Brazilian undergraduates' and dentists' knowledge on preventing, diagnosing and managing dentin hypersensitivity: A cross-sectional questionnaire study

OBJECTIVES

To analyse the knowledge of dental undergraduates and dentists on the prevention, diagnosis and management of dentin hypersensitivity (DH); to compare their knowledge scores; and to understand the related variables using a regression model.

METHODS

An original online questionnaire investigated the attitudes, self-reported knowledge ('how much they thought they knew') and real knowledge ('how much they really knew') of 132 students and 338 dentists. Data were analysed descriptively, both knowledge scores were compared using Mann-Whitney and Wilcoxon signed-rank tests and data were subjected to two multiple linear regression analyses considering real knowledge scores as the dependent variable (α < 0.05).

RESULTS

The self-reported knowledge on DH was higher than the real knowledge for both students and dentists, but dentists presented the highest scores. Gingival recession and acidic diet were reported as the main predisposing factors for DH by undergraduates and dentists. Students normally managed DH with dietary and hygiene instructions followed by a desensitizing agent application, while dentists managed with occlusal adjustments. The mechanism of glutaraldehyde/HEMA and bioactive fillers on DH is widely unknown by students and dentists. The majority of the questioned individuals cannot differentiate DH from sensitivity of caries or molar-incisor hypomineralization.

CONCLUSION

Both students and dentists overestimate their knowledge of DH, revealing deficiencies in prevention, diagnosis and management. Students' knowledge improves towards the end of the Dentistry course, while younger dentists and PhD holders are more knowledgeable. Institutions should implement ongoing DH education for undergraduates and conduct interventions for experienced professionals, especially older ones.

The prevalence and predictive factors of dentine hypersensitivity among adults in Turkey

AIM

This study sought to determine the prevalence of dentine hypersensitivity (DH) among adults in Turkey. Also, to ascertain the association between DH and both etiological predictors and demographic patient characteristics.

MATERIAL METHOD

Using a questionnaire and thermal and evaporative tests, 259 women and 209 men in the age range of 18 to 72 were analyzed. Individually, a clinical evaluation of DH signs was conducted. The DMFT index, gingival index, and gingival bleeding were reported for each subject. The gingival recession and tooth wear of sensitive teeth were also evaluated. Pearson Chi-square test was used to compare categorical data. Logistic Regression Analysis was used to examine the risk factors of DH. Data with dependent categorical variables were compared using the McNemar-Browker test. The significance level was p < 0.05.

RESULTS

The average age of the population was 35.6 years. In the present study, a total of 12,048 teeth were analyzed. 1755 had thermal hypersensitivity (14.57%), while 470 experienced evaporative hypersensitivity (3.9%). The incisors were the teeth most impacted by DH, whereas the molars were the least affected. Exposure to cold air and sweet foods, gingival recession, and the presence of noncarious cervical lesions were all strongly linked to DH (Logistic regression analysis, p < 0.05). The cold stimulus increases sensitivity more than the evaporation stimulus.

CONCLUSION

Significant risk factors for both thermal and evaporative DH include cold air, consumption of sweet food, presence of noncarious cervical lesions, and gingival recession. More epidemiological research in this area is still required to fully characterize the risk factors and implement the most effective preventive interventions.

Effects of Photodynamic Therapy on Streptococcus mutans and Enamel Remineralization of Multifunctional TiO2-HAP Composite Nanomaterials

BACKGROUND

As photosensitizer and photocatalyst, titanium dioxide (TiO₂) can produce a photodynamic reaction for antibacterial treatment. This study aims to explore a Titanium dioxide/nano-hydroxyapatite (TiO₂-HAP) composite combined with the dental curing lamp (385-515 nm) in clinical which could inhibit the dental plaque biofilm formed by Streptococcus mutans (S. mutans) and promote the enamel surface remineralization simultaneously.

METHODS

X-ray Diffraction (XRD) and high resolution transmission electron microscope (HRTEM) were used to detect the characterization of TiO₂-HAP composite nanomaterials. Photodynamic properties of TiO₂-HAP were detected by Diffuse reflectance spectrum (DRS) and fluorescence spectroscopy. Bacterial growth was measured by reading the absorbance of bacterial cultures and confocal microscope was used to observe the biofilm removal ability of nanomaterials. The ability of TiO₂-HAP to promote enamel remineralization was measured by Scanning electron microscope (SEM).

