When pain is in multiple quadrants

When a patient presents complaining of pain to temperature changes in all parts of the mouth, think dentine hypersensitivity. Differential diagnoses such as pain to caries, cracked teeth  or debonded restorations tend to have different symptoms. This is due to the latter symptoms being caused by a pulpitis. Pain from pulpitis generally waxes and wanes and rarely will affect all quadrants at once whereas pain from dentine hypersensitivity due to toothbrush abrasion, erosion or recession will typically occur in a less inflamed pulp and the causes for these generally affect all quadrants simultaneously.

The easiest way to isolate dentine hypersensitity as the cause is to pre test with cold water swished around, Apply a varnish such as Duraphat or MI varnish to the exposed dentine surfaces only and then retest with the cold water. If there is a marked improvement then dentine hypersensitity is the likely culprit.

Most commonly, undiagnosed reflux and a hard toothbrushing habit must be addressed as well as symptomatic relief from sensitive toothpaste. In terminal cases, restorative work can be commenced but ideally the causes will be controlled as if they persist they will cause breakdown of the restorations.