Dentin hypersensitivity: Recent trends in management

[Dentin hypersensitivity and its treatment]

A dentin-túlérzékenység előfordulása napjainkban már szinte minden embert érint élete folyamán. A különböző ingerek – mint például a hideg, a meleg, az ozmotikus hatás – heves fájdalommal járhatnak, amennyiben a fog külső szerkezete, a zománc-, illetve a cementréteg megsérül, vagy a zománc–cement határ anatómiailag szabad dentinfelszínt idéz elő. A fájdalom a fogszuvasodáshoz és annak következményes betegségeihez hasonló tüneteket válthat ki, így a páciens számára nem egyértelmű, hogy mi is okozza a fájdalmát. A dentin-túlérzékenység megállapítása a gyakorló fogorvos feladata. A kiváltó okok megelőzése, a már fennálló probléma megoldása a mai modern kezelési lehetőségek ismerete nélkül nem valósulhat meg. Összefoglaló tanulmányunk ismerteti a dentin-túlérzékenység okait, hatásmechanizmusát és a lehetséges terápiás megoldásokat. Orv Hetil. 2024; 165(44): 1723–1727.

Automated monitoring of tooth wear progression using AI on intraoral scans

OBJECTIVES

This study aimed to develop and evaluate a fully automated method for visualizing and measuring tooth wear progression using pairs of intraoral scans (IOSs) in comparison with a manual protocol.

METHODS

Eight patients with severe tooth wear progression were retrospectively included, with IOSs taken at baseline and 1-year, 3-year, and 5-year follow-ups. For alignment, the automated method segmented the arch into separate teeth in the IOSs. Tooth pair registration selected tooth surfaces that were likely unaffected by tooth wear and performed point set registration on the selected surfaces. Maximum tooth profile losses from baseline to each follow-up were determined based on signed distances using the manual 3D Wear Analysis (3DWA) protocol and the automated method. The automated method was evaluated against the 3DWA protocol by comparing tooth segmentations with the Dice-Sørensen coefficient (DSC) and intersection over union (IoU). The tooth profile loss measurements were compared with regression and Bland-Altman plots. Additionally, the relationship between the time interval and the measurement differences between the two methods was shown.

RESULTS

The automated method completed within two minutes. It was very effective for tooth instance segmentation (826 teeth, DSC = 0.947, IoU = 0.907), and a correlation of 0.932 was observed for agreement on tooth profile loss measurements (516 tooth pairs, mean difference = 0.021mm, 95% confidence interval = [-0.085, 0.138]). The variability in measurement differences increased for larger time intervals.

CONCLUSIONS

The proposed automated method for monitoring tooth wear progression was faster and not clinically significantly different in accuracy compared to a manual protocol for full-arch IOSs.

CLINICAL SIGNIFICANCE

General practitioners and patients can benefit from the visualization of tooth wear, allowing quantifiable and standardized decisions concerning therapy requirements of worn teeth. The proposed method for tooth wear monitoring decreased the time required to less than two minutes compared with the manual approach, which took at least two hours.

Efficacy and Durability of Two Desensitizing Agents on Dentinal Tubule Occlusion: An In Vitro Study

BACKGROUND

Dentin hypersensitivity (DH) is a common condition caused by exposed dentinal tubules, often requiring treatment with desensitizing agents. This in vitro study conducted at Narayana Dental College and Hospital (Nellore, AP, IND) between January 2022 and March 2022, aimed to evaluate the effectiveness of two desensitizing agents, SDI Riva Star (SDI Ltd., Bayswater, VIC, AUS) and Gluma Desensitizer (Kulzer, Hanau, DEU) in occluding dentinal tubules and their long-term durability following simulated brushing.

MATERIALS AND METHODS

Fifty maxillary premolar specimens were sectioned and treated with 17% ethylenediamine tetraacetic acid (EDTA) to expose dentinal tubules. They were divided into three groups: (I) a control group, (II) SDI Riva Star, and (III) Gluma Desensitizer. Tubule occlusion was assessed using scanning electron microscopy (SEM) immediately after application and after one month of brushing.

RESULTS

Both test agents occluded the dentinal tubules effectively (SEM score 1), with no significant difference between SDI Riva Star and Gluma Desensitizer immediately post-application. However, after 30 days of brushing, SDI Riva Star demonstrated superior durability, with significantly better occlusion scores than Gluma Desensitizer (p<0.01).

CONCLUSION

Both SDI Riva Star and Gluma Desensitizer were effective in occluding dentinal tubules, but SDI Riva Star showed greater durability over time, making it a more effective option for long-term desensitization.

Evaluation of Fluoride and Silver Ion Concentrations in e-Silver Diamine Fluoride and Advantage Arrest: An Ion Chromatography and Atomic Absorption Spectrometer Study

Aims and background

Dentin hypersensitivity (DH) is characterized by sharp shooting pain due to exposed dentin, and the most common method for treating this pain is the occlusion of the dentinal tubules with the help of desensitizing agents. E-silver diamine fluoride (e-SDF) (Kids-e-Dental, Mumbai, India) is a commercially available 38% SDF solution in the Indian market. Despite the fact that its application for caries prevention has been proven, the fluoride (Fl) and silver (Ag) ion concentrations of e-SDF for use in treating DH have yet to be standardized. The aim of this study is to determine and compare the Fl and Ag ion concentrations released from two commercially available 38% silver diamine fluoride (SDF) solutions.

Materials and methods

The two most common commercially available 38% SDF solution brands, namely Advantage Arrest and e-SDF were used. Two drops of each of these solutions were taken in three beakers and diluted with distilled water. The Fl ion concentration was evaluated using a calibrated ion-specific electrode. The free Ag ion concentration was assessed using an atomic absorption spectrometry (AAS).

Results

Release of Ag ions shows that on days 1, 2, 5, 6, and 7, concentration (mg/L) was higher in the Advantage Arrest group but is statistically nonsignificant. On days 3 and 4, it is higher in an e-SDF group with a t-value of 1.085 and 0.243 and is statistically nonsignificant. Release of Fl ion showed that in comparison to the baseline, it was more with Advantage Arrest on days 2, 4, and 7 with a t-value of -3.766, -0.999, and 0.347 and on day 2 was statistically significant. On days 3, 5, and 6 Fl ion release from baseline was more with e-SDF in comparison with Advantage Arrest but statistically insignificant.

Conclusion

The AAS analysis as well as the ion chromatography showed that the Ag and Fl ion release respectively on days 1-7 from e-SDF was similar to the one seen in the case of Advantage Arrest.

Clinical significance

This helps dentists choose among different brands of the same commercially available 38% SDF solutions depending on the cost and availability of the product.

How to cite this article

Kamath P, Kamath P, P AN, et al. Evaluation of Fluoride and Silver Ion Concentrations in e-Silver Diamine Fluoride and Advantage Arrest: An Ion Chromatography and Atomic Absorption Spectrometer Study. Int J Clin Pediatr Dent 2024;17(10):1141-1145.

Comparative Gene Signature of Nociceptors Innervating Mouse Molar Teeth, Cranial Meninges, and Cornea

BACKGROUND

The trigeminal ganglion (TG) collects afferent sensory information from various tissues. Recent large-scale RNA sequencing of neurons of the TG and dorsal root ganglion has revealed a variety of functionally distinct neuronal subpopulations, but organ-specific information is lacking.

METHODS

To link transcriptomic and tissue-specific information, we labeled small-diameter neurons of 3 specific subpopulations of the TG by local application of lipophilic carbocyanine dyes to their innervation site in the dental pulp, cornea, and meninges (dura mater). We then collected mRNA-sequencing data from fluorescent neurons. Differentially expressed genes (DEGs) were analyzed and subjected to downstream gene set enrichment analysis (GSEA), and ion channel profiling was performed.

RESULTS

A total of 10,903 genes were mapped to the mouse genome (>500 reads). DEG analysis revealed 18 and 81 genes with differential expression (log 2 fold change > 2, Padj < .05) in primary afferent neurons innervating the dental pulp (dental primary afferent neurons [DPAN]) compared to those innervating the meninges (meningeal primary afferent neurons [MPAN]) and the cornea (corneal primary afferent neurons [CPAN]). We found 250 and 292 genes differentially expressed in MPAN as compared to DPAN and to CPAN, and 21 and 12 in CPAN as compared to DPAN and MPAN. Scn2b had the highest log 2 fold change when comparing DPAN versus MPAN and Mmp12 was the most prominent DEG when comparing DPAN versus CPAN and, CPAN versus MPAN. GSEA revealed genes of the immune and mitochondrial oxidative phosphorylation system for the DPAN versus MPAN comparison, cilium- and ribosome-related genes for the CPAN versus DPAN comparison, and respirasome, immune cell- and ribosome-related gene sets for the CPAN versus MPAN comparison. DEG analysis for ion channels revealed no significant differences between the neurons set except for the sodium voltage-gated channel beta subunit 2, Scn2b . However, in each tissue a few ion channels turned up with robust number of reads. In DPAN, these were Cacna1b , Trpv2 , Cnga4 , Hcn1 , and Hcn3 , in CPAN Trpa1 , Trpv1 , Cacna1a , and Kcnk13 and in MPAN Trpv2 and Scn11a .

CONCLUSIONS

Our study uncovers previously unknown differences in gene expression between sensory neuron subpopulations from the dental pulp, cornea, and dura mater and provides the basis for functional studies, including the investigation of ion channel function and their suitability as targets for tissue-specific analgesia.

Effects of Propolis-Based Herbal Toothpaste on Dentine Hypersensitivity

INTRODUCTION

The objective of this in vitro study was to compare the effectiveness of a propolis-based herbal toothpaste with 5% sodium fluoride varnishin obstructing human dentinal tubules; Scanning electron microscopy was utilised to obtain quantitative and qulitative data on tubular obstruction.

