Effectiveness of laser therapy and topical desensitising agents in treating dentine hypersensitivity: a systematic review

Hypnosis in controlling anxiety during third molar extraction: a critical review

The use of hypnosis as an alternative for controlling stress and anxiety in patients undergoing surgical treatment has been discussed in recent years. The aim of this study was to critically review Randomized Clinical Trials (RCTs) on the clinical efficacy of hypnosis in controlling anxiety related to third molar extraction. The PICO strategy was adopted: Population (Patients undergoing third molar extraction), Intervention (Hypnosis), Comparator (Other therapies to control anxiety) and Outcome (Reduced anxiety). The descriptors "Hypnosis," "Anxiety," "Dental treatment," "Third Molar" and "Oral Surgical Procedures" were used, combined or not, in the following databases: Medline (via PubMed), Scopus, Web of Science, Cochrane and Embase. Of the 255 articles found, only 1 met the inclusion criteria. Therefore, the first 100 articles from the Gray Literature (Google Scholar) were consulted, from which 2 studies were included. Although the three articles evaluated were RCTs, they were all classified as level III evidence with a high risk of bias. In two studies, the group that received hypnosis had a lower anxiety index, a statistically significant result (p < .05), according to the Spielberger Anxiety Inventory. These data show that, despite the advantages of hypnosis in controlling anxiety in patients undergoing third molar extraction, the literature is still limited. There is therefore a need for more RCTs, using a rigorous methodology that can support reliable clinical results.

Effect of Low- and High-Level Laser Therapy on the Treatment of Dentin Hypersensitivity: An Umbrella Review

Introduction: Dentin hypersensitivity (DH) is a prevalent unpleasant condition which might affect quality of life. Laser therapy is one of the non-invasive treatments for dentin hypersensitivity. The aim of this umbrella review was to assess the effect of lasers on the treatment of dentin hypersensitivity by analyzing the previously published systematic reviews and meta-analyses. Methods: Electronic databases (PubMed, Embase, Scopus, Cochrane, and ISI) were searched to identify relevant systematic reviews and meta-analyses based on the keyword search strategy. Two independent reviewers carried out the selection of studies, extraction of data, and assessment of methodological quality. The actual overlap of primary studies was measured through the visual tool known as the citation matrix and three indices of % overlaps, covered area (CA), and corrected covered area (CCA). The reviews were appraised for methodological quality through A Measurement Tool to Assess Systematic Reviews (AMSTAR)-2, and the risk of bias was evaluated using the Risk of Bias in Systematic Reviews (ROBIS) tool. Results: Following eliminating duplicates, a total of 2,768 articles were found, and of them, 9 systematic reviews met the inclusion criteria. Six of them included a meta-analysis as well. The actual overlap of primary studies was low. The AMSTAR 2 tool classified one systematic review as high quality, three as moderate quality, three as low quality, and the remaining two as critically low quality. The results of the included reviews generally showed that all types of lasers reduced dentin hypersensitivity compared to placebo/no treatment. Conclusion: Lasers are effective in treating dentin hypersensitivity.

An SEM study on the effect of 9.3-µm CO2 laser on dentinal tubules for hypersensitivity treatment

OBJECTIVES

In-vitro studies were performed on dentin of extracted human molars to investigate the effectiveness of 9.3 μm CO2 laser irradiation to occlude dentinal tubules. The observed occlusion of dentinal tubules with the irradiation was compared with application of three reagents: 2% Sodium Fluoride gel, an aqueous solution of hydroxyapatite nanoparticles and an equal mix of the two. We show that 9.3 μm CO2 laser irradiation occludes dentinal tubules, and the use of laser irradiation produces better occlusion of the opened tubules compared to the use of topical reagents.

METHODS

Nine extracted and cleaned human molars were cut to obtain dentin disks of thickness of 3-5 mm. Each disc was divided into four quarters, and each quarter served as two samples corresponding to irradiated and non-irradiated group counterparts. Five disks were used to study the effect of various laser irradiation energies on the dentinal tubules to find a good pulse fluence for occlusion of the dentinal tubules, and four disks were used for studying the effects of reagents and irradiation at the pulse fluences found in the first part of the study. The samples were irradiated with a beam diameter of 1 mm (1/e2) at 15 Hz pulse repetition rate, scanned automatically using a set of scanning mirrors. Samples were imaged using Scanning Electron Microscope (SEM) which were processed to determine tubule diameter. Safety of the irradiation treatment was investigated on 6 samples by measuring pulpal temperature rise. The effect of three topical reagents corresponding to 2% Sodium Fluoride gel (F), Hydroxyapatite nanoparticles (HA) and an equal mix of F and HA (HAF) on dentinal tubule occlusion was evaluated and compared with the laser irradiation.

RESULTS

In all examined cases, laser irradiation at a fluence of 0.81 J/cm2 resulted in a temperature increase less than 3 °C which is safe, and no surface cracking was observed. There is a threshold pulse fluence of 0.27 J/cm2 above which, laser produced surface melting. At a pulse fluence of 0.81 J/cm2 a layer of recast of melted dentin was formed. Under this layer, peritubular dentin melting and occluding of the dentinal tubules was observed. Application of either F or HA or HAF did not produce visible occlusion effect on open tubules after washing and microbrushing with excess distilled water.

CONCLUSIONS

9.3 μm CO2 laser irradiation on extracted human molar dentin at pulse fluence of 0.81 J./cm2 resulted in tubule area reduction by 97% without rising pulpal temperatures to unsafe levels.