RESULTS

The OD 600 of S. mutans was 0.76 in the control group and 0.13 in group of TiO₂-HAP with exposure to light-emitting diode (LED) (150 mW/cm²) for 5 min, suggesting its sustained antibacterial potency and inhibition of the metabolic activity of dental plaque microcosm biofilm. Also, the release of calcium and phosphorus ions in TiO₂-HAP can promote enamel mineralization simultaneously. After 15 days of remineralization, the Ca/P ratio of demineralized enamel surface increased from 1.28 to 1.67, which was similar to that of normal enamel.

CONCLUSIONS

The TiO₂-HAP exhibit a promising anti-bacterial activity and remineralization capacity which can prevent the occurrence of caries to the greatest extent and promote the biomimetic mineralization of dental tissues.

The prevalence, clinical features, and related factors of dentin hypersensitivity in the Turkish population

OBJECTIVES

The purpose of this study was to identify the prevalence and predisposing and etiologic factors of dentin hypersensitivity (DH), as well as the demographic characteristics of patients.

MATERIALS AND METHODS

The 1210 patients were examined. The research was based on a two-step investigation: questionnaire and clinical examination. DH was evaluated by the response of the patient to tactile and air-blast stimuli. Loss of attachment and gingival recession of sensitive teeth was measured on the buccal and lingual surfaces. Also, the tooth wear of sensitive teeth was graded on the buccal and lingual surfaces. Comparisons of nonnormally distributed continuous variables were performed using the Mann-Whitney U test and Kruskal-Wallis one-way analysis of variance (ANOVA) and Dunn's post hoc test. Comparisons of categorical variables were performed using Pearson's chi-square, Fisher's exact chi-square, Yates's chi-square, and the Monte Carlo chi-square test.

RESULTS

One hundred twenty-four patients reported DH, showing a prevalence for self-reported DH of 10.2%. Eight hundred forty teeth were diagnosed as having DH, giving a clinical diagnosis rate of DH of 29.4%. Females (76.8%), the 31-40 years age group (26%), housewives (36.8%), and high school education level (38%) had the highest prevalence of DH as demographic properties. A cold stimulus was the most common stimuli trigger for hypersensitivity (97.1%). Occasional pain (55.5%) showed the highest prevalence in terms of frequency of DH. A higher rate of DH was found with the use of medium brushes (47.4%) and brushing twice per day (59.4%) for 1-2 min (56.2%) with the circular method (33.8%) as oral hygiene habits. The buccal surface of the lower right central incisors (5.7%) had the highest prevalence. The most affected teeth by DH were incisors (38.4%). The buccal surfaces (86.3%) of teeth showed a higher high prevalence of DH compared with the lingual surface (52.7%), similar to gingival recession (40.9% vs. 15.7%) and loss of attachment (68.3% vs. 42.6%).

CONCLUSIONS

Clinically diagnosed DH was more common than self-reported DH. Some factors related to patients such as sex (female), the 31-40 years age group, housewives, high school students, using medium brushes, brushing twice per day, and the circular brushing method were more likely to have a risk for DH. Also, buccal surfaces of teeth, gingival recession, and loss of attachment on the buccal surface of teeth should be considered as predisposing factors for DH.

CLINICAL RELEVANCE

To control and prevent DH, clinicians should consider patients' demographics, predisposing factors, and etiologic factors.

Prevalence of sensitive teeth and associated factors: a multicentre, cross-sectional questionnaire survey in France

BACKGROUND

As far as we know, little data, whether obtained from self-administered questionnaires or upon dental clinical examination, has been published on the prevalence of sensitive teeth (ST) in the French adult population. The objectives of the present work were to estimate ST prevalence and characteristics in the general population of France and to explore the associated factors.

METHOD

A multicentre cross-sectional study was conducted between November 2011 and March 2013 in six French cities. Adult passers-by in public places were invited to answer an electronic questionnaire on a tablet computer. Only people who declared having at least one natural tooth were included in the study. A logistic regression model was used for the multivariate analysis.

RESULTS

The prevalence of ST during the previous 12 months reported by the sample of 2413 participants was 42.2% [95% CI: 40.2-44.1%]. The final logistic regression model showed significant statistical associations between ST and female gender, use of tobacco, consumption of soft drinks, limited access to oral care and poor oral hygiene habits (p < 0.05).

CONCLUSIONS

This study provides prevalence data on ST in a general population in France, which seems to remain high despite the existence of many therapies. It should alert professionals to a clinical manifestation that is becoming increasingly prevalent and that they will have to take into consideration to help reduce the discomfort arising from it.

Prevalence of self-reported versus diagnosed dentinal hypersensitivity: a cross-sectional study and ROC curve analysis

OBJECTIVE

This study aimed to identify and compare the self-reported and diagnosed prevalence of dentinal hypersensitivity (DH) in an University population; and to verify accuracy, sensitivity and specificity of DH stimuli tests.

