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

Objective

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

Methods

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

Results

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

Conclusion

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

The Role of Transient Receptor Potential (TRP) Channels in the Transduction of Dental Pain

Dental pain is a common health problem that negatively impacts the activities of daily living. Dentine hypersensitivity and pulpitis-associated pain are among the most common types of dental pain. Patients with these conditions feel pain upon exposure of the affected tooth to various external stimuli. However, the molecular mechanisms underlying dental pain, especially the transduction of external stimuli to electrical signals in the nerve, remain unclear. Numerous ion channels and receptors localized in the dental primary afferent neurons (DPAs) and odontoblasts have been implicated in the transduction of dental pain, and functional expression of various polymodal transient receptor potential (TRP) channels has been detected in DPAs and odontoblasts. External stimuli-induced dentinal tubular fluid movement can activate TRP channels on DPAs and odontoblasts. The odontoblasts can in turn activate the DPAs by paracrine signaling through ATP and glutamate release. In pulpitis, inflammatory mediators may sensitize the DPAs. They could also induce post-translational modifications of TRP channels, increase trafficking of these channels to nerve terminals, and increase the sensitivity of these channels to stimuli. Additionally, in caries-induced pulpitis, bacterial products can directly activate TRP channels on DPAs. In this review, we provide an overview of the TRP channels expressed in the various tooth structures, and we discuss their involvement in the development of dental pain.

Dentin hypersensitivity induces anxiety and increases corticosterone serum levels in rats

AIMS

Investigate the relationships between experimentally induced dentin hypersensitivity (DH) with behavioral, endocrine and dentin erosion data.

METHODS

Male Wistar rats divided into four groups, two controls and two experimental, received tap water or isotonic solution (Gatorade®, lemon, pH2.7) for 30 or 45 days. The DH test was performed by a cold water stimulus on molars. A score (0-3) was given to the rats' pain response. Anxiety was evaluated by the elevated plus maze model and by serum corticosterone levels. The dentin erosion was observed by scanning electron microscopy (SEM). Anatomopathological studies were performed on the stomach, adrenal, kidney, and liver.

RESULTS

Relative to control groups, experimental rats showed: 1) increased hypersensitivity scores (control group, 0; experimental groups, 2 (limits 0.5-3) on the 30th day and 2 (limits 1-3) on the 45th day); 2) reduced percentage of time and entries in the open arms and in serum corticosterone levels; 3) totally exposed dentinal tubules on the 30th day in SEM analysis of the teeth; and 4) no alterations in the anatomopathological and histological evaluations.

CONCLUSIONS

The treatment with isotonic solution for 30 days was able to induce DH after erosive challenge and severe DH was observed after isotonic solution treatment for 45 days. The pain induced by cold stimuli was consistent with the grade of DH. The close relationships between dental erosion, response to pain, serum levels of corticosterone and the EPM behavior responses reveal the effects of DH at several levels.

Validation of a dental pain screening questionnaire in a semi-urban hospital setting in South India

AIMS

To assess the validity of modified DePaQ items in correctly classifying dental pain patients into three groups of common dental conditions when compared against clinically-determined classification; generate a model of classification equations from a sub-population of the sample; and assess the validity of the model in predicting group membership of new dental pain cases.

METHODS

Consecutive adult hospital dental patients aged 18 years and older attending with a dental pain complaint were diagnosed by a dentist. Before treatment commenced a self-complete questionnaire was completed. The examining dentist was blinded to the questionnaire responses. The sample was randomly split into two groups (RS1 and RS2). Discriminant analysis was carried out on RS1 to develop a model for classifying new dental pain cases into three groups. This model was used to classify dental pain cases in RS2.

