In-office treatment of dentinal hypersensitivity

Intratubular crystal formation in the exposed dentin from nano-sized calcium silicate for dentin hypersensitivity treatment

The aim of this study is to evaluate intratubular crystal formation from the experimental material consisting of dicalcium silicate (C2S) and tricalcium silicate (C3S) with nano-scaled particle size. A total of twenty-four specimens were made by isolating 8 mm of the cervical part centered at the cementoenamel junction of extracted premolars. Twelve specimens were not treated and considered as control. The experimental material was applied to the other twelve specimens by brushing for 10,000 strokes. Each group was randomly divided into four subgroups according to the period of immersion in phosphate buffer saline (PBS) for 1, 30, 60, and 90 days each. The specimens were sectioned longitudinally and examined with scanning electron microscopy and energy dispersion X-ray spectroscopy. The intratubular crystal were formed in PBS and densely filled the dentinal tubules over time. The crystal formation occurred at a depth of more than 50 μm from the dentin surface. The Ca/P ratio of formed intratubular crystals was 1.68 after 3 months. The experimental material consisting of C2S and C3S with a nanoscale particle size can form hydroxyapatite-like crystals in dentinal tubules in PBS, and there is a possibility of reducing dentin hypersensitivity by blocking the dentinal fluid flow.

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.

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.

Effect of desensitizing agents on dentin hypersensitivity after non-surgical periodontal therapy: A systematic review and meta-analysis

OBJECTIVE

To investigate the effectiveness of desensitizing agents (DA) on dentin hypersensitivity (DH) after non-surgical periodontal treatment (NSPT) through a systematic review and meta-analysis.

DATA

The PICO strategy was used to include randomized clinical trials in human subjects with DH (P) after NSPT treated with DA (I) compared to those treated with placebo or control (C) to identify DH relief (O). The Cochrane guidelines and GRADE was used to classify the risk of bias and the quality of the evidence, respectively.

SOURCES

PubMed, Web of Science, Scopus, Lilacs, Cochrane Library databases, and OpenGrey were searched on the 20^th of May 2020.

STUDY SELECTION

Nine studies were included in the quantitative synthesis. Five meta-analyses were performed. Three meta-analyzes assessed the effectiveness of DA compared to a placebo or control in relation to pain assessment stimuli and two meta-analyzes assessed the mechanism of action of DA. For the mechanical stimulus in overall analysis, the control group presented a higher mean of pain reduction (SMD 1.03 [0.73, 1.32], p < 0.001) with very low certainty of evidence. For water (SMD -0.78 [-1.22, -0.35], p = 0.0009) and evaporative in overall analysis (SMD -1.21 [-1.79, -0.64], p < 0.001) stimuli, the DA decreased DH pain with very low and low certainty of evidence, respectively.

CONCLUSION

Due to the limited quality of evidence, there is no definitive conclusion on the effectiveness of DA on DH after NSPT. Thus, further clinical studies with a low risk of bias and high-quality evidence are encouraged to reinforce the certainty of evidence on that issue.

CLINICAL SIGNIFICANCE

The use of desensitizing agents show promise for relief of dentin hypersensitivity after non-surgical periodontal therapy.

Effect of desensitizing agents on the microtensile bond strength of two-step etch-and-rinse adhesives to dentin

Desensitizers can be used to control postoperative sensitivity in adhesive restorations. The aim of this study was to evaluate the effect of desensitizing agents on the bond strength of two-step etch-and-rinse adhesive systems to dentin. Forty-two human molars were sectioned to obtain 3-mm-thick dentin discs. The discs were divided into three groups (n = 14 in each) - no-treatment control group (CT), and oxalic acid [BisBlock (BB)] and calcium phosphate [Desensibilize Nano-P (NP)] desensitizers - before the application of two adhesive systems [Adper Single Bond Plus (SB) and One-Step Plus (OSP)]. A nanoparticle composite resin was used to create a 3-mm-thick build-up. The specimens were stored in distilled water for 24 h before a microtensile bond-strength test was performed. The failure modes were determined using a stereomicroscope at 100 × magnification. Specimens were sectioned perpendicular to the interface for scanning electron microscopy analyses. The CT-SB group exhibited the highest bond strength, differing significantly from BB-SB and BB-OSP groups. Mixed failures were prevalent for all groups. Scanning electron microscopy revealed a continuous hybrid layer and resin tags in all groups. Dentin bond strength of etch-and-rinse adhesive systems was reduced by an oxalic acid desensitizer but was not affected by a calcium phosphate-containing desensitizer.

