Lasers Med Sci (2010) 25:647–650

DOI 10.1007/s10103-009-0685-0

ORIGINAL ARTICLE

Dentinal hypersensitivity following scaling and root planing:

comparison of low-level laser and topical fluoride treatment
Snezana Pesevska & Marija Nakova & Kiro Ivanovski &
Nikola Angelov & Ljiljana Kesic & Radmila Obradovic &
Sonja Mindova & Salvador Nares

Received: 26 May 2008 / Accepted: 12 May 2009 / Published online: 1 June 2009
# Springer-Verlag London Limited 2009

Abstract The aim of this study is to compare the
effectiveness of low-level laser irradiation to traditional
topical fluoride treatment for treatment choices of dentinal
hypersensitivity following scaling and root planing. The
experimental group (15 patients) was treated with low-
energy-level diode laser at each site of dentinal hypersen-
sitivity following scaling and root planning. The control
group (15 patients) received topical fluoride treatment
(protective varnish for desensitization). All the patients
were treated at baseline visit, and then at day 2 and 4 after
the initial treatment; the pain was subjectively assessed by
the patients as strong, medium, medium low, low, or no
pain. Total absence of the dental hypersensitivity was
reported in 26.66% of the examined group even after the
second visit, compared to the control group where complete
resolution of the hypersensitivity was not present after the
second visit in any of the treated cases. Complete absence
S. Pesevska (*) : M. Nakova : K. Ivanovski : S. Mindova
Faculty of Dentistry, University “St. Cyril and Methodius”,
Skopje, Macedonia
e-mail: pesevska@gmail.com
N. Angelov
Department of Periodontics,
Loma Linda University School of Dentistry,
Loma Linda, CA, USA
L. Kesic : R. Obradovic
Faculty of Medicine, Department of Oral
Medicine and Periodontology, University Nis,
Bul. dr Zorana Djindjica,
Nis 18 000, Serbia
S. Nares
Department of Periodontology,
University of North Carolina at Chapel Hill,
Chapel Hill 27599 NC, USA
of pain was achieved in 86.6% of patients treated with laser
and only in 26.6% in the fluoride treated group, after the
third visit. Based on our findings, we conclude that low-
energy biostimulative laser treatment can be successfully
used for treatment of dental hypersensitivity following
scaling and root planing.
Keywords Dentinal hypersensitivity . Scaling and root
planing . Low-level laser . Fluoride
Introduction
Loss of enamel, cementum and/or gingival recession very
often results in exposed dentin, which in turn can cause
sensitivity characterized with sharp pain immediately after
mechanical, chemical, or osmotic stimulation [1, 2]. Some
dental treatments, such as removing of dental deposits and
debridment of root surfaces during scaling and root planing
can facilitate elimination of necrotic cementum and cause
subsequent exposure of large number of dental tubules to
stimuli of oral environment [3, 4]. Elimination of pain and
discomfort due to dental hypersensitivity is our main
concern, regardless of the origin of this discomfort [5, 6].
Current treatment modalities are based on chemically
induced mechanical obstruction of dentinal fluid movement
by various solutions, adhesives, and medications [7, 8].
Some of these desensitizing agents have caries prophylactic
activity, such are variety of fluoride-based solutions, while
others act as dentinal tubule occlusive agents, producing a
protective varnish membrane layer [9–11]. Nevertheless, all
this treatment modalities produce relatively short-lived and
limited effects. The low-level laser irradiation has been
used for treatment of dentinal hypersensitivity with notable
success [12–14]. The successful outcome of this therapeutic
648
approach typically increases with the number of repeated
treatments, even reaching up to 100% success, after the
third laser application [15]. Brugnera JR et al. [16] reported
91.27% success in the treatment of dentinal hypersensitivity
while some authors even reported immediate attenuation of
pain instantly after laser therapy [17, 18]. Prolonged effects
on improvement of dentinal hypersensitivity have been
reported even after 1 month following laser application
[18–20].
Aim
The aim of this study is to compare the effectiveness of low-
level laser and fluoride application when dealing with
dentinal hypersensitivity following scaling and root planning.
Materials and methods
Thirty patients (age 25–40) complaining of dentinal
hypersensitivity following scaling and root planning were
divided into two experimental groups. Inclusion criteria
were reported dentinal hypersensitivity after scaling and
root planing in over 30% of the present teeth, plaque score
bellow 20% and no gross carious lesions, defective
restorations, tooth attrition, cracked enamel, and/or prema-
ture teeth contact. The dentinal hypersensitivity was
subjectively assessed as strong, medium, medium low,
low, or no pain and was marked by the patients as ++++,
+++, ++,+, and 0, respectively. Only patients with pain
level determined as “strong” at the baseline visit were
included in this study. The first experimental group (15
patients) was treated with low-level diode laser (Scorpion
D-4057A, Optika Laser, Bulgaria) at each site of dentinal
hypersensitivity (630–670 nm; 100 mW/cm2), at baseline,
and than at day 2 and 4 following the initial, baseline visit.