MATERIAL AND METHODS

Three hundred and eighty patients (67.2% women and 32.8% men) were assessed by questionnaire, clinical exam, tactile and cold water tests. The intensity of DH was assessed using a visual analogue scale, and a calibrated examiner measured the scores using a caliper. The ICC for intra-examiner was 0.990. Scores above 5 mm were considered sensitive teeth. The association between variables was assessed by Chi-square test. ROC curve analysis determined accuracy, sensitivity and specificity of the tests (p < .05).

RESULTS

The mean age of participants was 24.08 years. 158 (41.7%) volunteers self-reported the presence of DH, while, 88.7% of the participants were clinically diagnosed (p = .023). In total, 8958 teeth were evaluated, of those 3367 (37.6%) were diagnosed sensitive. The most prevalent teeth with DH were incisors and premolars. The accuracy of the tests with cold water and tactile were 99%. The sensitivity and specificity for cold water and tactile tests were 99.9%, 99.7%, 99.1% and 87.6%, respectively.

CONCLUSION

The self-reported prevalence of DH was significantly lower than that clinically diagnosed. The cold test proved to be a highly accurate stimulus for the diagnosis of DH.

A national survey of tooth wear on facial and oral surfaces and risk factors in young Nigerian adults

Objective:

The objective of this study is to assess the prevalence of tooth wear and to identify risk factors in a sample of young Nigerian adults.

Materials and Methods:

Participants were individuals aged 18–35 years, attending dental clinics located in eight centers representing the six geopolitical zones of the country. Calibrated examiners measured tooth wear using basic erosive wear examination (BEWE) index. Individuals were characterized by the highest BEWE score recorded for any facial/oral tooth surface. Previously validated questionnaire was used to gather information on demographics and risk factors.

Results:

A total of 1349 participants were examined. The prevalence of tooth wear was 60.2%. Bivariate analysis showed significant differences in the prevalence of tooth wear with age, educational level, and occupation (P ≤ 0.05). There were significant differences in tooth wear among the participants from the different states. Tooth wear was found to increase with smoking. Tooth wear was associated with brushing frequency, use of chewing stick, and other local cleaning agents. Multiple regression analysis showed that age, brushing frequency, brushing after breakfast added statistically significantly to the prediction of tooth wear (P < 0.05).

Conclusion:

Tooth wear was common in the population. The frequency of tooth brushing, use of chewing sticks and other local tooth cleaning agents may be contributory.

Prevalence of dentin hypersensitivity among the residents of Xi'an city, China

OBJECTIVE

To investigate the prevalence and intra-oral distribution of dentine hypersensitivity (DH) and to evaluate the related risk factors.

MATERIAL AND METHODS

A total of 1320 subjects, aged between 20 and 69 years old, were selected from six communities in the urban areas of Xi'an, China. The data were collected by conducting individual interviews using a standard questionnaire; then, the clinical examination was performed for patients who reported about the discomforts they felt in their teeth when subjected to chemical, mechanical and thermal stimuli. Dentine hypersensitivity (DH) was diagnosed by a subject short, sharp pain in response to a blast of cold air from a triple syringe.

RESULTS

While replying to the questionnaire, 445 subjects reported about signs of discomfort in the teeth. DH was diagnosed in 336 persons by clinic examination. Thus, the overall prevalence of DH was 33.7% in the questionnaire and 25.5% in the intraoral test. The prevalence of DH was higher in females (33.8%) than in males (22.2%). Furthermore, we found that the prevalence of DH was highest in the age group of 50-59 years (39.3%). The most common initiation factors were acid (37.7%) followed by cold stimuli (35.8%). In general, most subjects with sensitive teeth had a higher educational background.

CONCLUSIONS

The prevalence of DH was 25.5% in the population of Xi'an City in China. More emphasis should give to middle-aged and old females while planning oral health intervention campaigns. In addition, premolars and cervical surfaces should be examined for the prevention of DH.

Knowledge, diagnosis and management of dentine hypersensitivity: a national survey of dentists in Nigeria

AIM

To assess the knowledge of Nigerian dentists regarding dentine hypersensitivity (DH) and their methods of diagnosis and management.

METHODS

A cross-sectional questionnaire-based study of dentists practicing in all six geopolitical zones of Nigeria was conducted. The questionnaire focussed on participant's demography, exposure to patients with DH, knowledge-based questions, diagnosis and management of DH. Data analysis using EPI Info statistical software determined frequencies and proportions. Associations between discrete variables were assessed using the chi-square test (P ≤ 0.05).

