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Effect of Tooth-Brushing with a Microcurrent on Dentinal Tubule Occlusion Gangjae KIM1, Byoung-Duck ROH2, Sung-Ho PARK2, Su-Jung SHIN3 and Yooseok SHIN2

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Effect of Tooth-Brushing with a Microcurrent on Dentinal Tubule Occlusion Gangjae KIM1, Byoung-Duck ROH2, Sung-Ho PARK2, Su-Jung SHIN3 and Yooseok SHIN2 Dental Materials Journal 2020; 39(5): 766–772 Effect of tooth-brushing with a microcurrent on dentinal tubule occlusion Gangjae KIM1, Byoung-Duck ROH2, Sung-Ho PARK2, Su-Jung SHIN3 and Yooseok SHIN2 1 Department of Conservative Dentistry, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea 2 Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea 3 Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Gangnam Severance Hospital, Yonsei University, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea Corresponding author, Yooseok SHIN; E-mail: [email protected] The purpose of this study was to investigate whether tooth-brushing with a microcurrent was effective in inducing dentinal tubule occlusion. The specific aims of the study were (1) to evaluate the effectiveness of tooth-brushing with a microcurrent on dentinal tubule occlusion by using scanning electron microscopy (SEM); and (2) to compare the dentinal fluid flow rate after tooth-brushing with a microcurrent by using a sub-nanoliter-scaled fluid flow measuring device (NFMD). All experimental groups showed partially occluded dentinal tubules and crystal-like structures at a specific microcurrent intensity indicated that tooth-brushing with a microcurrent could efficiently occlude dentinal tubules. The decrease in dentinal fluid flow rate in the tooth-brushing with microcurrents group indicated that dentinal tubules were occluded and the flow of dentinal fluid had decreased. Keywords: Dentin hypersensitivity, Dentinal tubule, Microcurrent, Nanoliter-scaled fluid flow measuring device, SEM electrostatic repulsion and allows the simultaneous INTRODUCTION penetration of neutral molecular chemicals when water is Dentin hypersensitivity is a common disease caused by infiltrated using electro-osmosis5). Iontophoresis was first exposure of the dentinal tubules that allow the movement used in the early 1960s to treat dentin hypersensitivity6). of intradentinal fluid1). The most commonly accepted A previous study reported that using iontophoresis hypothesis for explaining pulpal stimulus transmission treatment with fluoride, dentin hypersensitivity can was provided by the Brannstrom hydrodynamic theory in be reduced by blocking the dentinal tubules, which 7) 1966. Brannstrom proposed that the inflicting stimulus are coated with CaF2 . Another study suggested that causes dynamic intradentinal fluid flow in dentinal fluoride iontophoresis treatment is effective and safe tubules, resulting in deformation of odontoblastic and significantly decreases dentin hypersensitivity8). processes along with adjacent nerve fibers and leading However, iontophoresis treatment is expensive and to dentin hypersensitivity2). requires special equipment, preventing its daily use by To date, many desensitizing agents have been patients suffering from dentin hypersensitivity. developed to reduce dentin hypersensitivity, and the Recently, a smart toothbrush using a microcurrent most accessible such agent is toothpaste. If daily brushing (Microworld, Seoul, Korea) has been developed, and it can with a desensitizing toothpaste occludes open dentinal be used more easily with similar effects as iontophoresis. tubules, it could be an effective method to reduce dentin The toothbrush contains a chip behind the head. This hypersensitivity3). Using scanning electron microscopy chip is an ultra-thin membrane-type microcurrent (SEM), Ling et al. showed that different desensitizing cell and is composed of staneless steel and aluminum. toothpastes were able to occlude dentinal tubules. They These two metals cause oxidation-reduction reactions also confirmed that brushing dentin surfaces with with saliva and the fluoride-containing toothpaste. The toothpastes using many desensitizing agents created microcurrent cell and the toothbrushes are electrically smear layers or smear plugs in dentinal tubules that connected to supply microcurrents directly to the teeth could reduce dentin hypersensitivity4). with an electrolyte. Thus, without an additional source Although many studies have revealed an abundance of electric power, when the smart brush is applied with of desensitizing agents, no single agent can be considered saliva in the mouth, it can generate microcurrents, ideal for long-term relief from dentin hypersensitivity. which are expected to occlude dentinal tubule efficiently. Therefore, new ways to decrease dentin hypersensitivity However, no previous studies have assessed the were introduced in dentistry, with iontophoresis being