The Prevalence of Root Sensitivity following Periodontal Therapy: A Systematic Review

Periodontitis is associated with decreased experimental pressure pain tolerance: The Tromsø Study 2015-2016

AIM

To assess the relationship between periodontitis and experimental pain tolerance.

MATERIALS AND METHODS

Participants from the population-based seventh survey of the Tromsø Study with data on periodontitis were included (n = 3666, 40-84 years old, 51.6% women). Pain tolerance was assessed through (i) pressure pain tolerance (PPT) test with a computerized cuff pressure algometry on the leg, and (ii) cold-pressor tolerance (CPT) test where one hand was placed in circulating 3°C water. Cox proportional hazard regression was used to assess the association between periodontitis and pain tolerance adjusted for age, sex, education, smoking and obesity.

RESULTS

In the fully adjusted model using the 2012 Centers for Disease Control/American Academy of Periodntology case definitions for surveillance of periodontitis, moderate (hazard ratio [HR] = 1.09; 95% confidence interval [CI]: 1.01, 1.18) and severe (HR = 1.25, 95% CI: 1.11, 1.42) periodontitis were associated with decreased PPT. Using the 2018 classification of periodontitis, having Stage II/III/IV periodontitis was significantly associated with decreased PPT (HR = 1.09; 95% CI: 1.01, 1.18) compared with having no or stage I periodontitis. There were no significant associations between periodontitis and CPT in fully adjusted models.

CONCLUSIONS

Moderate and severe periodontitis was associated with experimental PPT.

Bioactive glass and arginine dentifrices reduce root sensitivity during daily activities following non-surgical periodontal therapy: A randomized controlled trial

BACKGROUND

Evidence on the efficacy of calcium sodium phosphosilicate (CSPS) and arginine dentifrices on reducing root sensitivity (RS) following non-surgical periodontal therapy (NSPT) is limited. The aim of this study was to compare the efficacy of these dentifrices in reducing RS during daily activities in patients undergoing NSPT.

METHODS

Using a double-blind randomized controlled trial, CSPS, arginine, or control dentifrices were randomly assigned to 45 RS individuals following NSPT. The participants used the dentifrices 2×/day for 8 weeks. A self-reported visual analog scale (VAS) was assessed during daily activities.

RESULTS

Self-reported VAS scores were similar among the three groups at each time point. The with-in group analysis revealed that the arginine dentifrice reduced RS from Week 1-8 compared with baseline in response to cold. Similarly, the CSPS dentifrice reduced RS at Week 4 and 8. The CSPS and arginine dentifrices exhibited RS relief resulting from toothbrushing starting at Week 4 and 2, respectively. In response to air, RS relief was observed from Week 4 in the arginine group. The number of patients with VAS > 2 in response to cold declined at Week 2 and 4 in the CSPS and arginine groups, respectively. In response to toothbrushing, only 10% in the test groups still had RS at Week 8. In response to air, the number of RS patients only in the arginine group decreased at Week 4.

CONCLUSION

The CSPS and arginine dentifrices provided comparable RS relief during daily activities within 2-4 weeks and remained effective up to 8 weeks.

Dentists' education, knowledge, and professional behavior concerning the diagnosis and treatment of dentin hypersensitivity: An exploration

OBJECTIVES

Dentin hypersensitivity (DH) affects patients' oral health-related quality of life, but is not always optimally treated in dental offices. The objectives were to assess dentists' DH-related education, knowledge, and professional behavior and explore relationships between education, knowledge, and behavior.

METHODS

Survey data were collected from 220 ADA members in the United States. Descriptive and correlational analyses were performed.

RESULTS

About half of the respondents agreed/strongly agreed that their dental school had educated them well about diagnosing DH in classroom-based (53.6%) and clinical settings (48.9%). Lower percentages agreed being well educated about treating DH (40.9%/37.3%). The majority self-educated themselves about DH after dental school by attending continuing education courses in person or online (60.6%/36.8%), reading articles (64.1%), or consulting with colleagues (59.6%). The majority knew that patients with DH describe their pain as stimulated (91.4%) and that recessed gingiva (89.6%), abrasion lesions (72.3%), tooth whitening (63.1%), erosion lesions (58.6%), and abfraction lesions (51.4%) are risk factors for DH. The majority diagnosed DH with patient self-reporting, confirmed by exams (81.8%), applying air blasts (53.7%), or cold-water (52.3%). They treated patients with DH often/very often with over-the-counter desensitizing agents (90%), and prescribing fluoride formulations toothpaste (82.8%) and/or potassium nitrate toothpastes (60.9%). In their offices, the majority (73.2%) educated their patients often/very often about DH and used fluoride dental varnish for treating DH (71.8%). The more recently respondents had graduated from dental school, the more positively they described their dental school education (r = 0.14; p < 0.05), the more ways to diagnose DH they used (r = 0.16; p < 0.05) and the more often they used fluoride dental varnish in their offices (r = 0.23; p < 0.001). The more dentists had educated themselves, the more methods for diagnosing DH they used (r = 0.23; p < 0.001) and the more often they used potassium oxalate products (r = 0.19; p < 0.01), Arginine/calcium products (r = 0.19; p < 0.01) and dentin bonding (r = 0.22; p < 0.001).

