A new treatment alternative for sensitive teeth: A desensitizing oral rinse

Mussel-inspired remineralizing agent: effects on morphology and permeability of dentin after erosion and abrasion cycling protocol

OBJECTIVE

This study aimed to evaluate the effects on morphology and permeability of dentin after an erosive and abrasive cycling protocol followed by treatment with an experimental solution containing dopamine.

MATERIALS AND METHODS

Dentin hypersensitivity was simulated in human dentin discs by applying EDTA for 5 min. After assessing maximum dentin permeability (initial), specimens were randomly allocated into four groups: distilled water (control), NaF 0.05% solution, a commercial solution (Colgate® Sensitive Pró-AlívioTM), or an experimental solution containing dopamine and laccase (n = 15). An erosive/abrasive cycling protocol was applied, including 0.3% citric acid for 2 min 4x/day, brushing for 5 s 2x/day, treatments for 5 min 2x/day. Dentin permeability was reassessed (final). Percentage permeability for each time point was calculated relative to maximum permeability (%Lp) and analyzed by generalized linear mixed models (α = 0.05). Surface effects were analyzed by scanning electron microscopy.

RESULTS

A significant reduction in permeability occurred in all groups post-cycling and treatment (p < 0.05), with no significant differences between groups (p = 0.6082). All groups exhibited sparse surface deposits, with few occluded tubules. Tubules appeared smaller in diameter in the Colgate® and experimental solution groups, while distilled water and NaF groups showed more open tubules.

CONCLUSION

In this model, dopamine demonstrated a limited effect, showing no significant protection of the dentin surface or reduction in permeability, similar to the other tested solutions.

CLINICAL RELEVANCE

Changes in the habits of modern society have increased the prevalence of tooth wear and dentin hypersensitivity. In this context, it is essential to develop not only new active ingredients to prevent or minimize mineral loss but also new treatment methods.

Evaluation and comparison of the effects of a new paste containing 8% L-Arginine and CaCO3 plus KNO3 on dentinal tubules occlusion and dental sensitivity: a randomized, triple blinded clinical trial study

BACKGROUND

Dentin hypersensitivity, often occurring after dental treatments or from erosive lesions, is a prevalent patient complaint. This study introduces a paste combining 8% L-arginine, calcium carbonate, and potassium nitrate to evaluate its impact on dentinal tubules occlusion, dentin permeability, and tooth sensitivity.

METHODS

Dentin surfaces from 24 third molars (thickness: 2 mm) were divided into two groups of 12. One received the experimental paste, while the other received a placebo without desensitizer. Permeability and sealing ability were assessed through scanning electron microscopy (SEM) and dentin permeability measurement. The pastes' effects on hypersensitivity were then examined in a triple-blind, randomized parallel-armed clinical trial with 16 eligible patients. Sensitivity to cold, touch, and spontaneous stimuli was recorded using the VAS scale at various intervals post-treatment. Statistical analysis was conducted using Shapiro-Wilk, Mann-Whitney U, Friedman, and Wilcoxon tests (α = 0.05).

RESULTS

The permeability test demonstrated a significant reduction in dentin permeability in the experimental group (P = 0.002) compared to the control (P = 0.178). SEM images revealed most dentinal tubules in the intervention samples to be occluded. Clinically, both groups showed a significant decrease in the three types of evaluated sensitivity throughout the study. However, no significant difference in sensitivities between the two groups was observed, with the exception of cold sensitivity at three months post-treatment (P = 0.054).

CONCLUSION

The innovative desensitizing paste featuring 8% L-arginine, calcium carbonate, and potassium nitrate effectively occluded dentinal tubules and reduced dentin permeability. It mitigated immediate and prolonged dentin hypersensitivity to various stimuli, supporting its potential role in managing dentin hypersensitivity.

TRIAL REGISTRATION

http://irct.ir : IRCT20220829055822N1, September 9th, 2022.

Does a pretreatment with a dentine hypersensitivity mouth-rinse compensate the pain caused by professional mechanical plaque removal? A single-blind randomized controlled clinical trial

Objectives

Pain is affecting acceptance of supportive periodontal therapy and primary periodontitis prevention. Our objective was to evaluate the efficacy of a 1-week pre-treatment use of dentinal-hypersensitivity-reducing mouth-rinses (DHM) in periodontal maintenance (SPT) or dental prophylaxis patients.

Material and methods

One hundred fifty-five participants attending for professional mechanical plaque removal (PMPR) were randomly assigned to use a mouth-rinse twice daily for 1 week prior to their next PMPR. Rinses were containing either potassium oxalate (n = 52), arginine (n = 52), or herbal extracts (n = 51). At baseline and reassessment, procedural pain was assessed by visual analogue scale (VAS) and verbal rating scale (VRS). Self-reported efficacy was documented.

Results

No inter-group differences were estimated between both test groups and the control for baseline and reassessment means (VAS, VRS). In the SPT group, VAS reduction and self-reported efficacy were found (p < 0.05).