RESULTS

A total of 1,057 dentists responded; the majority (83.8%) had practiced for up to 15 years, and 92.0% reported that, on average, between one and 10 of their patients each week complained of DH. The majority (92.8%) of dentists described DH as stimulated brief pain from the tooth; 24.2% expressed that DH can be treated by altering the number of dentinal tubules. A diagnosis of DH is made by tapping (20.6%) or scratching (73.4%) the tooth. Although radical treatments, such as extraction (24.7%) and root canal therapy (34.5%), were mentioned by some, the majority identified aetiological and predisposing factors (98.8%) and provided diet (95.1%) and oral hygiene (95%) counselling as part of the management of DH. Evaluation of 36 knowledge-based questions revealed that only 1.8% of the respondents provided at least 25 correct answers. Knowledge was significantly associated with respondent age and number of years in practice (P ≤ 0.05) but was not associated with the number of patients with DH seen per week (P = 0.46).

CONCLUSION

Dentists practicing in Nigeria exhibited knowledge gaps concerning DH and its diagnosis and management.

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.

A cross-sectional study of dentine sensitivity in periodontitis patients in Trinidad and Tobago

OBJECTIVE

This cross-sectional study aimed to determine the prevalence, distribution and associated factors of dentine sensitivity (DS) among periodontitis patients in Trinidad.

METHODS

Sequential patients meeting the periodontitis criteria (BPE 4/4*) were included and completed a questionnaire on DS prior to a full periodontal examination. Clinically elicited symptoms of DS and presence of cervical tooth wear were recorded.

RESULTS

DS prevalence was 73.1% (n = 130; mean age 50 years). Mean number of sensitive teeth increased with increased severity of gingival recession. Most common initiating factors of DS were cold stimuli (70.5%), brushing (25.3%) and sour food (11.6%). Correlations were obtained for DS and race, toothbrush texture hardness, cervical tooth wear and gingival recession severity (P < 0.05; binary logistic regression). Cervical tooth wear was recorded in 46.3% of DS patients. Full-mouth plaque scores (FMPS) and full-mouth bleeding scores (FMBS) were statistically significantly (P < 0.05; Mann-Whitney U) test lower for DS versus non-DS patients. Patients reported a low usage (27.4%) and satisfaction (53.8%) rating for desensitizing agents.

CONCLUSIONS

The high prevalence of DS was comparable to other studies on periodontitis patients. Progressive periodontal disease and toothbrush abrasion were possible aetiological factors for DS in this study. Knowledge of local dietary practices and the role of acidic (sour) foods in eliciting DS may aid in management. The high prevalence of cervical tooth wear and the lower FMPS and FMBS among DS patients may reflect more aggressive tooth brushing. DS does not seem to be a limitation to plaque control in DS versus non-DS patients in this study.

Dentine sensitivity: past, present and future

OBJECTIVE

This review defines dentine sensitivity (DS), its prevalence, its aetiology, the mechanism(s) responsible for DS, its diagnosis and its treatment. The review then examines the modes of action of various treatments for DS including potassium salts, strontium salts, bioglasses, arginine/calcium carbonate and professional treatments such as adhesives and oxalates. The methods used to evaluate the various treatment modalities are discussed, including laboratory studies and randomised controlled clinical trials.

DATA SOURCES AND STUDY SELECTION

A literature search was conducted using PubMed, Ovid Medline and Cochrane reviews for information on DS and its treatments, as well as laboratory and clinical studies used to evaluate the efficacy of various DS treatments. With regard to efficacy of treatments for DS only reports of clinical studies that were randomised, controlled and blinded were reviewed. The authors offer new insights into the shortcomings of the recent systematic review of the use of oxalates for DS.

CONCLUSION

The authors introduce the concept of a novel desensitising mouthrinse containing 1.4% potassium oxalate: Listerine® Advanced Defence Sensitive mouthrinse. Readers of this supplement issue of the Journal of Dentistry are invited to review the significance of managing the clinical problem of DS. They are also invited to assess data from laboratory and randomised controlled clinical studies in order to understand the advantages offered by regular use of 1.4% potassium oxalate-containing mouthrinse, Listerine Advanced Defence Sensitive, in particular its resistance to daily erosive and/or abrasive challenges.

The prevalence of dentin hypersensitivity in general dental practices in the northwest United States

BACKGROUND

The prevalence of dentin hypersensitivity is uncertain, yet appropriate diagnosis and treatment of dentin hypersensitivity require accurate knowledge regarding its prevalence. The authors conducted a study to estimate the prevalence of dentin hypersensitivity in general dental practices and to investigate associated risk factors.