CONCLUSIONS

More recently graduating from dental school correlates with more positive evaluations of DH-related dental school education. The finding that most dentists engage in self-education about DH after dental school should motivate dental educators to increase education about this topic not only in dental school, but also in continuing education courses.

Effect of bioactive glasses used as dentin desensitizers on the dentin-pulp complex in rats

Bioactive glasses have been recommended for the occlusion of dentinal tubules in treating cervical dentin hypersensitivity. This study evaluates an in vivo model of dentin exposure, and tests the efficacy of bioglass treatments. Thirty male Wistar rats received gingival recession surgery on the upper left first molar. The treatments were applied over the surface of the exposed dentin every 4 days for 28 days. The groups were as follows: Naive; Gingival recession; Cavity varnish; Biosilicate^®; Strontium bioglass; and Potassium bioglass. Changes in the dentin-pulp complex, and the presence of substance P, were evaluated through hematoxylin-eosin and immunohistochemical staining. The groups had similar results. Teeth with exposed dentinal tubules in rats showed a typical pattern in the dentin-pulp complex and immunotracing for substance P. The materials did not cause pulp damage. The effects of gingival recession and open dentinal tubules on pulp tissue require further clarification.

ISP Good Clinical Practice Recommendations for the management of Dentin Hypersensitivity

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

Sequential Application of Calcium Phosphate and ε-Polylysine Show Antibacterial and Dentin Tubule Occluding Effects In Vitro

In this study, ε-polylysine and calcium phosphate precipitation (CPP) methods were employed to induce antibacterial effects and dentin tubule occlusion. Antibacterial effects of ε-polylysine were evaluated with broth dilution assay against P. gingivalis. CPP solution from MCPM, DCPD, and TTCP was prepared. Four concentrations of ε-polylysine(ε-PL) solutions (0.125%, 0.25%, 0.5%, 1%) were prepared. Dentin discs were prepared from recently extracted human third molars. Dentin discs were incubated with P. gingivalis (ATCC 33277) bacterial suspension (ca. 10⁵ bacteria) containing Brain Heart Infusion medium supplemented with 0.1 g/mL Vitamin K, 0.5 mg/mL hemin, 0.4 g/mL L-cysteine in anaerobic jars (37 °C) for 7 days to allow for biofilm formation. P. g–infected dentin specimens were randomly divided into four groups: CPP + 0.125% ε-PL, CPP + 0.25% ε-PL, CPP + 0.5% ε-PL, CPP + 1% ε-PL. On each dentin specimen, CPP solution was applied followed by polylysine solution with microbrush and immersed in artificial saliva. Precipitate formation, antibacterial effects, and occlusion of dentinal tubules were characterized in vitro over up to 72 h using scanning electron microscopy. ε-PL showed 34.97% to 61.19% growth inhibition levels against P. gingivalis (P. g) after 24 h of incubation. On P. g-infected dentin specimens, DCPD + 0.25% ε-PL, and DCPD + 0.5% ε-PL groups showed complete bacterial inhibition and 78.6% and 98.1% dentin tubule occlusion, respectively (p < 0.001). The longitudinal analysis on fractured dentin samples in DCPD and TTCP groups revealed deeply penetrated hydroxyapatite-like crystal formations in dentinal tubules after 72 h of incubation in artificial saliva.

Efficacy of erythritol powder air-polishing in active and supportive periodontal therapy: A systematic review and meta-analysis

OBJECTIVE

This systematic review aimed to analyse available evidence to answer two focused questions about the efficacy of erythritol powder air-polishing (EPAP) (i) as an adjunctive during active periodontal therapy (APT) and (ii) as an alternative to hand/ultrasonic instrumentation during supportive periodontal therapy (SPT). Additionally, microbiological outcomes and patient's comfort/perceptions were assessed as secondary outcomes.

METHODS

PubMed, Cochrane and Medline were searched for relevant articles published before February 2021 following PRISMA guidelines. The search was conducted by three independent reviewers, and the agreement was measured by Cohen's kappa score. Out of 1043 articles, eight randomized clinical trials were selected for systematic review and quantitative synthesis. Only periodontal parameters, such as clinical attachment level (CAL), probing pocket depth (PPD) and bleeding on probing (BoP), showed homogeneity and, thus, were selected for meta-analysis.

RESULTS

The improvement in PPD and BoP scores after using EPAP was comparable with hand/ultrasonic instrumentation during both APT and SPT. Significant CAL gain was achieved with EPAP during APT (0.16 mm, p < 0.02) compared with hand/ultrasonic instrumentation at the end point, whereas non-significant CAL gain was achieved during SPT. No differences were observed regarding microbiological outcomes between the two treatment modalities. However, EPAP inflicted less pain and was better perceived by the patients.

CONCLUSION

Erythritol powder air-polishing can substitute hand/ultrasonic instrumentation for SPT, and CAL gain is significantly improved when EPAP is used as an adjunct during APT. For microbiological outcomes, no significant differences were observed between the two approaches; however, EPAP was better tolerated by the patients than hand/ultrasonic instrumentation.

CLINICAL RELEVANCE

Erythritol powder air-polishing can be used as an adjunct during APT and as an alternative to conventional mechanical debridement during SPT.