Molar Incisor Hypomineralization: Optimizing Treatment Protocols for Hypersensitivity: A Randomized Clinical Trial

Dentin hypersensitivity (DH) is a common challenge in pediatric patients with molar incisor hypomineralization (MIH), stemming from enamel porosity or exposed dentin after enamel breakdown. This three-arm randomized controlled clinical trial aims to evaluate the effectiveness of three different desensitizing treatment protocols. The study was conducted on 39 children, aged 6-14 years old, with MIH and DH. Group A received casein phosphopeptide plus amorphous calcium phosphate fluoride (CPP-ACPF) mousse and sham light therapy, Group B received placebo mousse and photo-bio-modulation therapy (PMBT), and Group C received both CPP-ACPF mousse and PMBT. DH evaluation using a visual analogue scale was performed at multiple time points. Both CPP-ACPF mousse and PMBT individually demonstrated desensitizing effects on dental elements affected by MIH. While PMBT had a greater immediate effect, the combination of the two therapies proved most effective in reducing DH. The VAS scores were statistically lower in group C compared to groups A and B, both after the first session (p = 0.0001) and after 28 days (p = 0.0005). This study suggests promising avenues for managing DH in MIH patients, highlighting the potential of combined therapies, specifically CPP-ACPF mousse and PMBT, for enhanced clinical outcomes.

Ozone and Laser Effects on Dentin Hypersensitivity Treatment: A Randomized Clinical Study

INTRODUCTION

The aim of this study was to evaluate and compare the clinical efficacy of diode laser and ozone gas in the treatment of dentin hypersensitivity (DHS).

METHODS

One hundred thirty-two teeth from 44 patients with moderate DHS were randomized into 3 groups according to a split-mouth design. In the diode laser group, the operator irradiated the superficial dentin exposed with an 808-nm wavelength and incremental power from 0.2 to 0.6 W with a 20-second interval. In the ozone gas group, the operator applied a high dose of ozone (32 g/m3) for 30 seconds using a silicon cup. In the placebo group, no therapy was applied. The dentin sensitivity level was evaluated upon enrollment (T0), immediately after treatment (T1), 3 months post-treatment (T2), and 6 months post-treatment (T3) with a cold air blast challenge and tactile stimuli. The pain severity was quantified according to the visual analogue scale. The Wilcoxon signed rank test was used to scrutinize potential statistical disparities among the treatments. Statistical significance was predetermined at P < .05.

RESULTS

A significant decrease of DHS was observed in the ozone gas group and the `diode laser group immediately after treatment and after 3 and 6 months of the therapy. After 6 months from the therapy, the sensitivity values in the teeth treated with ozone gas remained statistically lower than those treated with diode lasers (P < .05).

CONCLUSIONS

A laser diode and ozone gas are both efficient as dentin sensitivity treatment. Ozone maintains an invariable effectiveness after 6 months.

Comparative clinical evaluation of two different formulated in-office newer desensitizing agents (Clinpro XT and Tokuyama Shield Force Plus) in reducing dentin hypersensitivity - A randomized clinical trial

Aim

The aim of this study was to assess the effectiveness of two various in-office newer desensitizing agents in reducing dentinal hypersensitivity in patients with mild-to-moderate sensitivity for a 1-month follow-up.

Materials and Methods

Forty subjects with cervical dentin hypersensitivity (otherwise healthy patients) were included. A split-mouth, randomized clinical trial was conducted. A Visual Analog Scale (VAS) was used to record the initial sensitivity levels at the baseline visit. Each individual has been exposed to thermal (ethyl chloride spray) and evaporative (air blast) stimuli to elicit sensitivity. A single application of two different in-office desensitizing agents, Clinpro XT Varnish (3M ESPE, Minnesota, USA) and Shield Force Plus (Tokuyama Dental, Tokyo, Japan), was done. The sensitivity scores were recorded after the application of the desensitizing agent immediately, after 1 week, and after 1 month using both air and cold stimuli in the same manner as initially.

Results

Mean VAS scores represent teeth that were more sensitive to cold stimuli compared to air blasts in both groups. For both stimuli at all-time intervals except baseline, there is a significant difference between CXT and SFP, with low mean VAS scores for CXT. Post hoc analysis revealed that in the CXT group, there is a significant difference in mean VAS score between pre-and postintervention at all-time intervals except between immediate and 1-week time intervals (P < 0.001) but only at immediate and 1-week time intervals in SFP.

Conclusion

Clinpro XT Varnish is more efficient compared to Shield Force Plus at all-time points irrespective of the stimuli after a 1-month follow-up.

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

Objective

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

Materials and Methods

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

Results

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

Conclusion

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

Effect of Neodymium-Doped Yttrium Aluminum Garnet (Nd:YAG) Laser Enamel Pre-Treatment on the Whitening Efficacy of a Bleaching Agent

BACKGROUND

There are a number of different substances and treatments that are effective in mitigating the negative effects of tooth bleaching. It is essential, however, to consider whether or not the presence of these factors affects the efficiency of the bleaching agent.

AIM

The purpose of this study is to determine how the pretreated enamel with a Neodymium-Doped Yttrium Aluminum Garnet (Nd:YAG) laser affects the bleaching effect of hydrogen peroxide at a concentration of 35%.

METHODS AND MATERIALS

Thirty samples were prepared from human-extracted permanent anterior teeth and stained using a tea solution. Based on the pre-treatment protocol, the samples were split into two equal groups (n = 15): In Group I, samples were submerged in saline solution for five minutes, while in Group II, Nd:YAG laser treatment was performed. Following pretreatment, samples from both groups were bleached with 35% hydrogen peroxide. Colour analysis of all samples was done before and after bleaching using a spectrophotometer. For the colour analysis, the CIE L*a*b* (Commission Internationale de l'Eclairage) System of colour measurement was used. For statistical analysis, Student t-tests (two-tailed, unpaired) were used to compare the means of two groups on a continuous scale.

RESULTS

Samples from both groups became lighter in colour following bleaching. After bleaching, there was no discernible difference in the total colour change between the two groups.

