Treatment of dentinal hypersensitivity using low-level laser therapy and 5% potassium nitrate: A randomized, controlled, three arm parallel clinical study

Comparison of the Effects of Gluma Gel, Sensodyne Repair and Protect Toothpaste, and an 810 nm Low Power Diode Laser on the Closure of Dentinal Tubules: An In Vitro Study

Introduction: One of the common problems among dental patients is tooth hypersensitivity. There are various treatments for hypersensitivity, such as gels, solutions, toothpaste, and laser treatments. This report examined the effect of three treatments, namely 810 nm wavelength diode laser, Gluma gel, and Sensodyne Repair and Protect toothpaste, on tooth hypersensitivity. Methods: This experimental survey selected 40 premolars free of caries, fractures, restorations, root canal therapy, or wear. The enamel of the midline in the cervical part of the buccal surface was removed by a bur (the area was 2*2 mm and the depth was 2 mm), and the samples were then prepared and divided into four groups. Sensodyne Repair and Protect toothpaste, Gluma gel, and an 810 nm diode laser with 0.5 W power were applied to three groups of teeth. The samples were analyzed by using a field emission scanning electron microscope (FE-SEM). The data from the occluded dentinal tubules, partially occluded tubules, and open tubules were analyzed by using the Tamhane test. Results: The amount of occluded dentinal tubules was 83.2±9% in the laser group, 74.4±11.62% in the Gluma group, 67.1±18% in the Sensodyne group, and 15.03±3.39% in the control group. The difference between the treatment groups and the control group was meaningful (P<0.05). However, the difference between the Gluma group, the Sensodyne group, and the 810 nm laser group was not significant (P>0.05). Conclusion: The three treatments (810 nm diode laser, Gluma, and Sensodyne) were all effective in occluding dentinal tubules compared to the control group. However, there was no significant difference between these three treatment methods (P>0.05).

A Comparative Study on the Safety and Efficacy of Erbium Laser Therapy Versus Traditional Treatments in Managing Dentin Hypersensitivity: An Observational Study

Background This study aimed to explore the potential efficacy and safety of laser therapy compared with traditional desensitizing treatments in the management of dentin hypersensitivity. Methodology A comprehensive observational study was conducted on 138 adult individuals aged 18-65 diagnosed with dentin hypersensitivity. Participants were allocated to either the laser therapy or traditional treatment group. The laser therapy group received treatment using the Fotona LightWalker® Erbium laser at 2,940 nm. The energy density was set at 20 J/cm² using continuous and contact modes, with the laser tip held perpendicularly to the irradiated site. Each session lasted five minutes, conducted bi-weekly for three months. Traditional treatment included the in-office application of 5% sodium fluoride varnish application once every 15 days for three months and the use of desensitizing toothpaste as part of regular oral hygiene routines. Follow-up assessments were conducted 6 and 12 months post-treatment to evaluate the longevity and stability of the treatment effects. Primary outcomes were assessed by dentin hypersensitivity reduction measured using Visual Analog Scale (VAS) scores and tactile hypersensitivity assessments. Results Laser therapy consistently surpassed traditional treatment in reducing dentin hypersensitivity, as reflected by the significantly lower VAS scores. Notably, at 3, 6, and 12 months, laser therapy demonstrated mean VAS scores of 2.5 (±1.5), 1.2 (±0.9), and 0.6 (±0.5), respectively, while the traditional treatment group exhibited higher scores (3.8 ± 1.2, 4.5 ± 1.0, and 4.0 ± 0.7, respectively). Statistical analysis revealed that these differences were highly significant (p < 0.001). Tactile hypersensitivity assessments echoed these findings, with laser therapy consistently maintaining lower scores (0.8 ± 0.7 at 6 months, 0.4 ± 0.3 at 12 months) compared to traditional treatment (3.5 ± 1.0 at 6 months, 4.0 ± 0.7 at 12 months) with statistical significance at all time points (p < 0.001). Conclusions Although this study lacks a randomized controlled design, the observed substantial reduction in VAS scores and tactile hypersensitivity assessments, along with the favorable safety profile of laser therapy, suggest its potential as an effective alternative for managing dentin hypersensitivity.

