Clinical efficiency of a natural resin fluoride varnish (Shellac F) in reducing dentin hypersensitivity

Bioplastic Floss of a Novel Microwave-Thermospun Shellac: Synthesis and Bleaching for Some Dental Applications

In this paper, crude flakes (CFs) of shellac were converted into purified, nonwoven, thermospun fibers (shellac floss) using two devices, namely, an electric thermospinner (ETS) and a microwave thermospinner (MTS). This conversion was achieved by the action of heating and the centrifugal forces that arose toward the outside of the spinner-head cavity. The dissolved MTS floss was bleached using hydrogen peroxide to produce the bleached MTS floss. The unbleached shellac (CFs, ETS floss, and MTS floss) and the bleached MTS floss were characterized physically and chemically. There was no deterioration in the floss properties due to the heating tools or bleaching process. For the unbleached shellac, although there were no statistical differences in properties among the three shellac types (CFs, ETS floss, and MTS floss), except for insolubility in hot alcohol, acid value, and moisture content, the MTS floss exhibited superior values compared with the other types for nearly all the properties studied. Bleaching the MTS floss produced the greatest color change among other studies, caused a high reduction in insoluble solid matter due to increasing the solubility of some of the solid constituents of shellac, and slightly decreased its Young's modulus (E). The important dental applications were surveyed and it was suggested that the suitability was enhanced by using the bleached MTS floss, based on its superior whiteness, along with the unique properties detected.

ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity

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

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

OBJECTIVES

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

METHODS AND MATERIALS

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

RESULTS

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

CONCLUSIONS

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

Clinical efficacy of nanohydroxyapatite-containing toothpaste at relieving dentin hypersensitivity: an 8 weeks randomized control trial

Objective

The objective of this study was to investigate and compare the effectiveness of several toothpastes containing nanohydroxyapatite (nano-HAP) to relieve dentin hypersensitivity (DHS) with that of a commercial desensitizing dentifrice containing calcium sodium phosphosilicate (CSPS).

Materials and methods

In this double-blind, randomized, parallel-group clinical trial, patients diagnosed with DHS and qualified to participate were randomized into four groups: toothpaste containing 10% nano-HAP (10%nano-HAP), 15% nano-HAP (15%nano-HAP), 10% nano-HAP supplemented with potassium nitrate (KNO₃) (10%nano-HAPKN), or CSPS. Subjects’ baseline and post-treatment sensitivities were assessed using visual analog scale (VAS) after the application of ice-cold and air stimuli. Subjects used their assigned toothpaste for routine toothbrushing twice daily. Post-treatment sensitivity was assessed every 2 or 8 weeks. Mean change in VAS (mm) from baseline at each time point were compared using random-intercept, mixed-model analysis and Duncan test (P < 0.05).

Results

With either air or cold stimulus, VAS indicated a significant (P < 0.001) reduction from baseline DHS at each time point with all test toothpastes. Among the nano-HAP toothpastes, 15%nano-HAP and 10%nano-HAPKN were consistent in DHS reduction with both stimuli. With either stimuli, the CSPS did not significantly differ from 15%nano-HAP and 10%nano-HAPKN at any time point.

Conclusions

Toothpaste containing nano-HAP (10 or 15%) alone or supplemented with KNO₃ was as effective as CSPS for relief of DHS symptoms when used at least twice daily.

Comparative Evaluation of Efficacy of Diode Laser and Clinpro XT Varnish for Treatment of Dentin Hypersensitivity: A Randomized Clinical Trial

Context

Dentin hypersensitivity (DH) is a very common dilemma and often results in temporary relief by the conventional treatment method. An in vivo comparative study of various methods and materials helps in evaluation of a superior method to provide a long-lasting relief.

Aim

The aim of this study was to evaluate the efficacy of diode laser (DL) and Clinpro XT Varnish for managing DH.

Materials and Methods

This study was a randomized, single-blinded, clinical trial, designed, adhering to the CONSORT (Consolidated Standards of Reporting Trials) Guidelines using DL and fluoride-based varnish for managing DH. A total of 40 teeth were selected from eight patients and randomly divided into two groups. All patients received tactile and air syringe stimulus to assess for DH and a visual analog scale (VAS) was used to obtain readings at baseline, 15min, 1 week, and 3 weeks, posttreatment. Student's t test was used, paired t test was for the intragroups, and unpaired t test was for intergroups.

