Dentine Hypersensitivity - Coursework Example

Does application of the professionally applied dentine bonding agents compared to desensitizing toothpastes provide greater reduction in hypersensitivity? SSU code: 56 Introduction Dentine hypersensitivity refers to a short sharp pain that arises from exposed dentine in response to some stimuli, which is hard to ascribe to any other form of dental defect. The feeling is also a response to typically thermal, evaporative, tactile, osmotic, or chemical stimuli, which becomes hard to attribute to any other form of pathology. This can be proved by Odontogenic pain transmission, which is primarily mediated by the help of some sensory neurons of the trigeminal nerve (Andy, 1992 p 407- 408). These peripheral nerve terminals innervate the dental pulp as well as other oral tissues while the central terminals nerves release neurotransmitters that are involved in pain initiation in the areas where the myelinated and unmyelinated nerve fibers are contained within the nerve bundles. This is what leads into this kind of pain associated to hypersensitivity and many people who suffer from this disorder are not aware that the condition can be identified easily and treated. In regard to my clinical experience, patients with dental sensitivity present concerns at least once per week. This is one of the most frequent complains that experts in this area, receive from patients. According to recent research conducted in this area, it is clear that 88 percent of the dental professionals suppose that dentine hypersensitivity can obstruct the quality life of a patient. In addition, it is also deemed that the condition is on rise. In spite of this, most of the dental professionals fail to routinely monitor patients for the clause resulting in them, going regularly undiagnosed (Miglani. 2010 p 218-224). This lead to the question on the best method to use aimed at having a greater reduction in this form of sensitivity. The predicament in this case is the dental hypersensitivity disorders, which remains one of the commonly dental complications that are mostly encountered. In general, the prevalence of these dental complications is high in adult dentate population ranging from 8- 30 percent. This complication does not only manifest as a physical discomfort, but also as an emotional uneasiness for the patient (Miglani, 2010 p 218-224) Therefore, there is need to indentify the most effective method in the management of dental hypersensitivity. The most cost effective method of treatment is prevention option. The first recommendation that a patient with DH can receive from dental experts should include termination of habits that are destructive, which may include; aggressive or dynamic use of brushing aids (Rees. 2000 p 860-865). A twice-daily application of a desensitizing dentifrice should also be advocated. . This has been shown during the clinical trials aimed at improving hypersensitivity in order to increase its effectiveness eventually. There are some cases after use of a desensitizing dentifrice where the hypersensitivity of patients persists, in such instance; clinicians are required to re-evaluate the discrepancy diagnosis where they should think about in-office treatments commencing with the appliance of topically applied desensitizing agents (Miglani, 2010 p 222-224). However, the most frequent treatment line for DH is patient’s self-treatment procedures in the appearance of desensitizing toothpaste. One thing to note is that the leading professional treatment of dentine sensitivity is the use of fluoride varnish, which is applied over the areas that are sensitive within the affected teeth (Pamir. 2005p 73-76). Dentine bonding agents come second in the treatment line to help in the preservative sensitive teeth management. These DH management procedures raise the question on the most effective method between dentine bonding agents and desensitizing toothpastes (DT) once they are applied from a professional point of view to persons with dentine hypersensitivity. Therefore, the clinical question in this case is, does application of the professionally applied dentine bonding agents compared to desensitizing toothpastes provide greater reduction in hypersensitivity? In addition, PICO is defined as follows: P –Refers to those people with dentine hypersensitivity I – This stands for the professionally applied functional dentine-bonding agent C – This represents the desensitizing toothpaste and, O – Refers to Sensitivity Reduction Methods The clinical question in this case is, does application of the professionally applied dentine bonding agents compared to desensitizing toothpastes provide greater reduction in hypersensitivity? In addition, PICO is defined as follows: P –Refers to those people with dentine hypersensitivity I – This stands for the professionally applied functional dentine-bonding agent C – This represents the desensitizing toothpaste and, O – Refers to Sensitivity Reduction The Search methods used to identify studies included the following: After the protocol development, there were article citations that were obtained through electronic search within the databases. There was also hand-searching process on published primary and bibliographic referencing list, as well as review studies. Ovid MEDLINE® included terms such as dentin sensitivity” OR “dentin hypersensitivity”. One thing to note is that during the search there were no language limits or restrictions that were functional. This was done to enable and facilitate the process of counting all the potential clinical trials. Some other features that were applied in the electronic search process included the following: Time limitations Period: 1946 to Present Boolean operators