Management of dentine hypersensitivity: efficacy of professionally and self-administered agents

Applications of Bioactive Strontium Compounds in Dentistry

Divalent cations have captured the interest of researchers in biomedical and dental fields due to their beneficial effects on bone formation. These metallic elements are similar to trace elements found in human bone. Strontium is a divalent cation commonly found in various biomaterials. Since strontium has a radius similar to calcium, it has been used to replace calcium in many calcium-containing biomaterials. Strontium has the ability to inhibit bone resorption and increase bone deposition, making it useful in the treatment of osteoporosis. Strontium has also been used as a radiopacifier in dentistry and has been incorporated into a variety of dental materials to improve their radiopacity. Furthermore, strontium has been shown to improve the antimicrobial and mechanical properties of dental materials, promote enamel remineralization, alleviate dentin hypersensitivity, and enhance dentin regeneration. The objective of this review is to provide a comprehensive review of the applications of strontium in dentistry.

Progress in Biomaterials and Technologies in Dentistry

The field of dental biomedicine continues to evolve with significant advancements that are aimed at improving oral health outcomes [...].

A Drop-By-Drop Self-Assembled All-Natural Hydrogel as a Desensitizer for Rapid and Enduring Management of Dentin Hypersensitivity

Dentin hypersensitivity (DH) is a prevalent dental condition arising from the exposure of dentin tubules (DTs), leading to discomfort upon external stimuli. However, achieving swift and profound occlusion of these exposed DTs for immediate and enduring relief remains challenging due to the intricate dentin structure and oral environment. Herein, a pioneering and facile drop-by-drop strategy involving an in situ generated natural supramolecular hydrogel formed by self-assembling silk fibroin (SF) and tannic acid (TA) within the narrow DT space is proposed. When SF and TA aqueous solutions are applied successively to exposed dentin, they penetrate deeply within DTs and coassemble into compact gels, robustly adhering to DT walls. This yields a rapid and compact occlusion effect with an unprecedented depth exceeding 250 µm, maintaining stable occlusion efficacy even under rigorous in vitro and in vivo erosion and friction conditions for no less than 21 days. Furthermore, the biocompatibility and effective occlusion properties are verified through cell studies in simulated oral settings and an in vivo rabbit model. This study, for the first time, demonstrates the translational potential of hydrogel-based desensitizers in treating DH with prompt action, superior occlusion depth and enduring treatment benefits, holding promise as clinical-friendly restorative solutions for delicate-structured biosystems.

Clinical evidence for silver diamine fluoride to reduce dentine hypersensitivity: A systematic review

OBJECTIVE

To assess the clinical evidence for silver diamine fluoride (SDF) to reduce dentine hypersensitivity in adults.

METHODS

Two independent researchers searched the English literature in five databases (Scopus, PubMed, Web of Science, EMBASE and the Cochrane Library) up to 15th July 2023 for clinical trials investigating the desensitising effect of professionally applied SDF to manage dentine hypersensitivity in adults aged 18 or above at any follow-up period. The primary outcome was the change in dentine hypersensitivity between baseline and follow-up visits after SDF application regarding any validated pain outcome measures. The Cochrane guidelines were used for the risk of bias assessment.

RESULTS

Three hundred and thirty-one studies were identified, and four of them were finally included. Three of the included studies were rated as having a 'low risk' of bias. The SDF solution reduced dentine hypersensitivity in adults. The percentage reduction in dentine hypersensitivity ranged from 23 % to 56 % after a single application of SDF solution. Moreover, the SDF solution was more effective than potassium nitrate, potassium oxalate and glutaraldehyde plus hydroxyethyl methacrylate in reducing dentine hypersensitivity. Meta-analysis indicated a more significant reduction in visual analogue scales (1-10) by 1.35 (95 % CI:0.9-1.8; p<0.00001) after receiving the SDF application than controls.

CONCLUSION

The included clinical trials showed that SDF solution reduced dentine hypersensitivity in adults. However, clinical trials are few, and their protocol varied from one another. Further well-designed clinical trials should be conducted to provide more evidence on its use to manage dentine hypersensitivity.

CLINICAL SIGNIFICANCE

SDF is cleared as desensitizing agents by the US Food and Drug Administration to manage dentine hypersensitivity, which induces pain, limits food choice, and impacts the quality of life. Evidence from this systematic review informs clinicians and provides researchers insight for future research on SDF use for dentine hypersensitivity. THE INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS (PROSPERO) REGISTRATION NUMBER: CRD42023462613.

Novel resin-based material containing β-tricalcium phosphate nanoparticles for the reduction of dentin permeability

OBJECTIVES

To synthesize and characterize a novel dentin adhesive containing Beta-Tricalcium Phosphate (β-TCP) nanoparticles and test its ability to reduce dentin permeability (dP).

METHODS

Experimental adhesives were prepared by mixing Bis-GMA, TEGDMA, HEMA (50/25/25 wt.%), photo-initiators, and inhibitors. The following groups were tested: Experimental adhesives without β-TCP (Exp.); with 10 wt.% β-TCP (Exp.10 wt.% β-TCP); with 15 wt.% β-TCP (Exp.15 wt.% β-TCP), Scotchbond Multi-Purpose (SBMP) and Clearfil SE Protect Bond (CFPB). Degree of conversion (DC%, 10 and 20 s); Flexural Strength (FS), Knoop Hardness (KHN), and Cell Viability (OD%) tests were performed. dP was evaluated by hydraulic conductance, using human dentin disks (n=12), at three-time intervals: post-EDTA (T0); post-treatment (T1); and post-erosion/abrasion cycling (T2). Data were statistically analyzed (α=0.05).

RESULTS

For all groups, exposure time for 20 s presented a higher DC% than for 10 s. For FS, filled adhesives did not differ from unfilled and from CFPB. Experimental adhesives did not differ among them and showed lower KHN than the commercial products. Cell viability did not differ among adhesives, except Exp. 15 wt.%, which showed lower OD% than Exp., Exp. 10% and, CFPB. For dP, only Exp.10 and 15 wt.% β-TCP did not present difference between the times T1 and T2. After cycling, Exp.10 wt.% β-TCP presented lower permeability than Exp. and CFPB.

CONCLUSIONS

The incorporation of 10 wt.% β-TCP nanoparticles into the resin-based dental material did not affect its mechanical properties and biocompatibility, and promoted the greatest reduction in dentin permeability, sustaining this effect under erosive/abrasive challenges.

CLINICAL SIGNIFICANCE

A novel resin-based dental material containing β-TCP nanoparticles was able to reduce dentin permeability, maintaining its efficacy after erosive/abrasive challenges. The synthesized material did not affect dental pulp cell viability and might be promising for other conditions that require dental remineralization, such as tooth wear and dental caries.

Chemical and Ultrastructural Characterization of Dentin Treated with Remineralizing Dentifrices

The aim of this study is to investigate dentin chemical and ultrastructural changes upon exposure to remineralizing dentifrices. Dentin disks were obtained from permanent human molars and treated for 7 days with the dentifrices: (1) C group-control (no dentifrice); (2) S group-Sensodyne Repair & Protect; (3) D group-Dentalclean Daily Regenerating Gel; and (4) DB group-D group + Dentalclean regenerating booster. Afterwards, samples were submitted to an additional 7 days of toothbrushing associated with daily acidic challenge. Samples were imaged and analyzed (days 1, 7, and 14) for Young's modulus by atomic force microscopy (AFM), scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX), transmission electron microscopy (TEM) and selected area electron diffraction (SAED). SEM and AFM revealed precipitate deposition on dentin surfaces in groups S, D, and DB, formed as early as day 1. Surface elemental analysis showed a Si increase on all brushed surfaces. Similar surface morphology was maintained after the acidic challenge period. Bright-field TEM/SAED revealed the formation of nanocrystalline hydroxyapatite inside the dentin tubules of groups S, D, and DB after day 7. Group C presented a gradual reduction of Young's modulus from days-1-14, whereas all remaining groups had increased values. All evaluated dentifrices led to successful formation of hydroxyapatite and increased dentin stiffness.

