Dentine surface modification and remineralization induced by bioactive toothpastes.

OBJECTIVE: In this study, dentine surface was analysed through Environmental-scanning-electron-microscopy (ESEM) with energy-dispersive-X-ray-spectrometry (EDX) and Fourier-transform-infrared-spectroscopy (FTIR) with attenuated total-reflectance (ATR) to assess the morpho-chemical changes and variations in mineralization degree after demineralizing treatment, after five toothpastes application (HA & Citrate toothpaste, Zinc-HA toothpaste, Calcium Sodium Phosphosilicate toothpaste, Arginine & Calcium carbonate toothpaste, Colgate-Triple-Action, and Control toothpaste), after soaking in artificial saliva and after citric acid attack. METHODS: Ca/P, Ca/N and P/N ratios were calculated from EDX atomic data to evaluate the mineralization degree of dentine surface. The IR calcium phosphate (CaP)/collagen and carbonate/collagen ratios has been evaluated to assess the remineralization changes in dentine; the carbonate/collagen IR ratio was calculated to identify the nucleation of B-type-carbonated apatite and calcium carbonate. RESULTS: ESEM-EDX and ATR-FTIR showed residuals of toothpastes after the treatments in all cases, with a general increase in the mineralization degree after soaking in artificial saliva and a decrease after acid attack. Treatment with Arginine & Calcium carbonate toothpaste showed the highest Ca/P value after treatment (Ca/P 1.62) and acid attack (Ca/P 1.5) in confirmation, IR showed the highest amount of carbonate after treatment and soaking in artificial saliva. Arginine and calcium carbonate toothpaste and HA and citrate toothpaste remained to a higher extent on the dentine surface and revealed a higher remineralization activity. These formulations showed higher resistance to demineralization attack, as demonstrated by a higher ICaP /IAmide II intensity ratio than those obtained after EDTA treatment. CONCLUSIONS: Toothpastes that remained to a higher extent on dentine surface (arginine and calcium carbonate toothpaste in particular) were more able to promote remineralization. The formed calcium phosphate (CaPs) phase was intimately bound to dentine rather than a simple deposit.

Comparative evaluation of fluorinol and calcium sodium phosphosilicate-containing toothpastes in the treatment of dentin hypersensitivity.

BACKGROUND: Dentin hypersensitivity is one of the most commonly encountered clinical problems. Various desensitizing agents have been widely used in the management of dentin hypersensitivity. Fluorinol, a fluoride-containing agent, has shown to be effective in fluoridating the hydroxyapatite crystal and thus reduce enamel solubility. Calcium sodium phosphosilicate mechanically occludes open tubules and releases calcium and phosphorous to remineralize tooth structure. OBJECTIVE: To compare and assess the efficacy of fluorinol-containing toothpaste with 7.5% sodium calcium phosphosilicate-containing toothpaste in reducing dentin hypersensitivity. METHODOLOGY: Thorough oral prophylaxis was done, and the patients were subjected to the washout phase, after which they were randomly allocated to the two study groups, Group A-fluorinol-containing toothpaste, Group B-sodium calcium phosphosilicate-containing toothpaste. Patients were recalled on 2nd , 3rd and 4th weeks, and sensitivity was assessed using VAS scores by means of tactile, evaporative and cold water stimuli. Oral health-related quality of life was assessed using OHIP-14 questionnaire at baseline and 4 weeks. RESULT: Compared to baseline, there was a significant decrease in dentin hypersensitivity in both the groups. The VAS scores for tactile stimuli were significantly lower in group A at 3rd and 4th weeks. CONCLUSION: Fluorinol-containing toothpaste was shown to be effective in reducing dentinal hypersensitivity. Hence, it can be used routinely in the management of dentin hypersensitivity.

Nd:YAG laser and calcium sodium phosphosilicate prophylaxis paste in the treatment of dentin hypersensitivity: a double-blind randomized clinical study.

