arise during the teenage years and early adulthood. These disorders will likewise influence the development of ETW lesions, which, in turn, can be related to DH.In addition to determining the factors associated with gingival recession and ETW, it is also important to assess the patient’s oral hygiene and behavioural characteristics, especially those related to drinking habits (swishing or holding erosive drinks in the mouth). Follow‐up assessments and monitoring of these patients can help achieve the best diagnosis and clinical management of DH. Clinical Management ofDHFirst and foremost, dental professionals must provide a clinical management individually tailored to their patients. This should begin with the least invasive procedures, such as the use of homecare products like tooth-pastes and mouthrinses. Products containing specific desensitising agents (e.g. potassium, stannous fluoride, calcium sodium phospho-silicate, arginine) are capable of reducing DH in adults (Bae etal., 2015). They act by hin-dering the nervous response or by blocking the opening of the tubules, where they pre-cipitate and thus reduce fluid movement. These products should be considered as the first treatment choice for DH, although there are still a limited number of studies regarding their use in children.For an extra degree of safety, in‐office desensitising agents can be applied. Amongst the products available for in‐office use, flu-oride varnishes are a good option for children (Miller and Vann, 2008). These varnishes form a layer over the dentine surface, which serves as a physical barrier against external stimuli and acts as a source of fluoride. They should be considered as an initial treatment option for use in DH, but they provide only an immediate and short‐term pain relief. If the pain persists, other minimally invasive options (e.g. sealants) should be considered.Sealants such as glass ionomer, resin‐based sealants and adhesives can provide a physical barrier over the exposed dentine. These materials have shown successful results in the treatment of DH, with pain relief lasting several months (Veitz‐Keenan etal., 2013; West et al., 2014; Madruga et al., 2017). Sealants can be used in DH cases where treatment with fluoride varnishes has not been successful. However, when the loss of dental hard tissue is so substantial that a restoration is required, further treatment is advocated. As a rule, all restorative treat-ments should follow the principles of mini-mally invasive treatment, preferably using adhesive materials such as composites. Moreover, restorative treatment should always be carried out in conjunction with continuous preventive management, to reduce the effect of the predisposing factors related to gingival recession and ETW (Carvalho etal., 2015). 273 References ConclusionDespite the lack of studies on DH in children, recent findings show that the condition is becoming increasingly frequent in younger patients. If children or adolescents complain about oral pain, dental professionals are urged to carry out a full clinical assessment, and to verify whether the pain is related to exposed dentine. Children who present exposed dentine in their deciduous teeth are more likely to present dentine exposure in their permanent ones. So, staying alert to the clinical signs related to DH allows the dental professional to establish and implement preventive managements as early as possible. ReferencesAinamo, J., Paloheimo, L., Nordblad, A., Murtomaa, H. 1986. Gingival recession in schoolchildren at 7, 12 and 17 years of age in Espoo, Finland. Community Dentistry and Oral Epidemiology, 14(5), 283–6.Amarasena, N., Spencer, J., Ou, Y., Brennan, D. 2011. Dentine hypersensitivity in a private practice patient population in Australia. Journal of Oral Rehabilitation, 38(1), 52–60.Bae, J. H., Kim, Y. K., Myung, S. K. 2015. Desensitizing toothpaste versus placebo for dentin hypersensitivity: A systematic review and meta‐analysis. Journal of Clinical Periodontology, 42(2), 131–41.Bahsi, E., Dalli, M., Uzgur, R., Hamidi, M., Olak, H. 2012. Clinical features of dentine hypersensitivity. European Review for Medical and Pharmacological Sciences, 16(8), 1107–16.Bamise, C. T., Kolawole, K., Oloyede, E., Esan, T. 2010. Tooth sensitivity experience among residential university students. International Journal of Dental Hygiene, 8(2), 95–100.Brännström, M., Lindén, L. A., Aström, A., 1967. The hydrodynamics of the dental tubule and of pulp fluid. A discussion of its significance in relation to dentinal sensitivity. Caries Research, 1(4), 310–17.Canadian Advisory Board on Dentin Hypersensitivity. 