Dentine hypersensitivity: New perspectives on an old problem

Desensitizing efficacy of a universal dentin adhesive containing mesoporous bioactive glass on dentin hypersensitivity: a randomized clinical trial with a split-mouth model

This split-mouth blinded randomized controlled study compared the efficacy of a desensitizing agent with oxalate/resin polymer and a universal adhesive containing mesoporous bioactive glass (MBG) for dentin hypersensitivity (DH) relief, using Schiff sensitivity score (SSS) and visual analog scale (VAS). Split quadrants containing teeth with DH were treated with either MS Coat ONE or Hi-Bond Universal with MBG as the functional additive. Assessments at baseline, immediately post-application, and at 1- and 2-week follow-ups used standardized stimulus protocols (air, cold, and acid). The SSS difference was the primary outcome, while the VAS difference was the secondary outcome. A mixed linear effect model performed statistical analysis. Immediate DH reduction occurred in response to air stimuli, with a significant decrease in Group HB than in Group MS (p = 0.0178). Cold stimulus reduction exhibited a gradual cumulative effect, with consistently greater reductions in Group HB than in Group MS (p ≤ 0.0377). Both groups effectively managed acidic stimuli, with no significant differences (p > 0.05). The VAS scores decreased gradually over the follow-up period (p < 0.0001). This study highlights the differential efficacy of treatments for various DH triggers and recommends specific approaches based on different stimulus types. The universal adhesive containing MBG demonstrated DH relief potential, promising efficacy identical to or superior to that of a dedicated desensitizing agent. Further research exploring the long-term efficacy and underlying mechanisms is warranted. The universal adhesive containing MBG can be adopted as an in-office desensitizing agent for DH relief. The desensitizing efficacy of universal adhesive matches or surpasses dedicated agents for air and cold stimuli.

Efficacy of seventh generation bonding agents as desensitizers in patients with dentin hypersensitivity: a randomized clinical trial

BACKGROUND

Dentin hypersensitivity (DH) is one of the most challenging and persistent dental complaints characterized by transient, intense pain triggered by various stimuli. It affects a significant portion of the global population, predominantly those aged 20-40. This study aims to evaluate the desensitizing efficacy of seventh-generation dentin bonding agents (Single Bond Universal by 3 M ESPE and Xeno-V + by Dentsply) against a control group using Bifluorid 12 by Voco in mitigating DH within a month of the follow-up period.

METHODS

This was a single-center, parallel-group, double-blind, controlled randomized clinical trial conducted at Dow University of Health Sciences, Karachi, Pakistan. A total of 105 patients with DH were allocated into three groups for this study. The patients were divided into three groups (Single Bond Universal by 3 M ESPE and Xeno-V + by Dentsply) and the control group containing fluoride varnish (Bifluorid 12 by Voco). Discomfort Interval Scale scores and Schiff Cold Air Sensitivity Scale scores were recorded at baseline, immediately after the intervention, after 01 weeks, and after 01 month.

RESULTS

All the materials demonstrated a statistically significant reduction in discomfort and sensitivity (DIS scores p-value 0.01) immediately after 01 week and over a period of 01 month after treatment compared with the baseline scores before application, with no single material proving superior over the one-month observation period. The study also provided insights into dental hygiene practices, with a significant majority using a toothbrush and sensitivity patterns, with cold stimuli being the most common cause of sensitivity.

CONCLUSION

The study demonstrates that Single Bond Universal, Xeno V+, and Bifluorid 12 are equally effective in reducing dentin hypersensitivity, with no distinct superiority observed over a one-month period. The findings highlight the potential of fluoride varnishes as a less technique-sensitive and cost-effective option for treating DH, offering valuable insights for future research and clinical practice.

TRIAL REGISTRATION

NCT04225247 ( https://clinicaltrials.gov/study/NCT04225247 ), Date of Registration: 13/01/2020. (Retrospectively registered).

Single-session associative protocol for dentin hypersensitivity management: a 1-year randomized, blinded clinical study

Objectives

This study aimed to establish a single-session associative protocol for non-restorative management of dentin hypersensitivity (DH).

Materials and Methods

Twenty-four individuals with DH and a minimum sensitivity level of 4 on the visual analog scale (VAS) were selected. The study was conducted in a split-mouth design, with each participant (n = 20) having at least 1 affected tooth in all quadrants. The management protocols consisted of control group: universal adhesive, Neural Desensitizing Protocol group: 5% potassium nitrate, Mixed Desensitizing Protocol (PAM) group: 5% sodium fluoride and 5% potassium nitrate, Remineralizing Desensitizing Protocol (PDR) group: surface-partially reacted glass technology photopolymerizable varnish. Evaluations were performed immediately after application, at 1 week, 1 month, 2 months, and 12 months using the VAS sensitivity test.

Results

The scores were subjected to statistical analysis using the Friedman test (p < 0.05), Durbin-Conover test (p < 0.05), and Wilcoxon test (p < 0.05). At the 12-month evaluation, all groups showed statistically significant differences compared to the initial assessment. For the evaluation after 12 months, there was a statistically significant difference between the PAM group, the control group, and the PDR group.

Conclusions

It can be concluded that all groups were effective in controlling DH, but there were significant results in the control group and PDR group. The clinical relevance of this study is to demonstrate that the application of single-session desensitizing protocols can be effective in controlling DH for up to 12 months.

Trial Registration

Brazilian Clinical Trials Registry Identifier: RBR-4r63d7s.

In-depth occlusion of dentine tubules via the application of (poly-L-aspartic acid)‑strontium and phosphate/fluoride to treat dentine hypersensitivity

Dentine hypersensitivity (DH) is a common oral health issue and occlusion of the exposed dentinal tubules (DTs) is regarded as the most effective therapeutic treatment nowadays. However, it is still difficult to develop easy and effective strategies for deep occlusion of DTs. In this study, we develop a strategy for occluding DTs deeply and compactly via simple application of occlusion media including (poly-L-aspartic acid)‑strontium (PAsp‑strontium) and phosphate/fluoride. The bonding of strontium ions to poly-L-aspartic acid formed a positively charged PAsp‑strontium complexes. After application of 15 min each, the PAsp‑strontium and phosphate/fluoride rapidly penetrated into the DTs in turn via the electrostatic interaction, then occluded the DTs with crystals up to a depth of 150 μm. The occlusion within DTs was resistant to abrasive and acidic challenges. The occlusion media performed better than commercial desensitizers Duraphat and Gluma. Moreover, this strategy possessed sufficient biocompatible and excellent performance in vivo. The application of occlusion media would shed light on in the management of DH.

The Effect of Whitening Toothpastes on the Color Stability of a Smart Monochromatic Composite Resin

OBJECTIVE

The aim of this study was to evaluate the color stability of smart monochromatic composite resin after coloring with coffee solution, thermal aging and brushing with four different kinds of toothpaste.

MATERIALS AND METHODS

According to the manufacturer's instructions, 40 smart monochromatic composite resin (Omnichroma, Tokuyama Dental, Japan) specimens were prepared with a thickness of 2 mm and a diameter of 10 mm. The samples were divided into four groups. The first group (SFM) was brushed with Sensodyne Fresh Mint (Sensodyne GSK, UK), the second group (CW) with Colgate 2 in 1 Whitening (Colgate Palmolive, USA), the third group (OW) with Opalescence Whitening (Ultradent Products, Inc., USA), the fourth group (COW) with Colgate Optic White With Charcoal (Colgate Palmolive, USA). At time point t0, no brushing and thermal cycles were performed. For time point t1, simulations corresponding to 10 days of staining, thermal aging and brushing were performed. For time point t2, simulations corresponding to one year of staining, thermal aging and brushing were performed. The color of all specimens was measured at t0, t1 and t2 with a spectrophotometer. To examine the color change, ΔE00 values were calculated with the CIEDE 2000 color system. Shapiro Wilk, Kolmogorov Smirnov, Wilcoxon Signed Rank, Kruskal Wallis, and Mann-Whitney U tests were used to analyze the data.