METHODS

Thirty-nine extracted human premolar teeth were collected. The cementum layer was removed using a water-cooled diamond bur and the smear layer using ethylenediaminetetraacetic acid (EDTA) 17%. Then, the samples were randomly divided into 3 groups (n = 13 each), as follows: group 1: dentin discs exposed to the propolis-based herbal toothpaste (Herbex); group 2: dentin discs exposed to 5% sodium fluoride varnish; and group 3: control. Then, all discs were observed and imaged in 4 non-overlapping fields by an electron microscope at 2000× magnification. The topography and number of open, closed, and semi-closed tubules were counted in all images. The data were analysed using Kruskal-Wallis test, Mann-Whitney U test, and Friedman test. The statistical analysis was performed with SPSS statistic 22.0 software, with a significance level of α = 0.05.

RESULTS

In pairwise comparisons of the groups considering the percentage of open, closed, and semi-closed tubules, the difference was not statistically significant between the 5% sodium fluoride varnish and propolis groups in the closed and semi-closed tubules, but it was statistically significant with the control group. Additionally, the percentage of open tubules in the propolis-based herbal toothpaste group was significantly lower than in the 5% sodium fluoride varnish and control group.

CONCLUSIONS

Both propolis-based herbal toothpaste and 5% sodium fluoride varnish is effective in blocking human dentin tubules to various extents.

Comparative Evaluation of Er: YAG Laser, Diode Laser, and Novamin Technology for Dentinal Tubule Occlusion: An In-Vitro Scanning Electron Microscope (SEM) and Energy Dispersive X-Ray Analysis (EDX) Study

BACKGROUND

Dentinal hypersensitivity is a brief and painful oral condition that is characterized by an abrupt shooting sensation. Stimulation occurs when hot, cold, sweet, or sour food comes into contact with exposed dentinal tubules. The present study used a scanning electron microscope (SEM) and energy dispersive X-ray analysis (EDX) to investigate the efficacy of Er: YAG, 810 nm diode LASER, and NovaMin Technology in obstructing dentinal tubules.

MATERIAL AND METHODS

We extracted the outer layers of 30 human teeth to expose the tubules and then treated the surfaces with 17% ethylenediaminetetraacetic acid (EDTA) to create an etched effect. Three cohorts were created from the portions. Group A was subjected to the application of Erbium:Yttrium-Aluminum-Garnet (Er: YAG) laser with a power output of 2W in the non-contact mode for 1 minute. Group B was subjected to the application of an 810nm diode laser with a power output of 1W in continuous mode for 30 seconds. Group C was subjected to the application of NovaMin paste, which contains a 927 ppm fluoride content. Following the therapy, occluded dentinal tubules were analyzed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) for both quantitative and qualitative examination. The data analysis was conducted using a one-way analysis of variance (ANOVA) and Tukey's test, with a significance threshold of 0.05.

RESULTS

The average percentages of complete blockage of dentinal tubules in Groups A, B, and C were evaluated using the number of entirely unobstructed dentinal tubules at magnifications of 2000X (F = 3.05, p = 0.064), 5000X (F = 5.33, p = 0.011), and 10000X (F = 8.63, p = 0.001). The count of partially open dentinal tubules seen at magnifications of 2000X, 5000X, and 10000X was F = 10.15 (P < 0.001), F = 5.97 (p = 0.007), and F = 2.12 (p = 0.140) accordingly.

CONCLUSION

NovaMin technology has demonstrated more effectiveness in blocking dentinal tubules compared to 810nm diodes and Er: YAG lasers.

Effect of desensitizing agents on the resin bond strength to sound dentin

This study aimed to evaluate the effect of dentin hypersensitivity treatments on immediate and long-term shear bond strength (SBS) of composite restorations. Ninety non-carious extracted human molars were cut to expose dentin, which was embedded in acrylic resin, and randomly divided into three groups (n = 30/group) according to surface treatment: 1) no treatment (C and C*; control); 2) silver diamine fluoride with potassium iodide (SDF/KI and SDF/KI*; Riva Star); and 3) nano-hydroxyapatite (nHAp and nHAp*; PrevDent). The specimens were etched through the etch-and-rinse technique, followed by universal adhesive application and resin composite cylinders (2.38 mm in diameter × 3.5 mm high). The SBS was tested immediately (24 h after the restoration) and after thermocycling (*) (5000 cycles, 5 °C to 55 °C) at a 0.5 mm/min crosshead speed using a universal testing machine. A stereomicroscope was used to evaluate the mode of failure, and representative scanning electron microscopy (SEM) images were also acquired. Data normality was verified, and two-way ANOVA and Tukey's post hoc tests were performed for multiple comparisons (α = 0.05). The control group presented the highest SBS (27.10 MPa), while SDF/KI* had the lowest values (6.87 MPa). nHAp-based desensitizer exhibited higher SBS than SDF/KI for both immediate (22.6 MPa) and thermocycled (19.03 MPa) conditions. No intragroup difference was evidenced between immediate and thermocycled samples for any group. Most specimens for the C and nHAp groups presented mixed failure, while the SDF/KI groups presented comparable adhesive and mixed failures. The SBS of adhesive restorations after the application of desensitizing agents is material dependent, where SDF/KI reduces SBS values below the acceptable minimum bond strength, while the nHAp application meets the minimally required bond strength.

Efficacy of a stannous fluoride dentifrice for relieving dentinal hypersensitivity in Chinese population: an 8-week randomized clinical trial

OBJECTIVES

To compare the effectiveness of using a 0.454% stannous fluoride-containing dentifrice twice daily in relieving dentinal hypersensitivity (DH) in a Chinese population.

MATERIALS AND METHODS

This was a single-centre, randomized, controlled, examiner-blind, three-treatment-arm, parallel-group study in participants with clinically diagnosed DH. Subjects who met inclusion criteria (n = 197) were randomly allocated into 3 groups: test group (n = 66)-using a 0.454% stannous fluoride-containing dentifrice twice daily; positive control group (n = 64)-using a 5.0% calcium sodium phosphosilicate-containing dentifrice twice daily; negative control group (n = 67)-using a 1150 ppm of NaF dentifrice twice daily. Status of DH was assessed at week 4 and week 8 by the same independent examiner. Changes from baseline in Schiff sensitivity score, tactile threshold and Dentine Hypersensitivity Experience Questionnaire (DHEQ) score were analysed using analysis of covariance models. The DHEQ evaluated subject-perceived oral health-related quality of life (OHRQoL).

RESULTS

Statistically significant improvements in mean Schiff scores (p < 0.0001 for all products at Weeks 4 and 8), tactile threshold (p < 0.0001 for test and negative control at Weeks 4 and 8: Week 4 p = 0.0040 and Week 8 p < 0.0001 for positive control) and all DHEQ scores (p < 0.01 for all groups) were observed. No statistically significant differences were observed in the adjusted mean between all dentifrices at both timepoints, potentially driven by a placebo effect. Forty-two treatment-emergent adverse events (TEAEs) were reported (n = 32 subjects), with 2 serious AEs (n = 1) in the test group. TEAEs were not considered treatment-related.

CONCLUSIONS

All groups demonstrated statistically significant improvements in Schiff score, tactile threshold and OHRQoL. However, due to a possible placebo effect in the negative control, there were no statistically significant differences between the dentifrices.

CLINICAL RELEVANCE

This study adds to the growing research exploring why the placebo effect is a common phenomenon in DH studies.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04950465.

The Synergistic Effect of Ozonated Oil and Desensitising Toothpaste on Dentinal Tubule Occlusion: An In Vitro Study

Introduction Dentin hypersensitivity (DH) is the most common problem encountered by clinicians. It can be managed either by blocking neural activities or by occluding tubules. Ozonated oil facilitates the simple passage of desensitizing agents into dentinal tubules. Aim This study aimed to evaluate the effect of ozonated oil on dentinal tubule occlusion before and after the application of desensitizing toothpaste. Materials and methods The study was carried out in Kalinga Institute of Dental Sciences, KIIT (Deemed to be University), Bhubaneswar, India. The sample size of the study was 80. The first group contained specimens for control. The second group comprised specimens treated with ozonated oil. The third group comprised specimens being treated with a desensitizing agent. The fourth group contained specimens treated with both the desensitizing agent and ozonated oil. The specimens then received an acid challenge. The specimens were observed under a scanning electron microscope (SEM) before any therapy, after the application of the therapeutic agents and after the 37.5% ortho-phosphoric acid challenge. Results Inferential statistics to compare between the groups was calculated using one-way analysis of variance (ANOVA) statistics. Post-hoc Tukey's honestly significant difference (HSD) was performed to compare the groups. The mean scores of the partial tubular occlusion of Group 1, Group 2, Group 3 and Group 4 before the acid challenge were 0.035, 0.691, 0.564 and 0.368, respectively. The maximum score was obtained in the case of Group 2, which was statistically significant. The mean scores for partial tubule occlusion after the acid challenge for Group 1, Group 2, Group 3 and Group 4 were 0.055, 0.531, 0.733 and 0.142, respectively. There was evidence of maximum partial tubule occlusion after the acid treatment in the case of Group 3. The mean scores of Group 1, Group 2, Group 3 and Group 4 before the acid challenge were 0.019, 0.309, 0.442 and 0.609, respectively. The maximum score was obtained in the case of Group 4, implying a greater number of total tubular occlusions before the acid challenge. The mean scores of the total tubular occlusions after the acid challenge for Group 1, Group 2, Group 3 and Group 4 were 0.047, 0.465, 0.272 and 0.890, respectively. There was evidence of maximum tubule occlusion in the case of Group 4, which was statistically significant. Conclusion Overall, the application of a desensitizing toothpaste with ozonated oil holds promise as a potentially more effective treatment approach for DH. Further research and clinical studies may be needed to fully validate its efficacy and safety in dental practice.