Conclusion

The 1-week use of DHM failed to show a predictable effect on discomfort during PMPR overall. Around 20% of the patients showed a quantifiable benefit from both test mouth-rinses, whereas more than 50% reported a subjective pain reduction. Focusing patients undergoing supportive periodontal therapy, quantifiable effects were found for both test groups. From a patient’s point of view, DHM might be a suitable adjunct to enhance procedural comfort, especially in patients with a history of periodontitis.

Clinical relevance

The 1-week use of the dentinal-hypersensitivity-reducing mouth-rinses prior to professional-mechanical-plaque-removal showed to be a suitable adjunct to enhance procedural comfort during instrumentation, especially in patients undergoing supportive periodontal therapy.

Registration number: DRKS00010811

Electronic supplementary material

The online version of this article (10.1007/s00784-020-03643-4) contains supplementary material, which is available to authorized users.

Effect of a stannous fluoride toothpaste on dentinal hypersensitivity: In vitro and clinical evaluation

BACKGROUND

The authors conducted an in vitro and a clinical study to assess the effect of a toothpaste containing stannous fluoride to occlude dentin tubules and reduce dentinal hypersensitivity.

METHODS

For the in vitro study, the authors treated the surface of human dentin specimens with test or control toothpaste slurries and then evaluated them by using various spectroscopic techniques. For the clinical study, male and female participants who met the inclusion criteria brushed their teeth twice daily for 1 minute with test or control toothpaste. The authors assessed dentinal hypersensitivity by using tactile and air blast stimuli at baseline and after 4 and 8 weeks. All statistical tests of hypotheses were 2 sided, with a significance level of α set at .05.

RESULTS

Results from in vitro studies showed that the test toothpaste effectively occluded the dentinal tubules with a deposit consisting of tin, zinc, phosphate, and silicon. The test and control toothpastes occluded the tubules 82% and 35%, respectively. Clinically, at the 4- and 8-week examinations, the test toothpaste provided statistically significant (P < .001) improvements in tactile dentinal hypersensitivity scores of 27.8% and 42.0% and in air blast hypersensitivity scores of 21.4% and 32.3%, respectively, relative to the control toothpaste.

CONCLUSIONS

The in vitro results indicate the toothpaste containing 0.454% stannous fluoride effectively coated dentin surfaces and occluded patent dentin tubules. Compared with the control toothpaste, the test toothpaste provided a significant reduction in dentinal hypersensitivity after 8 weeks of product use.

PRACTICAL IMPLICATIONS

A multi-benefit option for patients with dentinal hypersensitivity.

Prevalence of Hypersensitivity in Teeth Affected by Molar-Incisor Hypomineralization (MIH)

AIM

This study aimed to investigate the prevalence of hypersensitivity in molar-incisor hypomineralization (MIH)-affected molars through a census carried out in 8-year-old schoolchildren.

METHODS

Examinations were conducted by a calibrated examiner, using the Nyvad criteria for caries diagnosis and a new criterion for MIH assessment. For hypersensitivity assessment, all MIH-affected molars were included. Nonaffected molars from the same child were used as controls. Air blast reaction was measured using the Visual Analogue Scale (VAS) and the Schiff Cold Air Sensitivity Scale (SCASS) scale, while tactile hypersensitivity was scored using VAS only. Statistical analysis was performed using the Kruskal-Wallis test followed by Dunn's multiple comparisons test for quantitative data. χ2 was used for the comparison of categorical data.

RESULTS

In total, 631 children were assessed, of whom 102 had MIH-affected molars (16.1%). Of these, 51.7 and 8.7% presented enamel and dentin carious lesions, respectively. Regarding the number of teeth, 239 molars were MIH affected (59.8%), with 188 (78.7%) being classified as mild (opacities only), 20 (8.4%) as moderate (posteruptive enamel breakdown), and 31 (13%) as severe (posteruptive breakdown involving dentin/atypical restorations). Hypersensitivity was recorded in only one control molar, while the prevalence of hypersensitivity in MIH-affected molars was 34.7%, being of low intensity and more prevalent in moderate (55%) and severe cases (51.6 %) than in mild cases (29.8%, p = 0.008). An association between hypersensitivity and the presence of mild and moderate cases was observed. Although the same association was observed for severe cases, it was not considered a reliable information as 90% of the MIH-affected molars with posteruptive breakdown involving dentin were affected by carious lesions. It is known that dental caries is a confounding factor for the presence of hypersensitivity.

CONCLUSIONS

Hypersensitivity was significantly higher in MIH-affected molars than in nonaffected molars, being associated with MIH teeth presenting opacities and posteruptive enamel breakdown.