AIM: This double-blind, placebo-controlled, randomized clinical trial evaluated the effectiveness of Nd:YAG laser and a calcium sodium phosphosilicate-containing paste (NovaMin®) in the treatment of cervical dentin hypersensitivity (CDH). MATERIALS AND METHODS: Seventy patients were randomly allocated into the following experimental groups: control-placebo, calcium sodium phosphosilicate paste (NovaMin®), and Nd:YAG laser (1 W, 10 Hz, 85 J/cm2). Pain was evaluated by means of a visual analog pain scale (VAS) after evaporative stimulation with a jet of air and tactile stimulation with an exploratory probe, before treatment (baseline) and after 5 min, 1week, and 4 weeks. When patients presented more than one tooth with CDH, the mean of the values obtained was calculated. Irradiation with Nd:YAG laser was performed twice in the mesial-distal and twice in the occlusal-gingival direction. The NovaMin®-containing paste was applied with a rubber cup at low speed for 60 s. Patients of the placebo group received simulations of the two treatments. As the data presented normal distribution, the two-way ANOVA repeated measures test was used. RESULTS: In all the experimental times, reduction in pain was demonstrated in comparison with baseline for all treatments (p < 0.05); however, there was no difference among the experimental groups in any of the time intervals evaluated (p > 0.05). CONCLUSION: All treatments were equally effective in reducing the pain of CDH. CLINICAL RELEVANCE: Nd:YAG laser irradiation and the calcium sodium phosphosilicate paste could reduce the symptoms of CDH; thus, they stand out as viable alternatives for the treatment of this condition.

Enamel remineralization effect of a dentifrice containing calcium sodium phosphosilicate: an optical coherence tomography observation.

OBJECTIVE: The purpose of this study was to examine the effects of a dentifrice containing 5% calcium sodium phosphosilicate (CSP) on the remineralization of the enamel using optical coherence tomography (OCT). MATERIALS AND METHODS: Bovine incisors were sliced and shaped in a rectangular form. One group of five specimens was treated with undersaturated 0.1 M lactic acid buffer solution (pH 4.75) for 10 min and then placed in artificial saliva (pH 7.0) (De group). Other specimens were stored in solutions of toothpaste containing CSP for 10 min, followed by 10-min immersion in the lactic acid buffer solution twice a day before storage in artificial saliva (CSP group). An additional group was stored in only artificial saliva (control group). OCT imaging on the selected location of the enamel surface was performed. The peak intensity and width at 1/e2 were recorded in each of the six areas on the sample and averaged, and the sample size of each group was six. The integrated value in units (dB × µm) was calculated in the area of peak intensity. The data for each group was subjected to one-way repeated-measures ANOVA and Tukey HSD tests (α = 0.05). RESULTS: The changes in integrated values of each group were different. A slight but significant increase in the integrated value was observed in the control group, whereas a slight but significant decrease in the value was observed the De group. Integrated values increased in the CSP group. CONCLUSIONS: Remineralization occurred upon immersion in the toothpaste containing CSP.

In Situ Study to Confirm the Anticaries Potential of a Sodium Monofluorophosphate Dentifrice Containing Calcium Sodium Phosphosilicate.

OBJECTIVES: A randomized, investigator-blind, five-treatment, crossover, non-inferiority study was conducted to investigate the effect of the addition of calcium sodium phosphosilicate (CSPS), an agent known to relieve dentin hypersensitivity, to a sodium monofluorophosphate (SMFP)-containing dentifrice on the enamel remineralization potential of fluoride (F), as assessed by percentage surface microhardness recovery (%SMHR) and enamel fluoride uptake (EFU) using a standard in situ caries model. METHODS: Seventy-seven subjects wearing bilateral mandibular partial dentures holding partially demineralized bovine enamel specimens 24 hours/day brushed their teeth with their assigned randomized dentifrice containing either 1500 or 0 ppm F with 5% CSPS or 1500, 500, or 0 ppm F with 0% CSPS twice daily for 21 days. The success criterion was to observe a difference in % SMHR between dentifrices containing 1500 ppm F of six units or less in the upper bound of the two-sided 95% confidence interval (CI). RESULTS: Following 21 days of treatment, the upper bound CI of the %SMHR difference between the dentifrices containing 1500 ppm F was 1.66, thus within the non-inferiority limit. No statistically significant differences for %SMHR (p = 0.2601) and EFU (p = 0.2984) were noted between these two dentifrices. CONCLUSIONS: The present in situ caries study provides evidence demonstrating that the addition of the calcium-containing compound CSPS to a 1500 ppm F dentifrice does not interfere with the ability of fluoride to remineralize surface-softened enamel; i.e., CSPS neither impairs nor improves the potential cariostatic value of SMFP dentifrice.

A Randomized Clinical Trial Investigating the Effect of Particle Size of Calcium Sodium Phosphosilicate (CSPS) on the Efficacy of CSPS-containing Dentifrices for the Relief of Dentin Hypersensitivity.