used (OR, AND, NOT) Keywords: dentin hypersensitivity [Mesh terms] Restrictions and boundaries [ ] Text word search Key words: dentin*, sensitive*, hypersensitive*, toothpaste*, dentifrice*, gel, bond*, agent*, adhesive*. The search results from the database(s) Ovid MEDLINER(R) are outlined in the table below: Table 1: Key terms for the search strategy # Searches Results 1 (Dentine* adj (hypersens* or sensitivity*)).tw. 711 2 (Toothpaste* or dentifrice* or gel or rins*).tw. 241064 3 1 and 2 247 4 ((Bond* adj agent*) or adhesive*).tw. 41054 5 3 and 4 10 The electronic search used from all available sources managed to retrieve 10 unique citation sources. Initially, a total of 10 papers were deemed legible for the study, however, nine of these papers did not meet the legibility standards required forcing them to be excluded. In order to screen the content, titles and abstracts were used and managed to exclude nine papers because they had no connection to intervention and comparison criteria used in my clinical question. Some studies were conducted in vitro. Another reason was because some of the sources were review or opinion papers. The remaining paper report was subjected to detailed analysis. Results This study by Gibson in 2013 was an RCT that incorporated 75 adult participants, and was conducted in general practice by a single dental practitioner. In this case, the dentist put three modalities comprising of: desensitizing toothpaste (DT), Professional Desensitizing Agent, and Non-Desensitizing toothpaste (NDT). A thermal pain stimulus was used by the dentist to aid in the evaluation of sensitivity by means of Vascale. Table 2: Study design Design RCT Total time taken 6 months Country United Kingdom Participants 75 Age 18-75 Setting General Dental Practice Experimental intervention Desensitizing toothpaste (DT), and Non-Desensitizing toothpaste (NDT), Comparison Professional Desensitizing Agent Pain stimuli Thermal: 14-26 C, at 40-65 psi air-blast directed to the buccal cervical root surfaces at a distance 1-3 mm. Exclusion Criteria Allergy, unpleasant reactions attributed to several used materials, sensitivity attributed to a lesion requiring restoration, poor oral hygiene, and failure to obey with trial procedure. In order to analyze the data collected, SPSS version 17 was used where initial investigative analyses were done with an aim of ascertaining if the data met the set and expected assumptions of ANNOVA, which included variance homogeneity, sphericity and normality. The test for homogeneity variance was conducted with the use of Lenene’s equality and variance error test. According to the results, variances were different at 3 moths (p 0.05). The following table gives in a clear figure of how data was distributed across the groups that were involved in the study Table 3: Data Distribution In regard to the above study’s limitations, it is clear that DA application to the teeth tested with hypersensitivity (DH) shows the greatest reduction in DH after 2 weeks and 6 months compared to the desensitizing toothpaste, as well as, normal fluoridated toothpaste. In the examination process, the participants in the RCT were expected to record the sensitivity severity in a VAS within a span of 2, 3 and 6 weeks. The sensitivity level was later assed using the patient VAS questionnaires (Gibson. 2013 p 668-674). The assessment methods used clearly revealed that the sensitivity data slightly deviated from the normal distribution in all the groups that were being treated. The deviations were predominantly slight in all groups apart from the DA group. The Inclusion and Exclusion criteria comprised of the following aspects; In the inclusion criteria the sextants that had 0 BPE scores were selected. The age limit accepted ranged from 18 to 75 years. In addition the participants selected had to have had at least 1 tooth ache, which according to least VAS score participants were required to assent to and at the same time be in a position to abide by the test regime. Medical contraindications were used in the exclusion process. This specifically was due to allergy or adverse reactions to whichever materials applied in the study, material receipt or dental treatment that had a likelihood interfering with the parameters of the study, sensitivity resulting from a greatly restored tooth, that is resulting from pulpitis or attributed sensitivity to a laceration requiring restoration (Mostafa, 1985 p 256). Underprivileged oral sanitation and failure to fulfill with trial procedure also led to the exclusion of these selection aspects. This study is reliable to appraisal overall. The following table clearly shows some appraisal aspects in Gibson, 2013 study. Table 4: Appraisal Aspects Randomization Yes Allocation concealment Yes Blinding of Participants/care provider/outcome assessors No/Yes Trial dropouts reported Yes Other bias sources Prohibition/Eligibility criterion précised Yes Age of the participants précised Yes Assortment of the desensitizing formulations used standardized Yes  Groups alike at baseline Yes The study is well planned and organized, however, from the analyses obtained it is clear that, there are some issues with the study that have the potential of causing problems in terms of applicability and generalizability to the entire general population with DH. One important aspect to note is that this study was performed single blindly by only one dental professional within a single surgery. The other thing is that the number of participants used was not large enough in accordance with the calculations made (Brunton. 