Managing dentin hypersensitivity

The Effect of Three Desensitizing Agents on Dentin Hypersensitivity: A Randomized, Split-mouth Clinical Trial

The aim of this study was to evaluate the efficacy of three desensitizing agents to provide relief to dentin hypersensitivity after one session in a four-week follow-up. Forty selected patients participated in a double-blind study following a split-mouth model. One application of the desensitizing agents (A, Admira Protect [Voco]; B, Bifluorid 12 [Voco]; and C, Colgate Pro-Relief in office [Colgate Palmolive]) was performed in three different quadrants for each patient. Each tooth was evaluated by tactile and evaporative stimuli, and the sensitivity response was measured using the Visual Analogue Scale. Evaluations were performed at baseline, immediately after treatment, and after one, two, three, and four weeks. The application of Kruskal-Wallis and Dunn multiple comparisons tests (5%) for both tactile and evaporative stimuli showed that all agents presented a significant desensitizing effect. In groups A and B this relief was maintained for four and three weeks, respectively, as measured by tactile stimulus and for four weeks with evaporative stimulus. The desensitizing effect for group C was maintained for two weeks for both tactile and evaporative stimuli. It is concluded that all desensitizing agents tested were effective in reducing sensitivity compared to baseline values. One application of Admira Protect and Bifluorid 12 presented a longer-lasting desensitizing effect than did Colgate Pro-Relief (applied in the office) on both tactile and evaporative stimuli.

Comparative In Vitro Effect of TiF4 to NaF and Potassium Oxalate on Reduction of Dentin Hydraulic Conductance

Dentin hypersensitivity (DH) is related to an increase in dentin permeability. This study tested the effect of titanium tetrafluoride (TiF4) compared with sodium fluoride (NaF) and potassium oxalate gel on reducing hydraulic conductance (Lp) from the perspective of diminishing dentin permeability. The Lp of the dentin disks (1.0 ± 0.2 mm) was evaluated using Flodec. The maximum Lp values of each disk were taken after phosphoric acid etching (15 seconds) and randomly allocated to seven groups (n=8) according to the treatments. The minimum (smear layer) and the maximum (after acid etching) Lp values were recorded. Treatments were performed for 4 minutes as follows: 1) NaF varnish 2) and solution (2.45% F, pH 5.0), 3) TiF4 varnish and 4) solution (2.45% F, pH 1.0), 5) 3% potassium oxalate gel, 6) free fluoride varnish (placebo, pH 5.0), 7) and no treatment (control). The Lp after each treatment was assessed. Samples were exposed to an erosive challenge (6% citric acid, pH 2.1, 1 minute), and the final Lp was recorded. The data were statistically analyzed using repeated measures two-way analysis of variance (p<0.05). All treatments were effective in reducing dentin Lp compared with the control immediately after the application. However, only potassium oxalate and NaF varnish significantly differed from placebo varnish (p<0.0001). The same results were found after the erosive challenge. Therefore, the TiF4 was less effective than the NaF varnish and potassium oxalate gel in reducing dentin permeability. Using this experimental model, both NaF varnish and potassium oxalate gel reduced the Lp similarly to the presence of smear layer.

Observations on dentine hypersensitivity in general dental practices in the United Arab Emirates

Dentine hypersensitivity is a common clinical finding with a wide variation in prevalence values and etiological factors. The objective of this cross-sectional study was to investigate the prevalence and some etiological factors of dentine hypersensitivity of Emirati patients visiting general dental clinics in the United Arab Emirates (UAE) over a period of three calendar months.

MATERIALS AND METHODS

Six general dental practitioners examined 204 Emirati patients over a period of three calendar months and patients who had dentine hypersensitivity diagnosed were questioned further about their smoking habits and the frequency, severity, and duration of their pain. Furthermore, cervical tooth surface loss was noted.

RESULTS

A total of 55 patients were diagnosed as having dentine hypersensitivity, giving a prevalence figure of 27%. The most common teeth affected were the lower anterior teeth.

CONCLUSIONS

The prevalence of dentine hypersensitivity in Emirati patients visiting a general dental clinic in the UAE was 27%. The most common etiology appeared to be the loss of cervical tooth surface structure.

The effect of dentin desensitizers and Nd:YAG laser pre-treatment on microtensile bond strength of self-adhesive resin cement to dentin

PURPOSE

The purpose of this study is to evaluate if pre-treatment with desensitizers have a negative effect on microtensile bond strength before cementing a restoration using recently introduced self-adhesive resin cement to dentin.

MATERIALS AND METHODS

Thirty-five human molars' occlusal surfaces were ground to expose dentin; and were randomly grouped as (n=5); 1) Gluma-(Glutaraldehyde/HEMA) 2) Aqua-Prep F-(Fluoride), 3) Bisblock-(Oxalate), 4) Cervitec Plus-(Clorhexidine), 5) Smart protect-(Triclosan), 6) Nd:YAG laser, 7) No treatment (control). After applying the selected agent, RelyX U200 self-adhesive resin cement was used to bond composite resin blocks to dentin. All groups were subjected to thermocycling for 1000 cycles between 5-55℃. Each bonded specimen was sectioned to microbars (6 mm × 1 mm × 1 mm) (n=20). Specimens were submitted to microtensile bond strength test at a crosshead speed of 0.5 mm/min. Kolmogorov-Smirnov, Levene's test, Kruskal-Wallis One-way Analysis of Variance, and Conover's nonparametric statistical analysis were used (P<.05).