RESULTS

According to the results of the intergroup comparison, there is no statistically significant difference between the groups in ΔE00(t0-t1) values in terms of t0-t1 time period measurement (p>0.05). There is a statistically significant difference between the groups in ΔE00(t1-t2)values in terms of t1-t2 time period measurement (p<0.05). The COW group had the lowest ΔE00(t1-t2) value and the OW group had the highest ΔE00(t1-t2) value. There is a statistically significant difference between the groups in ΔE00 (t0-t2) values in terms of t0-t2 time period measurement (p<0.05). The COW group had the lowest ΔE00(t0-t2) value and the OW group had the highest ΔE00(t0-t2) value.

CONCLUSION

The whitening efficacy of different kinds of toothpaste whitening mechanisms may differ from each other. Toothpastes also show whitening on composite resins. The lowest discoloration was observed in the group brushed with toothpaste containing activated charcoal and blue covarine. The efficacy of whitening toothpastes should be supported by in vivo studies.

Effectiveness of Cyanoacrylate in the Treatment of Dentin Hypersensitivity: A Systematic Review

Objective

To compare the effectiveness of cyanoacrylate to other treatments or placebo in the management of dentin hypersensitivity (DH).

Materials and Methods

The present review was organized based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. The search aimed to answer the following question: is cyanoacrylate effective in the treatment of DH when compared to other treatments or placebo? The following databases were used: PubMed/MEDLINE, Scopus, BVS, Web of Science, Cochrane, Clinicaltrials.gov, Portal Periódicos Capes, Google Scholar, and manual search. The evaluation process started with the information collected from the selected articles according to the Consolidated Standards of Reporting Trials (CONSORT).

Results

Two randomized and five nonrandomized clinical trials were analyzed in the qualitative synthesis. The studies presented different cyanoacrylate formulations, different scales for evaluating pain, and different methods for provoking a painful stimulus. Cyanoacrylate-based products reduce DH in shorter follow-up periods and this reduction persisted throughout the study. The results varied according to the methods used to stimulate the pain. Only two articles showed a low risk of bias and a high level of scientific evidence.

Conclusion

Although there is a limited number of studies in the scientific literature with appropriate methodological quality, the available evidence proves the effectiveness of cyanoacrylate in the treatment of DH. Clinical Relevance. Cyanoacrylate is easy to access, effective, easily applicable, and a low-cost product with satisfactory results.

Nanofluorapatite Hydrogels in the Treatment of Dentin Hypersensitivity: A Study of Physiochemical Properties and Fluoride Release

The aim of this work was to prepare a new hydrogel based on nanohydroxyapatite (nFAP, 10% w/w) and fluorides (4% w/w), both of which are used as sources of fluoride ions in the treatment of dentin hypersensitivity, and to characterize its physicochemical properties. The release of fluoride ions from 3 gels (G-F, G-F-nFAP, and G-nFAP gel) was controlled in Fusayama–Meyer artificial saliva at pH 4.5, 6.6, and 8.0. The properties of the formulations were determined by an analysis of viscosity, a shear rate test, a swelling study, and gel aging. Various methods, i.e., FT-IR spectroscopy, UV-VIS spectroscopy, and thermogravimetric, electrochemical, and rheological analysis, were used for the experiment. The profiles of fluoride release indicate that the amount of fluoride ions released increases with a decrease in the pH value. The low pH value facilitated water absorption by the hydrogel, which was also confirmed by the swelling test, and it promoted the exchange of ions with the surrounding environment. Under conditions similar to physiological conditions (at pH 6.6), the amounts of fluorides released into artificial saliva were approximately 250 µg/cm2 and 300 µg/cm2 for the G-F-nFAP hydrogel and G-F hydrogel, respectively. The aging study and properties of the gels showed a loosening of the gel network structure. The Casson rheological model was used to assess the rheological properties of the non-Newtonian fluids. Hydrogels consisting of nanohydroxyapatite and sodium fluoride are promising biomaterials in the prevention and management of the dentin hypersensitivity.

Comparative efficacy of self-administered dentifrices for the management of dentine hypersensitivity - A systematic review and network meta-analysis

OBJECTIVES

This systematic review with network meta-analysis synthesises available randomised controlled trials evidence concerning efficacy of self-administered dentifrices for management of dentine hypersensitivity (DH) pain.

STUDY SELECTION

Following systematic review registration (CRD42019154064), three data bases (MEDLINE, Embase, CENTRAL) were searched to December 2022 for parallel randomised controlled trials conducted in adults diagnosed with DH, using at least two recognised stimuli, assessing the short-term efficacy of home-use dentifrice treatment in reducing pain. Thirty-two studies and 4,638 participants were included. A Network meta-analysis (NMA) approach was used to compare relative effectiveness between interventions.

CONCLUSIONS

Twice daily application of self-applied dentifrice containing formulations of stannous, potassium +/- stannous, or arginine can be recommended for the reduction of dentine hypersensitivity pain. There is a need for standardised methodology guideline development to improve the conduct, analysis and reporting of DH clinical studies.

CLINICAL RELEVANCE

This is the first comprehensive NMA to be performed, that follows guidelines for conduct of DH trials to determine the efficacy of self-applied dentifrices for the management of dentine hypersensitivity. Indirect comparisons can be made between formulations that have not been compared to one another in randomised controlled trials.

Three-dimensional visualization of dentine occlusion based on FIB-SEM tomography

The occlusion of dentinal tubules has become a rapid and effective method for treating dentin hypersensitivity. Accurate evaluation of dentin occlusion is critical to illustrate the efficacy of oral care products and to optimize dental therapy in the clinics, which is limited by the conventional two-dimensional (2-D) characterization methods. Here, we demonstrate the visualization of the dentin occlusion via three-dimensional (3-D) characterization using a focused ion beam-scanning electron microscopy (FIB-SEM) tomography. Using the "Slice and View" approach, the material used for occluding dentin tubules is imaged with a very high-resolution voxel (10 nm × 10 nm × 20 nm) from 2-D SEM images and then reconstructed into a 3-D volume, which presents the mode of action of toothpaste for treating dentin hypersensitivity. Meanwhile, quantitative analysis of the depth of occlusion is successfully obtained. This work validates the feasibility of FIB-SEM tomography in the analysis of dentin occlusion within the complicated networks of dentine tubules at the nanoscale, and provides a novel approach to facilitate the research and development of oral care products.

The Effect of Eggshell and Seashell Nanoparticles Alone and Combined With Nd: YAG Laser on Occlusion and Remineralization Potential of Patent Dentinal Tubules: An In Vitro Study

Introduction: There is an interest in developing materials with bioactive potential that could block exposed dentinal tubules. This study compared the effects of eggshell and seashell nanoparticles individually or combined with ND:YAG laser on dentinal tubules occlusion and remineralization. Methods: Fifty radicular dentin discs were prepared from freshly extracted human premolars. The smear layer created by cutting was removed using 37% phosphoric acid gel for 15 sec. The discs were divided into five groups according to the applied treatment(A) (n = 10 each): (A1) control, (A2); Nano eggshells, (A3); Nano seashells, (A4); Nano eggshells + Nd: YAG Laser, and (A5); Nano sea shell + Nd: YAG Laser. Each specimen was evaluated for tubular patency and mineral contents before and after each therapy using ESEM-EDXA energy dispersive spectroscopy for the assessment of tubule occlusion and remineralization. Results: ESEM results revealed a statistically significant decrease in the mean percent changes of the dentinal tubules number after the treatment of the experimental groups compared to the control. The greatest percent decrease was recorded in the seashell NPs + Nd: YAG laser, followed by the eggshell NPs + Nd: YAG laser, then Eggshell NPs only and then Seashell NPs only, while the lowest percentage decrease was recorded in the control group. EDXA revealed that the greatest percentage increase in Ca wt% was recorded in the Eggshell + Nd:YAG laser group, followed by Eggshell only, then Seashell only and then Seashell NPs + Nd: YAG laser, while the lowest percent increase was recorded in the control group. The post hoc test revealed no significant difference between the experimental groups. Conclusions: Both eggshell and seashell nanoparticles are effective in the occlusion and remineralization of dentinal tubules. The combined treatments with Nd: YAG laser had no benefits when compared to the effect of treatments alone.

