The Complete Guide to Sensitive Teeth and Dentine: a domain map from mechanism through differential diagnosis to the evidence spectrum of management｜證據鏈

The Complete Guide to Sensitive Teeth and Dentine: a domain map from mechanism through differential diagnosis to the evidence spectrum of management｜證據鏈

F-Units (fact-unit ledger)

F1｜The precondition of dentine hypersensitivity is that dentine is exposed to the oral environment

• Source #: #12｜confidence: high｜basis: peer_reviewed (PMID 24571559)｜geo: universal｜period: Compend Contin Educ Dent, 2014
• caveat: That journal is of a continuing-education character, and its level of evidence stands below that of a systematic review; only its qualitative framework is taken here, and it is not used for any quantified claim.

F2｜The mainstream mechanistic explanation of the pain is fluid movement inside the dentinal tubules (the hydrodynamic theory)

• Source #: #10｜confidence: high｜basis: peer_reviewed (PMID 32762733)｜geo: universal｜period: BMC Oral Health, 2020
• caveat: It is "a widely accepted explanation", not a single mechanism proven by experiment; the same review states plainly that the underlying neurosensory mechanisms remain unclear to this day (Fn89). This item supports no description of the "character" of the pain (brief / sharp / ceasing when the stimulus ceases) — no abstract retrieved in this round carries verbatim wording of that kind, so that description has been deleted from the body text. See F3.

F3｜The literature has proposed five mechanisms of dentinal sensation that are not mutually exclusive; the pulpal response to injury may alter their relative contribution, and pulpal inflammation may lead to neuronal sprouting and peripheral sensitisation

• Source #: #11｜confidence: moderate｜basis: peer_reviewed (PMID 34302871)｜geo: universal｜period: J Endod, 2021
• caveat: This is a narrative review; "may" is the modality of the source wording and must not be rewritten as an inevitability. The direction of inference in the source is "the pulpal response to tissue injury → the relative contribution of each mechanism may change", and it must not be read in reverse as "the character of the symptom changes → the composition of the mechanisms changes" (the source does not discuss any correspondence between the character of a symptom and the mechanisms). This item supports no diagnostic inference about any individual symptom.

F4｜Sensitivity is statistically significantly associated with erosive tooth wear and with gingival recession; it is also significantly associated with heartburn; users of a powered toothbrush show lower related indices

• Source #: #13｜confidence: moderate｜basis: peer_reviewed (PMID 39317300)｜geo: universal｜period: J Dent, 2024; a seven-country cross-sectional study
• caveat: A cross-sectional design can show association only and cannot support a causal inference. That abstract does not report an association between sensitivity and caries, and it must not be inferred in reverse that sensitivity "has nothing to do with caries".

F5｜There is no direct evidence to confirm that brushing is the sole cause of gingival recession or of non-carious cervical lesions; local factors and patient-related factors are highly relevant

• Source #: #04｜confidence: high｜basis: clinical_guideline (consensus report of the 11th European Workshop on Periodontology, PMID 25626357)｜geo: universal｜period: J Clin Periodontol, 2015
• caveat: "No direct evidence" denotes a gap in the evidence; it is not proof that brushing is unrelated. This item constitutes no instruction on any method of brushing.

F6｜The reported prevalence of sensitivity in the adult population varies widely: 57% (quoted in an overview) and 75.9% (measured clinically in seven countries, Schiff ≥ 1)

• Source #: #12 (57%) / #13 (75.9%)｜confidence: moderate｜basis: peer_reviewed (PMID 24571559 / 39317300)｜geo: universal｜period: 2014 / 2024
• caveat: The two figures were measured in different ways; they may neither be compared with one another nor averaged; the source wording behind the 57% of #12 is `up to 57 percent`, an upper bound rather than a point estimate, and the body text marks it as such; the authors of #13 state themselves that their prevalence is higher than most of the existing literature. The difference between the two is 18.9 percentage points, and the body text writes only "nearly nineteen percentage points"; it must not be written as "more than twenty percentage points" (a hit corrected in this round).

F7｜The prevalence of sensitivity declines after about the ages of 38-47; the proportion of incisors affected is higher than that of molars

• Source #: #13 (the age curve) / #W9 (the distribution by tooth position)｜confidence: low｜basis: peer_reviewed (PMID 39317300 / 37434150)｜geo: universal｜period: 2024 / 2023
• caveat: The two are cross-sectional studies from different countries with different sampling, and the conclusion on the distribution by tooth position comes from a single-country sample (Turkey, 259 women plus 209 men, aged 18–72, Fn92), and the denominator of the percentages is at the level of teeth (12,048 teeth in all, Fn93) and not of people; it must not be generalised into a universal pattern, nor compared with prevalence figures whose denominator is people. All three places in the body text that mention #W9 have had the country, the sample and the level of the denominator added to them one by one (a hit corrected in this round).

