Long-Term Effect of Diode Laser Irradiation Compared to Sodium Fluoride Varnish in the Treatment of Dentine Hypersensitivity in Periodontal Maintenance Patients: A Randomized Controlled Clinical Study

Efficacy of Biosilicate Glass-ceramic and Fluoride Varnish in the Treatment of Dentin Hypersensitivity-A Randomized Controlled Clinical Trial

OBJECTIVE

The objective of this study was to compare the efficacy of Biosilicate and Duraphat in the treatment of dentin hypersensitivity (DH).

METHODS AND MATERIALS

This clinical trial was conducted with young adults presenting DH. A visual analogue scale (VAS) was used to assess the level of pain, using volatile and tactile tests. Forty participants presenting two teeth with DH were included, and these teeth were divided into two groups according to the treatment: Biosilicate or Duraphat. Each product was randomly applied on one tooth per participant once a week for 4 weeks and evaluated every 15 days for 60 days after the last application.

RESULTS

The mean and standard deviation (SD) of VAS values for the initial volatile sensitivity evaluation were 6.18 (1.99) and 6.08 (1.98) for the Biosilicate and Duraphat groups, respectively, and at the fourth week 0.48 (1.5) and 0.83 (1.58). After 60 days, the volatile sensitivity showed the following values: 0.63 (1.19) for Biosilicate and 1.03 (1.07) for Duraphat. The intragroup comparison showed a significant reduction of mean VAS values for DH-related pain assessed by volatile testing for both groups (p<0.001), and the assessment at the 60-day follow-up showed mean values statistically similar to those obtained at the end of treatment. Initial tactile sensitivity observed was 1.48 (2.39) for the Biosilicate and 1.4 (2.2) for the Duraphat group and at the 60-day follow-up 0.23 (0.73) and 0.15 (0.36), respectively, with significant statistical difference (p<0.002). When the reduction in tactile and volatile sensitivities between both groups was compared, no statistically significant difference was observed.

CONCLUSION

This study indicated that both products were able to promote an important reduction in dentin hypersensitivity with similar results within a 60-day follow-up.

Fluoride Varnish in Dentistry: A Bibliometric Analysis of the 100 Most-Cited Papers

A highly cited paper is a milestone and might impact research and clinical practice. The present study analyzed the 100 most-cited papers on fluoride varnishes in dentistry. A search was performed on July 20, 2022, on the Web of Science Core Collection. Two independent researchers extracted the following data: number and citation density; year and journal of publication; study design; main topic; authors; institutions; keywords; countries and continents. Scopus and Google Scholar were consulted to compare the number of citations. Bibliometric networks were generated in the VOSviewer. The number of citations ranged from 36 to 351, and thirteen papers were cited more than 100 times. The papers were published between 1977 and 2018, most of which were published after 2008 (48%). The most prevalent journal was Caries Research (17%). Intervention studies were the most common design (41%). The most discussed topics were dental caries prevention (48%) and dental remineralization (31%). Europe was the continent with the highest number of publications (46%), mainly from Sweden (14%), and Umea University had the most substantial number of studies (8%). Petersson L.G. was the author with more papers in the top 100 (6%). The most used keywords were "dental caries" (34%) and "fluoride varnish" (31%). It can be concluded that the top 100 cited papers on fluoride varnish primarily originated from Europe, with the majority consisting of intervention studies focusing on the utilization of fluoride varnish for the prevention of dental caries.

Comparison of Lasers and Desensitizing Agents in Dentinal Hypersensitivity Therapy

The main objective of this review is to verify the validity of laser therapy in the treatment of dentin hypersensitivity, an extremely common problem in patients, with Nd: YAG lasers or high- and/or low-power diode lasers to obtain a definitive protocol for the treatment of hypersensitivity, given the multiplicity of laser treatments proposed by the numerous authors evaluated. The authors performed an electronic search on PubMed, favouring it as a search engine. Lasers represent a means of treating dentin hypersensitivity, used alone and/or in conjunction with specific products for the treatment of such a pathology. The selected articles that examined diode lasers were divided according to the wattage (w) used: low-level laser therapy protocols, i.e., those using a wattage of less than 1 W, and high-level laser therapy protocols, i.e., those using a wattage of 1 W or more. Regarding the Nd: YAG laser, it was not necessary to subdivide the studies in this way, as they used a wattage of 1 W or more. A total of 21 articles were included in the final selection. Laser therapy was found to be effective in the treatment of dentin hypersensitivity. However, the level of effectiveness depends on the laser used. The results obtained from this review show that both the Nd: YAG laser and the diode laser (high and low power) are effective in the treatment of dentin hypersensitivity. However, the high-power laser appears to be more effective in combination with fluoride varnish and the Nd: YAG laser achieved greater long-term benefits than the diode laser.

Efficacy of 810 nm and 650 nm Diode Laser Alone and in Combination With Sodium Fluoride Gel in Treating Dentin Hypersensitivity: A Split-Mouth Randomized Clinical Study

Introduction Dentin hypersensitivity has been defined as a short, sharp pain caused by exposing naked dentin to external stimuli such as evaporation, heat, cold, osmotic liquids, and tactile effects. None of the available treatments has been considered the gold standard in treating dentin hypersensitivity. The use of laser has recently become more popular, and it is a promising treatment method in this field. The study aimed to compare the effectiveness of both 810 nm and 650 nm diode lasers in treating dentin hypersensitivity. Materials and methods This study was conducted on six patients who were referred to the Department of Oral Medicine, Faculty of Dental Medicine, Damascus University (4 females and 2 males) with 108 teeth suffering from generalized dentin hypersensitivity and were randomly divided into two groups. Group 1 consisted of three patients with 50 teeth treated with an 810 nm diode laser; it was divided by the split-mouth design into two subgroups. The first subgroup was treated by the application of the laser alone toward the target area with 1-watt power, continuous mode, and a total application time of 90 seconds, and the second subgroup was treated by applying sodium fluoride gel for one minute, then the laser was applied with the same settings as the first subgroup. Group 2 consisted of three patients with 58 teeth treated with a 650 nm diode laser; it was divided by the split-mouth design into two subgroups. The first subgroup was treated by the application of the laser alone toward the target area with 200 m watt power, continuous mode, and a total application time of 120 seconds, and the second subgroup was treated by applying sodium fluoride gel for one minute and then applying the laser with the same settings as the first subgroup. The pain was evaluated using a numeric rating scale (NRS) of 100 degrees before and immediately after treatment, and then after three to six and nine months by applying an air stream from a dental chair syringe at a distance of 0.5 cm from the target area. Results This study showed that both types of lasers were effective in treating pain caused by dentinal hypersensitivity. The average values ​​of pain reduction on the NRS showed the superiority of the 810 nm diode laser over the 650 nm after treatment and at all time points of pain assessment. No statistically significant differences were detected between applying laser alone and applying it combined with sodium fluoride gel in pain reduction values. Conclusions The application of an 810 nm diode laser either alone or in combination with sodium fluoride gel in treating dentin hypersensitivity is effective and better than the application of a 650 nm diode laser either alone or in combination with sodium fluoride gel. In addition, applying a 650 nm diode laser either alone or in combination with sodium fluoride gel has slight effectiveness in treating dentine hypersensitivity, and it is believed that a single treatment session with a 650 nm diode laser was not enough to obtain the required pain reduction.