Efficacy of GLUMA for the Treatment of Dentin Hypersensitivity Compared to Lasers: A Systematic Review

OBJECTIVE

Dentin hypersensitivity (DH) is characterized by a short, sharp pain in response to a thermal or tactile stimulus. The application of desensitizing agents such as GLUMA and laser is a non-invasive and safe approach to decrease sensitivity. The evidence for the efficacy of GLUMA desensitizer compared to laser desensitization in patients with DH was evaluated for 6 months.

DESIGN

In March 2022, an electronic search of PubMed, Scopus, and Web of Science databases was conducted. Articles published in English that compared GLUMA and laser in the treatment of DH with a follow-up of 6 months or more were included. Randomized, non-randomized controlled trials, and clinical trials were included. Risk of bias assessment tools developed by the Cochrane collaboration ROB 2 and ROBINS-I were used to assess the quality of studies. The GRADE assessment method was used to assess the certainty of evidence.

RESULTS

About 36 studies were identified in the search results. After applying the predefined eligibility criteria, eight studies with 205 participants and 894 sites were included in this review. Of the eight studies, four were judged to be at high risk of bias, three had some concerns, and one had a serious risk of bias. The certainty of the evidence was graded as low.

CONCLUSION

Based on limited evidence, GLUMA and laser appear to be equally effective in providing relief from DH. GLUMA showed an immediate effect and provided pain relief. Over the course of a week, laser showed long-term stable results. GLUMA is effective in providing immediate relief.

Effect of bioactive glasses used as dentin desensitizers on the dentin-pulp complex in rats

Bioactive glasses have been recommended for the occlusion of dentinal tubules in treating cervical dentin hypersensitivity. This study evaluates an in vivo model of dentin exposure, and tests the efficacy of bioglass treatments. Thirty male Wistar rats received gingival recession surgery on the upper left first molar. The treatments were applied over the surface of the exposed dentin every 4 days for 28 days. The groups were as follows: Naive; Gingival recession; Cavity varnish; Biosilicate^®; Strontium bioglass; and Potassium bioglass. Changes in the dentin-pulp complex, and the presence of substance P, were evaluated through hematoxylin-eosin and immunohistochemical staining. The groups had similar results. Teeth with exposed dentinal tubules in rats showed a typical pattern in the dentin-pulp complex and immunotracing for substance P. The materials did not cause pulp damage. The effects of gingival recession and open dentinal tubules on pulp tissue require further clarification.

ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity

Dentin hypersensitivity (DH) is a rising concern in clinical dentistry that causes pain and discomfort and negatively affects the quality of life of patients. Indian Society of Periodontology conducted a nationwide survey, involving 3000 dentists in December 2020, which revealed significant knowledge gaps regarding DH, viz., under-diagnosis, incorrect differential diagnosis, and treatment strategies/recommendations for the management of DH patients in daily clinical practice. The current paper has been envisioned and conceptualized to update the practicing Indian dentists regarding the so-called enigma of dentistry “Dentin Hypersensitivity,” based on the best available contemporary evidence. An expert panel was constituted comprising 30 subject experts from across the country, which after extensive literature review and group discussions formulated these recommendations. The panel advocated routine screening of all dentate patients for exposed dentin areas and DH to avoid under-diagnosis of the condition and suggested an early preventive management. Consensus guidelines/recommendations for the use of desensitizing agents (DAs) at home, including the use of herbal agents, are also provided within the backdrop of the Indian context. The guidelines recommend that active management of DH shall be accomplished by a combination of at home and in-office therapies, starting with the simplest and cost-effective home use of desensitizing toothpastes. A diagnostic decision tree and a flowchart for application in daily practice are designed to manage the patients suffering from DH or presenting with exposed dentin areas in dentition. Various treatment methods to manage DH have been discussed in the paper, including the insights from previously published treatment guidelines. Further, a novel system of classification of DH patients based on specific case definitions has been developed for the first time. Explicit charts regarding the available treatment options and the chronology of institution of the agent, for the management in different case categories of DH, have been provided for quick reference. The management strategy takes into account a decision algorithm based on hierarchy of complexity of treatment options and intends to improve the quality of life of the patient by long-term maintenance with an innovatively defined triple C's or 3Cs approach.

Evaluation of Dentin Tubule Plugging Efficiencies and Effects on Dentin Surface Roughness of Dentin Desensitizing Agents, the Er,Cr:YSGG Laser, and Their Combination After Erosion-Abrasion Cycles: An In Vitro Study

OBJECTIVES

The purposes of this in vitro study were to evaluate the tubule plugging efficiencies and effects on the surface roughness of dentin of different dentin desensitizing agents (DDAs; Teethmate Desensitizer, Kuraray; Gluma Desensitizer, Kulzer; Clinpro White Varnish, 3M ESPE; Enamelast, Ultradent) and the Er,Cr:YSGG laser (Biolase, Waterlase), both alone and in combination with DDAs, after application and after an erosion-abrasion cycle.

METHODS AND MATERIALS

For surface roughness examinations, superficial buccal dentin specimens were divided into 10 groups: the control, Teethmate Desensitizer, Gluma Desensitizer, Enamelast, Clipro White Varnish, Er,Cr:YSGG Laser, Teethmate Desensitizer-Laser, Gluma Desensitizer-Laser, and Enamelast-Laser, and Clinpro White Varnish-Laser groups. Profilometric analyses and scanning electron microscopy (SEM) examinations were performed after applications and after a 5-day erosive-abrasive cycle. For the statistical analysis of surface roughness measurements, 2-way analysis of variance (ANOVA), 1-way ANOVA, and Tukey post hoc test were used.

RESULTS

Among the treatments, only DDAs alone did not cause increase in surface roughness after application. All of the laser applications increased the surface roughness of dentin, and after the erosion-abrasion cycle, all of the test groups had increased surface roughness. However, SEM images showed that morphological changes were less frequently observed in all of the experimental groups than in the control group. In addition, all of the laser-DDA combinations had stronger tubule occlusion effects than did DDAs alone, even after erosion-abrasion.

CONCLUSIONS

All of the test treatments showed protective effects on dentin surfaces against the negative effects of erosion-abrasion. The addition of the laser to DDA applications increased tubular plugging efficiencies of DDAs, and the tubule plugs of the combination treatments were resistant to the erosion-abrasion cycle.