Dentinal tubule blockage using nanobioglass in the presence of diode (980 nm) and Nd:YAG lasers: an in vitro study

OBJECTIVES

The main objective of this study was to enhance the blockage of dentinal tubules using nanobioglass in the presence of diode (980 nm) and Nd:YAG lasers in order to reduce permeability and dentin hypersensitivity.

MATERIALS AND METHODS

Thirty-six dentinal samples were randomly divided into 6 subgroups (n = 6): (A) control, (B) diode laser (980 nm, 3-W), (C) Nd:YAG laser (1064, 1.0-W), (D) nanobioglass, (E) nanobioglass + diode laser (980 nm), (F) nanobioglass + Nd:YAG laser. The average number of open dentinal tubules was qualitatively and quantitatively evaluated by scanning electron microscopy (SEM). Data were evaluated by SPSS software version 22, Kruskal-Wallis test, and Mann-Whitney tests with Bonferoni's correction (α = 0.008).

RESULTS

Based on the results of Mann-Whitney test, there was a significant difference in the mean number of open dentinal tubules between the control group and the other groups (p < 0.008). However, the difference among the other groups was not statistically significant (p > 0.008).

CONCLUSIONS

Findings of this study showed that high-power laser radiation, such as Nd:YAG and diode (980 nm) alone or with nanobioglass, has a significant effect on the blockage of dentinal tubules.

CLINICAL RELEVANCE

Introduction of non-invasive methods with long-term and lasting effect on reducing pain and discomfort caused by dentin hypersensitivity.

Laser therapy for dentinal hypersensitivity

BACKGROUND

Dentinal hypersensitivity is characterized by short, sharp pain from exposed dentine that occurs in response to external stimuli such as cold, heat, osmotic, tactile or chemicals, and cannot be explained by any other form of dental defect or pathology. Laser therapy has become a commonly used intervention and might be effective for dentinal hypersensitivity.

OBJECTIVES

To assess the effects of in-office employed lasers versus placebo laser, placebo agents or no treatment for relieving pain of dentinal hypersensitivity.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 20 October 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library 2020, Issue 9), MEDLINE Ovid (1946 to 20 October 2020), Embase Ovid (1980 to 20 October 2020), CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 20 October 2020), and LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; from 1982 to 20 October 2020). Conference proceedings were searched via the ISI Web of Science and ZETOC, and OpenGrey was searched for grey literature. The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Randomized controlled trials (RCTs) in which in-office lasers were compared to placebo or no treatment on patients aged above 12 years with tooth hypersensitivity.

DATA COLLECTION AND ANALYSIS

Two review authors independently and in duplicate screened the search results, extracted data, and assessed the risk of bias of the included studies. Disagreement was resolved by discussion. For continuous outcomes, we used mean differences (MD) and 95% confidence intervals (CI). We conducted meta-analyses only with studies of similar comparisons reporting the same outcome measures. We assessed the overall certainty of the evidence using GRADE.

MAIN RESULTS

We included a total of 23 studies with 936 participants and 2296 teeth. We assessed five studies at overall low risk of bias, 13 at unclear, and five at high risk of bias. 17 studies contributed data to the meta-analyses. We divided the studies into six subgroups based on the type of laser and the primary outcome measure. We assessed the change in intensity of pain using quantitative pain scale (visual analogue scale (VAS) of 0 to 10 (no pain to worst possible pain)) when tested through air blast and tactile stimuli in three categories of short (0 to 24 hours), medium (more than 24 hours to 2 months), and long term (more than 2 months). Results demonstrated that compared to placebo or no treatment the application of all types of lasers combined may reduce pain intensity when tested through air blast stimuli at short term (MD -2.24, 95% CI -3.55 to -0.93; P = 0.0008; 13 studies, 978 teeth; low-certainty evidence), medium term (MD -2.46, 95% CI -3.57 to -1.35; P < 0.0001; 11 studies, 1007 teeth; very low-certainty evidence), and long term (MD -2.60, 95% CI -4.47 to -0.73; P = 0.006; 5 studies, 564 teeth; very low-certainty evidence). Similarly, compared to placebo or no treatment the application of all types of lasers combined may reduce pain intensity when tested through tactile stimuli at short term (MD -0.67, 95% CI -1.31 to -0.03; P = 0.04; 8 studies, 506 teeth; low-certainty evidence) and medium term (MD -1.73, 95% CI -3.17 to -0.30; P = 0.02; 9 studies, 591 teeth; very low-certainty evidence). However, there was insufficient evidence of a difference in pain intensity for all types of lasers when tested through tactile stimuli in the long term (MD -3.52, 95% CI -10.37 to 3.33; P = 0.31; 2 studies, 184 teeth; very low-certainty evidence). Most included studies assessed adverse events and reported that no obvious adverse events were observed during the trials. No studies investigated the impact of laser treatment on participants' quality of life.