RESULTS

Gluma, Smart Protect and Nd:YAG laser treatments showed comparable microtensile bond strengths compared with the control group (P>.05). The microtensile bond strengths of Aqua-Prep F, and Cervitec Plus were similar to each other but significantly lower than the control group (P<.05). Bisblock showed the lowest microtensile bond strength among all groups (P<.001). Most groups showed adhesive failure.

CONCLUSION

Within the limitation of this study, it is not recommended to use Aqua-prep F, Cervitec Plus and Bisblock on dentin when used with a self-adhesive resin cement due to the decrease they cause in bond strength. Beside, pre-treatment of dentin with Gluma, Smart protect, and Nd:YAG laser do not have a negative effect.

The Efficacy of Selected Desensitizing OTC Products: A Systematic Review

Objectives. The aim of the present study was to review the published literature in order to identify relevant studies for inclusion and to determine whether there was any evidence on the clinical effectiveness of selected desensitizing toothpastes, calcium sodium phosphosilicate (CSPS), amorphous calcium phosphate (ACP), nanohydroxyapatite, and casein phosphopeptide-amorphous calcium phosphate (tooth mousse) on reducing dentine hypersensitivity (DH). Materials and Methods. Following a review of 593 papers identified from searching both electronic databases (PUBMED) and hand searching of relevant written journals, only 5 papers were accepted for inclusion. Results. Analysis of the included studies (3 CSPS and 2 ACP) would suggest that there may be some benefit for patients using these products for reducing DH. No direct comparative studies were available to assess all these products under the same conditions neither were there any comparative randomised controlled studies that compared at least two of these products in determining their effectiveness in treating DH. Conclusions. Due to the small number of included studies, there are limited clinical data to support any claims of clinical efficacy of these OTC products. Further studies are therefore required to determine the efficacy of these products in well-controlled RCT studies with a larger sample size.

Prevalence of dentine hypersensitivity in Chinese rural adults with dental fluorosis

The aim of this study was to estimate the prevalence of dentine hypersensitivity (DH) among residents of rural China with dental fluorosis aged 30-69 years. A village located in northern China in which dental fluorosis was common was selected. Some 1250 residents with fluorosis ranging in age from 30 to 69 years completed a structured questionnaire and underwent clinical examination. Diagnosis of DH was based on the combination of the subject's self-evaluation and clinical examination. Dental fluorosis was evaluated using Dean's index (DI). In the village, the fluoride concentration in drinking water was 1.15-1.50 mg L(-1) . The community fluorosis index was 1.47, and 74 (9.7%) of the participants with dental fluorosis were diagnosed with DH. There was no significant difference between men and women. DH was most commonly observed in the lower incisors, and the most common cause of DH was cold stimulation. Logistic regression analysis showed acid reflux to be the only risk factor for DH in the current study. Among subjects with DH, none took treatment measures, visited a hospital or clinic, or used antisensitivity toothpaste. The prevalence of DH in the selected subjects with dental fluorosis was 9.7%. Acid reflux was found to be a risk factor for DH in the current study.

Clinical evaluation of two desensitizing treatments in southern Brazil: A 3-month follow-up

OBJECTIVE

This study aimed to evaluate and compare the effectiveness of two treatments for dentin hypersensitivity in vivo during 90 days of follow-up.

MATERIALS AND METHODS

The sample consisted of 117 teeth (13 patients) that were divided into three groups: control with carbomer 940 gel (n = 32) (placebo treatment), 2% sodium fluoride gel (n = 31) and low-level infrared diode laser (n = 54). Prior to the desensitizing treatment, the dentin hypersensitivity status of each tooth was assessed by an evaporative stimulus; the patient's response was evaluated using the Visual Analogue Scale (VAS) and by counting the Exposure Time to Air Blast (ETAB) with a dental air syringe. Re-evaluations of the treatments occurred after 5 min, 7, 15, 30 and 90 days. The statistical analysis was performed using the Kruskal-Wallis test, Friedman test, one-way ANOVA, Tukey's test and Spearman's rank correlation (α = 5%).

RESULTS

No significant differences were observed among the low-level laser, 2% topical fluoride and carbomer 940 gel applications. When the methods of evaluation (VAS and ETAB) were compared, there was no difference among the groups with respect to the values for every period of evaluation (p < 0.001), verifying that the scores obtained with the VAS decreased at the same proportion as the remaining time of ETAB increased.

CONCLUSIONS

This study showed that both tested therapies were efficacious in controlling painful symptoms associated with dentin hypersensitivity over the entire 90-day follow-up period. The treatments were able to reduce the painful symptoms caused by dentin hypersensitivity, including placebo.