Evaluation of Cytotoxicity of Dentin Desensitizing Products

Objectives

To evaluate the cytotoxic effects of the dentin desensitizing products (DDPs) used in the treatment of dentin hypersensitivity on cultured human gingival and pulpal fibroblast cells.

Methods and Materials

The cytotoxic effects of DDPs (Smart Protect, Systemp Desensitizer, Seal & Protect, Aqua-Prep F, Isodan, Gluma, BisBlock, D/Sense Crystal, UltraEZ, Colgate Sensitive Pro-Relief, Topex, and Clinpro White Varnish) on cultured human gingival- and pulp-derived fibroblast cells were evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) test (Serva, Heidelberg, Germany) under two different conditions. In the first test, different dilutions of the DDPs were directly applied onto cultured gingival fibroblast cells, and in the second test, the products were applied onto different-thickness dentin discs (0.5 and 1 mm) placed above cell culture medium, which contained pulp fibroblast cells.

Results

According to the cytotoxicity evaluations of gingival fibroblast cells, the cytotoxicity of all of the DDPs was very high at 50% concentrations (p&lt;0.05). Colgate Sensitive Pro-Relief, Clinpro White Varnish, and Topex showed higher cytotoxicity than did the other products (p&lt;0.05), decreasing with further dilutions, and these products were found to be less cytotoxic to both types of cells (p&lt;0.05) than were the other products with further dilutions. The cytotoxicity to human gingival and pulpal fibroblast cells of Systemp Desensitizer, Aqua-Prep F, Isodan, and Gluma did not show any decrease with further dilutions, and these products were found to be more cytotoxic than the other products (p&lt;0.05).

Conclusions

According to the findings of this study, Colgate Sensitive Pro-Relief, Topex, and Clinpro White Varnish were less cytotoxic than the other DDPs used in this study.

Prevalence of dentin hypersensitivity and related factors among adult patients visiting a dental school in andhra pradesh, southern India

BACKGROUND AND AIM

Dentine hypersensitivity (DH) is a relatively common problem which may disturb the patient during eating, drinking, brushing and sometimes even breathing. It is a painful condition highly prevalent in the general adult population. The aim of this study is to determine the prevalence of DH and to examine some associated factors such as initiating stimuli among adult patients.

MATERIALS AND METHODS

The study is done under two phases. In the first phase a cross-sectional study was carried out in 665 study volunteers. Only 212 adult patients who were meeting the inclusion and exclusion criteria were conveniently selected to the study. A detailed demographic data and a structured questionnaire regarding type of response, sensitivity episodes, and duration of sensation, and stimulus for initiation were recorded by the examiner. Evidence of DH was confirmed by the use of air blast and water from the air-water jet of the dental chair and scratching the suspected tooth surfaces which is indicated by study subjects with a dental probe and noting the responses by using visual analog scale (VAS). In the second phase the related factors or characteristics of DH were surveyed. Statistical analysis preformed by using methods of descriptive statistics and Kruskal Wallis test.

RESULTS

The overall prevalence of DH was found to be 32%. The most common cause was consuming cold food or drinks (92%) and common predisposing factor was gingival recession (28%). Probe method yields a higher VAS score followed by Air at 10 seconds and Water at 10 seconds which is statistically significant.

CONCLUSION

The prevalence of DH in present study was 32% which is attributed to gingival recession as predisposing factor and cold stimuli.

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.