A novel biofilm removal approach (Guided Biofilm Therapy) utilizing erythritol air-polishing and ultrasonic piezo instrumentation: A randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of biofilm removal of a treatment protocol combining an air-abrasive device using erythritol powder (AIRFLOW®) and an ultrasonic piezon instrumentation (Guided Biofilm Therapy/GBT) compared with the conventional mechanical approach (Scaling and Root Planing/SRP) during supportive periodontal treatment (SPT).

MATERIALS AND METHODS

Fifty patients, scheduled for supportive periodontal treatment at the Department of Preventive Dentistry, Periodontology and Implant Biology of the Aristotle University of Thessaloniki were randomly assigned to either a GBT (group A: 24 participants) or a SRP (Group B: 26 participants) treatment protocol. Therapeutic interventions and clinical measurements were performed at baseline and repeated at 6 weeks. Oral hygiene instructions were reinforced at each visit. A questionnaire was handed to the participants for evaluation of patient perception of both utilized approaches.

RESULTS

At 6 weeks, the two groups showed statistically significant reduction in plaque score and in gingival bleeding index compared with baseline. GBT required approximately 15% less chair-time than SRP with a mean difference of 5.1 min, which was statically significant (p = 0.049). Patient perception was more favourable for GBT than SRP.

CONCLUSIONS

Biofilm removal using erythritol AIRFLOW® and ultrasonic piezo-electric instruments (GBT) can be considered equally efficient compared with the conventional SRP. Moreover, GBT seemed to require shorter treatment time and to exhibit a more favourable patient perception than the conventional approach.

Bioactive glass and arginine dentifrices immediately relieved dentine hypersensitivity following non-surgical periodontal therapy: A randomized controlled trial

BACKGROUND

There is no report concerning calcium sodium phosphosilicate (CSPS) and arginine dentifrices in reducing dentine hypersensitivity (DH) in patients undergoing non-surgical periodontal therapy. The aim of the study was to compare the efficacy of a dentifrice containing bioactive glass, 5% CSPS, and 8% arginine dentifrice in relieving DH in patients undergoing non-surgical therapy.

METHODS

Using a double-blind randomized controlled trial, 45 volunteers with DH following non-surgical therapy were immediately applied with one of three dentifrices containing: 5% CSPS, 8% arginine, or control on DH teeth. The participants then continued to brush twice daily for 8 weeks. DH was assessed using the Schiff cold air sensitivity scale and tactile tests at baseline, immediately after application, and up to 8 weeks.

RESULTS

The Schiff analysis revealed that the CSPS dentifrice significantly reduced DH immediately and declined through week 8. The arginine group demonstrated reduced DH through week 2. In contrast, DH reduction in the control began later at week 1. The visual analog scale analysis demonstrated that only CSPS had a significantly reduced percentage DH at the immediate, 2, 4, and 8 weeks compared with the baseline. The percentage of patients with DH (Schiff score ≥2) in the CSPS and arginine groups reduced to ≈ 50% after the in-office application. The number of DH patients treated with CSPS then decreased to 9% at the 2-week evaluation.

CONCLUSION

The CSPS and arginine dentifrices were beneficial in reducing periodontitis patient's discomfort, immediately and in the first 2 weeks following non-surgical periodontal therapy.

A 12-month randomized controlled trial evaluating erythritol air-polishing versus curette/ultrasonic debridement of mandibular furcations in supportive periodontal therapy

Background

Due to complex morphology and limited access, the cleaning of the furcation area is extremely challenging. Therefore, novel therapeutic approaches need to be tested to potentially overcome debridement limitations. The aim of the present prospective 12-month study was to compare clinical and microbiological effects following erythritol air-polishing versus conventional mechanical debridement of furcation defects in a cohort of periodontal maintenance patients.

Methods

Twenty patients with grade II mandibular molar furcation defects volunteered to enroll in this single-centre, examiner masked, randomized controlled trial. In a split-mouth study design, two furcation sites in each patient were randomly assigned to either receive subgingival debridement using erythritol air-polishing (test) or conventional ultrasonic/curette debridement (control) at baseline, and at 3, 6, 9 and 12 months. Probing depth, clinical attachment level and bleeding on probing were recorded at 3-month intervals. Subgingival microbiological samples obtained at baseline, 6 and 12 months were analyzed using checkerboard DNA–DNA hybridization. Discomfort from treatment was scored at 12 months using a visual analogue scale. The differences between treatments, and time-points, were tested using multilevel analysis (mixed effect models and robust variance estimates).

Results

A significant reduction in probing depth took place following both treatments (p < 0.001). Control sites experienced a significant mean gain in clinical attachment level of 0.5 mm (± 0.2) (p = 0.004), whereas a non-significant gain of 0.4 mm (± 0.3) was observed at test sites (p = 0.119). At 6 months, a significant between-treatment difference of 0.8 mm (± 0.4) was observed in favor of the control (p = 0.032). No significant between-treatment differences were observed in microbial load or composition. Notably, at 12 months patients experienced significantly less discomfort following air-polishing compared with control (p = 0.001).

Conclusions

The 12-month observations indicate that erythritol air-polishing and conventional mechanical debridement both support clinical improvements. A significant between-treatment difference in clinical attachment level was, however, detected in favour of control debridement at 6 months. In terms of patient comfort, erythritol air-polishing is superior.

