Does application of the professionally applied dentine bonding agents compared to desensitizing toothpaste provide a greater reduction in hypersensitivity?
Dentine hypersensitivity refers to a short sharp pain that arises from exposed dentine retort to some stimuli, which is hard to ascribe to any other form of dental defect. The felling is also a response to stimuli typically thermal, evaporative, tactile, osmotic or chemical, which becomes hard to attribute to any other form of pathology. It is important to note that this kind of pain associated to hypersensitivity affects about 37 per cent people in American; however, many of those who suffer from this disorder are not aware that the condition can be identified easily and treated.
This clinical question under review is relevant for a clinical review in regard to some factors. According to recent research conducted in this area it is clear that 88 per cent of the dental professionals suppose that dentine hypersensitivity can interfere with the quality life of a patient. In addition, they also deem that the condition is on rise. In spite of this, most of these dental professionals fail to routinely monitor patients for the clause; as a result, they result in going undiagnosed regularly (Miglani. 2010 p 218-224). Consequently, what happened later is that patient’s alteration of their behaviour to avoid the pain is interfered. Some of these behaviours include aspects like oral hygiene negligence, failure to abide to oral care directives and in other cases failing to visit dental checkups. All these factors affect, increase the risk, and chances of developing dental complications.
The predicament, in this case, is the dental hypersensitivity disorders, which remains one of the common dental complications that are mostly encountered. In general, the prevalence of these dental complications is high in adults dentate population that ranges from 8- 30 per cent. This complication does not only manifest as physical discomfort, but also as an emotional uneasiness for the patient (Miglani. 2010 p 218-224)
Therefore, there is need to identify the most effective method between the application of desensitizing toothpaste and dentine bonding agents in the management of dental hypersensitivity. The most cost effective method of treatment is prevention option. The first recommendation that a patient with HD can receive from dental experts should include termination of habits that are destructive, which may include; aggressive or dynamic cross coiffure (Rees. 2000 p 860-865). They should also advocate for a twice-daily application of a desensitizing dentifrice. This has been shown during the clinical trials aimed at improving hypersensitivity in order to increase its effectiveness eventually.
There are some cases after use of a desensitizing dentifrice where the hypersensitivity of patients persists, in such a case, clinicians are required to re-evaluate the discrepancy diagnosis where they should think about in-office treatments commencing with the appliance of topically practical desensitizing agents. However, the most frequent treatment line for DH is patients self-treatment procedures in the appearance of desensitizing toothpaste. In this case, the professional treatment which is in the forefront is the use of fluoride varnish, and thermal pain stimuli which is applied over the areas that are sensitive within the affected teeth (Pamir. 2005p 73-76). The desensitizing agents, non-desensitizing toothpaste, and dentine bonding agents come second in the treatment line to help in the preservative sensitive teeth management.
These DH management procedures raises the question on the most effective method between dentine bonding agents, professional desensitizing agent, non-desensitizing toothpaste (NDT), and desensitizing toothpaste (DT) once they are applied from a professional point of view to persons with dentine hypersensitivity.
In order to analyze the data collected SPSS version was used where initial investigative analyses were done with an aim of ascertaining if the data met the set and expected assumptions of ANOVA, which included variance homogeneity, sphericity and normality. The test for homogeneity variance was conducted with the use of Lenene’s equality and variance error test. According to the results, variances were different at 3 months (p<0.01) and (p<0.01) in 6 months. In the case, data of transformation functions well in order to transform data that goes against the assumption of the homogeneity variance. The successive Levene’s tests for homogeneity of variance showed that assuming of variances could be tacit equal in all groups that is, 3 months; p > 0.05, and in 6months;p > 0.05). The following table gives in a clear figure of how data was distributed across the groups that were involved in the study
In regard to the above study limitations, it is clear that DA application to the teeth that is tested with hypersensitivity (DH) shows the greatest reduction in DH after 2 weeks and 6 months compared to the desensitizing toothpaste, as well as, normal fluoridated toothpaste.
|Total time taken||6 months|
|scenery||General Dental Practice|
|Experimental intrusion||Desensitizing toothpaste (DT), and Non-Desensitizing toothpaste (NDT),|
|Professional Desensitizing Agent||Thermal|
|Exclusion Criteria||Allergy, unpleasant reactions attributed to several used materials, sensitivity attributed to a lesion requiring restoration, poor oral hygiene, and failure to obey with trial procedure.|
|Evaluation of Outcome||VAS ( 1-10)|
The Gibson in 2013 study was an RCT that incorporated 75 adult participants, and was conducted in General Practice by a single dental practitioner. In this case, the dentist put three modalities comprising of: desensitizing toothpaste (DT), Professional Desensitizing Agent, and Non-Desensitizing toothpaste (NDT). A thermal pain stimulus was used by the dentist to aid in the evaluation of sensitivity by means of Vascale. The table below shows the allocation of materials used in the study.
