Clinical evaluation of pulp and dentine sensitivity after supragingival and subgingival scaling

A Novel Piezoelectric-Assisted Non-Surgical Periodontal Treatment: A Prospective Case Series

The purpose of this study was to evaluate the clinical efficacy of a non-surgical periodontal treatment using a piezoelectric power-driven device with a novel insert. Plaque index (PlI), bleeding on probing (BoP), probing depth (PD), recession depth (Rec) and clinical attachment level (CAL) were assessed at 6 weeks, 3 months and 6 months. Furthermore, tooth mobility and furcation involvement were recorded and chewing discomfort and dental hypersensitivity were evaluated. Eighteen stage I to IV periodontitis patients providing 437 teeth and 2622 sites in total were analyzed. At six weeks, CAL gain (0.4; p < 0.0001), PD reduction (0.4; p < 0.0001) and Rec increase (0.1; p = 0.0029) were statistically significant. Similarly, the mean number of sites with PD > 4 mm and absence of BoP significantly decreased between baseline and 6 weeks (-12.7; p < 0.0001). At this time point, the patient's chewing discomfort was also significantly diminished (1.4; p = 0.0172). Conversely, no statistically significant changes were observed between 6 weeks and 3 months and between 3 months and 6 months for any of the clinical variables evaluated. In conclusion, within the limitation of this study, mechanical piezo-assisted non-surgical periodontal treatment in conjunction with an innovative tip resulted significantly efficacious to reduce pathological periodontal pockets, to gain clinical attachment and to reduce gingival inflammation.

Complications and treatment errors in nonsurgical periodontal therapy

Nonsurgical periodontal therapy can be subject to iatrogenesis, which includes all the complications directly or indirectly related to a treatment. These complications include both operator-dependent harms and errors and the consequences and adverse effects of the therapeutic procedures. The complications arising following nonsurgical periodontal treatment can be categorized as intraoperative and postoperative and can affect both soft and hard tissues at an intra-oral and extraoral level. Soft-tissues damage or damage to teeth and restorations can occur while performing the procedure. In the majority of cases, the risk of bleeding associated with nonsurgical therapy is reported to be low and easily controlled by means of local hemostatic measures, even in medicated subjects. Cervicofacial subcutaneous emphysema is not a frequent extraoral intraoperative complication, occurring during the use of air polishing. Moreover, side effects such as pain, fever, and dentine hypersensitivity are frequently reported as a consequence of nonsurgical periodontal therapy and can have a major impact on a patient's perception of the treatment provided. The level of intraoperative pain could be influenced by the types of instruments employed, the characteristics of tips, and the individual level of tolerance of the patient. Unexpected damage to teeth or restorations can also occur as a consequence of procedural errors.

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

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

Novel Approach to Dental Biofilm Management through Guided Biofilm Therapy (GBT): A Review

Dental biofilm plays a very crucial role in the etiopathogenesis of periodontal andperi-implant diseases. Over the past decade, tremendous research has been carried outto know the structure of biofilm and the mechanism by which it causes the destruction of supporting tissues of tooth or implant. Periodontal or peri-implant therapy usually begins with primarily removing thebiofilm and is considered as non-surgical mechanical debridement. Although scaling and root planing (SRP) is regarded as a gold standard for mechanical plaque debridement, various other means of biofilm removal have constantly been evolving. These may vary from different scaling systems such as vector systems to decontamination of pockets with LASER therapy. Nowadays, a new concept has emerged known as “guided biofilm therapy” (GBT). It is beneficial in removing the biofilm around the tooth and implant structures, resulting in better or comparable clinical outcomes than SRP. These results were substantiated with the reduction in the microbial load as well as the reduction in the inflammatory cytokines. This review will highlight the various aspects of GBT used in periodontal and peri-implant disease.

A 12-month randomized controlled trial evaluating erythritol air-polishing versus curette/ultrasonic debridement of mandibular furcations in supportive periodontal therapy

Background

Due to complex morphology and limited access, the cleaning of the furcation area is extremely challenging. Therefore, novel therapeutic approaches need to be tested to potentially overcome debridement limitations. The aim of the present prospective 12-month study was to compare clinical and microbiological effects following erythritol air-polishing versus conventional mechanical debridement of furcation defects in a cohort of periodontal maintenance patients.