CONCLUSION

The application of the Nd:YAG laser before bleaching did not influence the whitening efficacy of 35% hydrogen peroxide.

Effect of Orthophosphoric Acid and Er:YAG Laser Etching on Micro-shear Bond Strength to Enamel: An In Vitro Pilot Study

Background:

Dental conditioning is one of the most important phases during enamel bonding procedures to obtain clean surfaces, smear layer removal with collagen active sites and hydroxyapatite exposure.

Objective:

The aim of this study was to compare the micro-shear bond strength (µSBS) of different adhesive systems after two different etching techniques: 37% orthophosphoric acid (H3PO4) and Er:YAG laser.

Methods:

Ninety permanent extracted molars were embedded into epoxy resin blocks and sectioned longitudinally. Specimens were randomly assigned to one of the following groups (n=30), depending on the etching protocol: 37% H3PO4 for 30 s (Group 1), Er:YAG laser 100mJ-10Hz (Group 2), and Er:YAG laser 100mJ-10Hz followed by 37% H3PO4 for 30 s (Group 3). Each group was further divided into two subgroups depending on the bonding agent used on enamel (n=15): A) EE-Bond (Tokuyama) and B) Peak universal (Ultradent). A two-way analysis of variance (two-way ANOVA) was conducted and the level of significance was set to p=0.05.

Results:

The etching procedure was a significant factor influencing the results (p=0.006), while no differences were observed for the two adhesive systems tested (p>0.05). Group 3 recorded the highest bond strength values, according to the following sequel: Group 3 < Group 2 < Group 1 < 0.05.

Conclusion:

The combination of phosphoric acid etching with Er:YAG laser provided the most favourable bond strength to enamel. Further morphological studies are currently ongoing.

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSION

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

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 the Effectiveness on Dentin Hypersensitivity of Sodium Fluoride and a New Desensitizing Agent, Used Alone or in Combination with a Diode Laser: A Clinical Study

(1) Background: Dentine Hypersensitivity (DH) is a frequent clinical problem that causes long-term painful discomfort to patients and is a diagnostic and therapeutic challenge for dentists. The aim of this research was to verify the efficacy of a Sodium Fluoride (NaF) gel and the VivaSens® varnish used alone or in combination with a Creation Soft Diode Laser (DL) to treat DH pain. (2) Methods: The study included 121 Non-Carious Cervical Lesions (NCCLs) in 48 patients who complained of DH pain of variable intensity, between 4 and 7 points in VAS, after application of a cold stimulus. Four study groups of 12 patients each were created and subjected to four different types of treatment. Group 1 comprised 27 NCCLs with a total VAS score of 142, who received a topical treatment of NaF. Group 2 comprised 34 NCCLs with a total VAS score of 179, who were treated with NaF in association with DL. Group 3 comprised 31 NCCLs with a total VAS score 172, who received the VivaSens varnish. Group 4 comprised 29 NCCLS with a total VAS score of 155, who were treated with VivaSens in association with DL, using a power of 0.2 Watt in continuous emission and a fiber of 400 µm diameter. (3) Results: The results for each NCCL were evaluated by the cold stimulus response and recorded according to the VAS at the end of each treatment (t1) as well as after one week (t2), 1 month (t3), and 6 months (t4). All treatments resulted in pain relief at all study times, but the best results were obtained for Group 4 at t1, with a total VAS score of 26, and for Group 2 at t2, t3, and t4, with total VAS scores of 41, 51, and 65, respectively. (4) Conclusions: The treatment with VivaSens allowed pain relief immediately after its application, but the greatest long-term benefits (t2, t3, and t4) were obtained with the topical application of NaF associated with a DL.

Sensitivity Treatments for Teeth with Molar Incisor Hypomineralization: Protocol for a Randomized Controlled Trial

Background

The sensitivity of teeth with molar incisor hypomineralization (MIH) can affect children’s quality of life and is a challenging problem for dentists. Remineralizing agents such as sodium fluoride varnish seem to reduce the sensitivity of teeth with MIH, but long-term clinical trials with large samples are still needed for more evidence about its effectiveness as a desensitizing agent before its clinical recommendation.

Objective

This randomized clinical trial aims to compare three treatment interventions for teeth with MIH and hypersensitivity.

Methods

A total of 60 children aged 6-10 years presenting with at least one first permanent molar with sensitivity and no loss of enamel will be randomly assigned to three groups: the control group (sodium fluoride varnish; Duraphat, Colgate); experimental group I (4% titanium tetrafluoride varnish); and experimental group II (a coating resin containing surface prereacted glass-ionomer filler; PRG Barrier Coat, Shofu). The sodium fluoride varnish and 4% titanium tetrafluoride varnish will be applied once per week for 4 consecutive weeks and the PRG Barrier Coat resin will be applied in the first session and the application will be simulated the following 3 weeks to guarantee the blinding of the study. The primary outcome will be sensitivity level measured at different moments (before each material application, immediately after application or simulation, and 1, 2, 4, and 6 months after the last application/simulation) by one examiner using the Wong-Baker FACES Pain Rating Scale, the Schiff Cold Air Sensitivity Scale, and the FLACC (Face, Legs, Activity, Cry, Consolability) scale. As secondary outcomes, parental satisfaction and child self-reported discomfort after the treatment will be measured with a questionnaire prepared by the researcher. The data will undergo statistical analysis and the significance level will be set at 5%.

Results

The project was funded in 2018, and enrollment was completed in November 2019. The recruitment of participants is currently underway and the first results are expected to be submitted for publication in 2022.

Conclusions

If found effective in reducing the patient’s sensitivity long term, these agents can be considered as a treatment choice, and the findings will contribute to the development of a treatment protocol for teeth with sensitivity due to MIH.