Reinforced dentin remineralization via a novel dual-affinity peptide

OBJECTIVES

In light of the constantly flowing saliva, anti-caries remineralization agents are inclined to be taken away. Owing to their limited residence time, the remineralization effect is not as desirable as expected. Hence, our study aimed to synthesize a novel peptide (DGP) with high affinity to both collagen fibrils and hydroxyapatite, and investigated its dentin remineralization efficacy in vitro and anti-caries capability in vivo.

METHODS

DGP was synthesized through Fmoc solid-phase reaction. The binding ability and interaction mechanism of DGP to demineralized dentin were investigated. Dentin specimens were demineralized, then treated with DGP and deionized water respectively. The specimens were incubated in artificial saliva and in-vitro remineralization effectiveness was analyzed after 14 days. The rat caries model was established to further scrutinize the in-vivo efficacy of caries prevention.

RESULTS

DGP possesses an enhanced adhesion force of 12.29 ± 1.12 nN to demineralized dentin. The favorable adsorption capacity is ascribed to the stable hydrogen bonds between S2P-101 and ASP-100 of DGP and GLY33 and PRO-16 of collagen fibers. Abundant mineral deposits and remarkable tubule occlusion were observed in the DGP group. DGP-treated dentin obtained notable microhardness recovery and higher mineral content after a 14-day remineralization regimen. DGP also demonstrated potent caries prevention in vivo, with substantially fewer carious lesions and significantly lower Keyes scoring.

SIGNIFICANCE

DGP proves to possess a high affinity to demineralized dentin regardless of saliva flowing, thus enhancing remineralization potency significantly in vitro and in vivo, potential for dental caries prevention and combatting initial dentin caries clinically.

Evaluation of the Efficacy of LASER, Desensitizing Agents, and their Combined Effect on Dentinal Hypersensitivity in Bicuspids: In Vitro Study

Aim

This study aimed to know the potential of diode light amplification by stimulated emission of radiation (LASER) and desensitizing agents on blocking the dentinal tubules, which may further help in reducing the most common dental problem named dentinal hypersensitivity (DH).

Materials and Methods

Sixty human permanent bicuspids were selected, and preparation was performed in the cervical region measuring 2.5 mm × 2.5 mm × 2.5 mm, followed by acid etching for 15 seconds. These are then divided according to the groups mentioned: group 1-nano-hydroxyapatite (HA) was applied for 15 minutes; group 2-biosilicate was applied for 15 minutes; group 3-diode LASER application was performed twice for 60 seconds in noncontact mode; group 4-nano-HA plus diode LASER application; and group 5-biosilicate plus diode LASER application. The same procedure was followed on the 1st, 7th, and 14th days and then rinsed and stored in artificial saliva, and the saliva was changed every 24 hours. The dentinal tubular occlusion was observed under a scanning electron microscope (SEM) after the 14th day.

Result

The maximum dentinal tubular occlusion was observed in group 4, where nano-HA and diode LASER application was performed.

Conclusion

All the investigated treatment groups have promising occluding potential, but the maximum was found in group 4 >group 5 >group 3 >group 1 >group 2. LASER plus desensitizing together prove to be potent and effective in reducing dentinal tubular diameter.

Thermophysical properties and bonding with composite resin of premixed mineral trioxide aggregate for use as base material

Dental bases require low thermal conductivity and good mechanical properties, such as bonding with composite resins. This study aims to elucidate the physicochemical properties of premixed mineral trioxide aggregate (MTA) for its suitability as a dental base and to explore the optimal adhesive strategy with composite resin. The thermal conductivity and compressive strength of this premixed MTA are 0.12 W/(m•K) and 93.76 MPa, respectively, Which are deemed adequate for its application as dental base. When bonded to composite resin, the use of 37% phosphoric acid etching before applying the Clearfil SE bond significantly reduced the bonding strength between composite resin and premixed MTA. This was because the compressive strength and Vickers hardness of premixed MTA decreased, and tricalcium silicate was dissolved from the surface during acid etching. Therefore, it is recommended to avoid using 37% phosphoric acid etching when bonding premixed MTA and composite resin as a dental base.

Evaluation of Fluoraphat Pro and VivaSens® In-Office Desensitizing Agents in Controlling Natural Dental Hypersensitivity: A Clinical Study

Introduction Dental erosion from acidogenic diets, vigorous tooth brushing, excessive tooth whitening, gingival recession, periodontal debridement, or surgery may induce dentine hypersensitivity (DH). It manifests as a phenomenon observed in structurally intact teeth devoid of pathological or defective conditions. Hence, this study aimed to evaluate DH risk reduction after using Fluoraphat Pro (Neumunster, Germany) and VivaSens® (Ivoclar Vivadent, Schaan, Liechtenstein, Switzerland) in-office desensitizing agents. Method Twenty-two participants with at least two hypersensitive teeth were randomly selected. Participants were divided into two groups with 22 teeth each, and a desensitizing agent (Fluoraphat Pro and Vivasens) was applied accordingly. Participants were recalled the next day, and a decrease in sensitivity (if any) was evaluated by self-reporting using a 5-point Likert-type scale. Relative Risk (RR) was used to compare the likelihood of sensitivity between two groups and Cohen's d to measure the effect size. A value of p<0.05 was considered significant for all statistical purposes. Result The relative risk (RR) results indicated that Fluoraphat Pro has significantly lower RR than Vivasens for patients with dental sensitivity (RR = 0.350, 95% CI 0.187 - 0.654, z = 3.28, p = 0.001). Fluoraphat Pro was significantly more effective concerning lower sensitivity in teeth located in the upper right (dCohen = 3.217, p = 0.038) and lower right (dCohen = 3.193, p = 0.017) of the mouth than VivaSens®. Conclusion The two commercially available desensitizing agents Fluoraphat Pro and Vivasens tested in this study were effective in controlling DH. Fluoraphat Pro was more efficient in relieving the risk of dental hypersensitivity than VivaSens®. Further research is needed to evaluate the long-term effects of the desensitizing agents and compare DH reduction with other marketed desensitizing products.

Treatment of Gingival Recession in Multiple Teeth Using Coronally Advanced Flap with Connective Tissue Graft: A Case Report

This report describes a case of gingival recession in multiple teeth with severe dentin hypersensitivity (DH) in which treatment included periodontal plastic surgery. The patient was a 34-year-old woman presenting with the chief complaint of DH at gingivalrecession sites. The patient had undergone orthodontic treatment when she was 30 years old. An initial examination revealed that none of the sites showed a probing depth of ≥4 mm and 21% of sites bleeding on probing. The clinical diagnosis was plaque-induced gingivitis. Teeth #14, 16, 23, 25, 26, 34, 35, 45, and 46 showed gingival recession ranging from 1 to 4 mm. Gingival recession at #45 extended to the muco-gingival junction. No association with alveolar bone loss was observed in any of the interdental areas. Therefore, the sites presenting with gingival recession were classified as Miller Class I, except #45, which was classified as Class II. The periodontal phenotype was 'thin'. Based on the results of clinical examination and diagnosis, initial periodontal therapy (IP) consisting of oral hygiene instruction, supra-gingival scaling, application of a desensitizing agent, and composite resin restoration was performed. The Visual Analog Scale (VAS) score, which was used to assess degree of DH, showed only a minimal decrease, however, at post-IP. Subsequently, a modified coronally advanced tunnel (a modified technique for achieving a coronally advanced flap) using a connective tissue graft was performed in #14, 16, 23, 25, 26, 45, and 46. After re-evaluation, the patient was placed on maintenance care. The series of interventions resulted in a considerable improvement in the VAS and oral health-related quality of life scores. Furthermore, a change in the periodontal phenotype, from 'thin' to 'thick', was observed, which may contribute to the prevention of further gingival recession and DH. The present case suggests that periodontal plastic surgery is an effective treatment modality for the resolution of DH.

Dentinomimetics and cementomimetics of Moringa oleifera leaves extract

To evaluate the biomimetic remineralization capabilities of Moringa oleifera leaves (MOL) extract on coronal dentin and acellular cementum, two different concentrations (50 and 200 mg/ml) of MOL extract loaded in plain varnish (M1 and M2 groups respectively) were compared to fluoride varnish (FL group) and native surface (C group). Eighty sound premolar teeth were collected. Forty teeth (10 teeth in each group) were used for coronal dentin testing while the other forty (10 teeth in each group) were used for acellular cementum testing. Teeth in M1, M2, and FL groups were etched for 30 s and then received the specific varnish treatment. All samples were immersed in artificial saliva for 14 days and then collected, dried, and examined by scanning electron microscopy and energy dispersive X-ray spectroscopy (EDX). Histologically, FL group showed mineral deposition as discrete vesicular granules of various sizes on the surface of both coronal dentin and acellular cementum. Mineral deposition only occurred on some DTs openings while opened tubules remained. The surface of the acellular cementum revealed regular grooves, micro-fissures, and cracks. In the M1 and M2 groups, mineral deposition appeared as a homogenous continuous layer on coronal dentin and acellular cementum. Only a few DTs and cementum fissures were not filled completely. In L.S. sections of the coronal one-third, the DTs appeared almost sealed with varying lengths of mineral deposition. EDX results statistical analysis showed that the M2 group had the highest phosphate ions (P-) and calcium ions (Ca+2) at%. MOL has an extraordinary effect on the remineralization of coronal dentin and acellular cementum. It would have a promising ability to control dentinal hypersensitivity and formation of biomimetic cementum tissue.

