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Treatment of root sensitivity after periodontal therapy
Howard E. Strassler, DMD
Commentary by Howard E. Strassler, DMD
Fiocchi MF, Moretti AJ, Powers JM, Rives T. Am J Dent. 2007;20(4):217-220.
PURPOSE: To compare the effectiveness of an agent that promotes deposition of amorphous calcium phosphate (Quell Desensitizer) to a commonly used product, sodium fluoride solution (Nupro Neutral), in the reduction of root sensitivity after periodontal therapy in a prospective, convenient sample, double-blind clinical trial. METHODS: Thirty patients were enrolled and treated resulting in 40 teeth treated with the test product and 40 teeth treated with the control product. The clinical parameters tested at baseline and in follow-up visits (1, 2, and 4 weeks after treatment) were the following: plaque index, gingival index, gingival recession, and response to mechanical and cold stimulation with airblast and ice. Patients were also asked to report the grade of pain response on a Visual Analogue Scale (VAS) on the same schedule as the clinical parameters. RESULTS: Plaque index and gingival index were not significantly different between test and control groups throughout the study. Most recession was observed on the midbuccal surfaces. Buccal surfaces evoked higher pain response reported compared to lingual surfaces. It was concluded that both control and test treatments reduced root sensitivity response reported with mechanical or cold stimulation. No statistically significant differences were observed when the data of both groups were compared by a Student’s t-test at the .05 level of significance.
Every day in practice the clinician encounters at least one patient with sensitive teeth. Dentinal hypersensitivity refers to a sharp, sudden pain when teeth are exposed to a stimulus. This stimulus can be tactile, exposure to hot and cold food and beverages, exposure to breathing in cold air, or even brushing and/or flossing. No vital tooth in the mouth is immune to dentinal hypersensitivity. Root sensitivity has been reported in incisors, canines, premolars, and molars. The prevalence of dentinal hypersensitivity has been reported to be between 4% and 57% in the general population. Among periodontal patients, the frequency of tooth hypersensitivity is considerably higher (60% to 98%).
The prevalence of dentin hypersensitivity is so great that there is an entire selection of toothpastes that are primarily marketed for treating sensitivity. Manufacturers constantly make claims about their products being superior to others. These two studies present some of what we already know, but it is still important to see it verified with clinical trials: professionally dispensed desensitizing agents work at reducing dentin hypersensitivity. Most times the sensitivity is not completely eliminated, and even when it is, there is a high likelihood of recurrence, which means re-treatment of the sensitive area. Is there one product or treatment that works best?
In the Fiocchi study, patients who had root sensitivity after periodontal therapy were treated with amorphous calcium phosphate (which promotes deposition and clogging of the dentinal tubules) compared to treatment with neutral sodium fluoride. Both products were applied following the manufacturers’ instructions for in-office application. No additional at-home treatment was recommended. In this study there was no difference between the test (ACP) and the control treatment (sodium fluoride) in reducing root sensitivity after scaling and root planing. What was interesting was that ice applied to the buccal surfaces produced the greatest sensitivity. For both products there was a reduction of sensitivity, with the greatest reductions at week 3 and week 4. Also, the study noted prevalence of sensitivity from different teeth: the most prevalent tooth with sensitivity was No. 3 followed by Nos. 6 and 14.
In the Pamir study, all three in-office desensitizing agents clogged the dentinal tubules: one product with a light-cured resin, the other two with precipitation products. The manufacturers’ instructions were followed. Four weeks after application, all three products exhibited similar effects and alleviated dentin hypersensitivity. What was of interest in this study was a significant reduction to the thermal stimulus for the placebo product.
These studies provide valuable information in our dental practices for the treatment of dentin hypersensitivity. It was disappointing that neither study recalled the patients at 6 months or 1 year to provide data on the long-term effectiveness of the treatments. Desensitizing toothpastes (usually with an active ingredient of 5% potassium nitrate) have been demonstrated in many studies to be effective pain reducers. Using an in-office product such as the ones tested, combined with a recommended sensitivity toothpaste, may be the best route for clinical treatment. Patients also need to understand that there is no one-shot treatment that eliminates the pain forever. Dentin hypersensitivity is a chronic condition that must be re-treated on a regular basis to achieve reductions in sensitivity, making eating and breathing at extreme temperatures more bearable.
Howard E. Strassler, DMD
Professor and Director of Operative Dentistry
Department of Endodontics, Prosthodontics and Operative Dentistry
University of Maryland Dental School, Baltimore, Maryland