Methods

Twenty patients with grade II mandibular molar furcation defects volunteered to enroll in this single-centre, examiner masked, randomized controlled trial. In a split-mouth study design, two furcation sites in each patient were randomly assigned to either receive subgingival debridement using erythritol air-polishing (test) or conventional ultrasonic/curette debridement (control) at baseline, and at 3, 6, 9 and 12 months. Probing depth, clinical attachment level and bleeding on probing were recorded at 3-month intervals. Subgingival microbiological samples obtained at baseline, 6 and 12 months were analyzed using checkerboard DNA–DNA hybridization. Discomfort from treatment was scored at 12 months using a visual analogue scale. The differences between treatments, and time-points, were tested using multilevel analysis (mixed effect models and robust variance estimates).

Results

A significant reduction in probing depth took place following both treatments (p < 0.001). Control sites experienced a significant mean gain in clinical attachment level of 0.5 mm (± 0.2) (p = 0.004), whereas a non-significant gain of 0.4 mm (± 0.3) was observed at test sites (p = 0.119). At 6 months, a significant between-treatment difference of 0.8 mm (± 0.4) was observed in favor of the control (p = 0.032). No significant between-treatment differences were observed in microbial load or composition. Notably, at 12 months patients experienced significantly less discomfort following air-polishing compared with control (p = 0.001).

Conclusions

The 12-month observations indicate that erythritol air-polishing and conventional mechanical debridement both support clinical improvements. A significant between-treatment difference in clinical attachment level was, however, detected in favour of control debridement at 6 months. In terms of patient comfort, erythritol air-polishing is superior.

Trial Registration: The clinical trial was retrospectively registered in ClinicalTrial.gov with registration NCT04493398 (07/28/2020).

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.

Incidence and severity of postoperative complications following oral, periodontal, and implant surgeries: A retrospective study

BACKGROUND

Incidence and severity of postoperative complications are key elements in determining the risk-benefit relationship of any surgical procedure. The aim of this retrospective study was to assess and categorize the postoperative complications that occur following, and are associated with, oral, periodontal, and implant surgeries.

METHODS

A total of 3,900 patients who underwent surgical procedures including, but not limited to, sinus floor elevation, guided tissue regeneration, crown lengthening, implant placement, soft tissue graft, open flap debridement or surgical removal of impacted teeth were included. Postoperative complications were recorded and graded based on impedance to routine daily activity and favorable surgical outcomes. Regression models were generated to evaluate correlations between complication types, as well as between patient/surgical characteristics and the incidence of complications.

RESULTS

Surgical removal of impacted teeth and lateral sinus floor elevation had the highest incidence and severity of complications. Postoperative dentinal hypersensitivity (5.7%) was the most frequent complication, followed by excessive pain (4.1%), and moderate postoperative bleeding (3.5%). Based on the devised grading system described in this paper, the complications were 11.1% of Grade I, 3.3% of Grade II, 8.3% of Grade III, 0.1% of Grade IV, and no complications recorded under Grades V or VI.

CONCLUSIONS

Surgical removal of impacted teeth and lateral sinus floor elevation are more prone to more severe complications compared with other procedures. Additionally, complications that do not impede favorable surgical outcomes and/or routine daily activity are the most likely to occur. Smoking and diabetes are generally associated with postoperative complications.

Evaluation of the effectiveness of the photobiomodulation in the treatment of dentin hypersensitivity after basic therapy. A randomized clinical trial

BACKGROUND

Dentin hypersensitivity (DH) in one of the most common causes of patient discomfort in the general population and its prevalence is higher in patients who have received basic or surgical periodontal treatment. Efficiency of the diode laser with different wavelengths has been studied by several authors, showing an improvement rate of the DH between 60-98%. The aim of the present study was to evaluate the effect of photobiomodulation (PBM) treatment on the reduction of DH after non surgical periodontal treatment.