RESULTS

Of the 311 questionnaires distributed, 306 (98.4%) were returned. Of the 205 Group 1 cases diagnosed clinically 186 (90.7%) were correctly predicted as belonging to that group by M-DePaQ. For 54 clinically diagnosed Group 2 cases 44 (81.5%) were correctly predicted, and for 32 Group 3 cases, 26 (81.3%) were correctly predicted. The model of classification equations derived from RS1 were capable of correctly classifying 85%, 82% and 79% of clinically-derived classification for Group 1, 2 and 3 respectively.

CONCLUSIONS

This study has demonstrated that the M-DePaQ is valid in classifying dental pain patients into three groups of common dental conditions. Classification equations generated from a sub-group of the sample provided a valid statistical model for classifying dental pain cases from the same setting.

A comparative clinical study evaluating stain removal efficacy of a new sensitivity whitening dentifrice compared to commercially available whitening dentifrices

OBJECTIVE

To assess the extrinsic stain removal efficacy of a new sensitivity dentifrice containing sodium tripolyphosphate (STP) to marketed whitening toothpastes after six weeks of product use.

METHODS

This was a single-center, double-blind, stratified, six-week clinical study comparing the reduction in stain area and intensity of Sensodyne Extra Whitening to Crest Maximum Strength Sensitivity Protection Whitening plus Scope and Colgate Tartar Control Plus Whitening Mint dentifrice, as measured by MacPherson's Modification of the Lobene Stain Index (MMLSI) in a forced stain model.

RESULTS

Two-hundred and ninety-five subjects completed the study. Tooth stain MMSLI scores showed significant differences between Sensodyne and Crest dentifrices in favor of Sensodyne for all surface sites (p = 0.014), and individually for facial (p = 0.023), lingual (p = 0.027), and interproximal (p = 0.014) surfaces. No significant statistical differences between Sensodyne and Colgate dentifrices were observed for any of the surfaces.

CONCLUSION

Results from this stain removal clinical study demonstrate significant extrinsic stain removal efficacy for all dentifrices relative to baseline. Significant differences between the two marketed sensitivity whitening dentifrices were demonstrated in favor of the new Sensodyne Sensitivity Whitening dentifrice.

Oral rehabilitation of a patient with hypoplastic amelogenesis imperfecta: a case report

To report a case of oral rehabilitation of a patient diagnosed with hypoplastic amelogenesis imperfecta. A 18-year-old female with hypoplastic amelogenesis imperfecta presented for prosthodontic treatment to eliminate tooth sensitivity while enhancing esthetics and restoring masticatory function. Treatment included, lengthening of the maxillary and mandibular clinical crowns, and placement of metal-ceramic fixed partial dentures. The 1-year recall examination revealed no pathology associated with the rehabilitation, and the patient's esthetic and functional expectations were satisfied. For successful prosthodontic therapy, the clinician should be aware of all condition of patient.

The effect of anti-sensitivity dentifrices on brushing abrasion of eroded dentin in vitro

OBJECTIVE

To investigate the abrasive effects of three marketed anti-sensitivity, and one marketed regular dentifrice on dentin, using an erosion-abrasion in vitro model.

METHODS

Standardized human dentin specimens were prepared and exposed to cycles of erosion, remineralization, and tooth brushing, utilizing the four commercially available dentifrices. Dentin surface loss was then measured by optical profilometry after a total of nine complete cycles. The RDA and pH values of the dentifrices were also measured to assist in the interpretation of results.

RESULTS

Profilometry showed significantly greater dentin surface loss for both Colgate Sensitive Fresh Stripe and Colgate Sensitive Multi Protection when compared with Sensodyne Total Protection or Crest Cavity Protection dentifrices. The abrasive level of dentifrices correlated positively (r-squared = 0.66; p < 0.05) with dentin surface loss.

CONCLUSION

This study demonstrated that the abrasivity of dentifrices can have a significant effect on the wear of eroded dentin in vitro.