OBJECTIVES: To investigate the effect of reducing the particle size of calcium sodium phosphosilicate (CSPS) bioactive glass from ~14 µm (NovaMin®) to ~4 µm (Vitryxx®), and of changing the fluoride source in a 5% CSPS dentifrice from sodium monofluorophosphate (SMFP) to sodium fluoride (NaF) on the efficacy of CSPS-containing dentifrices in dentin hypersensitivity (DH) relief. METHODS: A randomized, controlled, examiner-blind, five-treatment arm, parallel group, stratified, exploratory study of NaF dentifrices containing 2.5% or 5% small particle size CSPS (~4 µm), NaF or SMFP dentifrices containing 5% CSPS (~14 µm), and a regular fluoride dentifrice in healthy subjects with DH. Sensitivity to tactile stimulus (Yeaple probe) and evaporative (air) stimulus (Schiff Sensitivity Scale, visual analogue scale) was assessed at baseline and after one, two, four, and eight weeks' twice-daily treatment. The study was not statistically powered to detect significant between-treatment differences. RESULTS: One hundred thirty-three of 134 randomized subjects completed the study. All treatments showed similar, statistically significant (p < 0.007) improvements in DH compared to baseline at Weeks 2, 4, and 8. No trends favoring any specific treatment were observed. Treatments were generally well tolerated. CONCLUSIONS: The apparent absence of a positive treatment effect for the CSPS-containing dentifrices compared to the regular fluoride dentifrice is inconsistent with other previously reported efficacy studies for CSPS dentifrices.

A Randomized Non-Inferiority Clinical Study to Evaluate the Efficacy of Two Dentifrices for Dentin Hypersensitivity.

OBJECTIVES: Calcium sodium phosphosilicate (CSPS) is a particulate bioactive material incorporated into oral healthcare products for the treatment of dentin hypersensitivity (DH). This study aimed to determine whether a dentifrice containing 5% CSPS and fluoride as sodium fluoride (NaF; "Test dentifrice") was non-inferior to a dentifrice containing 5% CSPS and fluoride as sodium monofluorophosphate (SMFP; "Comparator dentifrice") in reducing DH after eight weeks' twice-daily brushing. METHODS: This was a randomized, examiner-blind, parallel-group, non-inferiority study in healthy adults with self-reported and clinically diagnosed DH. After an initial lead-in period, subjects were randomized to either the Test (n = 150) or Comparator dentifrice (n = 154) and instructed to brush twice daily for the next eight weeks. DH was assessed at baseline and following four and eight weeks of dentifrice use by response to a tactile stimulus (tactile threshold) and evaporative (air) stimulus (Schiff sensitivity score and 100 mm visual analog scale [VAS]). The non-inferiority margin was defined as 6 mm on the VAS. RESULTS: Both dentifrices were associated with statistically significant reductions in DH from baseline after four and eight weeks' use for all efficacy parameters (all p < 0.0001). There were no statistically significant differences between the groups. After eight weeks' use, the between-treatment difference in VAS scores was 2.67 mm (per-protocol analysis) in favor of the Comparator dentifrice; the upper limit of the 95% confidence interval (CI) of the between-treatment difference in VAS scores exceeded the pre-specified non-inferiority margin of 6 mm (upper 95% CI = 7.4). The non-inferiority margin was also exceeded after four weeks. Both dentifrices were generally well tolerated. CONCLUSIONS: The pre-defined non-inferiority margin of 6 mm was not met, thus it is not possible to conclude from the present analysis that the Test dentifrice is non-inferior to the Comparator. However, for all efficacy measures, a statistically significant reduction in DH was observed for both dentifrice groups. There were no statistically significant differences between dentifrice groups, suggesting that changing the source of fluoride from SMFP to NaF does not affect the overall efficacy of the dentifrice in alleviating DH.

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.

Evaluation of Bioactive Glass Treatment for Dentin Hypersensitivity: A Systematic Review.