MATERIAL AND METHODS

A randomized split mouth clinical trial was performed involving 30 patients (120 teeth) diagnosed with DH after scaling and root planning. Two teeth of the experimental side were treated with the laser and 2 teeth of the control side were treated without activating the laser. The laser treatment parameters for each tooth were 660nm, 200mW, CW, illuminated area 1.15cm2, 173mW/cm2, 60 seconds, 12 J, 10.4J/cm2. Age, gender, smoking, plaque index, gingival recession, probing and VAS (for tactile and thermal stimulation) were registered before the laser treatment, immediate post treatment (after 2 minutes), 2 weeks, 1 month and 2 months after treatment.

RESULTS

There was significant difference (p<0.01) in discomfort to thermal and mechanical stimulation between the control and diode laser treatment sites at all evaluation periods. The level of discomfort decreased immediately following diode laser therapy, and continued to demonstrate a decrease for the duration of the study. All teeth remained vital after laser treatment, without adverse reactions or complications.

CONCLUSIONS

The PBM can be used to reduce DH without detrimental pulpal effects. Key words:Dental hypersensitivity, laser, diode laser, photobiomodulation.

The Effect of Calcium Sodium Phosphosilicate on Dentin Hypersensitivity: A Systematic Review and Meta-Analysis

OBJECTIVE

To investigate the effect of calcium sodium phosphosilicate (CSPS) in treating dentin hypersensitivity (DH) and to compare this effect to that of a negative (placebo) control.

MATERIALS AND METHODS

Several databases, including Medline, EMBASE, Web of Science, The Cochrane Library, and the Chinese Biomedical Literature Database, were searched to identify relevant articles published through January 2015; grey literature (i.e., academic literature that is not formally published) was also searched. Two authors performed data extraction independently and jointly using data collection forms. The primary outcome was the DH pain response to routine activities or to thermal, tactile, evaporative, or electrical stimuli, and the secondary outcome was the side effects of CSPS use. Each study was evaluated using the Cochrane Collaboration tool for assessing risk bias. Meta-analysis of studies with the same participant demographics, interventions, controls, assessment methods and follow-up periods was performed. The Grading of Recommendations Assessment Development and Evaluation System was used to assess the quality of the evidence and the risk of bias across studies.

RESULTS

Meta-analysis demonstrated that toothpaste containing 5% CSPS was more effective than the negative control at relieving dentin sensitivity, with the level of evidence classified as "moderate". In addition, prophylaxis paste containing 15% calcium sodium phosphosilicate was favored over the negative control at reducing post-periodontal therapy hypersensitivity, with the level of evidence categorized as "low". Only two studies reported side effects of CSPS use.

CONCLUSIONS

The majority of studies found that calcium sodium phosphosilicate was more effective than the negative control at alleviating DH. Because strong evidence is scarce, high-quality, well-designed clinical trials are required in the future before definitive recommendations can be made.

Iatrogenic Damage to the Periodontium Caused by Periodontal Treatment Procedures

Periodontitis is an inflammatory disease affecting the periodontium i.e. the tissues that surround and support the teeth. Periodontitis manifests as progressive loss of the alveolar bone around the teeth, and if left untreated, can cause loosening and subsequent loss of teeth. Periodontitis is initiated by microorganisms that adhere to and grow on the tooth's surfaces, besides an over -aggressive immune response against these microorganisms. The primary goal of periodontal therapy is to preserve the natural dentition by accomplishing and preserving a healthy functional periodontium. Many treatment modalities have been introduced to improve the therapeutic result of periodontal treatment which may also damage the periodontiumiatrogenically.

A novel potassium oxalate-containing tooth-desensitising mouthrinse: a comparative in vitro study

OBJECTIVE

To compare the efficacy of a new potassium oxalate (KO)-containing mouthrinse [Listerine® Advanced Defence Sensitive (LADS)] in reducing dentine permeability and occluding open dentinal tubules versus other desensitising products.

METHODS

The permeability of acid-etched dentine disks was measured by hydraulic conductance; dentine surfaces were examined by scanning electron microscopy and energy-dispersive X-ray spectroscopy. The KO concentration was optimised for tubule occlusion by screening formulations containing 0.0-2.0% KO (n=5 disks per concentration). The optimal formulation was compared with five commercial products with non-oxalate occlusion technologies. After establishing the baseline permeability of acid-etched dentine disks, disks (n=6 per product) were randomly treated with the desensitising products (12 treatments, each 60 s, alternated with distilled-water rinses) and permeability was measured at intervals. Occluded disks were acid challenged. All experiments were conducted at room temperature. An unpooled, two-tailed t test was performed to assess between-treatment differences in relative residual permeability.