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

Aim

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

Materials and Methods

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

Results

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

Conclusion

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

Comparative Evaluation of the Effectiveness of Three Commercially Available Desensitizing Mouthwash on Dentinal Tubule Occlusion: An In Vitro Scanning Electron Microscopic Study

Aim

To compare and evaluate the effectiveness of three commercially available desensitizing mouthwashes on dentinal tubule occlusion in vitro using a scanning electron microscope (SEM).

Materials and Methods

Twenty-seven premolar maxillary teeth were collected and cleaned to remove debris and tissue using an ultrasonic scaler. Enamel was removed with the help of a high-speed plain cut tungsten carbide fissure bur under continuous water spray. Dentinal discs measuring 5 mm × 5 mm × 3 mm were prepared from the coronal region of the extracted teeth using a double-sided carborundum disc and straight micromotor handpiece. Using carborundum paper, the discs were polished and washed with distilled water. The discs were etched using 37% phosphoric acid to remove any smear layer that was caused by the grinding process and to simulate dentinal hypersensitivity by opening the dentinal tubules. The specimens were again washed and stored in distilled water until use. Samples were then randomly allocated into Group A: calcium sodium phosphosilicate mouthwash, Group B: potassium nitrate mouthwash, and Group C: dipotassium oxalate monohydrate mouthwash. The specimens were immersed in a test tube filled with the respective mouthwash and vigorously shaken for 60 s for simulating the natural mouth rinsing action. This procedure was repeated for 7 days, twice daily. To compare and assess the proportion of dentinal tubule occlusion, all the samples were processed and examined under an SEM.

Results

The efficacy of the mouthwash on the obliteration of dentinal tubules was compared using the Kruskal-Walis analysis of variance test followed by the post hoc Mann-Whitney U test for pairwise comparison. Group A showed completely occluded tubules in 5 (55.6) and mostly occluded tubules in 4 (44.4). Group B showed mostly occluded in 4 samples (44.4) and partially occluded in 5 samples (55.6) and Group C showed completely occluded tubules in 3 samples (33.3) and mostly occluded tubules in 6 samples (66.7). A P value of 0.05 or less is regarded as statistically significant. *P ≤ 0.05 is statistically significant. Between Group A and Group B as well as between Group B and Group C, there was a statistically significant difference. However, a statistically significant difference between Group A and Group C does not exist.

Conclusion

The calcium sodium phosphosilicate group was shown to have the most occlusion of the dentinal tubule, followed by dipotassium oxalate monohydrate and potassium nitrate group.

Influence of three different types of desensitizing agents on bond strength of etch-and-rinse and self-etch adhesive system on dentin: An in vitro study

Aim

To determine the effect of three different dentin hypersensitivity treatment procedures on the microtensile bond strength of etch and rinse and self-etch adhesive system.

Materials and Methods

Eighty extracted intact human permanent lower premolars were decoronated, and dentin was exposed on the buccal surface. The teeth were randomly assigned to two experimental groups of 40 teeth each: etch and rinse system or self-etch system. The 40 samples assigned were further randomly assigned to four desensitizing treatment subgroups: Control, Gluma, NovaMin, and GC tooth Mousse with 10 samples per subgroup. Desensitizing treatment was performed two times each day for 2 weeks respectively. The exposed dentin was subjected to etch and rinse or self-etch adhesive system bonding agent as per the group and restored using composite to 4-mm thickness. Samples were then subjected to universal testing machine for microtensile bond strength.

Results

The bond strength to the dentin obtained with etch and rinse adhesive system group where significantly higher (P < 0.05) when compared to self-etch adhesive system. However, there was no significant effect of the desensitizing agent on the microtensile bond strength in its own. Scanning electron microscope imaging reviled tubular occlusion in all specimens treated with desensitizer.

Conclusion

The bond strength was majorly impacted by the type of adhesive system used. While the desensitizing agents used in the study had little or no adverse effect on the bond strength of composites to dentin surface.

Effectiveness of immediate dentine sealing and resin coating in reducing dental sensitivity in a child with idiopathic neuropathy and anterior dental attrition: Case report

BACKGROUND

Idiopathic neuropathy is a peripheral nervous system disorder of unknown etiology. Patients with this disorder often suffer from bruxism problems. Bruxism is defined as an oral parafunction characterized by occlusal contacts resulting from non-physiological, repetitive, and involuntary masticatory motor activities. These events can trigger accentuated wear of the tooth structure leading to sensitivity. Tooth sensitivity is the pain arising from the exposed dentin in response to chemical, thermal, tactile, or osmotic stimuli that cannot be explained as the result of any other dental defect or disease. Sensitivity treatment using adhesive systems has a long-term or permanent effect. Therefore, this article is aimed at describing the management of dental sensitivity, through dentin sealing and resin coating techniques, during the dental restoration process of a child with idiopathic neuropathy and dental attrition in the anterior sector. All of this, with the consideration of using the minimal intervention philosophy.

CASE PRESENTATION

A 6-year-old male patient diagnosed with idiopathic neuropathy and suffering from multiple dental attritions with dental sensitivity in the upper anterior teeth. With the clinical-radiographic evaluation, the family history, and the interconsultations with the neuropaediatrics service, the definitive diagnosis of dental sensitivity due to stage-3 moderate attrition was obtained, for which rehabilitation of the upper anterior sector was planned through the use of immediate dentin sealing (IDS) and resin coating (RC).

CONCLUSION

The use of IDS and RC techniques shows acceptable sensitivity, which is why these techniques are recommended in cases of moderate attrition in early mixed dentition. The immediate rehabilitation along with the stamping technique improved the aesthetic and functional aspects. Therefore, it is advisable to use them immediately after dentin sealing.

Intratubular crystal formation in the exposed dentin from nano-sized calcium silicate for dentin hypersensitivity treatment

The aim of this study is to evaluate intratubular crystal formation from the experimental material consisting of dicalcium silicate (C2S) and tricalcium silicate (C3S) with nano-scaled particle size. A total of twenty-four specimens were made by isolating 8 mm of the cervical part centered at the cementoenamel junction of extracted premolars. Twelve specimens were not treated and considered as control. The experimental material was applied to the other twelve specimens by brushing for 10,000 strokes. Each group was randomly divided into four subgroups according to the period of immersion in phosphate buffer saline (PBS) for 1, 30, 60, and 90 days each. The specimens were sectioned longitudinally and examined with scanning electron microscopy and energy dispersion X-ray spectroscopy. The intratubular crystal were formed in PBS and densely filled the dentinal tubules over time. The crystal formation occurred at a depth of more than 50 μm from the dentin surface. The Ca/P ratio of formed intratubular crystals was 1.68 after 3 months. The experimental material consisting of C2S and C3S with a nanoscale particle size can form hydroxyapatite-like crystals in dentinal tubules in PBS, and there is a possibility of reducing dentin hypersensitivity by blocking the dentinal fluid flow.

Effect of Commercially Available Nano-Hydroxyapatite Containing Desensitizing Toothpaste and Mouthwash on Dentinal Tubular Occlusion: A SEM Analysis

The aim of this in vitro study was to evaluate and compare the dentinal tubule occlusion using nano-hydroxyapatite (n-HAP) containing toothpaste and mouthwash under a scanning electron microscope. The specimens were randomly divided into two groups with five specimens each: group 1-toothpaste group and group 2-mouthwash group. The percentage of the occluded dentinal tubules was assessed at the baseline, 7th, 14th, 21st, and 28th days under a scanning electron microscope. The toothpaste group showed a higher percentage of occluded dentinal tubules as compared to the mouthwash group at the 7th, 14th, 21st, and 28th days, respectively. It can be concluded that brushing twice daily with n-HAP containing toothpaste for duration of 28 days produced good dentinal tubule occlusion.

The Effectiveness of Calcium Phosphates in the Treatment of Dentinal Hypersensitivity: A Systematic Review

Dentin hypersensitivity (DH) pain is a persistent clinical problem, which is a common condition known to affect patients' quality of life (QoL), but no treatment has ever been agreed upon. Calcium phosphates, available in different forms, have properties that allow sealing the dentinal tubules, which may relieve dentin hypersensitivity. The aim of this systematic review is to evaluate the ability of different formulations of calcium phosphate to reduce dentin hypersensitivity pain level in clinical studies. The inclusion criterion was as follows: clinical randomized controlled studies using calcium phosphates in treating dentin hypersensitivity. In December 2022, three electronic databases (Pubmed, Cochrane and Embase) were searched. The search strategy was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The bias assessment risks results were carried out using the Cochrane Collaboration tool. A total of 20 articles were included and analyzed in this systematic review. The results show that calcium phosphates have properties that reduce DH-associated pain. Data compilation showed a statistically significant difference in DH pain level between T0 and 4 weeks. This VAS level reduction is estimated at about -2.5 compared to the initial level. The biomimetic and non-toxic characteristics of these materials make them a major asset in treating dentin hypersensitivity.

