Effect of Casearia sylvestris on the obliteration of dentinal tubules and the control of dental sensitivity / Efecto de Casearia sylvestris sobre la obliteración de los túbulos dentinarios y el control de la sensibilidad dental

The present study evaluated the efficacy of the mineralizing action of Casearia sylvestris ethanolic extract on bovine dentin blocks in its pure form and in dental paste, through scanning electron microscopy. The dentin blocks were immersed in artificial saliva and incubat ed at 37°C for 7 days. Subsequently, six groups were treated with different test substances and analysed qualitatively and quantitatively at 30 and 60 days. The tests used were Kruskal - Wallis and Dunn's. Shapiro - Wilk and ANOVA. The qualitative analysis at 30 days showed a difference between the groups treated with ethanolic extract and toothpaste. Quantitatively, at 30 days, treatment with ethanolic extract of Casearia showed a greater number of open dentinal tubules. At 60 days, the difference persisted on ly for the blocks treated with toothpaste. The results obtained indicated that there is a positive relationship between the use of Casearia sylvestris and obliteration of dentinal tubules

El presente estudio evaluó la eficacia de la acción mineralizante del extracto etanólico de Casearia sylvestris sobre bloques de dentina bovina en su forma pura y en pasta dental, mediante microscopía electrónica de barrido. Los bloques de dentina se sumergieron en saliva artificial y se incubaron a 37°C durante 7 días. Posteriormente, se trataron seis grupos con diferentes sustancias de ensayo y se analizaron cualitativa y cuantitativamente a los 30 y 60 días. Las p ruebas utilizadas fueron Kruskal - Wallis y Dunn's. Shapiro - Wilk y ANOVA. El análisis cualitativo a los 30 días mostró una diferencia entre los grupos tratados con extracto etanólico y pasta dentífrica. Cuantitativamente, a los 30 días, el tratamiento con ex tracto etanólico de Casearia mostró un mayor número de túbulos dentinarios abiertos. A los 60 días, la diferencia persistió sólo para los bloques tratados con pasta dentífrica. Los resultados obtenidos indicaron que existe una relación positiva entre el us o de Casearia sylvestris y la obliteración de los túbulos dentinarios

Evaluation of potassium binoxalate gel and Nd:YAG laser in the management of dentinal hypersensitivity: a split-mouth clinical and ESEM study.

Dentinal hypersensitivity is one of the oldest recorded complaints of discomfort to mankind and yet there appears to be no permanent treatment for this clinical condition. This study was designed to evaluate the clinical efficacy of potassium binoxalate gel and neodymium:yttrium-aluminum-garnet (Nd:YAG) laser on dentin hypersensitivity for a period of 9 months. Eighty teeth (20 subjects, 25-55 years old, M = F) were evaluated in a split-mouth design to receive potassium binoxalate (group A, 40 teeth) and Nd:YAG (group B, 40 teeth: 1 W, 10 Hz, and 60 s, irradiated twice). The diameter of output beam was about 300 µm with a distance of 2 mm between laser fiber or tip and tooth surface. The clinical efficacy was evaluated by air-blast test and cold-water test using visual analog scale. Electron microscopy photomicrographs were taken to confirm the results. Analysis was done at baseline; immediately post-treatment; and at 3, 6, 9 months post-treatment. Student's paired and unpaired T tests were used to evaluate the statistical analysis. Both treatment modalities were effective in reducing dentine hypersensitivity. However, Nd:YAG laser was better when intragroup comparison was made at 9 months post-treatment. Nd:YAG lasers is better in long-term treatment (up to 9 months) owing to the melting of dentinal tubules. However, due to depth of penetration of microcrystals, gel was better when ease of the procedure is considered. Nevertheless, both treatment modalities resulted in recurrence. Hence, further studies are needed to discover an agent, which can be considered as a "gold standard".

Comparative evaluation of diode laser, stannous fluoride gel, and potassium nitrate gel in the treatment of dentinal hypersensitivity.

