Dentin hypersensitivity, an enigma revisited: Mechanisms, diagnosis and therapeutic advances

Dentin hypersensitivity is a common clinical condition characterized by short, sharp pain arising from exposed dentin in response to thermal, evaporative, tactile, osmotic, or chemical stimuli, in the absence of any other dental pathology. Despite its high prevalence, dentin hypersensitivity remains diagnostically challenging due to its multifactorial etiology, overlap with other dental pain conditions, and variable response to treatment. An electronic literature search of major biomedical databases and relevant dental journals was undertaken, supplemented by hand-searching reference lists, with studies selected based on clinical relevance, methodological quality, and applicability to the diagnosis and management of dentin hypersensitivity. This narrative review provides a comprehensive overview of dentin hypersensitivity from a restorative dentistry and endodontic perspective, integrating current understanding of dentin structure, permeability, and pain transmission with practical clinical considerations. The biological basis of hypersensitivity is discussed with reference to dentinal tubule characteristics and the evolution of mechanistic theories, with particular emphasis on the hydrodynamic concept and emerging insights into neural sensitization. Diagnostic approaches are reviewed as a systematic process involving careful history taking; controlled clinical stimulation tests; pain assessment; and exclusion of pulpal, periodontal, restorative, and structural pathologies. Contemporary management strategies are examined, ranging from patient education and noninvasive desensitizing agents to in-office therapies, restorative interventions, and evolving biomimetic approaches. Recent advances in bioactive materials and minimally invasive technologies highlight a shift toward biologically informed and patient-centered care. A stepwise, evidence-based approach to diagnosis and management remains essential for achieving predictable and durable clinical outcomes in patients with dentin hypersensitivity.