Dentine hypersensitivity: The effects of brushing desensitizing toothpastes, their solid and liquid phases, and detergents on dentine and acrylic: Studies in vitro
Division of Restorative Dentistry, Dental School, University of Bristol, UK. Journal of Oral Rehabilitation
(Impact Factor: 1.68).
01/1999; 25(12):885-95. DOI: 10.1046/j.1365-2842.1998.00339.x
Dentine exhibiting symptoms of dentine hypersensitivity has tubules open at the dentine surface and patent to the pulp. The mechanisms whereby dentinal tubules are exposed is ill understood but probably involves a variety of abrasive and/or erosive agents. This study in vitro examined the quantitative and qualitative effects of toothpastes, their solid and liquid phases and detergents on dentine and acrylic. Abrasion of dentine and acrylic were measured by surfometry. Morphological changes to dentine were assessed by scanning electron microscopy. Abrasion of dentine and acrylic by toothpastes increased with increasing brushstrokes with marked differences in the extent of abrasion between different pastes. Brushing dentine with water or detergents produced progressive abrasion but which appeared to plateau around 2 microm loss. Water and detergents produced minimal effects on acrylic. At 5000 strokes dentine abrasion by solid phases was less than the parent toothpastes but the ranking order of abrasivity was the same as the parent toothpastes. Loss of dentine produced by liquid phases was minimal and in the order of 1-2 microm. Observationally, all toothpastes removed at least the dentine smear layer to expose many tubules; with one desensitizing product leaving a particulate deposit occluding most tubules. The solid phases of the toothpaste produced identical morphological changes to the parent paste. The liquid phases and detergents all exposed dentinal tubules by 5000 strokes. Water had little or no effect on the dentine smear layer. It is concluded that toothpastes, solid phase, liquid phase and detergents have the potential to abrade or erode dentine to a variable degree and result in tubule exposure. The effects of the liquid phases and detergents appear limited to the removal of the smear layer. Such detrimental effects seen in vitro could have relevance to the aetiology and management of dentine hypersensitivity. Toothpaste formulations which despite exposing tubules have ingredients capable of occluding tubules may be an area of development for such products.
Available from: Richard Bryan Cartwright
- "Abrasive tooth brushing and the use of abrasive toothpastes may also initiate dentinal hypersensitivity (Addy, 2005). These actions can damage or remove tooth tissue and may also remove protective plaque layers, exposing open dentinal tubules to stimuli within the oral environment (West et al., 1998). The ingestion of fruits, fruit juices and other acid beverages are able to produce oral conditions that can cause tooth erosion (Larsen, 1975). "
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ABSTRACT: Dentinal hypersensitivity is an exaggerated response to a sensory stimulus that usually causes no response in a normal healthy tooth. It is a source of chronic irritation that can severely affect an individual's eating and drinking habits. The management of tooth hypersensitivity by oral healthcare professionals requires an appreciation of the complexity of the problem together with knowledge of available treatments.
To review the symptoms, contributing oral factors, prevalence, measurement and mechanisms of dentinal hypersensitivity, together with current and potential future therapies for the condition.
Narrative literature review.
The permeability and fluid movement in open, exposed dentinal tubules has provided a favoured theory for stimulus transmission through dentine. Occlusion of dentinal tubules has been identified as a potential method of reducing pain associated with sensitive teeth. Current treatments work to occlude dentinal tubules. However these treatments can be expensive and their effects are often transient. In comparison, future therapies could be based upon either laser or iontophoresis techniques.
Future therapies may provide a more permanent and cost effective way of treating dentinal hypersensitivity for health care professionals and their patients.
Available from: Adrian Lussi
- "Brushing with an occluding toothpaste can occlude tubules [146–149] with deposition of toothpaste ingredients on dentin and in tubule orifices. However, non-occluding toothpastes may open tubules due to their abrasive nature [144, 150, 151]. A systematic review conducted by von Troil et al.  looked at the prevalence of root sensitivity following periodontal therapy, concluding that root sensitivity occurs in approximately half of the patients following subgingival scaling and root planing due to opening and closing of the tubules, respectively. "
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The paper’s aim is to review dentin hypersensitivity (DHS), discussing pain mechanisms and aetiology.
Materials and methods
Literature was reviewed using search engines with MESH terms, DH pain mechanisms and aetiology (including abrasion, erosion and periodontal disease).
The many hypotheses proposed for DHS attest to our lack of knowledge in understanding neurophysiologic mechanisms, the most widely accepted being the hydrodynamic theory. Dentin tubules must be patent from the oral environment to the pulp. Dentin exposure, usually at the cervical margin, is due to a variety of processes involving gingival recession or loss of enamel, predisposing factors being periodontal disease and treatment, limited alveolar bone, thin biotype, erosion and abrasion.
The current pain mechanism of DHS is thought to be the hydrodynamic theory. The initiation and progression of DHS are influenced by characteristics of the teeth and periodontium as well as the oral environment and external influences. Risk factors are numerous often acting synergistically and always influenced by individual susceptibility.
Whilst the pain mechanism of DHS is not well understood, clinicians need to be mindful of the aetiology and risk factors in order to manage patients’ pain and expectations and prevent further dentin exposure with subsequent sensitivity.
Available from: dental-expert.jp
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