|Allocation of materials
In the examination process, the participants in the RCT were expected to record the sensitivity severity in a VAS within a span of 2, 3 and 6 weeks. The sensitivity level was later assed using the patient VAS questionnaires (Gibson. 2013 p 668-674 ). The assessment methods used clearly revealed that the sensitivity data slightly deviated from the normal distribution in all the groups that were being treated. The deviations were predominantly slight in all groups apart from the DA group.
The Search methods used to identify studies included the following:
After the protocol development, there were article citations that were obtained through electronic search within the databases. There was also hand searching process on published primary and bibliographic referencing list, as well as review studies. Ovid MEDLINE® included terms such as dentin sensitivity” OR “dentin hypersensitivity”. One thing to note is that during the search there were no language limits or restrictions that were functional. This was done to enable and facilitate the process of counting all the potential clinical trials. Some other features that were applied in the electronic search process included the following:
- Time limitations Period: 1946 to Present
- Boolean operators used (OR, AND, NOT)
- Keywords: dentin hypersensitivity [Mesh terms]
- restrictions and boundaries [ ]
- Text word search
The Inclusion and Exclusion criteria comprised of the following aspects;
The sextants that had 0 scores were selected. The age limit accepted ranged from 18 to 75 years. In addition, the participants selected had to contain at least 1 toothache, which according to least VAS score participants were required to assent to and at the same time be in a position to abide by the test regime.
Medical contraindications were used in the exclusion process for all other 9 search results.This speciﬁcally was due to allergy or adverse reactions to whichever materials applied in the study, material receipt or dental treatment that had a likelihood interfering with the parameters of the study, sensitivity resulting from a greatly restored tooth, that is resulting from pulpitis or attributed sensitivity to a laceration requiring restoration (Mostafa, 1985 p 256). Underprivileged oral sanitation and failure to fulfill with trial procedure also led to the exclusion of these search aspects.
The electronic search used from all available sources managed to retrieve 10 unique citation sources. In order to screen the content titles and abstracts were used and managed to exclude 9 papers because they had no connection to DH studies in humans. Another reason was that those sources were review or opinion papers. The agreement between the paper reviewers was good and the remaining citation full evaluation on the article content in respect to the provided information was done. The actions were taken in correspondence to the needed author. Another thing to note is that 7 of the excluded papers did not meet the inclusion criteria and 3 were previous reports of included studies. The remaining paper report was subjected to detailed analysis.
It is clear that trial in randomized controlled clinical is rare in a dental practice setting. In addition, there are also RCT designed specifically for testing the DH effectiveness in comparison to desensitizing toothpaste (Gibson. 2013 p 668-674). The following table clearly shows the randomization aspects in Gibson, 2013 study.
|Participants blinding or concern provider/result assessors||Yes/No/Unclear|
|Trial dropouts reported||Yes|
|Other bias sources|
|prohibition/Eligibility criterion précised||Yes|
|Age of the participants précised||Yes|
|assortment of the desensitizing formulations used standardized||Yes|
|Groups alike at baseline||Yes|
This study is reliable to appraisal overall. The study is a well planned and organized, however, from the analysis got it is clear that there are some issues with the study that have the potential of causing problems in terms of applicability and generalizability to the entire general populace with DH. One important mania to note is that it the study was a performed single blindly by only one dental professional within a single surgery. The other thing is that the number off participants used was not large enough in accordance with the calculations made (Brunton. 2000 p 351-5). There was no well controlled environment for the data collection, especially where the patients were recommended to use toothpaste at home. That is, it was hard to tell whether they used the toothpaste prescribed or other things while brushing their teeth. In other words, the pts technique, adherence and frequency to the protocol of toothpaste are prone to a lot of questions. In addition, the manuscripts in the study did not provide any information in regard to the protocol of the toothpaste at all.
In the case of the desensitizing agents’ application, again the study has portrayed some tribulations in the referencing sections. This is despite the fact that the study looks perfect. The question of how randomization was achieved is very important as it forms the basis of how the participants were selected from the large population. In this case, in order to achieve a balance in the baseline, the study subjects were allocated to the respective group through the use of random number tables, and a block randomization process with an aim of ensuring that there were a balanced number of participants in each group (Al-Mullahi, 2011 p 234).