The aim of the present study was to compare the efficacy of diode laser (DL) with stannous fluoride and potassium nitrate gels in the treatment of dentinal hypersensitivity (DH). Fifty-four subjects, ages 25-45, having 2 adjacent teeth sensitive to air blast stimulation were included. The subjects were divided randomly into 3 groups (n= 18): Group A, subjects treated with DL; Group B, subjects treated with 0.4% stannous fluoride gel; and Group C, subjects treated with 5% potassium nitrate gel. Each group was evaluated at baseline; at weekly intervals for 2 consecutive weeks; and at 1, 3, and 6 months. All 3 groups showed decreases in the DH scores between baseline and 6 months This was more pronounced in Group A at all time intervals. When the 3 groups were compared between baseline and Week 1, there was a statistically significant decrease across all 3 groups between (P = 0.0020). The greatest difference in the DH scores between baseline and Week 1 was in Group A, compared to Groups B and C. The 940 nm DL was not only efficacious, but also brought about improved immediate relief as compared to stannous fluoride and potassium nitrate gels in the reduction of DH.

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.

Tubular occlusion of simulated hypersensitive dentin by the combined use of ozone and desensitizing agents.

OBJECTIVE: Ozone was suggested for treatment of hypersensitive dentin. The purpose of this study was to investigate the effect of ozone, with or without the use of desensitizing agents, on patency and occlusion of simulated hypersensitive dentin. MATERIALS AND METHODS: Sixty standardized dentin slabs were randomly divided into six groups: distilled water (Control), ozone treatment, fluoride desensitizer (ALLSolutions, Dentsply), oxalate desensitizer (D/Sense Crystal, Centrix), combined use of ozone/fluoride and combined use of ozone/oxalate. Ozone gas was delivered from OzonyTronX (Mymed). Specimens were evaluated using a scanning electron microscope and digital image analysis before and after treatment. RESULTS: Statistical analysis using ANOVA and Mann-Whitney U-tests revealed significantly lower percentage of tubular occlusion with ozone treatment than distilled water at p ≤ 0.05. Scanning electron microscope photomicrographs of oxalate desensitizer specimens revealed a thick homogenous precipitate with significantly higher percentage of tubular occlusion than fluoride desensitizer and distilled water. Combined use of ozone/fluoride resulted in a significantly higher percentage of tubular occlusion than fluoride desensitizer alone. However, no significant difference was found between oxalate desensitizer and combined use of ozone/oxalate. CONCLUSIONS: The use of ozone gas is a viable adjunct to fluoride-containing desensitizers in enhancing tubular occlusion, but is not effective with oxalate desensitizers.

Low-level laser therapy of dentin hypersensitivity: a short-term clinical trial.

The aim of this study was to evaluate low-level laser therapy in cervical dentin hypersensitivity. A randomized controlled clinical trial was conducted with a total of 64 teeth. Dentin desensitizer and diode laser were applied on the cervical dentin surfaces. Distilled water and placebo laser was used as the placebo groups. The irradiance used was 4 J/cm(2) per treatment site. The baseline measurement of hypersensitivity was made by using visual analog scale (VAS). Twenty-four hours and 7 days after the application of desensitizer, diode laser and placebo groups, a new VAS analysis was conducted for the patients' sensitivity level. The mean pain scores of placebo groups were significantly higher than the desensitizer's and diode laser's mean scores (ANOVA, p < 0.05). The VAS analysis revealed a significant decrease in dentin hypersensitivity in 7 days with the use of the desensitizer and low-level laser therapy and no statistically significant difference was observed between these two treatments (p > 0.05). Although low-level laser and glutaraldehyde containing desensitizer present distinct modes of action, experimental agents caused a significant reduction of dentin hypersensitivity without showing secondary effects, not irritating the pulp or causing pain, not discoloring or staining the teeth, and not irritating the soft tissues at least for a period of 1 week with no drawbacks regarding handling and/or ease of application. Low-level laser therapy and desensitizer application had displayed similar effectiveness in reducing moderate dentin hypersensitivity.