Trial Registration: The clinical trial was retrospectively registered in ClinicalTrial.gov with registration NCT04493398 (07/28/2020).

Bioactive glass versus Arginine dentifrices on the reduction of dentin permeability and acid tolerance

Objectives

To compare the efficacy of calcium sodium phosphosilicate (CSPS) and arginine dentifrices on dentin permeability and acid tolerance.

Material and Methods

Sixty dentin discs were randomly assigned into 3 groups, then brushed for 1 min with CSPS, arginine, or fluoride (control) dentifrices. To test acid tolerance, each disc was soaked in 6% citric acid for 1 min. Dentin permeability was measured before, following brushing, and acid challenge. Ten discs per group were similarly treated and evaluated for tubule occlusion following a single dentifrice application, while other five discs per group were employed in an acid tolerance assay.

Results

The percentage reduction in dentin permeability was 39.26%, 32.27%, and 21.71% in the arginine, CSPS, and control groups, respectively. The differences in dentin permeability reduction between the arginine and CSPS groups following brushing and acid challenge were not significant (p = 0.398 and p = 0.211, respectively). The arginine dentifrice demonstrated a significant reduction in permeability compared with the control (p = 0.011). In addition, the occlusion exhibited by the arginine and CSPS dentifrices was more resistant to acid challenge compared with that of the control (p < 0.001). From SEM analysis, dentinal tubule occlusion was observed after a single application in all groups. Some open dentinal tubules were detected in the test groups, while almost all of the orifices were open in the fluoride group following acid challenge.

Conclusions

There is no significant difference between arginine and CSPS dentifrices in reducing dentin permeability following a single application and acid challenge. Following acid challenge, the reduced permeability generated by arginine and CSPS was more stable compared with the fluoride dentifrice.

Effect of desensitizing agents on dentin hypersensitivity after non-surgical periodontal therapy: A systematic review and meta-analysis

OBJECTIVE

To investigate the effectiveness of desensitizing agents (DA) on dentin hypersensitivity (DH) after non-surgical periodontal treatment (NSPT) through a systematic review and meta-analysis.

DATA

The PICO strategy was used to include randomized clinical trials in human subjects with DH (P) after NSPT treated with DA (I) compared to those treated with placebo or control (C) to identify DH relief (O). The Cochrane guidelines and GRADE was used to classify the risk of bias and the quality of the evidence, respectively.

SOURCES

PubMed, Web of Science, Scopus, Lilacs, Cochrane Library databases, and OpenGrey were searched on the 20^th of May 2020.

STUDY SELECTION

Nine studies were included in the quantitative synthesis. Five meta-analyses were performed. Three meta-analyzes assessed the effectiveness of DA compared to a placebo or control in relation to pain assessment stimuli and two meta-analyzes assessed the mechanism of action of DA. For the mechanical stimulus in overall analysis, the control group presented a higher mean of pain reduction (SMD 1.03 [0.73, 1.32], p < 0.001) with very low certainty of evidence. For water (SMD -0.78 [-1.22, -0.35], p = 0.0009) and evaporative in overall analysis (SMD -1.21 [-1.79, -0.64], p < 0.001) stimuli, the DA decreased DH pain with very low and low certainty of evidence, respectively.

CONCLUSION

Due to the limited quality of evidence, there is no definitive conclusion on the effectiveness of DA on DH after NSPT. Thus, further clinical studies with a low risk of bias and high-quality evidence are encouraged to reinforce the certainty of evidence on that issue.

CLINICAL SIGNIFICANCE

The use of desensitizing agents show promise for relief of dentin hypersensitivity after non-surgical periodontal therapy.

Air polishing with erythritol powder - In vitro effects on dentin loss

Context:

Low-abrasive polishing powders such as glycine (GLY) or erythritol (ERY) are used for subgingival air polishing. GLY was reported to possibly affect the dentin surface, while this is unclear for ERY.

Aims:

This in vitro study aimed to evaluate the substance loss from the dentin surface by air polishing with ERY at different settings for pressure (PR), distance (DI), and angulation of the spray jet to the surface (AJ).

Materials and Methods:

The in vitro testing was performed on smooth human root dentin surfaces. In 18 groups with 10 specimens each, ERY was applied with constant water supply for 5 s without moving the handpiece at the following settings: PR minimum (min), medium (med), and maximum (max); DI at 1, 3, and 5 mm; and 45° or 90° AJ. The substance loss was measured as defect depth (DD) using three-dimensional (3D)-laser profilometry. ANOVA with Bonferroni correction and α = 0.05 were used for statistical analysis.

Results:

The DD was statistically significantly higher at a DI of 1 mm compared to a DI of 5 mm for the respective groups of the same PR and AJ (P < 0.05). For DI 1 mm, max PR, and AJ 90°, the maximum loss of substance amounted DD of 117 ± 43 μm. The minimal loss of substance occurred at minimal PR, 45° AJ, and a DI of 5 mm (15 μm × 20 μm). DD related directly with the parameters PR and AJ and inversely with DI. The highest influence on DD was proven for DI.

Conclusions:

Slight loss of dentin might occur during air polishing with ERY depending on DI, PR and AJ. The setting influences the amount of dentin loss.

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).