The aim of this systematic review is to compare home and office desensitizers containing bioactive glass with control groups in randomized controlled trials (RCT) conducted between 2018 and 2022. According to PRISMA guidelines, three electronic databases (Scopus, PubMed, and Cochrane Library) were searched for published scientific articles in October 2022. RCT with adult participants with dentin hypersensitivity (DH) diagnosed by evaporative, mechanical, or thermal stimulation, with a follow-up period and quantified pain assessment were included in the study. Studies that reported DH due to tooth restoration, crown preparation, bleaching, or periodontal surgery or used bioactive glass-ceramics were excluded. The quality of the studies was assessed using version 2 of the Cochrane Risk-of-Bias Tool for randomized studies (RoB 2 tool). Articles that were duplicative or unrelated to this study were excluded. Nine articles were selected for full-text evaluation, whereas two articles were rejected. The remaining seven reports were included in this review. The calcium sodium phosphosilicate group (CSPS) was not significantly different from the positive control groups. Compared with the control groups, fluoro calcium phosphosilicate (FCPS) may be the most effective long-term treatment option. In terms of DH symptom reduction, the FCPS group performed better than the CSPS group. CSPS at a concentration of 5-15% and FCPS at a concentration of 5% are effective in treating DH in adult participants.

Improving Oral Health with Fluoride-Free Calcium-Phosphate-Based Biomimetic Toothpastes: An Update of the Clinical Evidence.

As the demand for clinically effective fluoride-free oral care products for consumers increases, it is important to document which types of toothpastes have been shown in clinical studies to be effective in improving oral health. In this review, we included different indications, i.e., caries prevention, improving periodontal health, reducing dentin hypersensitivity, protecting against dental erosion, and safely improving tooth whitening in defining what constitutes improvement in oral health. While there are several professional and consumer fluoride-containing formulations fortified with calcium-phosphate-based ingredients, this review focuses on fluoride-free toothpastes containing biomimetic calcium-phosphate-based molecules as the primary active ingredients. Several databases were searched, and only clinical trials in human subjects were included; in vitro and animal studies were excluded. There were 62 oral health clinical trials on biomimetic hydroxyapatite (HAP), 57 on casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), 26 on calcium sodium phosphosilicate (CSPS, or so called Bioglass), and 2 on ß-tricalcium phosphate (ß-TCP). HAP formulations were tested the most in clinical trials for benefits in preventing caries, dentin hypersensitivity, improving periodontal health, and tooth whitening. Based on the current clinical evidence to date, fluoride-free HAP toothpaste formulations are the most versatile of the calcium phosphate active ingredients in toothpastes for improving oral health.

Bioactive glass versus Arginine dentifrices on the reduction of dentin permeability and acid tolerance.

OBJECTIVES: To compare the efficacy of calcium sodium phosphosilicate (CSPS) and arginine dentifrices on dentin permeability and acid tolerance. MATERIAL AND METHODS: Sixty dentin discs were randomly assigned into 3 groups, then brushed for 1 min with CSPS, arginine, or fluoride (control) dentifrices. To test acid tolerance, each disc was soaked in 6% citric acid for 1 min. Dentin permeability was measured before, following brushing, and acid challenge. Ten discs per group were similarly treated and evaluated for tubule occlusion following a single dentifrice application, while other five discs per group were employed in an acid tolerance assay. RESULTS: The percentage reduction in dentin permeability was 39.26%, 32.27%, and 21.71% in the arginine, CSPS, and control groups, respectively. The differences in dentin permeability reduction between the arginine and CSPS groups following brushing and acid challenge were not significant (p = 0.398 and p = 0.211, respectively). The arginine dentifrice demonstrated a significant reduction in permeability compared with the control (p = 0.011). In addition, the occlusion exhibited by the arginine and CSPS dentifrices was more resistant to acid challenge compared with that of the control (p < 0.001). From SEM analysis, dentinal tubule occlusion was observed after a single application in all groups. Some open dentinal tubules were detected in the test groups, while almost all of the orifices were open in the fluoride group following acid challenge. CONCLUSIONS: There is no significant difference between arginine and CSPS dentifrices in reducing dentin permeability following a single application and acid challenge. Following acid challenge, the reduced permeability generated by arginine and CSPS was more stable compared with the fluoride dentifrice.

Is there evidence for Novamin application in remineralization?: A Systematic review.