Mechanism of action of a desensitizing fluoride toothpaste delivering calcium and phosphate ingredients in the treatment of dental hypersensitivity. Part III: Prevention of dye penetration through dentin vs a calcium- and phosphate-free control.

It is generally accepted that the pain of dental hypersensitivity resulting from gum recession is from the movement of fluid within the exposed tubules of dentin, causing changes in pressure on the nerve within the pulpal cavity. One method of treating hypersensitivity is to occlude the tubules, preventing fluid movement. This article discusses the use of a dye penetration technique, which establishes this mechanism of action for a desensitizing fluoride toothpaste containing calcium and phosphate. Two groups of intact teeth were perfectly sealed with enamel paint. Windows 100-micro to 200-micro deep were opened on opposite sides of each tooth at the dentin-enamel junction and briefly etched using 20% polyacrylic acid. One batch of teeth was treated eight times for 30 mins each with a 1:3 slurry of the desensitizing toothpaste and another set with a similar slurry prepared from a calcium- and phosphate-free control. A 0.85% aqueous solution of acid red fuchsin dye was applied to each window and allowed to dry. After a brief rinse, the teeth were sectioned across the windows. Almost no dye penetration was seen in teeth treated with the desensitizing toothpaste; however, extensive penetration through the dentin was visible in the control-treated teeth. The differences in dye penetration for the two sets of teeth were significant by both subjective (P < .001) and objective (P < .01) measures. Tubule occlusion because of calcium and phosphate ions from the desensitizing toothpaste accounts for its tooth desensitizing efficacy.

Effects of ammonium hexafluorosilicate concentration on dentin tubule occlusion and composition of the precipitate.

UNLABELLED: Ammonium hexafluorosilicate [SiF: (NH(4))(2)SiF(6)] was prepared in order to overcome the tooth discoloration caused by diamine silver fluoride [AgF: (NH(3))(2)AgF] application. We employed a single concentration of SiF solution in our previous study; therefore, it is still unclear how the concentration of SiF solution affects the occlusion of dentin tubules and composition of the precipitate. OBJECTIVE: The aim of this study was to evaluate the effects of changing the concentration of SiF on its clinical use as a dentin hypersensitivity treatment. METHODS: To simulate dentin tubules subject to dentin hypersensitivity, dentin disks were treated with EDTA for 2 min. Then, the disks were treated with several concentrations of SiF solution (from 100 to 19,400 ppm) for 3 min. The occlusion of dentin tubules was evaluated using scanning electron microscopy (SEM), and the composition of the precipitate formed in the tubules after SiF treatment was assessed using energy dispersive X-ray analysis (EDXA). RESULTS: SEM photographs demonstrated that dentin tubules after treatment with SiF were occluded homogeneously and fully regardless of the concentration of SiF solution. The Ca/P molar ratio of the precipitate formed in dentin tubules after SiF treatment was increased with the concentration of SiF solution. SIGNIFICANCE: It was concluded that the capacity to occlude dentin tubules was the same regardless of the concentration of SiF solution. However, the composition of the precipitate formed in the tubules was dependent on the concentration of SiF solution.

Clinical evaluation of desensitizing treatments for cervical dentin hypersensitivity.