Treating hypersensitivity in older adults with silver diamine fluoride: A randomised clinical trial

OBJECTIVE

This study aimed to evaluate the desensitizing effect of topically applied 38% silver diamine fluoride (SDF) solution on the exposed root surface of hypersensitive teeth in older adults.

METHOD

This double-blind randomised clinical trial recruited healthy older adults with dentine hypersensitivity. A trained examiner tested the most hypersensitive tooth root surface with a blast of compressed cold air from a three-in-one syringe. The participants gave a sensitivity score (SS) in visual analogue scale from 0 (no pain) to 10 (agonizing) at the baseline visit. Then, they received 38% SDF or 5% potassium nitrate solution (control) as intervention on the root surface. After the intervention, they received a compressed cold air test and reported the SS again. The compressed cold air test followed by intervention was repeated at 4- and 8-week follow ups. The primary outcome was the reduction in SS at 8-week follow-up with reference to the SS at baseline before intervention. Shapiro-Wilk and Mann-Whitney U tests were performed for data analysis following a normality test of SS.

RESULTS

This trial recruited 148 participants, and 139 (94%) participants completed the trial. The median percentage reductions in SS in the SDF and potassium nitrate groups were 60% and 50%, respectively (p < 0.001).

CONCLUSION

According to the results, 38% SDF solution reduced hypersensitivity on the exposed root surface of older adults. In addition, 38% SDF was more effective than 5% potassium nitrate solution to reduce hypersensitivity on the exposed root surface of older adults.

CLINICAL SIGNIFICANCE

Dentin hypersensitivity is common amongst older adults and negatively affects their quality of life. To date, there is no gold standard professionally applied desensitizing therapy in treating hypersensitivity. Evidence from this clinical trial could aid clinical practice and improve oral health in older adults.

TRIAL REGISTRATION

This study was registered at ClinicalTrials.gov (NCT05392868).

Epigallocatechin-3-gallate/mineralization precursors co-delivery hollow mesoporous nanosystem for synergistic manipulation of dentin exposure

As a global public health focus, oral health plays a vital role in facilitating overall health. Defected teeth characterized by exposure of dentin generally increase the risk of aggravating oral diseases. The exposed dentinal tubules provide channels for irritants and bacterial invasion, leading to dentin hypersensitivity and even pulp inflammation. Cariogenic bacterial adhesion and biofilm formation on dentin are responsible for tooth demineralization and caries. It remains a clinical challenge to achieve the integration of tubule occlusion, collagen mineralization, and antibiofilm functions for managing exposed dentin. To address this issue, an epigallocatechin-3-gallate (EGCG) and poly(allylamine)-stabilized amorphous calcium phosphate (PAH-ACP) co-delivery hollow mesoporous silica (HMS) nanosystem (E/PA@HMS) was herein developed. The application of E/PA@HMS effectively occluded the dentinal tubules with acid- and abrasion-resistant stability and inhibited the biofilm formation of Streptococcus mutans. Intrafibrillar mineralization of collagen fibrils and remineralization of demineralized dentin were induced by E/PA@HMS. The odontogenic differentiation and mineralization of dental pulp cells with high biocompatibility were also promoted. Animal experiments showed that E/PA@HMS durably sealed the tubules and inhibited biofilm growth up to 14 days. Thus, the development of the E/PA@HMS nanosystem provides promising benefits for protecting exposed dentin through the coordinated manipulation of dentin caries and hypersensitivity.

In vitro dentin permeability and tubule occlusion of experimental in-office desensitizing materials

OBJECTIVES

This study investigates the dentin permeability (by hydraulic conductance) and tubule occlusion (by confocal and scanning electron microscopies) of in-office desensitizing materials.

MATERIALS AND METHODS

Bovine dentin blocks were immersed in EDTA to open dentinal tubules. Placebo varnish (PLA), fluoride varnish (FLU), NaF 5% + 5% nanoparticulate sodium trimetaphosphate varnish (TMP), universal adhesive system (SBU), S-PRG filler varnish (SPRG), Biosilicate (BIOS), and amelotin (AMTN) solution were the materials tested. After application, the specimens underwent an erosive-abrasive challenge. Dentin permeability was evaluated at T0 (initial), T1 (after treatment), and T2 (after challenge). Confocal and scanning electron microscopy (SEM) were used to evaluate, respectively, length and number of dentinal tubule occlusions and opened dentinal tubules, after challenge. Permeability and SEM data were analyzed by two-way repeated measures ANOVA and Tukey's tests. Confocal data were analyzed by one-way ANOVA, Tukey's test, and Kruskal-Wallis and Dunn's tests. Spearman and Pearson's correlation tests were also used. Significance level was set at 5%.

RESULTS

At T1, the AMTN group showed the lowest permeability value, following the increasing order at T2: AMTN = SBU < BIOS = SPRG < TMP < FLU < PLA. The SBU group had the highest value of occluded dentinal tubule length. The AMTN group presented more occluded dentinal tubules compared to PLA and FLU. AMTN and SBU had the lowest values of opened dentin tubules. Results showed a negative correlation between the analyses.

CONCLUSION

The SBU and AMTN solution were more effective in reducing dentin permeability by occluding dentin tubules.

CLINICAL RELEVANCE

All materials reduced permeability after challenge, except fluoride varnish.

Comparative evaluation of diode laser alone and in combination with desensitizing toothpaste in occlusion of dentinal tubules - A SEM study

Background

In regular dental practice, dentinal hypersensitivity is a common oral condition affecting the adult population. Although a variety of treatment procedures are available, there is no single method that proved to be potent in eliminating dentine hypersensitivity and providing patients with complete relief. Hence the present study performed to estimate the occlusion of dentinal tubules using a diode laser alone and in combination with various desensitizing toothpaste, using the scanning electron microscope.

Materials and methods

This in-vitro study consisted of five groups wherein cervical cavities were prepared on the extracted teeth followed by the application of 17% EDTA. The cavities were then treated with Novamin toothpaste, pro-arginine toothpaste, diode laser, and in combinations respectively. Then SEM analysis was done and the results obtained were statistically analyzed using tukey's multiple post hoc analysis for intra and inter group comparisons.

Results

The groups which were treated with a combination of diode laser and the desensitizing agent showed statistically significant (P < 0.05) better dentinal tubule occlusion than other groups.

Conclusion

The use of a diode laser has an added benefit in treating dentinal tubule occlusion when compared to desensitizing kinds of toothpaste.

Comparative efficacy of self-administered dentifrices for the management of dentine hypersensitivity - A systematic review and network meta-analysis

OBJECTIVES

This systematic review with network meta-analysis synthesises available randomised controlled trials evidence concerning efficacy of self-administered dentifrices for management of dentine hypersensitivity (DH) pain.

STUDY SELECTION

Following systematic review registration (CRD42019154064), three data bases (MEDLINE, Embase, CENTRAL) were searched to December 2022 for parallel randomised controlled trials conducted in adults diagnosed with DH, using at least two recognised stimuli, assessing the short-term efficacy of home-use dentifrice treatment in reducing pain. Thirty-two studies and 4,638 participants were included. A Network meta-analysis (NMA) approach was used to compare relative effectiveness between interventions.

CONCLUSIONS

Twice daily application of self-applied dentifrice containing formulations of stannous, potassium +/- stannous, or arginine can be recommended for the reduction of dentine hypersensitivity pain. There is a need for standardised methodology guideline development to improve the conduct, analysis and reporting of DH clinical studies.

CLINICAL RELEVANCE

This is the first comprehensive NMA to be performed, that follows guidelines for conduct of DH trials to determine the efficacy of self-applied dentifrices for the management of dentine hypersensitivity. Indirect comparisons can be made between formulations that have not been compared to one another in randomised controlled trials.