BACKGROUND: Calcium sodium phosphor-silicate material, a type of bio-glass was originally developed as an implant material to regenerate bone and recently adapted for use in oral care products (NovaMin Technology Inc.). Novamin is used for many dental problems like hypersensitivity, gingivitis, bleeding, non-carious lesions, carious lesions, whitening and is currently emerging as one of the treatment modality for the remineralization of the tooth. Since the prescription of these novel materials to the patients are based on cost effectiveness, efficacy and effectiveness, a clinician should make decision based on best available evidence. Hence, the objective of this review is to find out the current evidence available on the use of Novamin as an agent for remineralization. MATERIALS AND METHODS: Relevant articles were searched and screened from several databases including PubMed, Cochrane review, Science Direct and trip which were published till 1988 to July 2017; The articles relevant to the objective of this review were included (RCT's) and articles out of interest of this review were excluded. The primary outcome for the chosen studies is the remineralization capacity of Novamin. Data extraction is done independently and jointly by 3 authors using data collection forms. Studies obtained were evaluated using the Cochrane Collaboration tools for accessing risk bias. The assessment of the quality of the evidence and the bias risk was obtained using the Grading of Recommendations Assessment Development and evaluation System. RESULTS: The articles from the database obtained for further review was N = 1. According to the study reviewed, the baseline comparisons using decalcification index obtained between Novamin study group (ReNew) and the control group (Crest) yield a P-value of 0.97 whereas after a 3 months interval follow up the value is 0.0403 suggesting there was a trend towards improvement in white spot lesions in the control group and at 6 months' time point the p-value is 0.81 concluding that there are no significant difference of remineralization process obtained by using traditional toothpaste and Novamin. CONCLUSION: Review shows that Novamin has significantly less clinical evidence to prove its effectiveness as a remineralization agent in treating both carious and non-carious lesion. Hence, better designed clinical trials should be carried out in the future before definitive recommendations can be made.

Effectiveness of polyacrylic acid-bioactive glass air abrasion preconditioning with NovaMin remineralization on the microhardness of incipient enamel-like lesion.

BACKGROUND: Bioactive glass (BAG) remineralization is a promising method for dental hard tissue regeneration. The aim of this study was to evaluate the microhardness of incipient enamel-like lesions with or without preconditioning by air abrasion using polyacrylic acid (PAA)-BAG before application of NovaMin remineralizing agent. MATERIALS AND METHODS: Forty extracted human molars were selected, sectioned mesiodistally obtaining buccal and lingual halves, and embedded in resin molds. Specimens were randomly assigned to four groups (n = 10) according to the remineralization protocol: G1 (control, artificial saliva), G2 (preconditioning), G3 (NovaMin), and G4 (preconditioning and NovaMin). Enamel windows 4 mm × 4 mm were done on the buccal and lingual surfaces. Specimens were immersed in a daily renewed demineralizing solution to create white spot lesions. Remineralizing agents were applied according to the manufacturer's instructions, and specimens were stored in a daily renewed artificial saliva. Microhardness was assessed using Vickers hardness number (VHN) at baseline (positive control), after demineralization (negative control), and after 24-h and 1-month remineralization. RESULTS: The preconditioning/NovaMin group after 1 month showed a statistically significant high VHN, with no statistically significant difference between it and the positive control. This was followed by the NovaMin group after 1 month, while the lowest VHN was found in the demineralized group, with no statistically significant difference between it and the preconditioning group, whether after 24 h or 1 month. CONCLUSIONS: Enamel preconditioning with PAA-BAG air abrasion play a major role in enhancement of remineralization when it is accompanied with NovaMin. Furthermore, an extended period of time had helped to attain more benefits from NovaMin remineralization. CLINICAL SIGNIFICANCE: Enamel remineralization with NovaMin after conditioning by bioactive glass air abrasion, provides the patients with a fast and durable treatment of incipient enamel lesions, which would reduce the possibility of future progression of demineralization and caries occurrence.

An Exploratory Randomised Study to Evaluate the Efficacy of an Experimental Occlusion-based Dentifrice in the Relief of Dentin Hypersensitivity.

PURPOSE: To compare the efficacy of a 2.5% w/w smaller particle-size (ca 4 µm) calcium sodium phosphosilicate (CSPS) dentifrice (test) to an occluding dentifrice (8% w/w arginine) (comparator) and a negative control dentifrice in an 8-week, randomised, controlled, parallel-group, stratified (maximum baseline Schiff sensitivity score) study in adults with dentin hypersensitivity. MATERIALS AND METHODS: The sensitivity of two selected teeth was assessed at baseline and after 1, 2, 4 and 8 weeks in response to evaporative (air) (Schiff sensitivity score and visual analogue scale [VAS]) and tactile (tactile threshold) stimuli. RESULTS: Of 151 randomised subjects, 147 completed the study. Statistically significant changes from baseline were reported for test and comparator dentifrices at all weeks on all measures (p < 0.05) with no statistically significant differences between them. The negative control dentifrice group was statistically significantly different from baseline in all measures by week 8 (p < 0.05). Test and comparator dentifrices demonstrated statistically significantly greater improvements in Schiff sensitivity from week 2 compared to the negative control (p < 0.05). There was a statistically significant difference in favour only of the comparator dentifrice over the negative control at week 8 when examining tactile threshold (p = 0.0435) and at week 4 with VAS (p = 0.0425), with no other between-group differences. The dentifrices were generally well tolerated. CONCLUSION: No statistically significant differences were found between a small particle size 2.5% w/w CSPS dentifrice and an 8% w/w arginine dentifrice in terms of a dentine hypersensitivity decrease.

