So, I have this patient who reported that she has a sensitive tooth. Upon further query and examination I determined that this was not irreversible nor reversible pulpitis and that she just had thermal sensitivity, and I also discovered that it was tooth #30. I gave her the usual advice of using a sensitive strength toothpaste, esp on the tooth, and to use Fl- mouthwash bid and to not eat or drink for 30 min after. If that didn't work then we can try a "sealer" (desensitization with resin bonding) that will for sure work. At her next recare exam she stated that the tooth is still VERY sensitive and that she would like to try the "sealer".

At the appointment for bonding desensitization I followed the usual protocol that works instantly on everyone:

-isolate the tooth (isodry)

-thuroughly cleanse the tooth with sodium bicarbonate air polisher

-etch for 20 sec

-apply microprime G and let it sit for one minute, dry and apply again for a minute and dry

-apply coat of bonding agent (adper easy bond), air thin and light cure, apply second coat of bonding agent (adper easy bond).

This always works instantly... Except this time. This patient was numbed because she didn't want to feel air and water on her ultra sensitive tooth, so I didn't have the typical instant "viola" moment where the patient is amazed that their tooth is no longer sensitive. Instead she calls me back the next day to tell me that the tooth is still VERY sensitive and that now she cannot even brush the tooth. So, I had her come in that day to evaluate. Upon examination I found that the explorer and air did cause sensitivity on #30 at the gumline, especially in the mesialbuccal area. I offered to do the bonding desensitization procedure again at no charge and she accepted.

So, I got her numb and then repeated the same procedure as before. However, I did three things differently this time: 1) I placed retraction cord so as to gain subgingival access, 2) I used clearfil SE Bond, and 3) I used a paintbrush-style microbrush instead of the fuzz-head microbrush so that I would be sure to get the bonding agent into the hard-to-reach areas.

I never heard from the patient after that. Months have elapsed and she popped into my head the other day and I wondered how things were going so I called her up. She reported that the tooth is still very sensitive and it still hurts to brush. Upon further query I determined that she does not have irreversible pulpitis and it is still just ultra thermal and now tactile sensitive, but nothing that lingers. The pain is super intense and then is gone.

Any recommendations on further tx or on what the dealio is?

Has this ever happened to any of you?