Symptomatology and clinical features of hypersensitive teeth

Clinical Efficacy of Mouthwashes with Potassium Salts in the Treatment of Dentinal Hypersensitivity: A Systematic Review and Meta-analysis

AIM

This systematic review and meta-analysis evaluated whether the home use of mouthwashes containing potassium salts is effective in reducing and controlling dentin hypersensitivity (DH).

METHODS AND MATERIALS

This study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist and was registered in PROSPERO (CRD42021228410). Randomized clinical trials evaluating the use of mouthwashes containing potassium salt for daily household mouthwash for at least four weeks to reduce DH compared with a control mouthwash were selected, with no limitation on year of publication. Electronic research was carried out in PubMed/MEDLINE, Scopus, Web of Science, and Cochrane Library by two independent researchers. One hundred thirty-three articles were obtained, and nine were selected according to the inclusion criteria.

RESULTS

The selected studies evaluated DH through tests of sensitivity to tactile and evaporative stimuli and showed that, for the tactile stimulus, there were no baseline differences between groups (p=0.12; mean difference: -0.33; confidence intervals [CI]: -0.73 to 0.08). However, there were significant differences after two weeks of use (p=0.00001; mean difference: 4.67; CI: 4.53 to 4.81), after four weeks (p=0.00001; mean difference: 13.29; CI: 13.03 to 13.55), and after eight weeks (p=0.00001; mean difference: 8.88; CI: 5.73 to 12.02) favoring the experimental group. The results of the evaporative test showed no differences in the baseline assessment between the two groups (p=0.50; mean difference: -0.02; CI: -0.09 to 0.04), but after four weeks (p=0.00001; mean difference: -0.32; CI: -0.44 to -0.20), and eight weeks of use (p=0.00001; mean difference: -0.42; CI: -0.57 to -0.27) there were differences favoring the experimental group. The incidence of side effects showed no differences between the two groups (p=0.89; mean difference: 1.03; CI: 0.67 to 1.58).

CONCLUSION

The daily use of mouthwashes containing potassium salt is effective in the treatment of dentinal hypersensitivity, as a complementary step to brushing at least twice a day for two weeks, four weeks, and up to eight weeks, without presenting side effects.

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.

Comparison of the Effectiveness of Combined Diode Laser and GLUMA Bonding Therapy With Combined Diode Laser and 5% Sodium Fluoride Varnish in Patients With Dentin Hypersensitivity

Introduction: Dentin hypersensitivity (DH) is one of the most common complaints of patients referred to a dental office, so this study aimed to compare the effectiveness of combined diode laser and GLUMA bonding therapy with combined diode laser and 5% sodium fluoride varnish in patients with DH. Methods: Sixty patients were divided into three groups (bonding, laser-bonding, laser-varnish), and before the intervention, the amount of DH was measured with the visual analogue scale (VAS) scale. In the bonding group, GLUMA Desensitizer solution was applied and then air-dried. In the bonding-laser group, first bonding was used, and then the affected tooth was irradiated with a diode laser. In the varnish-laser group, 5% sodium fluoride varnish was coated and then the laser was irradiated with the said method. DH was measured immediately after the treatment and then 2, 7 and 30 days after the treatment. Results: Laser-varnish treatment was not different from laser-bonding treatment at all measurement times (P=1). Laser-varnish and bonding treatment were not significantly different up to one week after the intervention, but on the 30th day after the intervention, the difference in pain was significant (P=0.01). There was no significant difference in laser-bonding treatment up to one week after the intervention, but on the 30th day after the intervention, the difference in pain was significant (P=0.003). Conclusion: The combined treatment with GLUMA bonding and the 660 nm diode laser is effective in reducing DH and this is more effective than GLUMA bonding alone in the long term. However, it does not have a significant advantage over the combined varnish-laser method, but it seems that due to its ease of use, it can be a suitable alternative to the varnish-laser method.

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 two desensitizing agents on dentin hypersensitivity: A randomized split-mouth clinical trial

Background:

Clinical research is important to evaluate the effect of desensitizing agents.

Aims:

This randomized clinical trial evaluated the immediate and 1 week desensitizing effect of two desensitizing agents Uno Topical Gel and Profluorid.

Materials and Methods:

Thirtyfive patients with teeth presenting with dentin hypersensitivity were included in this clinical trial. Each quadrant in a patient was randomly assigned to one of two groups: Uno Topical Gel or Profluorid Varnish. A VAS score was used to assess tooth sensitivity at baseline, immediately after application of desensitizer and after 1 week. Additionally, 30 dentin discs were prepared, divided into Group 1(Control Group), Group 2 (Profluorid Varnish) and Group 3 (Uno Topical Gel) and examined using scanning electron microscopy (SEM) after 1hour and 24 hours to evaluate tubule occlusion.

Statistical Analysis:

Clinical data were analysed using Friedman's test and Mann – Whitney U test. SEM data was analysed using Student's 2-sample t-test.

Results:

Uno group was significantly better to evaporative stimuli immediately (P=0.01) after application. After 1 week, Uno group was significantly better to tactile (P=0.000) and evaporative (P=0.000) stimuli than Profluorid. SEM images showed that 1 hour after application, Uno and Profluorid demonstrated more than 90% and 80% dentin tubule occlusion respectively. At 24 hours, Uno and Profluorid demonstrated more than 50% and 60% dentin tubule occlusion respectively.

Conclusions:

Uno Topical Gel was significantly better than Profluorid in reducing pain of dentin hypersensitivity due to tactile and evaporative stimuli after 1 week.