METHODS

The authors conducted a cross-sectional survey of 787 adult patients from 37 general dental practices within Northwest Practice-based Research Collaborative in Evidence-based DENTistry (PRECEDENT). Dentin hypersensitivity was diagnosed by means of participants' responses to a question regarding pain in their teeth and gingivae, and practitioner-investigators conducted a clinical examination to rule out alternative causes of pain. Participants recorded their pain level on a visual analog scale and the Seattle Scales in response to a one-second air blast. The authors used generalized estimating equation log-linear models to estimate the prevalence and the prevalence ratios.

RESULTS

The prevalence of dentin hypersensitivity was 12.3 percent; patients with hypersensitivity had, on average, 3.5 hypersensitive teeth. The prevalence of dentin hypersensitivity was higher among 18- to 44-year olds than among participants 65 years or older; it also was higher in women than in men, in participants with gingival recession than in those without gingival recession and in participants who underwent at-home tooth whitening than in those who did not. Hypersensitivity was not associated with obvious occlusal trauma, noncarious cervical lesions or aggressive toothbrushing habits.

CONCLUSIONS

One in eight participants from general practices had dentin hypersensitivity, which was a chronic condition causing intermittent, low-level pain. Patients with hypersensitivity were more likely to be younger, to be female and to have a high prevalence of gingival recession and at-home tooth whitening.

PRACTICAL IMPLICATIONS

Given dentin hypersensitivity's prevalence, clinicians should diagnose it only after investigating all other possible sources of pain.

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.

Epidemiology of dentin hypersensitivity

OBJECTIVE

In contrast to the well-established caries epidemiology, data on dentin hypersensitivity seem to be scarce and contradictory. This review evaluates the available literature on dentin hypersensitivity and assesses its prevalence, distribution, and potential changes.

MATERIALS AND METHODS

The systematic search was performed to identify and select relevant publications with several key words in electronic databases. In addition, the articles' bibliographies were consulted.

RESULTS

Prevalence rates range from 3 to 98 %. This vast range can be explained partly by the differences in the selection criteria for the study sample and also the variety in diagnostic approaches or time frames. Women are slightly more affected than men and an age peak of 30-40 years has been reported. Still, the prevalence of erosions with dentin exposure seems to increase in younger adults, often resulting in hypersensitivity. In older patients, root surfaces are frequently exposed due to periodontal disease which is associated with a high rate of dentin hypersensitivity, especially after periodontal treatment and intensified brushing activity. On the other hand, the number of affected seniors with tooth loss or even edentulism is reduced. About 25-30 % of the adult population report dentin hypersensitivity. Most dentists also consider it to be a relevant problem in their practice, but they request more information on this topic. Maxillary teeth are affected to a higher extent, but the different teeth show very similar rates. Buccal surfaces clearly show the highest prevalence rates.

CONCLUSION

In spite of the advances regarding management of dentin hypersensitivity, it still remains an epidemiologically understudied field.

CLINICAL RELEVANCE

Although great variations have been observed in the prevalence of dentin hypersensitivity, this issue is often observed by dentists and related by patients. However, further studies are necessary to find the cause of this condition and refine its management.

Oral hygiene measures and the periodontal status of school children

BACKGROUND

Tooth brushing and other mechanical cleaning procedures are considered the most reliable methods of effective plaque removal, which is essential for prevention of periodontal diseases.

OBJECTIVE

To investigate the relationship between oral hygiene practices, socioeconomic status and gingival health in a group of Nigerian children.

METHODS

 Our study population consisted of 242 randomly selected school children in Ile-Ife, Nigeria. Participants completed a questionnaire on oral hygiene measures, their gingival health was assessed using oral hygiene index (OHI), plaque index (PI) and index of gingival inflammation (GI).

RESULTS

Toothbrushing once daily was the most common practice (52.1%). Toothbrush with a fluoride-containing toothpaste was the most common tooth cleaning aid, while the up and down brushing technique was predominantly used. There was no statistically significant gender difference in toothbrushing frequency; however, significant gender differences were observed in PI and OHI scores (P<0.05). Gingivitis was absent in 28.9% of the children,, while 50.8% had mild, 13.6% moderate and 6.6% severe gingivitis. There was a weak but significant negative correlation between oral hygiene frequency and GI (P<0.05). Socioeconomic status had no relationship with oral hygiene frequency, however it had low but significant correlation with OHI and GI (P<0.05). A logistic regression analysis of the predictors on gingivitis showed that male gender and medium textured toothbrush had significant association with gingival health.

CONCLUSIONS

Gingival health was influenced by gender, socioeconomic status, oral hygiene frequency and toothbrush texture. Motivation to apply instructions given on oral health care and regular reinforcement are essential.