ArticleLiterature Review

Effect of dentin hypersensitivity treatment on oral health related quality of life − A systematic review and meta-analysis

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Abstract

Objective: This study aimed to evaluate if in patients with dentin hypersensitivity (DH), the DH treatments are able to improve individuals' oral health related quality of life (OHRQoL). Data and sources: A systematic review was performed based on PRISMA guidelines (PROSPERO CRD42016050864). Clinical trials reporting OHRQoL before and after DH treatment were included. The search was performed in the PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, LILACS, EMBASE and Scielo databases until May 2017. Hand searches and grey literature were included. Three researches independently selected the studies, extracted data, and assessed the methodological quality. The risk of bias was estimated based on the Cochrane Handbook for Systematic Reviews of Interventions. Meta-analysis was performed by I2 test. The quality of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Study selection: Six clinical trials were included. DH was assessed by evaporative, cold, and tactile stimuli. OHRQoL was evaluated by OHIP-14 and DHEQ questionnaires. In-home and in-office desensitizing agents for DH treatment were used. The revised studies reported statistically significant reduction of DH and significant improvement in quality of life after treatment (p<0.05). Two studies were judged as high risk of bias. The studies presented high heterogeneity (I2=0.8407). The evidence was very low to moderate. Conclusions: The studies indicated decreasing of DH and improving of OHRQoL after DH treatment, although, they presented low to moderate methodological quality. Clinical significance: The Oral Health Relate Quality of Life of whom complaint of DH can be improved after DH treatment.

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... It occurs when physical, chemical and/or tactile stimuli reach exposed dentin tissue. 3 Dentin exposure is usually caused by gingival recession, abfraction, abrasion, or erosion, and may not be associated with carious lesions or pulp pathologies. 4 Pain is a subjective sense and depends on both the physiological process of nerve fibers stimulation, and the psychosocial environment in which the individual lives. ...
... 8 This diversity resulted in several studies with no standardized methodology to assess DH, which makes it difficult to compare the results. 3 A consequence might be the wide range of reported prevalence of DH, from 1.34% to 98%. 9,10 Several studies have been conducted to investigate the intensity of DH and the effectiveness of DH treatment, 3,11 however, there is a gap in the literature about the sensitivity and specificity of pain scales used to specifically assess DH. 6,12,13 The aim of the present study was to compare the sensitivity and specificity of pain scales to assess DH. ...
... 3 A consequence might be the wide range of reported prevalence of DH, from 1.34% to 98%. 9,10 Several studies have been conducted to investigate the intensity of DH and the effectiveness of DH treatment, 3,11 however, there is a gap in the literature about the sensitivity and specificity of pain scales used to specifically assess DH. 6,12,13 The aim of the present study was to compare the sensitivity and specificity of pain scales to assess DH. As for secondaries aims, the preferred scale, and toothbrushing and drinking habits were investigated. ...
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The aim of the present study was to compare the sensitivity and specificity of pain scales used to assess dentin hypersensitivity (DH). The preferred scale, and toothbrushing habits of participants were also investigated. This cross-sectional study was conducted with students and employees of a Brazilian Federal University who presented DH. The participants answered a questionnaire about their toothbrushing and drinking habits. Hypersensitive and non-sensitive teeth were submitted to tactile and ice stick stimuli. Then, the subjects marked their pain level in the visual analogue (VAS), numeric scale (NS), faces pain scale (FPS) and verbal evaluation scale (VES). DH was also assessed by Schiff scale (SS). The data were analyzed by Wilcoxon and Chi-Square tests, as well as by ROC curve. The mean age of the sample (56 women, 16 men) was 27.8 years. The most prevalent acidic beverage was coffee (36.0%) and the most preferred scale was the NS (47.2%). The pain level was statistically higher in teeth with DH compared to teeth without DH (p < 0.05). The accuracy ranged from 0.729 (SS) to 0.750 (NS). The highest sensitivity value was 81.9% for NS. The SS presented the highest specificity (91%). The visual analog, numerical, verbal evaluation, faces pain, and Schiff scales were accurate for DH diagnosis. The Schiff scale was the preferred scale for DH assessment.
... Previous studies have revealed that the pain associated with DH can limit oral functions and negatively affect the quality of life (QoL) of individuals [24][25][26][27][28][29]. The concept of QoL defines the individual's perception in life considering the culture and environment in which it lives, summed with its goals, expectations, and concerns [30][31][32]. ...
... Restrictions on daily activities have an important effect on the patient's quality of life, and corroborating with that, a few evidence suggests that health-related quality of life (HRQoL) is negatively affected in patients with CDH [27]. A recent systematic review and metanalysis [29] demonstrated that desensitizing therapies could increase the quality of life since these therapies promote the reduction of negative impacts on daily activities, however, was not able to conclude if one kind of treatment is better than other. In this study, an effort was made aiming to evaluate if a neural/ occlusal (potassium oxalate) treatment could perform better in terms of quality life than the neural/photobiomodulation one (low power laser). ...
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Objectives To assess the improvement on oral health-related quality of life (OHRQoL) of individuals with cervical dentin hypersensitivity (CDH) with the noncarious cervical lesion (NCCLs) subjected to different treatments. Material and methods A single-blind randomized clinical trial was conducted with patients (n = 74) randomly allocated into three groups according to the treatment performed: PO, potassium oxalate (Oxa-Gel BF); LL, low-power laser irradiation; and POLL, potassium oxalate (Oxa-Gel BF) associated with low-power laser irradiation. The treatments were applied in four steps, weekly. The questionnaire Oral Health Impact Profile (OHIP-14) was applied before initiating and immediately after the fourth session. The greater the sum of the score, the smaller the measurement of OHRQoL. Results The total mean values of the variables at the final moment were significantly lower than the initial one for all dimensions (p value ranging from < 0.001 to 0.006). Furthermore, the OHIP-14 scores final analysis between the groups indicated that the POLL group compared to LL had a significantly lower final score for the functional limitation (p = 0.009), physical pain (p = 0.049), and psychological discomfort (p = 0.035) dimensions and that group PO compared to group LL had a significantly lower final score for the functional limitation dimension (p = 0.024). Conclusions There was a reduction in the OHIP-14 score for all dimensions, indicating an improvement in patients’ quality of life after the use of desensitizing therapies. Patients in group LL had a higher functional limitation, physical pain, and psychological discomfort. Clinical relevance This study indicated improvement of desensitizing therapies for CDH to improve patients’ OHRQoL. Trial registration: This trial was registered in the Brazilian Clinical Trials Registry Platform (REBEC protocol number RBR-4ybjmt).
... DH is conventionally defined as an episode of short sharp pain arising from exposed dentin after the application of thermal, tactile, chemical, osmotic, or evaporative stimuli, which cannot be caused by any other dental pathology and/or defect [5]. This condition impacts oral health-related quality of life [3], causing significant impairment on patients' daily life such as speaking, eating, drinking, and toothbrushing [6][7][8]. ...
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Dentinal hypersensitivity represents one of the most widespread dental problems and symptoms in the general population. It mainly affects the age group between 18 and 65 years old, presents an incidence of 35%, and may negatively affect the oral health-related quality of life of these patients. This longitudinal study aims to measure dentinal hypersensitivity in adult patients after the use of domiciliary desensitizing devices. In this study, 52 patients were included (32 females and 20 males, mean age: 53 ± 9.4) At T0 (baseline), patients were instructed to use a desensitizing toothpaste and, at T1, 27 patients reported using sodium monofluorophosphate (1450 ppm) and arginine 8% product (product A), while 25 patients reported using a toothpaste containing n-HAp (nano-hydroxyapatite) in effective dose 2.25% and 0.15% fluoride (1500 ppm) (product B). The study was carried out through three follow up appointments, 14 days apart from one another (T1 and T2). Results showed that the air sensitivity test did not exhibit a significant difference between the time points (p > 0.05), while a significant improvement of DH was recorded for tactile, osmotic, cold thermic, acid, and omni-comprehensive tests in both groups. Both desensitizing agents were effective in reducing DH for different stimuli.
... Dentin hypersensitivity is a common oral health problem globally and is an important issue to be addressed, both from a diagnostic and treatment perspective. [4] Treatment to relieve dentin hypersensitivity demands effective and robust dentin occlusion for instant and lasting action. Lasers are the new innovation in the treatment of dentin hypersensitivity. ...
... However, many of these treatments may be unsatisfactory, since most of the conventionally used desensitizers are related to the occlusion of the dentinal tubules without considering the causal factors that have triggered the problem [6]. Therefore, the initial therapeutic strategies should aim to eliminate predisposing factors, such as abrasion, erosive components, and abfraction, thus avoiding recurrence of symptoms [7]. The therapeutic procedures options for reducing dental hypersensitivity are based on substances that depress transmission, such as potassium salts or potassium nitrate, substances that occlude the dentin tubules by stimulating mineral deposits, such as fluorides, oxalates, varnishes, adhesive resins, Bioglass ® , and Portland cement, while low power (Helium-Neonium; He-Ne, Aluminum Gallium Arsenide; AsGaAl) and high power laser treatments (Neodymium Yttrium Aluminum Granate; Nd:YAG, carbon dioxide;CO 2 ) are considered therapeutic treatments [8]. ...
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The sealing and bonding characteristics of luting cements may be affected by the application of desensitizers containing ingredients that induce chemical interaction with dentin organic matrix. This study evaluated the effect of different desensitizers on the immediate and long-term shear bond strength (SBS) of a self-adhesive resin cement (SARC) to dentin. Healthy bovine dentin specimens were used for the study. Gluma® Desensitizer, Desensibilize Nano P®, and Soothe® desensitizer were used in study groups, while the control group did not receive any treatment. Next, SARC (RelyXTM U200) in cylindrical mold was applied to the sample surface. All specimens were stored at 37 °C for 24 h or six months and tested for SBS. Additionally, water contact angle was measured using an optical tensiometer. Results were analyzed by analysis of variance and Student-t tests (p ˂ 0.05). Application of the different types of desensitizers had no significant influence on immediate or long-term SBS of SARC to dentin (p > 0.05). Differences for water contact angle were not statistically significant among the tested groups (p = 0.450). Within the limitations of the present study, it can be concluded that the application of the different types of desensitizers had no significant influence on the SBS of a SARC to dentin.
... All these previous observations result in a change in society's lifestyle, leading us to face new diseases such as non-carious cervical lesions and, consequently, CDH [2][3][4][5]19]. Epidemiological studies suggest an increase in the prevalence of CDH and a negative impact on daily activities such as eating, drinking, breathing, and brushing teeth [3,4,[19][20][21]. In this study, some patients reported that the level of pain was so intense that they needed to warm up the water to brush their teeth. ...
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Objectives This randomized controlled trial aimed to evaluate different protocols for dentin hypersensitivity treatment with low-power lasers and desensitizing agents, and the association between low-power lasers and desensitizing agents. Materials and methods Fifty-four patients (303 teeth) were randomly allocated to three groups: G1, 3% nitrate potassium gel, UltraEZ (n = 17); G2, photobiomodulation therapy (PBM) with a low-level infrared laser (n = 17), 100 mW, spot size of 0.028 cm², and dose of 1 J per point; and G3, nitrate potassium + PBM (n = 20). Treatments were applied to the buccal cervical region at intervals of 72 h, and all protocols were performed in three sessions. The patients’ response to evaporative stimuli was rated using the visual analog scale (VAS). Re-evaluations were performed immediately after each application and 1 week, 1 month, and 3 months after treatment. A two-way repeated measures test and Tukey’s post hoc test were used for multiple comparisons (α = 5%). Results There was a reduction in pain levels at the end of treatment in all groups. There were no significant differences in VAS score changes between the groups immediately after treatment and after the third month, compared to the baseline (p > 0.05). Conclusion Under the limitations of this in vivo study, the proposed three-session protocol was effective in reducing dentin hypersensitivity after 3 months, regardless of the desensitization mechanism used. Conservative and long-term protocols are interesting for the control of pain caused by dentin hypersensitivity. Clinical relevance The increase in cervical dentin hypersensitivity prevalence warrants easy-to-apply and long-lasting desensitizing protocols for pain control.
