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Dentine Hypersensitivity: Analysis of Self-Care Products§

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Dentine Hypersensitivity: Analysis of Self-Care Products§ Periodontics Periodontics Dentine hypersensitivity: analysis of self-care products§ Cassiano Kuchenbecker Rösing(a) Abstract: Dentine hypersensitivity is a condition that is often present in (b) Tiago Fiorini individuals, leading them to seek dental treatment. It has been described Diego Nique Liberman(b) Juliano Cavagni(b) as an acute, provoked pain that is not attributable to other dental prob- lems. Its actual prevalence is unknown, but it is interpreted as very un- pleasant by individuals. Several therapeutic alternatives are available to (a) Professor of Periodontology; (b)Graduate Student, Graduate Program in Dentistry manage dentine hypersensitivity, involving both in-office treatment and – School of Dentistry, Federal University of home-use products. The aim of this literature review was to evaluate self- Rio Grande do Sul, Porto Alegre, RS, Brazil. care products for managing dentine hypersensitivity. Among the prod- ucts available, dentifrices and fluorides are the most studied self-care products, with positive effects. However, a high percentage of individu- als is affected by the placebo effect. Among dentifrices, those containing potassium salts seem to be the most promising. Dental professionals need to understand the advantages and limitations of these therapies and use this knowledge in a positive approach that might help in decreasing den- tine hypersensitivity among patients. Descriptors: Dentin hypersensitivity; Review; Dental devices, home-care. § Paper presented at the “Oral Health Self-Care Products: Realities and Myths” international symposium, sponsored by the Brazilian Association for Oral Health Promotion (ABOPREV), September 25-27, 2008, São Paulo, SP, Brazil. Corresponding author: Cassiano Kuchenbecker Rösing Rua Dr. Valle, 433/801 Porto Alegre - RS - Brazil CEP: 90560-010 E-mail: [email protected] Received for publication on Nov 21, 2008 Accepted for publication on Dec 11, 2008 56 Braz Oral Res 2009;23(Spec Iss 1):56-63 Rösing CK, Fiorini T, Liberman DN, Cavagni J Introduction Mechanisms associated with Dentine hypersensitivity is characterized by an pain sensation acute, short-duration pain related to exposed den- Dentin is normally sensitive to external stimuli tine in response to typically thermal, tactile, osmot- since it has structural and functional relationships ic, chemical or evaporative stimuli that cannot be at- with the dental pulp.6 However, tooth hypersen- tributed to any other pathological condition.1 It is a sitivity is observed when the dentinal tubules of a very unpleasant condition, limiting the daily habits vital tooth are exposed and subjected to mechani- of patients, such as the possibility of eating/drinking cal, chemical and/or thermal stimuli.1 Owing to its different kinds of foods and drinks. It is frequently thin cementum layer, the cervical area generally has one of the main reasons for visiting a dentist. dentinal tubules that are exposed by toothbrushing, As any other pain sensation in the body, tooth dietary erosion7 and abrasive dentifrices.8 This area hypersensitivity is viewed by individuals as an im- is responsible for more than 90% of hypersensitive portant health problem, sometimes leading to an surfaces.4 Several theories have been proposed to increased concern about their health status. Despite explain the pain mechanisms of this condition: the its acute character, and because it is not spontane- transduction theory, the modulation theory, the gate ous but rather stimulated, dentine hypersensitivity control and vibration theory and the currently most can be considered a chronic pain condition. With accepted hypothesis, the hydrodynamic theory. this in mind, dental professionals need to develop The hydrodynamic theory was developed in the strategies for managing dentine hypersensitivity, 1960’s and suggests that a stimulus could remove thus improving the quality of life of individuals. fluid from the dentinal tubules causing a rapid out- The reported prevalence of dentine hypersensi- ward flow and a pressure change across the dentine, tivity presents a large variation, depending on the thus resulting in the activation of pain fibers, mainly target population, on the methods employed to ass- A-delta fibers, on the pulp wall.9 Dentin covered es tooth hypersensitivity and on analysis of the data. with smear layer or cementum can be less sensitive For example, after a clinical evaluation of more than than a freshly exposed dentin surface. Similarly, the 3,000 individuals in the United Kingdom, Rees2 number and the width of exposed tubules and the (2000) reported a prevalence of 4%. On the other presence of sclerotic dentin can influence the intensi- hand, studies by