Effect of Two Desensitizing Agents in Reducing Dentin Hypersensitivity: An in-vivo Comparative Clinical Trial

OBJECTIVE

A randomized, double blind, split mouth, controlled clinical trial was conducted to evaluate the effect of two desensitizing agents on reduction of Dentin Hypersensitivity (DH).

MATERIAL AND METHODOLOGY

A sample of 73 teeth from 13 patients, among which at least 3 teeth had dentin hypersensitivity, was randomly allocated into 3 treatment groups: Group A: treated with 30% ethenolic extract of Indian Propolis, Group B: treated with GC tooth mousse, and Group C: treated with sterile water. A Verbal Rating Scale (VRS) was used to record the degree of hypersensitivity, based on patient's response to tactile and air blast stimuli. The baseline scores were obtained. Each intervention group received applications of their respective agents consecutively on 1(st), 7(th), 14(th) and 21(st) days. After each application, the scores were recorded.

RESULTS

Both the 30% Indian Propolis and GC tooth mousse showed significant reductions in dentin hypersensitivity.

CONCLUSION

GC tooth mousse was found to be significantly better in reducing the dentinal hypersensitivity as compared to Propolis and sterile water (p< 0.01).

Making sense of sensitivity

Our professional understanding of the causes and treatment options for dentine hypersensitivity should now allow the dental profession to manage this condition reliably. This paper reviews the aetiology and explains the scientific basis for what has become a confusing number of products and methods available to patients and dental clinicians.

CLINICAL RELEVANCE

Dentine hypersensitivity appears to be an increasing problem for patients and the dental profession alike. Clinicians need to have up-to-date knowledge of this condition and the products available to treat patients presenting with this troublesome complaint.

An investigation of dentinal fluid flow in dental pulp during food mastication: simulation of fluid-structure interaction

This study uses fluid-structure interaction (FSI) simulation to investigate the relationship between the dentinal fluid flow in the dental pulp of a tooth and the elastic modulus of masticated food particles and to investigate the effects of chewing rate on fluid flow in the dental pulp. Three-dimensional simulation models of a premolar tooth (enamel, dentine, pulp, periodontal ligament, cortical bone, and cancellous bone) and food particle were created. Food particles with elastic modulus of 2,000 and 10,000 MPa were used, respectively. The external displacement loading (5 μm) was gradually directed to the food particle surface for 1 and 0.1 s, respectively, to simulate the chewing of food particles. The displacement and stress on tooth structure and fluid flow in the dental pulp were selected as evaluation indices. The results show that masticating food with a high elastic modulus results in high stress and deformation in the tooth structure, causing faster dentinal fluid flow in the pulp in comparison with that obtained with soft food. In addition, fast chewing of hard food particles can induce faster fluid flow in the pulp, which may result in dental pain. FSI analysis is shown to be a useful tool for investigating dental biomechanics during food mastication. FSI simulation can be used to predict intrapulpal fluid flow in dental pulp; this information may provide the clinician with important concept in dental biomechanics during food mastication.

In vitro evaluation of Biosilicate® dissolution on dentin surface: a SEM analysis

INTRODUCTION: Biomaterials such as bioactive glasses and glass-ceramics have been proposed for the treatment of dentinal hypersensitivity. OBJECTIVE: to evaluate by scanning electron microscopy (SEM), the dissolution of a novel bioactive glass-ceramic (Biosilicate® 1-20 µm particles) on dentin surface samples, with different application methods and different dilution medium used for applying Biosilicate®. MATERIAL AND METHOD: 280 dentin samples were randomly divided into four groups: (1) Biosilicate® plus fluoride gel applied with Robinson brush; (2) Biosilicate® plus fluoride gel applied with microbrush; (3) Biosilicate® plus distilled water applied with Robinson brush; (4) Biosilicate® plus distilled water applied with microbrush. After treatment, the samples were immersed in saliva at different periods (0, 15 and 30 minutes, 1, 2, 12 and 24 hours). Two photomicrographs were obtained from each sample and were further analyzed by a blind calibrated examiner according to a "Particle Dissolution Index" created for this study. RESULT: The data were analyzed using the Mann-Whitney, Kruskal-Wallis and Dunn's tests. There was no statistical difference among the degrees of dissolution between the 4 groups in any period. CONCLUSION: Biosilicate® can be incorporated in both substances without differences in the degree of dissolution of the particles in any of the evaluated periods and the application of dentine can be performed with both methods evaluated.

A practice-based randomised controlled trial of the efficacy of three interventions to reduce dentinal hypersensitivity

OBJECTIVES

The aim of this study was to evaluate the efficacy of three different interventions (non-desensitising toothpaste, desensitising toothpaste and professionally applied dentine bonding agent) in reducing dentinal hypersensitivity over a 2-week, 3-month and 6-month-period in a dental practice setting.

METHODS

This was a randomised controlled, single-blind; parallel-group trial conducted in general dental practice by a single general dental practitioner. Seventy-five subjects were randomly allocated to three groups; non-desensitising toothpaste (NDT), desensitising toothpaste (DT) and professionally applied desensitising agent (DA). Dentinal hypersensitivity was measured using a Visual Analogue Scale (VAS) to record the response from a standardised short blast of air from a triple syringe. Dentinal hypersensitivity was recorded at baseline, two weeks, three months and six months for all groups.

