Efficacy in reducing dentine hypersensitivity of a regimen using a toothpaste containing 8% arginine and calcium carbonate, a mouthwash containing 0.8% arginine, pyrophosphate and PVM/MA copolymer and a toothbrush compared to potassium and negative control regimens: An eight-week randomized clinical trial

Arginine: A New Paradigm in Preventive Oral Care

Dental caries is ubiquitous and one of the most prevalent oral diseases and the foremost cause of dental pain and poor quality of life (QoL). Fluoride is an effective caries preventive agent; however, despite its use, there remain some gaps in prevention of dental caries. Arginine, an amino acid, helps to maintain a noncariogenic plaque. It shows synergistic effects with fluoride in dental caries and can help nourish the tooth by enhancing the remineralization effect of fluoride. Supplementing fluoride dentifrices with arginine can bridge the gap in caries prevention. Several clinical studies with 1.5% arginine + fluoride provide evidence for its use in prevention of dental caries. This report throws light on the benefits of arginine in dental caries and guides on its use with fluoride. Recommendations given in the report will help in effective prevention of dental caries.

How to cite this article

Goyal V, Damle S, Puranik MP, et al. Arginine: A New Paradigm in Preventive Oral Care. Int J Clin Pediatr Dent 2023;16(5):698-706.

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.

Tropical Oral Disease: Analysing Barriers, Burden, Nutrition, Economic Impact, and Inequalities

Traditionally, a healthy mouth is a good indicator of good general health. Poor oral hygiene reflects the health of the oral cavity and is a risk factor for overall health. Although oral diseases like dental decay and periodontitis are prevalent, awareness of oral diseases is still limited. Oral disorders include a wide range of diseases that may not be confined to the oral anatomical structures but may be manifestations of systemic diseases. Identification of the risk factors of dental and oral diseases, including socio-economic determinants, plays a major role in the type of oral health care, and in the promotion of dental health awareness. This article reviews oral diseases in the Caribbean and aims to raise awareness of this subject while suggesting a research agenda for the region.

Evaluating the efficacy of desensitizing dentifrices on dentinal hypersensitivity management: A scanning electron microscopic analysis

Introduction

Dentin hypersensitivity (DH) adversely affects quality of life by impairing the ability to eat and drink certain foods, therefore, should be addressed promptly with a contingency plan that includes initial treatment with a noninvasive prophylactic home care approach, followed by in-office treatment if desired result is not achieved.

Aim

The purpose of this study was to evaluate the effectiveness of four different pastes containing 5% NovaMin (Sensodyne Repair and Protect^®), Propolis (Phytoshield Propolis^®), 5% potassium nitrate (Sensodyne^®), and 8% arginine (Colgate Sensitive Pro Relief^®) based toothpastes in the treatment of DH.

Materials and Methods

One hundred dentin slices were cut from the crown section of molars. Etching with 37% orthophosphoric acid was done to open the tubules. Scanning electron microscope (SEM) study was done to ensure that the tubules are opened. The dentin specimens were divided into four groups: Group 1 -5% NovaMin, Group 2 - Propolis, Group 3 - 5% potassium nitrate, and Group 4 - 8% arginine. Samples were brushed for 2 min twice daily with a soft toothbrush for 15 days and were stored in distilled water. The samples were rinsed under running water to remove the toothpaste. The SEM was performed to check the obliteration of tubules.

Results

5% NovaMin group showed more completely occluded dentinal tubules when compared to other groups. The differences among all the groups were statistically significant (P ≤ 0.05).

Conclusion

In the present study, all materials, NovaMin, Propolis, potassium nitrate, and arginine, were effective in occluding dentinal tubules but NovaMin appeared most proficient in occluding tubules, followed by arginine, potassium nitrate, and Propolis. Topical NovaMin is an upcoming agent demonstrating desensitization and remineralization properties.

An in vitro analysis of the effect of adjunctive use of ozonated oil with a desensitizing agent on dentinal tubule occlusion

Introduction

Dentinal hypersensitivity (DH), is a commonly encountered clinical problem, the management of which is by two main approaches that involve blockage of nerve activity and tubular occlusion. Desensitizing agents containing arginine and calcium carbonate have emerged effective in occluding tubules. Ozone removes the smear layer and opens up the dentinal tubules for easy penetration of these desensitizing agents.

Objective

To comparatively evaluate the effect of ozonated oil on the patency and occlusion of dentinal tubules with and without adjunctive application of a desensitizing agent containing arginine.

Materials and methods

80 dentin specimens that were distributed into 4 groups as Group 1 (control), Group 2 (ozonated oil), Group 3 (desensitizing agent) and Group 4 (desensitizing agent following the application of ozonated oil), underwent an acid challenge. Scanning electron microscopic (SEM) images of the dentin specimens were obtained prior to any treatment, after the application of the therapeutic agents and after acid challenge and mean tubule occlusion scores were recorded in each case employing a suitable scoring system. The statistical analysis employed One-way ANOVA test followed by Tukey's Post hoc test and Student Paired t-test for intergroup and intragroup comparisons of the mean tubule occlusion scores respectively.