... As NCCLs expose dentin, it is common for patients to complain of compromised esthetics caused by the cervical lesion, as well as dentin hypersensitivity. A recent estimate indicates that approximately 33.5% of NCCLs showed some degree of dentin hypersensitivity [3], which could affect the patients' quality of life [4]. ...
Article
Objectives To evaluate the clinical performance of a new dual-cure universal adhesive system (Futurabond U, Voco) when applied using different application strategies in non-carious cervical lesions (NCCLs) after 36 months. Material and Methods Futurabond U was applied in NCCLs of 50 subjects using four adhesion strategies (n = 50 restorations per group): only self-etch (SEE); selective enamel etching + self-etch (SET); etch-and-rinse with dry dentin (ERDry); and etch-and-rinse with wet dentin (ERWet). All cavities were restored using Admira Fusion composite resin (Voco). Restorations were evaluated after 36 months using the World Federation criteria (FDI) and the modified United States Public Health Service (USPHS) criteria. Results The after 36-month retention rates were 87% (75–92%) for SEE, 94% (83–98%) for SET, 91% (80–97%) for ERDry, and 94% (83–98%) for ERWet. Forty-three restorations were considered to have minor discrepancies in marginal adaptation at the 36-month recall (18 for SEE, 12 for SET, 7 for ERDry, and 6 for ERWet; p > 0.05). One restoration was detected as a minor marginal discoloration at the 36-month recall (1 for SET; p > 0.05). No restorations showed postoperative sensitivity and caries recurrence at 36 months. Conclusion The clinical performance of the Futurabond U did not depend on the employed bonding strategy, and it was considered reliable after 36 months of clinical evaluation. However, greater marginal discrepancy was observed in the self-etch groups. Clinical Relevance NCCLs restorations using a dual-cure universal adhesive in self-etch and etch-and-rinse modes showed satisfactory clinical performance after 36 months.
... Dentin hypersensitivity can be defined as a short sharp pain that arises from the exposed dentin in response to thermal, tactile, osmotic, chemical, or evaporative stimuli that cannot be attributed to any other form of dental defect or pathology 2 . This condition impacts oral health-related quality of life 3,4 , producing significant impairment on patients' daily life such as speaking, eating, drinking and tooth brushing 5,6 . The clinical management of DHS has been a challenge for clinician, various treatment modalities are available, but the success of any sound treatment plan is depended on taking a detailed clinical and dietary history, differentially diagnose the condition from other dental pain conditions and identify and manage etiological and predisposing factors [7][8][9][10] All of these terms convey the same clinical conception and can be used interchangeably Common terms which are used refer to dentin hypersensitivity Dentin Hypersensitivity/ Sensitivity Dentinal Hypersensitivity/ Sensitivity Cervical Hypersensitivity/ Sensitivity Root Hypersensitivity/ Sensitivity Cemental Hypersensitivity/ Sensitivity 7-10 ...
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Dentine hypersensitivity (DHS) is a widespread painful dental problem that is characterized by short sharp pain arising from exposed dentin in response to several different stimuli. This accepted definition, indicates the need to consider a differential diagnosis to rule out other causes of dental pain before the diagnosis of dentin hypersensitivity is made. The management strategy of this dental problem required a good understanding of the complexity of the condition and the variety of the treatment options. The aim of this review is to inform practitioners about dentin hypersensitivity, to provide a brief overview of the diagnosis, etiology and clinical management of dentin hypersensitivity.
... These ingredients resulted in rapid fluorapatite crystallisation at exposed tubular ends of dentin [12]. These fluorapatite crystals were less susceptible to acidic dissolution than hydroxyapatite crystals and thus were more desirable [13]. In vitro analysis suggested that FCPS-based dentifrice enabled the slow and sustained release of fluoride contents, resulting in more stable fluorapatite crystals in saliva [14,15]. ...
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Background: Dentin hypersensitivity (DH) is a sharp toothache that influences a patients' oral health-related quality of life. Oral dentifrices have been marketed for pain relief within a minute for DH. The permanent management of DH is being investigated with the remineralisation potential of bioactive agents in dentinal tubules. This study investigated the relief from pain in DH in one minute after applying over the counter (OTC) dentifrices with Pro-Argin™ and strontium acetate and directly compared them with fluoro-calcium phospho-silicate (FCPS)-based dentifrices for immediate and sustained inhibition of painful stimulus provoking DH. Methods: A randomised, controlled, triple-blinded clinical trial was conducted with 140 participants clinically diagnosed with DH and equally randomized into four groups with parallel treatment assignment of FCPS, Pro-Argin™, 8% strontium acetate, and sodium fluoride-based OTC dentifrices, and tested for DH with air blast, mechanical, and water jet stimuli on SCHIFF cold air sensitivity scale (SCASS) and visual analogue scale (VAS) at interim efficacy intervals of one minute, three days, two, four, and six weeks, subsequently. Results: A total of 128 participants completed the trial. All the treatment groups showed statistically significant improvement in DH with p < 0.001 relative to baseline at all time points. Pro-Argin™ showed a greater reduction in DH with mean scores of (1.34 ± 0.68) (4.20 ± 1.70) (3.05 ± 2.17) followed by strontium acetate (1.57 ± 0.81) (4.65 ± 1.87) (3.75 ± 1.97) on SCASS and VAS for mechanical and water jet stimuli, one minute after application. There was no statistically significant treatment difference between the two (p = 0.499). FCPS showed the highest reduction in DH on SCASS and VAS for waterjet stimuli with mean scores of (0.97 ± 0.68) (1.80 ± 1.73) and Pro-Argin™ on VAS for mechanical stimuli with mean scores of (2.15 ± 1.92) in six weeks. Conclusion: OTC dentifrices with Pro-argin™ and strontium acetate are effective for immediate pain relief from DH, and FCPS could be the best possible treatment option for long term management of DH. Trial registration: ID: NCT04249336 ( https://clinicaltrials.gov/ct2/show/NCT04249336 ), Date of Registration: January 30, 2020 (Retrospectively registered).
... NCCLs associated with DH not only affect esthetics but also the overall quality of life by impacting everyday habits such as speaking, drinking, eating, and tooth brushing [12,13]. Unfortunately, these increasingly prevalent clinical conditions still pose a significant management challenge for the clinician [14]. ...
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Noncarious cervical lesions (NCCLs) are a common clinical finding often linked with dentin hypersensitivity (DH). Aim. The aim of the study was to evaluate the influence of diode laser for the treatment of DH on microleakage of subsequent NCCL restorations. Materials and Methods. Forty-eight extracted human premolars were collected. All teeth received standardized cervical preparation on both the buccal and palatal surfaces and were randomly divided into three groups (n=16) according to the restorative material used: nanohybrid composite resin (CR), resin-modified glass ionomer (RMGI), and conventional glass ionomer (GIC). The prepared cavities on the palatal surfaces were treated by diode laser using SIROlaser Blue (Sirona Dental Systems, Bensheim, Germany) prior to restoration, while preparations on the buccal surfaces were directly restored. After thermocycling, the teeth were immersed in methylene blue dye for microleakage evaluation under 40x magnification at both occlusal and cervical margins. The Kruskal-Wallis test followed by the Bonferroni tests was conducted to determine inter- and intragroup differences (P
... Conversely, DH treatment may be associated with the improvement of the individual's well-being. [16] Therefore, the objective of the present study was to evaluate the effectiveness of diode laser and fluoride gel in the treatment of individuals with DH. ...
Article
Background: This randomized single-blinded clinical trial aimed to evaluate the effectiveness of diode laser and fluoride in the treatment of dentin hypersensitivity (DH) due to gingival recession. Materials and methods: Twenty-eight individuals randomly distributed across three groups participated: 10 individuals who were treated with diode laser, nine who were treated with fluoride, and nine who received placebo. Pain was assessed with the Visual analog scale (VAS). Evaporative stimulus and tactile stimulus were evaluated with the verbal rating scale (VRS). VAS was applied shortly after, 6 h after, 12 h after, and 24 h after the single-session treatment for DH, whereas VRS was applied shortly after, 15 min and 7 days after the treatment. Participants' quality of life was assessed with the validated Brazilian version of the Dentine Hypersensitivity Experience Questionnaire assessing functional limitations, coping behaviors, emotional, and social impacts caused by DH. Descriptive statistics and the ANOVA test were used. Values of P < 0.05 were statistically significant. Results: Diode laser significantly reduced the DH to the evaporative stimulus (P = 0.002). The application of fluoride did not change the degree of DH to evaporative and tactile stimuli (P > 0.05). The group of individuals who were treated with diode laser presented a higher reduction in DH (25.4%) when compared to the group of individuals treated with fluoride (17.1%), and the group of individuals among whom placebo had been used (2.9%). Descriptive analysis indicated that the items measuring the emotional and social impacts of DH were those with a more negative impact on the individuals. Conclusion: Therapy with diode laser was more effective in reducing DH than therapy with fluoride.
... 11 This undesirable influence 12 is the main motivation that leads individuals to seek dental assistance to improve their quality of life. 13 DH treatment is based on controlling or removing etiological factors, by way of occlusal adjustment, dietary advice, toothbrushing instruction and desensitizing agents. 1,14 A large number of in-office DH treatment options have been reported to date, such as fluoride cavity varnishes, potassium-based agents, glutaraldehyde-based agents, oxalates, calcium phosphates, strontium or acetate chlorides, resinbased sealants and laser therapy. ...
Article
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The aim of this study was to investigate how Brazilian dentists perceive and manage dentin hypersensitivity (DH) in their clinical routine. A 13-item questionnaire-based survey was developed and sent electronically to a convenience sample of dentists. The questionnaire assessed the personal and dental practice characteristics of the sample, the occurrence of DH in their daily clinical practice, and management strategies. The data were analyzed descriptively and together with the chi-square test (a = 0.05). A total of 353 responses were obtained from September 2017 to March 2018. Of all the respondents, 62% were females, 49.9% reported fewer than five years of dental practice, and 70.5% were self-identified as private practitioners. Most of the dentists reported an estimated frequency (30–60%) of patients with DH in their practice. The most frequently cited (91.79%) trigger of DH was air blast and/or scratching with a probe. The first-choice strategy to manage DH was a dentin desensitizer (48.16%). The number of years in clinical practice did not influence DH relapse frequency (p = 0.76) significantly, or consider DH treatment as a problem (p = 0.22). The present findings indicate that, regardless of clinical experience, dentists in Brazil still consider DH management a challenge in their daily dental practice. In addition, the results suggest that guidelines should be developed to disseminate the available knowledge regarding this condition in ways that may influence decision-making processes among practitioners.
... Several treatments for DH are available but none are considered the "gold standard," since most desensitizing agents have shown short-term effectiveness about up to two weeks from treatment conclusion [10,16], demonstrating the necessity of clinical trials to evaluate desensitizing treatments effectiveness in reducing DH and improving the health related quality of life (HRQL) of DH patients [17]. DH affects the patient's psychosocial well-being by compromising daily activities such as brushing teeth, eating, drinking, and even social interaction [18]. ...