RESULTS

The optimal concentration of KO in LADS was 1.4%, which provided ≈ 100% reduction in dentine permeability after nine treatments. Only LADS reduced permeability to zero and was significantly more effective in reducing dentine permeability than the other products (p ≤ 0.033 vs all other test products). All products partially occluded dentine. The occlusion associated with LADS was substantially more stable in resisting acid challenge versus Colgate® Sensitive Pro-Relief mouthrinse (p=0.054) and significantly more stable versus all other test products (p ≤ 0.045), as determined by dentine permeability.

CONCLUSION

LADS was significantly more effective in occluding open dentinal tubules versus other desensitising products.

CLINICAL SIGNIFICANCE

LADS provides fast, complete and stable intratubular occlusion of patent dentinal tubules.

Dentine sensitivity: past, present and future

OBJECTIVE

This review defines dentine sensitivity (DS), its prevalence, its aetiology, the mechanism(s) responsible for DS, its diagnosis and its treatment. The review then examines the modes of action of various treatments for DS including potassium salts, strontium salts, bioglasses, arginine/calcium carbonate and professional treatments such as adhesives and oxalates. The methods used to evaluate the various treatment modalities are discussed, including laboratory studies and randomised controlled clinical trials.

DATA SOURCES AND STUDY SELECTION

A literature search was conducted using PubMed, Ovid Medline and Cochrane reviews for information on DS and its treatments, as well as laboratory and clinical studies used to evaluate the efficacy of various DS treatments. With regard to efficacy of treatments for DS only reports of clinical studies that were randomised, controlled and blinded were reviewed. The authors offer new insights into the shortcomings of the recent systematic review of the use of oxalates for DS.

CONCLUSION

The authors introduce the concept of a novel desensitising mouthrinse containing 1.4% potassium oxalate: Listerine® Advanced Defence Sensitive mouthrinse. Readers of this supplement issue of the Journal of Dentistry are invited to review the significance of managing the clinical problem of DS. They are also invited to assess data from laboratory and randomised controlled clinical studies in order to understand the advantages offered by regular use of 1.4% potassium oxalate-containing mouthrinse, Listerine Advanced Defence Sensitive, in particular its resistance to daily erosive and/or abrasive challenges.

Dental erosion and dentinal sensitivity amongst professional wine tasters in South East Queensland, Australia

Background/Aims. Professional wine tasters face a hidden occupational hazard due to the high acid content in wine. This study evaluates the self-perceived dentinal sensitivity and erosive effects of wine on the professional wine tasters of the Granite Belt and the Scenic Rim regions of South East Queensland, Australia. Methods. Seventy wineries were contacted and participants were surveyed about their professional wine tasting experience and oral health. Participants were also required to rate their tooth sensitivity prior to being examined for erosion using a modified Smith & Knight tooth wear index. The data were analysed using Mann Whitney U test and Spearman's correlation test. Results. The results showed that most participants (25 males, 22–66 yrs), brushed twice a day; however, the majority did not floss daily and had limited knowledge of the erosive effect of wine. There was a direct correlation between years of wine tasting, age of participants, and the erosion index. Correlation was not observed between the participant's sensitivity index and erosion index. Conclusion. The lack of significant experience of dentinal hypersensitivity amongst professional wine tasters should not prevent oral health practitioners from providing necessary counselling and undertaking preventive measures, as tooth wear can have serious long-term effect on oral health of an individual.