The aim of this study was to compare different treatments for dentin hypersensitivity in a 6-month follow-up. One hundred and one teeth exhibiting non carious cervical lesions were selected. The assessment method used to quantify sensitivity was the cold air syringe, recorded by the visual analogue scale (VAS), prior to treatment (baseline), immediately after topical treatment, after 1 week, 1, 3 and 6 months. Teeth were randomly assigned to five groups (n = 20): G1: Gluma Desensitizer (GD); G2: Seal& (SP); G3: Oxa-gel (OG); G4: Fluoride (F); G5: Low intensity laser-LILT (660 nm/3.8 J/cm(2)/15 mW). Analysis was based on the non-parametric Kruskal-Wallis test that demonstrated statistical differences immediately after the treatment (p = 0.0165). To observe the individual effects of each treatment, data was submitted to Friedman test. It was observed that GD and SP showed immediate effect after application. Reduction in the pain level throughout the six-month follow-up was also observed. In contrast, LILT presented a gradual reduction of hypersensitivity. OG and F showed effects as of the first and third month respectively. It can be concluded that, after the 6-month clinical evaluation, all therapies showed lower VAS sensitivity values compared with baseline, independently of their different modes of action.

Effectiveness of a baking soda toothpaste delivering calcium and phosphate in reducing dentinal hypersensitivity.

OBJECTIVE: The purpose of this controlled clinical trial was to determine the effectiveness and safety of a single-phase dentifrice that delivers calcium, phosphate, and fluoride to the tooth surface (Arm & Hammer Enamel Care for Sensitive Teeth toothpaste, United Kingdom) in reducing dentinal hypersensitivity. METHODS: Two-hundred and eight qualifying subjects were randomly assigned to either the Enamel Care dentifrice group or a control dentifrice group, and brushed twice daily with their assigned dentifrice for eight weeks. Pain/discomfort in response to a thermal stimulus was assessed at baseline, week 4, and week 8 using a Visual Analogue Scale (VAS; primary outcome variable) and the Schiff Thermal Sensitivity Scale (STSS; secondary outcome variable). After eight weeks, volunteers from the Enamel Care group were switched to the control dentifrice and participated in a second eight-week study to determine the degree of persistence of pain reduction. RESULTS: Both groups had statistically significant VAS score reductions from baseline at weeks 4 and 8, with mean VAS scores in the Enamel Care group decreasing by 45.6% at week 4 and 61.1% at week 8 (p < 0.0001). Enamel Care was statistically significantly more effective than the control at weeks 4 and 8, with respective mean VAS reductions of 63% (p < 0.0001) and 33% (p = 0.0004) greater than the control. Consistent with the VAS score results, the Enamel Care group had respective statistically significant STSS score reductions of 77% and 58% greater than the control group (p < 0.0001). The reductions in dentinal hypersensitivity seen in the Enamel Care group at week 8 persisted for an additional eight weeks, during which the subjects discontinued use of Enamel Care and brushed with the control dentifrice. CONCLUSION: Enamel Care for Sensitive Teeth toothpaste (United Kingdom) is an effective dentifrice for the management of dentinal hypersensitivity, and its efficacy persists for a least eight weeks following discontinued product use.

Clinical evaluation of desensitizing treatments for cervical dentin hypersensitivity

The aim of this study was to compare different treatments for dentin hypersensitivity in a 6-month follow-up. One hundred and one teeth exhibiting non carious cervical lesions were selected. The assessment method used to quantify sensitivity was the cold air syringe, recorded by the visual analogue scale (VAS), prior to treatment (baseline), immediately after topical treatment, after 1 week, 1, 3 and 6 months. Teeth were randomly assigned to five groups (n = 20): G1: Gluma Desensitizer (GD); G2: Seal&Protect (SP); G3: Oxa-gel (OG); G4: Fluoride (F); G5: Low intensity laser-LILT (660 nm/3.8 J/cm²/15 mW). Analysis was based on the non-parametric Kruskal-Wallis test that demonstrated statistical differences immediately after the treatment (p = 0.0165). To observe the individual effects of each treatment, data was submitted to Friedman test. It was observed that GD and SP showed immediate effect after application. Reduction in the pain level throughout the six-month follow-up was also observed. In contrast, LILT presented a gradual reduction of hypersensitivity. OG and F showed effects as of the first and third month respectively. It can be concluded that, after the 6-month clinical evaluation, all therapies showed lower VAS sensitivity values compared with baseline, independently of their different modes of action.