Article
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Objective This randomized controlled clinical trial aimed to evaluate the effect of the casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) and photobiomodulation (PBM) in the treatment of dentin hypersensitivity (DH), and the impact of this on the health-related quality of life (HRQL). Methods Eighty teeth with DH were randomized into four groups and received three treatment sessions: PLACEBO = placebo + LASER application mimicking; CPP-ACPF = CPP-ACPF + LASER application mimicking; PBM = placebo + LASER active application; CPP-ACPF+PBM = CPP-ACPF + LASER active application. Tactile (exploratory probe) and evaporative (triple syringe) stimuli were used to measure DH and were recorded with the aid of a visual analogue scale (VAS) after the 1st, 2nd and 3rd treatment sessions and one-month follow-up. The HRQL was recorded in the DH experience questionnaire (DHEQ). Results The intragroup comparison showed a significant reduction in DH (p < 0.05) with both stimuli after one-month follow-up. The intergroup comparison with the evaporative stimulus showed that CPP-ACPF+PBM significantly reduced DH when compared to the rest of treatments, after one-month follow-up. CPP-ACPF+PBM group statistically differed from the other treatment groups in the DHEQ evaluation after one-month follow-up. Conclusion After one-month follow-up, the association of CPP-ACPF with PBM was effective in the reduction of DH and promoted a positive impact on the HRQL of the participants of this study.
... According to Holland et al. [36], the stimuli for assessing DH can be thermal, evaporative or tactile; and the weakest stimulus should be performed first. There is a variety of tests in stimulating DH which are efficient in evaluating DH [37]. It is important to note that the cold water and tactile had high specificity, in other words, this test is highly able to rule out hypersensitivity, leading to a low proportion of false positive results [38]. ...
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Objective: This study aimed to identify and compare the self-reported and diagnosed prevalence of dentinal hypersensitivity (DH) in an University population; and to verify accuracy, sensitivity and specificity of DH stimuli tests. Material and methods: Three hundred and eighty patients (67.2% women and 32.8% men) were assessed by questionnaire, clinical exam, tactile and cold water tests. The intensity of DH was assessed using a visual analogue scale, and a calibrated examiner measured the scores using a caliper. The ICC for intra-examiner was 0.990. Scores above 5 mm were considered sensitive teeth. The association between variables was assessed by Chi-square test. ROC curve analysis determined accuracy, sensitivity and specificity of the tests (p < .05). Results: The mean age of participants was 24.08 years. 158 (41.7%) volunteers self-reported the presence of DH, while, 88.7% of the participants were clinically diagnosed (p = .023). In total, 8958 teeth were evaluated, of those 3367 (37.6%) were diagnosed sensitive. The most prevalent teeth with DH were incisors and premolars. The accuracy of the tests with cold water and tactile were 99%. The sensitivity and specificity for cold water and tactile tests were 99.9%, 99.7%, 99.1% and 87.6%, respectively. Conclusion: The self-reported prevalence of DH was significantly lower than that clinically diagnosed. The cold test proved to be a highly accurate stimulus for the diagnosis of DH.
... This clinical condition can have a negative effect on the individual's oral health-related quality of life (OHRQoL) [2]. A recent systematic review by Douglas-de-Oliveira et al. [3] indicated that reducing DH is related to improvement in OHRQoL. ...
Article
Objectives: To evaluate the desensitizing effect of nano-hydroxyapatite (n-HAP) on dentine hypersensitivity (DH). Sources: Seven electronic databases were searched on April 27, 2018. Study selection: Randomized clinical trials (RCTs) were included based on the PICO strategy: Participants - Humans with DH; Intervention - n-HAP-containing desensitizing; Comparison -n-HAP-free treatments or placebo/negative control; and Outcomes - relief of DH. The risk of bias was classified by the Cochrane guidelines. Five meta-analyses were performed to evaluate the efficacy of n-HAP with regard to pain assessment stimuli (primary outcome); comparison of n-HAP with other treatments or placebo/negative control, and effectiveness of at-home and in-office n-HAP use (secondary outcomes). The quality of the evidence was evaluated using the GRADE. Data: Six RCTs with 4 weeks of follow-up were included in the meta-analysis. For the primary outcome, n-HAP showed a better desensitizing effect for evaporative stimuli (SMD -1.09 [-1.24, -0.94], p < 0.00001) and tactile stimuli (SMD -0.93 [-1.42, -0.43]) than other treatments (p = 0.0002). However, there was no difference between n-HAP and other treatments for the cold stimuli (SMD -0.17 [-0.81, 0.48], p = 0.61). In an overall analysis, n-HAP-containing treatment showing the most significant desensitizing effect (SMD -0.93 [-1.19, -0.68], p < 0.00001) with a high quality of evidence for pooled results. In the secondary outcomes, n-HAP showed the best effect in the overall analysis (p < 0.05) with moderate quality evidence. Conclusions: The n-HAP-containing treatment showed better clinical performance than other treatments for DH relief. However, long-term follow-up RCTs are required in the future before definitive recommendations can be made. Clinical significance: Dentin hypersensitivity is a common global condition and its multifactorial etiology has led to the development of several treatments. The n-HAP-containing treatment showed greater DH relief when compared to other desensitizing agents, placebo or negative control.
Article
Dentin hypersensitivity (DH) treatment is far from being unequivocal in providing a superior strategy that combines immediate and long-term efficiency of dentinal tubule (DT) occlusion and clinical applicability. In order to achieve this aim, a type of multifunctional yolk-shell nanocomposite with acid resistance, mechanical resistance and biomineralization properties was developed in this study, which consists of a silica/mesoporous titanium-zirconium nanocarrier (STZ) and poly(allylamine hydrochloride) (PAH)-stabilized amorphous calcium phosphate (ACP) liquid precursor. First, the nanocomposite, named as PSTZ, immediately occluded DTs and demonstrated outstanding acid and mechanical resistance. Second, the PSTZ nanocomposite induced intrafibrillar mineralization of single-layer collagen fibrils and remineralization of demineralized dentin matrix. Finally, PSTZ promoted the odontogenic differentiation of dental pulp stem cells by releasing ACP and silicon ions. The reconstruction of the dentin-mimicking hierarchical structure and the introduction of newly formed minerals in the upper, middle and lower segments of DTs, defined as sandwich-like structures, markedly reduced the permeability and achieved superior long-term sealing effects. The nanocomposite material based on mesoporous yolk-shell carriers and liquid-phase mineralized precursors developed in this study represents a versatile biomimetic sandwich desensitization strategy and offers fresh insight into the clinical management of DH.
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Purpose: The present study was carried out to assess and compare the efficacy of OliNano Seal (OS) and Curodont D’Senz (CS) in the treatment of dentin hypersensitivity (DH) and the reduction of dentin permeability. Materials and Methods: The current study was a single-blinded, clinical trial and in vitro study using OS and CS in the treatment of DH. A total of 72 hypersensitive teeth were selected from 18 patients and randomly divided into two groups. Prior to the desensitizing agent’s application (the baseline), as well as immediately, 2 weeks, 4 weeks, and 3 months afterward, the evaluated materials were applied. Patients were instructed to use the visual analogue scale (VAS) to score their perception of tactile, air, and cold stimuli (VAS). In total, 90 samples were used for the evaluation, and they were randomly divided into two main groups: group A1, which had the smear layer fully removed, and group A2, which had the smear layer partially removed. According to the desensitizing agent used, each group was divided into three subgroups: OS, CS, and the control group that was left untreated. The results of the dentin permeability test were analyzed using the analysis of variance test, whereas the pain scores were analyzed using the Mann–Whitney test. Results: The study showed that there was a high statistically significant difference between pain scores prior to and after the application of both tested desensitizing agents. Permeability results revealed a high statistically significant difference between the study groups, with the lowest statistically significant mean depth of dye penetration found with OS-treated samples. Conclusion: OS and CS were both effective in the treatment of DH and the reduction of dentin permeability, with OS being more effective within 1 week and sustained up to 3 months. Keywords: Curodont D’Senz, dentin hypersensitivity, dentin permeability, OliNano Seal
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Dentinal hypersensitivity (DH) is a common clinical condition usually associated with exposed dentinal surfaces. The aim of this study was to study the effect of sodium fluoride varnish, Gluma, and Er,Cr:YSGG laser, in the dentin hypersensitivity treatment. One hundred sixty-five teeth with dentin hypersensitivity in 55 patients were involved in this study. Teeth are divided into five groups based on the received treatment (n = 33): G group: Gluma; F group: sodium fluoride varnish (5%); L group: Er,Cr:YSGG laser (wavelength 2780 nm, frequency 20 Hz, power 0.25 W, energy density 44.3 J/cm², and pulse width of 150 µs at distance of 1 mm for 30 s) which was followed by Er,Cr:YSGG laser; GL group: Gluma + laser; VL group: both sodium fluoride varnish and Gluma, which are common treatments for hypersensitivity, were selected as control groups. The treatment was performed in one session, and the sensitivity to air spray conditioning was recorded after the treatment, at 15 min, 1 week, 1 month, and 6 months as the VAS. Statistical analysis was performed using SPSS Ver. 21 software. One-way ANOVA was used to compare the VAS between all treatment groups at each time-point. One-way repeated measurements ANOVA (RM-ANOVA) and two-way-repeated measurements ANOVA (RM-ANOVA) were used to compare the hypersensitivity of each group and sensitivity of all treatment groups, respectively. Tukey post hoc test was used to compare the groups pairwise. The hypersensitivity between different groups at before and 15 min after the treatment was not significantly different (P = 0.063). The hypersensitivity of all studied groups was decreased after the treatment. The Er,Cr:YSGG laser, alone or in combination with Gluma, in 1 week, 1 month, and 6 month follow-ups, had significantly reduced the hypersensitivity instead of sodium fluoride varnish. All treatments significantly reduced the dentin hypersensitivity up to 6 months. Er,Cr:YSGG laser alone or in combination with Gluma was more effective than sodium fluoride varnish; however, it was not significantly different from other treatments. In a 6-month follow-up of dentine hypersensitivity treatment, Gluma had a significantly higher effect than sodium fluoride. Trial registration: IRCT20190422043343N1. Registered 19 July 2019.
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Aim: Dentin hypersensitivity (DH) is a health condition with variable prevalence rates, affecting a large portion of the population, especially young adults. This study aimed to verify the level of knowledge on the subject both of dentistry professionals and students and the general population. Methodology: An exploratory-descriptive study with quantitative analysis was carried out using a digital form released via social media to be filled in by the Google Forms tool. Four dimensions were evaluated regarding general characteristics and the presence of DH, as well as specific characteristics related to the group (dentists/dental students or general population). Results: The form was answered by 212 participants. Of these, 69% of the lay population claimed to frequently consume acidic foods and drinks, 35% claimed to have sensitive teeth and 30% self-indicated products for the treatment of DH. In relation to the group linked to dentistry, 46% did not know the difference between agents with obliterating and neural action; and 51% did not know the Hydrodynamic Theory. Conclusion: the population linked to dentistry showed a lack of knowledge about DH. The lay population, on the other hand, showed a superficial knowledge of DH, but with information acquired from informal sources.
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The present study aimed to assess dentin hypersensitivity (DH) level and quality of life in patients before and after treatment with ozonated oil compared with extra virgin oil. This is a randomized triple-blind controlled clinical trial, consisting of patients with dentin hypersensitivity which was stimulated by evaporative and thermal stimuli. DH level was measured using a numerical rating scale. The patients were treated with ozonated oil and olive oil. Data were measured at baseline, immediately, and 4 weeks after treatment. The Dentine Hypersensitivity Experience Questionnaire (DHEQ-15) and the Oral Health Impact Profile (OHIP-14) were applied at baseline and 4 weeks after treatment. The sample consisted of 8 women and 3 men, with an average age of 23.82 years. The test group was 40 teeth while the control group consisted of 36 teeth, with the most prevalent tooth being the incisor (52.6%). There was a significant reduction in the DH level and an improvement in the quality of life after treatment. Among the sample, 90.1% reported an improvement in the final result. Both ozonated oil and olive oil were effective in reducing dentin hypersensitivity level and improving oral health-related quality of life 30 days after treatment.