AUTHORS' CONCLUSIONS

Limited and uncertain evidence from meta-analyses suggests that the application of laser overall may improve pain intensity when tested through air blast or tactile stimuli at short, medium, or long term when compared to placebo/no treatment. Overall, laser therapy appears to be safe. Future studies including well-designed double-blinded RCTs are necessary to further investigate the clinical efficacy of lasers as well as their cost-effectiveness.

Low-power laser and potassium oxalate gel in the treatment of cervical dentin hypersensitivity-a randomized clinical trial

OBJECTIVE

To evaluate the effectiveness of different protocols for the treatment of cervical dentin hypersensitivity (CDH) in non-carious cervical lesions (NCCLs).

MATERIALS AND METHODS

The CONSORT checklist was used to design this study. The sample with n = 74 participants (389 NCCLs) was randomly allocated into three groups: G1, potassium oxalate (Oxa-Gel BF); G2, GaAlAs (gallium-aluminum-arsenate) low-power laser (100 mW, 808nn, 60 J/cm²); and G3, potassium oxalate (Oxa-Gel BF) associated with the GaAlAs low-power laser. The CDH was triggered by the evaporative stimulus test (EST) and by the tactile stimulus test (TST). The visual analog scale (VAS) was used to quantify the degree of CDH. Changes in sensitivity were assessed from baseline over 3 weeks. Data were analyzed for NCCLs using mixed-effects models with unstructured direct product covariance structure (α = 0.05).

RESULTS

After the first application, participants from G1 and G3 had a reduction in CDH (p < 0.05) compared with group G2 for TST. After the second application, G3 participants had a reduction in CDH (p < 0.05) in relation to G2 for both stimuli. Reduction in CDH (p < 0.05) occurred over 3 weeks for EST and TST for all groups; however, there was no difference between groups at the end of the therapies.

CONCLUSION

Potassium oxalate was more effective in reducing immediate CDH. After four applications, all groups showed similar results for the reduction of CDH.

CLINICAL RELEVANCE

GaAlAS laser irradiation and oxalate potassium gel could reduce the symptoms of CDH; thus, they are viable alternatives for the treatment of this condition. Chemical occlusion of dental tubules showed effective results after a shorter time interval.

TRIAL REGISTRATION

Brazilian Clinical Trials Registration Platform under protocol number RBR-4ybjmt. http://www.braziliantrials.com/?keywords=RBR-4ybjmt&order=%7Eensaios.patrocinador_primario.

Dentinal Hypersensitivity Treatment Using Diode Laser 980 nm: In Vivo Study

The discomfort of patients due to dentinal hypersensitivity (DH) is one of the main challenges that dentists face in daily practice. Difficulties in DH treatment gave rise to many protocols which are currently used. The aim of this clinical study is to evaluate the effectiveness of a new protocol on the reduction of dentinal hypersensitivity with diode laser 980 nm and the application of a graphite paste. 184 patients enrolled in the study, the degree of pain was evaluated by visual analog scale (VAS), graphite paste was applied on the exposed dentine before irradiation, the application of diode laser 980 nm with continuous mode, backward motion, tangential incidence of the beam in non-contact mode and a delivery output of 1 W. Fiber’s diameter was 320 μm and total exposure time depended on the time necessary to remove the graphite paste from the teeth. Statistical analyses were performed with Prism 5^® software. Pain in post-operative significantly decreased immediately after the treatment. Mean values stayed stable until a 6-month follow-up. The application is considered to be safe with long-term effectiveness.

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

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

The Effectiveness of Remineralizing Agents on Dentinal Permeability

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