Trial Registration

Brazilian Registry of Clinical Trials Universal Trial Number U1111-1237-6720; https://tinyurl.com/mr4x82k9

International Registered Report Identifier (IRRID)

DERR1-10.2196/27843

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.

Low level laser therapy, Er,Cr:YSGG laser and fluoride varnish for treatment of dentin hypersensitivity after periodontal surgery: A randomized clinical trial

This clinical trial aimed to compare the effects of low-level laser therapy (LLLT), Er,Cr;YSGG laser, and fluoride varnish, as compared to the placebo laser on decreasing dentin hypersensitivity (DH). This randomized, double-blinded clinical trial included 60 jaw quadrants in 24 patients who underwent periodontal surgery. The quadrants were randomly assigned to 4 groups and received treatments as follows. Group 1: LLLT with a combination of red and infrared wavelengths, group 2: Er,Cr:YSGG laser (0.25 W and 0.5 W), group 3: fluoride varnish, and group 4: placebo laser. The sensitivity response to the cold spray was recorded using visual analogue scale (VAS) at baseline, immediately, and 1 week post-treatment. The data were analyzed by repeated measures analysis at the significance level of P<0.05. There was a significant reduction in DH after treatment by low-level lasers, Er,Cr:YSGG laser, or fluoride varnish compared to the baseline data (P<0.05), but the placebo group displayed no significant alteration in DH (P=0.069). At 1 week, the VAS score in the Er,Cr:YSGG laser group was significantly lower than that of the LLLT (P= 0.043) and placebo (P<0.001) groups. Furthermore, the subjects who received fluoride varnish exhibited significantly lower DH compared with the placebo group (P = 0.023). Er,Cr:YSGG laser was the most effective strategy in dealing with DH, as it caused the greatest pain reduction over the study period and showed a significant superiority over LLLT and placebo groups. Alternatively, the application of fluoride varnish could be recommended for attenuating DH following periodontal surgery.

Use of high- and low-intensity lasers in the treatment of dentin hypersensitivity: A literature review

Background

Dentin hypersensitivity (DH) is defined as an exaggerated sensitivity of vital dentin exposed to thermal, chemical and tactile stimuli. This study aimed to evaluate, through a literature review, the applicability of high- and low-intensity lasers in the treatment of DH for the past 10 years, as well as its therapeutic potential.

Material and Methods

The electronic databases MEDLINE/PubMed and LILACS were searched using the descriptors (“Dentin Sensitivity” OR “Dentin Hypersensitivity”) AND (“Low-Level Therapy” OR Laser), for articles published between 2010 and 2020. Only randomized clinical trials with full-text and full case resolution were included.

Results

We found 187 articles in total, among which 61 were pre-selected and 10 included in this literature review.

Conclusions

Considering the found results and their possible limitations, high- and low-intensity lasers, associated or not with other therapies, have demonstrated beneficial effects in the treatment of DH, being considered a promising, safe, easy, and effective field of research, reducing pain sensitivity and preserving pulp vitality.

Key words:Dentin sensitivity, dentistry, laser.

Evaluation of the Effects of 810 nm Diode Laser Alone and in Combination With Gluma© and Chromophore on Dentinal Tubule Occlusion: A Scanning Electron Microscopic Analysis

Introduction: Tooth hypersensitivity is among the most common patient complaints caused by the response of exposed dentin to external stimuli. No definite treatment has been suggested so far for dentin hypersensitivity (DH). This study aimed to compare the efficacy of the diode laser alone and in combination with Gluma and chromophore in occluding opened dentine tubules and the treatment of DH. Methods: This in vitro study was conducted on 30 extracted human third molars kept in 0.1% thymol solution. The teeth were mounted in transparent acrylic resin and the buccal enamel was cut to expose the outer third of dentin. The samples were then divided into 6 groups of negative control (no smear layer removal), positive control (smear layer removal with 6% citric acid application), 810 nm diode laser irradiation (energy density 55.55 J/cm2 , 1 W for 20 seconds in a continuous mode), chromophore (1 mg/mL indocyanine green, ICG) plus diode laser irradiation (1 W, 20 seconds), Gluma plus diode laser irradiation, and Gluma + chromophore + diode laser. Dentinal tubules were evaluated under a scanning electron microscope at x2000 magnification. The mean percentage of the obstruction of dentinal tubules was reported as mean and standard deviation. Considering the normal distribution of the data, two-way ANOVA was applied to compare the efficacy of treatments, and an independent-samples t test was used for pairwise comparisons at P<0.05 level of significance. Results: The highest mean percentage of the obstruction of dentinal tubules was noted in the diode laser/chromophore/Gluma group (65.68±12.31%) while the lowest value was noted in the diode laser/Gluma group (24.33±5.90%). Pairwise comparisons revealed significant differences between all groups (P <0.05) except for the difference between the laser/Gluma/chromophore and laser/ chromophore groups (P =0.20). Conclusion: It seems that chromophore increases the efficacy of the diode laser for the obstruction of dentinal tubules.

Alencar C, de Paula BLF, de A. Jassé FF, Araújo JLN, Silva CM. Photobiomodulation vs. Placebo on Post-Bleaching Sensitivity and Color Change: A Split-Mouth Clinical Study

Objective:

This study aimed to investigate the efficiency of Photobiomodulation (PBM) with low-level LASER therapy compared to placebo in post-bleaching sensitivity and color change during a three-week office bleaching treatment.

Methods:

A split-mouth model was used to evaluate 21 subjects. The right and left hemi-archs were randomized to one of two groups: GP (placebo): simulated LASER application followed by tooth bleaching with 35% hydrogen peroxide; and GL: treated with PBM followed by tooth bleaching with 35% hydrogen peroxide. A four-degree modified Visual Analog Scale (VAS) was used to assess tooth sensitivity after the application of an evaporative stimulus (stimulated pain). In addition, a daily questionnaire was used to measure unstimulated pain. The color change was measured using a spectrophotometer. The Friedman and Wilcoxon tests were used to analyze data sensitivity. Color results were statistically analyzed using Analysis Of Variance (ANOVA) followed by the Tukey post-hoc test.