Effectiveness of Two Different Fluoride-Based Agents in the Treatment of Dentin Hypersensitivity: A Prospective Clinical Trial

Hyperesthesia is related to increased sensitivity of dental tissues to mechanical, chemical and thermal stimuli. The aim of this prospective clinical trial was to compare the effectiveness of a calcium-fluoride-forming agent (Tiefenfluorid^®, Humanchemie GmbH, Alfeld, Germany) with that of a fluoride varnish (Enamelast^TM, Ultradent Inc., Cologne, Germany) in the treatment of dental hyperesthesia in adult patients. In total, 176 individuals (106 females and 70 males, aged 18-59 years old) diagnosed with dental hyperesthesia (DH) were enrolled. The main clinical symptoms were hyperesthesia from coldness and sweetness during chewing; the types of clinical lesions were also determined and recorded. The patients were selected randomly and divided into two groups: (i) the first group of 96 patients was treated with Tiefenfluorid^® applied in three appointments at 7-day intervals; (ii) the second group of 80 patients was treated with Enamelast^TM, applied seven times at 7-day intervals. All the patients were recalled 7 days, 14 days, 1 month, 3 months, and 6 months from the last application. At the baseline and during every follow-up visit, the DH was measured with a pulp tester. A random intercept/random slope model was used to evaluate the effect of the treatment, at various times with respect to the initial diagnosis. Within the limits of the present study, Tiefenfluorid^® was more effective than Enamelast^TM against DH in that it provided long-lasting results, with a significant improvement still detected at the latest 6-month follow-up.

Effect of silver diamine fluoride, potassium nitrate, and glutaraldehyde in reducing the post vital tooth preparation hypersensitivity: A randomized controlled trial

Aim

Hypersensitivity is the most common clinical problem which is encountered by most of dental patients undergoing a vital tooth preparation for a fixed crown prosthesis. The aim of this study is to evaluate the effect of silver diamine fluoride, potassium nitrate, and glutaraldehyde in reducing dentinal hypersensitivity following vital tooth preparation.

Settings and Design

This study is a randomized control trial performed on 119 teeth of 68 patients who are in need of fixed prosthesis treatment.

Materials and Methods

After a thorough clinical examination, patients were allocated into any of the randomly assigned four groups (Control, silver diamine fluoride, potassium nitrate, and glutaraldehyde) and the level of hypersensitivity was measured by blasting air on the surface of tooth at five different intervals (before preparation, after preparation, after application of desensitizers, before cementation and after a follow up period of about 30 days) and is graded using Schiff 's cumulative hypersensitivity index.

Statistical Analysis Used

Kruskal wallis test is used to compare the rate of sensitivity between the 4 groups. Friedman and Wilcoxon test is used to compare the rate of sensitivity at 5 different intervals.

Results

All the desensitizers used in this study reduced the level of hypersensitivity. Among which, silver diamine fluoride was found to be more effective after application, before cementation, and after a follow up period of about 30 days followed by GLUMA and potassium nitrate.

Conclusion

The results of this study suggest that silver diamine fluoride was found to be more effective after application, before cementation of the definitive prosthesis and after a follow up period of 30 days.

Effect Of Calcium Silicate, Sodium Phosphate, and Fluoride on Dentinal Tubule Occlusion and Permeability in Comparison to Desensitizing Toothpaste: An In Vitro Study

This study compared the ability of a calcium silicate-, sodium phosphate-, and fluoride-based (CSSPF) toothpaste (TP) in promoting dentinal tubule occlusion and reducing dentin permeability with that of other commercially available antisensitivity TPs. Seventy-eight dentin discs (1.0±0.1 mm thick) were prepared from the midcoronal area and were treated with 37% phosphoric acid for 2 minutes; then they were randomly divided into six groups according to treatments: No treatment [positive control (PC)], entirely covered with nail varnish [negative control (NC)], hydroxyapatite (HAP)-containing TP [Desensin Repair (DES)], NovaMin-based [Sensodyne Repair & Protect (SEN)], CSSPF-based TP [Regenerate Advanced (REG)], sodium monofluorophosphate, potassium citrate, zinc citrate TP [Signal Sensitive Expert (SIG)]. Dentin permeability was tested by the dye percolation method (DP%). Scanning electron microscope (SEM) micromorphological and energy dispersive X-ray elemental analysis (EDX) of the dentin surfaces were done following each treatment. Results were analyzed using one-way analysis of variance (ANOVA) followed by Tukey post hoc test at a 95% confidence level (α=0.05). All the tested groups showed higher DP% than NC and lower percolation than the PC (p<0.05). REG and SIG were statistically comparable, and showed significantly lower DP% (p<0.05) than SEN and DES. None of the TPs tested was able to obliterate the lumen of the dentinal tubules (DT) completely. REG exhibited the highest weight percentage of calcium deposition, followed by SEN. Compared to the tested desensitizing TPs, CSSPF-based TPs demonstrated equal or less dentin permeability and better DT occlusion.

Use of optical coherence tomography in orthodontics

Optical coherence tomography (OCT) is a modern imaging method with applicability in orthodontics. In recent years, there has been an increasing trend in the use of ceramic brackets. The aim of the present study was to investigate the effects of bonding metallic and ceramic brackets on tooth enamel, using optical coherence tomography. For this purpose, 20 permanent teeth we bonded and were subsequently debonded using a side cutter or anterior bracket removal pliers. Using the OCT technique, the enamel, the amount of adhesive remaining and the bracket fragments remaining on the tooth surface were analyzed following the debonding procedure. It was demonstrated that enamel cracks were present only in the samples bonded with ceramic brackets. At the same time, it was noted that the type of pliers did not affect the incidence and extent of damage to the enamel. The type of debonding technique (using the side cutter or the anterior removal pliers) used did not markedly affect the amount of adhesive remaining on the teeth. Thus, as demonstrated herein, by analyzing the enamel structure through the use of OCT, the quality of the processes and the materials used for manufacturing brackets can be increased.

Effects of whitening toothpastes on the esthetic properties and surface roughness of a composite resin

PURPOSE

The aim of this study was to investigate and compare the effects of some whitening toothpastes on the surface roughness and coloration susceptibility of a composite resin, as well as their whitening effectiveness.

METHODS

This study was carried out in two different stages. In experiment A, samples were divided into 7 subgroups to compare the surface roughness and coloration susceptibility of the composite resin: distilled water, conventional toothpaste, and 5 different whitening toothpastes. In experiment B, samples were divided into 8 subgroups to compare the whitening effectiveness of the whitening toothpastes: conventional toothpaste, 5 other whitening toothpastes, and two bleaching groups. After toothbrushing simulation, the color and surface roughness of the samples were measured. Data were subjected to one-way analysis of variance, paired t-test and Tukey post-hoc test (α = 0.05).

RESULTS

There were no statistically significant differences among the surface roughness values for the groups for any period before and after brushing (P > 0.05). In terms of the coloration susceptibility of the composite resin and the whitening effects of the toothpastes, no statistically significant differences were evident among the groups for any period before and after brushing (P > 0.05).

CONCLUSION

The results of this study indicate that effective toothbrushing is more important than the type of toothpaste employed.

Late Post-Operative Occurrence of Dentin Hypersensitivity in Adult Patients Following Allogeneic Hematopoietic Stem Cell Transplantation-A Preliminary Report

Allogeneic hematopoietic stem cell transplantation (alloHSCT) is one of the most commonly performed transplantation procedures nowadays. Despite the significant progress made in the treatment, alloHSCT is still associated with numerous complications also affecting the oral cavity. One of them is dentin hypersensitivity (DH)-a sharp, short-term pain that occurs when stimuli act on exposed dentin. Various authors point out that DH may result in a significantly lower quality of life, among other things by impeding the consumption of food as well as causing difficulties in daily oral hygiene. The aim of the study was a preliminary analysis of the incidence rate and severity of DH pain in adult patients during late period after alloHSCT. The impact of chronic graft-versus-host disease (cGvHD) and time after alloHCT were also considered. A total of 80 patients were examined. cGvHD was identified in 52 participants. The incidence rate and severity of DH pain was assessed on the basis of a questionnaire and a clinical examination. DH pain appeared a serious problem in late period after alloHSCT regardless of post-transplant time. DH primarily affected cGvHD patients. The prevention-treatment protocol for DH should be developed for this group.