Assessment of Patients’ Experience and Perception Toward Dentinal Hypersensitivity for Its Diagnosis and Management: A Cross-Sectional Study

Background Dentinal hypersensitivity (DH) is a common clinical finding that varies greatly in prevalence. An appropriate impulse that detonates noxious stimuli in the pulp/dentin boundary causes the typical DH pain, which is sudden, short, sharp, and of rapid onset. The objective of this research was to ascertain the incidence of DH in Keralites and evaluate some contributory factors, along with other initiating stimuli. Methodology Over three months, from June 2022 to August 2022, a cluster sampling technique was employed to conduct the study in 14 districts of Kerala. Patients from five clinics from each district who reported having DH and were aged 25 to 65 years were chosen at random. Using Google Survey forms, a 20-question, closed-ended survey was mailed to patients. The data were collected, evaluated, and analyzed using SPSS Version 23.0 (IBM Corp., Armonk, NY, USA). The statistical difference in the distribution of DH and the patient's age was determined using analysis of variance (ANOVA). A chi-square test was carried out to test the association between dentinal hypersensitivity, gender, and other parameters; P < 0.05 was considered to be statistically significant. Results Among the 2,520 persons to whom questionnaires were mailed, 2,321 responded, with an unresponsive rate of 7.89%. The study revealed a sensitivity predilection among females (54%), although statistically insignificant. Respondents aged 25 to 35 years (41.01%) were commonly reported to have DH, the age distribution of which was found to be highly significant statistically (P < 0.01). Teeth whitening resulted in 82.98% of the sensitivity, whereas 47.99% accepted poor oral hygiene as an additional contributory factor. DH was reported in 52.01% of the patients with gastritis and 63.03% of the patients with gingival recession. Further, blame for poor dental treatment (88.88%) and climate change (82.92%) were also found relevant. The quality of life was claimed to be afflicted in 90.99% of the patients. Desensitizing agents were used by 68.97% of the patients, with which 68.03% reported satisfaction. Of the subjects who underwent professional treatment, 87.03% reported being satisfied. Oral prophylaxis-induced sensitivity was reported in 57.99%, indicating enhanced oral health awareness among Kerala residents. There was a statistically highly significant difference in the patient distribution based on the exposure to DH, and their perception of the causes and factors affecting DH (P < 0.01). Conclusions DH is a frequently and widely prevalent dental malady. Respondents demonstrated that they were conversant with DH. The quality of life and enjoyment of daily activities are both impacted by dentin hypersensitivity, and many patients are unaware that it is a treatable illness. Various desensitizing substances are also available and can be applied quickly to sensitive areas. Patients prefer this procedure as it is simpler to apply these agents and the effects are pleasant and beneficial.

Effectiveness of a Single Chair Side Application of NovaMin® [Calcium Sodium Phosphosilicate] in the Treatment of Dentine Hypersensitivity following Ultrasonic Scaling-A Randomized Controlled Trial

Dentinal hypersensitivity or cervical dentinal sensitivity is one of the commonest clinical problems. The aim of this randomized controlled trial was to evaluate the effectiveness of a single chair side application of 100% pure calcium sodium phosphosilicate (NovaMin^®) in reducing dentin hypersensitivity following ultrasonic scaling as evaluated on a visual analogue scale (VAS). The study included 50 subjects who were selected based on an evaluation of dentinal hypersensitivity on a VAS carried out using a metered air blast from a three-way syringe and divided into two groups (n = 25/group); i.e., the test group (Group A) received the NovaMin^® paste and the control group (Group B) received a placebo paste made from pumice. All the 50 subjects included in the study were had VAS scores of 3 or more. The NovaMin^® powder mixed with distilled water was applied. Dentinal hypersensitivity was reassessed immediately and after 1, 2 and 4 weeks after the procedure. Results showed that the percentage reduction of dentinal hypersensitivity following a single application of NovaMin^® in powder form was about 76.38% immediately, 67.72% one week postoperatively, 52.76% two weeks postoperatively and 26.78% four weeks postoperatively. It can be concluded from the results of the current clinical study demonstrated that a single chair side application of NovaMin^® in powder form has a significant and immediate reduction in dentinal hypersensitivity, which lasted nearly for four weeks.

Desensitizing toothpastes for dentin sealing and tertiary dentin formation in vitro and in vivo: a comparative analysis

Background

Dentin hypersensitivity is a painful response to external stimuli applied to exposed dentinal tubules. Various toothpastes with active desensitizing ingredients for the relief of dentin hypersensitivity are commercially available. However, data from several studies suggest that the effects of desensitizing toothpastes are unstable and brief. This study aimed to investigate the effect of toothpastes containing CPNE7-derived oligopeptide (CPNE7-DP) and other active desensitizing ingredients in the dentin microleakage, tubule occlusion and tertiary dentin formation.

Methods

Using scanning electron microscopy (SEM), we evaluated the patency of dentinal tubules on the surface of human dentin disks after brushing experiments with the various toothpastes. Dentin was histologically evaluated in a hypersensitivity model of canine teeth, after the exposed dentin area was brushed for 6 weeks. The toothpaste used in group 1 (control) did not contain any desensitizing ingredients; that used in group 2 contained CPNE7-DP; Colgate Sensitive was used in group 3; and Sensodyne Rapid Relief was used in group 4. Finally, we conducted microleakage analysis to investigate the dentin sealing effect. The microleakage analysis data were subjected to one-way ANOVA and post-hoc Tukey tests (alpha = 0.05).

Results

In the SEM images, all four groups of teeth exhibited partial occlusion of the dentinal tubules on the tooth surface. In the in vivo hypersensitivity model, group 2 exhibited a newly formed tertiary dentin, whereas no new hard tissue formation was observed in groups 1, 3, and 4. Microleakage analysis revealed that the volume of dentinal fluid flow was significantly smaller in group 2 than in group 1.

Conclusions

These results indicate that CPNE7-DP is a promising active ingredient with long-term dentin sealing effects.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02558-8.

Effect of milk as a mouthwash on dentin hypersensitivity after non-surgical periodontal treatment

Background. Limited evidence is available on the effect of milk as a mouthwash on treating dentin hypersensitivity. The present study aimed to compare the effect of milk as a mouthwash with one anti-hypersensitivity mouthwash in decreasing dentin hypersensitivity after non-surgical periodontal treatment. Methods. Patients with generalized moderate-to-severe chronic periodontitis were selected randomly in the present study and underwent scaling and root planing (SRP). Seventy patients with severe dentin hypersensitivity after two days were assigned to two groups. In group A, the patients were asked to use milk as a mouthwash, and in group B, the patients were asked to use anti-hypersensitiv-ity Misswake mouthwash. The patients' hypersensitivity was measured during follow-up visits. The independent t-test was used to compare denim hypersensitivity between the two groups. Statistical significance was set at P<0.05. Results. The results showed a significant decrease in dentin hypersensitivity in both groups on days 15 and 30. In the milk group, 11 and 29 patients fully recovered from dentin hypersensitivity on days 15 and 30, respectively. However, in the anti-hypersensitivity mouthwash group, 8 and 27 patients fully recovered from dentin hypersensitivity on days 15 and 30, respectively. Therefore, more patients benefited from the anti-hypersensitivity effects of milk as a mouthwash. However, the differences were not significant during the whole treatment sessions. Conclusion. Using milk as an inexpensive and available mouthwash can decrease dentin hypersensi-tivity after SRP.

The Retention Effect of Resin-Based Desensitizing Agents on Hypersensitivity-A Randomized Controlled Trial

Recently, the development of dental materials has increased the availability of various hyperesthesia desensitizers. However, there are no studies on the duration of retreatment in terms of adherence rates. Thus, the adhesion rates of resin-based desensitizers were investigated. We used a conventional desensitizer and a recently developed desensitizer containing calcium salt of 4-methacryloxyethyl trimellitic acid (C-MET) and 10-methacryloyloxydecyl dihydrogen calcium phosphate (MDCP). These colored agents were applied to the surfaces of premolars and molars, and the area was measured from weekly oral photographs. Areas were statistically analyzed and mean values were calculated using 95% confidence intervals. A p-value of <0.05 was considered statistically significant. These rates were significantly higher on the buccal side of the maxilla and lower on the lingual side of the maxilla. In addition, the desensitizer containing C-MET and MDCP displayed significantly higher adhesion rates. It is suggested that this will require monthly follow-ups and reevaluation because both agents cause less than 10% adherence and there is almost no sealing effect after 4 weeks. In addition, the significantly higher adhesion rate of the desensitizer containing C-MET and MDCP indicated that the novel monomer contributed to the improvement in the adhesion ability.

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.

Effect of sodium fluoride varnish, Gluma, and Er,Cr:YSGG laser in dentin hypersensitivity treatment: a 6-month clinical trial

Dentinal hypersensitivity (DH) is a common clinical condition usually associated with exposed dentinal surfaces. The aim of this study was to study the effect of sodium fluoride varnish, Gluma, and Er,Cr:YSGG laser, in the dentin hypersensitivity treatment. One hundred sixty-five teeth with dentin hypersensitivity in 55 patients were involved in this study. Teeth are divided into five groups based on the received treatment (n = 33): G group: Gluma; F group: sodium fluoride varnish (5%); L group: Er,Cr:YSGG laser (wavelength 2780 nm, frequency 20 Hz, power 0.25 W, energy density 44.3 J/cm², and pulse width of 150 µs at distance of 1 mm for 30 s) which was followed by Er,Cr:YSGG laser; GL group: Gluma + laser; VL group: both sodium fluoride varnish and Gluma, which are common treatments for hypersensitivity, were selected as control groups. The treatment was performed in one session, and the sensitivity to air spray conditioning was recorded after the treatment, at 15 min, 1 week, 1 month, and 6 months as the VAS. Statistical analysis was performed using SPSS Ver. 21 software. One-way ANOVA was used to compare the VAS between all treatment groups at each time-point. One-way repeated measurements ANOVA (RM-ANOVA) and two-way-repeated measurements ANOVA (RM-ANOVA) were used to compare the hypersensitivity of each group and sensitivity of all treatment groups, respectively. Tukey post hoc test was used to compare the groups pairwise. The hypersensitivity between different groups at before and 15 min after the treatment was not significantly different (P = 0.063). The hypersensitivity of all studied groups was decreased after the treatment. The Er,Cr:YSGG laser, alone or in combination with Gluma, in 1 week, 1 month, and 6 month follow-ups, had significantly reduced the hypersensitivity instead of sodium fluoride varnish. All treatments significantly reduced the dentin hypersensitivity up to 6 months. Er,Cr:YSGG laser alone or in combination with Gluma was more effective than sodium fluoride varnish; however, it was not significantly different from other treatments. In a 6-month follow-up of dentine hypersensitivity treatment, Gluma had a significantly higher effect than sodium fluoride. Trial registration: IRCT20190422043343N1. Registered 19 July 2019.