Patients' perception of their oral and periodontal health and its impact: a cross-sectional study in the NHS

Aims To determine patient awareness of periodontal health, dentine hypersensitivity and tooth wear, and their impact on oral health quality of life in patients attending NHS practices in South West England.Method In this cross-sectional, multi-centre epidemiological study 814 adult NHS patients completed an oral health questionnaire and then underwent a clinical examination. Pocket probing depths (mm), gingival recession (mm), gingival bleeding (yes/no), dentine hypersensitivity (Schiff score, and yes/no) and tooth wear (basic erosive wear examination score) were measured.Results Participants were regular dental attenders, with good oral hygiene practices and a low prevalence of periodontal disease (probing depth of 4 mm or more) (25%). For all conditions assessed, self-reported data and clinical indices were significantly positively associated, with the strongest associations being seen for dentine hypersensitivity and the weakest for tooth wear. Periodontal disease and dentine hypersensitivity were significantly associated with all four patient-reported measures of oral health quality of life studied.Conclusion This NHS patient population is well cared for and educated with respect to their oral health. The findings confirm the negative impact of periodontal disease and dentine hypersensitivity, and identifies the need to increase awareness of the signs and symptoms of tooth wear.

Oral status and aesthetics after nonsurgical periodontal treatment: Do patient's perception and dentist's evaluation agree?

Objectives

Periodontal healing is often accompanied by side effects, which may cause an aesthetic deficit. The present investigation was focussed to compare patient's subjective perception of their posttherapy aesthetics with the objective measures of the results.

Materials and methods

Survey results from patients (subjective parameters) on oral status and aesthetics were compared against routine clinical parameters and corresponding survey results from treating dentists (objective parameters), both before and after periodontal treatment. Subjective outcome parameters were then suitably transformed and compared with the objective ones to investigate the agreement between patients' perception and actual outcomes.

Results

Objective recordings of periodontal status by the dentist and subjective awareness of the patient are quite contradictory to each other for almost all participants. Further, it was found that their aesthetics in the front were better after treatment, but dentist professionals targeted for future treatment needs.

Conclusions

In this study, it was found that patients improved aesthetically on the upper jaw front after the therapy, which was not shared by the dentists. This discrepancy was due to the clinicians' view on more aesthetic corrective procedures than on patients' need.

A Survey of Dentists in the Management of Dentine Hypersensitivity: A Questionnaire-based Study

Objective Previous studies have indicated that dentists may be uncertain about the etiology, diagnosis, and effective management of dentine sensitivity/dentine hypersensitivity (DH) . The purpose of the present study was to evaluate the knowledge and understanding of Greece-based dental professionals in treating DH .

Materials and Methods A 26-item questionnaire was sent to a representative sample of Greek dentists.

Results Two hundred thirty questionnaires were originally provided to the participants and of the 210 questionnaires that were returned, 191 questionnaires (90 M; 86 F; mean age 36.26 years [standard deviation: 11.34]) were included for analysis, a response rate of 83% was observed. 39.8% of dentists indicated that 1 in 10 of their patients experienced discomfort from DH with 76.4% of dentists indicating that their patients initiated the conversation on DH. In contrast, 44% of the dentists indicated that they initiated the relevant conversation. 34.9% of dentists indicated that the duration of discomfort lasted up to 3 weeks and 76.4% indicated that DH had an impact on their patients’ quality of life. Incorrect tooth brushing was considered to be a major etiological factor (68.6%) with “air blast” (37.3%) and “probing” (15%) as the main methods for identification. 83.6% of dentists indicated that they were confident in recommending over-the-counter products for home use.

Conclusion The results of this study suggest that in terms of knowledge and understanding of DH, there is still confusion concerning some aspects of the diagnosis and management of the condition.

Grit blasted aggregates of hydroxyl apatite functionalized calcium carbonate in occluding dentinal tubules

Objectives

This study aimed to investigate the effects of using hydroxyl apatite functionalized calcium carbonate (FCC) particles on occluding dentinal tubules.

Methods

Dentine specimens extracted from eighteen human molars with exposed dentinal tubules were divided into three groups (n = 6/group): a) Cut surface with smear layer; b) EDTA (smear layer removed with 17% EDTA for 1 min); and c) Grit blasted functionalized calcium carbonate (FCC) with and air pressure of 280 kPa. Microscopic dentinal tubule occlusion, tubule diameter and tubule area were evaluated using scanning electron microscopy (SEM) before and after grit blasting. Biomineralization of specimens was carried out in a simulated body fluid (SBF). Elemental analysis of occluding materials was carried out using energy-dispersive X-ray spectroscopy (EDX). X-ray diffraction (XRD) analysis was performed to demonstrate the crystal structure of the biomineralized layer on dentine.

Results

FCC particles showed penetration into the dentinal tubules by breakage of their original particle shape and size. EDTA treated surface had higher number and larger size tubules than those with smear layer or grit blasted (p < 0.005). SEM-EDX analysis revealed mineral precipitation of calcium phosphate on the SBF immersed dentin specimens. XRD analysis showed typical crystal structure of hydroxyl apatite for the biomineralized surface layer on dentine.

Conclusions

Grit blasted FCC particles initially occluded effectively the opened dentinal tubules and biomineralization occurred in tubules primarily occluded by the FCC particles. However, in the optimal in vitro conditions in SBF, no difference between biomineralization was found between the grit blasted surface and the control surface.