Effectiveness of 38% Silver Diamine Fluoride in Reducing Dentine Hypersensitivity on Exposed Root Surface in Older Chinese Adults: Study Protocol for a Randomised Double-Blind Study

Background: Dentine hypersensitivity on an exposed root surface induces pain, affects daily oral hygiene practice, limits dietary choices and negatively affects quality of life. Silver diamine fluoride is marketed in the United States as a desensitising agent, but well-designed clinical trials are limited. This study evaluates the anti-hypersensitivity effect of silver diamine fluoride on hypersensitive teeth due to an exposed root surface in older Chinese adults. Methods/design: We will conduct a randomised double-blind clinical trial with a sample size of at least 148 Chinese older adults aged 65 or above who have dentine hypersensitivity due to an exposed root surface. We will collect written consent before the study. A trained examiner will examine the participants’ teeth with a blast of compressed air from a 3-in-1 syringe. Those adults who report a self-perceived sensitivity score (SS) (0 to 10) of 8 or more on at least one tooth with an exposed root surface will be recruited. The recruited older adults will be randomly allocated into two groups using a block randomisation of six. Group 1 participants will receive the application of 38% silver diamine fluoride solution every 4 weeks. Group 2 participants will receive the application of 5% potassium nitrate solution every 4 weeks. Dietary advice, oral hygiene instruction and fluoride toothpaste at 1450 ppm will be provided to participants in both groups. The same trained examiner will perform follow-up examinations for the participants and determine the dentine hypersensitivity in SS of the most hypersensitive tooth (with the highest pre-treatment SS) immediately after the intervention and at 4-week and 8-week intervals. Discussion: There is no consensus on the standard of care for a professionally applied desensitising agent in older adults. This trial will provide evidence for clinicians to devise an effective dental care plan for older adults with dentine hypersensitivity. Trial registration: NCT05392868 Registered on 22 May 2022.

Zwitterionic/phosphonate copolymer coatings endow excellent antifouling properties and robust re-mineralization ability of dentine substrates

Inhibition of biofilm formation and induction of the re-mineralization of damaged dental tissues are two major strategies to combat dental hypersensitivity (DH). However, single component synthetic materials normally cannot fulfil these two functions during the repairing of damaged dental tissues. Here, we report zwitterionic phosphorylcholine based polymers to be a new type of dual functional coating for the repairing of DH. Zwitterionic/phosphonate copolymers, p(DEMMP-co-MPC), bearing varied zwitterionic contents (95 and 75 mol%) were prepared through conventional radical copolymerization. ¹H NMR spectroscopy clearly indicated the precise preparation of the copolymers. The copolymers can be easily coated on dentine substrates based on the high affinity between the phosphonate group and the calcium phosphate minerals of the dentine substrates, as evidenced by XPS and water contact angle measurements. Antifouling evaluations indicated that zwitterionic coating can efficiently inhibit protein adsorption (BSA, egg white, and milk, by 85%) and bacterial adhesion (by 97.1%) on dentine substrates. Furthermore, in vitro and in vivo experiments consistently indicated that the zwitterionic coating could not only induce the robust re-mineralization of dentine surfaces, but also template the extensive re-mineralization of dentine tubules to a similar level of pristine dentine. Both the antifouling properties and the re-mineralization potency are positively correlated with the content of zwitterionic pMPC in the coating copolymer. These findings may provide the zwitterionic phosphorylcholine based materials to be a promising candidate to treat dental hypersensitivity and other related dental diseases.

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

OBJECTIVES

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

METHODS AND MATERIALS

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

RESULTS

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

CONCLUSIONS

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

Effects of low-level light therapy on dentin hypersensitivity: a systematic review and meta-analysis

OBJECTIVE

To investigate the treatment efficacy of low-level light therapy on dentin hypersensitivity.

MATERIALS AND METHODS

Following the PRISMA guideline, six electronic databases supplemented with bibliographies were searched till December 2020. Two reviewers performed the screenings independently with a reliability assessment. Studies fulfilling the pre-registered eligibility criteria were included for risk-of-bias assessment and data synthesis.

RESULTS

Thirty-five articles ultimately informed this systematic review based on the eligibility criteria and underwent risk-of-bias assessment (ĸ = 0.86). Quantitative results were deduced by meta-analysis of 20 randomised controlled trials: LLLT showed favourable outcomes compared to placebos for immediate (SMD: 1.09, 95% CI: 0.47 to 1.70), interim (SMD: 1.32, 95% CI: 0.41 to 2.23), and persistent efficacies (SMD: 2.86, 95% CI: 1.98 to 3.74). However, substantial heterogeneity existed among included studies (I2: 64-95%). Regarding comparisons with other desensitising strategies, LLLT showed no significant benefits in DH alleviation over others except fluorides for interim efficacy (SMD: 0.31, 95% CI: 0.10 to 0.52) and persistent efficacy (SMD: 0.45, 95% CI: 0.03 to 0.86).

CONCLUSIONS

This systematic review shows that LLLT has positive immediate, interim, and persistent DH-treatment efficacies compared with placebo. No superior treatment effects of LLLT were observed except fluoride agent use. Further studies are warranted-RCTs with low risk of bias, consistent technical settings, comprehensive assessments, and long follow-up periods.

CLINICAL RELEVANCE

This systematic review bridges a critical research gap by analysing clinical evidence in the DH-alleviating efficacy of LLLT in comparison with placebo and other in-office desensitising strategies.

Effects of desensitizing dentifrices on dentin tubule occlusion and resistance to erosive challenges

Background

Many studies have demonstrated efficacy of casein phosphopeptide (CPP) containing products for dentin tubule occlusion for treatment of dentin sensitivity, but their effectiveness under dynamic erosive challenges remains to be elucidated. The purpose of the present study was to investigate the effectiveness of a desensitizing dentifrice containing CPP in occluding dentin tubules and resisting erosive challenges in comparison to that containing polyvinyl methyl ether/maleic acid (PVM/MA) copolymers.

Methods

A total of 33 dentin discs were prepared from coronal sections of human third molars and divided into 3 groups: a toothpaste containing CPP; a toothpaste containing PVM/MA and submicron silica; and a regular toothpaste (Controls). A soft-bristle toothbrush was used to brush the dentin discs with the dentifrices for 45 strokes in 30 s at a force of approximately 200 g. The brushing cycle was repeated after immersion of the dentin discs in artificial saliva overnight. The dentin discs were then challenged in orange juice for 10 min in an incubator rocking at 120 rpm. Three fields were randomly selected on each dentin disk surface to assess dentin tubule occlusions after each brushing cycle and after orange juice challenge with a 3D laser scanning microscope. Specimen cross sections were examined with a scanning electron microscope equipped with energy dispersive spectroscopy (SEM/EDS).

Results

After the first and second cycles of brushing, dentin tubules were occluded on average by 56.3% and 85.7% in CPP group, 66.2% and 88.1% in PVM/MA group, and 0.0 and 13.0% in the controls, respectively. There were no statistically significant differences in dentin tubule occlusions between the CPP and PVM/MA groups after two cycles of brushing (p>0.05). After dynamic erosive challenges with orange juice, 20.3% of the dentin tubules in the CPP group, 79.1% in the PVM/MA group and none in the control remained occluded (P<0.05). SEM/EDS imaging showed that dentin tubules were blocked with plugs containing dentifrice substances in CPP and PVM/MA groups after treatments, but none in the controls.

Conclusions

Desensitizing dentifrices containing CPP or PVM/MA could effectively occlude dentin tubules after two cycles of brushing. PVM/MA in combination with submicron silicon dioxide exhibited stronger resistance to dynamic erosive challenges by acidic beverages. Inorganic fillers that can enter dentin tubules and resist erosive challenges may be key for desensitizing dentifrices.

Long-Term Effectiveness of Treating Dentin Hypersensitivity with Bifluorid 10 and Futurabond U: A Split-Mouth Randomized Double-Blind Clinical Trial

Background: The definition of dental hypersensitivity is “pain derived from exposed dentin in response to chemical, thermal tactile or osmotic stimuli which cannot be explained as arising from any other dental defect or disease”. One of the treatments proposed is tubular occlusion. The aim of this in vivo split-mouth randomized clinical trial was to evaluate the clinical efficacy of a in-office application of a fluoride varnish (Bifluorid 10) and a bonding resin (Futurabond U) in adults with dentin hypersensitivity. Material and methods: A total of 180 teeth were treated with Bifluorid 10 and 160 with Futurabond U. Outcome measurements were taken one or two weeks before treatment, at baseline at the application days, at 1 week and at 1–6 months after first treatment. Results: Both treatments reduced pain intensity. Bifluorid 10 and Futurabond U have similar efficacy in reducing SCHIFF-measured pain reduction, while Bifluorid 10 is significantly more efficient for VAS-measured pain reduction, mainly due to long-term pain reduction. Patient age has a significant negative influence on pain reduction, while the influence of patient gender and BEWE of the tooth is insignificant. Conclusions: Bifluorid 10 and Futurabond U are effective in the treatment of dental hypersensitivity. The RCT was registered at the US National Institutes of Health (ClinicalTrials.gov) #NCT04813848.

