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The Efficacy of 8% Arginine-Caco Applications on Dentine

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The Efficacy of 8% Arginine-Caco Applications on Dentine Med Oral Patol Oral Cir Bucal. 2013 Mar 1;18 (2):e298-305. The treatment of dentin hypersensitivity with 8% Arginine-CaCO3 Journal section: Periodontology doi:10.4317/medoral.17990 Publication Types: Research http://dx.doi.org/doi:10.4317/medoral.17990 The efficacy of 8% Arginine-CaCO3 applications on dentine hypersensitivity following periodontal therapy: A clinical and scanning electron microscopic study Ahu Uraz 1, Özge Erol-Şi̇ mşek 2, Selcen Pehli̇ van 3, Zekiye Suludere 4, Belgin Bal 5 1 PhD, Assist. Prof, Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey 2 DDS, Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey 3 MA, Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey 4 PhD, Prof, Department of Zoology and Botany (Biology), Faculty of Science, Gazi University, Ankara, Turkey 5 PhD, Prof, Department of Periodontology, Faculty of Dentistry, Gazi University, Ankara, Turkey Correspondence: Gazi University, Faculty of Dentistry Department of Periodontology 84. Sokak, 8. Cadde, Emek, 06510 Ankara, Turkey Uraz A, Erol-Şi̇ mşek Ö, Pehli̇ van S, Suludere Z, Bal B. The Efficacy of [email protected] 8% Arginine-CaCO3 Applications on Dentine Hypersensitivity Follow- ing Periodontal Therapy: A Clinical and Scanning Electron Microscopic Study. Med Oral Patol Oral Cir Bucal. 2013 Mar 1;18 (2):e298-305. http://www.medicinaoral.com/medoralfree01/v18i2/medoralv18i2p298.pdf Received: 03/10/2011 Accepted: 07/06/2012 Article Number: 17990 http://www.medicinaoral.com/ © Medicina Oral S. L. C.I.F. B 96689336 - pISSN 1698-4447 - eISSN: 1698-6946 eMail: [email protected] Indexed in: Science Citation Index Expanded Journal Citation Reports Index Medicus, MEDLINE, PubMed Scopus, Embase and Emcare Indice Médico Español Abstract Objectives: Periodontal therapy is one of the etiological factors of dentine hypersensitivity (DH). This study aimed to evaluate the efficacy of %8Arginine-CaCO3 on DH that affects patients after periodontal treatment. Study design: Seventy-one teeth from the volunteers (n=36) with history of DH caused by periodontal therapy were included in this study, and randomly divided into two groups: group-1, who received 8%Arginine-CaCO3 and group-2, who received 1.23%NaF-gel. The clinical indices were recorded at first visit.DH was evaluated by using tactile, air-blast, and thermal stimuli. The subject’s response was recorded at baseline, immediately (Day-0) and one month after the application. Results and conclusions: The results were statistically analyzed, and it was found that 8% Arginine-CaCO3 treat- ment was more effective than 1.23% NaF-gel at time intervals. Sensitivity score differences between the groups were statistically significant at Day-28. The 8% Arginine-CaCO3 group exhibited statistically significant reduc- tion in DH on three stimuli at baseline to Day-28. It was concluded that 8% Arginine-CaCO3 is more effective than 1.23% NaF-gel in reduction of patients’ pain. Key words: Arginine, desensitizing agent, hypersensitivity, periodontal treatment, scaling and root planning, sodium fluoride. e298 Med Oral Patol Oral Cir Bucal. 2013 Mar 1;18 (2):e298-305. The treatment of dentin hypersensitivity with 8% Arginine-CaCO3 Introduction In the treatment of dentine hypersensitivity, variety of Dentine hypersensitivity (DH) is characteristically in methods and materials are applicable to both home and response to an array of stimuli which is thermal, tac- office use (1,2,4,12,13). The agents used at home include tile, evaporative, osmotic or chemical and which cannot desensitizing dentifrices or mouthwashes with sodium be attributed to any other form of dental defect, disease fluoride (NaF), stannous fluoride, potassium nitrate, or pathology (1-3). The exposed dentin can be affected formaldehyde, strontium chloride, etc. The agents used from stimuli due to loss of enamel or cementum (4). at office include fluoride compounds, calcium com- DH is typically common clinical condition, and previ- pounds, cavity varnishes, restorative resins, etc. (4,7,9, ous studies have suggested higher prevalence levels up 11,13). Previous clinical studies have shown that treat- to 57%. The emergence of sensitivity to even touch the ment of exposed root surfaces with fluoride toothpaste root dentin surface lightly with a tooth brush causes and concentrated fluoride solutions is very efficient in deficiency of oral hygiene practices (5). There are var- managing dentinal hypersensitivity. Tal et al. (14) dem- ied etiologic and predisposing factors related to DH onstrated that desensitizing effect of fluoride is related including acute and chronic inflammatory periodontal to precipitated fluoride