Results:

There was no significant difference between GP and GL for stimulated pain evaluation (p> 0.05). However, there was a significant difference between the groups for unstimulated pain evaluation (p≤ 0.05). In addition, ΔE data did not reveal any significant difference in tooth color between groups at any time (p> 0.05).

Conclusion:

PBM prevented post-bleaching sensitivity compared to placebo, based on the daily pain assessment questionnaires. PBM did not compromise the quality of bleaching treatments.

Influence of Er,Cr:YSGG laser, associated or not to desensitizing agents, in the prevention of acid erosion in bovine root dentin

This in vitro study evaluated the influence of the Er,Cr:YSGG laser, associated or not to desensitizing agents, in the prevention of acid erosion in bovine root dentin. Eighty dentin specimens were selected and divided into eight groups (n = 10): G1: negative control; G2: positive control (5% fluoride varnish-FV); G3: Er,Cr:YSGG laser; G4: FV + laser; G5: 3% potassium oxalate; G6: 3% potassium oxalate + laser; G7: biphasic calcium silicate/phosphate gel (gel); G8: gel + laser. Laser parameters: 0.5 W, 6.25 J/cm² at 1-mm distance. The erosive drink used was a cola soft-drink (pH = 2.42 at 4 °C), lasting 5 min, twice a day, with 6-h intervals between the challenges, during 14 days. Kolmogorov-Smirnov and Levene's tests were satisfied. The surface roughness data were submitted to ANOVA and Tukey post hoc tests. For the wear profile, Kruskal-Wallis and Dunn post hoc tests were used. Afterwards, the Spearman correlation test was performed. All statistical tests assumed a significance level of 5% (α = 0.05). G1 presented the highest surface roughness value after the erosive challenge (3.586 μm² ± 0.205 μm²) and the G7 presented the lowest surface roughness value after the erosive challenge (1.071 μm² ± 0.180 μm²). For the lost volume, G4 presented the lowest percentage (9.7% ± 0.9%), while G1 had the highest percentage (41.8% ± 2.5%), both with p < 0.05. There was a weak correlation between the response variables (ρ = 0.33). All groups presented lower values of surface roughness and loss of volume when compared to the negative control group. For the surface roughness, the biphasic calcium silicate/phosphate gel presented the best result. For volume loss, the 5% fluoride varnish + Er,Cr:YSGG laser showed the best results compared to the other groups.

Effect of low-level laser therapy combined with 5000 parts per million fluoride dentifrice on postbleaching sensitivity: A clinical, randomized, and double-blind study

OBJECTIVE

The aim of this double-blind, randomized, controlled clinical study was to assess the efficacy of low-level laser therapy (LLLT) combined with 5000 ppm fluoride dentifrice on postbleaching sensitivity in teeth exposed to 35% hydrogen peroxide for four weeks.

MATERIALS AND METHODS

Twenty-five volunteers were evaluated using the split-mouth model in which the right and left maxillary/mandibular quadrants were randomized and allocated to one of two groups: GPLACEBO, in which the laser tip was positioned without the emission of light (placebo effect) + 5000 ppm sodium fluoride, or GLASER, which comprised LLLT + 5000 ppm sodium fluoride. For both groups, LLLT and placebo were used before bleaching, whereas fluoride was applied after bleaching. LLLT was applied at two points: on the central cervical and medial regions of the incisors, canines, and premolars in the corresponding hemi-arch. At each point, 60 J/cm² was applied for 16 seconds with an irradiance of 3.75 W/cm² using the therapeutic infrared device. To assess tooth sensitivity, a modified visual analogue scale was used after an evaporative stimulus, and a daily pain questionnaire was also applied.

RESULTS

The Wilcoxon and Friedman tests demonstrated a significant difference in the incidence of sensitivity pain between GPLACEBO and GLASER (P ≤ .05), with different evaluation times.

CONCLUSION

Teeth treated with laser therapy in combination with the topical use of sodium fluoride at each bleaching session demonstrated less sensitivity compared with the application of sodium fluoride only.

CLINICAL SIGNIFICANCE

The use of a low-level laser therapy in combination with topical use of sodium fluoride improves symptoms of dentin sensitivity at each bleaching session.

Evaluation of Tooth Surface Irradiated With Erbium: Yttrium Aluminum Garnet and Carbon Dioxide Lasers by Atomic Force Microscopy

Introduction: Laser irradiation of dentin surface can affect its surface topography and roughness. Atomic force microscopy (AFM) is among the most efficient tools for determination of surface topography of natural biomolecules in nano-scales. Surface roughness affects plaque retention especially in the cervical region. This study aimed to assess and compare the obstruction of dentinal tubules and dentin surface roughness after irradiation of erbium: yttrium aluminum garnet (Er:YAG ) and CO2 lasers for treatment of dentin hypersensitivity (DH). Methods: Five disc-shaped samples measuring 3 mm in thickness were fabricated by horizontal sectioning of the cervical area of five extracted human molars using a low speed saw. Each disc was divided into 3 segments by a bur under water coolant. The three segments of each disc were placed on a glass slide. First segment: No intervention (control group). Second segment: Er:YAG laser irradiation (2940 nm, 50 mJ, 10 Hz and 0.5 W, 30 seconds) along with water coolant. Third segment: CO2 laser irradiation (10600 nm, 80 Hz, 0.3 W, 30 seconds) along with water coolant. After that, the surfaces underwent non-contact AFM. The diameters of dentinal tubules as well as surface roughness were then measured and statistically analyzed using repeated measures ANOVA. Results: The surface roughness parameters (Ra, Rq) showed increased roughness after laser irradiation and this increase in roughness after Er:YAG laser application was significant compared to the control group (P=0.048). However, CO2 laser caused no significant change in surface roughness. Also, after Er:YAG laser application, fewer open dentinal tubules were observed and the remaining open tubules had a smaller diameter. Conclusion: Based on the results, Er:YAG laser irradiation obstructs the dentinal tubules and increases the dentin surface roughness. This increase in surface roughness can cause microbial plaque retention and increase the risk of caries and periodontal disease. Application of CO2 laser (compared to Er:YAG) lead to slight but clinically significant obstruction of dentinal tubules and surface roughness.