The Stability of Dentin Surface Biobarrier Consisting of Mesoporous Delivery System on Dentinal Tubule Occlusion and Streptococcus Mutans Biofilm Inhibition

Background

The dentin exposure always leads to dentin hypersensitivity and/or caries. Given the dentin’s tubular structure and low mineralization degree, reestablishing an effective biobarrier to stably protect dentin remains significantly challenging. This study reports a versatile dentin surface biobarrier consisting of a mesoporous silica-based epigallocatechin-3-gallate (EGCG)/nanohydroxyapatite delivery system and evaluates its stability on the dentinal tubule occlusion and the Streptococcus mutans (S. mutans) biofilm inhibition.

Materials and Methods

The mesoporous delivery system was fabricated and characterized. Sensitive dentin discs were prepared and randomly allocated to three groups: 1, control group; 2, casein phosphopeptide–amorphous calcium phosphate (CPP–ACP) group; and 3, the mesoporous delivery system group. The dentin permeability, dentinal tubule occlusion, acid and abrasion resistance, and S. mutans biofilm inhibition were determined for 1 week and 1 month. The in vitro release profiles of EGCG, Ca, and P were also monitored.

Results

The mesoporous delivery system held the ability to sustainably release EGCG, Ca, and P and could persistently occlude dentinal tubules with acid and abrasion resistance, reduce the dentin permeability, and inhibit the S. mutans biofilm formation for up to 1 month compared with the two other groups. The system provided prolonged stability to combat oral adverse challenges and served as an effective surface biobarrier to protect the exposed dentin.

Conclusion

The establishment of the dentin surface biobarrier consisting of a mesoporous delivery system indicates a promising strategy for the prevention and the management of dentin hypersensitivity and caries after enamel loss.

A randomised controlled trial to compare the efficacy of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste with a control toothpaste for the prevention of dentine hypersensitivity

OBJECTIVES

To determine the efficacy of a cosmetic aluminium lactate/potassium nitrate/hydroxylapatite toothpaste for the reduction of dentine hypersensitivity (DH) pain as compared to a control toothpaste containing potassium nitrate.

METHODS

The study was a randomised, examiner-blind, two treatment arm, parallel controlled trial in healthy adults with at least 2 sensitive teeth (Schiff >2). At baseline, immediately after treatment and at 7 and 14 days of twice-daily brushing of the test or control toothpaste the sensitivity of 2 test teeth was measured following iced-water (Schiff and VAS) and tactile (Yeaple probe) stimuli, and a whole mouth plaque score was obtained. Participants also completed a whole-mouth VAS and DHEQ15 quality of life questionnaire at baseline, 7 and 14 days.

RESULTS

Both toothpastes reduced DH in test teeth, but pain reduction in the test group was significantly better at all timepoints and by all measures (p = 0.005, tooth-level VAS immediately after brushing; p < 0.001 all other comparisons). There was a relative risk reduction of Schiff sensitivity of 55 % immediately after brushing which rose to 81 % after 7 and 88.6 % after 14 days (all p < 0.001). There were no differences in plaque, whole mouth VAS or DHEQ15 scores at any time point.

CONCLUSION

This study demonstrated the efficacy of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste compared to a potassium nitrate control toothpaste for the prevention of dentine hypersensitivity both immediately and over a 2 week period. This agent appears to have potential for pain alleviation from the common oral pain condition of DH and further research is warranted.

CLINICAL SIGNIFICANCE

DH pain, whilst transient in nature, is arresting in magnitude, affecting quality of life. Daily application of efficacious toothpastes can relieve DH pain however, as yet, there is no gold standard treatment. The results of this study support further investigation of an aluminium lactate/potassium nitrate/hydroxylapatite toothpaste for DH management.

Remineralization of dentine tubules induced by phosphate-terminated PAMAM dendrimers

Various sealants have been developed to treat the exposure of dentinal tubules (DTs) and further dental hypersensitivity. Herein, the phosphate-terminated fourth generation polyamidoamine dendrimers (PAMAM-PO₃H₂) was successfully synthesized. Six duplicates of demineralized dentin and type I collagen matrix were incubated in artificial saliva solution with or without PAMAM-PO₃H₂ treatment at 37 °C for 2 weeks, respectively. The artificial saliva solution was replaced every day. These regenerated crystals on the surface of dentin and collagen matrix were confirmed to be hydroxyapatite (HAp). The approach thus demonstrates that PAMAM-PO₃H₂ can offer an efficient therapy for seal DTs in clinical dentistry.

Bioavailable gluconate chelated stannous fluoride toothpaste meta-analyses: Effects on dentine hypersensitivity and enamel erosion

OBJECTIVES

To compare the effect of bioavailable gluconate-chelated stannous fluoride (SnF₂) toothpaste with control toothpastes for treatment of dentine hypersensitivity (DH) and enamel erosion.

DATA AND SOURCES

A Procter & Gamble Oral Care archive of clinical studies was reviewed from 2000 to 2020. Eligible studies were Randomised Controlled Trials (RCTs) investigating bioavailable gluconate-chelated SnF₂ toothpaste efficacy compared to controls in adult participants measured following tactile (Yeaple force) and/or evaporative stimuli (Schiff score) in-vivo, duration <2 months (DH); or by erosive toothwear (profilometry) from in-situ samples, duration 10-15 days. Two authors independently assessed eligibility and resolved disagreements by discussion. A meta-analysis was undertaken and Risk of Bias (RoB) assessed using the Cochrane collaboration RoB tool for randomized parallel-group and cross-over trials.

RESULTS

Fourteen RCTs (1287 participants) assessed DH relief and Six RCTs (184 participants) enamel erosion protection. For DH SnF₂ toothpastes provided a 57 % (evaporative air) and 142 % (tactile) benefit versus negative controls (sodium fluoride/monofluorophosphate, 8 studies; p < 0.001). Compared to positive controls (potassium nitrate or arginine, 6 studies), a 22 % advantage (p = 0.036) was seen for evaporative air. In erosion studies, SnF₂ toothpastes provided an 83 % benefit versus control toothpastes (arginine or sodium fluoride; p < 0.001) with a change (95 %CI) in average surface profilometry level (μm) of -2.02(-2.85, -1.20).

CONCLUSIONS

The use of these bioavailable SnF₂ toothpastes, as part of a daily oral hygiene regimen, will provide patients with enamel erosion protection, combined with alleviation of DH pain when present, improving quality of life.

Using Laser-Doppler Flowmetry to Evaluate the Therapeutic Response in Dentin Hypersensitivity

Dentin hypersensitivity (DH) is a common medical condition with underreported prevalence and it is difficult to quantify. This study aimed to investigate whether assessing dental pulp vascular micro-dynamics by laser-Doppler flowmetry (LDF) would be functional for therapeutic evaluation, in contrast to a verbal rating scale (VRS). A split-mouth single-blind randomized study was conducted on seven patients and a total of 36 teeth. Two DH therapeutic methods were employed: (i) fluoride gel; (ii) Nd:YAG radiation combined with fluoride gel. For each tooth, five consecutive LDF determinations of pulp blood flow were made (before and immediately after desensitizing treatment, then after 24 h, 7 days, and 1 month), and the VRS was applied each time. Spearman’s correlation was applied for concurrent validation. Two-way (treatment and patient) repeated measures ANOVA full factorial was applied, followed by Tukey’s post-hoc comparisons and Pillai’s trace multivariate statistic. While VRS scores had moderate reliability, LDF could objectively estimate treatment effects. Based on partial eta-squared values, treatment and patient characteristics were estimated to explain about 84% and 50% of the variability, respectively. In conclusion, LDF is an objective technique that can quantitatively assess DH evolution, and it is effective in reliably monitoring oral health therapeutic interventions.