The Prevalence of Root Sensitivity following Periodontal Therapy: A Systematic Review

The reported prevalence of dentine/root (hyper)sensitivity (DH/RS) in the published literature varies, and this may be due in part to a) the different study populations and (b) the different methodologies employed in evaluating the pain response. According to von Troil et al. (2002) there are limited data available in terms of the prevalence and intensity of DH/RS following periodontal therapy. Objectives. The aim of the present study was therefore to review the literature in order to identify all relevant studies for inclusion and to determine whether there was any evidence of DH/RS following periodontal procedures in the published literature up to 31st December 2009 using an agreed search protocol. Methods. 840 papers were identified, from searching both electronic databases (PUBMED) and hand searching of relevant written journals. Twelve papers were subsequently accepted for inclusion. Results. The results of the present study would indicate that the reported prevalence for DH/RS (following nonsurgical therapy) was between 62.5% and 90% one day after treatment decreasing to approximately 52.6% to 55% after one week. The prevalence of DH/RS following surgical therapy was between 76.8% and 80.4% one day after treatment subsequently decreasing over time to 36.8% after 1 week, 33.4% after 2 weeks, 29.6% after 4 weeks, and 21.7% after 8 weeks. Conclusions. It is evident from reviewing the included studies that patients may suffer from mild discomfort following periodontal procedures although both the prevalence and intensity of DH/RS may vary depending on the duration and the type of procedure involved. Most of the studies included in this paper would tend to suggest that DH/RS may be relatively mild/moderate in nature and transient in duration.

Effect of photodynamic therapy, diode laser, and deep scaling on cytokine and acute-phase protein levels in gingival crevicular fluid of residual periodontal pockets

BACKGROUND

There is an ongoing controversy on the benefits of treatment protocols, including dental lasers and photodynamic therapy (PDT). The purpose of this study is to compare the local biologic effects of PDT, diode soft laser (DSL) therapy, and conventional deep scaling and root planing (SRP) in residual pockets.

METHODS

Thirty-two individuals were included based on a history of previous treatment for periodontitis and the persistence of sites with probing depths >4 mm and bleeding on probing. Residual pockets were debrided with an ultrasonic device and then randomly assigned either to PDT, DSL, or SRP. Gingival crevicular fluid was collected before treatment, after 14 days, and at 2 and 6 months. Levels of 13 cytokines and nine acute-phase proteins were measured using a bead-based multiplexing analysis system.

RESULTS

Treatment with PDT, DSL, or SRP led to significant changes in several cytokines and acute-phase proteins: Compared with baseline, levels of interleukin-17, basic fibroblast growth factor, granulocyte colony-stimulating factor, granulocyte macrophage colony-stimulating factor, and macrophage inflammatory protein 1-α were lower 14 days and 2 months after treatment. Except for granulocyte colony-stimulating factor, these differences remained significant throughout the observation period. The levels of five acute-phase proteins (α-2 macroglobulin, haptoglobin, serum amyloid P, procalcitonin, and tissue plasminogen activator) were significantly higher at 6 months than at baseline. No significant differences were observed among the three treatment modalities at any time point for any biochemical parameter.

CONCLUSIONS

Levels of several cytokines and acute-phase proteins significantly changed after treatment regardless of treatment modality. There was no evidence for a specific DSL- or PDT-enhanced expression of inflammatory mediators.

Periodontal therapy

Periodontal disease is the most common disease in small animal patients. It not only creates severe localized infection, but it has been linked to numerous severe systemic maladies. Proper therapy of this disease process results in a significant increase in the overall health of the patient. The treatment of periodontal disease is currently evolving due to the acceptance of the specific plaque hypothesis of periodontal disease. These findings have led to the development of the "one-stage full-mouth disinfection" treatment as well as a vaccine against these organisms. However, the cornerstone of therapy is still meticulous plaque control. This control is achieved via a combination of regular dental prophylaxis and home care. With progressive disease, advanced periodontal surgery or extraction becomes necessary.

Effect of a 3% Potassium Oxalate Topical Application on Dentinal Hypersensitivity After Subgingival Scaling and Root Planing

BACKGROUND

The present study aimed to verify the effect of a single application of 3% potassium oxalate gel compared to a placebo gel immediately after subgingival scaling and root planing (SRP) on dentinal hypersensitivity (DH).

METHODS

Fifteen patients undergoing periodontal treatment volunteered for this randomized controlled clinical trial. They presented with periodontitis on homologous contralateral canines and premolars, with complaints of dentinal hypersensitivity before periodontal therapy. Immediately after SRP under local anesthesia, the test and placebo agents were randomly applied on the cemento-enamel junction. Evaluation of DH reduction after treatment was self-reported, with assessment made by the patient's indication of how painful each treated. tooth was on a visual analog scale (VAS) at baseline, and 7, 14, and 21 days post-treatment. The results were analyzed by DH percent reduction for each observational moment in relation to baseline, for test and control teeth separately. Mean percent reductions for each group were compared by paired sample t test, with an alpha level of 0.05.