Article
Many studies use dental patient-reported outcomes (dPROs) to evaluate treatments and interventions. However, the consensus on the methodology for combining results of dPROs for meta-analysis has not yet been fully established or widely discussed. The aim of this study is to conduct a scoping review for the methodological issues and difficulties specific to meta-analysis of dPROs and to put forward recommendations for improving quality of meta-analyses of dPRO. We searched the Google Scholar and PubMed databases and identified meta-analysis with dPROs in English. A total of 22 meta-analyses were included in our scoping review, and their characteristics, such as reported outcomes, questionnaires, and effect measures, were extracted. We identified several methodological issues within current literature: (1) synthesizing results from studies with different rating scales; (2) meta-analyses with few studies; (3) the interpretation of standardized mean difference; (4) including studies of different cut-off values in a meta-analysis; and (5) systematic errors due to different instruments. According to each issue mentioned, we provided guidance and recommendations on how to resolve those issues, including using the same Likert scale, conducting an overall and subgroup meta-analysis, using a random-effects model in a meta-analysis, etc. More efforts are required to improve the conduct and interpretation of meta-analyses on dPROs.
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Background. Dental hypersensitivity is due to the exposure of the dentin layer after wear of enamel or cementum, exposing the dentinal tubules and the nerve endings of odontoblasts within these tubules. The present study aimed to assess the factors related to dental hypersensitivity in individuals with cleft lip and palate and the most common therapy received. Methods. The medical records of 536 patients with cleft lip and/or palate (281 males, 255 females) with a mean age of 18 were analyzed in a single center. The inclusion criterion was patients reporting dental hypersensitivity from May 2015 to October 2019. The origin of dental hypersensitivity was evaluated considering orthodontic movement, periodontal diseases, and reversible and irreversible pulpitis. The therapy indicated by the dental professionals for dental hypersensitivity were recorded. Descriptive statistics were performed. Results. Of 61 teeth with dental hypersensitivity, 10 were attributed to orthodontic movement, 21 to periodontal problems, 27 to reversible pulpitis, and three to irreversible pulpitis. The most used therapies were the application of fluoride varnish and prophylaxis, dentifrice indication for dental sensitivity, free gingival grafts, pulpectomy, desensitizing agent application, conservative endodontic treatment (direct pulp protection), and restoration of non-carious cervical lesions. Conclusion. Reversible pulpitis was the most prevalent etiologic factor of dental hypersensitivity in individuals with cleft lip and palate. Dentifrices for dental sensitivity and fluoride varnish application were frequently recommended.
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Background: Dentin hypersensitivity (DH) is a common dental clinical condition presented with a short and sharp pain in response to physical and chemical stimuli. Currently no treatment regimen demonstrates long-lasting efficacy in treating DH, and unesthetic yellow tooth color is a concern to many patients with DH. Aim: To develop a bi-functional material which can occlude dentinal tubules in-depth and remineralize dentin for long-lasting protection of the dentin-pulp complex from stimuli and bleach the tooth at the same time. Methods: A mixture containing CaO, H3PO4, polyethylene glycol and H2O2 at a specific ratio was mechanically ground using a planetary ball. The mineralizing complex paste was characterized by X-ray diffraction (XRD) and scanning electron microscopy (SEM). Dentin was exposed to the synthesized paste for 8 h and 24 h in vitro. The mineralizing property was evaluated using SEM and microhardness tests. Red tea-stained tooth slices were exposed to the synthesized paste for 8 h and 24 h in vitro. The bleaching effect was characterized by a spectrophotometer. Results: The complex paste had very a fine texture, was injectable, and had a gel-like property with 2.6 (mass/volume) % H2O2 concentration. The X-ray diffraction pattern showed that the inorganic phase was mainly monetite (CaHPO4). The mineralizing complex paste induced the growth of inorganic crystals on the dentin surface and in-depth occlusion of dentin tubules by up to 80 μm. The regenerated crystals were integrated into the dentin tissue on the dentin surface and the wall of dentinal tubules with a microhardness of up to 126 MPa (versus 137 Mpa for dentin). The paste also bleached the stained dental slices. Conclusion: The mineralizing complex paste is a promising innovative material for efficient DH management by remineralizing dentin and in-depth occlusion of dentin tubules, as well as tooth bleaching.
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Objectives To investigate the deposition, formation of hydroxyapatite (HAP) and acid resistance of dentine surfaces following brushing with a toothpaste containing calcium silicate and sodium phosphate (CSSP) and fluoride in vitro. Methods Human dentine specimens were brushed with a slurry of CSSP toothpaste followed by exposure to simulated oral fluid (SOF) in two in vitro studies, with a silica-based non-occluding toothpaste as control. The surface and tubule deposits were analysed after 14 cycles with scanning electron microscopy (SEM), energy dispersive x-ray spectroscopy (EDX), transmission electron microscopy (TEM) and selected area electron diffraction (SAED). In a third study, dentine specimens were additionally exposed to citric acid erosive challenges for 30, 300 or 600 s after 2, 6, 10 and 14 cycles of SOF and either the CSSP toothpaste or a positive control toothpaste containing calcium sodium phosphosilicate and fluoride. The level of tubule occlusion was evaluated using SEM. Results The SEM analyses indicated complete coverage of the dentine surface following 14 cycles of brushing with CSSP toothpaste with no observable patent tubules, in contrast to the non-occluding control toothpaste. The TEM and SAED analyses confirmed the deposited material on the surface and within tubules was HAP. The deposited material from CSSP toothpaste was more acid resistant than the deposited material from the positive control toothpaste at all time points and acid exposure levels (p < 0.05). Conclusions The CSSP toothpaste fully occluded dentine tubules and formed the mineral HAP. The dentine deposition on and within dentine tubules was resilient to acid erosive challenges. Clinical significance A novel toothpaste containing CSSP can form HAP on dentine surfaces and within tubules. The potential of this technology is for a novel approach for the protection of dentine surfaces to acid challenges and the reduction of dentine hypersensitivity.
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Abstract Though dentin hypersensitivity (DHS) is one of the most common complaints from patients in dental clinics, there are no universally accepted guidelines for differential diagnosis as well as selection of reliable treatment modalities for this condition. The neurosensory mechanisms underlying DHS remain unclear, but fluid movements within exposed dentinal tubules, i.e., the hydrodynamic theory, has been a widely accepted explanation for DHS pain. As several dental conditions have symptoms that mimic DHS at different stages of their progression, diagnosis and treatment of DHS are often confusing, especially for inexperienced dental practitioners. In this paper we provide an up-to-date review on risk factors that play a role in the development and chronicity of DHS and summarize the current principles and strategies for differential diagnosis and management of DHS in dental practices. We will outline the etiology, predisposing factors and the underlying putative mechanisms of DHS, and provide principles and indications for its diagnosis and management. Though desensitization remains to be the first choice for DHS for many dental practitioners and most of desensitizing agents reduce the symptoms of DHS by occluding patent dentinal tubules, the long-term outcome of such treatment is uncertain. With improved understanding of the underlying nociceptive mechanisms of DHS, it is expected that promising novel therapies will emerge and provide more effective relief for patients with DHS.
Article
Objectives To design and validate a new index to assess tooth wear (TW) in the cervical region and its association with gingival recession (GR), for use both in research studies and as resource in General Dental Practice, with focused prevention and management strategiesparticularly related to aetiology of dentine hypersensitivity provided for each Code score. Methods Codes to reflect clinical presentations of the cervical region in health and disease recording both TW and GR were defined. Validation of the Code was undertaken by 3 trained examiners who scored buccal and lingual surfaces of eligible teeth in 42 adult healthy volunteers. Each volunteer underwent 4 identical clinical examinations, being assessed twice by the examiner who performed the first and last exam. Results Cervical Localisation Code definitions were A: no GR, no coronal TW, B: no GR, distinct coronal TW, C: GR but no coronal TW, D: GR with distinct coronal and root TW. For validation 2073 eligible tooth surfaces were scored. There were only 57 within and 201 between examiner disagreements, the most common being between scores C and D. Conclusions The Cervical Localisation Code was used reproducibly by three independent examiners. It will provide focussed data on the cervical region in research studies allowing the association of patient reported dietary and lifestyle factors with specific lesion types, and a tool to aid the management of clinical scenarios, specifically those that lead to dentine hypersensitivity in general dental practice. Clinical Significance Exposure of dentine at the cervical margin by TW and/or GR often results in dentine hypersensitivity, however current TW indices do not record TW location or GR presence. The Cervical Localisation Code captures both parameters and suggests likely aetiology for dentine hypersensitivity and guide clinical management of the cervical region.
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Background: Dentin hypersensitivity is a frequent finding especially in periodontitis patients. Conventional treatment aims for obstruction of dentin tubules by disabling liquid and osmotic fluctuation to and from the pulpal chamber. A novel bioglass-based desensitizer was shown to obstruct tubules and to resist periodic exposure to lactic acid. Whether this obstruction is resistant to brushing had not been tested so far. Accordingly, the present study aimed to assess dentin tubule obstruction after repeated acid exposure and brushing. Methods: Sixty dentin discs were cleaned with 17% EDTA, mounted into a pulp fluid simulator and randomly divided into 3 groups: No surface treatment in Group A, Seal&Protect® in group B and DentinoCer in group C. Discs were exposed to 0.1 M non-saturated lactic acid thrice and standardized brushing twice a day for 12 days. At baseline and after 2, 4 and 12 d samples were removed from the setting and prepared for top-view SEM analysis to assess tubule obstruction using the Olley score. Discs were then vertically cut and the section surface morphologically assessed using backscatter imaging. For both vertical and sectional surfaces EDX analysis was used to characterize the surface composition in the tubular and inter-tubular area. Results: Group A showed clean tubular lumina at all time points. From day 2 onwards dentin showed exposed collagen fibers. Group 2 initially showed a complete surface coverage that flattened out during treatment without ever exposing tubules. At baseline, samples of Group C displayed a complete homogeneous coverage. From day 2 on tubules entrances with obstructed lumen became visible. While on day 4 and 12 the dentin surface exposed collagen fibers the lumina remained closed. EDX analysis of the vertical and horizontal views showed that P and Ca were predominant elements in both the inter- and tubular dentin while Si peaks were found in the tubule plugs. Conclusion: While group B displayed a packed layer on the surface during the whole investigation time group C samples lost their superficial layer within 48 h. Tubule plugs containing considerable Si proportions indicated previous presence of DentinoCer, while high Ca and P proportions suggest obturation by dentin-like material.
Article
Objective: The aim of this split-mouth, triple-blind, randomized clinical trial was to evaluate the long-term clinical efficacy of experimental potassium oxalate concentration (10%) in relieving dentin hypersensitivity (DH), after a four-session application protocol. Methods: Potassium oxalate gels with different concentrations (5 and 10%) were randomly assigned to half of the 31 patients from the sample in a split-mouth design. The desensitizers were applied following a four-session protocol, one session every 48 h. The primary outcome was the assessment of pain level with the visual analog scale (VAS, 0-10), at baseline, immediately after each desensitizing session, and also after the seventh day and along 1-,3-, 6-, 9- and 12-months follow-ups. Statistical analyses were performed using Friedman repeated measures and Wilcoxon signed rank tests (α = 0.05). Results: For both groups, the minimum of three sessions were required for the achievement of lower DH levels. Regardless of the concentration, the desensitizing effect was maintained all the way to the end of the 6-month follow-up. The 10%-potassium oxalate group was more effective for both 9 and 12-months follow-up periods (p < 0.001). No complications and adverse effects were observed. Conclusions: When a four-session protocol is applied, both concentrations of potassium oxalate (5 and 10%) proved to be effective on DH reduction for up to six months. However, the higher concentration promoted better long-term results. Clinical significance: The DH is an increasing condition in clinical practice, which affects the patient's life quality. This study provides primary clinical evidence, suggesting that multiple application sessions and higher concentrations of potassium oxalate may result in maintenance of the desensitizing effect for more extended periods. Trial registered under number: ClinicalTrials.gov NCT03083496.