Clinical Efficacy of Different Dentin Desensitizers

CLINICAL RELEVANCE

Teethmate Desensitizer, Clinpro White Varnish, Shield Force Plus, and Gluma could be recommended for treating dentin hypersensitivity in terms of clinical efficacy.

SUMMARY

Objective: The aim of this study was to evaluate the clinical efficacy of widely used dentindesensitizing agents (DDAs) (Teethmate Desensitizer, Clinpro White Varnish, Shield Force Plus, and Gluma) in the treatment of dentin hypersensitivity (DH) according to different evaluation parameters over a four-week follow-up period.Methods and Materials: This study was a randomized, single-center, controlled, parallel group study involving 144 teeth in 40 subjects. The baseline DH levels of the subjects were determined using different evaluation parameters. Daily life hypersensitivity and evaporative air stimulus hypersensitivity scores were recorded using a visual analog scale (VAS), and tactile hypersensitivity scores were recorded using a Yeaple probe and measured in grams and on the VAS. Subjects who experienced evaporative air stimulus DH (30-80 mm on the VAS) and tactile hypersensitivity (10-50 g with the Yeaple probe) were included in the study. After application of the DDAs, these evaluation parameters were recorded throughout the follow-up period (immediately after application and at one day and two and four weeks post-application).Results: All four DDAs demonstrated clinical dentin-desensitizing effects throughout the follow-up period according to evaporative air hypersensitivity, tactile sensitivity (g-VAS), and daily life hypersensitivity scores (p<0.05). Only Clinpro White Varnish had tactile sensitivity (g) scores that were similar at baseline and the one-day follow-up (p>0.05). A comparison of DH-reducing effects among the DDAs revealed that they yielded different results immediately after application and at the one-day follow-up time point, depending on which evaluation parameter was used. However, all DDAs showed similar DH-reducing effects at the two- and four-week follow-up time points.Conclusions: Teethmate Desensitizer, Clinpro White Varnish, Shield Force Plus, and Gluma DH showed clinical efficacy for four weeks. DDAs may produce inconsistent clinical evaluation scores not only across different evaluation parameters but also between early and later follow-up time points.

Chemical and mechanical resistance of novel experimental hybrid coatings on dentin permeability

This study aimed to evaluate the capacity of novel experimental hybrid coatings (HC) to reduce dentin permeability and to verify their resistance to erosive and abrasive challenges. Dentin disc specimens (1 mm thick) were treated with 0.5 M EDTA solution and randomly allocated into three experimental groups (n = 10): Control (Saliva); Concentrated Hybrid Coating (TEOS/GPTMS/Y-APS); and Diluted Hybrid Coating (1:3 ratio with distilled water). Dentin permeability was assessed by hydraulic conductance in the following experimental time periods: post-EDTA, post treatment, post erosion (5 min in 0.05 M citric acid solution, pH = 3.8), and post abrasion (toothbrushing for 3,900 cycles). Dentin permeability percent was calculated with respect the values of post-EDTA for each experimental time. The morphology of the surface of extra dentin specimens was examined by scanning electron microscopy (SEM) in the same time periods (n = 3). Permeability data were analyzed by two-way repeated measures ANOVA and Tukey tests (p < .05). Both HC presented significantly lower dentin permeability than control post treatment and post erosion (p < .05), without difference between them (p > .05). Post abrasion, there were no significant difference among groups (p > .05). Post treatment and post erosion, the HC seemed to flow into the tubules, occluding them, while the tubules in control remained opened. Post abrasion, the tubules appear to be occluded in all groups. In conclusion, the experimental hybrid coatings were capable of reducing dentin permeability after treatment. They were also able to resist to erosive and abrasive challenges, with the advantage of forming thinner and colorless films that can be potentially used to treat dentin hypersensitivity.

Efficacy of nano-carbonate apatite dentifrice in relief from dentine hypersensitivity following non-surgical periodontal therapy: a randomized controlled trial

Background

Dentine hypersensitivity (DH) could occur or intensify after non-surgical periodontal therapy because of the exposure of dentine tubules, but currently no gold standard exists to treat DH. It has been demonstrated that nano-sized particles presented potential for dentine tubules blocking and remineralization. This randomized controlled trial aimed to investigate the efficacy of dentifrice containing nano-carbonate apatite (n-CAP) in reducing dentine hypersensitivity (DH) after non-surgical periodontal therapy.

Methods

48 periodontitis patients with DH were included in this clinical trial. After non-surgical periodontal therapy, patients included were randomized to test and control group and the respective dentifrices were applied at chairside, after which they were instructed to brush teeth with the allocated dentifrices twice a day at home. Periodontal parameters were recorded at baseline and the last follow-up. DH was measured by air-blast test and recorded by visual analogue scale (VAS) and Schiff sensitivity scale at baseline, after polishing (0 week) and 2/4/6 weeks.

Results

45 participants completed the follow-up. Periodontal parameters were improved and comparable between groups. Significant reduction in DH was observed in both groups at all time-points compared to baseline in terms of VAS and Schiff score. The test group achieved significantly greater relief from hypersensitivity compared with the control group after 4-week at-home use (for change of VAS, test group: 2.27 ± 2.47 versus control group: 1.68 ± 2.24, p = 0.036; for change of Schiff, test group: 0.94 ± 0.92 versus control group: 0.61 ± 0.83, p < 0.001). The 6-week results showed borderline significance between groups in terms of change of Schiff (p = 0.027) and no significance in terms of change of VAS (p = 0.256).

Conclusions

Home-use of n-CAP based dentifrice had some benefit on alleviation of DH following non-surgical periodontal therapy after 4 weeks compared to the control product.

Trial registration

Chinese Clinical Trials Registry (No. ChiCTR-IPR-17011678, http://www.chictr.org.cn/, registered 16 June, 2017).

Effectiveness of diode laser and fluoride on dentin hypersensitivity treatment: A randomized single-blinded clinical trial

BACKGROUND

This randomized single-blinded clinical trial aimed to evaluate the effectiveness of diode laser and fluoride in the treatment of dentin hypersensitivity (DH) due to gingival recession.

MATERIALS AND METHODS

Twenty-eight individuals randomly distributed across three groups participated: 10 individuals who were treated with diode laser, nine who were treated with fluoride, and nine who received placebo. Pain was assessed with the Visual analog scale (VAS). Evaporative stimulus and tactile stimulus were evaluated with the verbal rating scale (VRS). VAS was applied shortly after, 6 h after, 12 h after, and 24 h after the single-session treatment for DH, whereas VRS was applied shortly after, 15 min and 7 days after the treatment. Participants' quality of life was assessed with the validated Brazilian version of the Dentine Hypersensitivity Experience Questionnaire assessing functional limitations, coping behaviors, emotional, and social impacts caused by DH. Descriptive statistics and the ANOVA test were used. Values of P < 0.05 were statistically significant.

RESULTS

Diode laser significantly reduced the DH to the evaporative stimulus (P = 0.002). The application of fluoride did not change the degree of DH to evaporative and tactile stimuli (P > 0.05). The group of individuals who were treated with diode laser presented a higher reduction in DH (25.4%) when compared to the group of individuals treated with fluoride (17.1%), and the group of individuals among whom placebo had been used (2.9%). Descriptive analysis indicated that the items measuring the emotional and social impacts of DH were those with a more negative impact on the individuals.

CONCLUSION

Therapy with diode laser was more effective in reducing DH than therapy with fluoride.