"Setting the scene in early childhood" - an MID approach for life

This article presents a discussion paper for both consideration and implementation of Minimal Intervention Dentistry (MID) principles by the general dental practitioner. It argues that if these concepts can be adopted in early childhood by both the community and the profession, "Teeth for Life" can become a reality for all. Oral Health promoting behaviours can be nurtured and supported from infancy and developed into everyday living practice for a lifetime thereby maintaining an optimal quality of life. MID techniques have become more refined and supported by scientific research in the recent times and should be considered an essential clinical guideline for the future disease management.

Comparison of the effectiveness of three different desensitizing toothpastes in reducing dentin hypersensitivity: A 4-week clinical study

Aim:

To compare the effectiveness of three different desensitizing toothpastes containing potassium salt, natural ingredients, and 8% arginine in reducing dentin hypersensitivity (DH).

Materials and Methods:

A 4-week study was conducted on 45 adult patients suffering from hypersensitivity associated with cervical abrasion of two or more teeth anterior to the molars. Patients were divided into three toothpaste groups as follows: Group I: potassium salt, Group II: herbal desensitizing paste containing natural ingredients, and Group III: 8% arginine. Using tactile stimulus and air stimulus, the sensitivity scores were recorded using Visual Analog Scale (VAS) at baseline, immediately after application, after 1 week, after 2 weeks, and after 4 weeks.

Statistical Analysis:

One-way ANOVA test and post hoc Tukey's test were used, and P ≤ 0.05 was considered statistically significant.

Results:

Group III showed significantly better reduction in DH at all time intervals when compared with Group I. Group III was significantly better than Group II at 1, 2, and 4 weeks.

Conclusion:

Desensitizing toothpaste containing 8% arginine was found to be the most effective in the reduction of DH after a single application up to a period of 4 weeks followed by herbal desensitizing toothpaste and potassium salt-containing toothpaste.

Prevalence of self-reported versus diagnosed dentinal hypersensitivity: a cross-sectional study and ROC curve analysis

OBJECTIVE

This study aimed to identify and compare the self-reported and diagnosed prevalence of dentinal hypersensitivity (DH) in an University population; and to verify accuracy, sensitivity and specificity of DH stimuli tests.

MATERIAL AND METHODS

Three hundred and eighty patients (67.2% women and 32.8% men) were assessed by questionnaire, clinical exam, tactile and cold water tests. The intensity of DH was assessed using a visual analogue scale, and a calibrated examiner measured the scores using a caliper. The ICC for intra-examiner was 0.990. Scores above 5 mm were considered sensitive teeth. The association between variables was assessed by Chi-square test. ROC curve analysis determined accuracy, sensitivity and specificity of the tests (p < .05).

RESULTS

The mean age of participants was 24.08 years. 158 (41.7%) volunteers self-reported the presence of DH, while, 88.7% of the participants were clinically diagnosed (p = .023). In total, 8958 teeth were evaluated, of those 3367 (37.6%) were diagnosed sensitive. The most prevalent teeth with DH were incisors and premolars. The accuracy of the tests with cold water and tactile were 99%. The sensitivity and specificity for cold water and tactile tests were 99.9%, 99.7%, 99.1% and 87.6%, respectively.

CONCLUSION

The self-reported prevalence of DH was significantly lower than that clinically diagnosed. The cold test proved to be a highly accurate stimulus for the diagnosis of DH.

Effect of Erosion/Abrasion Challenge on the Dentin Tubule Occlusion Using Different Desensitizing Agents

The aim of the study was to evaluate dentinal tubule occlusion, measuring the dentin permeability (Lp) and using different desensitizing agents before and after abrasive/erosive challenge. Dentin discs from 42 healthy human third molars were obtained. Minimum Lp was measured after a smear layer simulation using #600 SiC paper and maximum Lp after an immersion in 0.5 M EDTA. The specimens were treated with different desensitizers: two varnishes (Clinpro XT Varnish-CV, Fluor Protector-FP), a paste (Desensibilize Nano P-NP) and a gel (Oxa Gel-OG). The Lp of each specimen was measured immediately after the desensitizers' application. The discs were subjected to erosion/abrasion cycles for 7 days, with 0.5% citric acid solution (6x/day) and tooth brushing (3x/day). Lp was measured after the first, fourth and seventh day of the challenge. The data were analyzed by 3-way ANOVA with repeated measurements and by a Games-Howell test (α=5%). FP and CV did not show significant differences in Lp immediately after application until the 7th day (p<0.05). OG showed a significant increase in Lp after the 4th and 7th days. NP resulted in a significantly higher permeability compared to the other materials immediately after the application and after the 1st day of challenge. All the desensitizers reduced the dentin permeability immediately after application. However, only the varnishes were able to maintain the occlusive effect after the erosion/abrasion challenge.

Knowledge, diagnosis and management of dentine hypersensitivity: a national survey of dentists in Nigeria

AIM

To assess the knowledge of Nigerian dentists regarding dentine hypersensitivity (DH) and their methods of diagnosis and management.

METHODS

A cross-sectional questionnaire-based study of dentists practicing in all six geopolitical zones of Nigeria was conducted. The questionnaire focussed on participant's demography, exposure to patients with DH, knowledge-based questions, diagnosis and management of DH. Data analysis using EPI Info statistical software determined frequencies and proportions. Associations between discrete variables were assessed using the chi-square test (P ≤ 0.05).