effectiveness of such smart toothbrushes; therefore, in one of them. Iontophoresis is a well-known medical this study we attempted to determine whether dentinal treatment technique that increases the skin penetration tubules are actually occluded well when brushing with a of medicinal drugs with the same charge by using smart toothbrush and Colgate Total toothpaste (Colgate- Palmolive, New York, NY, USA). Evaluations of the effects of desensitizing agents on Color figures can be viewed in the online issue, which is avail- able at J-STAGE. Received Jul 9, 2019: Accepted Oct 1, 2019 doi:10.4012/dmj.2019-205 JOI JST.JSTAGE/dmj/2019-205 Dent Mater J 2020; 39(5): 766–772 767 dentinal tubule occlusion are commonly performed by with a microcurrent (20 μA) assessing the occlusion of the dentinal tubules using SEM Group 4: Phosphoric acid-etched specimens brushed or by observation of changes in dentin permeability by with a microcurrent (100 μA) measuring the hydraulic conductance of a dentin disc9). Group 5: Phosphoric acid-etched specimens brushed In this study, dentinal tubule occlusion was observed with a microcurrent (200 μA) by using SEM and dentin permeability was measured Group 6: Phosphoric acid-etched specimens brushed by a sub-nanoliter-scaled fluid flow measuring device with a microcurrent (500 μA) (NFMD). In group 2, a toothbrush (Oral-B, Seoul, Korea) Assessments of surface topography are commonly without microcurrents was applied to the dentin surface performed in dental material science10). Surface roughness at an inclination of about 90° under constant loading measurements are often used to identify changes in tooth at the rate of 40,000 strokes/min for 1 min/day in tap structure following erosive wear and to investigate the water for 7 days. In groups 3–6, the same protocol efficacy of anti-erosion and remineralizing products11). was applied to the specimens with a smart toothbrush Dentinal tubule occlusion can be expected to affect the utilizing a microcurrent. After each brushing session, surface roughness of dentin due to the surface nature of the specimens were washed with distilled water using dentin hypersensitivity12). Therefore, surface roughness an ultrasonic bath and kept wet in distilled water. can be a useful indicator of tubule patency. The purpose of this study was to investigate whether 2. Observation of dentin surface occlusion by SEM tooth-brushing with a microcurrent was effective One dentin disc for each treatment group was prepared in inducing dentinal tubule occlusion and surface for transverse observation. Specimens were dried in a roughness. Therefore, the specific aims of the study were desiccator and sputter-coated with gold in a vacuum (1) to evaluate the effectiveness of tooth-brushing with evaporator (EIKO IB-3 ion coater, Hitachi, Tokyo, a microcurrent in inducing dentinal tubule occlusion by Japan). Micrographs of the dentin surface were obtained using SEM; 2) to compare the surface roughness after using a scanning electron microscope (JEOL-7800F, tooth-brushing with a microcurrent, and 3) to compare JEOL, Tokyo, Japan) on September 3, 2018. the DFF rates after tooth-brushing with a microcurrent by using an NFMD. 3. Measurement of surface roughness One dentin disc from each group was imaged and analyzed for surface roughness by using the surface MATERIALS AND METHODS profiler (DektakXT Stylus Profiler, Bruker, Bilerica, MA, Dentin sample preparation USA). The surface profiler records the irregularities in Thirty extracted human third molars were collected after the dentin surface as it moves to the end of the specimen, obtaining informed consent under a protocol approved and the Ra value is calculated. The Ra value is used to by the dental hospital (IRB approval no:2-2019-0001). detect general variations in overall profile height. A Teeth with caries, cracks, or gross irregularities of change in Ra typically signifies a new variation in the dentin structure were excluded from the study. The process. Each dentin specimen’s Ra value was measured teeth were cleaned thoroughly and stored in distilled and analyzed. water no longer than a month prior to their use. Thirty dentin discs were cut perpendicular to the long 4. Selection of proper microcurrent axis of the tooth each with a thickness of 3.0 mm above Preliminary experiments were performed with one the cemento-enamel junction (CEJ) and 3.0 mm below specimen per group, which was assessed using SEM the CEJ by using a low-speed diamond cutter (Metsaw- and surface profiler. We selected the group that showed LS, R&B, Daejeon, Korea) with water as coolant. maximum dentinal tubule occlusion. Then, we compared the DFF rate in that group with those in groups 1 and 2 Experimet part 1 by using eight specimens per group. 1. Experimental design After preparation of the specimens, the occlusal surface Experiment part 2 of each specimen
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