pain is an unpleasant sensory experience associated with actual or potential tissue damage or describe in terms of such damage . dentine hypersensitivity ( dh ) as a state of uneasiness is a short , sharp pain arising from exposed dentine in response to stimuli , typically thermal , evaporative , tactile , osmotic , or chemical and which can not be ascribed to any other dental defect or pathology and affects the quality of life substantially . the occurrence of dh increases throughout life - course , peaking at 3040 years of age . further , sex differences have been found , with females more frequently affected than males , although not always statistically significant . potential causes include progressive erosive tooth wear , vigorous tooth brushing , abfractions or gingival recession ( gr ) . however , gaps still exist in our understanding as to the cause ( s ) of dh . psychological factors and oral health have emerged as important in our understanding of oral conditions and symptoms . biopsychosocial model consider the contributions of biological , psychological , and social factors and their complex interactions in understanding health , illness , and health care delivery . since psychological stress and psychopathological symptoms might be linked to the workings of the endocrine system , the immune system , and the nervous system , the study of their interrelationships may help in the comprehension of the nature of dh . an understanding of diverse factors associated with dh is important because some biological variables may not be good predictors of an individual 's pain reports . although a definitive treatment for dh may not materialize in the very near future , it is important to understand the clinical and psychological factors that contribute to the symptoms . a comprehensive approach should seek to prevent the disease , and enhance focused identification of new dental counseling and appropriate preventive therapy targets . for this reason , we designed a case  control study to identify those potential risk factors associated for dh . a nested case  control study was designed wherein individuals with diagnosis of dh were considered as cases  and a group without diagnosis of dh as  controls  . the cases and controls were nested 1:2 according sex , group of age and socio - economic status ( ses ) . patient volunteers were recruited from the general dentistry clinic from 2011 to 2012 . during the study period , a total of 61 out of 87 cases and 122 out 145 controls were selected and matched . the sample included individuals of both sexes , because of sex - related differences are important in pain perception . males and females differ in their responses to pain , with increased pain sensitivity and risk for clinical pain commonly more observed among women . hallin mentions these differences in pain sensitivity could be attributable to biological mechanisms such as sex hormones . we chose this age range because it has been reported that dh peaks between 30 and 40 years old and also , the literature suggests correlations among dh , tooth wear and acidic beverages in this age range . further , nesting the cases and controls by ses was important since greater pain disability has been reported in lower ses individuals . people in the lowest as compared to the highest ses were twice to 3 times more likely to feel disabled through pain . we excluded individuals whose tooth pain was related to pulp conditions , periodontal pockets and tooth damage , orthodontic appliances or removable dental prosthesis . these conditions probably could become confounding variables that can adversely affect the relation between other predisposing factors , such as psychological characteristics and the presence of dh . patients were queried as to the presence of dh in response to cold , heat , acid , and sweet stimulation at the baseline patient interviews . during clinical examination , individual tooth sensitivity responses were elicited to evaporative ( the air - dry syringe tip was positioned at a distance of 1 cm from the teeth ) , tactile ( a dental explorer was used to assess the tooth surfaces from mesial to distal ) , thermal ( small ice cubes were employed ) , and osmotic ( sweet solution made with 15 g of anhydrous dextrose and 50 ml of water was utilized ) . they assured these surfaces do not display color changes or become soft to the touch , especially in those subjects who perceived discomfort when osmotic method was used to evaluate sensitivity . since only 1.4% of people report pain when they have intact crowns we decided do not expose to patients to any type of x - ray examinations to confirm the presence of interproximal dental caries . information about potential risk factors related to socio - demographic characteristics , dental hygiene , and periodontal disease , acid diet , alcohol consumption and psychological variables was provided by participants in a structured interview . in addition , presence of dental plaque , time , and frequency of tooth brushing , hand utilized to brush the teeth , type of toothbrush and toothpaste , presence of gr and whether they had received periodontal therapy in the last month specially scaling and root planning were obtained . toothpaste was classified in relation to abrasivity according to a reported radioactive or relative dentine abrasivity ( rda ) , in low abrasivity ( 70 ) and medium and high abrasivity ( > 70 ) . we sought dietary information including the consumption of acidic beverages including natural and artificial fruit juices , carbonated and alcoholic drinks ( a previous analysis was done for measuring ph beverages at the chemistry laboratory ) . psychological factors were measured through levels of perceived stress with a simple evaluation scale , a well - documented perceived stress test perceived stress scale ( pss-10 ) in spanish version and psychopathological symptoms using the symptom checklist ( scl-90-r ) in spanish version . the latter scale is a self - report instrument designed to reflect nine symptoms of psychopathology seen in psychiatric and medical patients such as somatization , obsessive - compulsive , interpersonal sensitivity , depression , anxiety , anger - hostility , phobic anxiety , psychoticism , and paranoid ideation . risk factors were expressed as odds ratios ( ors ) and 95% confidence intervals ( ci ) and estimated by using a univariate binary logistic regression analysis . the data were analyzed with the statistical package for social sciences ( spss 17.0 , inc . , a nested case  control study was designed wherein individuals with diagnosis of dh were considered as cases  and a group without diagnosis of dh as  controls  . the cases and controls were nested 1:2 according sex , group of age and socio - economic status ( ses ) . patient volunteers were recruited from the general dentistry clinic from 2011 to 2012 . during the study period , a total of 61 out of 87 cases and 122 out 145 controls were selected and matched . the sample included individuals of both sexes , because of sex - related differences are important in pain perception . males and females differ in their responses to pain , with increased pain sensitivity and risk for clinical pain commonly more observed among women . hallin mentions these differences in pain sensitivity could be attributable to biological mechanisms such as sex hormones . we chose this age range because it has been reported that dh peaks between 30 and 40 years old and also , the literature suggests correlations among dh , tooth wear and acidic beverages in this age range . further , nesting the cases and controls by ses was important since greater pain disability has been reported in lower ses individuals . people in the lowest as compared to the highest ses were twice to 3 times more likely to feel disabled through pain . we excluded individuals whose tooth pain was related to pulp conditions , periodontal pockets and tooth damage , orthodontic appliances or removable dental prosthesis . these conditions probably could become confounding variables that can adversely affect the relation between other predisposing factors , such as psychological characteristics and the presence of dh . patients were queried as to the presence of dh in response to cold , heat , acid , and sweet stimulation at the baseline patient interviews . during clinical examination , individual tooth sensitivity responses were elicited to evaporative ( the air - dry syringe tip was positioned at a distance of 1 cm from the teeth ) , tactile ( a dental explorer was used to assess the tooth surfaces from mesial to distal ) , thermal ( small ice cubes were employed ) , and osmotic ( sweet solution made with 15 g of anhydrous dextrose and 50 ml of water was utilized ) . they assured these surfaces do not display color changes or become soft to the touch , especially in those subjects who perceived discomfort when osmotic method was used to evaluate sensitivity . since only 1.4% of people report pain when they have intact crowns we decided do not expose to patients to any type of x - ray examinations to confirm the presence of interproximal dental caries . information about potential risk factors related to socio - demographic characteristics , dental hygiene , and periodontal disease , acid diet , alcohol consumption and psychological variables was provided by participants in a structured interview . in addition , presence of dental plaque , time , and frequency of tooth brushing , hand utilized to brush the teeth , type of toothbrush and toothpaste , presence of gr and whether they had received periodontal therapy in the last month specially scaling and root planning were obtained . toothpaste was classified in relation to abrasivity according to a reported radioactive or relative dentine abrasivity ( rda ) , in low abrasivity ( 70 ) and medium and high abrasivity ( > 70 ) . we sought dietary information including the consumption of acidic beverages including natural and artificial fruit juices , carbonated and alcoholic drinks ( a previous analysis was done for measuring ph beverages at the chemistry