Impact of the combined effect of diode laser (976 nm) and Sodium Fluoride gel in the Treatment of Dentin Hypersensitivity: An Ex Vivo Study.. [DOI: 10.21203/rs.3.rs-2358206/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background: Dentin Hypersensitivity (DH) is a painful condition with challenging treatment options. Aims: This study aims to evaluate the effects of the diode laser on dentinal tubules by a diode laser, as well as the mechanism of the diode laser (976 nm) and chemical agent (sodium fluoride gel) in occluding the dentinal tubules in vitro. Materials and Methods: Ten extracted human premolars were utilized in the current in vitro experimental SEM study. Using a diamond saw at a coronal dentin, disks of 1.0 mm thickness were cut perpendicular to the long axis of each tooth. Ten dentin disks were selected, and each disk was divided into four equal parts, pre-treated with Ethylene Diamine Tetra Acetic Acid 17%, then divided into four groups; (Group 1) control, (Group 2) diode laser 976 nm of 1 watt, (Group 3) Sodium fluoride only and (Group 4) combined laser and sodium fluoride varnish. The samples were analyzed using a scanning electron microscope at different magnifications (100µm, 50µm, 20µm, and 2µm). ANOVA Test was used to compare the diameter of the tubules and area between the four groups, with the level of significance set at a p-value of ˂0.05. Results: Group 1 (control, no treatment) showed an opening of all the dentinal tubules. Both samples of Group 2 (laser) and Group 3 (Sodium Fluoride) demonstrated partial occlusion and narrowing of most dentinal tubules, while Group 4 (combined) showed total occlusion of almost all the dentinal tubules. There is a statistically significant difference between the four groups regarding the diameter of the dentinal tubules and the area of 5×5 mm diameter on the dentin disks. Conclusions: The combination of Diode laser (976 nm) 1W and sodium fluoride varnish significantly affected the dentinal tubule occlusion, thus preventing DH.

Effect of Different Desensitizers on Shear Bond Strength of Self-Adhesive Resin Cements to Dentin

The sealing and bonding characteristics of luting cements may be affected by the application of desensitizers containing ingredients that induce chemical interaction with dentin organic matrix. This study evaluated the effect of different desensitizers on the immediate and long-term shear bond strength (SBS) of a self-adhesive resin cement (SARC) to dentin. Healthy bovine dentin specimens were used for the study. Gluma® Desensitizer, Desensibilize Nano P®, and Soothe® desensitizer were used in study groups, while the control group did not receive any treatment. Next, SARC (RelyXTM U200) in cylindrical mold was applied to the sample surface. All specimens were stored at 37 °C for 24 h or six months and tested for SBS. Additionally, water contact angle was measured using an optical tensiometer. Results were analyzed by analysis of variance and Student-t tests (p ˂ 0.05). Application of the different types of desensitizers had no significant influence on immediate or long-term SBS of SARC to dentin (p > 0.05). Differences for water contact angle were not statistically significant among the tested groups (p = 0.450). Within the limitations of the present study, it can be concluded that the application of the different types of desensitizers had no significant influence on the SBS of a SARC to dentin.

Power Output of Two Semiconductor Lasers: An Observational Study

The objective of this study was to evaluate the power output of two dental devices. The study examined two semiconductor lasers, namely, SIROLaser Blue (445 nm, 970 nm) and Picasso (810 nm). The power output performance was studied at the maximum output power of the devices. The study compared the preset power output measured by a power meter in a continuous-wave mode and in pulsed mode at 50% duty cycles. Ten 60 s measurements were performed for each setting. The largest difference between the stipulated and the actual output power at continuous-wave (D-cw) and pulsed (D-p) modes was calculated. Moreover, the percentage variations in the mean output power at continuous-wave (%D-cw) and pulsed (%D-p) modes were calculated. The D-cw values for 445 nm, 970 nm, and 810 nm lasers were 0.7 W, 0.5 W, and −0.3 W, respectively, and %D-cw values were 21%, 23%, and −8%, respectively. The D-p values for 445 nm, 970 nm, and 810 nm lasers were 1.1 W, 0.5 W, and −0.1 W, respectively, whereas the %D-p values were 37%, 26%, and −3%, respectively. This study found that the actual power is not necessarily lower but can be higher than the displayed power output. Clinicians are recommended to calibrate the laser output by using a power meter before use.

Evaluation of Dentin Tubule Plugging Efficiencies and Effects on Dentin Surface Roughness of Dentin Desensitizing Agents, the Er,Cr:YSGG Laser, and Their Combination After Erosion-Abrasion Cycles: An In Vitro Study

OBJECTIVES

The purposes of this in vitro study were to evaluate the tubule plugging efficiencies and effects on the surface roughness of dentin of different dentin desensitizing agents (DDAs; Teethmate Desensitizer, Kuraray; Gluma Desensitizer, Kulzer; Clinpro White Varnish, 3M ESPE; Enamelast, Ultradent) and the Er,Cr:YSGG laser (Biolase, Waterlase), both alone and in combination with DDAs, after application and after an erosion-abrasion cycle.

METHODS AND MATERIALS

For surface roughness examinations, superficial buccal dentin specimens were divided into 10 groups: the control, Teethmate Desensitizer, Gluma Desensitizer, Enamelast, Clipro White Varnish, Er,Cr:YSGG Laser, Teethmate Desensitizer-Laser, Gluma Desensitizer-Laser, and Enamelast-Laser, and Clinpro White Varnish-Laser groups. Profilometric analyses and scanning electron microscopy (SEM) examinations were performed after applications and after a 5-day erosive-abrasive cycle. For the statistical analysis of surface roughness measurements, 2-way analysis of variance (ANOVA), 1-way ANOVA, and Tukey post hoc test were used.