The difference between the study by Gibson is that the follow-up length of six months is applied so that it can be able to support the benefits arising from DAS as shown by Tavares. The DAS efficacy, in this case, would result from its ability to be able to include tubules of the patent dental fairly than the surface coating provision parse that is easily lost during the tooth brushing and an abrasive diet.
The process of answering the clinical question on the most effective method between dentine bonding agents and desensitizing toothpastes once they are applied from a professional point of view to persons with dentine hypersensitivity is crowded by some difficulties especially in coming up with a conclusive decision that is based on only one single RCT(Andy. 1990 p 503-513 ). However, there are RTC’s required and which contains a great increased patient number, and outcome measures that are improved. Nevertheless, dentists may consider applying dentine bonding agents instead of prescribing desensitizing toothpastes for the administration of dentine hypersensitivity.
In the case of desensitizing toothpaste, Cochrane review which was last updated in the year 2006, comprised of potassium nitrate pastes. This was another systematic professional review that was recently conducted on the application of desensitizing agents. It established out that these agents are effective; however, there was no comparison to desensitizing toothpaste that was made in the review. As a result, it is not possible to umpire whether any or all the dentinal hypersensitivity management processes were effective, the ones that are comparatively more effectual, and worth using.
Finally, it is also important to mention on the placebo group, which was incorporated in the study. In any study where a measurement of pain is involved, placebo group is true in the control of DH clinical trials (Andy, 1992 p 410-412). Therefore, this clinical trial has a negative control group which applied standard ﬂuoridated toothpaste in order to have a baseline against making the measurement of the two other treatments measurable. The most note able thing with these DH trials is that there is a failure to include a placebo cluster such that the interpretation of the outcome reported must be done with some caution. These clinical trials have also shown that management interventions for DH contain or have indicated that the effects of placebo shows something other than lack of effects and dissimilarities from the groups that are not treatable. The possible reason to this is due to alliterations both physiologic and psychological which occurs as a result of medical intervention.
In accordance to the author, this group was incorporated to the measurement of the pain value although it deemed not necessary. The reason behind this fact is that most of the pt would still use non-desensitizing toothpaste. This can be proved by Odontogenic pain transmission which is primarily mediated by peripheral sensory neurons of the trigeminal nerve (Andy, 1992 p 407-408,.). These nerve peripheral terminals innervate the dental pulp and other oral tissues, On the other hand, the central terminals nerves release neurotransmitters that are concerned in the pain initiation where there are nerve fibers that are myelinated and unmyelinated and contained in the nerve bundles. The fibers that are myelinated are referred to as A-fibers and are grouped in regard to their diameter and transmission velocities. A-Fibers mainly innervate the dentine. The unmyelinated fiber, also known as C-fibers, innervates the body of the soft tissue. The trigeminal nerve cell bodies are situated in the Gasserian ganglion. This is the main neuron synapses that have the second-order neuron in the sub nucleus caudal area of the trigeminal spinal tract nucleus.
Al-Mullahi, A. 2011. A cross-sectional study of dentine hypersensitivity in Omani dental patients. Thesis (M.Med.Sc.) –NUI, 2006 at Department of Restorative Dentistry, UCC.
Andy, U. 1992. Dentine hypersensitivity: its prevalence, aetiology and clinical management. Dental Update , 407-408, 410-412.
Andy. 1990. Aetiology and clinical implications of dentine hypersensitivity. Dental Clinics of North America, 503-513.
Brunton. 2000. Resistance of two bonding agents and dentine desensitizer to acid erosion in vitro. Dental Material, 351-5
Gibson. 2013. A practice-based randomized controlled trial of the efficacy of three interventions to reduce dentinal hypersensitivity. Journal of Dentistry , 668-674.
International dental federation, world dental congress, & FDI world dental congress. 2002. Dentine hypersensitivity: general practice considerations for successful management: proceedings of a symposium held at the FDI World Dental Congress, Vienna 2002. London, FDI World Dental Press.
Miglani. 2010. Dentine Hypersensitivity: recent trends in management. Journal of Conservative Dentistry, 218-24
Mostafa, P. A. S. 1985. Dentine hypersensitivity Clinical and laboratory investigations. Cardiff, University College.
Pamir. 2005. The efficacy of three desensitizing gents in treatment of dentine hypersensitivity. Journal of Clinical Pharmacy and Therapeutics, 73-76.
Rees. 2000. The prevalence of dentine hypersensitivity in general dental practice. Journal of Clinical Periodontology, 860-865.
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