RESULTS

A total of 1,057 dentists responded; the majority (83.8%) had practiced for up to 15 years, and 92.0% reported that, on average, between one and 10 of their patients each week complained of DH. The majority (92.8%) of dentists described DH as stimulated brief pain from the tooth; 24.2% expressed that DH can be treated by altering the number of dentinal tubules. A diagnosis of DH is made by tapping (20.6%) or scratching (73.4%) the tooth. Although radical treatments, such as extraction (24.7%) and root canal therapy (34.5%), were mentioned by some, the majority identified aetiological and predisposing factors (98.8%) and provided diet (95.1%) and oral hygiene (95%) counselling as part of the management of DH. Evaluation of 36 knowledge-based questions revealed that only 1.8% of the respondents provided at least 25 correct answers. Knowledge was significantly associated with respondent age and number of years in practice (P ≤ 0.05) but was not associated with the number of patients with DH seen per week (P = 0.46).

CONCLUSION

Dentists practicing in Nigeria exhibited knowledge gaps concerning DH and its diagnosis and management.

Comparative Evaluation of Effectiveness of Three Desensitizing Tooth Pastes for Relief in the Dentinal Hypersensitivity

Context:

Dentinal hypersensitivity is a sharp pain occurring on exposure of the exposed dentin to various stimuli such as hot, cold, air, tactile, and chemical.

Aim:

This study aimed to compare the effectiveness of three desensitizing pastes in the treatment of dentinal hypersensitivity.

Materials and Methods:

A total of 45 individuals (with two teeth per patient) were considered for this study and randomly divided into three groups, Group 1: treated with 5% NovaMin-containing toothpaste, Group 2: treated with 8% arginine-containing toothpaste, and Group 3: herbal desensitizing toothpaste. Using tactile stimulus and air stimulus, the sensitivity scores were recorded on visual analog scale (VAS), immediately after paste application, then at 2 weeks, and then at the end of 4 weeks and compared.

Results:

There was a significant change in the VAS scores in Group 1 when compared to Group 2 and Group 3. Group 1 showed better reduction in the hypersensitivity in long term.

Statistical Analysis:

One-way ANOVA test, post hoc Tukey test, and post hoc Bonferroni test were used for statistical analysis.

Conclusion:

Desensitizing pastes can be an effective and economical option in the treatment of the dentinal hypersensitivity.

How to Bridge Research Results to Everyday Clinical Care?

Laboratory and clinical studies are essential to the advancement of sciences. However, a significant gap exists between the research findings and clinical practice. Therefore, research findings can be of little importance if their outcome cannot be directly or indirectly applied to everyday clinical care or readily translated. This paper focuses on how we can shorten the gap between the generation of new knowledge and their implementation into everyday clinical care. A new model is discussed where clinicians are the ones generating the research idea are paired with researchers. They collaborate on studies whose results are readily applicable to everyday practice. Partnering with health providers on studies that address everyday clinical research questions is a potential solution to speed up the translation of the research findings. Generating clinically applicable results can better improve the health of the public. Quoting Dr. Lawrence W. Green: "If we want more evidence-based practice, we need more practice-based evidence." This paper presents the practice-based research model as a solution to address this knowledge gap.

Surgical removal of third molars and periodontal tissues of adjacent second molars

OBJECTIVES

The aim of this study was to investigate the effect of mandibular third-molar (M3) removal on periodontal health of adjacent second molars (M2). Probing pocket depths (PPD) and probing attachment levels (PAL) have been described for primary outcome. As cofactors involved, gender, complications, two suture materials and two types of impaction were chosen as secondary outcomes.

MATERIALS AND METHODS

Seventy-eight patients (49 female; mean age: 16.0 ± 2.0 years) with 78 asymptomatic impacted mandibular M3 were included in this study. Plaque and gingival indices, PPD and PAL were recorded prior and 6 months after surgery. Impacted teeth were classified as either fully impacted (completely within in the bone) or submucosal (fully covered by oral mucosa).

RESULTS

Average baseline PPD was reduced from 3.3 mm to 2.6 mm after 6 months (p < 0.05). Average PAL was reduced from 3.0 to 2.5 mm (p < 0.05). Preoperative PPD ≥ 4 mm at the distolingual and distobuccal sites was positively correlated with clinical improvement (PPD: p < 0.05; PAL: p < 0.05). The impaction class was also identified as positive cofactor for PPD (p = 0.039), but not for PAL.

CONCLUSIONS

Young patients may benefit from an early removal of mandibular M3, especially in the presence of certain cofactors.

Comparison of efficacy of three different desensitizing agents for in-office relief of dentin hypersensitivity: A 4 weeks clinical study

Aim:

To evaluate the effectiveness of three different pastes containing 5% NovaMin, 8% arginine, and 15% hydroxyapatite nanoparticles (n-HA) respectively in the treatment of dentin hypersensitivity (DH).

Materials and Methods:

A 4 weeks study was conducted on 45 adult patients with cervical abrasions leading to hypersensitivity of two or more teeth anterior to molars. Patients were divided into three toothpaste groups. Group I: 5% NovaMin, Group II: 8% arginine, Group III: 15% n-HA. Sensitivity was assessed at baseline, immediately after application and after 1-week and 4 weeks. Tactile stimuli response using a visual analog scale and standard cold air blast using Schiff cold air sensitivity scale were used to compare the efficacies of toothpastes after a single application.

Statistical Analysis:

Two-way analysis of variance and post-hoc Tukey test were used and P ≤ 0.05 was considered statistically significant.

Results:

Visual analog scale analysis: Group III and Group II showed statistically significant reduction in DH at all-time intervals when compared with Group I. In SCA analysis there is no statistically significant difference between Group II and Group III immediately after application.

Conclusion:

Toothpaste containing 15% n-HA was found to be most effective in reduction of DH after a single application up to a period of 4 weeks followed by 8% arginine and 5% NovaMin toothpastes.