Clinical significance

Several materials and methods have been established for treatment of dentinal hypersensitivity although a golden standard treatment has not been discovered. Grit blasted functionalized calcium carbonate has a potential to occlude and remineralize exposed dentinal tubules. This could offer a more biological approach on treatment of dentin hypersensitivity.

Comparison between 940 nm Laser Diode and Topical 5 % Potassium Nitrate for Tooth Desensitization. Randomized Controlled Clinical trial

Purpose: To compare the effectiveness of two dental desensitization therapies, 940 nm laser diode and potassium nitrate, in patients with dental hypersensitivity (DH) symptoms. Methods: This randomized clinical trial included 30 patients who initially underwent basic periodontal therapy and presented gingival recessions Class I and II (Miller 1985) with symptoms of DH. Subjects were randomly assigned into two groups. The first group (n = 15) received laser 940 nm application for 90 seconds on the surface of the recession and were given a tube of glycerin to be applied daily in order to avoid generating bias. Patients in the second group (n = 15) were exposed to inactive laser simulating the actual application of the laser, and they were given a desensitizing gel containing 0.5 g of potassium nitrate to be applied twice daily during 14 days. Controls were carried out at 15 minutes, 8 days, 15 days, and 4 weeks. Data obtained were filled out in an Excel table. For comparison between groups the Mann Whitney U and t student tests were used (p=0.05). Results: All patients involve in the study experienced reduction in DH (p<0.01) and differences   between the two interventions performed. Conclusions:  Laser and nitrate therapies were effective to manage DH after basic periodontal therapy. However, a statistically significant higher  sensitivity reduction was observed in laser therapy group.

Evaluation of diode laser and stannous fluoride in the treatment of root sensitivity after access flap surgery: Randomized controlled clinical trial

Background:

Postsurgical root sensitivity has always been an enigma to the periodontists. There is a plethora of evidence suggesting the presence of root sensitivity following periodontal flap surgical procedures. Thus, the aim of the present study was to compare and evaluate the effect of low-power diode lasers with and without topical application of stannous fluoride (SnF₂) gel in the treatment of root sensitivity and also evaluate whether laser creates any placebo effect in the control group or not.

Materials and Methods:

Thirty patients participated in this study and 99 teeth were included. Root sensitivity was assessed for all groups with a Verbal Rating Scale (VRS). For each patient, the teeth were randomized into three groups. In the test Group I, sensitive teeth were treated with SnF₂ and diode laser. In the test Group II, sensitive teeth were irradiated with laser only. In the control group, no treatment was performed.

Results:

The mean ± standard deviation (SD) score for VRS and Visual Analog Scale at baseline was not statistically significant (P > 0.05) between the three groups. After 15 min, statistical significant difference was seen in test Group I and test Group II, although no difference was found in the control group. At 15^th day and 30^th day, the mean ± SD scores were statistically significant (P < 0.05).

Conclusion:

Within the limitations of the study, it can be concluded that diode lasers alone and in combination with 0.4% SnF₂ was effective in the treatment of root sensitivity after access flap surgery.

Efficacy of Milk as a Desensitizing Agent for the Treatment of Sensitivity Following Scaling and Root Planing

Background:

Dentine hypersensitivity (DH) is the most common problem encountered by most of the dentists in their day-to-day clinical practice. It is characterized by a sharp pain or discomfort arising as a response to thermal, chemical, or osmotic stimuli and is caused due to exposure of dentine after the enamel or cementum at the root surface has been lost by the treatment, underlying dental and gingival diseases or physiologic wear and tear of the teeth. This further complicates preventive oral hygiene procedures by the patients, which jeopardize periodontal treatment or may as well aid in periodontal treatment failure.

Aim and Objective:

To evaluate the efficacy of commercially available milk as a desensitizing agent for the treatment of sensitivity following scaling and root planing.

Materials and Methods:

Patients were selected randomly for scaling and then assessed for sensitivity. Those patients having DH were divided into two groups, wherein the Group A (test) patients were advised to rinse with commercially available milk at room temperature and those in Group B (control) with a commercially available mouthwash (Sentosil-SF). A four-point verbal rating scale was designed to record the numerical value of DH and were recalled for follow-up on 4^th, 7^th, and 10^th day posttreatment.

Results:

The study demonstrated that there was a considerable reduction in hypersensitivity in both the groups on the 7^th and 10^th day. In the milk group, eight patients showed a complete reduction in hypersensitivity on 7^th day and 13 patients on 10^th day, while in the mouthwash group, five patients showed the same on 7^th day and ten patients on the 10^th day, thus suggesting that more individuals in the milk group were benefited. However, there was no statistically significant difference between the groups in every visit.

Conclusion:

Although there is a vast literature available which suggests the efficacy of commercially available mouthwash in reducing hypersensitivity, this study is the first of its kind which evaluates the efficacy of commercially available milk in reducing sensitivity which is induced postscaling. Considering that milk rinse is cheap and easily available at home, it can be used as a desensitizing agent, and rinsing with milk for few days is effective and stable in quick reduction of hypersensitivity induced by scaling.

Comparing the effect of a desensitizing material and a self-etch adhesive on dentin sensitivity after periodontal surgery: a randomized clinical trial

Objectives

This double-blind randomized placebo-controlled clinical trial evaluated the ability of a desensitizing agent and a self-etch adhesive on cervical dentin sensitivity (CDS) after periodontal surgery.