compounds mechanically block- diseases, trauma, tooth flexure, occlusal forces, attri- ing dentinal tubules. Also topical NaF applications cre- tion, abrasion, erosion, tooth brushing, parafunctional ate a barrier on the tooth surface, blocking dentinal tu- habits, periodontal treatment, and acidic dietary com- bules and reducing hypersensitivity (15). ponents (1,6-8). An essential amino acid, arginine was first isolated from One of the important components of periodontal treat- a lupin seedling extract in 1886 by the Swiss chemist ment is mechanical debridement. Nonsurgical therapy Ernst Schultze and has been investigated as arginine including scaling and root planning is the most com- bicarbonate together with calcium carbonate for its monly used procedure. It designed to remove dental ability to occlude dentin tubules and reduce pain from deposits and necrotic cementum from the root surface. DH (16). The Colgate-Palmolive Company develops the The emergence of dentin hypersensitivity after the peri- new Pro-Argin technology for the treatment of dentin odontal treatment is expected hypersensitivity for this purpose. It is available as office result. Dentin hypersensitivity is most prevalent in the desensitizing paste and toothpaste. The Pro-Argin tech- cervical area of the roots, where the cementum is very nology consists of 8% Arginine-CaCO3, and the content thin. Periodontal procedures may entirely remove this of calcium in the form of an insoluble calcium carbon- thin cementum layer and induce hypersensitivity or, ate (17). Since the arginine and calcium carbonate can more correctly, root hypersensitivity. The prevalence of occlude the exposed dentin tubules and preventing the sensitivity observed to increase after scaling and root movement of dentinal fluid in the tubules. planning, compared to baseline was reported (4,9). The objective of this study was to determine of dentine Several theories have been proposed to explain the hypersensitivity, which occurs following periodontal mechanism of DH. Scientific evidence supports the therapy, and to compare the efficacy of 1.23% NaF-gel hydrodynamic theory. The main initial symptom of and %8 Arginine-CaCO3 after direct topical applica- hypersensitivity is sharp, sudden pain and disappears tions at office. In addition, an in vitro scanning electron when the stimulus is removed. The fact that root sur- microscopy (SEM) study to compare the effectiveness faces become sensitive to a variety of external stimuli of these agents in occluding dentinal tubules was car- after periodontal instrumentation and dentinal tubules ried out. become uncovered to the oral environment and to hy- drodynamic forces (1,6,9). When thermal and osmotic Material and Methods stimuli is applied to dentine, liquid in the dentin tubules The clinical study was a single-center, double-blind, are replaced rapidly. The move may stimulate nerve fib- randomized design. The study protocol has been re- ers of pulp mechanically, thereby inducing a painful viewed and approved by the Ethical Board of Gazi Uni- sensation according to the hydrodynamic theory of den- versity School of Medicine, and volunteers were asked tin sensitivity (1,9-11). This mechanism can certainly to give an informed written consent to participate, after explain the sensitivity that patients experience imme- a thorough explanation of the safety and potential ef- diately after the instrumentation procedure and during ficacy of 8% Arginine-CaCO paste, and the probabil- a short period afterwards, while it does not make clear 3 ity of receiving 8% Arginine-CaCO3 paste or 1.23% why the symptoms increase over time and why the pain NaF-gel. The study was performed in accordance with condition may affect certain patients and certain teeth the Helsinki Declaration of 1975, as revised in Tokyo (2,3,12). 2004. Most treatment procedures used commonly are based -Patient selection on desensitizing agents, which the proposed mode of Thirty-six female patients (mean age 33.2±4.5 years, action is tubule occlusion and/or desensitization (1,3). range 27-43 years) with a history of DH at least one e299 Med Oral Patol Oral Cir Bucal. 2013 Mar 1;18 (2):e298-305. The treatment of dentin hypersensitivity with 8% Arginine-CaCO3 tooth were selected from the Department of Periodon- performed. SRP process implemented 20 strokes for tics of Gazi University, Ankara. each tooth surface (18). Following standard periodontal Inclusion criteria were at least one vital tooth with hy- therapy, hypersensitive teeth were identified by the pa- persensitivity on facial surfaces to thermal, mechanical, tient and verified by the light stroke of a dental explorer tactile stimuli. Individuals were systemically healthy along the cervical area of all teeth present. The tooth and non-smokers. They had DH following
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