Effect of Dentin Desensitizer Containing Novel Bioactive Glass on the Permeability of Dentin

The objective of this study was to evaluate the effect of novel bioactive glass (BAG)-containing desensitizers on the permeability of dentin. Experimental dentin desensitizers containing 3 wt% BAG with or without acidic functional monomers (10-MDP or 4-META) were prepared. A commercial desensitizer, Seal & Protect (SNP), was used as a control. To evaluate the permeability of dentin, real-time dentinal fluid flow (DFF) rates were measured at four different time points (demineralized, immediately after desensitizer application, after two weeks in simulated body fluid (SBF), and post-ultrasonication). The DFF reduction rate (ΔDFF) was also calculated. The surface changes were analyzed using field emission scanning electron microscopy (FE-SEM). Raman spectroscopy was performed to analyze chemical changes on the dentin surface. The ΔDFF of the desensitizers containing BAG, BAG with 10-MDP, and BAG with 4-META significantly increased after two weeks of SBF storage and post-ultrasonication compared to the SNP at each time point (p < 0.05). Multiple precipitates were observed on the surfaces of the three BAG-containing desensitizers. Raman spectroscopy revealed hydroxyapatite (HAp) peaks on the dentin surfaces treated with the three BAG-containing desensitizers. Novel BAG-containing dentin desensitizers can reduce the DFF rate about 70.84 to 77.09% in the aspect of reduction of DFF through the HAp precipitations after two weeks of SBF storage.

Phototherapy Using Er,Cr:YSGG Laser as a Definitive Treatment for Dentin Hypersensitivity: A Systematic Review

Purpose

To assess the efficacy of Er,Cr:YSGG lasers in reducing dentine hypersensitivity (DH).

Methods

Electronic literature were searched through various databases (MEDLINE, SCOPUS, ProQuest, LILACS and EBSCO) up to March 2022 for articles addressing the following focused question: “In patients with dentine hypersensitivity, does an Er,Cr:YSGG laser provide a better outcome in terms of pain reduction than other dentine desensitizer agents?”. The literature was searched using combinations of the following medical subject heading (MeSH) terms and keywords: (laser OR phototherapy OR Er,Cr:YSGG laser) AND (dentine hypersensitivity OR dentine sensitivity OR dental sensitivity).

Results

A total of 486 studies were found, of which 7 randomized controlled trials were included in the review. The Er,Cr:YSGG laser wavelengths, power density and duration of irradiation used in the studies were 2780 nanometers, 0.25–0.5 watts and 20–60 seconds, respectively. The follow-up assessments were conducted ranging from immediately to 3 months after treatment. All studies showed that the Er,Cr:YSGG laser was effective in alleviating DH.

Conclusion

This systematic review suggests that the application of an Er,Cr:YSSG laser is effective in alleviating DH and may have limited adverse effects if adequate parameters are followed.

The Effect of Desensitizing Agent on Shear Bond Strength to Dentin using Three Self-etching Bonding Systems at Different Time Intervals. An In Vitro Study

Objectives: To investigate the shear bond strength of dentin surfaces using different self-etching bonding systems after treating with a desensitizing agent at different time intervals.   Materials and methods: 63 sound upper premolars were used, the ‎occlusal aspect was sectioned at the middle in a ‎vertical direction into buccal and ‎palatal halves. Each ‎specimen was mounted and a flat dentin surface was ‎prepared at the middle third of each specimen. The sectioned samples were divided into 3 groups according to the bonding agent n=42. One-half of each tooth was treated with desensitizing agent Quadrant FiniSense then both halves were bonded with one of the three self-etching bonding systems (G-Premio bonding‎,  i Bond,  Clearfil S3 bound plus). ‎After adhesive procedures, a composite resin was applied against the tooth to form ‎a cylinder ‎(2mm×4mm) and cured. From each group 14 specimens were stored in distilled water at 37° C for 24 ‎hours, 7 days, and 72 days.  At the end of each interval, the samples were tested for the shear bond strength using a universal testing machine (Instron). Data were analyzed using the Independent t-test and One Way ANOVA Test and Duncan’s Multiple Range Test.   Results: All bonding systems showed lower bonding strength when samples were treated with desensitizer with a significant difference at all time intervals except for the i bond group which showed no significant difference in bond strength at a period of 7 and 72 days in treated and without desensitizer treated samples.    Conclusion: Obliteration of dentinal by dentin desensitizer may have a negative effect on the bonding strength of the self-etching bonding systems.

Applications of scanning electron microscopy and focused ion beam milling in dental research

The abilities of scanning electron microscopy (SEM) and focused ion beam (FIB) milling for obtaining high-resolution images from top surfaces, cross-sectional surfaces, and even in three dimensions, are becoming increasingly important for imaging and analyzing tooth structures such as enamel and dentin. FIB was originally developed for material research in the semiconductor industry. However, use of SEM/FIB has been growing recently in dental research due to the versatility of dual platform instruments that can be used as a milling device to obtain low-artifact cross-sections of samples combined with high-resolution images. The advent of the SEM/FIB system and accessories may offer access to previously inaccessible length scales for characterizing tooth structures for dental research, opening exciting opportunities to address many central questions in dental research. New discoveries and fundamental breakthroughs in understanding are likely to follow. This review covers the applications, key findings, and future direction of SEM/FIB in dental research in morphology imaging, specimen preparation for transmission electron microscopy (TEM) analysis, and three-dimensional volume imaging using SEM/FIB tomography.

Super high-quality SEM/FIB imaging of dentine structures without collagen fiber loss through a metal staining process

Scanning Electron Microscope/Focused Ion Beam (SEM/FIB) system has become valuable and popular tool for the analysis of biological materials such as dentine structures. According to physiological and anatomical studies, dentine structures are a complicated system containing collagen fibers, nanocrystalline hydroxyapatite, and numerous networks of tubular pores. During a routine FIB milling process, collagen fibers and other organic structures are vaporized, which increases the number of pores on the milled surface of the dentine. This causes the final cross-section to be more porous than the pristine sample. Unfortunately, little attention has been paid to the collagen fiber loss and how to preserve them during a FIB milling process. In this work, we present a novel and simple approach to preserve the organic portions of the dentine structure through metal staining. By using this method, the porosity of the dentine structure after the FIB milling process is significantly reduced similar to the pristine sample. This indicates that the organic portion of the dentine structure is well protected by the metal staining. This approach enables the SEM/FIB system to generate super-high quality SEM images with less ion beam damage; and the SEM images can better reflect the original condition of the dentine structure. Further, serial energy-dispersive X-ray spectroscopy (EDS) mapping of the stained dentine structure is achieved without an additional metal coating; and three-dimensional (3-D) elemental mapping of an occluded dentine is achieved with a significantly reduced data acquisition time.

Effectiveness of Two Different Fluoride-Based Agents in the Treatment of Dentin Hypersensitivity: A Prospective Clinical Trial

Hyperesthesia is related to increased sensitivity of dental tissues to mechanical, chemical and thermal stimuli. The aim of this prospective clinical trial was to compare the effectiveness of a calcium-fluoride-forming agent (Tiefenfluorid®, Humanchemie GmbH, Alfeld, Germany) with that of a fluoride varnish (EnamelastTM, Ultradent Inc., Cologne, Germany) in the treatment of dental hyperesthesia in adult patients. In total, 176 individuals (106 females and 70 males, aged 18-59 years old) diagnosed with dental hyperesthesia (DH) were enrolled. The main clinical symptoms were hyperesthesia from coldness and sweetness during chewing; the types of clinical lesions were also determined and recorded. The patients were selected randomly and divided into two groups: (i) the first group of 96 patients was treated with Tiefenfluorid® applied in three appointments at 7-day intervals; (ii) the second group of 80 patients was treated with EnamelastTM, applied seven times at 7-day intervals. All the patients were recalled 7 days, 14 days, 1 month, 3 months, and 6 months from the last application. At the baseline and during every follow-up visit, the DH was measured with a pulp tester. A random intercept/random slope model was used to evaluate the effect of the treatment, at various times with respect to the initial diagnosis. Within the limits of the present study, Tiefenfluorid® was more effective than EnamelastTM against DH in that it provided long-lasting results, with a significant improvement still detected at the latest 6-month follow-up.

Effect of silver diamine fluoride, potassium nitrate, and glutaraldehyde in reducing the post vital tooth preparation hypersensitivity: A randomized controlled trial

Aim

Hypersensitivity is the most common clinical problem which is encountered by most of dental patients undergoing a vital tooth preparation for a fixed crown prosthesis. The aim of this study is to evaluate the effect of silver diamine fluoride, potassium nitrate, and glutaraldehyde in reducing dentinal hypersensitivity following vital tooth preparation.

Settings and Design

This study is a randomized control trial performed on 119 teeth of 68 patients who are in need of fixed prosthesis treatment.

Materials and Methods

After a thorough clinical examination, patients were allocated into any of the randomly assigned four groups (Control, silver diamine fluoride, potassium nitrate, and glutaraldehyde) and the level of hypersensitivity was measured by blasting air on the surface of tooth at five different intervals (before preparation, after preparation, after application of desensitizers, before cementation and after a follow up period of about 30 days) and is graded using Schiff 's cumulative hypersensitivity index.

