The effectiveness of a patient-applied tooth desensitizing gel. A pilot study

The efficacy of strontium and potassium toothpastes in treating dentine hypersensitivity: a systematic review

Objectives. The aim of the present paper was to review the published literature in order to identify all relevant studies for inclusion and to determine whether there was any evidence of the efficacy of strontium and potassium toothpastes in the treatment of dentine hypersensitivity (DH). Methods. Following a review of 94 relevant papers both from searching electronic databases (PUBMED) and hand searching of relevant written journals, 13 studies were identified, and 7 papers (1 for strontium-based toothpastes and 6 for potassium-based toothpastes) were finally accepted for inclusion. The main outcome measures were the methodology and assessment used by Investigators in studies designed to evaluate DH. Results. The results of the present paper would indicate that the reported efficacy of both strontium- and potassium-based toothpastes in relieving DH is questionable. Conclusions. The results from the present paper would appear to support the conclusions of previous investigators that there is only minimal evidence for the efficacy of both strontium- and potassium-based toothpastes in relieving symptoms of DH.

Evaluation of the efficacy of two potassium nitrate bioadhesive gels (5% and 10%) in the treatment of dentine hypersensitivity. A randomised clinical trial

AIM

A randomised clinical trial was designed to compare the immediate efficacy (48-96 h) of two treatments with bioadhesive gels with different concentrations of potassium nitrate (NK 5% versus NK 10%) on dentine hypersensitivity (DH). We evaluated DH by means of the use of the evaporative stimulus (ES), as the main outcome, using a placebo control group as reference.

PATIENTS AND METHODS

Forty-five consecutive patients who, after stimulation with a blast of air, had at least one tooth with DH > or = 2 according to the verbal ratings scale (VRS) scale were selected. They were randomly treated with a bioadhesive gel with 5% NK, 10% NK or a placebo gel without NK. The DH was evaluated at baseline, days 2, 4, 7 and 14 by an examiner blind to the procedure. The response to the ES with a blast of air, to the tactile stimulation with a probe and the subjective evaluation of the patient measured on the VRS scale were recorded. Statistical analysis was made using the Kruskal-Wallis test.

RESULTS

A greater reduction of DH after ES was observed after 48 h of treatment in the NK10% group (35.8%) compared to the NK5% group and placebo group (11.8% and 13.4%, respectively). This difference increased significantly at 96 h (p=0.003). No significant differences were observed for the other variables. These preliminary results may support the usefulness of an NK 10% gel to reduce the DH after stimulation with a blast of air during the first 4 days of its appearance.

Efficacy of a 3% potassium nitrate desensitizing mouthwash in the treatment of dentinal hypersensitivity

BACKGROUND

Potassium nitrate has been used previously in a dentifrice or gel to alleviate dentinal hypersensitivity. The aim of this study was to compare a 3% potassium nitrate/0.2% sodium fluoride mouthwash with a 0.2% sodium fluoride control mouthwash in a 6-week double-blind study.

METHODS

Fifty subjects were evaluated using 2 tactile methods and cold air sensitivity (dental air syringe), along with subjective perception of pain (0 to 10 scale) at baseline and at 2 and 6 weeks.

RESULTS

There was a general decrease in dentinal hypersensitivity levels in both groups over the 6-week study period as demonstrated by all 4 methods of assessment. There was also a statistically significant difference in decrease in sensitivity between the groups.

CONCLUSIONS

This study showed that a 3% potassium nitrate/0.2% sodium fluoride mouthwash appears to have therapeutic potential to alleviate dentinal hypersensitivity.

Efficacy of a potassium nitrate mouthwash in alleviating cervical dentine sensitivity (CDS)

Potassium nitrate (KNO3) has been used previously in a dentifrice or gel to alleviate cervical dentine sensitivity (CDS). The aim of this study was to compare a 3% KNO3 Silica/NaF mouthwash with a NaF/silica mouthwash in a 6-week multi-centre double-blind study. 47 subjects (12M; 35F, mean age 36.2 (SD 11.46) years) participated in the study. Subjects were evaluated for tactile (Yeaple probe) and air sensitivity (dental air syringe) together with subjective perception of pain (0-10 scale) at 0, 2 and 6 weeks. Results for Yeaple probe (gm wt) (Wilcoxon paired rank test) between 6 weeks and baseline, were highly significant for both groups. Differences between groups at 6 weeks were statistically significant. Subjective Yeaple probe scores (paired t-tests) between 6 weeks and baseline were significant for both groups. There were no significant differences (unpaired t-tests) between groups over 6 weeks for subjective Yeaple probe scores. Subjective air scores (paired t-tests) between 6 weeks and baseline were significant for both groups. There were significant differences (unpaired t-tests) between groups in favour of the 3% KNO3/Silica/NaF group at 6 weeks. The 2 weeks and baseline results for both groups were the same as reported for 6 weeks and baseline. The results demonstrated that a 3% KNO3/Silica/NaF mouthwash compared to a Silica/NaF control significantly reduced CDS when evaluated by tactile and thermal stimuli. A 3% KNO3/silica/NaF mouthwash would, therefore appear to have therapeutic potential to alleviate CDS.

Self-applied treatments in the management of dentine hypersensitivity

A summary of the research on the different self-applied treatments for hypersensitive dentine provides some support for several agents but invalidates others. This is true for toothpastes, mouthwashes and gels. Direct comparison of studies is difficult because the materials and methods used are different. In addition, the size of patient groups, and methods of stimulation and assessment of the evoked pain reaction are different. Therefore our concept of the efficacy of self-applied treatment is not so much based on a homogeneous pool of data, but rather on a collection of individual studies. If we subtract from these data sets those based on obviously older ways of evaluating efficacy, we are left with surprisingly few studies that properly assess the efficacy of compounds suited to self-applied treatment. Therefore, guidelines should be established for testing such compounds, and publication of the data sets should depend on proper use of such designs. Stimuli, design and pain assessment should be standardized. In addition, patient recruitment could be defined better in relation to criteria for inclusion. Another area of concern is the pretreatment history of the hypersensitive teeth, because some teeth will become hypersensitive during the observation period, whilst others, which were hypersensitive, will spontaneously become insensitive. Therefore one should know the rate of spontaneous change in tooth sensitivity levels in each patient, in order not to assign treatment effects to teeth that would have lost their sensitivity anyway.

Dentine hypersensitivity: a review

Dentine hypersensitivity is a relatively common pain condition. Local pulpal inflammation, traumatic oral hygiene and dietary habits have been considered in the etiology of dentine hypersensitivity. Dentine hypersensitivity is probably caused by a change in fluid flow in the dentinal tubules, which in turn excites the nerve endings located at the pulp-dentine border. Consequently, treatment success would depend on the prevention of fluid flow across the dentinal tubules (sodium fluoride, stannous fluoride, sodium monofluorophosphate, strontium chloride, sodium citrate, potassium oxalate, and resins/adhesives), or on the desensitization of the nerve endings located at the pulp-dentine border (potassium nitrate). Although a wide variety of treatment methods have been available, clinical data is characterized with ambiguity, warranting further research of the factors which could possibly be implicated in the occurrence of dentine hypersensitivity.