Interdisciplinary approach to treating a patient with amelogenesis imperfecta: a clinical report

Treatment of a patient with amelogenesis imperfecta (AI) presents a real problem from both functional and esthetic points of view. An esthetic result also will result in an improvement in the patient's quality of life. This clinical report illustrates the oral rehabilitation of a 24-year-old man diagnosed with hypomature type of AI. The aim of treatment was to both restore esthetics and improve masticatory function. Esthetic expectations of the patient were successfully attained by placing all-porcelain crowns from canine to canine in each arch, 12 crowns total. Moreover, metal-ceramic three-unit fixed partial dentures for the missing mandibular right first molars were fabricated for the patient's masticatory function. Resin composite restorations were applied to the maxillary premolars, the maxillary right first molar, the mandibular left premolars, and the right first premolar to modify the occlusion. No deterioration in the restorations and no pathology associated with the rehabilitation were found at the 1-year recall, and the patient's esthetic and functional expectations were satisfied. CLINICAL SIGNIFICANCE This article provides an overview of an interdisciplinary approach to treating the difficult condition of AI using a combination of treatments to achieve optimal esthetics and function.

Decision making for the patient who presents with acute dental pain

Patients who require dental emergency care for pain or trauma may not be able to see a dental practitioner for treatment. The patients often seek care in alternative medical facilities when the symptoms are too severe to be managed by over-the-counter medications. Nurses, physicians, and allied medical staff may be required to triage these patients and provide palliative treatment until the patient is able to seek definitive dental treatment. By using criteria to assess the etiology of the dental pain and implementing possible alternative treatments, these patients can receive palliative care until dental treatment becomes accessible. With the potential for development of resistant forms of microorganisms, the indiscriminate use of antibiotics for dental pain is to be avoided. Occasionally, dental patients presenting to medical settings exhibit symptoms and signs of dental-related problems that are potentially life threatening. Identification of signs of impending life-threatening complications is of paramount importance, since prompt treatment will significantly affect the prognosis.

A cross-sectional study of buccal cervical sensitivity in UK general dental practice and a summary review of prevalence studies

AIM

The initial aim of this study was to establish the prevalence of dentine hypersensitivity (DH) in a cross-sectional study of patients visiting general dental practitioners in the UK over a period of one calendar month.

METHODS

Eighteen dental practitioners examined 5,477 patients over a period of one calendar month, and patients who were diagnosed with DH were questioned further about their occupation and smoking habits. The amount of buccal gingival recession associated with the sensitive teeth was also recorded, as was the presence of periodontal disease.

RESULTS

One hundred and fifty-two patients were diagnosed as having DH, giving a prevalence figure of 2.8%. The commonest teeth affected were the first molars and premolars, and the commonest initiating factor was cold drinks. A tendency for a greater number of DH teeth was also found for patients with periodontal disease who also smoked. There was also a tendency for the patients with DH teeth to come from higher social groups.

CONCLUSION

At the time of conducting this study, the European Federation of Periodontology had not recommended that sensitive teeth associated with periodontal disease and treatment be termed root sensitivity (RS). The title of this paper was therefore chosen to reflect this decision, and the data represent teeth both within and between subjects with DH and RS.

Failure risk of posterior composites with post-operative sensitivity

Post-operative sensitivity (POS) may be observed in recently placed posterior composites. Evidence-based guidelines for the management of posterior composites with POS have yet to be determined. This study examined a retrospective analysis of the findings of a unique multi-center clinical trial to investigate the five-year risk of failure of posterior composites with POS and to determine the factors likely to have an important impact on the prognosis of the restorations. Longitudinal five-year data from the multi-center trial of Occlusin were analyzed. Data pertaining to a total of 1,101 restorations were included in the study. The failure rate at five years was calculated by means of three selected methods for all the restorations included in the study and for restorations with POS. Risk of failure for restorations with POS was analyzed by calculating an odds ratio along with the 95% confidence interval (CI). Logistic regression was carried out in order to identify those factors most likely to have had an important impact on the prognosis of restorations with POS. The analysis revealed that the restorations of Occlusin with POS were found to have been more likely to have failed at five years than the restorations of Occlusin without POS, with odds ratios ranging from 1.73 (95% CI: 1.04, 2.87) to 1.97 (95% CI: 1.36, 2.85). Distributions of patient age and cavity size were significantly different for successful and failed restorations (chi-square test, p < 0.05). Logistic regression indicated that cavity size was the only factor likely to have influenced the prognosis of the restorations with POS (p = 0.041, odds ratio 3.21, 95% CI 1.05: 9.70). Restorations with POS in large cavities were more likely to have failed by five years than restorations in small cavities. It was concluded that the restorations with Occlusin included in the Occlusin trial program were more likely to have failed at five years if POS occurred within one month of placement. Cavity size has been shown to have been an important factor in the prognosis of Occlusin trial restorations with POS.