Statistical Analysis Used

Kruskal wallis test is used to compare the rate of sensitivity between the 4 groups. Friedman and Wilcoxon test is used to compare the rate of sensitivity at 5 different intervals.

Results

All the desensitizers used in this study reduced the level of hypersensitivity. Among which, silver diamine fluoride was found to be more effective after application, before cementation, and after a follow up period of about 30 days followed by GLUMA and potassium nitrate.

Conclusion

The results of this study suggest that silver diamine fluoride was found to be more effective after application, before cementation of the definitive prosthesis and after a follow up period of 30 days.

Comparative evaluation of the efficacy of light amplification by the stimulated emission of radiation, desensitizing agents, and their combined effect on dentinal hypersensitivity in cuspids and bicuspids – In Vivo Study

Context:

Dentinal Hypersensitivity is the most common dental problem, in order to find a suitable treatment plan this study was conducted incorporating LASER and desensitizing agents on the patients complaining of dentinal hypersensitivity in cuspids and bicuspids. Most of the desensitizing agents provided incomplete relief hence the combination of LASER and Desensitizing agents proved to be successful.

Aim:

The aim of this study is to evaluate and compare the efficacy of individual desensitizing agents and c (LASER) and also to know their potential in reducing dentinal hypersensitivity when both desensitizing agents and LASER are combined together and applied on cuspids and bicuspids.

Setting and Design:

Sixty patients with sensitivity only in cuspids and bicuspids and not having caries, restoration, or undergoing any desensitizing therapy were selected. Patients were divided into 5 groups with 12 patients in each group.

Materials and Methods:

Air blast stimulus was given for 10 s from 1 cm distance on the affected group. Verbal analog score was recorded. Treatment was carried on according to the groups mentioned: Group I – nanohydroxyapatite was applied for 15 min; Group II – biosilicate was applied for 15 min; Group III – LASER application was done twice for 60 s in noncontact mode; Group IV – Nanohydroxyapatite plus LASER application; and Group V – biosilicate plus LASER application. Desensitizing agent was applied with the applicator tip and was left for 15 min. It was then rinsed and again the stimulus was given, and the score was recorded. The same treatment procedure was repeated on 1^st, 7^th, and 14^th day and the score was recorded and analyzed using ANOVA.

Results:

The maximum reduction in sensitivity score was observed in patients where nanohydroxyapatite and LASER application was done.

Conclusion:

All the investigated treatments have promising desensitizing potential, but maximum was found in Group IV > Group V > Group III > Group I > Group II.

Analysis of an Herbal Ayurdantham Medicated Tooth liquid on Dentinal Tubule Occlusion using Scanning Electron Microscopy

BACKGROUND

Dentin hypersensitivity is described as "short sharp pain arising from exposed dentin in response to various stimuli typically thermal, evaporative, tactile, osmotic or chemical and cannot be ascribed to any other form of dental defect or disease." Dentine hypersensitivity can be treated with various desensitizing agents ,where oral rinse has a promising effect in delivering the therapeutic effect all over the tooth surface including interproximal areas, as they can flow and reach areas where toothpastes are not much effective, hence the occlusion of dentinal tubules using Ayurdhantam medicated an herbal mouthwash was evaluated.

METHODOLOGY

Twenty such dentinal blocks were obtained; the surfaces of each dentin block were polished using a silicon carbide disc for 30 s to create a basic smear layer. The smear layer is finally detached by applying 17% EDTA solution onto the dentin blocks for 5 min to ensure the patency of the dentinal tubules, following which they were rinsed with distilled water. The specimens were placed into the Ayurdhantam solution (medicated) for 2 min every day for 7 days. The specimens were stored in artificial saliva during the study. The specimens were analyzed under scanning electron microscope (SEM) for the occlusion of dentinal tubules.

RESULTS

SEM images showed the partial occlusion of the tubules and a large amount of smear layer.

CONCLUSIONS

Based on this in vitro experiment carried out, it is shown that Ayurdhantam-medicated mouthwash can be used for treating dentine hypersensitivity effectively.

An Eggshell-Based Toothpaste as a Cost-Effective Treatment of Dentin Hypersensitivity

Objectives This study aimed to test the efficacy of two experimentally produced eggshell-based toothpastes on dentinal tubules occlusion.

Materials and Methods Two experimental eggshell toothpastes, based on natural ingredients, with or without titanium dioxide nanoparticles (TNPs) were produced and coded “TNPs eggshell toothpaste [TNPsESTP]” or “eggshell toothpaste [ESTP],” respectively. Mid-coronal dentin discs, from 28 human extracted molar teeth, etched with 37% phosphoric acid for 60 seconds to simulate the hypersensitive dentin, were randomly divided into four groups—G1: no treatment (negative control), G2: ESTP treated, G3: TNPsESTP treated, and G4: Biorepair treated (positive control). All treated discs were brushed for 2 weeks and 1 month using a toothbrush simulator at 40 mm/s. Dentinal tubules occlusion was studied using a cross-polarization optical coherence tomography (CP-OCT) and scanning electron microscopy (SEM).

Statistical Analysis Unpaired t -test was conducted using GraphPad software (San Diego, California, United States). Continuous variables were expressed as means ± standard deviation and p < 0.05 was considered statistically significant.

Results From CP-OCT, a marked increase in surface reflectivity of dentin was observed after brushing with tested toothpastes. ESTP and NPsESTP showed higher or comparable grayscale values than Biorepair indicating increase in surface density of dentin. From SEM, at 2 weeks, ESTP showed comparable number of completely occluded dentinal tubules to Biorepair. TNPsESTP showed significantly lower numbers of CODT than Biorepair. At 1 month, the number of CODT was difficult to count for all treated groups. Both ESTP and TNPsESTP showed significantly higher numbers of partially occluded dentinal tubules than Biorepair.

Conclusion ESTP or TNPsESTP could offer a cost-effective substitute for the treatment of dentin hypersensitivity.

Study on Occluding Dentinal Tubules with a Nanosilver-Loaded Silica System In Vitro

The effects of most clinical treatments for dentin hypersensitivity are not long-lasting. To overcome the defects, the mesoporous silica nanoparticles and silver nanoparticles entered the field of oral materials. This study aimed to synthesize a novel, low-cytotoxic dentin desensitizer and investigate its occlusion effects on dentinal tubules. The biphasic stratification approach, a chemical reduction method, and the Stöber method were used to synthesize silver nanoparticle-loaded and nonporous silica-encapsulated mesoporous silica (Ag-MSNs@nSiO₂), which was a noncrystalline structure with an average size of approximately 128 nm and a silver content of 3.506%. Atomic absorption spectrometry and the 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide cell viability assay showed that Ag-MSNs@nSiO₂ slowly released silver ions and had nearly no cytotoxicity. An electron microscope was used to observe the blocking effects on the dentinal tubules of sensitive tooth disc models, which were randomly divided into the following four groups: a deionized water group, a 5.9 M silver nitrate solution group, an Ag-MSNs@nSiO₂ group, and a Gluma desensitizer group. There were no significant differences in the relative area of open dentinal tubules between the Ag-MSNs@nSiO₂ group and the Gluma desensitizer group (P > 0.05). Detection of protein structures showed that multilevel structures of bovine serum albumin in dentin tubules were significantly changed by silver ions from Ag-MSNs@nSiO₂. These results suggest that nearly noncytotoxic Ag-MSNs@nSiO₂ was successfully synthesized by a series of methods. Ag-MSNs@nSiO₂ occluded dentin tubules immediately and effectively. Moreover, the blockage effects may be enhanced and maintained by continuous condensation of proteins in dentinal tubules.

Evaluating the efficacy of desensitizing dentifrices on dentinal hypersensitivity management: A scanning electron microscopic analysis

Introduction

Dentin hypersensitivity (DH) adversely affects quality of life by impairing the ability to eat and drink certain foods, therefore, should be addressed promptly with a contingency plan that includes initial treatment with a noninvasive prophylactic home care approach, followed by in-office treatment if desired result is not achieved.

Aim

The purpose of this study was to evaluate the effectiveness of four different pastes containing 5% NovaMin (Sensodyne Repair and Protect^®), Propolis (Phytoshield Propolis^®), 5% potassium nitrate (Sensodyne^®), and 8% arginine (Colgate Sensitive Pro Relief^®) based toothpastes in the treatment of DH.

Materials and Methods

One hundred dentin slices were cut from the crown section of molars. Etching with 37% orthophosphoric acid was done to open the tubules. Scanning electron microscope (SEM) study was done to ensure that the tubules are opened. The dentin specimens were divided into four groups: Group 1 -5% NovaMin, Group 2 - Propolis, Group 3 - 5% potassium nitrate, and Group 4 - 8% arginine. Samples were brushed for 2 min twice daily with a soft toothbrush for 15 days and were stored in distilled water. The samples were rinsed under running water to remove the toothpaste. The SEM was performed to check the obliteration of tubules.

Results

5% NovaMin group showed more completely occluded dentinal tubules when compared to other groups. The differences among all the groups were statistically significant (P ≤ 0.05).

Conclusion

In the present study, all materials, NovaMin, Propolis, potassium nitrate, and arginine, were effective in occluding dentinal tubules but NovaMin appeared most proficient in occluding tubules, followed by arginine, potassium nitrate, and Propolis. Topical NovaMin is an upcoming agent demonstrating desensitization and remineralization properties.

Comparison between effectiveness of dentine desensitizer and one bottle self-etch adhesive on dentine hypersensitivity

BACKGROUND

Dentine hypersensitivity is one of the most common chief complaints of patients observed by dentists in their practice. However, there is a lack of universal consensus over the selection of reliable treatment modality.

OBJECTIVES

To compare the effectiveness between dentine desensitizer and self-etch adhesive in patients complaining of moderate to severe dentine hypersensitivity pain.