RESULTS

Dentinal hypersensitivity reduced significantly (p<0.0001) in both groups DT and DA, in addition the reduction in sensitivity was sustained and continued to improve over a 6-month-period. The greatest reduction in dentinal hypersensitivity was recorded in group DA.

CONCLUSIONS

The results from this study suggest that application of dentine bonding agents, to teeth diagnosed with dentine hypersensitivity provides the greatest improvement in dentine hypersensitivity at 2 weeks and 6 months. This reduction in dentine hypersensitivity is greater than that achieved by the desensitising toothpaste tested and a non-desensitising toothpaste.

Immediate and short-term effects of in-office desensitizing treatments for dentinal tubule occlusion

OBJECTIVE

The objective of this in vitro study was to evaluate the immediate and short-term effects of laser neodymium-doped yttrium aluminum garnet (Nd:YAG) irradiation and in-office desensitizing treatment on dentin tubule occlusion.

BACKGROUND DATA

Literature shows a lack of long-lasting treatments for dentin hypersensitivity.

METHODS

Forty-eight dentin slabs (4×4×2 mm) were ground flat, polished, and treated with 27% ethylenediaminetetraacetic acid (EDTA) to open the dentinal tubules. Specimens were randomly divided into the following experimental groups (n=12): Group 1: Control (no treatment); Group 2: Nd:YAG laser irradiation (100 mJ, 85 J/cm(2) per pulse with a quartz fiber of 400 μm, in scanning movements); Group 3: In-office prophylaxis with pumice; Group 4: In-office Colgate Sensitive Pro-Relief™ Desensitizing Paste. Treatments were performed according to the manufacturer's instructions. After treatment, the specimens were submitted to a sequence of erosive and abrasive challenges, twice a day for 5 days. The specimens were qualitatively and quantitatively evaluated by scanning electron microscopy immediately after treatment and after 4 and 5 days. The response variable was the amount of occluded dentin tubules per area, determined by three different examiners with the use of visual criteria, with a standardized grade created in the PowerPoint program. Data were compared with ANOVA and Tukey's test, considering a 5% significance level.

RESULTS

Immediately after treatment, a reduction in the number of opened dentin tubules was observed for the laser group when compared with the control group (p<0.05). After the experimental procedures, there were no quantitative differences between the amount of opened dentin tubules for all groups; however, micrographs showed some qualitative tubule occlusion for the laser group after the erosive/abrasive challenge.

CONCLUSIONS

only laser irradiation was capable of immediately sealing the dentinal tubules; however, none of the treatments showed efficacy in maintaining tubule occlusion after the chemical and mechanical challenges.

Micro-shear bond strength of resin cement to dentin after application of desensitizing toothpastes

OBJECTIVES

The aim of the study was to evaluate the effect of three desensitizing toothpastes on bonding of resin cements to dentin.

MATERIALS AND METHODS

The occlusal surfaces of 72 maxillary third molars were ground to obtain flat dentin surfaces and then divided into three groups according to three desensitizing toothpastes used: Sensodyne Rapid Relief (GlaxoSmithKline, SmithKline Beecham Ltd., Slough, UK), Signal Sensitive Expert (Unilever Sanayi ve Ticaret Türk A.Ş., Ümraniye, İstanbul, Turkey) and Colgate Sensitive Pro-Relief (Colgate Palmolive, New York, NY). Following bonding of the resin cement (Clearfil™ SA Cement, Kuraray Co, Osaka, Japan) to dentin, the specimens were light cured for 40 s with a LED (Elipar S10, 3M Espe, St. Paul, MN). The strength measurements were accomplished with a micro-shear testing machine (Bisco, Schaumburg, IL) at a cross-head speed of 0.5 mm/min until the failure occurs. Failure modes were examined using a stereomicroscope and scanning electron microscope. The data were analyzed with one-way analysis of variance (ANOVA) and Tukey HSD test (α = 0.05).

RESULTS AND CONCLUSION

ANOVA revealed that the application of desensitizing toothpastes had significant effects on bond strength of the resin cement tested to dentin (p < 0.05). Mixed failures were observed in all of the groups.

CLINICAL SIGNIFICANCE

The use of a desensitizing toothpaste before cementation might alter the bond strength of adhesively luted restorations.

The efficacy of strontium and potassium toothpastes in treating dentine hypersensitivity: a systematic review

Objectives. The aim of the present paper was to review the published literature in order to identify all relevant studies for inclusion and to determine whether there was any evidence of the efficacy of strontium and potassium toothpastes in the treatment of dentine hypersensitivity (DH). Methods. Following a review of 94 relevant papers both from searching electronic databases (PUBMED) and hand searching of relevant written journals, 13 studies were identified, and 7 papers (1 for strontium-based toothpastes and 6 for potassium-based toothpastes) were finally accepted for inclusion. The main outcome measures were the methodology and assessment used by Investigators in studies designed to evaluate DH. Results. The results of the present paper would indicate that the reported efficacy of both strontium- and potassium-based toothpastes in relieving DH is questionable. Conclusions. The results from the present paper would appear to support the conclusions of previous investigators that there is only minimal evidence for the efficacy of both strontium- and potassium-based toothpastes in relieving symptoms of DH.