RESULTS

Among the treatments, only DDAs alone did not cause increase in surface roughness after application. All of the laser applications increased the surface roughness of dentin, and after the erosion-abrasion cycle, all of the test groups had increased surface roughness. However, SEM images showed that morphological changes were less frequently observed in all of the experimental groups than in the control group. In addition, all of the laser-DDA combinations had stronger tubule occlusion effects than did DDAs alone, even after erosion-abrasion.

CONCLUSIONS

All of the test treatments showed protective effects on dentin surfaces against the negative effects of erosion-abrasion. The addition of the laser to DDA applications increased tubular plugging efficiencies of DDAs, and the tubule plugs of the combination treatments were resistant to the erosion-abrasion cycle.

Deep and compact dentinal tubule occlusion via biomimetic mineralization and mineral overgrowth

Dentinal tubule (DT) occlusion by desensitizing agents has been widely applied to inhibit the transmission of external stimuli that cause dentin hypersensitivity (DH). However, most desensitizing agents merely accomplish porous blocking or the formation of a superficial tubular occlusion layer, resulting in a lack of mechanical and acid resistance and long-term stability. Herein, combining biomimetic mineralization and mineral overgrowth of the dentinal matrix was shown to effectively occlude DTs, resulting in the formation of a compact and deep occluding mineral layer that is strongly bound to the organic matrix on tubule walls. This DT occlusion method could achieve both mechanical resistance and acid resistance, demonstrating the potential of an inexpensive, long-term, and efficient therapy for treating DH.

Effects of low-level light therapy on dentin hypersensitivity: a systematic review and meta-analysis

OBJECTIVE

To investigate the treatment efficacy of low-level light therapy on dentin hypersensitivity.

MATERIALS AND METHODS

Following the PRISMA guideline, six electronic databases supplemented with bibliographies were searched till December 2020. Two reviewers performed the screenings independently with a reliability assessment. Studies fulfilling the pre-registered eligibility criteria were included for risk-of-bias assessment and data synthesis.

RESULTS

Thirty-five articles ultimately informed this systematic review based on the eligibility criteria and underwent risk-of-bias assessment (ĸ = 0.86). Quantitative results were deduced by meta-analysis of 20 randomised controlled trials: LLLT showed favourable outcomes compared to placebos for immediate (SMD: 1.09, 95% CI: 0.47 to 1.70), interim (SMD: 1.32, 95% CI: 0.41 to 2.23), and persistent efficacies (SMD: 2.86, 95% CI: 1.98 to 3.74). However, substantial heterogeneity existed among included studies (I2: 64-95%). Regarding comparisons with other desensitising strategies, LLLT showed no significant benefits in DH alleviation over others except fluorides for interim efficacy (SMD: 0.31, 95% CI: 0.10 to 0.52) and persistent efficacy (SMD: 0.45, 95% CI: 0.03 to 0.86).

CONCLUSIONS

This systematic review shows that LLLT has positive immediate, interim, and persistent DH-treatment efficacies compared with placebo. No superior treatment effects of LLLT were observed except fluoride agent use. Further studies are warranted-RCTs with low risk of bias, consistent technical settings, comprehensive assessments, and long follow-up periods.

CLINICAL RELEVANCE

This systematic review bridges a critical research gap by analysing clinical evidence in the DH-alleviating efficacy of LLLT in comparison with placebo and other in-office desensitising strategies.

Efficacy of near infrared dental lasers on dentinal hypersensitivity: a meta-analysis of randomized controlled clinical trials

Conventional therapies have aimed to try to help individuals suffering with dentine hypersensitivity (DH/DHS). A relatively new approach, laser therapy claims to be beneficial while having immediate and long-lasting effect. Therefore, our analysis aims to explore the immediate and 1-month efficacy of near-infrared laser (NIR) therapy in treating dentinal hypersensitivity. A systematic literature search conducted in databases, and analysis was undertaken utilizing a meta-analysis approach. Randomized controlled clinical trials comparing near-infrared lasers and placebo/no treatment in patients (> 18 years) were included. The risk of bias for included studies was assessed using Cochrane RoB tool (for randomized studies). Random effects meta-analyses model of standardized mean differences and 95% confidence intervals were performed using RevMan 5.4 software. A comprehensive electronic and manual search yielded a total of 1081 potential articles. Following the implementation of the inclusion and exclusion criteria, a total of 6 studies were included in the analysis. Near-infrared laser therapy led to statistical significant reduction in immediate and 1-month follow-up VAS (visual analog scale) scores compared to placebo/no treatment (p < 0.05). Statistical heterogeneity across the studies was high (I²-96%). The findings suggest that near-infrared laser therapy does have a significant immediate effect in reducing dentine hypersensitivity compared to placebo/no treatment. Furthermore, this effect is not diminished and endured at 1-month follow-up.

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 level laser therapy, Er,Cr:YSGG laser and fluoride varnish for treatment of dentin hypersensitivity after periodontal surgery: A randomized clinical trial

This clinical trial aimed to compare the effects of low-level laser therapy (LLLT), Er,Cr;YSGG laser, and fluoride varnish, as compared to the placebo laser on decreasing dentin hypersensitivity (DH). This randomized, double-blinded clinical trial included 60 jaw quadrants in 24 patients who underwent periodontal surgery. The quadrants were randomly assigned to 4 groups and received treatments as follows. Group 1: LLLT with a combination of red and infrared wavelengths, group 2: Er,Cr:YSGG laser (0.25 W and 0.5 W), group 3: fluoride varnish, and group 4: placebo laser. The sensitivity response to the cold spray was recorded using visual analogue scale (VAS) at baseline, immediately, and 1 week post-treatment. The data were analyzed by repeated measures analysis at the significance level of P<0.05. There was a significant reduction in DH after treatment by low-level lasers, Er,Cr:YSGG laser, or fluoride varnish compared to the baseline data (P<0.05), but the placebo group displayed no significant alteration in DH (P=0.069). At 1 week, the VAS score in the Er,Cr:YSGG laser group was significantly lower than that of the LLLT (P= 0.043) and placebo (P<0.001) groups. Furthermore, the subjects who received fluoride varnish exhibited significantly lower DH compared with the placebo group (P = 0.023). Er,Cr:YSGG laser was the most effective strategy in dealing with DH, as it caused the greatest pain reduction over the study period and showed a significant superiority over LLLT and placebo groups. Alternatively, the application of fluoride varnish could be recommended for attenuating DH following periodontal surgery.