F8｜Within the domain there is to this day no universally accepted guideline for differential diagnosis or for the selection of treatment; the similarity of symptoms across several conditions makes diagnosis confusing

• Source #: #10｜confidence: high｜basis: peer_reviewed (PMID 32762733)｜geo: universal｜period: 2020
• caveat: This is a statement of 2020; this round retrieved no evidence that a universal guideline has appeared since, but the existence of regional guidelines is not excluded.

F9｜Correct diagnosis requires the five elements of patient history, clinical examination including radiographs, a variety of tests, identification of risk factors and differential diagnosis; the consensus documents separately established a diagnostic algorithm and a clinical decision threshold

• Source #: #12 (the five elements) / #02 (the algorithm) / #01 (the decision threshold)｜confidence: high｜basis: clinical_guideline plus peer_reviewed (PMID 24571559 / 12662460 / 35049250)｜geo: universal｜period: 2014 / 2003 / 2022
• caveat: #02 is a consensus of 2003 and is comparatively old; all three belong to the level of expert consensus or of overview, and none is the conclusion of a randomised controlled trial.

F10｜The clinical gaps disclosed by a nationwide survey include under-diagnosis and incorrect differential diagnosis; the society accordingly recommends routine screening and has put forward a classification system based on case definitions

• Source #: #03｜confidence: moderate｜basis: clinical_guideline (official recommendations of the ISP, PMID 35959314)｜geo: universal｜period: J Indian Soc Periodontol, 2022
• caveat: The subjects of the survey were dentists in India (3,000 of them, in December 2020, Fn95), and it must not be extrapolated into a picture of clinical practice worldwide; every place in the body text that cites this item (§4-1, §10, §11) has to carry the country, and the places in §10 and §11 where it had been left out have been completed in this round. The PublicationType of that paper in PubMed is not marked Consensus Statement; it belongs to the level of a society's official recommendations.

F11｜A cracked tooth is an incomplete fracture that starts from the crown and progresses in a subgingival direction; the unknown extent of the crack makes diagnosis difficult; there is as yet no consensus in the literature on restorative and endodontic management; the ESE has issued a position statement

• Source #: #W5 (the definition / the absence of consensus / survival and monitoring) / #W6 (the difficulty of diagnosis) / #W4 (the ESE position statement)｜confidence: moderate｜basis: clinical_guideline (#W4, PMID 39840523) plus peer_reviewed (PMID 35809233 / 33770422)｜geo: universal｜period: 2025 / 2022 / 2021
• caveat: The abstract of #W4 states its scope and its character only and contains no citable specific criterion; this article quotes none of its full-text content verbatim.

F12｜The five-year probability of survival of a restored cracked tooth is recorded in a review as 74.1–96.8%

• Source #: #W6｜confidence: low｜basis: peer_reviewed (a narrative review, PMID 33770422)｜geo: universal｜period: Eur J Prosthodont Restor Dent, 2021
• caveat: The range is extremely wide and comes from a narrative review rather than a meta-analysis; the source also marks the prognosis as guarded. It serves as a reference for the order of magnitude only and must not be taken as the expectation for an individual tooth.

F13｜Desensitising management has two lines of action only (occlusion of the tubules / blocking of the pulpal nerve response); most agents act at the symptom end, and the long-term outcome is uncertain

• Source #: #04 (the two lines) / #10 (the symptom end and the long-term uncertainty)｜confidence: high (the classification of mechanisms) / moderate (the long-term uncertainty)｜basis: clinical_guideline plus peer_reviewed (PMID 25626357 / 32762733)｜geo: universal｜period: 2015 / 2020
• caveat: "The long-term outcome is uncertain" is the wording of the source and does not amount to ineffectiveness; nor may it be inferred in reverse that "effective in the short term means the cause has been dealt with".