RESULTS

On day 7, percent reduction for the test and control groups was 29.4% and 13.4%, respectively. On day 14 it was 64.6% and 20.5%, and on day 21 it was 81% and 34.7%, respectively. Significant differences between treatments were observed at 14 and 21 days.

CONCLUSION

It may be concluded that subgingival scaling and root planing followed by a single application of a 3% potassium oxalate gel resulted in a significantly higher reduction of dentinal hypersensitivity at 14 and 21 days, when compared to the placebo.

The long-term effectiveness of five current desensitizing products on cervical dentine sensitivity

The aim of this study was to compare the long-term effectiveness of five desensitizing products on 25 male and 27 female patients (total 52) aged 21-67 years (mean 36 +/- 7 years) suffering from cervical dentine sensitivity. All subjects were seen by the same examiner (ID) who was blinded to the applied treatment for 3-month clinical study. Patients were asked to record their overall sensitivity by marking a point on a 10 cm Visual Analogue Scale (VAS). Two hundred and seventy-seven sensitive teeth were treated by one of the five desensitizing products, all of which were placed following manufacturers' instructions by the other investigator (AS). A paired (split mouth) study design was used and selection of quadrants was randomized. At the post-treatment and at 10 days and 3 months periods, sensitivity measurements were recorded by the same investigator (ID). Statistical analysis showed that all of the VAS scores at post-treatment evaluation points were significantly decreased compared with baseline data (P < 0.05). There was a significant reduction in mean sensitivity scores in the Protect Liner F and the Health-Dent Desensitizer groups when compared with Fluoline varnish at the 10-day time point (P < 0.05). At 3 months, the Protect Liner F group continued to show a significantly reduced sensitivity level when compared with Health-Dent Desensitizer, Single Bond, Fluoline and Gluma Desensitizer (P < 0.05). The present study demonstrated that although at the end of 3-month evaluation period all desensitizers showed lower VAS sensitivity values compared with baseline, there were differences in the level of reduction of cervical dentine sensitivity.

A systematic review of the prevalence of root sensitivity following periodontal therapy

OBJECTIVES

To systematically review the evidence on the prevalence of root sensitivity following periodontal therapy.

MATERIAL AND METHODS

Cross-sectional and longitudinal clinical studies were searched for in electronic databases, hand searched journals and through contact with authors directly. The screening and data extraction were conducted by several reviewers independently. The main outcome measure was prevalence of root sensitivity following periodontal therapy.

RESULTS

The prevalence of root sensitivity was 9-23% before and 54-55% after periodontal therapy. An increase in the intensity of root sensitivity occurred 1-3 weeks following therapy, after which it decreased.

CONCLUSIONS

It is concluded that there are insufficient randomized controlled trials to adequately address the stipulated question. However, based on the scarce evidence from only two studies, root sensitivity occurs in approximately half of the patients following subgingival scaling and root planing. The intensity of root sensitivity increases for a few weeks after therapy, after which it decreases. In clinical practice, it may be recommended that patients should be made aware of the potential for root sensitivity prior to treatment. In research, it may be recommended to conduct randomized controlled and prospective studies with both short and long follow-up periods. Furthermore, to investigate the effects and the relationship of root instrumentation with the aetiology of root sensitivity, the efficacy of preventive and therapeutic regimes for root sensitivity, and the incidence and severity of root sensitivity by subjective patient-reporting, and the response to different modes of stimuli. Protocols should follow the criteria used in dentine hypersensitivity studies.

The reproducibility of methods of assessment for cervical dentine hypersensitivity

BACKGROUND

Many agents and toothpaste formulations have been proposed for treatment of dentine hypersensitivity. However, studies have reported equivocal or contradictory results, potentially related to a lack of clinical efficacy for agents being tested, poor study design or the use of assessment techniques which are unable to distinguish longitudinal changes in dentine hypersensitivity.

AIM

To investigate the reproducibility of commonly used measurement protocols for dentine hypersensitivity on single or multiple teeth. In addition, newly-developed controlled air and cold fluid stimuli were investigated.