2003. Consensus‐based recommendations for the diagnosis and management of dentin hypersensitivity. Journal of the Canadian Dental Association, 69(4), 221–6.Carvalho, T. S., Lussi, A., Jaeggi, T., Gambon, D. 2014. Erosive tooth wear in children. Monographs in Oral Science, 25, 262–78.Carvalho, T. S., Colon, P., Ganss, C., Huysmans, M. C., Lussi, A., Schlueter, N., etal. 2015. Consensus report of the European Federation of Conservative Dentistry: erosive tooth wear–diagnosis and management. Clinical Oral Investigations, 19(7), 1556–61.Chi, D., Milgrom, P. 2008. The oral health of homeless adolescents and young adults and determinants of oral health: preliminary findings. Special Care in Dentistry, 28(6), 237–42.Clayton, D. R., McCarthy, D., Gillam, D. G. 2002. A study of the prevalence and distribution of dentine sensitivity in a population of 17–58‐year‐old serving personnel on an RAF base in the Midlands. Journal of Oral Rehabilitation, 29(1), 14–23.Çolak, H., Aylikçi, B.U., Hamidi, M. M., Uzgur, R. 2012. Prevalence of dentine hypersensitivity among university students in Turkey. Nigerian Journal of Clinical Practice, 15(4), 415–19.Fischer, C., Fischer, R. G., Wennberg, A. 1992. Prevalence and distribution of cervical dentine hypersensitivity in a population in Rio de Janeiro, Brazil. Journal of Dentistry, 20(5), 272–6.Haneet, R. K., Vandana, L. K. 2016. Prevalence of dentinal hypersensitivity and study of associated factors: a cross‐sectional study based on the general dental population of Davangere, Karnataka, India. International Dental Journal, 66(1), 49–57.Holland, G. R., Narhi, M. N., Addy, M., Gangarosa, L., Orchardson, R. 1997. Guidelines for the design and conduct of 7.2 Dentine Hypersensitivity274clinical trials on dentine hypersensitivity. Journal of Clinical Periodontology, 24(11), 808–13.Lussi, A., Carvalho, T. S., 2014. Erosive tooth wear: a multifactorial condition of growing concern and increasing knowledge. Monographs in Oral Science, 25, 1–15.Madruga, M. M., Silva, A. F., Rosa, W. L. O., Piva, E., Lund, R. G. 2017. Evaluation of dentin hypersensitivity treatment with glass ionomer cements: a randomized clinical trial. Brazilian Oral Research, 31, e3.Miller, E. K., Vann, W. E. Jr. 2008. The use of fluoride varnish in children: a critical review with treatment recommendations. Journal of Clinical Pediatric Dentistry, 32(4), 259–64.Murakami, C., Oliveira, L. B., Sheiham, A., Corrêa, M. S. N. P., Haddad, A. E., Bönecker, M. 2011. Risk indicators for erosive tooth wear in Brazilian preschool children. Caries Research, 45(2), 121–9.Oderinu, O. H., Savage, K. O., Uti, O. G., Adegbulugbe, I. C. 2011. Prevalence of self‐reported hypersensitive teeth among a group of Nigerian undergraduate students. Nigerian Postgraduate Medical Journal, 18(3), 205–9.Rees, J. S. 2000. The prevalence of dentine hypersensitivity in general dental practice in the UK. Journal of Clinical Periodontology, 27, 860–5.Rees, J. S., Addy, M. 2002. A cross‐sectional study of dentine hypersensitivity. Journal of Clinical Periodontology, 29(11), 997–1003.Rees, J. S., Addy, M. 2004. A cross‐sectional study of buccal cervical sensitivity in UK general dental practice and a summary review of prevalence studies. International Journal of Dental Hygiene, 2(2), 64–9.Rees, J. S., Jin, L. J., Lam, S., Kudanowska, I., Vowles, R. 2003. The prevalence of dentine hypersensitivity in a hospital clinic population in Hong Kong. Journal of Dentistry, 31(7), 453–61.Shitsuka, C., Mendes, F. M., Corrêa, M. S. N. P., Leite, M. F. 2015. Exploring some aspects associated with dentine hypersensitivity in children. Scientific World Journal, 2015, 764905.Smith, R. G. 1997. Gingival recession. Reappraisal of an enigmatic condition and a new index for monitoring. Journal of Clinical Periodontology, 24(3), 201–5.Veitz‐Keenan, A., Barna, J. A., Strober, B., Matthews, A. G., Collie, D., Vena, D., etal.2013. Treatments for hypersensitive noncarious cervical lesions. Journal of the American Dental Association, 144(5), 495–506.von Baeyer, C. L., Spagrud, L. J. 2007. Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years. Pain, 127(1–2), 140–50.West, N. X., Sanz, M., Lussi, A., Bartlett, D., Bouchard, P., Bourgeois, D. 2013. Prevalence of dentine hypersensitivity and study of associated factors: a European population‐based cross‐sectional study. Journal of Dentistry, 41(10), 841–51.West, N., Seong, J., Davies, M. 2014. Dentine hypersensitivity. Monographs in Oral Science, 25, 108–22.

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