Intraoral fluoride releasing device: a new clinical therapy for dentine sensitivity

Comparison of the Effectiveness of Combined Diode Laser and GLUMA Bonding Therapy With Combined Diode Laser and 5% Sodium Fluoride Varnish in Patients With Dentin Hypersensitivity

Introduction: Dentin hypersensitivity (DH) is one of the most common complaints of patients referred to a dental office, so this study aimed to compare the effectiveness of combined diode laser and GLUMA bonding therapy with combined diode laser and 5% sodium fluoride varnish in patients with DH. Methods: Sixty patients were divided into three groups (bonding, laser-bonding, laser-varnish), and before the intervention, the amount of DH was measured with the visual analogue scale (VAS) scale. In the bonding group, GLUMA Desensitizer solution was applied and then air-dried. In the bonding-laser group, first bonding was used, and then the affected tooth was irradiated with a diode laser. In the varnish-laser group, 5% sodium fluoride varnish was coated and then the laser was irradiated with the said method. DH was measured immediately after the treatment and then 2, 7 and 30 days after the treatment. Results: Laser-varnish treatment was not different from laser-bonding treatment at all measurement times (P=1). Laser-varnish and bonding treatment were not significantly different up to one week after the intervention, but on the 30th day after the intervention, the difference in pain was significant (P=0.01). There was no significant difference in laser-bonding treatment up to one week after the intervention, but on the 30th day after the intervention, the difference in pain was significant (P=0.003). Conclusion: The combined treatment with GLUMA bonding and the 660 nm diode laser is effective in reducing DH and this is more effective than GLUMA bonding alone in the long term. However, it does not have a significant advantage over the combined varnish-laser method, but it seems that due to its ease of use, it can be a suitable alternative to the varnish-laser method.

Effects of desensitizing products on the reduction of pain sensitivity caused by in-office tooth bleaching: a 24-week follow-up

Objective

To clinically assess the effect of desensitizing gels and dentifrices on the reduction in pain sensitivity and color variation during tooth bleaching.

Methodology

A total of 108 volunteers were randomly separated into the following groups of n=12: GT/S-glycerine and thickener/sucralose; NF/S-potassium nitrate and sodium fluoride/sucralose; NA/S-potassium nitrate and arginine/sucralose; GT/AC-glycerine and thickener/arginine and calcium carbonate; NF/AC-potassium nitrate and sodium fluoride/arginine and calcium carbonate; NA/AC-potassium nitrate and arginine/arginine and calcium carbonate; GT/PN-glycerine and thickener/potassium nitrate; NF/PN-potassium nitrate and sodium fluoride/potassium nitrate; and NA/PN-potassium nitrate and arginine/potassium nitrate. Sensitivity was assessed with the numerical analogue scale, and color variation (ΔE) was measured with a spectrophotometer. The sensitivity values obtained were subjected to a multivariate analysis of variance (MANOVA) and color variation values were subjected to a randomized analysis of variance (p<0.05).

Results

The NF/AC, NA/AC, NF/PN, and NA/PN groups presented lower sensitivity values and reduced sensitivity compared to those of the other groups throughout the clinical sessions. None of the groups showed sensitivity at the 24-week assessment. Statistically, no significant difference were observed in the color values among the groups four weeks after the beginning of bleaching (p=0.074). Additionally, the color assessment of all groups was statistically similar four weeks (p=0.084) and 24 weeks (p=0.118) after the beginning.

Conclusion

Our results indicate that adding NF/S, NA/S, NF/AC, and NA/AC desensitizers to tooth bleaching protocols reduces pain sensitivity without affecting its effectiveness.

Effects of desensitizing dentifrices on the reduction of pain sensitivity caused by in-office dental whitening: a double-blind controlled clinical study

Objective: The purpose of this study was to clinically evaluate the influence of desensitizing dentifrices applied through a plastic tray on reducing the pain sensitivity and color variation caused by in-office dental whitening and to evaluate differences among such dentifrices through a controlled double-blind clinical study.

Materials and methods: A prospective study was conducted with 48 individuals between 18 and 30 years without gender distinction. For the dental whitening, 35% hydrogen peroxide was used in three clinical sessions. After each whitening session, the volunteers used a plastic tray containing one of the dentifrices (sucralose– S, sodium fluoride – SF, arginine and calcium carbonate – ACC, and 5% potassium nitrate – PN) for 4 hrs during the night. The evaluation of the sensitivity associated with the use of the plastic tray in each whitening session was performed using the analog numerical scale with scores from 0 to 10. The color variation (ΔE) was determined with a spectrophotometer. The pain sensitivity data were submitted to the multivariate analysis of variance with repeated measurements and a Lambda Wilks test (p<0.05). To analyze the color variation, a one-way ANOVA was applied (p<0.05).

Results: The ACC and 5% NP groups showed a reduction in sensitivity in relation to the other groups (p<0.05). There was a reduction in sensitivity after placement of the tray with dentifrice. The color evaluation associated with the dentifrice showed no difference (p=0.9186).

Conclusion: The use of desensitizing dentifrices with ACC or 5% NP in a plastic tray was effective for the reduction of pain sensitivity, and the use of a desensitizing dentifrice did not decrease the effectiveness of whitening.

A review of slow-release fluoride devices

BACKGROUND

Fluoride has been used to combat dental caries using a number of different clinical approaches. An exciting relatively new development is fluoride slow-releasing devices that consistently elevate intra-oral fluoride levels of plaque and saliva for prolonged periods of up to two years.