Efficacy of a dissolvable strip with calcium sodium phosphosilicate (NovaMin®) in providing rapid dentine hypersensitivity relief.

OBJECTIVE: To evaluate the efficacy of a dissolvable strip containing 15% w/w calcium sodium phosphosilicate (CSPS) (Novamin®) in providing rapid relief from dentine hypersensitivity (DH). METHODS: In this examiner-blind, proof-of-principle study, 120 healthy adults with DH were randomized 1:1 to the Test strip, professionally applied to facial surfaces of two selected teeth, or to No treatment. Sensitivity was assessed at baseline and 10min, 2h and 4h post-application in response to evaporative (air) and tactile stimuli (measured by Schiff sensitivity scale/a numeric rating scale and tactile threshold, respectively). Change from baseline was analyzed by ANCOVA. RESULTS: At 10min post-application, mean Schiff score change from baseline (primary endpoint) was statistically significant with the Test strip (-0.46; 95% confidence intervals [CI]: -0.563, -0.356; p<0.0001) but not with No treatment (-0.02; 95% CI: -0.119, 0.088; p=0.7664). The between-treatment group difference favored the Test strip (difference: -0.44; 95% CI: -0.591, -0.297; p<0.0001). Similar improvements with the Test strip were reported for all other evaporative (air) and tactile sensitivity endpoints (p<0.0001 vs no-treatment) at all timepoints (10min, 2h, 4h). Test strips were considered by most staff and participants slightly/moderately easy to apply (98%). Many participants rated the overall usage experience as "like moderately" (40%) or "like extremely" (20%). There were no treatment-related adverse events. CONCLUSION: This new CSPS-based technology may provide a novel treatment option for rapid relief from DH (Clinicaltrials.gov NCT02937623). CLINICAL SIGNIFICANCE: A dissolvable strip containing 15% w/w calcium sodium phosphosilicate (CSPS) demonstrated significantly greater dentine hypersensitivity reductions following a single application compared with no treatment. Strips were well-liked by participants and generally well tolerated. A strip containing CSPS, which dissolves within 10min, may provide rapid relief from dentine hypersensitivity.

Comparative Evaluation of the Remineralization Potential of Monofluorophosphate, Casein Phosphopeptide-Amorphous Calcium Phosphate and Calcium Sodium Phosphosilicate on Demineralized Enamel Lesions: An In Vitro Study.

AIM: The aim of the study is to compare the remineralization potential of monofluorophosphate, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and calcium sodium phosphosilicate on demineralized enamel lesions. MATERIALS AND METHODS: Enamel sections from 30 sound human premolar crowns were prepared and sectioned into quadrants. Early enamel lesions were created in each sample by immersion in a demineralizing solution for 72 hours. Of the four sections, the first quadrant (A) was not given any surface treatment, the second quadrant (B) was treated with monofluorophosphate dentifrice, the third (C) was treated with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and the fourth (D) was treated with calcium sodium phosphosilicate while being subjected to a five-day pH cycling protocol. The sections were further cross-sectioned to expose the lesion depth and were then viewed under the confocal laser scanning microscope after staining with 0.1 mM rhodamine B dye for 24 hours. The two parameters evaluated were the cross-sectional demineralized lesion area and total fluorescence. RESULTS: Amongst the dentifrices tested, the lowest values for lesion area and total fluorescence were recorded by calcium sodium phosphosilicate (3874.1 µ2 and 107282.6, respectively), followed by casein phosphopeptide-amorphous calcium phosphate (5776.6 µ2 and 129470.8) and then by monofluorophosphate dentifrice (7371.2 µ2 and 233765.9) in increasing order. The highest values for lesion area and total fluorescence were recorded by the no treatment group (16449.2 µ2 and 759743.1). One-way analysis of variance (ANOVA) showed significant variations (p<0.01) between the groups and Scheffe multiple comparisons confirmed the significance (p<0.01) of intergroup variations. CONCLUSION: The results of this study suggest that, among the three agents tested, calcium sodium phosphosilicate is the most effective remineralizing agent followed by casein phosphopeptide-amorphous calcium phosphate. Monofluorophosphate is the least effective remineralizing agent when tested under the conditions mentioned in this study.