Prevalence of dentine hypersensitivity: A cross-sectional study in rural Punjabi Indians

AIMS AND OBJECTIVES

To study the prevalence of dentine hypersensitivity and related risk factors in rural population of Punjab, India.

MATERIALS AND METHODS

A total of 650 subjects reporting dentine sensitivity were included in the study comprising of 270 males and 380 females. All the subjects completed an interview and the subjects reporting dentine hypersensitivity were examined further using air syringe to put a blast of air to confirm the diagnosis of dentine hypersensitivity. Periodontal attachment loss and gingival recession of all the sensitive teeth were examined and recorded.

RESULTS

The prevalence of dentine hypersensitivity was 25% in the oral test. The subjects receiving the treatment of hypersensitivity were only 15.1%. The older group in the 50-59 years had the highest number (98%) of subjects with dentine hypersensitivity. Most commonly affected teeth were mandibular incisors. The other factors related to dentine hypersensitivity were the socioeconomic status, lower education level, and access to dental care. The periodontal factors related to hypersensitivity were gingival recession and poor oral hygiene.

CONCLUSIONS

The prevalence of dentine hypersensitivity was 25% in the rural population of Punjab.

Evaluation of dentinal fluid flow behaviours: a fluid-structure interaction simulation

This study uses the fluid-structure interaction (FSI) method to investigate the fluid flow in dental pulp. First, the FSI method is used for the biomechanical simulation of dental intrapulpal responses during force loading (50, 100 and 150 N) on a tooth. The results are validated by comparison with experimental outcomes. Second, the FSI method is used to investigate an intact tooth subjected to a mechanical stimulus during loading at various loading rates. Force loading (0-100 N) is applied gradually to an intact tooth surface with loading rates of 125, 62.5, 25 and 12.5 N/s, respectively, and the fluid flow changes in the pulp are evaluated. FSI analysis is found to be suitable for examining intrapulpal biomechanics. An external force applied to a tooth with a low loading rate leads to a low fluid flow velocity in the pulp chamber, thus avoiding tooth pain.

Current diagnosis of dentin hypersensitivity in the dental office: an overview

OBJECTIVES

The aim of this overview is to consider the problems that may be associated with making a diagnosis of dentin hypersensitivity (DHS) and to provide a basis for clinicians to effectively diagnose and manage this troublesome clinical condition.

MATERIALS AND METHODS

A PUBMED literature research was conducted by the author using the following MESH terms: ('diagnosis'[Subheading] OR 'diagnosis'[All Fields] OR 'diagnosis'[MeSH Terms]) AND ('therapy'[Subheading] OR 'therapy'[All Fields] OR 'treatment'[All Fields] OR 'therapeutics'[MeSH Terms] OR 'therapeutics'[All Fields]) AND ('dentin Sensitivity'[MeSH Terms] OR ('dentin'[All Fields] AND 'sensitivity'[All Fields]) OR 'dentin sensitivity'[All Fields]). Variations to the above MeSH terms using terms such as 'cervical', 'dentine' and 'hypersensitivity' as substitutes were also explored, but these searches failed to add any further information.

RESULTS

The literature search provided only limited data on specific papers relating to the clinical diagnosis of DHS by dental professionals. Evidence from these published studies would therefore indicate that clinicians are not routinely examining their patients for DHS or eliminating other possible causes of dental pain (differential diagnosis) prior to subsequent management and may rely on their patients' self-reporting of the problem. Furthermore, the findings of the Canadian Consensus Document (2003) would also suggest that clinicians are not confident of successfully treating DHS.

CONCLUSIONS

It is apparent from reviewing the published literature on the diagnosis of DHS that there are a number of outstanding issues that need to be resolved, for example, (1) is the condition under- or overestimated by dentists, (2) is the condition adequately diagnosed and successfully managed by dentists in daily practice, (3) is the impact of DHS on the quality of life of sufferers adequately diagnosed and treated and (4) is the condition adequately monitored by clinicians in daily practice. These and other questions arising from the workshop forum should be addressed in well-conducted epidemiological and clinical studies in order for clinicians to be confident in both identifying and diagnosing DHS and subsequent management that will either reduce or eliminate the impact of DHS on their patients' quality of life.

CLINICAL RELEVANCE

Clinicians should be made aware not only of the importance of identifying patients with DHS but also of the relevance of a correct diagnosis that may exclude any confounding factors from other oro-facial pain conditions prior to the successful management of the condition.

Epidemiology of dentin hypersensitivity

OBJECTIVE

In contrast to the well-established caries epidemiology, data on dentin hypersensitivity seem to be scarce and contradictory. This review evaluates the available literature on dentin hypersensitivity and assesses its prevalence, distribution, and potential changes.