Factors influencing repair of dental restorations with resin composite

The presentation of patients with dental restorations that exhibit minor defects is one of the commonest clinical situations in the practice of general dentistry. The repair of such restorations, rather than replacement, is increasingly considered to be a viable alternative to replacement of the defective restoration. This paper considers factors influencing the repair of direct restorations, including indications and details of relevant techniques, based on the best available knowledge and understanding of this important aspect of minimal intervention dentistry. Practitioners who do not consider repair before deciding to replace restorations that present with limited defects are encouraged to consider including repair in the treatment options in such situations. The effective repair of direct restorations can greatly influence the rate of descent down the “restorative death spiral”.

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.

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.

Translating research into everyday clinical practice: lessons learned from a USA dental practice-based research network

OBJECTIVES

This paper discusses practice-based research (PBR) as a means to speed up the translation of research findings to clinical practice. It also reviews repair versus replacement of defective restorations as one example of the delay in the application of research findings to clinical practice.

METHODS

Despite the existence of clinical studies, a significant delay exists between the generation of new knowledge and its application into the medical/dental community and their patients. One example is the repair of defective dental restorations. About 75% of practitioners in general dental practices do not consider the repair of dental restorations as a viable alternative to the replacement of defective restorations. Engaging and partnering with health practitioners in the field on studies addressing everyday clinical research questions may offer a solution to speed up the translation of the research findings.

RESULTS

Practice-based research (PBR) offers a unique opportunity for practitioners to be involved in the research process, formulating clinical research questions. Additionally, PBR generates evidence-based knowledge with a broader spectrum that can be more readily generalized to the public. With PBR, clinicians are involved in the entire research process from its inception to its dissemination.

SIGNIFICANCE

Early practitioner interaction in the research process may result in ideas being more readily incorporated into practice. Clinical studies are of paramount importance for testing and translation of the research findings to the community.

Minimal intervention dentistry for managing dental caries - a review: report of a FDI task group

This publication describes the history of minimal intervention dentistry (MID) for managing dental caries and presents evidence for various carious lesion detection devices, for preventive measures, for restorative and non-restorative therapies as well as for repairing rather than replacing defective restorations. It is a follow-up to the FDI World Dental Federation publication on MID, of 2000. The dental profession currently is faced with an enormous task of how to manage the high burden of consequences of the caries process amongst the world population. If it is to manage carious lesion development and its progression, it should move away from the 'surgical' care approach and fully embrace the MID approach. The chance for MID to be successful is thought to be increased tremendously if dental caries is not considered an infectious but instead a behavioural disease with a bacterial component. Controlling the two main carious lesion development related behaviours, i.e. intake and frequency of fermentable sugars, to not more than five times daily and removing/disturbing dental plaque from all tooth surfaces using an effective fluoridated toothpaste twice daily, are the ingredients for reducing the burden of dental caries in many communities in the world. FDI's policy of reducing the need for restorative therapy by placing an even greater emphasis on caries prevention than is currently done, is therefore, worth pursuing.

Evaluation of the clinical efficacy of potassium nitrate desensitizing mouthwash and a toothpaste in the treatment of dentinal hypersensitivity

Potassium Nitrate has been used as a desensitizing agent to treat dentinal hypersensitivity. The effectiveness of a potassium nitrate is evaluated both in the form of a toothpaste and a mouthwash in a clinical study. Thirty patients were assessed using evaporative stimuli and thermal stimuli and response was evaluated using Visual Analogue Scale at baseline, at 2 weeks and 4 weeks. The patients were divided into. group I: fifteen patients who used toothpaste containing 5% potassium nitrate, sodium fluoride, xylitol and triclosan, group II: Fifteen patients who used mouthwash containing 3% potassium nitrate, sodium fluoride, xylitol and triclosan . The results of both the assessment methods indicated that potassium nitrate toothpaste as well as mouthwash showed statistically significant decrease in the sensitivity score on a Visual Analogue Scale. This was effective in reducing the symptoms of dentinal hypersensitivity when used either as toothpaste or as a mouthwash. But, there were no statistically significant differences between the groups, although both were effective in the treatment of hypersensitivity. Key words:Dentinal hypersensitivity, potassium nitrate toothpaste, potassium nitrate mouthwash, desensitizing agents.

Dentin Hypersensitivity—Etiology, Treatment Possibilities and Other Related Factors: A Literature Review

Dentinal hypersensitivity is a common painful condition of the teeth, associated with the exposure of the dentin to external environment of the mouth. However, little is known about the etiology and predisposing factors, which can compromise management. The aim of this paper is to summarize existing information about epidemiology, mechanisms, etiology, differential diagnosis and treatment.

Clinical relevance

A better understanding of the etiology and factors involved in dentin hypersensitivity will help the management of the hypersensitivity teeth.

How to cite this article

Borges AB, Barcellos DC, Torres CRG, Borges ALS, Marsilio AL, Carvalho CAT. Dentin Hypersensitivity— Etiology, Treatment Possibilities and Other Related Factors: A Literature Review. World J Dent 2012;3(1):60-67.

Alternative treatments to replacement of defective amalgam restorations: results of a seven-year clinical study

BACKGROUND

The authors conducted a prospective cohort clinical study to investigate the effectiveness of alternative treatments to the replacement of defective amalgam restorations.

