Patent Application
20070054243
The present invention is directed to a method and apparatus for reducing dental sensitivity particularly sensitivity resulting from exposed dentin that has lost its natural coverings of enamel or cementum.
Dentin is 25% fluid by volume, which is located almost completely within the tubules. The diameter of the tubules averages 2.5 microns at the pulp and 0.8 microns at cementum side. The tubules are devoid of nerve tissue except for very short extensions. The nerve cell bodies reside in the pulp and sense only pain. Over time the pulp may lay down additional dentin in the tubules known as reparative dentin which may produce long-term relief from hypersensitivity. However, short-term relief usually comes either from surface occlusion of the dentinal tubules by calcified materials or from a direct desensitizing effect on the pulpal tissues.
When the dentinal tubules become exposed to the oral cavity by trauma, disease, or by dental treatment, many patients experience some hypersensitivity, usually to cold. Exposed root surfaces are a prerequisite for dentinal hypersensitivity, but not all exposed dentin is hypersensitive. It is virtually impossible to predict which patients will experience dentinal hypersensitivity. Gingival recession causing exposure of dentin can result from destructive mechanical habits, ongoing tooth eruption as adjacent teeth are lost, and the result of prominent tooth position in the arch resulting in dehiscences.
Loss of gingival attachment may also occur due to periodontal diseases, the intentional outcome of periodontal surgery for pocket reduction and toothbrush/dentifrice abrasion. Root planning or even overly aggressive rubber cupping and jet polishing may cause minor gingival recession. Even patients who improve their oral hygiene practices can experience some gingival recession as a result of shrinkage of gingival tissues as inflammation resolves.
The differential diagnosis of teeth with dentinal hypersensitivity includes a list of reasons that patients may perceive intraoral discomfort. Carious lesions often manifest discomfort that is similar to dentinal hypersensitivity. It is also very common for teeth that have had recent restorative treatment to exhibit symptoms of pain upon exposure to cold or hot. Other restorative problems that may exhibit similar symptoms include open or defective margins on restorations, recurrent caries, or fractured restorations.
Patients that have had recent scaling and root planning often experience transient dentinal hypersensitivity. Also included in the differential diagnosis for hypersensitive dentin are sinusitis, pulpal necrosis, cracked tooth syndrome, and hyperemia from hyperocclusion, bruxism or parafunctional habits. Any condition that causes facial pain may be described as hypersensitivity by the patient, including myofascial pain or temporomandibular disorders. All of these entities can potentially react to mechanical, chemical, or thermal stimuli, but they can easily be differentiated from hypersensitive dentin by the appropriate tests.
There are many stimuli that can potentially produce discomfort in patients with dentinal hypersensitivity. Pain-producing stimuli are generally grouped as follows: mechanical-toothbrush contact, instrument touch, desiccation with air; chemical—citrus, sour, or sweet foods and beverages, and acidic bacterial plaque by-products; and thermal—extremes of hot or cold food, liquids, or inhaled air.
Over the years several theories about the mechanism of tooth pain transmission have been espoused. The most widely accepted is the “hydrodynamic” theory, which suggests that pain-producing stimuli cause the fluid in the tubules to move, thus triggering the nerve receptor at the pulpal end of the tubule. The perception of pain seems to be modified by systemic mechanisms within the individual and the patient's ability to produce natural painkillers such as endorphins. This is apparent in individuals who are already experiencing other forms of stress who will report heightened dentinal sensitivity.
Treatment choices are based on the patient profile, history, and clinical evidence. The features of an ideal treatment for dentinal hypersensitivity would be one which is not painful, easy to apply, rapid acting, profound in effect, long lasting, non-staining, predictable, and not irritating to the pulp. This ideal treatment could be applied by the patient, by the dental professional, or both. Unfortunately, the ideal treatment for dentinal hypersensitivity has not yet been developed, so the dental professional must use the available treatments in a logical sequence to achieve relief for the patient.
The present invention provides for such an ideal treatment.
A method in accordance with the present invention for treating dentin sensitivity in a patient generally includes applying an oxidizing gas onto the dentin, monitoring the dentin sensitivity, and in response to the monitoring, ceasing application of the oxidizing gas. More particularly, the oxidizing gas includes gaseous ozone which is applied onto the dentin.
The application to the dentin may be done through carious lesions or alternatively, the application of ozone onto the dentin may include application of gaseous ozone dome through cementum.
Still, another method for applying gaseous ozone onto the dentin includes applying gaseous ozone through a cracked tooth.
More specifically, monitoring the dentin sensitivity may include exposing a tooth with dentin sensitivity to a hot or cold temperature and eliciting a response from the patient.
Alternatively, the monitoring of dentine sensitivity may include exposing a tooth with dentin sensitivity to a chemical and eliciting a response from the patient. Pressure may also be applied to the tooth.
Any suitable monitoring system may be utilized such as any set forth in U.S. Pat. No. 5,984,368, “Patient Condition and Pain Location Intensity Communication Apparatus and the Method”, issued Nov. 16, 1989. This patent is to be incorporated herewith in its entirety by this specific reference thereto or examples of monitoring dentin sensitivity.
A method of treating dentin sensitivity may alternatively be considered as penetrating dentin tubuli with an oxidizing gas, monitoring the dentin sensitivity, and in response to the monitoring, ceasing penetration of the dentin tubuli with oxidizing gas.