MATERIALS AND METHODS

The systematic search was performed to identify and select relevant publications with several key words in electronic databases. In addition, the articles' bibliographies were consulted.

RESULTS

Prevalence rates range from 3 to 98 %. This vast range can be explained partly by the differences in the selection criteria for the study sample and also the variety in diagnostic approaches or time frames. Women are slightly more affected than men and an age peak of 30-40 years has been reported. Still, the prevalence of erosions with dentin exposure seems to increase in younger adults, often resulting in hypersensitivity. In older patients, root surfaces are frequently exposed due to periodontal disease which is associated with a high rate of dentin hypersensitivity, especially after periodontal treatment and intensified brushing activity. On the other hand, the number of affected seniors with tooth loss or even edentulism is reduced. About 25-30 % of the adult population report dentin hypersensitivity. Most dentists also consider it to be a relevant problem in their practice, but they request more information on this topic. Maxillary teeth are affected to a higher extent, but the different teeth show very similar rates. Buccal surfaces clearly show the highest prevalence rates.

CONCLUSION

In spite of the advances regarding management of dentin hypersensitivity, it still remains an epidemiologically understudied field.

CLINICAL RELEVANCE

Although great variations have been observed in the prevalence of dentin hypersensitivity, this issue is often observed by dentists and related by patients. However, further studies are necessary to find the cause of this condition and refine its management.

A decision tree for the management of exposed cervical dentin (ECD) and dentin hypersensitivity (DHS)

INTRODUCTION

Dentin hypersensitivity (DHS) is a problematic clinical entity that may become an increasing clinical problem for dentists to treat as a consequence of patients retaining their teeth throughout life and improved oral hygiene practices.

OBJECTIVES

The aim of this review was to develop a decision tree for the management of exposed cervical dentin (ECD) and DHS.

MATERIAL AND METHODS

A brief PUBMED literature search was performed on dentin hypersensitivity using "MeSH" terms, "review", and "management". In addition, some websites and local guidelines were screened.

RESULTS

From this review, it became clear that all dentate patients should routinely be screened for ECD and DHS. In this respect, underdiagnosis of the condition will be avoided and the preventive management can be initiated early.

CONCLUSION

A decision tree process and a flowchart for daily practice were designed which should be started up as soon as a patient present with ECD or suffers from DHS. This approach takes into account the possible improved quality of life of the patient and is further based on a hierarchy of treatment options. In this respect, active management of DHS will usually involve a combination of at-home and in-office therapies. Starting with the use of desensitizing toothpastes is strongly recommended.

Comparative evaluation of the effects of Nd:YAG laser and a desensitizer agent on the treatment of dentin hypersensitivity: a clinical study

Abstract Objective: The aim of this randomized longitudinal clinical study was to assess different treatment protocols for dentin hypersensitivity with high-power laser, desensitizing agent, and its association between high-power laser and desensitizing agent, for a period of 6 months.

BACKGROUND DATA

The literature shows a lack of treatment for dentin hypersensitivity, and lasers are contemporary alternatives.

METHODS

After inclusion and exclusion analysis, volunteers were selected. The lesions were divided into three groups (n=10): G1, Gluma Desensitizer (Heraeus Kulzer); G2, Nd:YAG Laser (Power Laser(™) ST6, Lares Research®) contact mode, laser protocol of 1.5 W, 10 Hz, and 100 mJ,≈85 J/cm(2), four irradiations performed, each for 15 sec, in mesiodistal and occluso-apical directions, totaling 60 sec of irradiation with intervals of 10 sec between them; G3, Nd:YAG Laser+Gluma Desensitizer. The level of sensitivity to pain of each volunteer was analyzed by visual analog scale (VAS) using cold air stimuli and exploratory probe 5 min, 1 week, and 1, 3, and 6 months after treatment. Data were collected and subjected to statistical analysis that detected statistically significant differences between the various studied time intervals of treatments (p>0.05).

RESULTS

For the air stimulus, no significant differences were found for each time interval. For the long-term evaluation, all groups showed statistical differences (p>0.05), indicating that for G2 and G3, this difference was statistically significant from the first time of evaluation (post 1), whereas in G1, the difference was significant from the post 2 evaluation (1 week). Comparison among groups using the probe stimulation showed significant differences in pain (p<0.001). Only in G1 and G3 did this difference become significant from post 01.

CONCLUSIONS

All protocols were effective in reducing dentinal hypersensitivity after 6 months of treatment; however, the association of Nd:YAG and Gluma Desensitizer is an effective treatment strategy that has immediate and long-lasting effects.