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

Background:

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

Materials and Methods:

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

Results:

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

Conclusion:

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

Avaliação ex vivoda obliteração de túbulos dentinários humanos pelo uso comparativo de agentes dessensibilizantes convencionais e dessensibilizantes contendo biovidro

O objetivo do presente estudo foi avaliar a eficácia ex vivo de um dentifrício dessensibilizante contendo biovidro (Sensodyne®Repair&Protect, GlaxoSmithKline Brasil Ltd., Rio de Janeiro, Brasil), quanto ao potencial de obliteração dos túbulos dentinários e compará-lo com os dentifrícios convencionais (Colgate® Sensitive Pro-Alívio™, Colgate-Palmolive, São Paulo, SP, Brasil eSensodyne® Rápido Alívio, GlaxoSmithKline Brasil Ltd., Rio de Janeiro, Brasil). Foram utilizados 12 pré-molares humanos divididos em: G1 (n=4) - escovação com Colgate®Sensitive Pró-Alívio; G2 (n=4) - escovação com Sensodyne® Rápido Alívio; e G3 (n=4) - escovação com Sensodyne®Repair&Protect. As amostras foram submetidas à simulação de escovação de um período de oito semanas, com duas escovações diárias e analisadas em microscopia eletrônica de varredura (MEV), quanto à presença e características dos túbulos dentinários; a espectroscopia de raios-X por dispersão em energia (EDS), a fim de avaliar os elementos químicos presentes nos túbulos dentinários. A análise qualitativa da obliteração dos túbulos dentinários foi avaliada por meio das fotomicrografias. Para verificar a distribuição normal dos dados da EDS, utilizou-se o teste de Shapiro-Wilk (p<0,05). De acordo com a normalidade apresentada, foram executados teste t-Studentde amostras pareadas e teste de Wilcoxon. No grupo G1 foi verificada diminuição na luz dos túbulos dentinários, enquanto no G2, além da diminuição dos túbulos, nítida deposição de partículas obliteradoras foi observada. No G3, foi detectada não só a obliteração dos túbulos, mas também a diminuição na quantidade dos mesmos; além da formação de uma camada de hidroxidocarbonato de apatita (HCA)sobre a dentina. A análise conjunta dos dados permitiu concluir que os dentifrícios testados foram capazes de ocluir os túbulos dentinários e que o dentifrício Sensodyne®Repair&Protect apresentou melhor eficácia na obliteração dos túbulos dentinários, seguido respectivamente dos dentifrícios Sensodyne® Rápido Alívioe Colgate®Sensitive Pró-Alívio.

Efficacy of desensitizing products containing 8% arginine and calcium carbonate for hypersensitivity relief in MIH-affected molars: an 8-week clinical study

Objectives

The objective of this study was to compare the efficacy in reducing hypersensitivity in molar incisor hypomineralization (MIH)-affected molars immediately and over 8 weeks combining a single in-office application and a homed-based program with desensitizing products containing 8% arginine and calcium carbonate.

Materials and methods

Nineteen children with at least one MIH-affected molar with hypersensitivity were included. Hypersensitivity was assessed with an evaporative (air) stimulus and a tactile stimulus. Each child received a single in-office treatment with a desensitizing paste containing 8% arginine and calcium carbonate (elmex Sensitive Professional desensitizing paste), followed by 8 weeks of brushing twice daily with a desensitizing toothpaste containing 8% arginine, calcium carbonate with 1450 ppm fluoride (elmex Sensitive Professional toothpaste), using the elmex Sensitive Professional toothbrush. Additionally, the corresponding mouthwash (elmex Sensitive Professional mouthwash) was used. Clinical assessments were made at baseline, immediately after the in-office treatment and after 1, 2, 4 and 8 weeks of brushing twice daily.

Results

Fifty-six molars with an air blast hypersensitivity score of 2 or 3 (Schiff Cold Air Sensitivity Scale) were included. Application of the desensitizing paste decreased hypersensitivity significantly immediately and throughout the 8 weeks recalls (p < 0.001).

Conclusions

In conclusion, 8% arginine and calcium carbonate were able to reduce hypersensitivity successfully during this 8-week trial.

Clinical relevance

Hypersensitivity is a major complaint in patients with MIH. This is the first study evaluating the desensitizing effect of a desensitizing paste containing 8% arginine and calcium carbonate in patients with MIH.

Effects of different desensitizing treatments on root dentin permeability

The objective of this study was to evaluate the effects of diode laser and a desensitizing dentifrice on dentin permeability. Fifty-two root dentin fragments were obtained (5 × 5mm) and treated with 24% EDTA gel. The samples were divided into 4 groups (n = 13): G1, control (no treatment); G2, diode laser (λ = 908 nm, 1.5 W, continuous mode, 20s); G3, application of abrasive dentifrice for 1 minute (Elmex Sensitive Professional (International Gaba); and G4, application of abrasive dentifrice for 1 minute followed by irradiation with diode laser. Ten samples per group were immersed in 2% methylene blue solution for 4h. The specimens were washed, longitudinally sectioned, observed under optical microscopy, photographed and assessed based on the degree of dye leakage. The remaining samples were observed under scanning electron microscopy (SEM). The leakage data were subjected to ANOVA test, followed by Tukey's t-test (α = 5%). Groups 2, 3 and 4 showed less dye penetration than the control group (p < 0.05), but were similar among each other. SEM images showed that dentinal tubules were open in G1, and fused and occluded in G2. Group 3 showed dentinal tubules that were occluded by the metal ions from the toothpaste. G4 presented similar characteristics to G3, and the presence of fused dentin. The diode laser and the dentifrice were effective in reducing dentinal permeability, and the combination of the two treatments did not show better results than either one used alone.