The dentin pellicle - A neglected topic in dental research

OBJECTIVE

All soft and solid surfaces exposed to the oral cavity are covered by an acquired pellicle. While the pellicle adsorbed on enamel is well researched, only limited data are available on the dentin pellicle. The purpose of the present review is to summarize studies considering the composition, structure and properties of the dentin pellicle and compare them with the current state of research on enamel pellicle.

METHODS

The literature search was conducted using Medline database and Google Scholar, including checking reference lists of journal articles by handsearching. Thereby, 19 studies were included in the present review.

RESULTS AND CONCLUSION

The dentin pellicle has a similar ultrastructure to the enamel pellicle, which is up to 1 μm thick depending on pellicle formation time and localization in the oral cavity. In contrast, due to the lack of studies on the dentin pellicle regarding its composition and properties, a comparison to the enamel pellicle is difficult. So far, only one study showed anti-abrasive properties and data on anti-erosive properties were controversial. Despite becoming more and more clinically relevant due to the increasing frequency of dentin exposure, the dentin pellicle is largely unexplored. For further investigations it is not only necessary to standardize dentin specimens, but also to assess fundamental research on dentin itself, as its complex morphology and composition may have a crucial influence on pellicle formation. Furthermore, a more detailed knowledge of the dentin pellicle may also reveal target sites for modification in favor of its protective properties.

Laser therapy for dentinal hypersensitivity

BACKGROUND

Dentinal hypersensitivity is characterized by short, sharp pain from exposed dentine that occurs in response to external stimuli such as cold, heat, osmotic, tactile or chemicals, and cannot be explained by any other form of dental defect or pathology. Laser therapy has become a commonly used intervention and might be effective for dentinal hypersensitivity.

OBJECTIVES

To assess the effects of in-office employed lasers versus placebo laser, placebo agents or no treatment for relieving pain of dentinal hypersensitivity.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 20 October 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2020, Issue 9), MEDLINE Ovid (1946 to 20 October 2020), Embase Ovid (1980 to 20 October 2020), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 20 October 2020), and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; from 1982 to 20 October 2020). Conference proceedings were searched via the ISI Web of Science and ZETOC, and OpenGrey was searched for grey literature. The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomized controlled trials (RCTs) in which in-office lasers were compared to placebo or no treatment on patients aged above 12 years with tooth hypersensitivity.

DATA COLLECTION AND ANALYSIS

Two review authors independently and in duplicate screened the search results, extracted data, and assessed the risk of bias of the included studies. Disagreement was resolved by discussion. For continuous outcomes, we used mean differences (MD) and 95% confidence intervals (CI). We conducted meta-analyses only with studies of similar comparisons reporting the same outcome measures. We assessed the overall certainty of the evidence using GRADE.

MAIN RESULTS

We included a total of 23 studies with 936 participants and 2296 teeth. We assessed five studies at overall low risk of bias, 13 at unclear, and five at high risk of bias. 17 studies contributed data to the meta-analyses. We divided the studies into six subgroups based on the type of laser and the primary outcome measure. We assessed the change in intensity of pain using quantitative pain scale (visual analogue scale (VAS) of 0 to 10 (no pain to worst possible pain)) when tested through air blast and tactile stimuli in three categories of short (0 to 24 hours), medium (more than 24 hours to 2 months), and long term (more than 2 months). Results demonstrated that compared to placebo or no treatment the application of all types of lasers combined may reduce pain intensity when tested through air blast stimuli at short term (MD -2.24, 95% CI -3.55 to -0.93; P = 0.0008; 13 studies, 978 teeth; low-certainty evidence), medium term (MD -2.46, 95% CI -3.57 to -1.35; P < 0.0001; 11 studies, 1007 teeth; very low-certainty evidence), and long term (MD -2.60, 95% CI -4.47 to -0.73; P = 0.006; 5 studies, 564 teeth; very low-certainty evidence). Similarly, compared to placebo or no treatment the application of all types of lasers combined may reduce pain intensity when tested through tactile stimuli at short term (MD -0.67, 95% CI -1.31 to -0.03; P = 0.04; 8 studies, 506 teeth; low-certainty evidence) and medium term (MD -1.73, 95% CI -3.17 to -0.30; P = 0.02; 9 studies, 591 teeth; very low-certainty evidence). However, there was insufficient evidence of a difference in pain intensity for all types of lasers when tested through tactile stimuli in the long term (MD -3.52, 95% CI -10.37 to 3.33; P = 0.31; 2 studies, 184 teeth; very low-certainty evidence). Most included studies assessed adverse events and reported that no obvious adverse events were observed during the trials. No studies investigated the impact of laser treatment on participants' quality of life.

AUTHORS' CONCLUSIONS

Limited and uncertain evidence from meta-analyses suggests that the application of laser overall may improve pain intensity when tested through air blast or tactile stimuli at short, medium, or long term when compared to placebo/no treatment. Overall, laser therapy appears to be safe. Future studies including well-designed double-blinded RCTs are necessary to further investigate the clinical efficacy of lasers as well as their cost-effectiveness.

Bioactive glass and arginine dentifrices immediately relieved dentine hypersensitivity following non-surgical periodontal therapy: A randomized controlled trial

BACKGROUND

There is no report concerning calcium sodium phosphosilicate (CSPS) and arginine dentifrices in reducing dentine hypersensitivity (DH) in patients undergoing non-surgical periodontal therapy. The aim of the study was to compare the efficacy of a dentifrice containing bioactive glass, 5% CSPS, and 8% arginine dentifrice in relieving DH in patients undergoing non-surgical therapy.

METHODS

Using a double-blind randomized controlled trial, 45 volunteers with DH following non-surgical therapy were immediately applied with one of three dentifrices containing: 5% CSPS, 8% arginine, or control on DH teeth. The participants then continued to brush twice daily for 8 weeks. DH was assessed using the Schiff cold air sensitivity scale and tactile tests at baseline, immediately after application, and up to 8 weeks.

RESULTS

The Schiff analysis revealed that the CSPS dentifrice significantly reduced DH immediately and declined through week 8. The arginine group demonstrated reduced DH through week 2. In contrast, DH reduction in the control began later at week 1. The visual analog scale analysis demonstrated that only CSPS had a significantly reduced percentage DH at the immediate, 2, 4, and 8 weeks compared with the baseline. The percentage of patients with DH (Schiff score ≥2) in the CSPS and arginine groups reduced to ≈ 50% after the in-office application. The number of DH patients treated with CSPS then decreased to 9% at the 2-week evaluation.

CONCLUSION

The CSPS and arginine dentifrices were beneficial in reducing periodontitis patient's discomfort, immediately and in the first 2 weeks following non-surgical periodontal therapy.

The control of pain due to dentin hypersensitivity in individuals with molar-incisor hypomineralisation: a protocol for a randomised controlled clinical trial

INTRODUCTION

Dentin hypersensitivity (DH) is defined as high sensitivity of the vital dentin when exposed to thermal, chemical or tactile stimuli. Two mechanisms are required for the occurrence of DH: (1) the dentin must be exposed and (2) the dentinal tubules must be open and connected to the pulp. Molar-incisor hypomineralisation (MIH) is a qualitative abnormality of a genetic origin that affects tooth enamel and, in most cases, is accompanied by DH. The control of tooth sensitivity is fundamental to the successful treatment of MIH. The aim of the proposed randomised, controlled, clinical trial is to evaluate the effectiveness of different protocols for the control of DH in patients with teeth affected by MIH.

METHODS AND ANALYSIS

One hundred and forty patients who meet the inclusion criteria will be allocated to four groups. Group 1 will be the control group (placebo). In Group 2, sensitive teeth will be sealed with PermaSeal (Ultradent). In Group 3, sensitive teeth will receive low-level laser (LLL, AsGaAl) at a wavelength of 780 nm (Laser XT Therapy, DMC, São Carlos, Brazil). In Group 4, sensitive teeth will be treated with both LLL and PermaSeal (Ultradent). DH will be evaluated 15 min after the application of the treatments and the patients will be reevaluated 1 week, 1 month, 3 months and 6 months after the treatments. The primary outcome of this study is change in pain/sensitivity, when evaluated through a Visual Analogue Scale, to determine the effectiveness of the proposed treatments, as well as differences among the evaluation times for each proposed treatment.