METHODS

The literature on the use of slow-releasing fluoride devices in dentistry were reviewed. A Medline search on key words was carried out. All papers in English were individually reviewed.

RESULTS

Slow-releasing fluoride devices have been shown to be effective in elevating salivary fluoride levels in both animals and human studies and to enhance the remineralisation of dental enamel. They have been demonstrated to be safe to use and without the risk of fluoride toxicity. A double blind randomised clinical trial demonstrated 76% fewer new carious surface increment in high caries-risk children after two years.

CONCLUSIONS

These devices have a number of potential uses in dentistry and in particular have great potential for caries prevention of non-compliant high caries-risk groups.

Slow-release fluoride devices: a literature review

Although the prevalence of caries has decreased dramatically over the past decades, it has become a polarised disease, with most of subjects presenting low caries levels and few individuals accounting for most of the caries affected surfaces. Thus it become evident for the need of clinical approaches directed at these high-risk patients, in order to overcome problems related to compliance and low attendance at dental care centres. Slow-release fluoride devices were developed based on the inverse relationship existing between intra-oral fluoride levels and dental caries experience. The two main types of slow-release devices - copolymer membrane type and glass bead - are addressed in the present review. A substantial number of studies have demonstrated that these devices are effective in raising intra-oral F concentrations at levels able to reduce enamel solubility, resulting in a caries-protective effect. Studies in animals and humans demonstrated that the use of these devices was able to also protect the occlusal surfaces, not normally protected by conventional fluoride regimens. However, retention rates have been shown to be the main problem related to these devices and still requires further improvements. Although the results of these studies are very promising, further randomised clinical trials are needed in order to validate the use of these devices in clinical practice. The concept of continuously providing low levels of intra-oral fluoride has great potential for caries prevention in high caries-risk groups.

Decision making for the patient who presents with acute dental pain

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

The clinical performance of professionally dispensed bleaching gel with added amorphous calcium phosphate

BACKGROUND

The authors undertook a study to measure how the addition of amorphous calcium phosphate (ACP) to a professionally dispensed 16 percent carbamide peroxide equivalent bleaching gel affects tooth color and dentinal hypersensitivity.

METHODS

The authors assigned two groups to use either the test gel containing ACP or a control gel. Both groups used their respective products for three hours daily for 14 days. At checkpoints during the treatment period, the authors studied tooth color, gingival health and three measures of hypersensitivity. They performed double-blinded clinical measurements on days three, seven, 14 and on the fifth day post-treatment.

RESULTS

The test group demonstrated significantly lower (P < .05) mean thermal sensitivity scores compared with baseline (day 14: 0.21 versus 0.31; fifth posttreatment day: 0.06 versus 0.18). Tactile sensitivity also was substantially lower (P < .05) for test subjects (day 14: 0.26 versus 0.48; fifth posttreatment day: 0.06 versus 0.19). Furthermore, at the conclusion of the study, twice as many subjects were free of thermal sensitivity (test group, 80 percent, compared with control group, 40 percent; P < .001) and there was a similar significant (P < .001) percentage difference for tactile sensitivity. Both groups demonstrated equivalent and significant tooth color enhancement as compared with baseline (control: -7.73 shade change versus test: -8.12; P < .05).

CONCLUSIONS

This study demonstrates that ACP could be added to a 16 percent carbamide peroxide equivalent bleaching gel and result in a significant reduction of clinical measures of dentinal hypersensitivity, both during and after treatment.

CLINICAL IMPLICATIONS

The results of this study offer evidence in support of clinical decisions to treat patients with bleaching gel containing ACP when uncompromised tooth whitening efficacy is desired, yet dentinal hypersensitivity may be a concern.

Incidence of tooth sensitivity after home whitening treatment

BACKGROUND

A potential side effect of dentist-dispensed home tooth-whitening systems is tooth sensitivity. The authors conducted a randomized prospective double-blind study to determine the incidence of tooth sensitivity after home whitening treatment.

METHODS

Fifty adult subjects used a gel containing 15 percent carbamide peroxide and 0.11 percent fluoride ion; an additional 50 adult subjects used a placebo gel daily for four weeks. Each subject's plaque index score, gingival recession status, caries status, current dentifrice and smoking history were recorded at baseline. The researchers evaluated sensitivity weekly by interview for four weeks.

RESULTS

Fifty-four percent of subjects in both test and control groups reported mild sensitivity; 10 percent of test subjects and 2 percent of control subjects reported moderate sensitivity; 4 percent of test subjects and no control subjects reported severe sensitivity. Sensitivity decreased with time; by the second week, no severe sensitivity was reported, and by the fourth week, no moderate sensitivity was reported. The authors found a statistically significant positive correlation between reported sensitivity and gingival recession. They found no statistically significant correlations between sensitivity and any of the other recorded parameters.

CONCLUSIONS

Mild tooth sensitivity can be expected in approximately one-half of patients who undergo home whitening treatment using the gel studied. Approximately 10 percent of patients may experience moderate sensitivity, and 4 percent of patients may experience severe sensitivity for one to two weeks. Patients with gingival recession appear more likely to experience tooth sensitivity during home whitening treatment.

CLINICAL IMPLICATIONS

Patients considering home whitening treatment should be advised that mild tooth sensitivity is a common side effect and that severe tooth sensitivity occasionally occurs. If gingival recession is present, the probability of tooth sensitivity increases, and tooth sensitivity tends to decrease as treatment progresses.