Apparatus for treating dentin sensitivity in a patient generally includes a source of oxidizing gas, a handpiece for delivering gas to a tooth with dentin sensitivity along with a cup attached to the handpiece for receiving the gas and exposing a selected area of the tooth to the gas.
Additionally, means are provided for eliciting a response from the patient in regard to the dentin sensitivity. The hereinabove incorporated U.S. Pat. No. 5,984,368 also provides apparatus which may be useful in accordance with the present invention and is further incorporated by this reference support for that purpose.
The apparatus further includes ozone as the oxidizing gas and in addition a source of reductant may be provided and interconnected with the handpiece for flushing the gas from the cup.
Further, the source of oxidizing gas may include an ozone pump and an aspiration pump may be provided along with an aspiration line connected to the handpiece coordinate with circulation of the gas into another cup.
In addition, a controller may be provided for regulating the ozone and aspiration pumps in order to circulate the gas in and out of the cup at a pressure insufficient to escape past a ceiling engaged between the cup and the tooth.
Still more particularly, the means for eliciting a response from the patient may include an applicator for introducing hot or cold gas or liquid to the tooth. Alternatively, the means for electing a response from the patient may include an applicator for introducing a chemical to the tooth or pressure onto the tooth.
The advantages and features of the present invention will be better understood by the following description when considered in conjunction with the accompanying drawings, in which:
With reference to
As illustrated in
Ozone is delivered at a pressure, concentration and for a period of time sufficient to penetrate dentin tubuli and kill substantial all of the micro-organism therewith. Specific examples of the use of ozone are set forth in U.S. Pat. Nos. 6,409,508 and 6,454,566 which are to be incorporated herewith in their entirety by this specific reference thereto.
As shown in
Many different sized and shaped cups may be utilized, as for example shown in
The applicator 62 facilitates the method of the present invention which includes applying an oxidizing gas onto dentin by way of carious lesions, breached cementum, or through a cracked tooth, monitoring dentin sensitivity through the applicator with patient elicitation, and in response to the monitoring, ceasing application of the oxidizing gas.
A further cup embodiment 64 is shown in cross-section in
While a resilient edge or sidewall may be used to couple the cup to the selected area 38 on the tooth 40, it should be appreciated that a separate sealant 68 (See
Another embodiment of a cup 70 is shown in cross-section in
All of the cups 34, 64, 70, cross-sectionally illustrated in
As shown in
With reference again to
A controller 126, which may be of any conventional circuit design, is provided for regulating the ozone and aspiration pumps 22, 120 in order to circulate the gas into and out of the cup chambers 92, 94, 96 at a pressure insufficient to permit escape of the gas past a sealed engagement between the cups 34, 64, 70 and teeth 40, 86, 88. Control of the gas flows may also be effected through valves 127, 127 regulated by the controller 126.
Additionally, the apparatus 10 may include a reductant source 128, which is in fluid communication with the cup chambers 92, 94, 96 through lines 30, 130 and a parastalic pump 131. The reductant, which may be a solution of thiocyanate or peppermint, is utilized to flush the cup chambers 92, 94, 96 of oxidizing gas. The oxidizing gas is flushed into the aspiration line 122 following ozone treatment of the tooth 40, 86, 88. The reductant is then aspirated through line 122 and into a waste accumulator 132.
Any residual ozone is then aspirated from the accumulator 132 through the line 124 and into a canister 134 through line 136 for final elimination of the ozone. Thus, the apparatus 12 provides for a totally closed system for the application and removal of ozone to and from teeth 40, 86, 88.
It should also be appreciate that when the cups 34, 36, 64 are utilized between teeth 40, 138 (not shown in
A method in accordance with the present invention utilizes a handpiece 150 with cup 152 to applying oxidizing gas 154 to the dentin 156 of a tooth 158 for penetrating dentin tubuli 160, 162. Typically, 99.9% of germs are killed after 20 seconds, however, for deeper lesions a time of 30-60 seconds may be utilized.
As illustrated, ozone penetrates into the tubuli and oxidizes amino acids present in the dentin fluid into CO2 and H2O, see
The acidic and metabolic products of the bacteria and the bacteria themselves are immediately dissolved by the ozone and immediately loose their effect. That means for the time being no chemical or physical transmission is present.
Accordingly, ozone ensures a germ and acid free content in the tubuli and when the patient feels the pain being relieved, by monitoring through temperature, pressure, or chemicals, the ozone has reached the tubuli and the same time has left the dentin germ-free.
It has been found that, as shown, in
In fact, it is found that this state is stable until the dentin fluid regenerates enough quantity to reach the tubulum entrance. This varies from patient to patient and is also dependent upon the success of the remineralization process within the tubulum. However, the desensitation has been found to be effective for between about 3 and about 6 months.
Although there has been hereinabove described a specific method and apparatus for treating dentin hypersensitivity in accordance with the present invention for the purpose of illustrating the manner in which the invention may be used to advantage, it should be appreciated that the invention is not limited thereto. That is, the present invention may suitably comprise, consist of, or consist essentially of the recited elements. Further, the invention illustratively disclosed herein suitably may be practiced in the absence of any element which is not specifically disclosed herein. Accordingly, any and all modifications, variations or equivalent arrangements which may occur to those skilled in the art, should be considered to be within the scope of the present invention as defined in the appended claims.