Results

Group 2, treated with ozonated oil alone showed a statistically significant increase in the number of open dentinal tubules. Group 4 showed more compact deposits of desensitizing agent and more densely occluded tubules as compared to Group 3 which was more retained in the former even after acid challenge.

Conclusion

Adjunctive application of the desensitizing agent containing arginine, with ozonated oil has a synergistic effect, where the latter causes opening of dentinal tubules allowing more compact penetration of the former and thus may be a potentially more effective treatment approach in the management of DH.

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.

A new arginine-based dental adhesive system: formulation, mechanical and anti-caries properties

Secondary caries at the margins of composite restorations has been attributed to adhesive failure and consequent accumulation of cariogenic biofilms.

OBJECTIVES

To develop and evaluate an etch-and-rinse adhesive system containing arginine for sustainable release and recharge without affecting its mechanical properties. Arginine metabolism by oral bacteria generates ammonia, which neutralizes glycolytic acids and creates a neutral environmental pH that is less favorable to the growth of caries pathogens, thus reducing the caries risk at the tooth-composite interface.

METHODS

Experimental adhesives were formulated with methacrylate monomers and arginine at 5%, 7%, and 10% or no arginine (control). Adhesives were tested for: (i) mechanical properties of true stress (FS and UTS), modulus of elasticity (E), degree of conversion (DC), Knoop hardness number (KHN) and dentin microtensile bond strength (μ-TBS), (ii) arginine release and recharge, and (iii) antibacterial activities. Data was analyzed by t-test, one-way ANOVA and Tukey's tests.

RESULTS

FS and UTS results showed no statistically significant differences between the 7% arginine-adhesive and control, while the results for E, DC, KHN and μ-TBS showed no difference among all groups. The 7% arginine-adhesive showed a high release rate of arginine (75.0μmol/cm²) at 2h, and a more sustainable, controlled release rate (up to 0.2μmol/cm²) at 30days.

CONCLUSIONS

Incorporation of 7% arginine did not affect the physical and mechanical properties of the adhesive. Arginine was released from the adhesive at a rate and concentration that exhibited antibacterial effects, regardless of shifts in biofilm conditions such as sugar availability and pH.

CLINICAL SIGNIFICANCE

Secondary caries is recognized as the main reason for failure of dental restorations. The development of an arginine-based adhesive system has the potential to dramatically reduce the incidence and severity of secondary caries in adhesive restorations in a very economical fashion.

Effect of desensitising paste containing 8% arginine and calcium carbonate on biofilm formation of Streptococcus mutans in vitro

OBJECTIVES

To evaluate the influence of desensitising paste containing 8% arginine and calcium carbonate (Ar-Ca) on biofilm formation on dentine.

METHODS

Dentine discs were cut from extracted third molars and divided into the following three groups: no treatment, pumice treatment and Ar-Ca treatment. Surface topography and roughness were examined using scanning electron microscopy (SEM) and non-contact 3D surface profiler. After sterilisation, samples were incubated with Streptococcus mutans (S. mutans) for 4 h, 24 h and 72 h. Bacterial adhesion and biofilm formation were analysed using SEM, whereas MTT and lactic acid production assays were used to analyse the metabolic activity of S. mutans.

RESULTS

After polishing with either pumice or Ar-Ca, the surfaces of the samples became smoother than in the control group. The Ra values of the three experimental groups decreased significantly to 0.43 μm, 0.3 μm and 0.26 μm, respectively. Compared to the control group, fewer bacteria adhered to the dentine surface in the Ar-Ca group, while biofilm thickness decreased significantly for both groups after incubating for 24 h and 72 h. MTT and lactic acid production levers also showed a significant reduction in the Ar-Ca group.

CONCLUSIONS

Ar-Ca appears to present antibiofilm efficacy and may provide a promising approach to combat bacterial infection in hypersensitive dentinal lesions.

CLINICAL SIGNIFICANCE

As a clinical application of desensitising polishing paste, the paste containing 8% arginine and calcium carbonate could also inhibit the biofilm formation effectively.

Possible role for arginine-containing toothpastes in managing dentine hypersensitivity

DATA SOURCES

The Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase and LILACS databases were searched. Reference lists of eligible studies and systematic reviews were cross-checked to identify additional studies.

STUDY SELECTION

Randomised and controlled clinical trials conducted in adults with at least two hypersensitive teeth confirmed by evaporative stimulus or tactile hypersensitivity assessment comparing arginine-containing desensitising toothpastes to non-arginine-containing control toothpastes were included.

DATA EXTRACTION AND SYNTHESIS

Data abstraction and risk of bias assessment were conducted independently by two reviewers and a qualitative summary presented.

RESULTS

Two randomised trials met the criteria; both showed a positive effect on dentine hypersensitivity in response to tactile and air-blast stimuli. No subjective measures of sensitivity were reported.

CONCLUSIONS

Data identified indicate a potential role for arginine-containing toothpastes in managing dentine hypersensitivity. However, this conclusion is based on small sample sizes and the studies identified did not follow patients up in the medium to long term. The authors recommend that there is a need for well-designed RCTs to be conducted prior to any definitive recommendations being made.