METHODS

Fifty patients aged 21 through 77 years (mean age, 56 years) with 113 defective amalgam restorations that were diagnosed during treatment planning participated in the study. The authors assigned each tooth to one of five treatment groups: repair with amalgam (n = 20), sealing of defective margins (n = 23), refinishing (n = 23), replacement (n = 22) or no treatment (n = 25). The replacement and no-treatment groups served as comparison groups, and the authors assigned 47 teeth randomly to these groups. Two clinicians examined the restorations before and after the assigned treatment and at subsequent recall visits by using modified U.S. Public Health Service criteria including marginal adaptation, anatomic form, occlusal and proximal contact, postoperative sensitivity and secondary caries.

RESULTS

The clinicians examined 94 restorations (83 percent) at the one-year recall visit, 74 (65 percent) at the two-year recall visit and 54 (48 percent) at the seven-year recall visit. They observed most of the downgraded and failed restorations after the first two years of clinical service.

CONCLUSIONS

The study results show that some degree of degradation occurred in all treatment groups, including the replacement group, at the seven-year recall examination, with no significant failure rate. The results support the repair of defective amalgam restorations as an alternative to replacement. Furthermore, the study findings show that in future controlled clinical trials, all teeth may receive random assignment.

CLINICAL IMPLICATIONS

The study findings support repair rather than replacement of amalgam restorations with localized defects. Randomized controlled trials are needed to confirm these findings.

Treatment of dentin hypersensitivity

Dentinal hypersensitivity is exemplified by brief, sharp, well-localized pain in response to thermal, evaporative, tactile, osmotic, or chemical stimuli that cannot be ascribed to any other form of dental defect or pathology. Pulpal pain is usually more prolonged, dull, aching, and poorly localized and lasts longer than the applied stimulus. Up to 30% of adults have dentinal hypersensitivity at some time. Current techniques for treatment may be only transient in nature and results are not always predictable. Two methods of treatment of dentin hypersensitivity are tubular occlusion and blockage of nerve activity. A differential diagnosis needs to be accomplished before any treatment.

Dentin hypersensitivity after treatment with desensitizing agents: a randomized, double-blind, split-mouth clinical trial

The aim of this study was to evaluate the efficacy of two desensitizing agents in the reduction of dentin hypersensitivity in a randomized, double-blind, split-mouth clinical trial. Seventy-seven teeth from 13 patients that presented some degree of sensitivity to probing and/or air stimulation were treated with one of the following desensitizing agents: Oxa-Gel (G1), Sensi Kill (G2) and placebo gel (G3 - control). According to paired t-test, all treatments, even the placebo gel, were capable of reducing sensitivity scores for both stimuli. Analysis of data by ANOVA and Tukey's test (?=0.05) showed that the sensitivity scores were significantly lower only for Sensi Kill in comparison to the other products (Oxa-Gel and placebo), when air stimulus was applied. It may be concluded that treatment with Sensi Kill presented a slightly better performance in reducing dentin hypersensitivity when compared to the other desensitizing agent.

A long-term evaluation of alternative treatments to replacement of resin-based composite restorations: results of a seven-year study

OBJECTIVE

In a seven-year prospective cohort study, the authors assessed the longevity of defective resin-based composite (RBC) restorations that were not treated or were treated by means of repair, sealing, refinishing or total replacement. They also aimed to identify and quantify the main reasons clinicians diagnosed restorations as defective.

METHODS

Thirty-seven patients--19 women and 18 men--who were aged 27 through 78 years (mean = 57 years, standard deviation [SD] = 13 years) and had a total of 88 defective restorations participated in the study. Two of the authors assigned each restoration to one of five treatment groups, depending on the patient's treatment need: repair (n = 25), sealing of defective margins (n = 12), refinishing (n = 19), replacement (n = 16) and no treatment (n = 16). The authors conducted a survival analysis (according to modified U.S. Public Health Service criteria) at baseline and again at six months, one year, two years and seven years after treatment.

RESULTS

The authors determined that the main reasons clinicians diagnosed the 88 restorations as being defective were marginal discoloration (n = 53, 60.2 percent), marginal degradation (n = 18, 20.5 percent) and color mismatch (n = 17, 19.3 percent). The authors examined 69 (78 percent) restorations at six months, 68 (77 percent) after one year, 62 (70 percent) after two years and 53 after seven years (60 percent). The percentages of failed restorations for each treatment after seven years were 0 percent for repair, 0 percent for sealing of defective margins, 18 percent for refinishing, 21 percent for replacement and 23 percent for no treatment. The P value for the log-rank test of equality for these groups was .36.

CONCLUSIONS

Restorations degraded to varying degrees in all criteria, and the survival of restorations differed among treatment approaches. Longitudinal data collected across seven years support the viability of all nonreplacement restoration treatment strategies.

Laser-activated fluoride treatment of enamel as prevention against erosion

BACKGROUND

Erosion is the loss of dental hard tissues from an acidic challenge, often resulting in exposure of dentinal tubules and hypersensitivity to environmental stimuli. Laser-activated fluoride (LAF) therapy with 488nm laser energy has been shown previously to increase the resistance of human enamel and dentine to acid dissolution. The aims of this study were to investigate the action spectrum of LAF in protecting tooth enamel from softening in response to an erosive challenge, and to examine for any temperature change with the treatment.

MATERIALS AND METHODS

Buccal and lingual surfaces of extracted sound molar and premolar teeth were used to prepare matched pairs of enamel slabs (N = 10 per group). After application of 1.23% neutral sodium fluoride gel (12 300ppm F ion), slab surfaces were lased with 488, 514.5, 532, 633, 670, 830 or 1064nm wavelength (energy density 15J/cm(-2); spot size 5mm), then exposed to an erosive challenge (1.0M HCI for five minutes). The Vicker's hardness number (VHN) was recorded before fluoride gel application and again following the acid challenge. Negative controls did not receive laser exposure.