ETHICS AND DISSEMINATION

This protocol has been ethically approved by the local medical ethical committee (protocol number: 4.020.261). Results will be submitted to international peer-reviewed journals and presented at international conferences.

TRIAL REGISTRATION NUMBER

NCT04407702.

Bioavailable gluconate chelated stannous fluoride toothpaste meta-analyses: Effects on dentine hypersensitivity and enamel erosion

OBJECTIVES

To compare the effect of bioavailable gluconate-chelated stannous fluoride (SnF₂) toothpaste with control toothpastes for treatment of dentine hypersensitivity (DH) and enamel erosion.

DATA AND SOURCES

A Procter & Gamble Oral Care archive of clinical studies was reviewed from 2000 to 2020. Eligible studies were Randomised Controlled Trials (RCTs) investigating bioavailable gluconate-chelated SnF₂ toothpaste efficacy compared to controls in adult participants measured following tactile (Yeaple force) and/or evaporative stimuli (Schiff score) in-vivo, duration <2 months (DH); or by erosive toothwear (profilometry) from in-situ samples, duration 10-15 days. Two authors independently assessed eligibility and resolved disagreements by discussion. A meta-analysis was undertaken and Risk of Bias (RoB) assessed using the Cochrane collaboration RoB tool for randomized parallel-group and cross-over trials.

RESULTS

Fourteen RCTs (1287 participants) assessed DH relief and Six RCTs (184 participants) enamel erosion protection. For DH SnF₂ toothpastes provided a 57 % (evaporative air) and 142 % (tactile) benefit versus negative controls (sodium fluoride/monofluorophosphate, 8 studies; p < 0.001). Compared to positive controls (potassium nitrate or arginine, 6 studies), a 22 % advantage (p = 0.036) was seen for evaporative air. In erosion studies, SnF₂ toothpastes provided an 83 % benefit versus control toothpastes (arginine or sodium fluoride; p < 0.001) with a change (95 %CI) in average surface profilometry level (μm) of -2.02(-2.85, -1.20).

CONCLUSIONS

The use of these bioavailable SnF₂ toothpastes, as part of a daily oral hygiene regimen, will provide patients with enamel erosion protection, combined with alleviation of DH pain when present, improving quality of life.

Bioactive glass versus Arginine dentifrices on the reduction of dentin permeability and acid tolerance

Objectives

To compare the efficacy of calcium sodium phosphosilicate (CSPS) and arginine dentifrices on dentin permeability and acid tolerance.

Material and Methods

Sixty dentin discs were randomly assigned into 3 groups, then brushed for 1 min with CSPS, arginine, or fluoride (control) dentifrices. To test acid tolerance, each disc was soaked in 6% citric acid for 1 min. Dentin permeability was measured before, following brushing, and acid challenge. Ten discs per group were similarly treated and evaluated for tubule occlusion following a single dentifrice application, while other five discs per group were employed in an acid tolerance assay.

Results

The percentage reduction in dentin permeability was 39.26%, 32.27%, and 21.71% in the arginine, CSPS, and control groups, respectively. The differences in dentin permeability reduction between the arginine and CSPS groups following brushing and acid challenge were not significant (p = 0.398 and p = 0.211, respectively). The arginine dentifrice demonstrated a significant reduction in permeability compared with the control (p = 0.011). In addition, the occlusion exhibited by the arginine and CSPS dentifrices was more resistant to acid challenge compared with that of the control (p < 0.001). From SEM analysis, dentinal tubule occlusion was observed after a single application in all groups. Some open dentinal tubules were detected in the test groups, while almost all of the orifices were open in the fluoride group following acid challenge.

Conclusions

There is no significant difference between arginine and CSPS dentifrices in reducing dentin permeability following a single application and acid challenge. Following acid challenge, the reduced permeability generated by arginine and CSPS was more stable compared with the fluoride dentifrice.

Using Laser-Doppler Flowmetry to Evaluate the Therapeutic Response in Dentin Hypersensitivity

Dentin hypersensitivity (DH) is a common medical condition with underreported prevalence and it is difficult to quantify. This study aimed to investigate whether assessing dental pulp vascular micro-dynamics by laser-Doppler flowmetry (LDF) would be functional for therapeutic evaluation, in contrast to a verbal rating scale (VRS). A split-mouth single-blind randomized study was conducted on seven patients and a total of 36 teeth. Two DH therapeutic methods were employed: (i) fluoride gel; (ii) Nd:YAG radiation combined with fluoride gel. For each tooth, five consecutive LDF determinations of pulp blood flow were made (before and immediately after desensitizing treatment, then after 24 h, 7 days, and 1 month), and the VRS was applied each time. Spearman’s correlation was applied for concurrent validation. Two-way (treatment and patient) repeated measures ANOVA full factorial was applied, followed by Tukey’s post-hoc comparisons and Pillai’s trace multivariate statistic. While VRS scores had moderate reliability, LDF could objectively estimate treatment effects. Based on partial eta-squared values, treatment and patient characteristics were estimated to explain about 84% and 50% of the variability, respectively. In conclusion, LDF is an objective technique that can quantitatively assess DH evolution, and it is effective in reliably monitoring oral health therapeutic interventions.

Clinical Efficacy of Different Dentin Desensitizers

CLINICAL RELEVANCE

Teethmate Desensitizer, Clinpro White Varnish, Shield Force Plus, and Gluma could be recommended for treating dentin hypersensitivity in terms of clinical efficacy.

SUMMARY

Objective: The aim of this study was to evaluate the clinical efficacy of widely used dentindesensitizing agents (DDAs) (Teethmate Desensitizer, Clinpro White Varnish, Shield Force Plus, and Gluma) in the treatment of dentin hypersensitivity (DH) according to different evaluation parameters over a four-week follow-up period.Methods and Materials: This study was a randomized, single-center, controlled, parallel group study involving 144 teeth in 40 subjects. The baseline DH levels of the subjects were determined using different evaluation parameters. Daily life hypersensitivity and evaporative air stimulus hypersensitivity scores were recorded using a visual analog scale (VAS), and tactile hypersensitivity scores were recorded using a Yeaple probe and measured in grams and on the VAS. Subjects who experienced evaporative air stimulus DH (30-80 mm on the VAS) and tactile hypersensitivity (10-50 g with the Yeaple probe) were included in the study. After application of the DDAs, these evaluation parameters were recorded throughout the follow-up period (immediately after application and at one day and two and four weeks post-application).Results: All four DDAs demonstrated clinical dentin-desensitizing effects throughout the follow-up period according to evaporative air hypersensitivity, tactile sensitivity (g-VAS), and daily life hypersensitivity scores (p<0.05). Only Clinpro White Varnish had tactile sensitivity (g) scores that were similar at baseline and the one-day follow-up (p>0.05). A comparison of DH-reducing effects among the DDAs revealed that they yielded different results immediately after application and at the one-day follow-up time point, depending on which evaluation parameter was used. However, all DDAs showed similar DH-reducing effects at the two- and four-week follow-up time points.Conclusions: Teethmate Desensitizer, Clinpro White Varnish, Shield Force Plus, and Gluma DH showed clinical efficacy for four weeks. DDAs may produce inconsistent clinical evaluation scores not only across different evaluation parameters but also between early and later follow-up time points.