Brazilian dentists' perception of dentin hypersensitivity management

The aim of this study was to investigate how Brazilian dentists perceive and manage dentin hypersensitivity (DH) in their clinical routine. A 13-item questionnaire-based survey was developed and sent electronically to a convenience sample of dentists. The questionnaire assessed the personal and dental practice characteristics of the sample, the occurrence of DH in their daily clinical practice, and management strategies. The data were analyzed descriptively and together with the chi-square test (a = 0.05). A total of 353 responses were obtained from September 2017 to March 2018. Of all the respondents, 62% were females, 49.9% reported fewer than five years of dental practice, and 70.5% were self-identified as private practitioners. Most of the dentists reported an estimated frequency (30-60%) of patients with DH in their practice. The most frequently cited (91.79%) trigger of DH was air blast and/or scratching with a probe. The first-choice strategy to manage DH was a dentin desensitizer (48.16%). The number of years in clinical practice did not influence DH relapse frequency (p = 0.76) significantly, or consider DH treatment as a problem (p = 0.22). The present findings indicate that, regardless of clinical experience, dentists in Brazil still consider DH management a challenge in their daily dental practice. In addition, the results suggest that guidelines should be developed to disseminate the available knowledge regarding this condition in ways that may influence decision-making processes among practitioners.

Dentin tubule obturation of a bioglass-based dentin desensitizer under repeated exposure to lactid acid and brushing

Background

Dentin hypersensitivity is a frequent finding especially in periodontitis patients. Conventional treatment aims for obstruction of dentin tubules by disabling liquid and osmotic fluctuation to and from the pulpal chamber. A novel bioglass-based desensitizer was shown to obstruct tubules and to resist periodic exposure to lactic acid. Whether this obstruction is resistant to brushing had not been tested so far. Accordingly, the present study aimed to assess dentin tubule obstruction after repeated acid exposure and brushing.

Methods

Sixty dentin discs were cleaned with 17% EDTA, mounted into a pulp fluid simulator and randomly divided into 3 groups: No surface treatment in Group A, Seal&Protect® in group B and DentinoCer in group C. Discs were exposed to 0.1 M non-saturated lactic acid thrice and standardized brushing twice a day for 12 days. At baseline and after 2, 4 and 12 d samples were removed from the setting and prepared for top-view SEM analysis to assess tubule obstruction using the Olley score. Discs were then vertically cut and the section surface morphologically assessed using backscatter imaging. For both vertical and sectional surfaces EDX analysis was used to characterize the surface composition in the tubular and inter-tubular area.

Results

Group A showed clean tubular lumina at all time points. From day 2 onwards dentin showed exposed collagen fibers. Group 2 initially showed a complete surface coverage that flattened out during treatment without ever exposing tubules. At baseline, samples of Group C displayed a complete homogeneous coverage. From day 2 on tubules entrances with obstructed lumen became visible. While on day 4 and 12 the dentin surface exposed collagen fibers the lumina remained closed. EDX analysis of the vertical and horizontal views showed that P and Ca were predominant elements in both the inter- and tubular dentin while Si peaks were found in the tubule plugs.

Conclusion

While group B displayed a packed layer on the surface during the whole investigation time group C samples lost their superficial layer within 48 h. Tubule plugs containing considerable Si proportions indicated previous presence of DentinoCer, while high Ca and P proportions suggest obturation by dentin-like material.

Effect of the casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) and photobiomodulation (PBM) on dental hypersensitivity: A randomized controlled clinical trial

Objective

This randomized controlled clinical trial aimed to evaluate the effect of the casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) and photobiomodulation (PBM) in the treatment of dentin hypersensitivity (DH), and the impact of this on the health-related quality of life (HRQL).

Methods

Eighty teeth with DH were randomized into four groups and received three treatment sessions: PLACEBO = placebo + LASER application mimicking; CPP-ACPF = CPP-ACPF + LASER application mimicking; PBM = placebo + LASER active application; CPP-ACPF+PBM = CPP-ACPF + LASER active application. Tactile (exploratory probe) and evaporative (triple syringe) stimuli were used to measure DH and were recorded with the aid of a visual analogue scale (VAS) after the 1^st, 2^nd and 3^rd treatment sessions and one-month follow-up. The HRQL was recorded in the DH experience questionnaire (DHEQ).

Results

The intragroup comparison showed a significant reduction in DH (p < 0.05) with both stimuli after one-month follow-up. The intergroup comparison with the evaporative stimulus showed that CPP-ACPF+PBM significantly reduced DH when compared to the rest of treatments, after one-month follow-up. CPP-ACPF+PBM group statistically differed from the other treatment groups in the DHEQ evaluation after one-month follow-up.

Conclusion

After one-month follow-up, the association of CPP-ACPF with PBM was effective in the reduction of DH and promoted a positive impact on the HRQL of the participants of this study.

Amyloid-Like Rapid Surface Modification for Antifouling and In-Depth Remineralization of Dentine Tubules to Treat Dental Hypersensitivity

Exposure of dentinal tubules (DTs) leads to the transmission of external stimuli within the DTs, causing dental hypersensitivity (DH). To treat DH, various desensitizers have been developed for occluding DTs. However, most desensitizers commercially available or in development are only able to seal the orifices, rather than the deep regions of the DTs, thus lacking long-term stability. Herein, it is shown that the fast amyloid-like aggregation of lysozyme (lyso) conjugated with poly(ethylene glycol) (PEG) (lyso-PEG) can afford a robust ultrathin nanofilm on the deep walls of DTs through a rapid one-step aqueous coating process (in 2 min). The resultant nanofilm provides a highly effective antifouling platform for resisting the attachment of oral bacteria such as Streptococcus mutans and induces remineralization in the DTs to seal both the orifices and depths of the DTs by forming hydroxyapatite (HAp) minerals in situ. Both in vitro and in vivo animal experiments prove that the nanofilm-coated DTs are occluded with a depth of over 60 ± 5 µ m, which is at least 6 times deeper than that reported in the literature. This approach thus demonstrates the concept that an amyloid-like proteinaceous nanofilm can offer an inexpensive, rapid, and efficient therapy for treating DH with long-term effect.

Toothpaste factors related to dentine tubule occlusion and dentine protection against erosion and abrasion

OBJECTIVES

To investigate the effect of toothpastes on dentine surface loss and tubule occlusion, and the association of toothpaste-related factors to each of the outcomes.

MATERIALS AND METHODS

One hundred and sixty human dentine specimens were randomly distributed into 10 groups, according to different toothpastes. The specimens were submitted to artificial saliva (60 min), citric acid (3 min), and brushing abrasion (25 s; totalizing 2 min in toothpaste slurries). This was repeated five times and two outcome variables were analyzed: dentine surface loss (dSL; μm) and tubule occlusion by measurement of the total area of open tubules (Area-OT; μm²). Data were analyzed with Kruskal-Wallis and Mann-Whitney tests (α = 0.05); bivariate and multivariate regressions were used to model the association of the chemical (pH, concentration of F^-, Ca²⁺, and PO₄^3- and presence of Sn²⁺) and physical (% weight of solid particles, particle size, and wettability) factors of the toothpastes to both outcome variables.

RESULTS

Toothpastes caused different degrees of dSL and did not differ in Area-OT. All chemical and physical factors, except the presence of Sn²⁺, were associated with dSL (p < 0.001). Area-OT was associated only with the presence of Sn²⁺ (p = 0.033).

CONCLUSION

Greater dSL was associated with lower pH, lower concentration of F^-, higher concentration of Ca²⁺ and PO₄^3-, greater % weight of solid particles, smaller particle size, and lesser wettability, whereas tubule occlusion was associated with the presence of Sn²⁺.

CLINICAL RELEVANCE

Depending on their chemical and physical composition, toothpastes will cause different degrees of dentine tubule occlusion and dentine surface loss. This could, in turn, modulate dentine hypersensitivity.

Three randomized studies of dentine hypersensitivity reduction after short-term SnF2 toothpaste use

Aim

To evaluate effects of a 0.454% stannous fluoride test toothpaste on dentine hypersensitivity (DH) applied by fingertip, then 3 days’ brushing, versus a sodium monofluorophosphate‐based control.

Materials and Methods

In three randomized clinical studies, DH was assessed using evaporative (Schiff scale) and tactile (Yeaple probe) stimuli. Participants applied toothpaste to two sensitive teeth by fingertip (60 s each); DH was re‐assessed, prior to brushing. Test treatment participants brushed their sensitive teeth, with all participants then brushing all teeth for ≥60 s, twice daily for 3 days. DH was re‐assessed. Data were analysed by study and then pooled.