Effect of acid fruit juices combined with electric or sonic toothbrushing on root dentin permeability--an in vitro study

The purpose of this in vitro study was to quantify the alterations on human root dentin permeability after exposure to different acid fruit juices and to evaluate the effect of toothbrushing with electric or sonic toothbrush after acid exposure. The root dentin of 50 extracted third molars was exposed with a high speed bur. Crowns were sectioned above the cementoenamel junction and root fragments were used to prepare dentin specimens. Specimens were randomly assigned to 5 groups according to the fruit juice (kiwifruit, starfruit, green apple, pineapple and acerolla). Each specimen was connected to a hydraulic pressure apparatus to measure root dentin permeability using fluid filtration method after the following sequential steps: I) conditioning with 37% phosphoric acid for 30 s, II) root scaling, III) exposure to acid fruit juices for 5 min and IV) electric or sonic toothbrushing without dentifrice for 3 min. Data were analyzed statistically by the Wilcoxon and Mann-Whitney tests at 5% significance level. All fruit juices promoted a significant increase of dentin permeability while toothbrushing decreased it significantly (p<0.05). It may be concluded that all acid fruit juices increased root dentin permeability, while toothbrushing without dentifrice after acid exposure decreased the permeability. The toothbrush mechanism (electric or sonic) had no influence on the decrease of root dentin permeability.

The durability of phosphoric acid promoted bioglass-dentin interaction layer

OBJECTIVES

Phosphoric acid-Bioglass 45S5 paste can create an interaction layer formed of calcium-phosphate crystals on the dentin surface. In this study, the efficiency of decreasing the dentin permeability exerted by the interaction layer formed between bioglass and dentin was compared to a resin-containing oxalate desensitizing agent (MS Coat One) and a resin-free oxalate desensitizing agent (Super Seal).

METHODS

Dentin permeability was measured before/after a brushing abrasion challenge, followed by examining the top and the fractured dentin surfaces with a field emission scanning electron microscope. Moreover, the chemical nature of the compounds formed on top of the dentin surface was examined using the field emission scanning electron microscope (FE-SEM) equipped with an energy-dispersive X-ray spectroscope (EDS), and the crystalline structures of the dentinal surfaces were examined by X-ray diffraction (XRD).

RESULTS

The results showed that application of 45S5 bioglass paste to dentin was able to occlude patent dentinal tubule orifices with a layer of calcium-phosphate crystals, while the oxalate containing agents were able to form small crystals which were found in dentinal tubule orifices and scattered along the superficial parts of the dentinal tubule lumen. The brushing-abrasion challenge significantly increased the permeability of dentin treated by Super Seal and MS Coat One, while these challenges had no significant effect on the dentin permeability of specimens treated with 45S5 bioglass paste.

SIGNIFICANCE

The new technique provided better durability than two products available on the market. Moreover, our previous research showed the biocompatibility of using this technique on dental pulp cells, suggesting that this technique can aid in treating dentin hypersensitivity cases.

The role of fluoride in the preventive management of dentin hypersensitivity and root caries

Objective

The objectives were to bring light on fluoride to control dentin hypersensitivity (DHS) and prevent root caries.

Materials and methods

Search strategy included papers mainly published in PubMed, Medline from October 2000 to October 2011.

Results

Fluoride toothpaste shows a fair effect on sensitive teeth when combined with dentin fluid-obstructing agents such as different metal ions, potassium, and oxalates. Fluoride in solution, gel, and varnish give an instant and long-term relief of dentin and bleaching hypersensitivity. Combined with laser technology, a limited additional positive effect is achieved. Prevention of root caries is favored by toothpaste with 5,000 ppm F and by fluoride rinsing with 0.025–0.1 % F solutions, as the application of fluoride gel or fluoride varnish three to four times a year. Fluoride measures with tablets, chewing gum, toothpick, and flossing may be questioned because of unfavorable cost effectiveness ratio.

Conclusion

Most fluoride preparations in combination with dentin fluid obstruction agents are beneficial to reduce DHS. Prevention of root caries is favorable with higher fluoride concentrations in, e.g., toothpaste.

Clinical relevance

Fluoride is an effective agent to control DHS and to prevent root caries particularly when used in higher concentrations.

Effects of dentifrice containing hydroxyapatite on dentinal tubule occlusion and aqueous hexavalent chromium cations sorption: a preliminary study

In order to endow environmental protection features to dentifrice, hydroxyapatite (HA) was added to ordinary dentifrice. The effects on dentinal tubule occlusion and surface mineralization were compared after brushing dentine discs with dentifrice with or without HA. The two types of dentifrice were then added to 100 µg/ml of hexavalent chromium cation (Cr⁶⁺) solution in order to evaluate their capacities of adsorbing Cr⁶⁺ from water. Our results showed that the dentifrice containing HA was significantly better than the ordinary dentifrice in occluding the dentinal tubules with a plugging rate greater than 90%. Moreover, the effect of the HA dentifrice was persistent and energy-dispersive spectrometer (EDS) revealed that the atomic percentages of calcium and phosphorus on the surface of dentine discs increased significantly. Adding HA to ordinary dentifrice significantly enhanced the ability of dentifrice to adsorb Cr⁶⁺ from water with the removal rate up to 52.36%. In addition, the sorption was stable. Our study suggests that HA can be added to ordinary dentifrice to obtain dentifrice that has both relieving dentin hypersensitivity benefits and also helps to control environmental pollution.