Article
Introduction Although conventional combined orthodontic-surgical treatment is frequently applied in orthodontic clinic practice, its actual effect on oral health–related quality of life (OHRQoL) remains inconclusive. We aimed to appraise trials investigating the effect of conventional combined orthodontic-surgical treatment on OHRQoL in patients with dentofacial deformities. Methods Electronic searches of 6 databases and manual searches were conducted up to January 2019. Randomized controlled trials, controlled clinical trials, and prospective cohort studies that investigated the impact of combined orthodontic-surgical treatment on OHRQoL using validated instruments were included. The risk of bias within individual studies was assessed with the use of the Cochrane tool or the Newcastle-Ottawa Scale according to study designs. Meta-analysis was conducted, and OHRQoL at different time points during conventional combined orthodontic-surgical treatment were statistically pooled and compared. Results Of the 893 records initially identified, 24 studies were included in this review. Relative to pretreatment, the condition-specific OHRQoL was significantly improved 6 months after surgery, particularly in the perceptions to social aspects (mean difference [MD] 4.88, 95% confidence interval [CI] 2.45 to 7.32), facial appearance (MD 5.48, 95% CI 4.18 to 6.79), and oral function (MD 4.49, 95% CI 3.27 to 5.72). In terms of changes during combined orthodontic-surgical treatment, the condition-specific OHRQoL worsened in the presurgical orthodontic treatment (MD −7.25, 95% CI −13.29 to −1.22) and improved postsurgically compared with pretreatment (MD 16.59, 95% CI 10.41 to 22.77). Similar patterns were observed in the general OHRQoL changes. Conclusions For patients undergoing combined orthodontic-surgical treatment, the OHRQoL seems to decrease temporarily in presurgical orthodontic treatment compared with pretreatment and to increase to a level better than it was before treatment during postsurgical orthodontic treatment. Based on the present review, combined orthodontic-surgical treatment could be an effective choice to improve OHRQoL for patients affected with severe dentofacial deformities.
Article
Objectives To compare the treatments used to treat dentin hypersensitivity (DH), based on its efficacy and effect duration. Methods Medline/PubMed, Cochrane Library, EMBASE, and ClinicalTrials were searched for articles published between January 1st, 2008 and November 14th, 2018, in English, Portuguese or Spanish, reporting clinical trials, completed and with results. This systematic review protocol was registered in PROSPERO, number CRD42019121986. Results 74 randomized clinical trials were included in the systematic review, reporting patients from 16 to 65 years old, with a clinical diagnosis of DH, that evaluate the efficacy of a desensitizing product, compared to pre‐treatment, used the evaporative method stimulation and the visual analogue scale. These studies evaluated 5366 patients and at least 9167 teeth. Seven follow‐up periods were considered corresponding to an immediate, medium or long‐time effect. 66 studies were included in the quantitative synthesis. Glutaraldehyde with HEMA, glass ionomer cements and Laser present significant immediate (until 7 days) DH reduction. Medium term (until 1 month) reduction was observed in stannous fluoride, glutaraldehyde with HEMA, hydroxyapatite, glass ionomer cements and Laser groups. Finally, long term significant reduction was seen at potassium nitrate, arginine, glutaraldehyde with HEMA, hydroxyapatite, adhesive systems, glass ionomer cements, and LASER. Conclusions All active ingredients show efficacy in DH reduction in different follow‐up times. Only in‐office treatments are effective in immediate DH reduction, maintaining its efficacy over time. For long time effects, at home treatments can also be used. More standardized evaluation protocols should be implemented to increase the robustly of the results.
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Background The aim of this study was to evaluate whether calcium (CaL) solution would enhance the capacity of sodium fluoride (NaF) solution in reducing the permeability of hypersensitive dentin. Material and Methods Thirty-two Wistar rats ingested for 45 days acidic isotonic drink (Gatorade, pH 2.7) ad libitum to induce dental erosion. Then, molar teeth received a cold stimulus to confirm the presence and score the intensity of dentin hypersensitivity based on body contraction and noise. Animals were allocated to four groups (n=8), according to the solution(s) applied in the oral cavity: NaF (12 mmol/L, 1 min); CaL (150 mmol/L, 1 min); CaL followed by NaF (CaF+NaF, 1 min each); distilled water (DW, 1 min, as negative control). The animals were euthanized and the mandibles dissected into hemimandibles, which were sealed with sticky wax, except for the occlusal surface of the molar teeth. The samples were immersed in 10% copper sulphate solution and in 1% dithioxamide alcoholic solution (25 min each). The samples were sectioned longitudinally and imaged under optical microscope. Then, dentin permeability was measured as the area of copper ion penetration, using ImageJ software. Photomicrographs were obtained by scanning electron microscopy. Results 68.7% of animals had body contraction associated or not with noise. One-way ANOVA followed by Tukey´s test indicated that groups treated with NaF solution, whether or not preceded by CaL solution, presented lower permeability than the remaining groups [CaL+NaF: 3405.7 μm2 (±1796.4); NaF: 4111.7 μm2 (±2450.6); CaL: 42254.6 μm2 (±30399.2); DW: 37064.6 μm2 (±21994.4)]. Photomicrographs showed that CaL+NaF group presented an increased proportion of occluded dentin tubules in comparison to the NaF-only group. Conclusions Although qualitatively there seems to be a benefit in using CaL pre-rinse, this solution did not quantitatively enhance the capacity of NaF in reducing permeability of hypersensitive dentin. Key words:Dentin hypersensitivity, Fluoride, Calcium lactate, Animal model.
Article
Objectives: The purpose of this study was to estimate the prevalence of dentin hypersensitivity in various populations. Sources: Four electronic databases (Medline via PubMed, Cochrane Library, Wiley Online Library and Web of Science) were searched until June 2018. Study selection: Cross-sectional studies on the prevalence of dentin hypersensitivity were included. Meta-analysis were conducted and meta-regression models were used to explain the variation of the prevalence measures. Data were extracted, and the studies were assessed for quality. Data: A total of 65 papers (reporting on 77 studies) met the inclusion criteria and were included in the meta-analysis. The prevalence range was observed to be as low as 1.3% and as high as 92.1%. Effect modifiers for dentin hypersensitivity prevalences were the type of participants included in the study, age range, recruitment strategy and number of study sites. Higher prevalences were observed in studies involving specialty practice patients, younger adults, convenience sample and those characterized as single-site. Conclusion: The best estimate of dentin hypersensitivity was 11.5% (95%CI:11.3%-11.7%) and the average from all studies was 33.5% (95%CI: 30.2%-36.7%). The extremely high degree of heterogeneity among studies can only be partially explained by characteristics of the studies. Clinical significance: Dentin hypersensitivity is a persistent clinical problem that poses significant challenge for clinicians and affects patients' quality of life. Better understanding of the dentin hypersensitivity burden and its associated factors can assist on resource planning for reducing/preventing any discomfort arising from this condition and will aid in the decision-making process.
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The revised edition of the Handbook offers the only guide on how to conduct, report and maintain a Cochrane Review. The second edition of The Cochrane Handbook for Systematic Reviews of Interventions contains essential guidance for preparing and maintaining Cochrane Reviews of the effects of health interventions. Designed to be an accessible resource, the Handbook will also be of interest to anyone undertaking systematic reviews of interventions outside Cochrane, and many of the principles and methods presented are appropriate for systematic reviews addressing research questions other than effects of interventions. This fully updated edition contains extensive new material on systematic review methods addressing a wide-range of topics including network meta-analysis, equity, complex interventions, narrative synthesis, and automation. Also new to this edition, integrated throughout the Handbook, is the set of standards Cochrane expects its reviews to meet. Written for review authors, editors, trainers and others with an interest in Cochrane Reviews, the second edition of The Cochrane Handbook for Systematic Reviews of Interventions continues to offer an invaluable resource for understanding the role of systematic reviews, critically appraising health research studies and conducting reviews.
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Background: The aim of this longitudinal study was to verify changes in patients' oral health related quality of life 180 days after the treatment of dentin hypersensitivity with laser and cyanoacrylate. Methods: This clinical, controlled, randomized, double-blind trial used a split-mouth design, and quadrants were randomized to receive either laser or cyanoacrylate treatments. All patients received both treatments. The study included 62 patients from 12-60 years of age (mean: 31.4yo) in whom a total of 432 teeth were treated. The quadrants were randomly distributed into 2 Groups: cyanoacrylate (n=218 teeth) or laser (n=216 teeth) treatment. Dentin hypersensitivity was evaluated with air and cold stimuli at 24 hours, 30, 90 and 180 days after treatment. The OHIP-14 questionnaire was applied at baseline and 180 days after treatment. Results: There were statistically significant differences in the following OHIP-14 subscales before and after treatment: physical pain (p = 0.002), psychological disability (p < 0.001), psychological incapacity (p = 0.003), disability (p = 0.013), and total score (p < 0.001). At the end of the study, 80.6% of participants reported an improvement in the condition. Conclusion: There was a reduction in the impact of dentin hypersensitivity on the quality of life of the participants of the study after interventions with laser and cyanoacrylate.
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Randomized clinical trial (RCT) is the gold standard study for the evaluation of health interventions and is considered the second level of evidence for clinical decision making. However, the quality of the evidence produced by these studies is dependent on the methodological rigor employed at every stage of their execution. The purpose of randomization is to create groups that are comparable independent of any known or unknown potential confounding factor. A critical evaluation of the literature reveals that, for many years, RCTs have been developed based on inaccurate methodological criteria, and empirical evidence began to accumulate. Thus, guidelines were developed to assist authors, reviewers, and editors in the task of developing and assessing the methodological consistency of this type of study. The objective of this article is to review key aspects to design a good-quality RCT, supporting the scientific community in the production of reliable evidence and favoring clinical decision making to allow the patient to receive the best health care.
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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.
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In clinical research, study results, which are statistically significant are often interpreted as being clinically important. While statistical significance indicates the reliability of the study results, clinical significance reflects its impact on clinical practice. The third article in this series exploring pitfalls in statistical analysis clarifies the importance of differentiating between statistical significance and clinical significance.
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Purpose: To present an overview of clinical evidence of strontium acetate and arginine-based toothpastes, in order to determine which of these substances was the most effective to relieve dentin hypersensitivity (DH). Methods: An electronic search was performed in PubMed, EMBASE, The Cochrane Library, LILACS, Web of Science and Open Grey databases. The search strategy included MeSH terms, synonyms and keywords with no language or date restriction. Randomized controlled clinical trial studies that compared the effectiveness of arginine/calcium carbonate and strontium acetate toothpaste were included. The risk of bias in the included studies was assessed and classified through the Cochrane Collaboration's common scheme for bias. Data were subgrouped and heterogeneity was tested via comprehensive meta-analysis. Results: A total of 3,883 potentially relevant studies were identified. After title and abstract examination, only six studies fulfilled the eligibility criteria and were classified as having a “low risk of bias”. The majority of studies found better results for arginine/calcium carbonate in comparison with strontium acetate in alleviating DH. Only one study reported superior efficacy of strontium acetate, and only for tactile stimuli, after 8 weeks of home use. The arginine/calcium carbonate-based toothpaste provided a higher level of efficacy in terms of DH relief than the strontium-based toothpaste. CLINICAL SIGNIFICANCE: Arginine-based toothpaste provided an effective level of dentin hypersensitivity relief in ashorter time period of use than the strontium-based toothpaste.
Article
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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.
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Objective: Dentin desensitizing agents are used in the treatment of dentin hypersensitivity, which is defined as a painful response in the exposed dentin to stimuli that are thermal, evaporative, tactile, osmotic, or chemical. A systematic review was conducted to analyze the clinical effectiveness of current desensitizer with at least 3 months of follow-up. Method and materials: Eight electronic databases were searched: MedLine (PubMed), Embase, Lilacs, Ibecs, Web of Science, Scopus, Scielo, and The Cochrane Library. Only those clinical trials published from 2000 to 2012 were included. Results: A total of 3,029 relevant records were identified. After title and abstract examination, 2,645 articles were excluded. A data extraction form was designed and completed by reviewers from the selected studies for a retrospective comparison. From the 99 studies retrieved for detailed review, only 17 had an evaluation time of at least 3-months follow-up and fulfilled the selection criteria. Conclusion: Cervitec Plus, SE Bond & Protect Liner F, laser, and iontophoresis have shown satisfactory posttreatment results between 3 and 6 months. However, additional clinical trials are warranted to better compare the different types of treatments and their effectiveness in the longer term.