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.

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

OBJECTIVE

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

DATA

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

SOURCES

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

STUDY SELECTION

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

CONCLUSION

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

CLINICAL SIGNIFICANCE

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

The evaluation of the desensitization effect of a desensitizing agent and desensitizing toothpastes in vitro

This study was evaluating how three desensitizing toothpastes used at home influence the effect associated with desensitizing agents after application in the clinic. Fifty dentine disks measure it permeability and 32 dentine disks with similar permeability levels were selected. Following Dental desensitizer treatment, dentine disks were randomly divided into three subgroups (n=10) that received applications of three toothpastes, respectively. The permeability (Lp) of each specimen was measured after each treatment. One specimen was selected from each group for scanning electron microscopy (SEM) observation. After each treatment, the Lp values decreased significantly for each group (p<0.05) and either completely or partially blocked the dentine tubules upon SEM observation. However, no significant differences in Lp values were observed amongst subgroups (p>0.05). After using the Dental desensitizer, Sensodyne, Crest and Colgate desensitizing toothpastes both can continued to reduce the permeability of the dentine disk, and no significant differences were found amongst them.

Effectiveness of fluoride varnish, diode laser, and their combination in treatment of dentin hypersensitivity: A randomized split-mouth clinical trial

Background:

Dentin hypersensitivity is a common dental problem with no permanent cure and predictable prognosis.

Aim:

The aim of this study was to evaluate the effectiveness of fluoride varnish (sodium fluoride [NaF]), diode laser, and the combination of NaF and diode laser in the treatment of dentin hypersensitivity.

Settings and Design:

This was a randomized split-mouth clinical trial.

Materials and Methods:

Sixty patients aged 20–60 years suffering from dentin hypersensitivity to air-blast, cold, and tactile stimulation corresponding to 4 cm and above on the Visual Analog Scale (VAS) in three quadrants with at least two hypersensitive teeth per quadrant were selected. Hypersensitive teeth were allotted to Group 1 – 5% NaF varnish application alone, Group 2 – 810-nm gallium–aluminum–arsenide laser (GaAlAs) diode laser (0.5 W) irradiation alone, and Group 3 – NaF varnish application, followed by diode laser irradiation. VAS score was recorded at baseline, 1 week, 2 weeks, 1 month, 3 months, and 6 months.

Results:

A statistically significant reduction in dentin hypersensitivity was observed in all the three groups, from the baseline to the 1^st-, 3^rd-, and 6^th-month follow-ups (P < 0.05). Group 2 and Group 3 demonstrated a significantly higher reduction (P < 0.05) in dentin hypersensitivity for all the stimuli as opposed to Group 1 at all follow-up intervals. However, no statistically significant difference (P > 0.05) was present between Group 2 and Group 3 at all follow-ups.

Conclusion:

Diode laser is significantly more effective than fluoride varnish alone in the treatment of dentin hypersensitivity over a period of 6 months.

Efficacy of nano-carbonate apatite dentifrice in relief from dentine hypersensitivity following non-surgical periodontal therapy: a randomized controlled trial

Background

Dentine hypersensitivity (DH) could occur or intensify after non-surgical periodontal therapy because of the exposure of dentine tubules, but currently no gold standard exists to treat DH. It has been demonstrated that nano-sized particles presented potential for dentine tubules blocking and remineralization. This randomized controlled trial aimed to investigate the efficacy of dentifrice containing nano-carbonate apatite (n-CAP) in reducing dentine hypersensitivity (DH) after non-surgical periodontal therapy.

Methods

48 periodontitis patients with DH were included in this clinical trial. After non-surgical periodontal therapy, patients included were randomized to test and control group and the respective dentifrices were applied at chairside, after which they were instructed to brush teeth with the allocated dentifrices twice a day at home. Periodontal parameters were recorded at baseline and the last follow-up. DH was measured by air-blast test and recorded by visual analogue scale (VAS) and Schiff sensitivity scale at baseline, after polishing (0 week) and 2/4/6 weeks.

Results

45 participants completed the follow-up. Periodontal parameters were improved and comparable between groups. Significant reduction in DH was observed in both groups at all time-points compared to baseline in terms of VAS and Schiff score. The test group achieved significantly greater relief from hypersensitivity compared with the control group after 4-week at-home use (for change of VAS, test group: 2.27 ± 2.47 versus control group: 1.68 ± 2.24, p = 0.036; for change of Schiff, test group: 0.94 ± 0.92 versus control group: 0.61 ± 0.83, p < 0.001). The 6-week results showed borderline significance between groups in terms of change of Schiff (p = 0.027) and no significance in terms of change of VAS (p = 0.256).

Conclusions

Home-use of n-CAP based dentifrice had some benefit on alleviation of DH following non-surgical periodontal therapy after 4 weeks compared to the control product.

Trial registration

Chinese Clinical Trials Registry (No. ChiCTR-IPR-17011678, http://www.chictr.org.cn/, registered 16 June, 2017).

Evaluation of the Effects of 660-nm and 810-nm Low-Level Diode Lasers on the Treatment of Dentin Hypersensitivity

Introduction: Dentin hypersensitivity is a common oral problem that occurs as a short and sharp pain. There are many techniques to treat this condition, the latest of which is laser treatment. The aim of this study was to evaluate the effect of two types of low-power diode lasers (660 nm and 810 nm) on dentin hypersensitivity in order to achieve an acceptable clinical application by adjusting the effective parameters. Methods: In this randomized, double-blind clinical trial, sensitive teeth of 7 patients were divided into three groups with a randomized matching method: group I, treated with 660-nm diode laser irradiation, group II, treated with diode laser 810-nm, and group III, the control group. Irradiation parameters for 660-nm and 810-nm diode lasers were the power of 30 mW and 100 mW respectively, in contact and continuous modes, perpendicular to the tooth surface with a sweeping motion. Treatments were carried out in four sessions at weekly intervals. The data obtained were analyzed with SPSS 22, using one-way repeated measures ANOVA and the LSD (least significant difference) test. The significance level was considered as P≤0.05. Results: There were no significant differences in visual analogue scale (VAS) score changes between the two laser groups after the intervention in the first, second and third weeks compared to the baseline (P>0.05). These changes in the fourth week were significantly higher in the 810-nm laser group compared to the 660-nm laser group (P=0.04), and in the 660-nm laser group, they were more than the control group (P=0.02). The mean VAS scores at 1-week, 1-month and 2-month postoperative intervals were significantly lower in the 810-nm laser group than in the 660-nm laser group, and in the 660-nm laser group, they were less than the control group (P<0.001). Conclusion: The use of 660-nm and 810-nm diode lasers with the power of 30 and 100 mW respectively for 120 seconds was effective in reducing pain in patients with dentin hypersensitivity. However, the effect of the 810-nm laser on reducing the dentin hypersensitivity was more long-lasting than that of the 660-nm laser.