Prevalence of sensitive teeth and associated factors: a multicentre, cross-sectional questionnaire survey in France

BACKGROUND

As far as we know, little data, whether obtained from self-administered questionnaires or upon dental clinical examination, has been published on the prevalence of sensitive teeth (ST) in the French adult population. The objectives of the present work were to estimate ST prevalence and characteristics in the general population of France and to explore the associated factors.

METHOD

A multicentre cross-sectional study was conducted between November 2011 and March 2013 in six French cities. Adult passers-by in public places were invited to answer an electronic questionnaire on a tablet computer. Only people who declared having at least one natural tooth were included in the study. A logistic regression model was used for the multivariate analysis.

RESULTS

The prevalence of ST during the previous 12 months reported by the sample of 2413 participants was 42.2% [95% CI: 40.2-44.1%]. The final logistic regression model showed significant statistical associations between ST and female gender, use of tobacco, consumption of soft drinks, limited access to oral care and poor oral hygiene habits (p < 0.05).

CONCLUSIONS

This study provides prevalence data on ST in a general population in France, which seems to remain high despite the existence of many therapies. It should alert professionals to a clinical manifestation that is becoming increasingly prevalent and that they will have to take into consideration to help reduce the discomfort arising from it.

Effect of a stannous fluoride toothpaste on dentinal hypersensitivity: In vitro and clinical evaluation

BACKGROUND

The authors conducted an in vitro and a clinical study to assess the effect of a toothpaste containing stannous fluoride to occlude dentin tubules and reduce dentinal hypersensitivity.

METHODS

For the in vitro study, the authors treated the surface of human dentin specimens with test or control toothpaste slurries and then evaluated them by using various spectroscopic techniques. For the clinical study, male and female participants who met the inclusion criteria brushed their teeth twice daily for 1 minute with test or control toothpaste. The authors assessed dentinal hypersensitivity by using tactile and air blast stimuli at baseline and after 4 and 8 weeks. All statistical tests of hypotheses were 2 sided, with a significance level of α set at .05.

RESULTS

Results from in vitro studies showed that the test toothpaste effectively occluded the dentinal tubules with a deposit consisting of tin, zinc, phosphate, and silicon. The test and control toothpastes occluded the tubules 82% and 35%, respectively. Clinically, at the 4- and 8-week examinations, the test toothpaste provided statistically significant (P < .001) improvements in tactile dentinal hypersensitivity scores of 27.8% and 42.0% and in air blast hypersensitivity scores of 21.4% and 32.3%, respectively, relative to the control toothpaste.

CONCLUSIONS

The in vitro results indicate the toothpaste containing 0.454% stannous fluoride effectively coated dentin surfaces and occluded patent dentin tubules. Compared with the control toothpaste, the test toothpaste provided a significant reduction in dentinal hypersensitivity after 8 weeks of product use.

PRACTICAL IMPLICATIONS

A multi-benefit option for patients with dentinal hypersensitivity.

Prevention of teeth hyperesis using domestic oral cavity care products

The evaluation of the effectiveness of the prevention of hyperesthesia of teeth in middle-aged people using the complex of domestic oral care products manufactured by JSC WERTEKS (St. Petersburg, Russia) has been carried out. It was shown that the best clinical result was achieved when using special toothpaste ASEPTA Plus Remineralization, mouthwash ASEPTA Parodontal Fresh and vitamin-mineral complex ASEPTA Parodontal containing coral calcium, coenzyme Q10, green tea extract and vitamins D3, C, A, B3, B6, B9 during individual oral hygiene.

Clinical Evaluation of Nd:YAG Laser With and Without Dentin Bonding Agent for the Treatment of Occlusal Hypersensitivity

Purpose:

The aim of the present study was to evaluate and compare both the immediate and delayed desensitizing effects of the Nd:YAG (neodymium-doped:yttrium aluminum garnet; Nd3+:Y3Al5O12) laser with and without dentin bonding agent (DBA) on occlusal dentinal hypersensitivity (DH).

Methods and Materials:

Twenty-one patients with a total of 117 chronic occlusal hypersensitive teeth were selected. Each subject had at least three hypersensitive teeth. These teeth were randomly allocated into three groups: group 1, DBA on the occlusal surface; group 2, Nd:YAG laser (1064-nm wavelength, 30 mJ of energy, 10 pulse/s, 60 seconds, two times); and group 3, Nd:YAG laser (1064-nm wavelength, 30 mJ of energy, 10 pulse/s, 60 seconds, two times) with DBA. Pain was assessed using a visual analog scale after stimulation of the sensitive teeth by using the sharp tip of an explorer and an air blast prior to treatment and immediately, one week, one month, and three months after treatment by one blinded examiner.

Results:

A significant reduction in occlusal DH occurred at all time points in all of the experimental groups. The three groups showed significant improvements in discomfort immediately after treatment and after one week (p&lt;0.001), but the Nd:YAG laser with DBA group had greater efficacy when compared with the other groups. The Nd:YAG laser group and Nd:YAG laser with DBA group had no significant differences at one month and three months after treatment (p&gt;0.05); however, their desensitizing efficacy was superior to the DBA group.

Conclusions:

The Nd:YAG laser with DBA may be most effective in the long-term treatment of occlusal DH, although other measures also reduce DH.

[Assessment of efficiency and satisfaction in the treatment of patients with teeth hyperesthesia considering their mental condition and compliance]

The purpose of the study was to assess treatment effectiveness and satisfaction of patients with teeth hyperesthesia considering their mental state and compliance. Satisfaction and compliance of patients using for individual oral hygiene Sensodyne instant effect toothpaste and Sensodyne mouthrinse ('GlascoSmithKlein', UK) was evaluated using the methods of assessing personal response to the disease known as 'syndrome of psychosensory-anatomical and functional maladjustment' in 37 men aged 19 to 25 years suffering from hyperesthesia of the teeth without visible damage of dental hard tissues. It was established that before treatment patients with dental hyperesthesia were in a state of inadaptation. Professional oral hygiene and use of oral care products recommended by dentists resulted in a positive change in personal response to the disease. Patients remained in the state of adaptation throughout the entire study period (3 months). Patients were fully satisfied with the results of dental hyperesthesia treatment, since the values of the indicator of satisfaction with dental care at the end of the study reached 8.03 points. However, throughout the entire observation period patients compliance did not reach the required level. Patients usually followed the recommendations of the dentist in the amount of 25 to 50% of those recommended. Despite the patient's knowledge of the medical recommendations, the possibility of negative consequences if they were not fulfilled, they did not have the proper commitment to implement of medical prescriptions and did not voluntarily fully follow the treatment regimen and behavior recommended by the dentists. The results should be considered when treating patients with dental hyperesthesia.

Comparison between 940 nm Laser Diode and Topical 5 % Potassium Nitrate for Tooth Desensitization. Randomized Controlled Clinical trial

Purpose: To compare the effectiveness of two dental desensitization therapies, 940 nm laser diode and potassium nitrate, in patients with dental hypersensitivity (DH) symptoms. Methods: This randomized clinical trial included 30 patients who initially underwent basic periodontal therapy and presented gingival recessions Class I and II (Miller 1985) with symptoms of DH. Subjects were randomly assigned into two groups. The first group (n = 15) received laser 940 nm application for 90 seconds on the surface of the recession and were given a tube of glycerin to be applied daily in order to avoid generating bias. Patients in the second group (n = 15) were exposed to inactive laser simulating the actual application of the laser, and they were given a desensitizing gel containing 0.5 g of potassium nitrate to be applied twice daily during 14 days. Controls were carried out at 15 minutes, 8 days, 15 days, and 4 weeks. Data obtained were filled out in an Excel table. For comparison between groups the Mann Whitney U and t student tests were used (p=0.05). Results: All patients involve in the study experienced reduction in DH (p<0.01) and differences   between the two interventions performed. Conclusions:  Laser and nitrate therapies were effective to manage DH after basic periodontal therapy. However, a statistically significant higher  sensitivity reduction was observed in laser therapy group.