Evaluation of the effects of Er:YAG laser, Nd:YAG laser, and two different desensitizers on dentin permeability: in vitro study

The purpose of this in vitro study was to evaluate and compare the efficacy of erbium-doped yttrium aluminum garnet (Er:YAG) laser, neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, PrevDent nano-hydroxyapatite toothpaste plus Repairing Serum Kit (PNH), and NUPRO Sensodyne Prophylaxis Paste with NovaMin (NPP) on dentin permeability reduction. Forty dentin discs obtained from bovine incisors were divided into four study groups: Er:YAG laser-treated (2940 nm; 0.2 W, 80 mJ/pulse, 3 Hz); Nd:YAG laser-treated (1064 nm; 1 W, 10 Hz); PNH-treated; and NPP-treated groups. The quantitative changes in permeability of each dentin disc were measured using a computerized fluid filtration method (CFFM) before and after desensitizer treatments. The data were analyzed using the Wilcoxon, paired-samples t, Kruskal-Wallis, and Mann-Whitney U tests. The dentin surfaces and tubules were also morphologically detected by scanning electron microscopy (SEM). In all groups, dentin permeability was significantly reduced after the desensitizer and laser treatments (p < 0.05). Among the groups, we detected a significant difference in only when comparing the Er:YAG laser- and NPP-treated groups (p = 0.034). SEM analysis revealed physical changes in the dentin surface in all groups. This in vitro study shows that all tested desensitizers and laser treatments reduced dentin permeability. Also, surface changes, such as complete or partial occlusion or shrinkage of dentin tubules, were observed in all groups. Although the laser groups performed best, the PNH protocol can be considered as an alternative therapeutic product. In addition, clinical and laboratory studies should be performed for this product, and their efficacy should be assessed by combined therapy with lasers.

Dentinal tubule sealing effects of 532-nm diode-pumped solid-state laser, gallic acid/Fe3+ complex, and three commercial dentin desensitizers

The purpose of this study was to compare dentinal tubule sealing effects of a 532-nm diode-pumped solid-state (DPSS) laser, gallic acid/Fe³⁺ complex, and three commercially available dentin desensitizers. Human premolars (n = 44) extracted for orthodontics had standardized cervical cavities prepared, etched (37% phosphoric acid) and randomly assigned to either a control (n = 4), or one of five treatment groups (n = 8/group). Desensitizing treatments were either a 532-nm DPSS laser, gallic acid/Fe³⁺ complex, oxalate-based Super Seal™ (SS), DIO™ Enamel Coating Pen Pro Tooth (Dio), or adhesive-type Hybrid Coat™ (HC). Dentinal fluid flow (DFF) was monitored continuously in real time during the application of each desensitizing agent, by using a nanoliter-scaled fluid flow-measuring device. Following treatment, morphological changes on dentinal surfaces and within tubules were observed by scanning electron microscopy (SEM). DFF rates were significantly reduced after treatment in all experimental groups (P < 0.05), except SS (P > 0.05). The gallic acid/Fe³⁺ complex reduced DFF rates the most, and significantly (P < 0.05) more than the three commercial dentin desensitizers. There were no significant differences in DFF reduction rates between the gallic acid/Fe³⁺ complex and the DPSS laser groups (P > 0.05). There were no significant differences in DFF reduction rates among the three commercial dentin desensitizers (P > 0.05). SEM examination of treated dentin showed that the degree of occlusion of dentinal tubules correlated closely with the corresponding reduction in DFF rates. The gallic acid/Fe³⁺ complex and 532-nm DPSS laser were superior to other desensitizing methods in occluding dentinal tubules and reducing DFF rates.

Application of Diode Laser in the Treatment of Dentine Hypersensitivity

INTRODUCTION

Dentine hypersensitivity is characterized by acute, sharp pain arising from the exposed dentine, most commonly in response to thermal, tactile, or chemical stimuli, and which cannot be linked to any other pathological changes in the tooth or the environment. Therapy uses various impregnating agents in the form of solutions or gels and, in more recent times, laser.

AIM

The aim of this research was to examine the effects of treatment of hypersensitive dental cervix with diode laser.

MATERIALS AND METHODS

The study included 18 patients with 82 sensitive teeth. The degree of dentine hypersensitivity was evaluated by visual analogue scale (VAS), and the treatment was carried out by application of low-power diode laser over the span of three visits, which depended on the initial sensitivity.

RESULTS

There is a significant difference in VAS values measured at the onset of treatment (baseline) and immediately after the first laser treatment (t=9.275; p=0.000), after 7 days, after the second laser treatment (14 days) (t=7.085, p=0.000), as well as after 14 days and the third laser treatment (t=5.517, p=0.000), which confirms the effectiveness of this therapeutic procedure. The results showed a reduction of hypersensitivity in response to tactile stimulus with a probe after the third treatment, even with teeth whose value on the VAS was very high at the beginning of treatment (baseline).

CONCLUSION

Within the scope of the conducted study, laser therapy has provided extremely safe and effective results in the treatment of cervical dentine hypersensitivity.