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Objectives Oral health-related quality of life is a relatively new but rapidly growing concept in dentistry. It is an aspect of dental health addressing the patient’s perception of whether his/her current oral health status has an impact upon his/her actual quality of life. Dentine hypersensitivity (DHS), which is a common condition of transient tooth pain associated with a variety of exogenous stimuli, may disturb the patient during eating, drinking, toothbrushing and sometimes even breathing. The resulting restrictions on everyday activities can have an important effect on the patient’s quality of life. The aims of this paper were to consider the concept of oral health-related quality of life and to review and discuss the literature on oral health-related quality of life and DHS. Material and methods A PubMed literature research was conducted using the terms (“dentin sensitivity” [MeSH Terms] OR (“dentin” [All Fields] AND “sensitivity” [All Fields]) OR “dentin sensitivity” [All Fields]) AND ((“oral health” [MeSH Terms] OR (“oral” [All Fields] AND “health” [All Fields]) OR “oral health” [All Fields]) AND related [All Fields] AND (“quality of life” [MeSH Terms] OR (“quality” [All Fields] AND “life” [All Fields]) OR “quality of life” [All Fields])). Furthermore, a manual search was carried out. Any relevant work published presenting pertinent information about the described issue was considered for inclusion in the review. Results The combination of the search terms resulted in a list of only three titles. The few published studies convincingly demonstrated that oral health-related quality of life is negatively affected in patients suffering from DHS. Conclusions Patients with sensitive teeth report substantial oral health-related quality of life (OHRQoL) impairment. Nevertheless, knowledge about the influence of DHS on oral health-related quality of life is incomplete and, therefore, needs further research. Clinical relevance Oral diseases can lead to physical, psychological and social disability. This paper shows that DHS can have a negative impact on the patients’ OHRQoL.
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Background: Root exposure due to gingival recession (GR) can cause cervical dentin hypersensitivity (CDH), which is characterized by tooth pain. The aim of this study is to evaluate the effect of surgical defect coverage on CDH and quality of life in patients with GR. Methods: Twenty-five GRs in maxillary canines and premolars were treated with coronally positioned flap plus connective tissue graft. GR dimensions, amount of keratinized gingiva, and clinical attachment level were evaluated. CDH was assessed by thermal and evaporative stimuli. Quality of life was assessed by use of the Oral Health Impact Profile-14 (OHIP-14) questionnaire. All parameters were evaluated at baseline and after 3 months. Results: Statistically significant reduction in CDH (P <0.001), significant reduction in impact of oral health on quality of life (P <0.001), and significant changes in periodontal parameters were observed after 3 months. Mean defect coverage of 67.90% was achieved, with full coverage in 11 cases. Percentage defect coverage showed no correlation with air blast-stimulated CDH (P = 0.256) or cold stimulus (P = 0.563). The OHIP-14 physical disability dimension was correlated with the amount of keratinized tissue (P = 0.010) and also with defect coverage (P = 0.035). Conclusions: Surgical defect coverage may reduce CDH and improve patient quality of life, by keratinized gingiva augmentation and impact on physical disability, irrespective of amount of defect coverage.
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Background: Cervical dentin hypersensitivity (CDH) is characterized by tooth pain arising from root exposure. The aim of the present systematic review is to survey the literature on the efficacy of surgical root coverage techniques at reducing CDH in cases of gingival recession. Methods: An online electronic search was performed in PubMed, Web of Science, and Cochrane Library databases. Randomized clinical trials dating from the inception of the respective databases through November 2011 were selected. Studies addressing clinical parameters of periodontal plastic surgery outcomes and variables related to CDH in patients ≥18 years of age were included. The studies were evaluated by two independent reviewers. For each article, methodologic quality, size effect, the periodontal parameters measured, study design, methods, and results were analyzed. Results: Nine relevant articles were analyzed in the present review. A decrease in CDH was observed after periodontal surgery for root coverage. The risk of bias was considered low in two studies, and the size effect was considered large in one study. Conclusions: There is not enough scientific evidence to conclude that surgical root coverage procedures predictably reduce CDH. Well-conducted clinical trials are needed to establish scientific evidence that allows periodontists to indicate root coverage as treatment for CDH.
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Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject.
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Boiko OV, Baker SR, Gibson BJ, Locker D, Sufi F, Barlow, APS, Robinson PG. Construction and validation of the quality of life measure for dentine hypersensitivity (DHEQ). J Clin Periodontol 2010; 37: 973–980. doi: 10.1111/j.1600-051X.2010.01618.x. Aim: To develop and validate a condition specific measure of oral health-related quality of life for dentine hypersensitivity (Dentine Hypersensitivity Experience Questionnaire, DHEQ). Materials and Methods: Questionnaire construction used a multi-staged impact approach and an explicit theoretical model. Qualitative and quantitative development and validation included in-depth interviews, focus groups and cross-sectional questionnaire studies in a general population (n=160) and a clinical sample (n=108). Results: An optimized DHEQ questionnaire containing 48 items has been developed to describe the pain, a scale to capture subjective impacts of dentine hypersensitivity, a global oral health rating and a scale to record effects on life overall. The impact scale had high values for internal reliability (nearly all item-total correlations >0.4 and Cronbach's α=0.86). Intra-class correlation coefficient for test–retest reliability was 0.92. The impact scale was strongly correlated to global oral health ratings and effects on life overall. These results were similar when DHEQ was validated in a clinical sample. Conclusions: DHEQ shows good psychometric properties in both a general population and clinical sample. Its use can further our understanding of the subjective impacts of dentine sensitivity.
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There is debate concerning methods for calculating numbers needed to treat (NNT) from results of systematic reviews. We investigate the susceptibility to bias for alternative methods for calculating NNTs through illustrative examples and mathematical theory. Two competing methods have been recommended: one method involves calculating the NNT from meta-analytical estimates, the other by treating the data as if it all arose from a single trial. The 'treat-as-one-trial' method was found to be susceptible to bias when there were imbalances between groups within one or more trials in the meta-analysis (Simpson's paradox). Calculation of NNTs from meta-analytical estimates is not prone to the same bias. The method of calculating the NNT from a meta-analysis depends on the treatment effect used. When relative measures of treatment effect are used the estimates of NNTs can be tailored to the level of baseline risk. The treat-as-one-trial method of calculating numbers needed to treat should not be used as it is prone to bias. Analysts should always report the method they use to compute estimates to enable readers to judge whether it is appropriate.
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Simpson's paradox is sometimes referred to in the areas of epidemiology and clinical research. It can also be found in meta-analysis of randomized clinical trials. However, though readers are able to recalculate examples from hypothetical as well as real data, they may have problems to easily figure where it emerges from. First, two kinds of plots are proposed to illustrate the phenomenon graphically, a scatter plot and a line graph. Subsequently, these can be overlaid, resulting in a overlay plot. The plots are applied to the recent large meta-analysis of adverse effects of rosiglitazone on myocardial infarction and to an example from the literature. A large set of meta-analyses is screened for further examples. As noted earlier by others, occurrence of Simpson's paradox in the meta-analytic setting, if present, is associated with imbalance of treatment arm size. This is well illustrated by the proposed plots. The rosiglitazone meta-analysis shows an effect reversion if all trials are pooled. In a sample of 157 meta-analyses, nine showed an effect reversion after pooling, though non-significant in all cases. The plots give insight on how the imbalance of trial arm size works as a confounder, thus producing Simpson's paradox. Readers can see why meta-analytic methods must be used and what is wrong with simple pooling.
Article
Purpose: To evaluate the efficacy of an experimental mouthwash containing 3% potassium nitrate (KNO3) in relieving dentin hypersensitivity when used as an adjunct to brushing with fluoride toothpaste compared with use of the same toothpaste alone. Methods: This was one of three randomized, two-treatment, examiner-blind, parallel-design, single-site, 8-week studies in healthy subjects with self-reported and clinically diagnosed dentin hypersensitivity. Subjects were randomized to receive either fluoride toothpaste plus 3% KNO3 mouthwash or the same fluoride toothpaste alone, and instructed to use their allocated treatment twice daily for the next 8 weeks. Dentin hypersensitivity was evaluated at baseline and following 4 and 8 weeks of treatment through assessment of responses to evaporative (air) and tactile stimuli [measured by the Schiff Sensitivity Scale, a visual rating scale (VRS), and tactile threshold, respectively], and using the Dentin Hypersensitivity Experience Questionnaire (DHEQ; a validated quality-of-life instrument for dentin hypersensitivity). Results: A total of 216 subjects were randomized and 214 completed the study. Both treatment groups demonstrated statistically significant reductions from baseline for each clinical measure of sensitivity (P≤ 0.01) at Weeks 4 and 8. Use of the 3% KNO3 mouthwash after brushing with fluoride toothpaste resulted in statistically significantly greater reductions in sensitivity to an evaporative (air) stimulus (mean Schiff score and mean VRS, P< 0.001; primary objective mean Schiff score at Week 8, P< 0.0001) and statistically significantly higher tactile threshold (P< 0.001) at Weeks 4 and 8 compared with toothpaste alone. The DHEQ responses reflected the clinical outcomes for several parameters, indicating a significant improvement in oral health-related quality of life after 8 weeks' use of the 3% KNO3 mouthwash. Clinical significance: The results of this study suggest that daily use of a 3% KNO3 mouthwash as an adjunct to brushing with fluoride toothpaste provides clinically relevant improvements in dentin hypersensitivity after 8 weeks' twice-daily use.
Article
Objective: This systematic review aimed to evaluate the scientific evidence on the efficacy of desensitizing mouthwashes for the treatment of dentin hypersensitivity (DH) and root sensitivity (RS). Material and methods: A thorough search in MEDLINE, PubMed and Cochrane Plus Library was conducted up to February 2015. Randomized clinical trials, parallel, double-blinded and placebo-controlled, with a follow-up of at least 6 weeks, reporting changes on response to tactile stimuli, thermal/evaporative stimuli or patients' subjective assessment of the pain experienced during their daily life after the home use of desensitizing mouthwashes were considered for inclusion. Results: The screening of titles and abstracts resulted in seven publications meeting the eligibility criteria. The desensitizing agents evaluated were potassium nitrate (n = 5), aluminium lactate (n = 1) and sodium fluoride (n = 1). A meta-analysis for each of the hypersensitivity stimuli was performed. Results demonstrated statistically significant reduction in sensitivity scores favouring test group when DH was assessed by means of patients' self-reported pain experience (SMD at 8 weeks = 0.77; 95% CI [0.23; 1.31]; P = 0.005). No significant effects were detected in response to tactile or thermal/evaporative stimuli. Meta-regression analysis demonstrated a tendency towards an increased effect favouring test group for the patients' subjective perception, whereas tactile and thermal/evaporative stimuli showed a slight tendency towards a reduction in the efficacy of the test mouthwash. Conclusions: There exists a tendency towards a decrease in DH or RS scores with time in both treatment groups, with significant differences in favour of test group when sensitivity is evaluated in terms of patients' self-reported sensitivity symptoms.