F14｜Evidence at the level of ingredients for at-home desensitising toothpaste: a network meta-analysis of 125 RCTs and 12,541 people shows CSP to be favourable for all three stimuli relative to a fluoride toothpaste comparator (high to moderate certainty); a network meta-analysis of 32 studies and 4,638 people recommends stannous, potassium ± stannous or arginine formulations twice daily; a meta-analysis of 53 studies and 4,796 people lists seven classes of effective ingredient (with the evidence graded at two tiers, low and moderate) and does not advise those containing strontium or amorphous calcium phosphate

• Source #: #06 / #07 / #08｜confidence: moderate｜basis: peer_reviewed (PMID 32037944 / 36753794 / 29787782)｜geo: universal｜period: 2020 / 2023 / 2018
• caveat: The three analyses reach conclusions pointing in different directions on strontium-containing agents (#08 does not advise them vs #04 shows an effect), and they must be set out side by side rather than one being chosen; all of them are short-term pain outcomes, not long-term outcomes on the cause; this article involves no brand. Four corrections were made in this round: ① the comparator for the effect size in #06 is fluoride toothpaste (Fn90), not a placebo or "using no agent at all", and both the body text and the FAQ now write this out; ② the lower bound of the confidence interval of the cold-stimulus item in #06 is only 0.34, close to zero, and the body text now discloses the interval; ③ the seven classes of ingredient in #08 are not level in their grade of evidence (strontium, potassium plus strontium, and potassium plus stannous fluoride are low-quality, the other five moderate, Fn91) and must not be flattened into a single list; ④ the source wording of #07 is `stannous` only, with no specification of stannous fluoride, and the body text has been changed accordingly.

F15｜The gold standard treatment modality in this domain has not yet been established; the data on 11 agents and 105 RCTs could not be meta-analysed because of heterogeneity; the evidence on the relative effectiveness of professionally applied agents is limited

• Source #: #05｜confidence: high｜basis: peer_reviewed (systematic review of the EFP workshop, PMID 25495777)｜geo: universal｜period: J Clin Periodontol, 2015
• caveat: The search closed in July 2014, so evidence appearing after it (such as #06 and #07) is not included; this item is used to mark the ceiling of the evidence, not to deny the effect of any individual agent.

F16｜Evidence for in-office management: professional prophylaxis pastes containing arginine and CSP show efficacy; 15% CSP is superior to the control for sensitivity after periodontal therapy (low grade of evidence); bioactive glass in 30 studies and 2,845 people shows a reduction of the sensitivity response (a time window up to 12 weeks, its long-term effect similar to that of other agents); lasers in 34 studies show that pain symptoms can be controlled, but no protocol could be established and most follow-up periods have a ceiling of 6 months

• Source #: #04 / #09 / #W8 / #W7｜confidence: moderate (the short-term outcomes of bioactive glass and of lasers) / low (15% CSP)｜basis: clinical_guideline plus peer_reviewed (PMID 25626357 / 26544035 / 40462050 / 37023343)｜geo: universal｜period: 2015 / 2015 / 2025 / 2023
• caveat: All the in-office conclusions are short-to-medium term; no direct comparison supports one in-office treatment being superior to another; this article gives no instruction on procedure or dose. A methodological qualifier was added to the laser item in this round (a hit corrected in this round): of the 34 studies in #W7 only 11 entered the quantitative analysis, and what the meta-analysis compared was "the average pain before treatment vs the average pain after 3 months of treatment" (Fn94), which is a within-group comparison of before and after and not a comparison against a control group, so a placebo effect and natural variation cannot be excluded; its only between-group comparison (high power vs low power) did not reach statistical significance. The words "an effective option" can therefore be read under that qualifier only.

F17｜Sensitivity after periodontal treatment (scaling / root planing) is a clinical phenomenon that has been studied: the EFP workshop took its management into the remit it reviewed; an RCT recruited 75 patients with sensitivity after SRP to compare three regimens

• Source #: #04 / #14｜confidence: moderate｜basis: clinical_guideline plus peer_reviewed (PMID 25626357 / 33552783)｜geo: universal｜period: 2015 / 2021
• caveat: #14 is a single-centre, 75-patient, short-term trial; this round retrieved no systematic review with time to resolution (in days or weeks) as its outcome measure, so no figure in days may be given.

F18｜In-office whitening carries a high risk of sensitivity, the cause being the inflammatory process of the pulpal tissue; in at-home whitening a high concentration increases the risk and the intensity of sensitivity, though the average intensity is mild and the quality of evidence is low

• Source #: #W3 (the mechanism and the risk) / #W1 (the concentration-risk relation and the qualifiers)｜confidence: low (because the QoE is low)｜basis: peer_reviewed (PMID 31446977 / 40484311)｜geo: universal｜period: JADA, 2019 / J Dent, 2025
• caveat: #W1 states of itself that the quality of evidence is low and that most of the included studies are at high risk of bias; "a high concentration carries a higher risk" must not be read as any recommendation on the choice of concentration — that decision belongs to the dentist. Two further points were added in this round: ① the mechanism sentence of #W3 comes from the BACKGROUND section of that paper, whose PICO is "can anti-inflammatory and analgesic drugs prevent sensitivity after whitening"; what its GRADE rates as high level is the outcome that the drugs are ineffective, not the mechanism itself, so §8-1 and §11 both mark this sentence as a background statement; ② the specific figures for the concentration tiers and the scale of the studies have been removed from the body text (the former Fn73 / Fn74 were retired), that sub-topic belonging to canonical card KM-DENTAL-19, and this article keeps only a one-sentence summary plus a downstream link.

