Between Gluma, Duraflor and other 1.1% fluoride toothpastes, what works best for dentin hypersensitivity?

This question was submitted by a general dentist: Between Gluma, Duraflor and other 1.1% fluoride toothpastes, what works best for dentin hypersensitivity?

Dr. Suham Alexander, Oasis Clinical Editor, and Dr. Gordon Schwartz, Periodontist at GumDocs, provided this quick initial response

DENTIN HYPERSENSITIVITY

Dentin hypersensitivity (DH) is a common clinical issue encountered by dentists. The incidence of occurrence is estimated to range from 4-74%. DH most commonly affects the buccal surfaces in the cervical areas of canines and premolars in both arches. There is a slightly higher incidence of DH reported in females than males. Most frequently, the age range of affected individual is between 20-50 years with a peak in the 30-40 age groups.

CHARACTERISTICS

Short, sharp pain in response to tactile, thermal, evaporative, chemical or osmotic stimuli.

PATHOGENESIS

Pulpal tissue and dentin share the same embryological origin even though they differ histologically. Pulpal tissue and dentin are connected such that a physiologic or pathologic change in one will affect the other. Dentinal fluid accounts for approximately 22% of the volume of dentin and surrounds odontoblastic processes, the major cells of the pulp-dentin complex. The odontoblastic processes are housed within the dentin tubules and extend from the dentin to the DEJ.

Dentin hypersensitivity occurs through the loss of the protective covering of dentin including:

• Loss of enamel (attrition, abrasion, abfraction or erosion)
• Gingival recession (toothbrush abrasion, tooth preparation, pocket reduction surgery, excessive flossing or as a result of periodontal disease)

Once the protective covering of the smear layer has been removed, the tubules are exposed and open to the environment. DH results from the movement of fluid within the tubules which trigger a pain response from the pulpal nerve fibres.

MANAGEMENT

1. At-Home Desensitizing Agents

Toothpastes

• Usually contain potassium salts, sodium fluoride, strontium chloride, dibasic sodium citrate, formaldehyde, sodium monofluorophosphate and stannous fluoride
• Potassium salts decrease excitability of nerve fibres within dentin
• Toothpaste containing potassium nitrate and sodium fluoride decreases sensitivity after bleaching
• Application of toothpaste with a soft-bristled toothbrush and minimal use of water to prevent dilution of the sensitizing agent

Gum and Mouthwash

• Should contain potassium nitrate, sodium fluoride or potassium citrate.

It takes approximately 4 weeks before any effects will be noticed.
If no relief after 3-4 weeks of using at-home desensitization, consider in-office management.

2. In-Office Desensitizing Agents

Fluorides

• Calcium fluoride precipitates within tubules prevents sensitivity by decreasing the permeability of dentin
• Formulations include: sodium fluoride, stannous fluoride, sodium monofluorophosphate, fluorosilicates and fluoride combined with iontophoresis
• Acidulated sodium fluoride has better penetration

Oxalates

• Reduce dentinal permeability and occlude tubules
• 30% formulation can reduce permeability by 98%
• Reacts with dentin forming calcium oxalate crystals within tubules and on external surface of dentin
• Effect decreases over time due to removal by brushing or dietary acids
• Improve effect via deeper penetration by acid etching dentin surface

Varnishes

• Mostly used as a short-term treatment

Adhesive Materials

• Resin-based adhesive systems create a hybrid layer by sealing dentinal tubules
• Gluma Desensitizer contains hydroxethyl methacrylate (HEMA), benzalkonium chloride, gluteraldehyde and fluoride
• Gluteraldehyde causes precipitation of protein and HEMA occludes tubules by creating resinous tags

Bioglass

• Used in orthopedics to stimulate union between bone and implant
• Dental use includes filling osseous defects during periodontal surgery
• Reports suggest bioglass can promote infiltration and remineralization of tubules
• Also aids in the formation of an apatite layer to occlude tubules
• NovaMin

Portland Cement

• Derivative calcium silicate cement occludes tubules by remineralization

Laser

• Mechanism of action is unclear – coagulation of proteins within the tubule and hinder fluid movement or affect neural transmission in dentinal tubules
• Nd-YAG and GaAIA lasers have been used in DH treatment and effective in comparison to a placebo 

Casein Phosphopeptide (CPP)-Amorphous Calcium Phosphate (ACP)

• GC Tooth Mousse remineralizing agent
• CPP attaches to ACP which helps to remineralize enamel subsurface lesions and prevents dissolution of calcium and phosphate ions resulting in a bioavailable super-saturated solution of calcium and phosphates

References

1. Miglani S, Aggarwal V, Ahuja B. Dentin hypersensitivity: Recent trends in management. J Conserv Dent. 2010;13(4):218-24.
2. Lin PY, Cheng YW, Chu CY, Chien KL, Lin CP, Tu YK. In-office treatment for dentin hypersensitivity: a systematic review and network meta-analysis. J Clin Periodontol. 2013;40(1):53-64.
3. Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A.  Lasers for the Treatment of Dentin Hypersensitivity: A Meta-analysis. J Dent Res. 2013;92(6):492-9.

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