Article
Purpose: To evaluate the efficacy of an experimental toothpaste containing 5% (w/w) calcium sodium phosphosilicate (CSPS) in relieving dentin hypersensitivity (DH) compared with control toothpastes containing no known anti-sensitivity ingredients. Methods: This was the first of two exploratory, randomized, four-treatment, examiner-blind, parallel-design, single-site, 8-week studies in healthy subjects with self-reported and clinically diagnosed DH. The experimental toothpaste contained 5% CSPS with a modified surfactant system, developed to enhance its organoleptic properties. Efficacy was evaluated against an abrasivity-matched placebo formulation (0% CSPS) with additional abrasive silica replacing the CSPS, and two commercially available fluoride toothpastes as controls. After an initial lead-in period, subjects were randomized to one of the four study treatments and instructed to brush twice daily for the next 8 weeks. DH was assessed at baseline and following 4 and 8 weeks of treatment by response to tactile and evaporative (air) stimuli, and using a Dentine Hypersensitivity Experience Questionnaire (DHEQ; a validated quality-of-life measure for DH). Results: A total of 134 subjects were randomized and completed the study. All treatments demonstrated statistically significant reductions in sensitivity from baseline at Week 4 and Week 8 for each clinical measure of sensitivity (all P < 0.001). The 0% CSPS toothpaste demonstrated small but statistically significant reductions in Schiff sensitivity score compared with the other study toothpastes at Week 8 (all P < 0.05), whereas the experimental 5% CSPS toothpaste significantly improved the tactile threshold at Week 4 compared with the 0% CSPS toothpaste (P= 0.0467). The DHEQ responses did not reveal any consistent statistically significant within-treatment changes from baseline or between-treatment differences. Correlation analysis showed weak-to-moderate associations between the DHEQ outcomes and clinical endpoints. Study treatments were well tolerated. The treatment differences observed in this exploratory study were small and inconsistent between measures. The reasons for the inconsistencies are not clear but may be related to the properties of the abrasivity matched 0% CSPS formulation, with the increased level of dental silica conferring an advantage in terms of reducing DH. The ability of dental silicas to occlude exposed dentin tubules and thereby reduce DH has been demonstrated in previous studies, and may warrant further clinical investigation.
Article
Purpose: To compare the efficacy of an experimental toothpaste containing 5% (w/w) calcium sodium phosphosilicate (CSPS) in relieving dentin hypersensitivity (DH) with that of control toothpastes containing no known anti-sensitivity ingredients. Methods: This was the second of two exploratory, randomized, four-treatment, examiner-blind, parallel-design, single-site, 8-week studies in healthy subjects with self-reported and clinically diagnosed DH. After an initial lead-in period, subjects were randomized to one of four study treatments: the experimental toothpaste containing 5% CSPS with a modified surfactant system, developed to enhance its organoleptic properties; an abrasivity-matched placebo formulation (0% CSPS) with additional abrasive silica replacing the CSPS; or one of two commercially available fluoride toothpastes as controls. Subjects were instructed to brush twice daily for the next 8 weeks. DH was assessed at baseline and following 4 and 8 weeks of treatment by response to tactile and evaporative (air) stimuli, and using a Dentine Hypersensitivity Experience Questionnaire (DHEQ; a validated quality of life measure for DH). Results: A total of 137 subjects were included in the efficacy analysis. The experimental 5% CSPS toothpaste demonstrated statistically significant reductions from baseline in sensitivity at Week 4 and Week 8 for each clinical measure (all P < 0.01). It also demonstrated significantly greater improvements in DH compared with the two control toothpastes for the majority of clinical measures at Week 4 (P < 0.01) and for all clinical measures at Week 8 (all P < 0.01). The abrasivity-matched 0% CSPS toothpaste was associated with similar outcomes to the 5% CSPS toothpaste. The DHEQ responses did not reveal any consistent statistically significant within-treatment changes from baseline or between-treatment differences. Strong correlations with DHEQ outcomes were only observed for the subjects' sensitivity rating in response to evaporative (air) stimuli at Week 8. Study treatments were well tolerated.
Article
Aim: To determine the prevalence and impact of dentine hypersensitivity (DH) on oral health-related quality of life (OHRQoL) in individuals receiving supportive periodontal care (SPC). Materials and methods: One hundred and two adults receiving SPC were recruited for a cross-sectional study. Subjects were categorized into those who self-reported DH (DH1) or did not (DH0). Impact of DH on OHRQoL was assessed using the Chinese Condition-Specific Oral Impact on Daily Performance questionnaire (CS-OIDP). Evaluation of DH included tactile-stimulation followed by air-blast, and recorded using a Visual Analogue Scale (VAS). Results: Sixty-one (59.8%) subjects self-reported DH with mean air-blast VAS score of 29.4 ± 21.3mm and mean tactile-stimulation VAS score of 10.9 ± 14.7mm. Fifty (49%) subjects reported impact on OHRQoL (mean CS-OIDP score = 4.7 ± 6.3). The most affected performance was cleaning the mouth (35.3%). Positive expression of DH and worse OHRQoL were associated with higher air-blast and tactile-stimulation VAS scores, and use of desensitizing agents. The minimally important difference (MID) in CS-OIDP scores was 2.0 points. Approximately 30% of subjects reported CS-OIDP scores above the MID. Conclusions: Dentine hypersensitivity affects OHRQoL in patients undergoing SPC. The extent of impact was associated with severity of DH. This article is protected by copyright. All rights reserved.
Article
Determining the quality of a randomized clinical trial (RCT) is necessary for decision-makers to determine the believability and applicability of the trial findings. Issues that are likely to affect the utility of RCT evidence include issues of bias, random error and applicability. In this article we focus primarily on issues of bias and examine the evidence for whether reporting methodological items, including allocation concealment, sequence generation, and blinding of participants can be relied upon as evidence of bias. We present the findings of a systematic review of meta-epidemiological studies and a simulation study demonstrating that commonly examined sources of bias likely play little role in treatment exaggeration. We discuss other issues that may additionally influence trial outcomes including sample size, publication bias, and expertise of trialists. We conclude by discussing strategies to moderate the effect of known biases in assessing overall estimates of treatment effects. Copyright © 2015. Published by Elsevier Inc.
Article
This paper reviews a number of studies in oral biology and endodontics that deal with the reactivity of the pulpo-dentine complex in response to mechanical and immunological stimuli. It can be hypothesized that these reactions could also apply to changes in dentine sensitivity following periodontal procedures. Some of these changes involve neurogenic inflammation of the pulp under exposed open tubules; this increases the rate of outward fluid flow through the tubules, making the overlying exposed dentine more sensitive. Other changes may be due to inflammation-related nerve sprouting of pulpal nerves, which can lead to innervation of more tubules than normal. Changes may also involve upregulation of new, more sensitive ion channels in the membranes of these nerves.
Article
ContextThe gold standard treatment modality for dentine hypersensitivity has not yet been established. This review examines the effectiveness of self and professionally applied treatments for the reduction of pain from dentine hypersensitivity.Materials and Methods Electronic (3 databases) and hand searches were performed 14-21 July 2014 to identify randomised clinical trials for the treatment of dentine hypersensitivity.ResultsThis systematic review provided numerous treatment modalities for dentine hypersensitivity. Eleven agents and 105 Randomised Controlled Trials were robust enough to be included. The studies varied considerably in design, observation period, active agents, formulation of the whole agent, negative and positive controls and comparator products investigated. The stimuli used were always airblast and often airblast/tactile. Due to the heterogeneity between the studies and lack of direct comparison between agents there was insufficient data to undertake a meta-analysis to compare agents for meaningful conclusions. Best available evidence for each treatment agent has been documented as a narrative.Conclusions Treatments including stannous fluoride, arginine and calcium sodium phosphosilicate and strontium toothpaste appear to be clinically effective for the treatment of dentine hypersensitivity compared to comparators and controls. There is limited evidence to confirm the relative effectiveness of individual professionally applied agents.This article is protected by copyright. All rights reserved.
Article
Background Several pain rating methods are used to quantify pain. Although these instruments have been extensively studied, their inter-agreement, especially in emergency department (ED) settings, has yet to be determined. Objective This study was designed to assess the agreement between Visual Analog Scale (VAS), Color Analog Scale (CAS), and verbally administered Numeric Rating Scale (NRS) in the emergency setting. Methods A sample of 150 adult patients presenting with acute pain to two EDs was recruited. Patients' pain severity at presentation, 30 and 60 min later was assessed using the three pain scales. The agreement between pain scales was assessed using Bland-Altman method and Spearman correlation. We described a composite measure to serve as the gold standard and to be compared with each score. Factor analysis was also performed to assess the underlying construct. Results Spearman correlation coefficients between NRS and CAS, NRS and VAS, and CAS and VAS were 0.95, 0.94, and 0.94, respectively (p < 0.001). On a scale of 0 to 10, the 95% limits of agreement between the paired NRS and VAS, VAS and CAS, and CAS and NRS as measured by Bland-Altman method ranged from −2.0 to 2.6, from −2.7 to 2.0, and from −2.1 to 2.0, respectively. The Kaiser−Meyer−Oklin measure of sampling adequacy was 0.785 and Bartlett's test for sphericity was significant (p < 0.001). Conclusions The three pain scales were strongly correlated at all time periods. The findings suggest that NRS, CAS, and VAS can be interchangeably applied for acute pain measurement in adult patients.
Article
Background The Oral Health Impact Profile (OHIP) is the most widely used quality of life (QoL) measure to evaluate the influence of oral diseases on individuals. QoL measures have been noted to be context and environment specific, and there is a need to cross-culturally adapt a scale before its introduction into any community. This study aimed to evaluate the psychometric properties, validity and internal consistency of the OHIP-14 measure in an adult patient population in Ibadan, Nigeria. Methods A cross-sectional study was conducted over a four-month period on 204 adult patients using OHIP-14 structured questionnaire, global self-report indicator of oral conditions and perceived treatment need. Oral examinations were performed to assess periodontal status, caries experience and attachment loss. Data were analyzed using SPSS and p-value for statistical significance was set at < 0.05. Results A total of 204 patients participated in the study with a mean OHIP score of 11.2 (± 9.8). OHIP scores were not related to the sociodemographic characteristics. Perception of need for treatment was greater among those who reported impacts on their QoL (89.3% vs. 14.3%, p < 0.001). The OHIP scores correlated negatively with global self rating of oral health status (rho = −0.23, p < 0.01). Higher OHIP scores were associated with having carious teeth (p = 0.023). The Cronbach's alpha for the 14 inventory items ranged from 0.857 to 0.871. Conclusion The OHIP-14 measure showed good psychometric properties with satisfactory validity and internal consistency in adult patients in Ibadan, Nigeria.
Article
“The generation of random numbers is too important to be left to chance.”—Robert R Coveyou The randomized controlled trial (RCT) has become the standard by which studies of therapy are judged. The key to the RCT lies in the random allocation process. When done correctly in a large enough sample, random allocation is an effective measure in reducing bias. In this article we describe the random allocation process.
Article
The use of unidimensional pain scales such as the Numerical Rating Scale (NRS), Verbal Rating Scale (VRS), or Visual Analogue Scale (VAS) is recommended for assessment of pain intensity (PI). A literature review of studies specifically comparing the NRS, VRS, and/or VAS for unidimensional self-report of PI was performed as part of the work of the European Palliative Care Research Collaborative on pain assessment. To investigate the use and performance of unidimensional pain scales, with specific emphasis on the NRSs. A systematic search was performed, including citations through April 2010. All abstracts were evaluated by two persons according to specified criteria. Fifty-four of 239 papers were included. Postoperative PI was most frequently studied; six studies were in cancer. Eight versions of the NRS (NRS-6 to NRS-101) were used in 37 studies; a total of 41 NRSs were tested. Twenty-four different descriptors (15 for the NRSs) were used to anchor the extremes. When compared with the VAS and VRS, NRSs had better compliance in 15 of 19 studies reporting this, and were the recommended tool in 11 studies on the basis of higher compliance rates, better responsiveness and ease of use, and good applicability relative to VAS/VRS. Twenty-nine studies gave no preference. Many studies showed wide distributions of NRS scores within each category of the VRSs. Overall, NRS and VAS scores corresponded, with a few exceptions of systematically higher VAS scores. NRSs are applicable for unidimensional assessment of PI in most settings. Whether the variability in anchors and response options directly influences the numerical scores needs to be empirically tested. This will aid in the work toward a consensus-based, standardized measure.