Results

In two studies, test treatment significantly reduced DH versus control treatment after fingertip application and 3 days’ brushing (both measures). In one study, both treatments significantly reduced DH without between‐treatment differences. Mean Schiff differences (95% confidence intervals) for fingertip/3d were as follows: Study 1: −0.09 (−0.280, 0.092)/ −0.18 (−0.442, 0.072); Study 2: −0.72 (−0.839, −0.610)/ −1.02 (−1.150, −0.882); and Study 3: −0.26 (−0.387, −0.123)/ −0.92 (−1.055, −0.793). Pooled analysis indicated test treatment significantly reduced DH versus control (both timepoints, both measures). Toothpastes were generally well‐tolerated.

Conclusion

Studies indicated that single, fingertip application of a SnF₂ toothpaste reduced DH versus a control. DH relief increased over 3 days.

Randomised clinical studies investigating immediate and short-term efficacy of an occluding toothpaste in providing dentine hypersensitivity relief

BACKGROUND

Dentine hypersensitivity (DH) can occur after gum recession or enamel loss and may impact quality of life. Treatments include toothpastes that decrease DH by occluding dentine tubules. One effective occluding ingredient used in toothpastes is stannous fluoride (SnF2), but this can be unstable in aqueous formulation. These three studies aimed to characterise the short-term effects of an experimental, anhydrous SnF2 dentifrice on DH.

METHODS

Three examiner-blind, parallel-group studies evaluated DH in participants with the condition after a single brushing and after 3d brushing with an experimental anhydrous 0.454% SnF2/polyphosphate toothpaste (Test) or a toothpaste containing 0.76% sodium monofluorophosphate (Control). Test treatment participants brushed two pre-identified sensitive teeth first, then their remaining dentition for ≥1 min ('focused brushing'). Control treatment participants brushed their whole dentition for ≥1 min. DH was measured after single brushing and after 3d twice-daily use, via evaporative (air) (Schiff Sensitivity Scale) and tactile (Yeaple probe) stimuli and analysed using an ANCOVA model.

RESULTS

In all studies, after 3d treatment, the Test toothpaste/brushing regimen significantly reduced DH compared to the Control regimen by both evaporative and tactile stimuli assessment (p < 0.0001 for all). The Test regimen also significantly reduced DH from baseline at both time-points by both measures in all studies (p < 0.0001 for all). Mean Schiff sensitivity score differences (95% confidence intervals) between Test and Control regimens after 3d were: Study 1: - 0.45 (- 0.577, - 0.319); Study 2: - 0.40 (- 0.505, - 0.300); Study 3: - 1.31 (- 1.500, - 1.128). Mean tactile score differences were: Study 1: 11.30 (7.927, 14.662); Study 2: 3.57 (2.531, 4.614); Study 3: 24.54 (20.349, 28.736). After single use, in Studies 2 and 3, the Test toothpaste/brushing regimen significantly reduced DH versus Control by both measures (p < 0.001 for all); in Study 1, treatment differences were not significant. Toothpastes were generally well-tolerated.

CONCLUSIONS

Taken together, these studies indicated focused brushing with an experimental anhydrous 0.454% SnF2/polyphosphate toothpaste reduces DH compared to brushing with a conventional toothpaste after single use, with greater reduction after 3d.

TRIAL REGISTRATION

Registrations at ClinicalTrials.gov : Study 1: NCT02832375 (registered 26.July.2016); Study 2: NCT02731833 (registered 26.April.2016); Study 3: NCT02923895 (registered 5.October.2016).

A randomised controlled trial to investigate the efficacy of an oxalate strip for the management of dentine hypersensitivity pain

OBJECTIVES

To compare a 3.14% potassium oxalate strip and 8% arginine calcium carbonate toothpaste for the reduction of dentine hypersensitivity after 2 and 4 weeks.

METHODS

This was an examiner-blind, parallel study in 80 healthy adults with dentine hypersensitivity (Schiff score >2) in >1 tooth. After acclimatisation, participants were randomised to the oxalate desensitising strip with fluoride toothpaste or the arginine desensitising toothpaste control which also contained fluoride. Products were applied under supervision of study staff after measuring baseline sensitivity, thereafter the strip or control toothpaste (fingertip application) was applied after 1 and 2 weeks, and teeth brushed twice-daily with the fluoride (test group) or the fluoridated arginine control toothpaste. Sensitivity was assessed following airblast (Schiff and VAS) and tactile stimuli (Yeaple probe) at baseline, 2 and 4 weeks.

RESULTS

Both groups showed significant reductions from baseline in VAS, Schiff and Yeaple sensitivity scores after 2 and 4 weeks (p < 0.0005). The oxalate group had significantly lower Schiff and higher Yeaple probe scores compared to control after both time points (p < 0.0002 and p < 0.05), but while scores favoured the oxalate group, there were no significant differences in VAS.

CONCLUSIONS

This study demonstrated application of a 3.14% potassium oxalate strip combined with toothbrushing with paste was more effective in pain management of dentine hypersensitivity than brushing with arginine toothpaste.

CLINICAL SIGNIFICANCE

Treatment of sensitive teeth with the oxalate strip reduced dentine hypersensitivity after 2 and 4 weeks to a significantly greater degree than a positive control sensitivity toothpaste demonstrating that oxalate strips are an effective targeted treatment for dentine hypersensitivity sufferers.

Dental Pain: Dentine Sensitivity, Hypersensitivity and Cracked Tooth Syndrome

Dentine hypersensitivity is a frequently encountered patient complaint that can present with a number of associated factors including erosion and abrasion. the hydrodynamic mechanism responsible for dentine hypersensitivity is intimately related to the anatomical and physiological composition of teeth. Alterations to the integrity of the enamel and dentine through processes of trauma, decay and toothwear can increase dentine permeability. This gives rise to symptoms of sensitivity as dentinal fluid movement in response to thermal, chemical and mechanical cues stimulate the pulpal Aδ fibres. Restorative procedures can also rapidly change the architecture of the protective enamel and dentine layers leading to pulpal inflammation and increased thermal sensitivity of the tooth.<br/> Patient-reported symptoms of dentine hypersensitivity can be attributed to a number of possible causes and a definitive diagnosis can therefore be difficult. A full history including social and medical factors such as occupation, diet and/or medication is likely to provide significant information to aid a diagnosis. Consideration of occlusal factors should not be overlooked as these may contribute to symptoms arising from a cracked tooth.<br/> Management strategies are linked to the diagnosis - from topically applied desensitising pastes and resin bonding agents to direct restorations and possibly more advanced restorative procedures such as root canal treatment. Management should, however, be staged to enable more conservative strategies to prevail prior to considering irreversible dental interventions.

In Vitro Effect of Innovative Desensitizing Agents on Dentin Tubule Occlusion and Erosive Wear

Purpose:

The purpose of this study was to evaluate the effects of four in-office desensitizing products on dentin tubule occlusion and erosive wear.

Methods:

Dentin hypersensitivity was simulated by EDTA application for five minutes. The specimens were randomly allocated into five groups (n=11), according to treatment: No treatment - Control (C), Duraphat (DUR), Desensibilize Nano P (NP), ClinPro XT Varnish (XTV), and ClinPro White Varnish (CWV). They were then submitted to erosive/abrasive cycling for five days. After EDTA, treatment, and cycling, the specimens were analyzed with an environmental scanning electron microscope (ESEM) to verify the number of opened dentin tubules (ODT) which were counted by using ImageJ software, and with a profilometer to determine the surface curvature/loss. ESEM data were analyzed with two-way repeated measure analysis of variance and Tukey tests. For the profilometer, data were analyzed with Kruskal-Wallis, Tukey, and Mann-Whitney tests.