Photobiomodulation in Endodontic, Restorative, and Prosthetic Dentistry: A Review of the Literature

Objective: To provide a review of the literature about the photobiomodulation therapy (PBMT) dental treatment protocols in endodontic, restorative, and prosthetic dentistry based on validated clinical studies published so far. More specifically, this study was carried out to carefully review therapeutic protocol of PBMT in clinical studies and their conclusions. Background data: The importance of using low-power lasers and photobiomodulation (PBM) is increasing in dentistry mainly due to their painless and noninvasive function. However, lack of sufficient clinical studies has led to unclear results regarding PBMT in dentistry, and also lack of an available precise protocol for clinicians. Moreover, scarcity of clinical studies in this area has made conduction of a precise systematic review study difficult. Methods: In our study, published clinical studies up to April 2019 were reviewed from library sources, Google Scholar, PubMed and Medline, Elsevier, Embase, Cochrane, Scopus, and Web of science (ISI). Inclusion criteria included those presented in clinical trials and case report/case series, language (English), and studies available in full text. Exclusion criterion was in vitro studies. Results: In general, findings of clinical studies have shown that PBMT can have a significant role in reducing postoperative dental pain, increasing depth of anesthesia, improving tooth hypersensitivity, reducing inflammation of the tissue, and helping wound healing. Conclusions: A review of clinical studies showed that the use of alternative or adjunctive PBMT is of great importance in controlling postoperative pain after endodontic treatments. In addition, evidence suggests that different parameters of light can be efficient in the treatment of tooth hypersensitivity. Nevertheless, lack of sufficient clinical studies and reliable results do not allow introducing a precise treatment protocol.

A Study of Dentists about Their Knowledge and Practice of Dentine Hypersensitivity

Objective  The aim of this study was to evaluate the knowledge and practice about dentine hypersensitivity (DH) among dental practitioners.

Materials and Methods  A pilot-tested questionnaire was sent to practicing dentists ( n = 588) working in private and public sectors in Lahore, Pakistan. The questions assessed dentists’ knowledge about type of pain and predisposing factors of DH. The dentists were asked about their preferred methods of diagnosing and managing the condition.

Statistical Analysis  Basic statistics, chi-squared test, and multivariate logistic regression were performed.

Results  Most dentists (64.3%) reported examining one to five patients with DH per week in their dental clinics. A large majority (85.4%) indicated DH as a stimulated short pain from a tooth. Recession of gums (96.6%), aggressive brushing (88.2%), and frequent use of teeth whitening procedures (83.1%) were most frequently reported predisposing factors of DH. Among most commonly used methods of diagnosis, spontaneous pain after the application of air blast was reported by 74.8% of the participants and followed by spontaneous patient report confirmed by dental examination (57.7%). Most widely used management approaches of DH included the use of fluoride products (96.2%), use of desensitizing potassium nitrate toothpastes (75%), and application of bonding agents (56.2%). Female versus male dentists (odds ratio [OR]: 7.79, p < 0.001) and private practitioners versus public dentists (OR: 7.34, p < 0.001) were more likely to examine greater number of patients with DH.

Conclusion  Dentists used various methods for diagnosing and managing patients with DH. Application of air blast to evaluate spontaneous pain and use of fluoride products were most widely used diagnostic and management preferences, respectively.

Effect of erosive and abrasive stress on sealing ability of different desensitizers: In-vitro study

This in vitro study examined the sealing ability of different desensitizing agents under a chemo-mechanical stress condition. For the study, a total of 144 extracted, caries-free human third molars were used to produce 1 mm-thick dentin discs. The specimens were divided randomly into four groups: Superseal (SS), Gluma (GL), Gluma Self-etch (GS), and Tooth Coat (TC). For each group, the permeability was measured before and after applying the desensitizer, after being exposed to Coca Cola for 5 minutes, and after 3150 strokes of a brushing abrasion. The decrease in permeability after the erosive and abrasive stress was analyzed by ANOVA and Tukey post hoc test. As a result, the dentin permeability decreased significantly for all desensitizers immediately after application (p < 0.05). SS and GS showed a significant difference in permeability reduction observed immediately after application and after acid action with Coca Cola (p < 0.05). After brushing abrasion, the permeability reduction decreased significantly for all desensitizers tested in this study (p < 0.05). TC showed the largest decrease in dentinal permeability compared to that of the other desensitizers and the differences were significant after brushing abrasion (p < 0.05). All tested desensitizers were effective in reducing dentin permeability. The behavioral characteristics under erosive and abrasive stress varied according to the products used. TC exhibited excellent sealing ability among the other desensitizers.

Laser Effects on the Prevention and Treatment of Dentinal Hypersensitivity: A Systematic Review

Introduction: Dentinal hypersensitivity (DH) is an acute intensive tooth pain which can lead to dental annoyances during eating and drinking. Stimulating exposed dentinal tubules by either kind of thermal, tactile, chemical and/or osmotic stimuli is believed to be the cause of this pain. It is hypothesized that dentinal tubules' orifice occlusion (DOO) can help relieve such dental irritations. Thus, this systematic review was conducted to evaluate the effectiveness of laser application as a prevention and treatment modality on DH reduction. Methods: Electronic databases (MEDLINE, SCOPUS) were searched among randomized clinical trials from January 2007 to December 2016. The extraction of data and quality assessments were carried out by different independent observers. Results: A total of 499 items were found of which3 9 relevant articles were extracted. The profound findings proved lasers' effectiveness as a treatment of DH. Although some of the researches reported no significant difference between laser and other desensitizing agents, most of the studies suggested that better results (both rapid and long-lasting) were obtained in combined modalities. Furthermore, the preventive role of this new technology has been emphasized as well. Nd-YAG (neodymium-doped yttrium aluminum garnet) and diode lasers reduce DH after bleaching. Lasers can also protect cervical restorations from DH due to tubular occlusion. Moreover, it is suggested to apply lasers in relief of DH following scaling and root planning. Nevertheless, a few researchers dispute its beneficence as a result of placebo effect. Conclusion: The results obtained from several studies in the present review revealed that the application of lasers is effective not only in terms of treatment of DH, but also in the prevention of this intensive tooth pain. Among various types of lasers, the application of Nd:YAG laser has shown the best results in DH treatment.