[Experimental and clinical rationale for the use of modern methods of teeth hyperesthesia treatment]

The aim of the study was to increase the effectiveness of treatment hyperesthesia of tooth tissues by improving medical and hygienic complexes based on the study of structural changes in dentin. A two-stage study was conducted. In the course of the experimental stage, the microstructure of the tooth dentin surface was studied in terms of its relief on an atomic force microscope in normal conditions, with hypersensitivity and under the influence of the studied preparations (Gluma Desensitizer, Tokuyama Shield Force Plus, Colgate SensitivePro-Relief, Biorepair Oral Care), the material for studing was human teeth with hypersensitive dentin (100) of 1-2 degrees and 25 teeth without hyperesthesia (control group). In the groups for the clinical study were included 100 people with localized hyperesthesia of teeth I-II degree, which, depending on the medical-hygienic complexes used, were divided into 2 groups, 4 subgroups of 25 people. The clinical efficacy of the proposed treatment regimens was assessed using indices: Schiff sensitivity, NRS pain scale, tooth hyperesthesia intensity and prevalence, OHI-S hygiene index in dynamics (before and after treatment, at 3 and 9 months). As a result of the in vitro experiment it was established that after the use of professional desensitizers, the roughness parameters of teeth with hypersensitivity approach the values of a healthy tooth, and after using home remedies there is no qualitative change in the surface. In clinical conditions, it was found that the means for professional use have a significant effect of reducing the sensitivity of teeth, the subsequent treatment of hyperesthesia of the teeth at home is necessary to achieve a stable result. The obtained results allowed to optimize the pathogenetic treatment regimens for dentine hypersensitivity and to integrate the developed medical-hygienic complexes.

Clinical study to monitor dentinal hypersensitivity with episodic use of a desensitising dentifrice

Objectives/Aims:

To evaluate continuous and episodic twice-daily usage regimens of a desensitising dentifrice containing 5% calcium sodium phosphosilicate (CSPS).

Materials and Methods:

In this exploratory, single-centre, randomised, examiner-blind study, subjects with dentinal hypersensitivity were randomised to continuous (24 weeks) use of a 5% CSPS-containing dentifrice or episodic use of the dentifrice comprising two 8-week treatment periods separated by 8 weeks′ use of a standard fluoride dentifrice. Sensitivity was assessed by tactile threshold (Yeaple probe) and evaporative (air) sensitivity (Schiff sensitivity score). Other measures included labelled magnitude scales to assess subjects′ responses to the evaporative stimulus, the Dentine Hypersensitivity Experience Questionnaire and a tooth sensitivity question.

Results:

Seventy-six subjects were randomised to continuous (n=38) or episodic (n=38) use. Small but statistically significant improvements from baseline in Schiff sensitivity scores were observed at weeks 8, 16 and 24 with both regimens (all P<0.05). Increases from baseline in tactile threshold were not statistically significant. No significant between-regimen difference was observed for any endpoint. No treatment-related adverse events were reported.

Discussion:

Dentifrice containing 5% CSPS improved dentinal hypersensitivity with both episodic and continuous twice-daily usage regimens over 24 weeks and was well tolerated.

Conclusion:

No performance differences were observed between the two usage regimens.

Self-assembling peptide matrix for treatment of dentin hypersensitivity: A randomized controlled clinical trial

BACKGROUND

Patient-reported dentin hypersensitivity [DHS] pain is a common finding linked with periodontal disease. This pilot clinical study investigates a novel therapeutic regimen using self-assembling peptide matrix [SAPM] gel (test) compared with use of an 8% arginine and calcium carbonate [ACC] toothpaste (control) for treatment of DHS.

METHODS

A total of 50 patients with history of supportive periodontal therapy were enrolled in this prospective, randomized monocentric clinical study, of which 45 (test: n = 22; control: n = 23) fulfilled all the study visits. Test group patients performed ex-office application of SAPM gel over 1 week, while control group patients performed ex-office application of ACC toothpaste over 90 days. DHS was assessed in office by Visual Analog Scale [VAS], and patient's perception of pain relief was evaluated by questionnaire. In support of the clinical data, scanning electron microscopy images were recorded to investigate tubule occlusion of both control and test product.

RESULTS

Both SAPM and ACC significantly reduced DHS in patients throughout the study, with the patient questionnaire indicating higher patient satisfaction at the earlier time points for the test group.

CONCLUSIONS

Both SAPM gel and ACC toothpaste were successful in providing relief from DHS and showed similar outcomes on VAS and verbal response scale (VRS) throughout the study period of 90 days. The new therapeutic regimen using SAPM resulted in higher patient satisfaction at day 7, as indicated by the patient questionnaire and the higher number of pain-free patients at day 7 and day 90. This is a pilot study describing a novel therapy for DHS.

Effect of combined application of high- and low-intensity lasers on dentin hypersensitivity: A randomized clinical trial

Background. Diode lasers (DLs) have demonstrated equal or better desensitizing effects than fluoride varnish, 10% potas-sium nitrate (NK) gel and Gluma. The current study evaluated the desensitizing effect of combined application of DLs with two different output powers and compared it with single DL therapy. Methods. Sixty-two hypersensitive teeth were allocated randomly into two groups: the single group was treated with 3-W DL beam once and in the combined group, the teeth were irradiated three times (the first time with 0.2-W and then with 3-W and the second and third times, 48 and 96 hours after the baseline visit, with 0.2-W DL beams). The amount of dentin hyper-sensitivity (DH) was evaluated, immediately before and after each visit, and 1 week and 1 and 3 months after the first visit. Data analysis was performed using chi-squared test, repeated measurement of ANOVA and Mann-Whitney U test. P<0.05 was considered statistically significant. Results. Statistically significant changes were observed in the means of VAS indices between all the measurement intervals and pretreatment measures, in both experimental groups (P<0.001). The difference in VAS reduction among the groups was not significant when the hypersensitive teeth were stimulated by a periodontal probe and a jet of air (P=0.63 and P=0.12). Conclusion. The results of the present study showed that using both high-intensity and combined DL beams gives rise to significant reductions in DH. There was no significant difference between combined and single laser therapies in the treatment of tooth hypersensitivity.

Comparative Evaluation of Effect of Nano-hydroxyapatite and 8% Arginine Containing Toothpastes in Managing Dentin Hypersensitivity: Double Blind Randomized Clinical Trial

Purpose: This double blind randomized clinical trial was conducted with the purpose of evaluating the effects of Nano-hydroxyapatite toothpaste as compared to 8% Arginine containing toothpaste in the management of Dentin hypersensitivity (DH). Method and materials: Patients (30 in each group) suffering from DH and eliciting a VAS score higher than 2 in air blast and tactile test were randomly allocated (block randomization) into either a group 1 (arginine toothpaste) or group 2 (nHA toothpaste). The primary outcome evaluated was the reduction of DH as measured by the electrical stimulus reading on the digital pulp tester. Current required for eliciting a VAS score of 2 was recorded before application of dentifrice. 1 cm of toothpaste was then expressed on the tooth surface for two minutes in each group and rinsed off. The electrical stimulus required to elicit a VAS score of 2 was recorded after 5 minutes, 1 week and 4 weeks. Results: The desensitizing paste containing arginine provided a statistically significant reduction in DH and so did the paste containing nHA. Mean increase in amperage value (reduction in DH) was higher for nHA based than the arginine containing dentifrice. This difference was not statistically significant showing that both toothpastes are equally effective. Conclusions: The findings of the present study encourage the use of Nano-hydroxyapatite and arginine containing dentifrice as an effective desensitizing agent providing relief from symptoms 5 minutes after application and after 1 and 4 weeks.