METHODS AND MATERIALS

Standardised pain stimulation techniques were used in 2 investigations with 63 and 42 subjects, respectively. The reproducibility of perceived hypersensitivity before and following stimulation was recorded over time periods of 14 and 2 days, respectively, using visual analogue scales and threshold techniques.

RESULTS

Subject demographics resembled those reported in other hypersensitivity investigations. Analysis using several measures of reproducibility indicated that subject-based reproducibility was limited, even when the stimuli were standardised. However, the data are consistent with the findings of investigations on pain assessment in other fields.

CONCLUSIONS

The reproducibility of subjects in clinical trials of dentine hypersensitivity may therefore contribute to difficulties in establishing treatment efficacy of agents in clinical trials.

Clinical evaluation of wound healing following multiple exposures to enamel matrix protein derivative in the treatment of intrabony periodontal defects

BACKGROUND

Multiple exposures to enamel matrix protein derivative (EMD) during periodontal therapy have been shown to be safe for the patient. The purpose of this study was to clinically determine if an altered course of wound healing would occur after multiple exposures to EMD in the treatment of intrabony defects. A secondary aim was to assess the efficacy of EMD in probing depth reduction and clinical attachment level gain.

METHODS

Thirty-two systemically healthy patients (18 females, 14 males, 33 to 69 years old) who were being treated for moderate to advanced periodontal disease were selected for the study. Surgical procedures involving 2 sites were separated by at least 8 weeks, and wound healing comparisons were made between the first and second procedure. Patients were given a diary card the day of surgery, which consisted of questions concerning the presence and severity of headaches, root hypersensitivity, tooth pain, swelling, and itching. Patients were also examined at postoperative visits to clinically assess wound healing and discuss responses to the questionnaire. Soft tissue measurements were taken the day of surgery and 6 months postoperatively to ascertain probing depth reduction (PD) and gains in clinical attachment levels (CAL).

RESULTS

The results revealed no clinically detectable reaction that could not be attributed to normal postoperative sequelae. There were no differences in reported symptoms between patient gender, first and second procedures, or intrabony and non-intrabony defects. Smokers were found to have a statistically significantly higher incidence of severe symptoms in root hypersensitivity, tooth pain, and swelling compared to non-smokers (n = 21). The mean probing depth reduction was 3.8 +/- 1.5 mm (2 to 9 mm), while the mean clinical attachment level gain was 2.8 +/- 1.7 mm (0 to 8 mm).

CONCLUSIONS

The findings of this study demonstrate that EMD is a clinically safe product to use in the treatment of periodontal defects and that multiple uses do not have a negative impact on periodontal wound healing. In addition, a statistically significant gain in clinical attachment and reduction in probing depth were demonstrated.

Treatment of dentinal hypersensitivity using a dentine bonding system

AIMS AND OBJECTIVES

Many agents have been used in treatment of dentinal hypersensitivity in the past, but dentine bonding systems have recently been suggested as being effective. This study examined the effectiveness of a dentine bonding system in the treatment of dentinal hypersensitivity in dental practice conditions.

METHODS

Dentists in two dental practices agreed to carry out the project. One practice was in the UK, the other in India. A total of 34 patients who were diagnosed to have dentinal hypersensitivity were treated using the dentine bonding system. Patients were requested to record their perception of their pain on a 100mm linear scale, pre-treatment, one day and one week post-treatment.

RESULTS

All patients experienced relief of pain, both 1 day and 1 week after treatment. Profile plots of the patients' perceived pain scores for the two practices separately indicated that there was a general trend across both practices for these to fall quite sharply one day after treatment and then generally level out one week post-treatment. There was evidence indicating a possible difference in pain perception in the two communities from which the patients were drawn.

CONCLUSION

The dentine bonding system evaluated was successful in reducing the pain of dentinal hypersensitivity, at least in the short term.

HIPERSENSIBILIDADE DENTINÁRIA: DIAGNÓSTICO E TRATAMENTO

A hipersensibilidade é a sensibilidade exagerada da dentina quando exposta ao meio bucal, que se torna permeável à ação de estímulos agressivos. O diagnóstico é feito através da anamnese e da inspeção clínica minuciosa. O tratamento pode ser feito pelo profissional ou pelo próprio paciente sob orientação, dependendo do caso. Ela ocorre comumente no final da terceira década, sendo ligeiramente mais freqüente nas mulheres do que nos homens.