How valid and applicable are current diagnostic criteria and assessment methods for dentin hypersensitivity? An overview

Objectives

Although dentin hypersensitivity is a common clinical condition and is generally reported by the patient after experiencing a sharp, short pain caused by one of several different external stimuli, it is often inadequately understood. The purpose of this paper is to discuss different available diagnostic approaches and assessment methods used in order to suggest a basis to diagnose, monitor, and measure these challenging painful conditions related to dentin hypersensitivity in daily practice and scientific projects properly.

Material and methods

A PubMed literature search strategy including the following MeSH terms were used as follows: “dentin sensitivity”[MeSH Terms] OR “dentin”[All Fields] AND “sensitivity”[All Fields] OR “dentin sensitivity”[All Fields] OR “dentin”[All Fields] AND “hypersensitivity”[All Fields] OR “dentin hypersensitivity”[All Fields] AND “diagnosis”[Subheading] OR “diagnosis”[All Fields] OR “diagnosis”[MeSH Terms] AND “assessment”[All Fields] AND (“methods”[Subheading] OR “methods”[All Fields] OR “methods”[MeSH Terms]. Furthermore, alternative terms such as “validity,” “reliability,” “root,” “cervical,” “diagnostic criteria,” and “hypersensitivities” were additionally evaluated.

Results

The literature search, also including the alternative terms and journals, revealed only a small number of specific papers related to valid diagnosis, diagnostic criteria, and assessment methods of dentin hypersensitivity. Outcomes from these publications showed that the response to different stimuli varies substantially from one person to another and is, due to individual factors, often difficult to assess correctly. Furthermore, the cause of the reported pain can vary, and the patient’s description of the history, symptoms, and discomfort might be different from one to another, not allowing a reliable and valid diagnosis.

Conclusions

The dental practitioner, using a variety of diagnostic and measurement techniques each day, will often have difficulties in differentiating dentin hypersensitivity from other painful conditions and in evaluating the success of a conducted therapy in a reliable way.

Clinical relevance

Correct diagnosis of dentin hypersensitivity including a patient’s history screening and a brief clinical examination in combination with the identification of etiologic and predisposing factors, particularly dietary and oral hygiene habits associated with erosion and abrasion, is essential. The relevant differential diagnosis should be considered to exclude all other dental conditions with similar pain symptoms.

Effect of hydroxyapatite film formed by powder jet deposition on dentin permeability

A powder jet deposition (PJD) process can be used to create a thick hydroxyapatite (HA) film on the surface of a human tooth. This study aimed to investigate in vitro the ability of an HA film, applied using PJD, to diminish dentin permeability. Discs of human coronal dentin were cut perpendicular to the tooth axis and the smear layer was removed by EDTA treatment. The HA film was created by accelerating HA particles, calcinated at 1200°C, onto the dentin discs at room temperature and atmospheric pressure. The surfaces and cross-sections of the HA PJD-treated samples were observed using scanning electron microscopy. Their permeability was indirectly recorded with a split-chamber device utilizing a chemiluminescence technique. MS-coat, a commercial dentin-desensitizing agent, was also evaluated for its effect on reducing liquid flow through the dentin. The scanning electron microscopy images showed that the HA particles were successfully deposited onto the dentin and solidly into the dentin tubules. The permeability of dentin after application of the HA films was significantly lower than that following application of MS-coat. This study showed the potential clinical application of PJD techniques in desensitizing dentin hypersensitivity.

Effects on dentin treated with eluted multi-mineral varnish in vitro

PURPOSE

The purpose of this pilot study was to assess the non-contact effects of a NaF varnish on the morphology and elemental compositions of sound and demineralized dentin in an in vitro pH cycling model.

METHODS

3 mm diameter dentin cores were extracted from bovine teeth, mounted in acrylic rods, and ground and polished. Sound and demineralized (in 10 mL unstirred 50% citric acid (pH = 1.2) for two minutes) specimens were divided into four groups (N=6) corresponding to treatments with either water (control group) or non-contact Vanish® 5% NaF White Varnish with tri-calcium phosphate (3M ESPE). For the non-contact varnish group, one 0.50 ml unit-dose was applied to acrylic rods and positioned in the same stopper as three dentin specimens. The four groups were then cycled in a regimen consisting of three rounds of one-hour treatments with each round followed by immersion in a three-minute static acid challenge (0.3% citric acid, pH = 3.8). For each one-hour treatment immersion the test groups were immersed in distilled water. The specimens were thoroughly rinsed with distilled water after each treatment and after each acid challenge. After the last challenge, specimens were rinsed with distilled water and immersed in artificial saliva (AS) overnight. All treatments, acid challenges and immersion in AS solution were performed in an incubator set at 37°C. After three days, the specimens were assessed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS).

RESULTS

SEM and EDS results demonstrated the non-contact varnish group can provide mineralization benefits relative to the control group for both sound and demineralized dentin substrates. Depositions from mineral eluting from the varnish developed on the intertubular and intratubular regions alike, with the most prominent depositions appearing on initially demineralized dentin.

CONCLUSIONS

In this observational study, acid-resistant mineral depositions were produced on the sound and dentin surfaces without direct application from a multi-mineral varnish containing fluoride, calcium and phosphate.