Chabanski et al.3 (1997) and Or- ty of the pain caused by an exogenous stimulus.10-14 chardson, Collings4 (1987), also in the United King- dom, reported prevalences of 73% and 74%, respec- Factors that may enhance tively. However, these two latter studies comprised pain sensation less than 100 individuals each. Some factors can clearly contribute or even po- In Brazil, Fischer et al.5 (1992), in a University tentiate the development of tooth hypersensitivity. Clinic, reported a prevalence of 25% of self-report- The most common clinical event related to the oc- ed tooth hypersensitivity, and 17% were confirmed currence of dentine hypersensitivity is gingival re- after clinical examination. This scenario indicates cession, when the cervical area becomes apparent that whatever the real prevalence might be, dentine and the exposure of dentinal tubules is observed hypersensitivity is an important problem that needs because of a thin cementum layer. A retrospective management, especially because pain is involved. study with a representative sample of an urban Bra- Different agents have been studied for the pre- zilian population15 revealed that more than half vention and treatment of tooth hypersensitivity. (51.6%) and 22.0% of individuals presented gingi- Home-care and in-office approaches have been pro- val recession ≥ 3 mm and ≥ 5 mm, respectively. This posed. The aim of the present study was to perform condition was primarily related to destructive peri- a review of the literature concerning the use of odontal disease and was associated with smoking home-care products in the management of dentine and the presence of supragingival calculus. hypersensitivity. In patients submitted to periodontal treatment, Braz Oral Res 2009;23(Spec Iss 1):56-63 57 Dentine hypersensitivity: analysis of self-care products tooth hypersensitivity is frequently correlated to clinician to identify factors that can potentiate tooth the procedures of scaling and root planing, which hypersensitivity. This information can be important remove the cementum layer from the root surface.5 in choosing a correct approach to change habits and Chabanski et al.3 (1997) described a prevalence of in treatment success. tooth hypersensitivity varying from 72.5% to 98% of individuals after periodontal therapy. More re- Difficulties and limitations in the cently, a systematic review16 revealed that the preva- study of dentine hypersensitivity lence of tooth hypersensitivity ranged from 9% to Pain is a subjective experience and depends on 23% before periodontal treatment and from 54% to various factors, such as the psychological profile of 55% after it. the individual, his/her previous pain experiences Another factor that can potentiate this condition and levels of anxiety. Therefore, great intra- and in- is the individual’s diet, especially after exposure to ter-individual variations are common in pain studies acidic drinks or fruits like lemon. When Prati et al.17 and, consequently, in tooth hypersensitivity studies. (2003) evaluated dentin permeability and morpholo- Different forms of stimulation are associated with gy after erosion in the presence of acidic drinks, they varying results. One of the most common stimuli found an increased dentin permeability caused by the used in dentine hypersensitivity studies is a blast of dissolution of the smear layer and smear plugs and, air during one second. Even this method, apparently consequently, an increased risk for dentin hypersen- simple and reliable, has been demonstrated to vary sitivity. Because the exposure of dentinal tubules quite importantly. The temperature of the air var- is involved, studies performed in beagle dogs18 and ies according to the external temperature and this in situ19 concluded that a good plaque control, per- variation may or may not exceed individual thresh- formed mechanically or chemically, can reduce the olds, resulting in distinct responses. Moreover, the patency of dentinal tubules by occluding them in a air pressure, the distance from the source of applica- natural reparative process of tooth hypersensitivity. tion and the time of stimulation may vary, thus giv- On the other hand, plaque control performed ing different intensities of the stimulus.24 with an abrasive dentifrice can result in increased pa- Concerning the quantification of pain, in some tency of dentinal tubules. The use of a less-abrasive studies it is performed with a verbal rating scale dentifrices is able to prevent dentin hypersensitivity (VRS) with 4 degrees of intensity, which may limit in cervical regions.20 Another current topic is that the options for the patient to describe the pain and tooth hypersensitivity has been the most commonly lead to less consistent results in the clinical observa- reported adverse effect of vital tooth whitening with tion. Other aspects that can make the
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