RESULTS

All wavelengths of laser light examined provided a protective LAF effect against softening, compared with the negative control surfaces.

CONCLUSION

From these findings, we conclude that the action spectrum of the LAF effect extends across the visible spectrum, providing protection to dental enamel from an erosive challenge.

Sonic and ultrasonic scalers in periodontal treatment: a review

Periodontal therapy aims at arresting periodontal infection and maintaining a healthy periodontium. The periodic mechanical removal of subgingival microbial biofilms is essential for controlling inflammatory periodontal disease. Mechanical periodontal therapy consists of scaling, root planing and gingival curettage. The sonic and ultrasonic scalers are valuable tools in the prevention of periodontal disease. The vibration of scaler tips is the main effect to remove the deposits from the dental surface, such as bacterial plaque, calculus and endotoxin. However, constant flushing activity of the lavage used to cool the tips and cavitational activity result in disruption of the weak and unattached subgingival plaque. The aim of the study was to review the safety, efficacy, role and deleterious side-effects of sonic and ultrasonic scalers in mechanical periodontal therapy.

Effect of commercially available and experimental potassium oxalate-based dentin desensitizing agents in dentin permeability: influence of time and filtration system

This study evaluated the influence of time after application of oxalate solutions in reducing dentin hydraulic conductance. Fifty dentin discs were obtained from extracted human third molars and assigned to 5 groups (n=10), according to the desensitizing agent used: Group I: OxaGel; Group II: experimental agent DD-1: Group III: experimental agent DD-2. In Groups IV and V, a placebo gel and deionized water were used as control, respectively. The agents were applied for 3 min, washed out and the hydraulic conductance was measured immediately and at 5-, 15- and 30-min intervals, and after acid etching. Data were analyzed statistically by two-way ANOVA and Duncan's test at 5% significance level. Groups I, II and III did not differ significantly from each other in any of the time intervals (p>0.05). Likewise, Groups IV and V were statistically similar to each other (p>0.05). The active agents reduced significantly dentin permeability in comparison to control groups (p<0.05). Dentin permeability measured in vitro decreased significantly with time regardless of the agent applied (either active or control agents). The results of Group V, in which no dentin desensitizing agent was employed, indicates that the assessment of dentin permeability by this method must be interpreted with caution.

Efficacy of Gluma Desensitizer® on dentin hypersensitivity in periodontally treated patients

The aim of this double-blind, controlled, split-mouth designed clinical trial was to assess the effect of a single application of Gluma Desensitizer® on alleviating dentin hypersensitivity. Twelve subjects entered the study and ten completed the protocol. Each subject had two teeth treated: one with Gluma Desensitizer® according to the manufacturer's instructions and one with water. The assessment of pain was performed with the VAS (Visual Analogue Scale), after tactile (probe), thermal (cold blast of water) and thermal/evaporative (cold blast of air) stimuli at baseline, immediately after treatment, after 1 week and after 4 weeks. The mean VAS values for the test and control teeth were compared by the paired t test (alpha = 0.05). Repeated measurements ANOVA was used to compare the different experimental times. The results showed that for test teeth, at baseline, mean VAS values were 1.76 (± 2.82), 7.10 (± 2.10) and 4.75 (± 2.65), and, after 4 weeks, the mean values were 1.70 (± 2.31), 5.50 (± 3.30) and 4.61 (± 3.14), respectively for probe, water and air stimuli. For the control teeth, at baseline, the mean VAS values were 1.86 (± 2.92), 6.61 (± 2.31) and 4.08 (± 2.91) and, after 4 weeks, 2.66 (± 3.07), 6.32 (± 2.94) e 4.76 (± 3.26).There were no statistically significant differences between test and control teeth at any time. No intra-group differences were demonstrated either. It was concluded that Gluma Desensitizer® had no effect on hypersensitive teeth from periodontally treated patients for a period up to 4 weeks.

Potassium containing toothpastes for dentine hypersensitivity

BACKGROUND

Dentine hypersensitivity may be defined as the pain arising from exposed dentine, typically in response to external stimuli, and which cannot be explained by any other form of dental disease. Many treatment regimens have been recommended over the years, and in recent years particular attention has been focused on toothpastes containing various potassium salts.

OBJECTIVES

To compare the effectiveness of potassium containing toothpastes with control toothpastes in reducing dentine hypersensitivity.

SEARCH STRATEGY

The following databases were searched: Cochrane Oral Health Group Trials Register (searched until August 2005); CENTRAL (until August 2005); EMBASE/MEDLINE, PubMed, Web of Science (until September 2005). Bibliographies of clinical studies and reviews identified in the electronic search were checked for studies published outside the electronically searched journals.

SELECTION CRITERIA

Randomised controlled trials (RCTs) in which the effect on dentine hypersensitivity of potassium containing toothpastes was tested against non-potassium containing control toothpastes.

DATA COLLECTION AND ANALYSIS

Two of the review authors independently recorded the results of the included trials using a specially designed form. Sensitivity was assessed by using thermal, tactile, air blast, and subjective methods.

MAIN RESULTS

Six studies were included in the meta-analysis which showed the statistically significant effect of potassium nitrate toothpaste on air blast and tactile sensitivity at the 6 to 8 weeks follow up, e.g. the meta-analysis of air blast sensitivity showed a standardized mean difference in sensitivity score of -1.25 (95% CI: -1.65 to -0.851) in favour of treatment. The subjective assessment failed to show a significant effect at the 6 to 8 week assessment.

