Why does dentine hypersensitivity remain undertreated despite being common and manageable? A qualitative study of patient experience and system-level barriers in Australia.

OBJECTIVE: Dentine hypersensitivity (DH) affects approximately one in three dentate adults yet remains poorly managed. This study aimed to generate a comprehensive, patient-centred account of how Australian adults experience, self-manage, and seek care for DH, and to identify system-level barriers to adequate management. MATERIALS AND METHODS: Eighteen Australian adults aged 26-67 years with clinically confirmed DH completed individual semi-structured interviews via Zoom, conducted by a single trained qualitative oral health researcher (N.T.), and analysed using Thematic Framework Analysis. Independent dual coding of a 22% subsample yielded Cohen's kappa = 0.83. Reporting followed the SRQR checklist. RESULTS: Six themes were identified, covering DH sensation, dietary adaptation, emotional responses, self-management strategies, financial burden, and interactions with the dental system. Seventeen of 18 participants reported dietary or behavioural modifications, yet nine simultaneously described DH as having no daily impact, a contradiction suggesting response shift: participants had gradually adjusted to long-standing restrictions and no longer noticed them as limitations. Desensitising toothpaste was used by 89% through self-initiation; no participant received proactive DH screening; and three independently discovered evidence-based leave-on application without clinical instruction. Financial barriers converted a treatable condition into irreversible tooth loss through cost-driven extractions. CONCLUSIONS: DH imposes a chronic, complex burden systematically underestimated by patients and clinicians alike. Proactive screening, structured communication, and equitable access to professional care are required to close the gap between guideline-recommended and actual management.