2000 p 351-5). There was no well-controlled environment for the data collection especially where the patients were recommended to use toothpaste at home. That is, it was hard to tell whether they used the toothpaste prescribed or other things while brushing their teeth. In other words, the patients’ technique, adherence, and frequency to the protocol of the prescribed toothpaste use are prone to a lot of questions. In addition, the manuscripts in the study did not provide any information in regard to the protocol of the home use of the toothpaste at all. In the case of the desensitizing agents’ application, again the study has portrayed some tribulations in the referencing sections. This is despite the fact that the study appears to be perfect. The question of how randomization was achieved is very important as it forms the basis of how the participants were selected from the large population (Al-Mullahi, 2011 p 234). In this case, in order to achieve a balance at the baseline the study subjects were allocated to respective groups through the use of random number tables, and a block randomization process with an aim of ensuring that there were a balanced number of participants in each group. Clinical Bottom Line The clinical bottom line and summary of the evidence from this review is that dentine-bonding agents are more successful than desensitizing toothpastes in reduction of dentine hypersensitivity. When looking at the results of the study, it is clear that dentine-bonding agent application to the teeth tested with hypersensitivity (DH) shows the greatest reduction in DH after 2 weeks and 6 months compared to the desensitizing toothpaste, as well as, normal fluoridated toothpaste. Summary and implementation of findings The process of answering the clinical question on the most effective method between dentine bonding agents and desensitizing toothpastes is crowded by some difficulties. These difficulties are evident once they are applied from a professional point of view to persons with dentine hypersensitivity. In addition, coming up with a conclusive decision that is based on only one single RCT is also a hard task (Andy. 1990 p 503-513). However, there are more RCT’s required containing greater patient numbers, with outcome measures that are improved. Nevertheless, dentists may consider applying dentine bonding agents instead or in addition to prescribing desensitizing toothpastes for administration of dentine hypersensitivity. In the case of desensitizing toothpastes, Cochrane review that was last updated in the year 2006 comprised of potassium nitrate pastes only. This was another systematic professional review that was recently conducted on the application of desensitizing agents. It established out that these agents are effective; however, there was no comparison to desensitizing toothpastes that was made in the review. As a result, it is not possible to umpire whether any or all the dentinal hypersensitivity management processes were effective, the ones that are comparatively more effectual, and worth using. Finally, it is also important to mention on the placebo group, which was incorporated in the study. In any study where a measurement of pain is involved, placebo group is true in the control of DH clinical trials (Andy, 1992 p 410-412). Therefore, this clinical trial has a negative control group which applied standard fluoridated toothpaste in order to have a baseline against making the measurement of the two other treatments. The most notable thing with these DH trials is that there is failure to include a placebo cluster such that the interpretation of the outcome reported must be done with some caution. These clinical trials have also shown that management interventions for DH contains or have indicated that the effects of placebo shows something other than lack of effects and dissimilarities from the groups that are not treatable. The possible reason to this is due to alliterations both physiological and psychological which occur as a result of medical intervention. In accordance to the author, this group was incorporated to the measurement of the pain value although it deemed not necessary. The reason behind this fact is that most of the patients would still use non-desensitizing toothpaste. This can also be considered in future dental trials. References Al-Mullahi, A. 2011. A cross-sectional study of dentine hypersensitivity in Omani dental patients. Thesis (M.Med.Sc.) --NUI, 2006 at Department of Restorative Dentistry, UCC. Andy, U. 1992. Dentine hypersensitivity: its prevalence, etiology and clinical management. Dental Update, 407-408, 410-412. Andy. 1990. Etiology and clinical implications of dentine hypersensitivity. Dental Clinics of North America , 503-513. Brunton. 2000. Resistance of two bonding agents and dentine desensitizer to acid erosion in vitro. Dental Material, 351-5 Gibson. 2013. A practice-based randomized controlled trial of the efficacy of three interventions to reduce dentinal hypersensitivity. Journal of Dentistry, 41 (8), pp. 668-674. International dental federation, world dental congress, & FDI world dental congress. 2002. Dentine hypersensitivity: general practice considerations for successful management : proceedings of a symposium held at the FDI World Dental Congress, Vienna 2002. London, FDI World Dental Press. Miglani. 2010. Dentine Hypersensitivity: recent trends in management. Journal of Conservative Dentistry, 13 (4), pp. 218-24 Mostafa, P. A. S. 1985. Dentine hypersensitivity Clinical and laboratory investigations. Cardiff, University College. Pamir. 2005. The efficacy of three desensitizing gents in treatment of dentine hypersensitivity. Journal of Clinical Pharmacy and Therapeutics, 30 (1), pp. 73-76. Rees. 2000. The prevalence of dentine hypersensitivity in general dental practice. Journal of Clinical Periodontology, 27 (11), pp. 860-865. Read More