AUTHORS' CONCLUSIONS

The evidence generated by this review is based on a small number of individuals. Furthermore, the effect varies with the methods applied for assessing the sensitivity. Thus no clear evidence is available for the support of potassium containing toothpastes for dentine hypersensitivity.

Clinical evaluation of dentin hypersensitivity treatment with the low intensity Gallium-Aluminum-Arsenide laser - AsGaAl

The dentin hypersensitivity is a painful condition rather prevalent in the general population. There are several ways of treatment for such condition, including the low intensity lasers. The proposal of this study was to verify the effectiveness of the Gallium-Aluminum-Arsenide diode laser in the treatment of this painful condition, using a placebo as control. MATERIALS AND METHODS: Thirty-two patients were selected, 22 females and 10 males, with ages ranging from 20 to 52 years old. The 32 patients were randomly distributed into two groups, treated and control; the sample consisted of 68 teeth, 35 in the treated group and 33 in the control group. The treated group was exposed to six laser applications with intervals from 48 to 72 hours, and the control group received, as placebo, applications of a curing light. RESULTS: A significant reduction was observed in the pain condition between the initial phase and after six laser applications; however, such reduction could also be observed for the control group exposed to the placebo. CONCLUSION: Therapy with the low intensity Gallium-Aluminum-Arsenide laser - AsGaAl induces a statistically significant reduction in the painful condition after each application and between the beginning and end of treatment, although there was no statistically significant difference between the treated group (laser) and the control group (placebo) at the end of treatment and after the mediate evaluation results (after 6 weeks), this way impairing the real measurement of laser effectiveness and placebo effect.

Effect of a 3% Potassium Oxalate Topical Application on Dentinal Hypersensitivity After Subgingival Scaling and Root Planing

BACKGROUND

The present study aimed to verify the effect of a single application of 3% potassium oxalate gel compared to a placebo gel immediately after subgingival scaling and root planing (SRP) on dentinal hypersensitivity (DH).

METHODS

Fifteen patients undergoing periodontal treatment volunteered for this randomized controlled clinical trial. They presented with periodontitis on homologous contralateral canines and premolars, with complaints of dentinal hypersensitivity before periodontal therapy. Immediately after SRP under local anesthesia, the test and placebo agents were randomly applied on the cemento-enamel junction. Evaluation of DH reduction after treatment was self-reported, with assessment made by the patient's indication of how painful each treated. tooth was on a visual analog scale (VAS) at baseline, and 7, 14, and 21 days post-treatment. The results were analyzed by DH percent reduction for each observational moment in relation to baseline, for test and control teeth separately. Mean percent reductions for each group were compared by paired sample t test, with an alpha level of 0.05.

RESULTS

On day 7, percent reduction for the test and control groups was 29.4% and 13.4%, respectively. On day 14 it was 64.6% and 20.5%, and on day 21 it was 81% and 34.7%, respectively. Significant differences between treatments were observed at 14 and 21 days.

CONCLUSION

It may be concluded that subgingival scaling and root planing followed by a single application of a 3% potassium oxalate gel resulted in a significantly higher reduction of dentinal hypersensitivity at 14 and 21 days, when compared to the placebo.

Smoking and smokeless tobacco: increased risk for oral pain

Tobacco has been linked with several pain conditions that include musculoskeletal pain, rheumatoid arthritis, and fibromyalgia. This study documented associations between smoking and smokeless tobacco use and measures of orofacial pain and oral pain impacts (activity reduction and trouble with sleep) assessed during a 48-month time period. These data were collected as part of the Florida Dental Care Study, a longitudinal study of oral health among 873 adults aged 45 years and older at baseline. Twenty-five percent of the study participants were current users of some form of tobacco, and 34% were former users. Separate models were tested for smoking and smokeless tobacco. Current tobacco users were at increased risk of experiencing a range of painful oral symptoms. We also found that behavioral impacts associated with oral pain are sensitive to differences in tobacco use status. Our data also support the supposition that once tobacco cessation occurs, the risk for pain associated with oral disease decreases significantly. No differences were found between former users and those never having used tobacco across any of the pain measures. Strengths of the current study include the longitudinal methodology, assessment of different pain symptoms with potentially differing etiology, and that several markers of tobacco use were used (prevalence, consumption, and duration).

PERSPECTIVE

This study considers the harmful effects of tobacco use on oral health. Smokers were at significantly increased risk for oral pain and related limitation of daily activities. The data also suggest that the risk for oral pain associated with tobacco use decreases significantly if tobacco cessation occurs.

Effect of the Clinical Application of the GaAlAs Laser in the Treatment of Dentine Hypersensitivity

OBJECTIVE

The aim of this study was to evaluate the effectiveness of the clinical use of the gallium-aluminum-arsenium (GaAlAs) laser at the maximum and minimum energies recommended by the manufacturer for the treatment of dentine hypersensitivity.

BACKGROUND DATA

Dentine hypersensitivity (DH) is a response to a stimulus that would not usually cause pain in a healthy tooth. It is characterized by sharp pain of short duration from the denuded dentin. Its etiology is unknown. The dentin only begins to show sensitivity when exposed to the buccal environment. This exposure can result after removal of the enamel and/or dental cement, or after root denudation. Different treatments are proposed for this disorder.

MATERIALS AND METHODS

In this study, 25 patients, with a total number of 106 cases of DH, were treated with GaAlAs low-level laser therapy (LLLT). 65% of the teeth were premolars; 14% were incisors and molars; 6.6% were canines. The teeth were irradiated with 3 and 5 J/cm2 for up to six sessions, with an interval of 72 h between each application, and they were evaluated initially, after each application, and at 15 and 60 days follow-up post-treatment.