In vitro evaluation of the effects of different treatment procedures on dentine tubules

OBJECTIVE

The objective of this preliminary study was to evaluate the occluding effect of topical gaseous ozone application and Er:YAG laser on human dentine tubules by scanning electron microscopic (SEM) analysis.

METHODS

Twenty-four dentine specimens were divided into three groups. Group I, including specimens treated only with citric acid, served as the control. Group II was treated with Er:YAG (30 Hz 60 mJ, 10 sec), and Group III received only topical gaseous ozone application (10 sec at level 2). Diameters and the number of open dentinal tubules per 100 μm(2) were counted from SEM photomigrophraphs at ×2000 magnification.

RESULTS

In terms of diameters and numbers of open dentinal tubules per 100 μm(2), both treatment modalities presented significant occlusion. The mean values of the diameters and the number of open dentinal tubules per 100 μm(2) were observed in Group I, Group II, and Group III, in decreasing order. Significant differences were found among the groups in favor of the topical gaseous ozone applied group.

CONCLUSIONS

The dentine tubules in both treatment groups were occluded, however more marked occlusion were seen in ozone treated group.

Caries-preventive Activity of Fluoride-containing Resin-based Desensitizers

Objective

The purpose of this study was to evaluate the effects of different desensitizing agents on the prevention of root caries when applied to root surfaces.

Materials and Methods

Thirty human roots were sectioned into quarters with a 3 × 4 mm window. A desensitizer (VX, Clinpro™ XT Varnish; SP, Seal & Protect®; or PB, Clearfil™ Protect Bond) was applied to three of the quarters in each window. Teeth were stored separately in water for one day, 30 days, or 60 days. The remaining quarter, without the application of desensitizer, served as a control. After storage in water, all specimens were subjected to pH cycling. Scanning electron microscopy was used to observe the demineralization bands created on the subsurface layer. The weight percentages of fluorine (F), silica, and calcium (Ca) were determined using electron probe microanalysis to quantify the elemental distributions in the root dentin. The concentrations of F released during a pH cycling were measured.

Results

For the control group, the average lesion depth was 18.92 ± 5.42 μm, and the average Ca loss was 15.66% ± 6.80% in the superficial layer and 30.44% ± 9.61% in the subsurface layer. No Ca loss occurred in the desensitizer-treated groups. All desensitizing agents remained intact for at least 60 days. F levels were increased in the hybrid layer but not in the subhybrid area. Outward release of F diminished with time.

Conclusion

The F-containing resin-based desensitizers protected exposed root surfaces from demineralization. F liberated from the desensitizers was detected only at minimal levels.

Seal that Heals

Introduction

Dentinal hypersensitivity can be treated by dentinal tubule occlusion which prevents any stimuli from causing dentinal fluid movement. This in vitro study aims to compare the dentinal tubule occluding capability of four chemical compounds, a bonding agent, a compound of fluoride and hydroxyapatite, potassium oxalate gel and sodium fluoride varnish.

Materials and methods

Forty dentin samples were divided into four groups of 10 samples each. Group A (treated with Clearfil SE Bond), Group B (treated with Remin Pro), Group C (treated with Potassium Oxalate, Vi-sense,) and Group D (treated with Pro Fluoride varnish). The samples were treated with ethylene diamine tetraacetic acid (EDTA) gel prior to application of desensitizing agents to remove the smear layer and open the dentinal tubule orifice. Following the desensitizing treatment the specimens were washed and dehydrated using graded series of ethanol treatments (25, 50, 75, 90 and 100%). After each treatment tubule occlusion was analyzed by scanning electron microscope.

Results

Qualitative and quantitative analysis demonstrated potassium oxalate gel to cause maximum tubule occlusion followed by Remin Pro > Sodium fluoride varnish > Clearfil SE Bond.

Conclusion

Life expectancy is increasing and patients are retaining their natural teeth for a longer time due to effective treatment strategies. The results showed the potential use of these products as an effective means of tubule occlusion.

How to cite this article

Benjamin S, Roshni, Pradhan S, Nainan MT. Seal that Heals. World J Dent 2012;3(3):243-246.