Materials and Methods

Ninety hypersensitive teeth of 13 subjects were included in the study. After periodontal surgery, the teeth of each posterior sextant treated with one of the following materials: G1: Clearfil S³ Bond (Kuraray Dental), G2: Gluma Desensitizer (Heraeus Kulzer), and G3: placebo (water). The sensitivity was assessed using evaporative stimuli before treatment (baseline, T0), 1 day after treatment (T1), after 1 week (T2), and after 1 month (T3) according to visual analog scale (VAS).

Results

Following the treatment, all the 3 groups showed significant reduction of CDS in T1 compared to T0. Reduction of CDS between T1 and T2 was observed only in G1 but there was no significant difference between T2 and T3 in this group. Although we observed a significant difference in T3 compared to T1 and T2 in G2 and G3, comparison of treatment groups in each assessment time showed a significant difference only in T3. According to paired comparison, this was due to the difference between G2 and G3.

Conclusions

Dentin sensitivity following periodontal surgery will decrease spontaneously over time, but treating the sensitive teeth with Gluma Desensitizer and Clearfil S³ Bond can have some benefits.

Pain perception during debridement of hypersensitive teeth elicited by two ultrasonic scalers

OBJECTIVES

The ultrasonic NO PAIN technology (Electro Medical Systems, Nyon, CH) promises minimal pain during debridement due to linear oscillating action combined with a sinusoidal power output and feedback control. The aim of the present study was to measure pain perception on a visual analogue scale (VAS) during supportive periodontal therapy including debridement of hypersensitive teeth. Two ultrasonic scalers were used, one with and one without NO PAIN technology.

MATERIAL AND METHODS

In a randomized-controlled clinical study with split-mouth design, 100 hypersensitive teeth matched for air blast hypersensitivity were either treated with the ultrasonic device Piezon Master 700 or the Mini Piezon (both EMS, Nyon, CH). Pain perception during debridement was assessed by a VAS (range 0-10).

RESULTS

The average VAS for the test device Piezon Master 700 with NO PAIN technology was 3.16 ± 2.10, and for the control device Mini Piezon without NO PAIN technology 3.40 ± 2.59 (p = 0.490). Placing an arbitrary threshold at the VAS score of 3 for significant pain experience, 60 % of the subjects experienced no significant pain with either instrument.

CONCLUSION

No statistically significant difference in perceived pain between the instruments used was found.

CLINICAL RELEVANCE

Both ultrasonic devices showed very small pain intensities during debridement of highly hypersensitive teeth and can therefore be recommended for supportive periodontal therapy.

Dentine sensitivity risk factors: A case-control study

Objective:

To identify the clinical and psychological risk factors associated with dentine hypersensitivity (DH) in order to provide an early diagnosis and preventive therapy.

Materials and Methods:

A nested case–control study was design between 2011 and 2012. A total of 61 DH cases and 122 controls participated in this investigation. Cases and controls were matched for sex, group of age and socioeconomic status in a ratio of 1:2. DH to different stimuli such as cold, heat, acid, and sweet was asked in patient interviews, and dental examinations were used to detect DH. Clinical and psychological risk factors such as dental hygiene, periodontal disease, acid diet, alcohol consumption, psychological stress, and psychopathological symptoms were inquired. Psychological stress was measured through the PSS-10 and psychopathological symptoms were evaluated by SCL-90-R in Spanish. Descriptive and univariate binary logistic regression analysis were performed to estimate the association between clinical and psychological risk factors and the presence of DH.

Results:

Toothpaste abrasivity (odds ratio [OR] 1.881, 95% confidence interval [CI] 1.010–3.502, P = 0.045), gingival recession (OR 2.196, 95% CI 1.020–4.728, P = 0.041), and periodontal therapy (OR 5.357, 95% CI 2.051–13.993, P < 0.001) were associated with DH. Subjects with perceived stress (OR 1.211, 95%, CI 0.518–2.833, P = 0.658), obsessive-compulsive (OR 1.266, 95%, CI 0.494–3.240, P = 0.623) and hostility (OR 1.235, 95%, CI 0.507–3.007, P = 0.642) symptoms had a clinical greater odd of DH.

Conclusion:

Oral hygiene products and periodontal conditions are important risk factors for DH. Individuals with perceived stress, obsessive-compulsive, and hostility symptoms may increase a clinical risk for this entity. Targeting to dental counseling focused on oral hygiene products, periodontal therapy and a psychological evaluation may be promising in DH prevention.

Milk as Desensitizing Agent for Treatment of Dentine Hypersensitivity Following Periodontal Treatment Procedures

BACKGROUND

Dentinal hypersensitivity is a commonly observed problem after periodontal treatment procedures in periodontal patients. This further complicates preventive oral hygiene procedures by patients which jeopardize periodontal treatment, or even may aid in periodontal treatment failure.

AIMS AND OBJECTIVES

The aims and objectives of present study were to assess the problem of dentine hypersensitivity after non-surgical periodontal treatment and selection of cases for evaluation of commercially available milk at room temperature as mouth rinse for the treatment of dentinal hypersensitivity caused by periodontal treatment.