Comparative evaluation of a low-level laser and topical desensitizing agent for treating dentinal hypersensitivity: A randomized controlled trial

Aim

The aim of this randomized, controlled, double-blinded, clinical study is to evaluate and compare the clinical effectiveness of low-level diode GaAlAs laser and glutaraldehyde-based topical desensitizing agent on cervical dentin hypersensitivity with the help of visual analog scale (VAS).

Materials and Methods

Fifty teeth of patients aged between 20 and 50 years were included, and VAS was used to assess the dentin hypersensitivity. The teeth were randomly allocated to either Group 1 or 2 using flip coin technique. Group 1 received glutaraldehyde desensitizer and Group 2 received 905 nm low-level laser. The sensitivity scores were recorded, immediately, after1 week and 3 months after therapy. Data was analyzed using Mann-Whitney U test for intergroup comparison and Friedman's test for intragroup comparison.

Results

There was a significant reduction in pain in both the groups at 3 months evaluation (P = 0.001).However, Group 2 showed a significant decrease in mean VAS scores when compared with Group 1 at both the one week and three month follow ups (P = 0.04, P = 0.03, respectively).

Conclusion

Although topical desensitizer and Low Level Laser are both effective in reducing dentinal hypersensitivity, Low Level Lasers are comparatively more effective at the studied time intervals.

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

Background:

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

Materials and Methods:

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

Results:

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

Conclusion:

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

Comparative Evaluation of Efficacy of Iontophoresis with 0.33% Sodium Fluoride Gel and Diode Laser Alone on Occlusion of Dentinal Tubules

INTRODUCTION

Dentinal Hypersensitivity (DH) is one of the most commonly encountered clinical problems. Literature reveals no specific therapy to satisfactorily eliminate dentinal hypersensitivity.

AIM

The aim of this study was to assess and compare the efficacy of iontophoresis with 0.33% Sodium Fluoride (NaF) gel and diode laser alone in dentinal tubule occlusion.

MATERIALS AND METHODS

This in vitro study included 20 teeth with intact root surfaces unaltered by extraction procedure for specimen preparation. Each tooth was cleaned, air dried and cut into three sections. Total 60 sections were prepared (30 longitudinal and 30 transverse sections), which were acid etched. In control group, no treatment was carried. In iontophoresis treatment group, samples were inserted into a foam tray containing 0.33 % NaF Gel and subjected to 1.5 mA output current for three minutes. In laser treatment group, specimens were lased with 980 nm diode laser at 0.5 W/PW (62.2J /cm²) in a noncontact mode for 30 seconds. Specimens were evaluated under Scanning Electron Microscope (SEM) at 10KV to 20KV under x 2000, x5000 magnification for surface characteristics and patency of dentinal tubules. Total number of tubules visible, open, completely and partially occluded were recorded in each microphotograph and compared.

RESULTS

On comparison, laser group showed the least number of open tubules i.e., 130 (31.1%) followed by iontophoresis group, 155 (51.32%) and control group 417 (100%).

CONCLUSION

Diode laser application provided better results as compared to iontophoresis on occlusion of dentinal tubules. Hence, it can be used to treat the patients with DH.

Application of Diode Laser in the Treatment of Dentine Hypersensitivity

INTRODUCTION

Dentine hypersensitivity is characterized by acute, sharp pain arising from the exposed dentine, most commonly in response to thermal, tactile, or chemical stimuli, and which cannot be linked to any other pathological changes in the tooth or the environment. Therapy uses various impregnating agents in the form of solutions or gels and, in more recent times, laser.

AIM

The aim of this research was to examine the effects of treatment of hypersensitive dental cervix with diode laser.

MATERIALS AND METHODS

The study included 18 patients with 82 sensitive teeth. The degree of dentine hypersensitivity was evaluated by visual analogue scale (VAS), and the treatment was carried out by application of low-power diode laser over the span of three visits, which depended on the initial sensitivity.

RESULTS

There is a significant difference in VAS values measured at the onset of treatment (baseline) and immediately after the first laser treatment (t=9.275; p=0.000), after 7 days, after the second laser treatment (14 days) (t=7.085, p=0.000), as well as after 14 days and the third laser treatment (t=5.517, p=0.000), which confirms the effectiveness of this therapeutic procedure. The results showed a reduction of hypersensitivity in response to tactile stimulus with a probe after the third treatment, even with teeth whose value on the VAS was very high at the beginning of treatment (baseline).

CONCLUSION

Within the scope of the conducted study, laser therapy has provided extremely safe and effective results in the treatment of cervical dentine hypersensitivity.

Treatment of Dentin Hypersensitivity Using Nano-Hydroxyapatite Pastes: A Randomized Three-Month Clinical Trial

Objectives: This randomized clinical trial tested the three-month desensitizing effect of two protocols using nano-hydroxyapatite formulations compared with Pro-Argin and fluoride varnish.

Methods: Twenty-eight subjects with 137 teeth presenting dentin exposure with a minimal hypersensitivity of four on the visual analog scale (VAS) took part of this study. The subjects were randomly assigned to four groups: Desensibilize Nano-P paste (20% hydroxyapatite [HAP], potassium nitrate, and sodium fluoride [NaF]; 9000 ppm fluoride [F]); Desensibilize Nano-P associated with experimental home-care pastes (10% HA, potassium nitrate, and NaF; 900 ppm F); Pro-Relief professional paste (8% arginine with Pro-Argin technology) associated with home-care toothpaste (8% arginine, sodium monofluorophosphate, 1450 ppm F); and Duraphat professional varnish (NaF varnish, 22,600 ppm F). The professional treatments were performed in weekly appointments over three weeks. The home-care products were used continuously for three months. A VAS was used to assess the tooth sensitivity response after standardized evaporative stimulus at baseline and after one month and three months. The baseline score was deducted from the final score, and the means were analyzed using nested analysis of variance, while the comparison between times was performed by a general linear model (p&lt;0.05).

Results: At the first month all treatments were effective, but there were no significant differences among them (p=0.94). At the third month, despite the fact that NaF varnish had the lowest effect in reducing hypersensitivity, no significant difference was found among the treatments (p=0.09). Only Pro-Relief increased its effect over time (p=0.049).