Laser-assisted treatment of dentinal hypersensitivity: a literature review

The purpose of this literature review was to evaluate the effectiveness of the laser-assisted treatment of dentinal hypersensitivity. A review with inclusion and exclusion criteria was performed from January 2009 to December 2014 with electronic data-bases: MedLine via PubMed, Science Direct and Cochrane Library. Research of paper magazines by hand was not considered. Forty-three articles were selected between literature reviews, in vitro studies, clinical trials, pilot and preliminary studies. The items were divided into laser-used groups for an accurate description, and then the reading of results into various typologies. Laser-assisted treatment reduces dentinal hypersensitivity-related pain, but also a psychosomatic component must be considered, so further studies and more suitable follow-ups are necessary.

Assessment of Pain Intensity in Patients with Dentin Hypersensitivity After Application of Prophylaxis Paste Based on Calcium Sodium Phosphosilicate Formula

Background

One of many functions of the pulp-dentin complex is sensory function. Acute, situated, receding pain after the cessation of the stimulus action is called dentin pain. Dentin hypersensitivity has been described as one of the most painful and least successfully treated chronic ailments of teeth. The aim of this research was the clinical evaluation of the effectiveness of professional polishing paste containing calcium sodium phosphosilicate formula (NovaMin) in eliminating dentin hypersensitivity after a single application.

Material/Methods

The study comprised 92 teeth with dentin hypersensitivity diagnosed on the basis of history and clinical examination. The pain reaction of exposed dentine was induced by tactile and dehydrating stimuli, asking patients to assess the severity of pain on the VAS scale. Clinical trial and survey were carried out twice: before and 1 week after the application of the polishing paste.

Results

After the application of the examined paste, the percentage of teeth reacting with a severe pain to the touch of the probe decreased from 16.3% to 4.3%, and with a moderate pain from 42.4% to 12%. Examination after applying dehydrating stimulus a week after carrying out the application showed a decrease in the proportion of teeth with strong pain from 28.3% to 0% and moderate pain from 38% to 15.2%. The lack of pain increased from 12% to about 50%.

Conclusions

The use of prophylactic professional paste with NovaMin formula in in-office procedure provides the reduction of dentin hypersensitivity noticeable by 1 week after application.

The evidence base for professional and self-care prevention--caries, erosion and sensitivity

BACKGROUND

The aim of this conference paper was to examine the evidence base for primary and secondary prevention of dental caries, erosions and dentin hypersensitivity through professional and self-care measures.

METHODS

A mapping of systematic reviews (SR) of literature was carried out in PubMed and the Cochrane library through April 2014 using established MeSH-terms and disease-related search words in various combinations. The search was restricted to SR's published in English or Scandinavian and all age groups were considered. The reference lists of the selected papers were hand-searched for additional review articles of potential interest. Meta-analyses, guidelines and treatment recommendations were considered only when SR's were lacking. In the event of updates or multiple systematic reviews covering the same topic, only the most recent article was included. No quality assessment of the systematic reviews was carried out. The quality of evidence was rated in four levels according to the GRADE scale.

RESULTS

In total, 39 SR were included. For primary caries prevention, the quality of evidence was high for the use of fluoride toothpaste (with and without triclosan) and moderate for fluoride varnish and fissure sealants. The quality of evidence for fluoride gel, fluoride mouth rinse, xylitol gums and silver diamine fluoride (SDF) was rated as low. For secondary caries prevention and caries arrest, only fluoride interventions and SDF proved consistent benefits, although the quality of evidence was low. Likewise, the GRADE score for preventing erosions located in the enamel with fluoride supplements was low. The quality of evidence for various professional and self-care methods to prevent and manage dentine hypersensitivity was very low.

CONCLUSIONS

There are knowledge gaps in many domains of cariology and preventive dentistry that must be addressed and bridged through clinical research of good quality.

The effects of CO2 laser with or without nanohydroxyapatite paste in the occlusion of dentinal tubules

The aim of this study was to evaluate a new treatment modality for the occlusion of dentinal tubules (DTs) via the combination of 10.6 µm carbon dioxide (CO2) laser and nanoparticle hydroxyapatite paste (n-HAp). Forty-six sound human molars were used in the current experiment. Ten of the molars were used to assess the temperature elevation during lasing. Thirty were evaluated for dentinal permeability test, subdivided into 3 groups: the control group (C), laser only (L-), and laser plus n-HAp (L+). Six samples, two per group, were used for surface and cross section morphology, evaluated through scanning electron microscope (SEM). The temperature measurement results showed that the maximum temperature increase was 3.2 °C. Morphologically groups (L-) and (L+) presented narrower DTs, and almost a complete occlusion of the dentinal tubules for group (L+) was found. The Kruskal-Wallis nonparametric test for permeability test data showed statistical differences between the groups (P < 0.05). For intergroup comparison all groups were statistically different from each other, with group (L+) showing significant less dye penetration than the control group. We concluded that CO2 laser in moderate power density combined with n-HAp seems to be a good treatment modality for reducing the permeability of dentin.