Reasons for placement and replacement of amalgam restorations in Jordan

AIMS

To record the reasons for placement and replacement of amalgam restorations in Jordan, to determine the use of amalgam restorations in common cavity types and to collect data on the age of the replaced amalgam restorations.

SUBJECTS AND SETTING

Dentists in Jordan (n=241).

METHOD

Cross-sectional study using postal survey backed up with personal contact. Data was recorded for all restorations placed or replaced over a period of one month.

RESULTS

Information was collected on 3,166 restorations from patients aged 9 to 66 years. Of all restorations, 54.8% were first time placements while 45.2% were replacements of old restorations. The major reason for the first time restorations was primary caries, while that for replacement was secondary caries (28.5%) followed by broken and lost restorations (20.4%), root canal therapy (17%), tooth fracture (12%), pain or sensitivity (8.8%), poor margins (8.5%).

CONCLUSIONS

In Jordan, the main reason for first placement of amalgam restoration is primary caries, the main reason for replacement is secondary caries.

MGDS case presentation: hypodontia with retained deciduous teeth

This case, which was presented as a log diary for the 1997 Diploma of Membership in General Dental Surgery (MGDS) examination, describes the examination, treatment planning, and subsequent treatment of a patient displaying mild hypodontia with retained deciduous teeth and lateral excursions guided by group function. It incorporates preventive treatment and management of early interproximal caries, prerestorative orthodontics, reorganisation to a canine-guided occlusion using conventional and adhesive cast restorations, and management of an occasional clenching habit.

Clinical dental application of Er:YAG laser for Class V cavity preparation

Following the development of the ruby laser by Maiman in 1960, the Nd:YAG laser, the CO2 laser, the semiconductor laser, the He-Ne laser, excimer lasers, the argon laser, and finally the Er:YAG laser capable of cutting hard tissue easily were developed and have come to be applied clinically. In the present study, the Er:YAG laser emitting at a wavelength of 2.94 microns developed by Luxar was used for the clinical preparation of class V cavities. Parameters of 8 Hz and approx. 250 mJ/pulse maximum output were used for irradiation. Sixty teeth of 40 patients were used in this clinical study. The Er:YAG laser used in this study was found to be a system suitable for clinical application. No adverse reaction was observed in any of the cases. Class V cavity preparation was performed without inducing any pain in 48/60 cases (80%). All of the 12 cases that complained of mild or severe intraoperative pain had previously complained of cervical dentin hypersensibility during the preoperative examination. Cavity preparation was completed with this laser system in 58/60 cases (91.7%). No treatment-related clinical problems were observed during the follow-up period of approx. 30 days after cavity preparation and resin filling. Cavity preparation took between approx. 10 sec and 3 min and was related more or less to cavity size and depth. Overall clinical evaluation showed no safety problem with very good rating in 49 cases (81.7%).

[Fundamentals of diagnosis, prognosis, treatment and prevention of root caries]

We have analyzed the principles for the diagnostic of root caries and its etiology. We have defined preventives and restoratives measures that the general practitioner or the specialist can indicate. We discussed the results and prognostic effects of these procedures.