Conclusions: Nano-hydroxyapatite formulations (with or without home-&gt;care product association) were as effective as the other treatments in reducing dentin hypersensitivity over three months.

Effects of a Dicalcium and Tetracalcium Phosphate-Based Desensitizer on In Vitro Dentin Permeability

The present study evaluated the effectiveness of a dicalcium and tetracalcium phosphate-based desensitizer in reducing dentin permeability in vitro. Dentin fluid flow was measured before and after treatment of dentin with patent dentinal tubules using 1 or 3 applications of the dicalcium and tetracalcium phosphate containing agent TeethmateTM (TM) and comparing the results with two sodium fluoride varnishes VellaTM (VLA) and VanishTM (VAN), after storage in artificial saliva for 24 h, 48 h and 7 days. Significant differences were observed among the 4 methods employed for reducing dentin permeability (p < 0.001) and the 3 post-treatment times (p < 0.001). VLA and VAN never achieved 50% permeability reductions consistently in any of the 3 time periods. Only the calcium phosphate-based desensitizer applied for 3 times consistently reduced dentin permeability by 50% after 24 h. When applied once, the permeability reduction of TM increased progressively over the 3 time periods. After 7 days, only one and three applications of the calcium phosphate-based desensitizer consistently reduced dentin permeability by more than 50%. Permeability reductions corresponded well with scanning electron microscopy examination of dentinal tubule orifice occlusion in dentin specimens treated with the agents. Overall, the dicalcium and tetracalcium phosphate-based desensitizer is effective in reducing dentin permeability via a tubule occlusion mechanism. The ability of the agent to reduce dentin permeability renders it to be potentially useful as a clinical dentin desensitizing agent, which has to be confirmed in future clinical studies. By contrast, the two sodium fluoride varnishes are not effective in dentin permeability reduction and should be considered as topical fluoride delivering agents rather than tubular orifice-blocking agents.

Laser-assisted treatment of dentinal hypersensitivity: a literature review

The purpose of this literature review was to evaluate the effectiveness of the laser-assisted treatment of dentinal hypersensitivity. A review with inclusion and exclusion criteria was performed from January 2009 to December 2014 with electronic data-bases: MedLine via PubMed, Science Direct and Cochrane Library. Research of paper magazines by hand was not considered. Forty-three articles were selected between literature reviews, in vitro studies, clinical trials, pilot and preliminary studies. The items were divided into laser-used groups for an accurate description, and then the reading of results into various typologies. Laser-assisted treatment reduces dentinal hypersensitivity-related pain, but also a psychosomatic component must be considered, so further studies and more suitable follow-ups are necessary.

Clinical Efficacy of Fluoride Varnish and Low-Level Laser Radiation in Treating Dentin Hypersensitivity

Abstract The objective of this study was to compare the efficacy of fluoride varnish (Fluorniz(r)) and irradiation with a gallium-arsenide-aluminum diode laser in the treatment of cervical dentin hypersensitivity. Cervical dentin hypersensitivity (CDH) is a painful condition that is highly prevalent in the world's adult population, with one in six patients presenting this symptom. Eighty-six teeth were divided into two groups: Group 1, teeth treated with Fluorniz; Group 2, teeth irradiated with a GaAlAs laser at a 4 J/cm2 dose. The two treatments were applied to the buccal cervical region in four sessions, at intervals of 72 to 96 h. The response of the patient to tactile and thermal-evaporative stimuli was rated on a visual analog scale. The results showed a reduction of hypersensitivity in response to tactile and thermal-evaporative stimulation at the end of treatment in both groups. In conclusion, short-term treatment with Fluorniz was found to be more effective than low-level laser radiation in reducing cervical dentin hypersensitivity.

In Vitro Evaluation of Dentin Hydraulic Conductance After 980 nm Diode Laser Irradiation

BACKGROUND

Dentin hypersensitivity treatments are based on the physical obliteration of the dentinal tubules to reduce hydraulic conductance. The aim of the present study is to evaluate the hydraulic conductance of bovine root dentin after irradiation with a 980-nm diode laser, with or without associated fluoride varnish.

METHODS

Sixty bovine root dentin specimens were divided into six groups (n = 10 in each group): G1, G3, and G5 (0.5 W, 0.7 W, and 1 W diode laser, respectively); G2, G4, and G6 (fluoride varnish application + 0.5 W, 0.7 W, and 1 W diode laser, respectively). The dentin hydraulic conductance was evaluated at four time periods with a fluxmeter: 1) with smear layer, 2) after 37% phosphoric acid etching, 3) after the treatments, and 4) after 6% citric acid challenge. After the dentinal fluid flow measurements, specimens were also evaluated for mineral composition using energy dispersive X-ray spectroscopy (EDS).

RESULTS

Analysis demonstrated a better result with increased irradiation power (P < 0.001), especially if the diode laser irradiation was associated with the application of fluoride varnish (P < 0.001), ensuring a greater reduction in permeability. Considering the groups treated only with laser irradiation, the 1 W group was superior when compared with the 0.5 W and 0.7 W irradiated groups immediately after treatment (P < 0.001). After citric acid testing, all groups showed similar results, except when comparing the 1 W groups with the 0.5 W groups (P = 0.04). EDS results of the irradiated groups showed an increase in the proportion of calcium and phosphorus ions, which demonstrates a superficial composition modification after laser treatments.

CONCLUSION

Laser irradiation of exposed dentin promoted significant reduction in the dentin hydraulic conductance, mainly with higher energy densities and association with fluoride varnish.

Comparative In Vitro Effect of TiF4 to NaF and Potassium Oxalate on Reduction of Dentin Hydraulic Conductance

Dentin hypersensitivity (DH) is related to an increase in dentin permeability. This study tested the effect of titanium tetrafluoride (TiF4) compared with sodium fluoride (NaF) and potassium oxalate gel on reducing hydraulic conductance (Lp) from the perspective of diminishing dentin permeability. The Lp of the dentin disks (1.0 ± 0.2 mm) was evaluated using Flodec. The maximum Lp values of each disk were taken after phosphoric acid etching (15 seconds) and randomly allocated to seven groups (n=8) according to the treatments. The minimum (smear layer) and the maximum (after acid etching) Lp values were recorded. Treatments were performed for 4 minutes as follows: 1) NaF varnish 2) and solution (2.45% F, pH 5.0), 3) TiF4 varnish and 4) solution (2.45% F, pH 1.0), 5) 3% potassium oxalate gel, 6) free fluoride varnish (placebo, pH 5.0), 7) and no treatment (control). The Lp after each treatment was assessed. Samples were exposed to an erosive challenge (6% citric acid, pH 2.1, 1 minute), and the final Lp was recorded. The data were statistically analyzed using repeated measures two-way analysis of variance (p&lt;0.05). All treatments were effective in reducing dentin Lp compared with the control immediately after the application. However, only potassium oxalate and NaF varnish significantly differed from placebo varnish (p&lt;0.0001). The same results were found after the erosive challenge. Therefore, the TiF4 was less effective than the NaF varnish and potassium oxalate gel in reducing dentin permeability. Using this experimental model, both NaF varnish and potassium oxalate gel reduced the Lp similarly to the presence of smear layer.

