Quality Resource Guide

Management of the Patient with Dentin Hypersensitivity

www.metdental.com

protective hydroxyapatite-like layer on the dentin

surface. A number of clinical studies investigating

efficacy of NovaMin have reported immediate

significant reduction of pain and a relief of dentinal

hypersensitivity that persisted 28 days after scaling

and root planning procedures were completed.

37,57-60

3. Prescription Dentifrices

PreviDent

5000 Sensitive (1.1% Sodium Fluoride,

5% Potassium Nitrate) is a prescription strength

(5000 ppm fluoride) toothpaste formulated for

sensitive teeth. It has a unique liquid gel formula that

enables faster fluoride dispersion than paste-form

toothpaste. It is recommended for use twice daily in

place of regular toothpaste.

61-64

Cavex Bite & White ExSense (Cavex Holland BV) is

another prescription dentifrice that has shown fast

and long-lasting relief from dentin hypersensitivity. It

has a blend of hydroxyapatite and hydro-dispersing

clay that has unique properties to ensure accelerated

dispersion, helping boost hydroxyapatite penetration.

It was reported that the hydroxyapatite penetrates

deep into the tubules and micro-cracks in the

enamel completely sealing off the areas causing

sensitivity.

65,66

Products combining 5,000 ppm sodium fluoride and

NovaMin technology have been introduced to the

market in the past few years. These products purport

that they provide significant dual benefits for patients

targeting caries and dentin hypersensitivity.

4. Bonding Agents

Light-cured bonding agents are used in the dental

offices to immediately block open dentinal tubules

and reduce dentin hypersensitivity. CLEARFIL

Protect (Kuraray Dental, Okayama, Japan) is a

self-etching long-term fluoride release light cure

monomer that has an antimicrobial benefit. The

ability to create a cross-linked protein leads to

plugging of the dentinal tubules. Dentists have

reported satisfactory clinical results.

Gluma

Desensitizer and Gluma

Desinstizer

PowerGel (Heraeus Kulzer, Hanau, Germany) have

been on the market for over 10 years and used

worldwide to reduce dentin hypersensitivity. They

have been reported to have the ability to penetrate

up to 200μm into the exposed dentinal tubules

where they form multiple layers of protein septa

preventing intratubular fluid movement following

osmotic

changes.

68,69

Calm-It™

Desensitizer

(DENTSPLY Caulk) has a similar concept.

5. Lasers

Various laser (light amplification by stimulated

emission of radiation) types have been tested and

used for dentin hypersensitivity treatment, including;

Nd:YAG; Er:YAG; CO2; He-Ne; and GaAlAs diode

lasers. The effectiveness ranges reported vary

widely, as do the laser type and parameters used.

Lasers were used with various energy settings and

with wavelengths ranging from 632.8 nm (He-Ne)

to 10,600 nm (Er:YAG, CO2).

10,21

The mechanism

of action of lasers in treating hypersensitivity is

not clear, but it has been proposed that lasers

coagulate the proteins inside the tubules and block

the movement of fluid. For low output-power lasers

(diode laser=780-900 nm or He-Ne lasers=632.8

nm) the desensitizing effect seems to be related

to laser activity at the nerve level mediating an

analgesic effect related to depressed nerve

transmission.

The desensitizing effect of the

middle output-power lasers (Nd:YAG, CO2, and

Er:YAG) could be related to an interaction with the

dental pulp, causing a photobiomodulating (PBM)

effect, increasing the cellular metabolic activity

of the odontoblasts and occluding the dentinal

tubules with tertiary dentin production. PBM is the

application of light delivered by a low power laser

of light-emitting diode to promote tissue repair,

reduce inflammation or induce analgesia.

6,21,70

systematic review comparing laser therapy with

desensitizing agents suggests that lasers may have

a slight clinical advantage over topically applied

medicaments, especially in severe cases.

A recent

study explored the possible synergistic effect of

lasers and topically applied treatments.

Long-Term Management of

Dentin Hypersensitivity

Treatment of dentin hypersensitivity, at-home or

in-office, is only one aspect of the management of

dentin hypersensitivity. It is imperative in achieving

lasting comfort to consider effective plaque control,

strategies to enhance salivary flow, increase

salivary pH and improve its buffering capacity and

implement dietary modifications as appropriate.

Controlling dentin hypersensitivity is an ongoing

challenge that requires dentist intervention AND

patient cooperation.

Conclusion

The management of dentin hypersensitivity

can be carried out at home with over

the counter agents containing potassium

salts or other effective compounds and

in-office using a variety of treatments

including topically applied desensitizing

agents

(fluoride,

potassium

nitrate,

oxalate, calcium phosphates), adhesives

and lasers. Prevention and at-home

treatments are a good place to start.

They can later be supplemented with

in-office treatments if needed. However,

with the conflicting findings about both

self-applied and professional methods,

evidence-based analysis cannot currently

proclaim one agent or technique to be

superior in the management of dentin

hypersensitivity. Clinicians should initiate

therapy for dentin hypersensitivity with

conservative approaches, progressing to

more aggressive, time-consuming or costly

procedures if they are unsuccessful.