F19｜Shortening the time for which an at-home whitening gel is used can significantly reduce events of sensitivity, but it should be applied with caution (the parameters of colour change perform better when the recommended time is used)

• Source #: #W10｜confidence: moderate｜basis: peer_reviewed (PMID 39623180)｜geo: universal｜period: Clin Oral Investig, 2024
• caveat: This is the description of a trade-off, not an instruction for practice; this article gives no recommendation on the time or the concentration of any whitening regimen.

F20｜The effect of desensitising toothpaste in the whitening setting varies with the regimen (an effect is shown for at-home whitening with high-concentration carbamide peroxide and for single-session in-office whitening; no effect is shown for at-home whitening with a low concentration or for in-office whitening over two sessions)

• Source #: #W2｜confidence: low｜basis: peer_reviewed (PMID 39078468)｜geo: universal｜period: Clin Oral Investig, 2024
• caveat: Only 5 studies and 387 people, and the sub-group samples for each setting are smaller still; it must not be extrapolated to whitening regimens that have not been studied.

F21｜High-level evidence does not support the use of anti-inflammatory and analgesic drugs to prevent the sensitivity caused by in-office whitening

• Source #: #W3｜confidence: high (the source marks the GRADE as high level)｜basis: peer_reviewed (PMID 31446977)｜geo: universal｜period: JADA, 2019
• caveat: This item is a negative conclusion about "one preventive route not being supported"; it must not be read in reverse as any recommendation on medication, and this article contains no instruction on medication.

F22｜Data on the side effects of CSP use are scarce (only two studies reported them)

• Source #: #09｜confidence: low｜basis: peer_reviewed (PMID 26544035)｜geo: universal｜period: PLoS One, 2015
• caveat: Scarce data are not the same as safety; this is a record of a gap in the evidence on the safety side.

Compliance note

• This article is a compilation of health education and of medical updates, is general health-education information, does not solicit medical business, does not constitute medical advertising, and does not constitute diagnostic or treatment advice.
• This article provides no amount, charge or reimbursement information, recommends no medical institution, dentist, brand or product, contains no identifiable individual case, and carries no third-party subjective comment on a course of treatment.
• Every statement in this article about desensitising ingredients and management is a compilation of the literature at the level of the ingredient or the method, not a claim about the performance of a product; products for oral cleaning cannot replace diagnosis and treatment.
• This article contains no instruction on medication, dose or procedure; the citations that involve drugs present a negative research conclusion only.
• All the figures in this article are research results at population level, and the actual treatment and its results vary from person to person and have to be assessed by a dentist before anything is decided.
• This article is a draft: it has not passed the publication gate, the four language versions are not yet complete, and it is for internal review only.

Source list

Date of retrieval / measurement: 2026-08-06 (all sources measured the same day with curl / PubMed E-utilities, HTTP 200, verbatim spans compared programmatically and passed)

Sources already verified in the anchor file (`ida-pillars/anchors/P16-anchors.md`)

Statement in the opening section of the anchor file: the official_statement tier is absent in this domain (the NIDCR topic page measured 404, and MedlinePlus has no topic page on the subject), so the authoritative sources of higher standing fall in substance within clinical_guideline; under the owner's decision of 2026-08-06 that the whole line is global, Taiwanese regulations, national health insurance and health-bureau content are not used as the basis of any medical or system claim in this article, and local systems are linked downwards without exception to the corresponding TW canonical cards and to P12.

WRITER-ADDED SOURCES (added in the writing of this article, with measured evidence)

Reason for adding: the anchor file covers four patient questions, but the scope of this domain article also includes (i) sensitivity after whitening (the dose-risk relation, desensitising strategies, the negative conclusion on drug prophylaxis), (ii) the differentiation from a cracked tooth (definition, difficulty of diagnosis, official position statement, prognosis), (iii) lasers and bioactive glass within the spectrum of in-office management, and (iv) independent cross-sectional support for the risk factors and the distribution by tooth position. All 10 items below were measured locally with curl (HTTP 200) and passed a programmatic verbatim comparison; the anchor file was not modified.