Clinical efficacy of low-level laser therapy on localized canine atopic dermatitis severity score and localized pruritic visual analog score in pedal pruritus due to canine atopic dermatitis

BACKGROUND

Canine atopic dermatitis is a genetically predisposed inflammatory skin disease often requiring multimodal treatment. There is a need to find further low-risk adjunctive therapies.

HYPOTHESIS/OBJECTIVES

To evaluate the localized effect of low-level laser therapy (LLLT) on the paws of dogs with atopic dermatitis using a localized canine atopic dermatitis severity score (LCADSS) and owner localized pruritic visual analog score (LPVAS) in comparison to treatment with a placebo.

ANIMALS

Thirty client-owned dogs with symmetrical pedal pruritus due to canine atopic dermatitis.

METHODS

Dogs were randomly assigned into two groups. In each group, one paw was treated with LLLT and one paw treated with a placebo laser (comparing either both fore- or hindpaws). Treatments were administered at 4 J/cm(2) (area from carpus/tarsus to distal aspect of digit 3) three times per week for the first 2 weeks and two times per week for the second 2 weeks. Scores were assessed for each paw at weeks 0, 2, 4 and 5.

RESULTS

There were no significant differences in LCADSS or LPVAS between LLLT and placebo treatments between weeks 0 and 5 (P = 0.0856 and 0.5017, respectively). However, LCADSS and LPVAS significantly decreased from week 0 at weeks 2, 4 and 5 in both LLLT and placebo groups (P < 0.0001 for all).

CONCLUSIONS AND CLINICAL IMPORTANCE

Low-level laser therapy is not an effective localized treatment for pedal pruritus in canine atopic dermatitis.

Clinical evaluation of two desensitizing treatments in southern Brazil: A 3-month follow-up

OBJECTIVE

This study aimed to evaluate and compare the effectiveness of two treatments for dentin hypersensitivity in vivo during 90 days of follow-up.

MATERIALS AND METHODS

The sample consisted of 117 teeth (13 patients) that were divided into three groups: control with carbomer 940 gel (n = 32) (placebo treatment), 2% sodium fluoride gel (n = 31) and low-level infrared diode laser (n = 54). Prior to the desensitizing treatment, the dentin hypersensitivity status of each tooth was assessed by an evaporative stimulus; the patient's response was evaluated using the Visual Analogue Scale (VAS) and by counting the Exposure Time to Air Blast (ETAB) with a dental air syringe. Re-evaluations of the treatments occurred after 5 min, 7, 15, 30 and 90 days. The statistical analysis was performed using the Kruskal-Wallis test, Friedman test, one-way ANOVA, Tukey's test and Spearman's rank correlation (α = 5%).

RESULTS

No significant differences were observed among the low-level laser, 2% topical fluoride and carbomer 940 gel applications. When the methods of evaluation (VAS and ETAB) were compared, there was no difference among the groups with respect to the values for every period of evaluation (p < 0.001), verifying that the scores obtained with the VAS decreased at the same proportion as the remaining time of ETAB increased.

CONCLUSIONS

This study showed that both tested therapies were efficacious in controlling painful symptoms associated with dentin hypersensitivity over the entire 90-day follow-up period. The treatments were able to reduce the painful symptoms caused by dentin hypersensitivity, including placebo.

Lasers for the Treatment of Dentin Hypersensitivity

This systematic review and meta-analysis assessed the efficacy of lasers in reducing dentin hypersensitivity (DH) as compared with placebo or no treatment. Seven electronic databases and a manual search resulted in 2,538 unique publications. After selection, 13 studies were included in the meta-analysis. A CONSORT-based quality assessment revealed that 3 and 10 studies were at low and high risk of bias, respectively. A random-effects model with the generic inverse variance standardized mean difference (SMD) was used because of expected heterogeneity. Meta-analyses of the baseline-end of follow-up changes in pain revealed no differences for Er,Cr:YSSG vs. placebo (SMD = 2.49; 95% CI, -0.25 to 5.22; p = .07) but did reveal differences in favor of lasers for Er:YAG vs. placebo (SMD, 2.65; 95% CI, 1.25 to 4.05; p = .0002), Nd:YAG vs. placebo (SMD, 3.59; 95% CI, 0.49 to 6.69; p = .02), and GaAlAs vs. placebo (SMD, 3.40; 95% CI, 1.93 to 4.87; p < .00001). High and significant heterogeneity was found for all comparisons. In conclusion, Er:YAG, Nd:YAG, and GaAlAs lasers appear to be efficacious in reducing DH. However, given the high heterogeneity of the included studies, future randomized controlled clinical trials are needed to confirm these results.

The role of fluoride in the preventive management of dentin hypersensitivity and root caries

Objective

The objectives were to bring light on fluoride to control dentin hypersensitivity (DHS) and prevent root caries.

Materials and methods

Search strategy included papers mainly published in PubMed, Medline from October 2000 to October 2011.

Results

Fluoride toothpaste shows a fair effect on sensitive teeth when combined with dentin fluid-obstructing agents such as different metal ions, potassium, and oxalates. Fluoride in solution, gel, and varnish give an instant and long-term relief of dentin and bleaching hypersensitivity. Combined with laser technology, a limited additional positive effect is achieved. Prevention of root caries is favored by toothpaste with 5,000 ppm F and by fluoride rinsing with 0.025–0.1 % F solutions, as the application of fluoride gel or fluoride varnish three to four times a year. Fluoride measures with tablets, chewing gum, toothpick, and flossing may be questioned because of unfavorable cost effectiveness ratio.

Conclusion

Most fluoride preparations in combination with dentin fluid obstruction agents are beneficial to reduce DHS. Prevention of root caries is favorable with higher fluoride concentrations in, e.g., toothpaste.

Clinical relevance

Fluoride is an effective agent to control DHS and to prevent root caries particularly when used in higher concentrations.