Results

This study showed that the effect of DL and Clinpro XT Varnish results in a significant decrease of DH. However, success decreased gradually over time.

Conclusion

Clinpro XT Varnish presented superior immediate effect and DL effect tends to become better with time. Hence, both had good results in the end.

Comparative evaluation of calcium phosphate-based varnish and resin-modified glass ionomer-based varnish in reducing dentinal hypersensitivity: A randomized controlled clinical trial

Objective:

The aim of this study was to evaluate the efficacy of MI varnish and Clinpro XT varnish in reducing dentinal hypersensitivity.

Materials and Methods:

Patients with cervical dentinal hypersensitivity were selected for the study. The teeth to be tested were isolated. Then, a blast of air and ice cold water was applied on the tooth surface, and the score was measured by visual analog scale. The patients were randomly assigned to one of the treatment groups (Group 1: MI varnish; Group 2; Clinpro XT varnish). The manufacturer's instructions were followed. The sensitivity scores were recorded immediately and after 1 week of therapy.

Statistical Analysis:

Mann–Whitney U-test and Wilcoxon-matched pairs test were used for the analysis.

Results and Conclusion:

Although both varnishes were shown to reduce the dentinal hypersensitivity in patients, according to statistics, MI Varnish was a better agent to reduce dentinal hypersensitivity than Clinpro XT varnish.

Effect of erosive and abrasive stress on sealing ability of different desensitizers: In-vitro study

This in vitro study examined the sealing ability of different desensitizing agents under a chemo-mechanical stress condition. For the study, a total of 144 extracted, caries-free human third molars were used to produce 1 mm-thick dentin discs. The specimens were divided randomly into four groups: Superseal (SS), Gluma (GL), Gluma Self-etch (GS), and Tooth Coat (TC). For each group, the permeability was measured before and after applying the desensitizer, after being exposed to Coca Cola for 5 minutes, and after 3150 strokes of a brushing abrasion. The decrease in permeability after the erosive and abrasive stress was analyzed by ANOVA and Tukey post hoc test. As a result, the dentin permeability decreased significantly for all desensitizers immediately after application (p < 0.05). SS and GS showed a significant difference in permeability reduction observed immediately after application and after acid action with Coca Cola (p < 0.05). After brushing abrasion, the permeability reduction decreased significantly for all desensitizers tested in this study (p < 0.05). TC showed the largest decrease in dentinal permeability compared to that of the other desensitizers and the differences were significant after brushing abrasion (p < 0.05). All tested desensitizers were effective in reducing dentin permeability. The behavioral characteristics under erosive and abrasive stress varied according to the products used. TC exhibited excellent sealing ability among the other desensitizers.

Dual-functionalised shellac nanocarriers give a super-boost of the antimicrobial action of berberine

We have developed highly efficient antimicrobial nanocarriers for berberine (BRB) based on shellac nanoparticles (NPs) which were surface-functionalised with a surface active polymer, Poloxamer 407 (P407), and the cationic surfactant octadecyltrimethylammonium bromide (ODTAB). These shellac nanocarriers were produced in a two-step process which involves: (i) a pH change from aqueous ammonium shellac solution using P407 as a steric stabilizer in the presence of berberine chloride, and (ii) addition of ODTAB to yield shellac nanocarriers of cationic surface. We determined the BRB encapsulation efficiency and release profiles from such nanocarriers. We explored the antimicrobial action of these nanocarriers at different stages of their preparation which allowed us gain better understanding how they work, fine tune their design and reveal the impact of the nanoparticle coatings on to its antimicrobial effect. The antimicrobial action of BRB loaded within such shellac NPs with cationic surface functionality was examined on three different microorganisms, C. reinhardtii, S. cerevisiae and E. coli and compared with the effect of free BRB as well as non-coated BRB-loaded nanocarriers at the same BRB concentrations. We found that the cationic surface coating of the shellac NPs strongly amplified the efficiency of the encapsulated BRB across all tested microorganisms. The effect was attributed to the increased attraction between the ODTAB-coated BRB-loaded NPs and the anionic surface of the cell walls which delivers locally high BRB concentration. This nanotechnological approach could lead to more effective antimicrobial and disinfecting agents, dental formulations for plaque control, wound dressings, antialgal/antibiofouling formulations and antifungal agents.