MATERIALS AND METHODS

Patients were selected randomly for nonsurgical periodontal treatment and then were assessed for dentine hypersensitivity. Those having dentine hypersensitivity were assigned in two groups. Group one patients were advised to rinse with commercially available milk at room temperature, group two patients were advised to rinse with luke warm water as control. A four point Verbal Rating Score (VRS) was designed to record the numerical value of dentine hypersensitivity.

RESULTS

The results show incidence of 42.5% and prevalence of 77.5% for dentine hypersensitivity after periodontal treatment procedures. After rinsing with milk following periodontal treatment procedures, there was found a significant reduction of dentine hypersensitivity with probability by unpaired t-test as 0.0007 and 0.0001 at tenth and fifteenth day post periodontal treatment procedures respectively.

CONCLUSION

This study demonstrated that the milk rinse is a suitable, cheaper, fast acting, home-use and easily available solution to the problem of dentine hypersensitivity after non-surgical periodontal treatment. Milk can be used as desensitizing agent and rinsing with milk for few days is effective in quick reduction of dentine hypersensitivity due to periodontal treatment procedures.

Prevalence of dentinal hypersensitivity and study of associated factors: a cross-sectional study based on the general dental population of Davangere, Karnataka, India

BACKGROUND

Dentin hypersensitivity (DH) is a common clinical finding with a wide variation in prevalence and aetiological factors. The aim of this cross-sectional study was to determine the prevalence and examine some associated aetiological factors of DH in a study of an Indian population residing in and around Davangere district of Karnataka.

MATERIAL AND METHODS

A total of 404 patients (3,859 teeth) were examined for the presence of DH by means of a questionnaire and intraoral tests (air and tactile stimuli). Plaque, gingival recession, abrasion/erosion, labioversion and toothbrushing habits were noted.

RESULTS

A total of 795 teeth, in 404 patients, were diagnosed as having DH, giving an overall prevalence figure for DH of 20.6%. The chi-square test and the Z-test values for proportions were used to evaluate statistical correlations. The 36-45 years' age group was the cohort with the highest number of subjects with DH, and female subjects had greater predilection for DH compared with male subjects. Incisors were the tooth type most affected. DH was significantly correlated with gingival recession, labioversion and abrasion/erosion (P<0.05). Both gingival recession and abrasion/erosion were significantly correlated with brushing once daily in a horizontal direction and use of a toothbrush with medium-hardness bristles (P<0.05).

CONCLUSION

The prevalence of DH in the Indian population is 20.6%, with a higher predilection for DH in the age cohort 36-45 years and in female subjects. DH is a multifactorial entity with several aetiological factors, making its diagnosis and treatment a challenge for the clinician.

Desensitizing Agent Reduces Dentin Hypersensitivity During Ultrasonic Scaling: A Pilot Study

BACKGROUND

Dentin hypersensitivity can interfere with optimal periodontal care by dentists and patients. The pain associated with dentin hypersensitivity during ultrasonic scaling is intolerable for patient and interferes with the procedure, particularly during supportive periodontal therapy (SPT) for patients with gingival recession.

AIM

This study proposed to evaluate the desensitizing effect of the oxalic acid agent on pain caused by dentin hypersensitivity during ultrasonic scaling.

MATERIALS AND METHODS

This study involved 12 patients who were incorporated in SPT program and complained of dentin hypersensitivity during ultrasonic scaling. We examined the availability of the oxalic acid agent to compare the degree of pain during ultrasonic scaling with or without the application of the dentin hypersensitivity agent. Evaluation of effects on dentin hypersensitivity was determined by a questionnaire and visual analog scale (VAS) pain scores after ultrasonic scaling. The statistical analysis was performed using the paired Student t-test and Spearman rank correlation coefficient.

RESULTS

The desensitizing agent reduced the mean VAS pain score from 69.33 ± 16.02 at baseline to 26.08 ± 27.99 after application. The questionnaire revealed that >80% patients were satisfied and requested the application of the desensitizing agent for future ultrasonic scaling sessions.

CONCLUSION

This study shows that the application of the oxalic acid agent considerably reduces pain associated with dentin hypersensitivity experienced during ultrasonic scaling. This pain control treatment may improve patient participation and treatment efficiency.

The Efficacy of Selected Desensitizing OTC Products: A Systematic Review

Objectives. The aim of the present study was to review the published literature in order to identify relevant studies for inclusion and to determine whether there was any evidence on the clinical effectiveness of selected desensitizing toothpastes, calcium sodium phosphosilicate (CSPS), amorphous calcium phosphate (ACP), nanohydroxyapatite, and casein phosphopeptide-amorphous calcium phosphate (tooth mousse) on reducing dentine hypersensitivity (DH). Materials and Methods. Following a review of 593 papers identified from searching both electronic databases (PUBMED) and hand searching of relevant written journals, only 5 papers were accepted for inclusion. Results. Analysis of the included studies (3 CSPS and 2 ACP) would suggest that there may be some benefit for patients using these products for reducing DH. No direct comparative studies were available to assess all these products under the same conditions neither were there any comparative randomised controlled studies that compared at least two of these products in determining their effectiveness in treating DH. Conclusions. Due to the small number of included studies, there are limited clinical data to support any claims of clinical efficacy of these OTC products. Further studies are therefore required to determine the efficacy of these products in well-controlled RCT studies with a larger sample size.