Treatment of dentinal hypersensitivity by means of Nd:YAP Laser: a preliminary in vitro study

Objective. The aim of this study is to evaluate the effectiveness of Nd:YAP laser to seal dentinal tubules at different parameters. Material and Methods. 24 caries-free human wisdom impacted molars were used. The crowns were sectioned transversally in order to totally expose the dentin. The smear layer was removed by a 1 min application of EDTA. Each surface was divided into four quadrants, but only three quadrants were irradiated at a different output power setting (irradiation speed: 1 mm/sec; optical fiber diameter: 320 µm; tangential incidence of beam and in noncontact mode). Samples were smeared with a graphite paste prior to laser irradiation. All specimens were sent for SEM analysis. Pulp temperature increases in additional twenty teeth were measured by a thermocouple. Results. Morphological changes in dentin surfaces depend on the value of used energy density. Higher energy densities (2 W–4 W; 200–400 mJ; pulse duration: 100 m sec.; and 10 Hz) induce higher dentin modifications. Our results confirmed that Nd:YAP laser irradiations can lead to total or partial occlusion of dentin tubules without provoking fissures or cracks. Measurements of pulp temperature increases showed that Nd:YAP laser beam can be considered as harmless for pulp vitality for following irradiation conditions: 2 W (200 mJ) to 4 W (400 mJ) with an irradiation speed of 1 mm/sec; fiber diameter: 320 micrometers; 10 Hz; pulse duration: 100 m sec; noncontact mode and in tangential incidence to exposed dentin. The perpendicular incidence of the laser beam on exposed dentin may injure pulp vitality even at low output power of 3 W. Conclusions. Nd:YAP laser beam was able to seal the dentin tubules without damaging dentinal surfaces and without harming pulp vitality. Nd:YAP laser is effective and may be safely used for future in vivo treatments of dentinal hypersensitivity under certain conditions.

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.

Lasers for the Treatment of Dentin Hypersensitivity

This systematic review and meta-analysis assessed the efficacy of lasers in reducing dentin hypersensitivity (DH) as compared with placebo or no treatment. Seven electronic databases and a manual search resulted in 2,538 unique publications. After selection, 13 studies were included in the meta-analysis. A CONSORT-based quality assessment revealed that 3 and 10 studies were at low and high risk of bias, respectively. A random-effects model with the generic inverse variance standardized mean difference (SMD) was used because of expected heterogeneity. Meta-analyses of the baseline-end of follow-up changes in pain revealed no differences for Er,Cr:YSSG vs. placebo (SMD = 2.49; 95% CI, -0.25 to 5.22; p = .07) but did reveal differences in favor of lasers for Er:YAG vs. placebo (SMD, 2.65; 95% CI, 1.25 to 4.05; p = .0002), Nd:YAG vs. placebo (SMD, 3.59; 95% CI, 0.49 to 6.69; p = .02), and GaAlAs vs. placebo (SMD, 3.40; 95% CI, 1.93 to 4.87; p < .00001). High and significant heterogeneity was found for all comparisons. In conclusion, Er:YAG, Nd:YAG, and GaAlAs lasers appear to be efficacious in reducing DH. However, given the high heterogeneity of the included studies, future randomized controlled clinical trials are needed to confirm these results.

In situ effect of dentifrices associated to CO2 laser in the permeability of eroded root dentin

OBJECTIVE

The aim of this study was to evaluate, through a crossover 2×2 in situ trial, the effect of a desensitizing dentifrice associated with CO2 laser irradiation to control the permeability of eroded root dentin.

BACKGROUND DATA

Facing the increased prevalence of erosive lesion and the need for preventive means to control painful symptoms related to them.

METHODS

Eighty slabs of bovine root dentin were subjected to initial erosive challenge (citric acid 0.3%, 2 h), followed by a remineralizing period in artificial saliva (24 h). Specimens were then divided according to dentin treatment: desensitizing dentifrice, desensitizing dentifrice+CO2 laser, fluoride anticavity dentifrice. and fluoride anticavity dentifrice+CO2 laser. After a 2-day lead-in period, 10 volunteers wore an intraoral palatal appliance containing four root dentin slabs, in two phases of 5 days each. During the intraoral phase, one side of the appliance was immersed in 0.3% citric acid, and the opposite side was immersed in deionized water, four times a day. One hour after the immersions, all specimens were brushed with dentifrice slurry provided by the researcher. After a 7-day washout period, volunteers were crossed over on the different dentifrice group. Each phase having been completed, the specimens were evaluated for permeability through an optical microscope.

RESULTS

Data were analyzed using ANOVA and no significant difference (p=0.272) was found between the surface treatments performed on bovine root dentin.

CONCLUSIONS

It can be concluded that fluoride anticavity or desensitizing dentifrice, regardless of the association with the CO2 laser irradiation, was able to control the permeability of eroded root dentin.

Laser therapy for dentine hypersensitivity

DATA SOURCES

Medline, Embase, the Cochrane Central database as well as the Cochrane Oral Health Group's Trials Register and the National Research Register. In addition relevant journals were hand searched from 2000 to 2010 (Lasers in Medical Sciences, Lasers in Surgery and Medicine, Photomedicine and Laser Surgery, Photodiagnosis and Photodynamic Therapy, Journal of Oral Rehabilitation, Journal of Periodontology, Journal of Clinical Periodontology, Journal of Endodontics, Clinical Oral Investigations, Journal of Dental Research, Journal of Oral Laser Applications, Journal of Periodontal Research and Periodontology 2000) together with the reference lists of relevant trials.

STUDY SELECTION

Randomised controlled trials (RCT) that included patients with two or more hypersensitive teeth confirmed by evaporative stimulus or tactile hypersensitivity assessment, comparing laser therapy versus other topical desensitising agents, such as fluoride varnish, dentine bonding agents etc, that were published in English.

DATA EXTRACTION AND SYNTHESIS

Studies were assessed for quality by two reviewers independently and data were extracted using a standardised form. Because of heterogeneity of the studies meta-analysis was not performed, so a qualitative synthesis is presented.

RESULTS

Eight trials (234 participants) met the inclusion criteria. Half of the included studies compared GaALAS laser with topical desensitising agents, but the findings were conflicting. The remaining studies involved Nd:YAG laser, Er:YAG laser and CO2 laser, and all showed that the three types of lasers were superior to topical desensitising agents, but the superiority was slight.

CONCLUSIONS

The review suggests that laser therapy has a slight clinical advantage over topical medicaments in the treatment of dentine hypersensitivity. However more large sample-sized, long-term, high-quality randomised controlled clinical trials are needed before definitive conclusions can be made.