RESULTS

The treatment was effective in 86.53% and 88.88% of the irradiated teeth, respectively, with the minimum and maximum energy recommended by the manufacturer. There was a statistically significant difference between DH and after a follow-up of 60 days for both groups. The difference among the energy maximum and minimum was not significant.

CONCLUSION

The GaAlAs low-level laser was effective in reducing initial DH. A significant difference was found between initial values of hypersensitivity and after 60 days follow-up post-treatment. No significant difference was found between minimum (3 J/cm2) and maximum (5 J/cm2) applied energy.

The prevalence of dentine hypersensitivity in a hospital clinic population in Hong Kong

OBJECTIVES

Dentine hypersensitivity is a common clinical finding with a wide variation in prevalence values. The aim of this study was to establish the prevalence of dentine hypersensitivity and to examine some associated aetiological factors in a cross-sectional study of patients visiting the Periodontology and Oral Hygiene Clinic at Prince Phillip Dental Hospital, Hong Kong over a three-week period.

METHODS

226 patients were examined over a three-week period using a triple syringe to administer a blast of cold air to confirm the diagnosis of dentine hypersensitivity. Additional factors such as smoking habits, initiating stimuli, gingival recession and cervical tooth surface loss were noted.

RESULTS

153 patients were diagnosed as having dentine hypersensitivity, giving a prevalence figure of 67.7%. The commonest teeth affected were the lower incisors and the commonest initiating factor was cold drinks.

CONCLUSIONS

The prevalence of dentine hypersensitivity in a hospital periodontology clinic population in Hong Kong was 67.7%.

Potassium nitrate toothpaste for dentine hypersensitivity

BACKGROUND

Dentine hypersensitivity may be defined as the pain arising from exposed dentine, typically in response to external stimuli, and which cannot be explained by any other form of dental disease. Many treatment regimes have been recommended over the years, and in recent years particular attention has been focused on toothpastes containing potassium nitrate.

OBJECTIVES

To compare the effectiveness of potassium nitrate containing toothpastes with placebo toothpastes in reducing dentine hypersensitivity.

SEARCH STRATEGY

The following databases were cross searched via the database host DIALOG: MEDLINE, EMBASE, ELSEVIER BIOBASE, BIOSIS PREVIEWS, CAB HEALTH, SCI SEARCH, CURRENT CONTENTS until 1 April 2000. The specialised Cochrane Oral Health Group Trials Register was also searched. Bibliographies of clinical studies and reviews identified in the electronic search were checked for studies published outside the electronically searched journals.

SELECTION CRITERIA

Randomised clinical trials (RCTs) in which the effect on dentine hypersensitivity of potassium nitrate toothpastes were tested against non-potassium nitrate containing placebo toothpastes.

DATA COLLECTION AND ANALYSIS

Two of the reviewers independently recorded the results of the included trials using a specially designed chart. Sensitivity was assessed by using thermal, tactile, air blast, and subjective methods. The quality of all RCTs, that fulfilled the inclusion criteria, was acceptable with Jadad scores ranging from 3 to 4 (Jadad 1998).

MAIN RESULTS

Out of the eight studies that initially fulfilled the criteria to be included in the review, four studies did not present mean and standard deviations and could thus not be included in the meta-analysis. Three of these did not show an effect on any of the measurements of dentine hypersensitivity, while one did. Four studies were included in the meta-analysis which showed statistically significant effect of potassium nitrate toothpaste on air blast and tactile sensitivity, e.g. the meta analysis of air blast sensitivity showed a standardized mean difference in sensitivity score of -1.51 (95% CI: -2.09 to -0.94) in favour of treatment. The subjective assessment failed to show a significant effect at the six to eight week assessment.

REVIEWER'S CONCLUSIONS

No strong evidence is available supporting the efficacy of potassium nitrate toothpaste for dentine hypersensitivity.

Intraoral fluoride releasing device: a new clinical therapy for dentine sensitivity

BACKGROUND

Dentinal sensitivity (DS) occurs frequently in adult populations in western countries. The purpose of this work was to assess the effectiveness of a new intraoral fluoride releasing device (IFRD) in reducing the level of pain in patients with primary or postsurgical dentine sensitivity.

METHODS

A total of 49 individuals were selected for this study, 15 of whom had post-periodontal surgery dentine sensitivity and 34 with primary sensitivity. An IFRD was applied to 39, while 10 received a placebo device. All individuals in the control group suffered from primary sensitivity. The IFRD used in this study consists of sodium fluoride encased in an acrylic polymer which releases fluoride at a rate of approximately 0.04 mg/day. All patients were asked to rinse with cold water (10 degrees C) and to indicate the level of pain on a 0 to 10 visual analog scale, 0 equalling "no pain" and 10 "maximum bearable pain." All subjects were evaluated once a week during 4 months. Statistical analysis of dentine sensitivity was performed as a univariate study, in relation to the main factors: age, gender, and primary sensitivity or postsurgical etiology.

RESULTS

Symptoms decreased dramatically in all treated patients. The level of sensitivity did not change during the first week after IFRD application, but decreased significantly within the fourth week and remained absent through the duration of the treatment (P <0.01). Difference in sensitivity with respect to different etiology was significant only after 4 weeks (P= 0.01), while there was no statistical difference with respect to age or gender.

CONCLUSIONS

This paper is an initial study to evaluate the effectiveness of the IFRD. The method is fast, painless, inexpensive, and it appears to be suitable as a routine treatment. The presented data support the conclusions at this stage and warrant more comprehensive evaluation.