Fluid shifts across human dentine in vitro in response to hydrodynamic stimuli

Most authorities agree that the hydrodynamic theory of dentine sensitivity best explains the stimulus-response relations of most painful stimuli. However, as the usual hydrodynamic stimuli are so different, it has been impossible to compare them. The equivalency of hydrodynamic stimuli can be evaluated from measurements of the fluid movement induced in vitro and relating this to the hydraulic conductance (Lp) of the same dentine specimen. From this determination, a common denominator is obtained which is equivalent to the hydrostatic pressure that would be required to cause the same magnitude of fluid movement. The purpose of this study was to measure the direction and magnitude of fluid shifts across dentine in extracted human crown segments with a flat, dentine occlusal surface in response to the following hydrodynamic stimuli; air blast, 56 degrees C water, 2 degrees C water, tactile and osmotic. In acid-etched superficial dentine, which simulates hypersensitive dentine, the largest to the smallest fluid flows obtained were: hot > cold > air blast > osmotic > tactile. When these were converted to equivalency units, the ranking of stimuli from strongest to weakest was hot > cold > air blast > osmotic > tactile. This new approach to comparing hydrodynamic stimuli should be verified in vivo.

Dentists' views on cervical hypersensitivity and their knowledge of its treatment

A random sample of 400 Dutch general practitioners was asked to complete a questionnaire dealing with the prevalence, conditions and therapies of cervical hypersensitivity of their patients. According to the 259 responding dentists an average of 10% of their patients suffered from moderate cervical pain. The estimated mode for severe pain was 1%. More than two thirds of the dentists reported inadequate brushing of the teeth to cause the hypersensitivity, about one half acknowledged periodontal causes, well over one quarter mentioned the involvement of dietary acids, and about one sixth implicated psychosomatic factors. Other causal factors were mentioned less often. Of the therapies available, the home-care methods appeared to be promoted most often, i.e. brushing with therapeutic toothpastes (77%), improvement of oral hygiene (51%) and local self-application (with finger) of a therapeutic toothpaste or fluoride preparations before the night (41%). Well over 50% reported to apply occasionally bondings/varnishes and 28% said to make sometimes cervical fillings. Other therapeutic possibilities were not, or very seldom, used.

The effects of outward forced convective flow on inward diffusion in human dentine in vitro

In vitro experiments were conducted to evaluate the influence of outward forced convective flow on the inward diffusion of radioactive iodide. When the smear layer was present, application of 15 cmH2O (1.47 kPa) outward-directed filtration pressure reduced the inward flux of iodide by about 10-20% depending upon the hydraulic conductance of each specimen. When the smear layer was removed by acid etching, the same 1.47 kPa pressure lowered the inward iodide flux by as much as 60%, depending on the hydraulic conductance. The results demonstrate the importance of the balance between inward diffusion and outward bulk-fluid movement on the rate of permeation of exogenous solutes.

Prevalence and distribution of cervical dentine hypersensitivity in a population in Rio de Janeiro, Brazil

The prevalence, distribution and possible causal factors of cervical dentine hypersensitivity were studied in a population from a Marine Dental Clinic in the city of Rio de Janeiro, Brazil. A total of 635 patients were examined for the presence of cervical dentine hypersensitivity by means of a questionnaire and intraoral tests (air and probe stimuli). There were 157 patients (25%) reporting to have hypersensitive teeth, but only 108 patients (17%) were diagnosed as having cervical dentine hypersensitivity. The prevalence of hypersensitivity was higher among females than males, but this difference was not statistically significant. Most females with hypersensitivity were aged 20-49 and most males were aged 40-59. Incisors and premolars had the highest prevalence of dentine hypersensitivity to air and probe stimuli, while molars had the lowest. The presence and history of dentine hypersensitivity were positively correlated with previous exposure to periodontal treatment. Only a few of the patients who claimed to have dentine hypersensitivity had tried treatment with desensitizing toothpastes or sought professional help.