Results:

After treatment, all groups showed lower ODT than the control, without significant differences between them. After cycling, the only group that showed lower ODT than the control was group XTV; however, it did not significantly differ from the other groups. For the profilometric analysis, there were significant differences in SL between the experimental times after treatment and after cycling for all groups (p&lt;0.05). After cycling, no surface loss was detected in groups DUR and XTV, which presented a significantly different curvature than group NP and the control group, but not from group CWV. Surface loss was detected for the control and groups NP and CWV, without difference among them.

Conclusion:

All desensitizing agents tested presented promising results concerning the obliteration of dentin tubules immediately after treatment. XTV was the only desensitizer capable of preventing the reopening of the tubules after the erosive/abrasive challenges. XTV and DUR presented a protective effect against dentin erosive wear.

Plaque control and reduction of gingivitis: The evidence for dentifrices

This paper focuses on plaque control and the management of gingivitis in adults and summarizes the evidence of commercially available dentifrices as gathered from existing systematic reviews. Three internet sources were used to search for appropriate papers (up to and including February 2017). The search strategy was designed to include any systematic review published on dentifrices that also included an evaluation of plaque and gingivitis scores. Characteristics of the individual reviews, such as methodological aspects, quantitative data and conclusions, were extracted. The potential risk of bias was estimated and the acquired evidence was graded. Independent screening of 205 unique reviews resulted in 10 published and eligible systematic reviews. One publication evaluated the mechanical contribution of dentifrice to plaque removal. Eight papers were identified that evaluated the efficacy of a proposed single active ingredients, of which two reviewed more than one potentially active ingredient. One study compared two active ingredients. This meta-review appraised the current state of evidence and found that toothbrushing with a standard fluoride dentifrice does not provide an added effect for the mechanical removal of dental plaque. Evidence suggests that compared with a standard dentifrice, those containing triclosan or stannous fluoride have benefits with respect to gingival health and control of dental plaque.

Efficacy Comparison of Nd:YAG laser, diode laser and dentine bonding agent in dentine hypersensitivity reduction: a clinical trial

Purpose

Dentin hypersensitivity is characterized by short, sharp pain arising from exposed dentin in response to external stimuli. Several modalities have been suggested for treatment of this condition such as low-level laser therapy (LLLT) and application of dentin bonding agents. The aim of this study was to compare the clinical efficacy of diode laser, Nd:YAG laser and dentin bonding agent for treatment of dentin hypersensitivity.

Materials and Methods

In this study, 135 teeth of 22 patients diagnosed with dentin hypersensitivity were divided into three groups: In group 1, the teeth were irradiated by diode laser with 810 nm wavelength for 30 seconds and in group 2, the teeth were irradiated by Nd:YAG laser with 1064 nm wavelength for 40 seconds. CLEARFIL SE BOND was applied on teeth in group 3. LLLT was carried out in 3 sessions with 7-day intervals between sessions, during a period of 3 consecutive weeks. Hypersensitivity was assessed by cold test according to the criteria proposed by Uchida at baseline, immediately after treatment and at 1, 3 and 6 months, postoperatively.

Results

Reduction of dentin hypersensitivity was observed at 3 and 6 months following the use of Nd:YAG laser (p < 0.001). Reduction in dentin hypersensitivity was observed immediately after treatment in all groups. Statistically significant differences in level of dentin hypersensitivity were found between groups at 3 and at 6 months (p ≤ 0.001). The reduction in dentin hypersensitivity by Nd:YAG laser was significantly superior to that in other groups at this time.

Conclusion

The efficacy of Nd:YAG laser in reduction of dentin hypersensitivity was significantly superior to that of other modalities at 3 and 6 months.

The Effectiveness of Remineralizing Agents on Dentinal Permeability

The effectiveness of remineralizing agents in reducing dentine permeability by tubule occlusion using fluid filtration device functioning at 100 cmH₂O (1.4 psi) pressure and SEM/EDX analysis were evaluated and compared. Seventy (n = 70) dentine discs of 1±0.2 mm width were prepared from sound permanent human molars. Fifty (n = 50) dentine discs were randomly divided into 5 groups (n = 10): Group 1: GC Tooth Mousse Plus (Recaldent GC Corporation Tokyo, Japan), Group 2: Clinpro™ White Varnish (3M ESPE, USA), Group 3: Duraphat® Varnish (Pharbil Waltrop GmbH, Germany), Group 4: Colgate Sensitive Pro-Relief™ dentifrice (Colgate Palmolive, Thailand), and Group 5: Biodentine™ (Septodont/UK). Dentine permeability was measured after treatment application at 10 minutes, artificial saliva immersion at 7 days, and citric acid challenge for 3 minutes. Data were analyzed by two-way repeated measures ANOVA. Dentine specimens (n = 20) were used for SEM/EDX analyses to obtain qualitative results on dentine morphology and surface deposits. Each treatment agent significantly reduced dentine permeability immediately after treatment application and created precipitates on treated dentine surfaces. All agents increased permeability values after 7 days of artificial saliva immersion except Clinpro White Varnish and Biodentine. Clinpro White Varnish exhibited significant resistance to acid challenge compared to others. Colgate Sensitive Pro-Relief dentifrice has a dual mechanism of action in reducing the dentine sensitivity.

Influence of the Extended Use of Desensitizing Toothpastes on Dentin Bonding, Microhardness and Roughness

The aim of this study was to evaluate the influence of an extended use of desensitizing toothpastes (DTs) on dentin bonding, microhardness and roughness. One hundred and twenty bovine incisor teeth were randomly divided into four groups: G1, distilled water (WATER); G2, Colgate Total 12 (CT12); G3, Colgate Sensitive Pro-Relief (CSPR); and G4, Sensodyne Repair ?αμπ; Protect (SRP). Dentin surfaces were etched with 17% EDTA and 2 years of simulated tooth brushing (20,000 cycles) was performed on their surfaces. Knoop microhardness, surface roughness and scanning electron microscopy (SEM) were performed before and after the simulated tooth brushing. For microshear bonding test, a 2-step self-etching adhesive system (Clearfil SE Bond) was used and 0.8 mm diameter composite resin (Filtek Z350 XT) cylinders were built. Microshear test was performed with an orthodontic wire and with a crosshead speed of 0.5 mm/min. The data were analyzed for: 1) bond strength (one-way ANOVA), 2) microhardness intra-group (Student's test) and inter-group (one-way ANOVA/Tukey's test) comparisons, 3) roughness intra-group (Student's test/Wilcoxon's test) and inter-group (Kruskal-Wallis/Student-Newman-Keuls test) comparisons. The extended use of both dentifrices (conventional and for sensitive teeth) did not affect the bond strength and produced a significant increase in microhardness and roughness of the dentin, except for the microhardness of the SRP group. The simulated tooth brushing technique with water produced an increase in roughness, without reducing significantly the dentin microhardness.

Effectiveness of Desensitizing Dentifrice and Mouthwash on Dentin Hypersensitivity and Tooth Remineralization

Background:

Over many years, numerous products have been suggested for the relief of dentin hypersensitivity (DH). Calcium sodium phosphosilicate is one desensitizing agent that has remineralizing potential. Available in toothpaste and mouthwash delivery vehicle, this study was carried out to compare the effectiveness on dentinal hypersensitivity (using the Airblast test and Cold test) and on tooth remineralization (using DIAGNOdent pen) in a 4-week period.

Materials and Methods:

Out of the 45 patients screened, 28 patients who fulfilled the inclusion criteria and who willingly signed the consent form were selected and were randomly allocated into two groups – toothpaste and mouthwash. The tooth numbers and specific site of dentinal hypersensitivity for every patient were noted and the air blast test, cold test, and DIAGNOdent scores were recorded at baseline visit. The patients were instructed about the use of the product and were asked to come on the 30^th day for re-evaluation.

Results:

Within-group comparison showed a significant reduction (P < 0.05) in the air blast score (toothpaste – 68.53% and mouth rinse – 48.52%), cold test score (toothpaste – 56.38% and mouth rinse – 38.87%), and DIAGNOdent score (toothpaste – 20.35% and mouth rinse – 9.49%). In-between group comparison showed no statistically significant difference (P > 0.05).

Conclusion:

Desensitizing mouthwash is as effective as toothpaste in reducing DH with a fair remineralization potential comparable with that of the toothpaste.