[Effect of calcium sodium phosphosilicate and potassium nitrate on dentin hypersensitivity: a systematic review and Meta-analysis].

OBJECTIVE: This systematic review and Meta-analysis aimed to compare the efficacy of calcium sodium phos-phosilicate (CSPS) and potassium nitrate as desensitizing agents for the treatment of dentin hypersensitivity (DH). METHODS: A thorough search in The Cochrane Library, PubMed, Embase, Chinese WanFang Data, CBM, and CNKI were conducted for studies published up to June 2017. Randomized controlled trials (RCTs) of the treatment of DH with CSPS and potassium nitrate toothpaste were included. Quality assessment and data extraction were performed by two reviewers independently, and Meta-analysis was performed by using RevMan 5.3 software. RESULTS: Eight RCTs involving 411 patients were included. Experimental group comprised 203 and control group had 208 patients. The Meta-analysis indicated the superior effect of CSPS dentifrice on air blast sensitivity at 2, 4, 6, and 8 weeks of follow-up [SMD=-1.85, 95%CI (-2.89, 
-0.81), P=0.000 5, I²=93%], [SMD=-1.61, 95%CI (-1.96, -1.26), P<0.000 01, I²=49%], [SMD=-3.79, 95%CI (-7.18, -0.40), P=0.03, I²=98%], and [SMD=-2.13, 95%CI (-2.69, -1.58), P<0.000 01] , respectively. No significant effects were seen at 12 weeks [SMD=-0.63, 95%CI (-1.47, 0.20), P=0.14, I²=71%]. CSPS dentifrice showed a better desensitizing effect at 2, 4, 6, 8, and 12 weeks of follow-up on cold water sensitivity [SMD=-1.07, 95%CI (-1.48, -0.66), P<0.000 01, I²=69%], [SMD=
-1.29, 95%CI (-1.81, -0.76), P<0.000 01, I²=64%], [SMD=-1.20, 95%CI (-1.57, -0.83), P<0.000 01, I²=86%], [SMD=-1.30, 95%CI (-2.51, -0.08), P=0.04, I²=82%], and [SMD=-0.79, 95%CI (-1.27, -0.31), P=0.001], respectively. No significant effects at 1 week of follow-up [SMD=0.00, 95%CI (-0.62, 0.62), P=1]. The favorable effect of CSPS dentifrice on tactile sensitivity was more obvious than the control group at 2, 4, and 8 weeks of follow-up [SMD=-1.31, 95%CI (-2.00, -0.62), P=0.000 2, I²=67%], [SMD=-1.37, 95%CI (-1.74, -0.99), P<0.000 01, I²=23%], and [SMD=-1.33, 95%CI (-1.82,-0.84), P<0.000 01], respectively. No significant effects at 1 week of follow-up [SMD=-0.32, 95%CI (-0.94, 0.31), P=0.32] were observed. CONCLUSIONS: Current evidence indicated that CSPS was more effective than potassium nitrate at reducing DH. The evidence generated by this review was based on a small number of individuals. High-quality and large sample size as well as ideally-designed clinical trials are required in the future before definitive recommendations can be made.

Comparative Evaluation of Desensitizing Efficacy of Dentifrice Containing 5% Fluoro Calcium Phosphosilicate versus 5% Calcium Sodium Phosphosilicate: A Randomized Controlled Clinical Trial.

BACKGROUND: A considerable number of agents are effective in the treatment of dentin hypersensitivity (DH). The present 2 months' randomized clinical trial compared the desensitizing efficacy of dentifrice containing 5% fluoro calcium phosphosilicate versus 5% calcium sodium phosphosilicate in participants with sensitive teeth. MATERIALS AND METHODS: A total of 60 participants above 18 years of age with a history of DH who displayed a visual analog scale (VAS) score of ≥ 4 to both subjective and thermal sensitivity in at least two teeth at the qualifying as well as baseline visit were considered eligible. Participants were randomly allocated to one of the following dentifrices: 5% fluoro calcium phosphosilicate; 5% calcium sodium phosphosilicate; and a standard dentifrice containing fluoride. Sensitivity scores (VAS) were measured at baseline, immediately after scaling and root planning, at 15, 30, and at 60 days. RESULTS: A statistically significant reduction in symptoms for all treatment groups from baseline to 15, 30, and 60 days for both measures of sensitivity was observed. A significant reduction in DH with time for all the variables during the 8 weeks of the active phase of the study independent of treatment groups was noted. However, the fluoro calcium phosphosilicate group showed a higher degree of effectiveness in reducing DH, followed by calcium sodium phosphosilicate then standard fluoride dentifrices. CONCLUSION: Under the conditions of a clinical trial, the fluoro calcium phosphosilicate group showed a comparable reduction in the symptoms of DH.