laboratory ) . psychological factors were measured through levels of perceived stress with a simple evaluation scale , a well - documented perceived stress test perceived stress scale ( pss-10 ) in spanish version and psychopathological symptoms using the symptom checklist ( scl-90-r ) in spanish version . the latter scale is a self - report instrument designed to reflect nine symptoms of psychopathology seen in psychiatric and medical patients such as somatization , obsessive - compulsive , interpersonal sensitivity , depression , anxiety , anger - hostility , phobic anxiety , psychoticism , and paranoid ideation . risk factors were expressed as odds ratios ( ors ) and 95% confidence intervals ( ci ) and estimated by using a univariate binary logistic regression analysis . the data were analyzed with the statistical package for social sciences ( spss 17.0 , inc . , among 61 study cases , 24.5% ( n = 15 ) were male and 75.5% ( n = 46 ) were female . our findings showed individuals who used a toothpaste with a rda higher than 70 ( or 1.881 , 95% , ci 1.0103.502 , p = 0.045 ) had gr ( or 2.196 , 95% , ci 1.0204.728 , p = 0.041 ) , and received periodontal therapy in the last month ( or 5.357 , 95% , ci 2.05113.993 , p < 0.001 ) increased the risk for dh . there were some clinical but not statistical associations between dh and type of toothbrush bristles ( or 1.622 , 95% , ci 0.6823.862 , p = 0.271 ) , ph of artificial fruit juices ( or 2.431 , 95% ci 0.8177.227 , p = 0.105 ) , carbonated drinks p / w ( or 1.697 , 95% , ci 0.9113.162 , p = 0.094 ) , or ph of alcohol ( or 3.818 , 95% , ci 0.32044.479 , p = 0.254 ) [ table 1 ] . odds ratios and 95% confidence intervals for dentine hypersensitivity and risk factors ( dental hygiene and periodontal disease , acid diet , and alcohol consumption ) there were no significant associations between dh and psychological factors . however , subjects with higher perceived psychological stress ( or 1.211 , 95% , ci 0.5182.833 p = 0.658 ) , obsessive - compulsive ( or 1.266 , 95% , ci 0.4943.240 p = 0.623 ) and hostility ( or 1.235 , 95% , ci 0.5073.007 p = 0.642 ) symptoms had a clinical greater odds of dh [ table 2 ] . odds ratios and 95% confidence intervals for dentine hypersensitivity and risk factors ( stress and psychopathological symptoms ) biological variations between females and males may make them differentially vulnerable to different oral health problems . even though case control studies can not provide any information about prevalence , we found there existed a difference in the number of females and males that were recruited in the  case  group ( sex ratio = 3:1 ) . the observed sex differences in this study may reflect the fact that more females than males seek care , as well as whether there are sex differences in dh prevalence . however , if dh is more prevalent in females , emotional imbalances may be translated into this particular health problem , as well . dh has been associated with diverse factors among them chronic trauma ( tooth brushing ) , dental erosion , gastric regurgitation or dietary substances , anatomical aspects , and gr caused by periodontitis or periodontal surgery . our outcomes revealed gr ( or 2.196 , 95% , ci 1.0204.728 , p = 0.041 ) and periodontal therapy such as scaling and root planning ( or 5.357 , 95% , ci 2.05113.993 , p < 0.001 ) were the major predisposing factors for dh . the occurrence of sensitivity on denuded root surfaces as a result of gr or following periodontal therapy could be named as  root sensitivity  ( rs ) , a concept suggested by the european federation of periodontology or cervical dh . in this sense , von troil et al . in a systematic review about the prevalence of dh / rs following periodontal therapy concluded this therapy cause rs and there are more than 50% of the patients from the selected studies who experienced this condition after periodontal treatment with an increased intensity during the next 3 weeks . furthermore , lin and gillam determined that about 1 week following periodontal therapy , the rs / dh was ranging from 36.8% to 100% after which the prevalence subsequently decreased . and lin and gillam mentioned that there are a lack of standardized data relating to evaluation of dh / rs following periodontal therapy , for this reason , some aspects about dh / rs might be unclear . it seems that this therapy may remove from 20 to 50 micrometers of cementum exposing the dentinal tubules to external stimuli . due to different cementum varieties that are found in human teeth , we really do not know whether dh can be attributed in 100% to the scaling and root planning . our findings about risk factors and the presence of dh / rs also confirm the association between this condition and oral hygiene products such as toothpaste abrasivity ( or 1.881 , 95% , ci 1.0103.502 , p = 0.045 ) . addy and west mentioned tooth brushing with most toothpastes removes the smear layer to expose tubules and can exacerbate erosive loss of dentine . suggest that abrasivity of the toothpaste needs to be moderate in