METHODS

A total of 254 patients with moderate to severe dentine hypersensitivity were randomly divided into Group A (Single Bond Universal Agent) and Group B (Seal & Protect Agent) according to the treatment provided. Sensitivity was assessed by means of mechanical (probing) and evaporative (air blast) stimuli. Discomfort Internal Scale (DIS) was explained to patients. DIS scores were recorded after one minute and one month following the application of both agents. Descriptive statistics were calculated. Stratification was done to control confounder and post stratification chi-square test was also applied.

RESULT

The statistically significant difference (p= 0.000) in effectiveness between the two groups was observed. The mean discomfort internal scale score at baseline, after 1 minute and after 1 month in Group A was 3.65 ± 0.60, 2.33 ± 0.64 and 0.41 ± 0.71 respectively, while in Group B, it was 3.55 ± 0.58, 2.40 ± 0.62 and 0.72 ± 0.92 respectively. Overall, 86.6% patients observed improvement in dentinal sensitivity in Group A while in Group B only 67.7% patients reported reduction in sensitivity.

CONCLUSION

Self-etch adhesive significantly reduces dentin hypersensitivity, immediately after one minute of its application and is effective for a period of one month compared to desensitizing agent.

Comparative evaluation of the efficacy of the desensitizing and remineralizing agent in the reduction of dentin hypersensitivity after orthodontic debonding - a randomized clinical trial

Introduction

Enamel loss is a common problem during various orthodontic procedures. The study aims to compare the efficacy of a desensitizer and remineralizer in the reduction of the dentin hypersensitivity (DH) associated with enamel microcracks after orthodontic debonding.

Methods

A unicentric two arm parallel study with 30 subjects randomly assigned to each groups following debonding. Group-1 subjects were treated with Gluma® desensitizer (5% glutaraldehyde and 35% hydroxyethyl methacrylate (HEMA)) and the Group-2 intervention included a remineralizing agent GC Tooth Mousse Plus® (casein phospho peptide and amorphous calcium Fluro phosphate (CPP:ACFP)). The Visual Analogue Scale (VAS) was utilized to evaluate DH as subjective perception of pain following the Air blast test and Cold test. The VAS scale was indexed from 0–10 markings based on the intensity of perception. Five different time points T0 and T1 - immediately after debonding and intervention on day 1, T2 – 48 hours, and T3 after 72 hours were taken for the assessment of VAS scores.

Results

The VAS scores for the airblast test for group 1 were (2.73, 0, 0.06, 0.03) and group 2 (2.46, 0, 0.16, 0.13) at different periods. The sensitivity scores for the cold blast test for group 1 were (2.73, 0, 0.13, 0.03) and for group 2 (2.46, 0, 0.16, 0.13). There was 98 percent reduction in DH between T0 and T3 and was statistically significant (p<0.05) for both the groups.

Conclusion

Gluma® desensitizer and GC Tooth Mousse Plus® are equally effective in the reduction of DH in the orthodontic patient following debonding.

Comparative evaluation of fluorinol and calcium sodium phosphosilicate-containing toothpastes in the treatment of dentin hypersensitivity

BACKGROUND

Dentin hypersensitivity is one of the most commonly encountered clinical problems. Various desensitizing agents have been widely used in the management of dentin hypersensitivity. Fluorinol, a fluoride-containing agent, has shown to be effective in fluoridating the hydroxyapatite crystal and thus reduce enamel solubility. Calcium sodium phosphosilicate mechanically occludes open tubules and releases calcium and phosphorous to remineralize tooth structure.

OBJECTIVE

To compare and assess the efficacy of fluorinol-containing toothpaste with 7.5% sodium calcium phosphosilicate-containing toothpaste in reducing dentin hypersensitivity.

METHODOLOGY

Thorough oral prophylaxis was done, and the patients were subjected to the washout phase, after which they were randomly allocated to the two study groups, Group A-fluorinol-containing toothpaste, Group B-sodium calcium phosphosilicate-containing toothpaste. Patients were recalled on 2^nd , 3^rd and 4^th weeks, and sensitivity was assessed using VAS scores by means of tactile, evaporative and cold water stimuli. Oral health-related quality of life was assessed using OHIP-14 questionnaire at baseline and 4 weeks.

RESULT

Compared to baseline, there was a significant decrease in dentin hypersensitivity in both the groups. The VAS scores for tactile stimuli were significantly lower in group A at 3^rd and 4^th weeks.

CONCLUSION

Fluorinol-containing toothpaste was shown to be effective in reducing dentinal hypersensitivity. Hence, it can be used routinely in the management of dentin hypersensitivity.

In Vitro Evaluation of Desensitizing Agents Containing Bioactive Scaffolds of Nanofibers on Dentin Remineralization

This study evaluated the effect of the incorporation of bioactive nanofibers in desensitizing agents on dentin permeability. Sixty disks of dentin were randomly distributed in four groups (n = 15). Distribution was based on the desensitizing agents, fluoride varnish and self-etching adhesive, and the presence of nanofibers: C (self-etching adhesive Clearfil SE Bond), CN (Clearfil SE Bond with 1% nanofiber), D (Duraphat varnish), and DN (Duraphat varnish with 1% nanofiber). Dentin permeability was determined using hydraulic conductivity. For a qualitative analysis, confocal laser microscopy and scanning electron microscopy were performed. The C group showed the lowest hydraulic conductance (Lp%) (89.33), while the DN group showed the highest Lp% (116.06). No statistical significance was observed in the Lp% values in all groups after the treatment and 6% citric acid challenge (p > 0.239). In the images, the CN group presented a higher superficial and intratubular deposition. In addition, this group presented a more homogeneous dentin surface and wide occlusion of dentinal tubules than the other treatments. Despite there being no statistical differences among the treatments employed, the images showed that the CN group presented a higher surface and intratubular deposition compared to the other treatments, even after the acid challenge.

Treatment of Gingival Recession: When and How?

Gingival recession is a common finding in daily clinical practice. Several issues may be associated with the apical shift of the gingival margin such as dentine hypersensitivity, root caries, non-carious cervical lesions (NCCLs), and compromised aesthetics. The first step in an effective management and prevention program is to identify susceptibility factors and modifiable conditions associated with gingival recession. Non-surgical treatment options for gingival recession defects include establishment of optimal plaque control, removal of overhanging subgingival restorations, behaviour change interventions, and use of desensitising agents. In cases where a surgical approach is indicated, coronally advanced flap and tunnelling procedures combined with a connective tissue graft are considered the most predictable treatment options for single and multiple recession defects. If there is a contraindication for harvesting a connective tissue graft from the palate or the patient wants to avoid a donor site surgery, adjunctive use of acellular dermal matrices, collagen matrices, and/or enamel matrix derivatives can be a valuable treatment alternative. For gingival recession defects associated with NCCLs a combined restorative-surgical approach can provide favourable clinical outcomes. If a patient refuses a surgical intervention or there are other contraindications for an invasive approach, gingival conditions should be maintained with preventive measures. This paper gives a concise review on when and how to treat gingival recession defects.

Oral care product formulations, properties and challenges

This review explores the physical, chemical and structural properties of key components of oral care products, whilst looking at the challenges which need to be overcome to continue to improve the efficacy of oral care, and improve dental health. Oral care has been an essential part of all populations and cultures around the world for thousands of years. To maintain good oral health, dental plaque causing bacteria and malodour must be controlled whilst also strengthening and protecting the teeth to prevent dental caries. Advanced modern formulations need to provide controlled and extended release of ingredients vital for dental health. With modern day products such as toothpastes and mouthwashes, it has never been easier to maintain good oral hygiene and health, yet the incidence of dental caries is still on the rise. The complex formulations of modern toothpastes and mouthwashes makes them one of the most sophisticated pharmaceutical products on the market today. The demands of the consumer coupled with the complexity of the oral cavity make it one of the most challenging development processes.

Acidic Monetite Complex Paste with Bleaching Property for In-depth Occlusion of Dentinal Tubules

Background

Dentin hypersensitivity (DH) is a common dental clinical condition presented with a short and sharp pain in response to physical and chemical stimuli. Currently no treatment regimen demonstrates long-lasting efficacy in treating DH, and unesthetic yellow tooth color is a concern to many patients with DH.

Aim

To develop a bi-functional material which can occlude dentinal tubules in-depth and remineralize dentin for long-lasting protection of the dentin–pulp complex from stimuli and bleach the tooth at the same time.

Methods

A mixture containing CaO, H₃PO₄, polyethylene glycol and H₂O₂ at a specific ratio was mechanically ground using a planetary ball. The mineralizing complex paste was characterized by X-ray diffraction (XRD) and scanning electron microscopy (SEM). Dentin was exposed to the synthesized paste for 8 h and 24 h in vitro. The mineralizing property was evaluated using SEM and microhardness tests. Red tea-stained tooth slices were exposed to the synthesized paste for 8 h and 24 h in vitro. The bleaching effect was characterized by a spectrophotometer.

Results

The complex paste had very a fine texture, was injectable, and had a gel-like property with 2.6 (mass/volume) % H₂O₂ concentration. The X-ray diffraction pattern showed that the inorganic phase was mainly monetite (CaHPO₄). The mineralizing complex paste induced the growth of inorganic crystals on the dentin surface and in-depth occlusion of dentin tubules by up to 80 μm. The regenerated crystals were integrated into the dentin tissue on the dentin surface and the wall of dentinal tubules with a microhardness of up to 126 MPa (versus 137 Mpa for dentin). The paste also bleached the stained dental slices.

Conclusion

The mineralizing complex paste is a promising innovative material for efficient DH management by remineralizing dentin and in-depth occlusion of dentin tubules, as well as tooth bleaching.