Exploratory randomised controlled clinical study to evaluate the comparative efficacy of two occluding toothpastes - a 5% calcium sodium phosphosilicate toothpaste and an 8% arginine/calcium carbonate toothpaste - for the longer-term relief of dentine hypersensitivity.

OBJECTIVE: To compare the longer-term clinical efficacy of two occlusion-technology toothpastes - a 5% calcium sodium phosphosilicate (CSPS) toothpaste and a commercially available 8% arginine/calcium carbonate toothpaste - in relieving dentine hypersensitivity (DH). Efficacy was also compared with that of a regular fluoride toothpaste control. METHODS: This was an exploratory, randomised, examiner-blind, parallel-group, 11-week, controlled study in healthy adults with self-reported and clinically diagnosed DH. After an acclimatisation period, subjects were randomised to one of three study treatments with which they brushed their teeth twice daily. Sensitivity was assessed at baseline and after 1, 2, 4, 6 and 11 weeks treatment in response to evaporative (air) and tactile stimuli (measured by the Schiff Sensitivity Scale/visual analogue scale and tactile threshold, respectively). RESULTS: A total of 135 subjects were randomised to treatment. The two occlusion-technology toothpastes performed similarly over the 11-week treatment period. All study treatments showed statistically significant reductions from baseline in DH at all timepoints for all measures (p<0.05). Statistically significant and clinically relevant sensitivity relief was observed for both occluding formulations compared with the regular fluoride toothpaste: for evaporative (air) sensitivity within 1 week and for tactile sensitivity at Week 11. No significant differences were detected between the two occluding formulations at any timepoint, for any endpoint. Study treatments were generally well tolerated. CONCLUSIONS: In this exploratory study, a 5% CSPS occluding toothpaste was effective in relieving DH compared with a regular fluoride toothpaste; an 8% arginine/calcium carbonate anti-sensitivity toothpaste provided similar benefits. Improvements in DH continued throughout the 11-week study. CLINICAL SIGNIFICANCE: Dentine hypersensitivity (DH) is a common and painful condition. Twice-daily use of a 5% calcium sodium phosphosilicate toothpaste reduces DH within 1-2 weeks of initiating use. Ongoing, twice daily use of the sensitivity toothpastes evaluated in this study was associated with continued, clinically significant improvements in DH.

Evaluation and comparison of efficacy of three desensitizing dentifrices on dentinal hypersensitivity and salivary biochemical characteristics: A randomized controlled trial.

BACKGROUND: This study aimed to evaluate and compare the efficacy of three desensitizing dentifrices on dentinal hypersensitivity (DH) and salivary biochemical characteristics. MATERIALS AND METHODS: A randomized, parallel arm, triple-blinded, clinical trial was conducted over a period of 12 weeks, with a total of three visits: baseline, 6 weeks, and 12 weeks. Calcium sodium phosphosilicate, potassium nitrate and amine fluoride dentifrices were compared. A total of 68 subjects who satisfied the inclusion criteria were included and randomly divided into four groups. Visual analog scale scores for controlled air stimulus were used to assess dentinal sensitivity and salivary pH and buffering capacity were recorded at baseline, 6 and 12 weeks. RESULTS: All groups showed a reduction in sensitivity scores at 6 and 12 weeks. The calcium sodium phosphosilicate group showed a higher degree of effectiveness in reducing DH than potassium nitrate, amine fluoride dentifrices, and placebo for sensitivity measures. Salivary pH of calcium sodium phosphosilicate group was more toward neutral, and the buffering capacity of the same group showed significant changes from baseline to 6 and 12 weeks compared to the other groups. CONCLUSION: The desensitizing toothpaste containing calcium sodium phosphosilicate was found to be more effective in reducing DH and showed improvement in salivary biochemical characteristics over a period of 12 weeks compared to others.