order to prevent removal of the underlying enamel and any exposed dentine . we found a clinical but not statistical association among dh and several risk factors reported in the literature that would promote the loss of enamel and lead to dh . for example , it has been demonstrated that toothbrushes with medium and hard bristles cause more abrasion than soft toothbrushes . our findings also showed ph of artificial fruit juices and frequency of carbonated drinks p / w were clinically associated with dh . acidic soft drinks that include both fruit juices and carbonated beverages , induce the dissolution or erosion of dental enamel . observed in patients with tooth wear that this condition may be initiated whether they consume acidic beverages more frequently . in the same way mulic et al . demonstrated that there was a difference between wine tasters compared to nonwine tasters , the exposed group had a higher prevalence and more severely affected teeth surfaces . our results suggest that perceived psychological stress , obsessive - compulsive , and hostility symptoms may be risks factors for dh . psychological stress increases the blood pressure , which may affect pulpal blood vessels and produce a severe sensitivity response to external stimuli . obsessive - compulsive symptoms may be related to a cleaning compulsion favoring the frequency and the intensity of tooth brushing which may be associated with gr and loss of enamel and dentine . otherwise , biological mechanism of hostility may contribute to the development of a late - adaptation syndrome with anxiety . , a chronic bruxism could favor the apparition of abfraction and attrition , as a result a more severe dh may be perceived . since dh has been a persistent condition ( chronic entity ) and the therapies seem do not give long - lasting relief ; it is very important to assess different risk factors in order to design more oral health education programs and develop more effective treatment options . consideration of psychological factors is important in assessing dh as well as other dental conditions . our sample size was inadequate to determine statistically significant associations between some risk factors and the presence of dh . finally , a small number of extant studies that have assessed dh etiology provide a limited context for comparison of our findings . dh is relatively common and significant oral health problem . oral hygiene products and periodontal conditions are important risk factors for dh . individuals with perceived psychological stress , obsessive - compulsive , and hostility symptoms increase a clinical risk for this entity . targeting to dental counseling focused on oral hygiene products , periodontal therapy and a psychological evaluation may be promising in dh prevention . the study was financially supported by the comit para el desarrollo de la investigacin ( conadi ) at cooperative university of colombia . the study was financially supported by the comit para el desarrollo de la investigacin ( conadi ) at cooperative university of colombia .
objective : to identify the clinical and psychological risk factors associated with dentine hypersensitivity ( dh ) in order to provide an early diagnosis and preventive therapy.materials and methods : a nested case 
 control study was design between 2011 and 2012 . 
 a total of 61 dh cases and 122 controls participated in this investigation . 
 cases and controls were matched for sex , group of age and socioeconomic status in a ratio of 1:2 . 
 dh to different stimuli such as cold , heat , acid , and sweet was asked in patient interviews , and dental examinations were used to detect dh . 
 clinical and psychological risk factors such as dental hygiene , periodontal disease , acid diet , alcohol consumption , psychological stress , and psychopathological symptoms were inquired . 
 psychological stress was measured through the pss-10 and psychopathological symptoms were evaluated by scl-90-r in spanish . 
 descriptive and univariate binary logistic regression analysis were performed to estimate the association between clinical and psychological risk factors and the presence of dh.results:toothpaste abrasivity ( odds ratio [ or ] 1.881 , 95% confidence interval [ ci ] 1.0103.502 , p = 0.045 ) , gingival recession ( or 2.196 , 95% ci 1.0204.728 , p = 0.041 ) , and periodontal therapy ( or 5.357 , 95% ci 2.05113.993 , p < 
 0.001 ) were associated with dh . 
 subjects with perceived stress ( or 1.211 , 95% , ci 0.5182.833 , p = 0.658 ) , obsessive - compulsive ( or 1.266 , 95% , ci 0.4943.240 , p = 0.623 ) and hostility ( or 1.235 , 95% , ci 0.5073.007 , p = 0.642 ) symptoms had a clinical greater odd of dh.conclusion:oral hygiene products and periodontal conditions are important risk factors for dh . 
 individuals with perceived stress , obsessive - compulsive , and hostility symptoms may increase a clinical risk for this entity . 
 targeting to dental counseling focused on oral hygiene products , periodontal therapy and a psychological evaluation may be promising in dh prevention .