Article
The aim of this prospective clinical pilot study was to evaluate the pain alleviation effectiveness of two desensitizing agents (VivaSens and Seal&Protect) on 30 patients suffering from cervical dentine sensitivity (CDS) over a six month period. Analysis of possible differences in pain alleviation effect between the agents and over time was performed. Further,the experienced pain was registered in a questionnaire regarding to what extent the treatment improved oral health/life quality among the patients. The patients (23 female, 7 male) were randomly divided into two groups. Each group was treated with one of the two desensitizing agents. Sensitivity measurements were recorded before treatment (baseline) and after treatment at time points of one week and six months. The patients were asked to rate the sensitivity experienced in the area during air stimulation by marking on a Visual Analogue Scale (VAS). At six months, 27 patients (90%) had completed the clinical trial. The results showed that a significant reduction of CDS was achieved by using VivaSens or Seal&Protect after both one week and six months. However, there were no differences found on treatment effects between the two desensitizing agents. The results from the questionnaire showed that the patients experienced improved oral health/life quality when comparing the status before and after treatment (0.000 < or = p < or = 0.0021) and there were no statistically significant difference in treatment effects between the products. In conclusion, both desensitizing agents were effective in relieving cervical dentin hypersensitivity during the time course of the study as evaluated both by air stimulation and a questionnaire related to oral health/quality of life status.
Article
This narrative review provides an overview on the topic of bias as part of a series of articles in Plastic and Reconstructive Surgery on evidence-based medicine. Bias can occur in the planning, data collection, analysis, and publication phases of research. Understanding research bias allows readers to critically and independently review the scientific literature and avoid treatments that are suboptimal or potentially harmful. A thorough understanding of bias and how it affects study results is essential for the practice of evidence-based medicine.
Article
Dentin hypersensitivity, or what patients may describe as "sensitive teeth," is defined as a short, sharp pain arising from exposed dentin in response to thermal, evaporative, tactile, electrical, osmotic or chemical stimuli. It is widely accepted that dentin hypersensitivity is an uncomfortable condition that also affects function and quality of life. This study determines the differences in efficiency of three desensitizing products when compared with a placebo. A randomized controlled clinical trial was conducted to compare three different professional dentin desensitizer agents in 52 patients. The age and sex of the patients was recorded. Gluma Desensitizer (Heraeus Kulzer), UltraEZ (Ultradent Products, Inc) and Duraphat (Colgate Oral Pharmaceuticals, Inc, New York, NY, USA) were used as desensitizer agents and distilled water was used as the placebo. The baseline measurement of the dentin hypersensitivity was made by using a visual analog scale (VAS). Twenty-four hours and seven days after application of the desensitizer agents and placebo, a new VAS analysis was conducted for patients' sensitivity level. The desensitizer agents were compared in terms of mean values, and ANOVA was used for testing differences among the groups (p<0.05). The results showed that the mean pain scores of the placebo group were significantly higher than that of the study groups (p<0.05). The VAS analysis revealed a significant decrease in dentin hypersensitivity over time with the use of agents (p<0.05). No statistically significant difference was found among the three desensitizing agents (p>0.05). These three desensitizing agents, which contain different active ingredients, were effective in relieving dentin hypersensitivity. However, no superiority was found in dentin sensitivity relief among the agents.
Article
The aim of the present study was to evaluate oral health-related quality of life (OHRQoL) impairment in patients seeking care for their hypersensitive teeth in comparison with general population subjects and to investigate the influence of gender and age on OHRQoL in these populations. Study participants were 656 patients without removable prosthodontics who sought treatment for their hypersensitive teeth in German dental offices. These patients were asked to complete the German form of the Oral Health Impact Profile (OHIP-G) prior to treatment. The sum of OHIP-G item responses (OHIP-G49, 0-196) characterized the OHRQoL impairment. Patients' OHIP summary scores were compared with those in a sample of the German general population (n = 1541). The influence of population (patients vs. general population subjects), gender and age was investigated using a multivariable linear regression model. Age presented a curvilinear association with OHRQoL, with lower OHIP scores associated with younger and older adults and higher OHIP scores (indicating impaired OHRQoL) associated with middle-aged adults in both the patient and general populations. Gender influence depended on the population, i.e. female general population subjects had lower OHIP scores than male general population subjects and female patients had higher OHIP scores than male patients. Mean OHIP summary scores indicated that patients with hypersensitive teeth reported considerably more impaired OHRQoL (approximately 22 OHIP units) than subjects in the general population. The present study suggests that the oral condition of hypersensitive teeth is significantly associated with impaired OHRQoL.
Article
Assessing the quality of randomized controlled trials (RCTs) is important and relatively new. Quality gives us an estimate of the likelihood that the results are a valid estimate of the truth. We present an annotated bibliography of scales and checklists developed to assess quality. Twenty-five scales and nine checklists have been developed to assess quality. The checklists are most useful in providing investigators with guidelines as to what information should be included in reporting RCTs. The scales give readers a quantitative index of the likelihood that the reported methodology and results are free of bias. There are several shortcomings with these scales. Future scale development is likely to be most beneficial if questions common to all trials are assessed, if the scale is easy to use, and if it is developed with sufficient rigor.
Article
The capacity of dental clinicians and researchers to assess oral health and to advocate for dental care has been hampered by limitations in measurements of the levels of dysfunction, discomfort and disability associated with oral disorders. The purpose of this research was to develop and test the Oral Health Impact Profile (OHIP), a scaled index of the social impact of oral disorders which draws on a theoretical hierarchy of oral health outcomes. Forty nine unique statements describing the consequences of oral disorders were initially derived from 535 statements obtained in interviews with 64 dental patients. The relative importance of statements within each of seven conceptual subscales was assessed by 328 persons using Thurstone's method of paired comparisons. The consistency of their judgements was confirmed (Kendall's mu, P < 0.05). The reliability of the instrument was evaluated in a cohort of 122 persons aged 60 years and over. Internal reliability of six subscales was high (Cronbach's alpha, 0.70-0.83) and test-retest reliability (intraclass correlation coefficient, 0.42-0.77) demonstrated stability. Validity was examined using longitudinal data from the 60 years and over cohort where the OHIP's capacity to detect previously observed associations with perceived need for a dental visit (ANOVA, p < 0.05 in five subscales) provided evidence of its construct validity. The Oral Health Impact Profile offers a reliable and valid instrument for detailed measurement of the social impact of oral disorders and has potential benefits for clinical decision-making and research.
Article
Clinical trials on dentine hypersensitivity have been numerous and protocols varied. To date there is little consensus as to the conduct of studies on this poorly-understood yet common and painful dental condition. A committee of interested persons from academia and industry was convened to discuss the subject of clinical trials on dentine hypersensitivity and a consensus report is presented. A double-blind randomized parallel groups design is recommended, although cross-over designs may be used for the preliminary screening of agents. Subjects may have multiple sites scored. Sample size will be determined by estimating the variability in the study population, the effect to be detected and the power of the statistical test to be used. Subject selection is based on a clinical diagnosis of dentine hypersensitivity, excluding those with conflicting characteristics such as currently-active medical or dental therapy. The vestibular surfaces of incisors, cuspids and bicuspids are preferred as sites to be tested. A range of sensitivity levels should be included. Tactile, cold and evaporative air stimuli should be applied. Negative and benchmark controls should be incorporated. Most trials should last 8 weeks. Sensitivity may be assessed either in terms of the stimulus intensity required to evoke pain or the subjective evaluation of pain produced by a stimulus using a visual analog or other appropriate scale. The subject's overall assessment may be determined by questionnaire. Outcomes should be expressed in terms of clinically significant changes in symptoms. Follow-up evaluation is required to determine the persistence of changes. At least 2 independent trials should be conducted before a product receives approval.
Article
The aim of this study was to evaluate in vivo the use of low-level galium-aluminium-arsenide (GaAlAs) (BDP 600) laser and sodium fluoride varnish (Duraphat) in the treatment of cervical dentine hypersensitivity. Twelve patients, with at least two sensitive teeth were selected. A total of 60 teeth were included in the trial. Prior to desensitizing treatment, dentine hypersensitivity was assessed by a thermal stimulus and patients' response to the examination was considered to be a control. The GaAlAs laser (15 mW, 4 J/cm2) was irradiated on contact mode and fluoride varnish was applied at cervical region. The efficiency of the treatments was assessed at three examination periods: immediately after first application, 15 and 30 days after the first application. The degree of sensitivity was determined following predefined criteria. Data were submitted to analysis and no statistically significant difference was observed between fluoride varnish and laser. Considering the treatments separately, there was no significant difference for the fluoride varnish at the three examination periods, and for laser therapy, significant difference (P < 0.05) was found solely between the values obtained before the treatment and 30 days after the first application. It may be concluded that both treatments may be effective in decreasing cervical dentinal hypersensitivity. Moreover, the low-level GaAlAs laser showed improved results for treating teeth with higher degree of sensitivity.
Article
This review aims to explore the research available relating to three commonly used pain rating scales, the Visual Analogue Scale, the Verbal Rating Scale and the Numerical Rating Scale. The review provides information needed to understand the main properties of the scales. Data generated from pain-rating scales can be easily misunderstood. This review can help clinicians to understand the main features of these tools and thus use them effectively. A MedLine review via PubMed was carried out with no restriction of age of papers retrieved. Papers were examined for methodological soundness before being included. The search terms initially included pain rating scales, pain measurement, Visual Analogue Scale, VAS, Verbal Rating Scale, VRS, Numerical/numeric Rating Scale, NRS. The reference lists of retrieved articles were used to generate more papers and search terms. Only English Language papers were examined. All three pain-rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. For general purposes the Numerical Rating Scale has good sensitivity and generates data that can be statistically analysed for audit purposes. Patients who seek a sensitive pain-rating scale would probably choose this one. For simplicity patients prefer the Verbal Rating Scale, but it lacks sensitivity and the data it produces can be misunderstood. In order to use pain-rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Interpretation of the data from a pain-rating scale is not as straightforward as it might first appear.
Article
This in vivo study determined whether the application of three different desensitizing agents on exposed dentin surfaces was effective in reducing dentin hypersensitivity in subjects with slight-to-moderate sensitivity. Sixty patients with a history of sensitivity were included in this study. At baseline visit, the initial sensitivity levels were recorded using a visual analog scale (VAS). In order to activate the sensitivity, evaporative (air-blast) and thermal (chloraethyl) stimuli were applied to each subject. The subjects' responses to the stimuli were marked on the VAS. Then, the subjects were assigned to one of the treatment groups or to a placebo. The agents used were Seal&Protect (Dentsply DeTrey GmbH, Konstanz, Germany), Vivasens (Ivoclar Vivadent AG, Schaan, Liechtenstein) and BisBlock (BISCO, Schaumburg, IL, USA); whereas, distilled water was used as the placebo. The subjects were recalled after four weeks, and their responses were again recorded. The VAS scores of the treatment and placebo groups were not different from each other at baseline (p > 0.05), and thermal stimuli caused higher patient discomfort than evaporative stimuli (p < 0.05). Alleviation effects of the desensitizing agents were not significantly different from each other; however, the placebo was an exception (p < 0.05). The differences between the VAS scores at baseline and after four weeks were significant for all three desensitizing agents (p < 0.05). However, in the placebo group, the evaporative stimuli led to insignificant pain variations (p > 0.05). It was concluded that the desensitizing agents used in this clinical study were effective in alleviating dentin hypersensitivity. Meanwhile, the placebo response was shown to play a significant role.
Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL), Qual
Study protocol for the World Health Organization project to develop a Quality of Life assessment instrument (WHOQOL), Qual. Life Res. 2 (1993) 153-159.