Boosting the antimicrobial action of vancomycin formulated in shellac nanoparticles of dual-surface functionality

We demonstrate a strong enhancement of the antimicrobial action of vancomycin encapsulated in shellac nanocarriers with cationic surface functionality which concentrate on the microbial cell membranes.

Clinical Efficacy in Relieving Dentin Hypersensitivity of Nanohydroxyapatite-containing Cream: A Randomized Controlled Trial

OBJECTIVE

The study aimed to investigate the effectiveness of Apadent Pro (Sangi) Nanohydroxyapatite (nHAP) dental cream to relieve Dentin Hypersensitivity (DHS), compared with a positive control cream containing 20% pure silica (Silica).

METHODS

In this double-blind, randomized, parallel-group clinical trial, patients diagnosed with DHS and qualified to participate were randomized into two groups, nHAP (n=25) and Silica (n=26). Subjects' baseline and posttreatment sensitivity were assessed using two pain scales, a four-point Dental Pain Scale (DPS) followed by a linear Visual Analog Scale (VAS), after the application of ice-cold and air stimuli. Subjects used custom-fabricated trays to apply their respective cream for 5 minutes once daily following brushing with standard fluoride toothpaste. Posttreatment sensitivity (efficacy) was assessed every 2 weeks for 8 weeks. Mean treatment outcomes (percentage change from baseline) at each time point were compared using the Tukey HSD test for multiplicity (P<0.05).

RESULTS

With either air or cold stimulus, VAS and DPS indicated a significant (P<0.001) reduction in DHS at each time point with either nHAP or Silica. Comparing pain scales, VAS showed no significant difference in DHS reduction between the products with either air or cold. However, with DPS, DHS reduction was significantly (P<0.05) better with Silica than with nHAP at all time points with cold, and at 2, 4, and 8 weeks with air.

CONCLUSION

Both Apadent Pro nHAP and Silica dental creams are effective at promoting the relief of DHS symptoms. When comparing the efficacy of the two compounds to relieve DHS, results of the two pain scales were conflicting.

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.

Effects of a Dicalcium and Tetracalcium Phosphate-Based Desensitizer on In Vitro Dentin Permeability

The present study evaluated the effectiveness of a dicalcium and tetracalcium phosphate-based desensitizer in reducing dentin permeability in vitro. Dentin fluid flow was measured before and after treatment of dentin with patent dentinal tubules using 1 or 3 applications of the dicalcium and tetracalcium phosphate containing agent TeethmateTM (TM) and comparing the results with two sodium fluoride varnishes VellaTM (VLA) and VanishTM (VAN), after storage in artificial saliva for 24 h, 48 h and 7 days. Significant differences were observed among the 4 methods employed for reducing dentin permeability (p < 0.001) and the 3 post-treatment times (p < 0.001). VLA and VAN never achieved 50% permeability reductions consistently in any of the 3 time periods. Only the calcium phosphate-based desensitizer applied for 3 times consistently reduced dentin permeability by 50% after 24 h. When applied once, the permeability reduction of TM increased progressively over the 3 time periods. After 7 days, only one and three applications of the calcium phosphate-based desensitizer consistently reduced dentin permeability by more than 50%. Permeability reductions corresponded well with scanning electron microscopy examination of dentinal tubule orifice occlusion in dentin specimens treated with the agents. Overall, the dicalcium and tetracalcium phosphate-based desensitizer is effective in reducing dentin permeability via a tubule occlusion mechanism. The ability of the agent to reduce dentin permeability renders it to be potentially useful as a clinical dentin desensitizing agent, which has to be confirmed in future clinical studies. By contrast, the two sodium fluoride varnishes are not effective in dentin permeability reduction and should be considered as topical fluoride delivering agents rather than tubular orifice-blocking agents.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

Objective

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

Materials and methods

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

Results

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

Conclusion

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

Clinical relevance

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