The sensitive teeth (were isolated with cotton rolls and
irradiated in contact mode with 15-mW output power. A
laser beam was directed perpendicularly to tooth surface at
two points: apical and cervical point and each area was
Fig. 1 Reduced hypersensitivity
in the control group
14
12
10
8
6
4
2
0
Baseline visit
Lasers Med Sci (2010) 25:647–650
irradiated for 20 s, thus ensuring complete irradiation. The
second group of 15 patients received topical fluoride
treatment with the protective varnish Fluor Protector
(Ivoclar Vivadent, Schaan, Principality of Liechtenstein) at
the same time schedule as the first experimental group.
Following isolation with cotton rolls, the varnish was
painted with a disposable brush at the cervical region of
both buccal and lingual surfaces strictly ensure dry tooth
surface by isolation with cotton rolls and air syringe. The
patients were instructed neither to eat/drink nor to brush
their teeth for 1 h following varnish application, as
suggested by the manufacturer. All the patients were treated
at baseline visit, and then at day 2 and 4 after the initial
treatment and evaluated the following days after each
treatment. At all visits, the dentinal hypersensitivity was
assessed by the patients as strong, medium, medium low,
low or no pain and was marked by the patients as ++++,
+++, ++, + , and 0, respectively.
Results
After conservative topical fluoride treatment (fluor
protector-protective varnish for desensitization), the control
group showed pattern of decreased dentinal hypersensitivity
after the second visit, and also after the third treatment visit.
However, complete resolution of the dentinal hypersensi-
tivity was observed in only four of the patients (Fig. 1).
Following low-level diode laser treatment, the examined
group showed decreased dentinal hypersensitivity even
after the second visit with complete resolution of pain in
four patients (Fig. 2).
This pattern continued and was especially evident after
the third treatment visit, where complete resolution of the
sharp pain was observed in total of 13 patients (n = 15),
demonstrating high efficacy of this treatment.
Regarding complete pain resolution (Fig. 3), the laser
treatment demonstrated therapeutic effects even after the
second visit, leading to complete resolution of pain in
26.67% of the patients, compared to the topical fluoride
treatment which did not demonstrated any. At the final
No pain
Low
Medium low
Medium
Strong
2 days 4 days
Lasers Med Sci (2010) 25:647–650
Fig. 2 Pronounced reduction in
hypersensitivity in the laser-
treated group 14
12
10
8
6
4
2
0
Baseline visit
(third) visit, complete resolution of pain was achieved in
86.67% of the laser-treated group, compared to the control
group with topical fluoride treatment where only 26.67% of
the patients reported absence of pain after treatment.
Discussion
Dentinal hypersensitivity is neither a recent problem nor a
rare one. However, it remains a poorly understood area and
consequently there appears to be no effective or permanent
treatment for this painful clinical condition. According the
Brannstrom Hydrodynamic Theory [21], the reason for
dentinal pain is fluid movement across the dentinal tubules.
Thermal and osmotic stimuli provoke movement of this
fluid and stimulate nociceptive nerves that are located on
the pulpal side of dental tubules. Fluid movement is
transductor that reports the presence of the stimuli on the
outer entry of the tubules, so movement of only 2 μm of
fluid in dentinal tubules, according the principle of capillary
diffusion in one or another way [22], activates nociceptores,
resulting in perception of pain. As a response to these
stimuli, reparatory dentin is formed. This dentin is atubular
and its aim is to reduce fluid movement inside the tubules.
A possible solution seems to be directly related to the
interruption of stimuli transmission to the nerve endings of
odontoblast processes by reducing the fluid movement
inside the dentinal canalicules, through the narrowing or
occlusion of tubules openings [23]. Efficiency of fluoride
100
80
60
40 Control
20 Laser group
0 analgesic effect, the laser therapy used with correct
Baseline visit 2 days 4 days
Fig. 3 Percentage of complete reduction in dentinal hypersensitivity
in laser and control groups
649
No pain
Low
Medium low
Medium
Strong
2 days 4 days
agents in dealing with dental hypersensitivity has already
been demonstrated [1, 5]. Our results show that topical
fluoride treatment of dentinal hypersensitivity resulting
from scaling and root planing procedures is effective in
decreasing the pain after the second and third treatment
visit. However, complete resolution of the dentinal hyper-
sensitivity was observed in only four out of 15; or 26.67%
of the patients treated with the topical fluoride.
This gradual therapeutic action (progressive in time) of
diminishing sharp pain has already been reported by Gaffar
[24]. The mechanism of action of the fluoride varnish is due
to the reaction between NaF and calcium ions that leads to
formation of calcium fluoride crystals, which are deposited
on the dentinal tubules openings. Because the crystal size is
small (about 0–.05 μm), a single application of NaF would
not be effective in narrowing the diameter of tubules [25]
and multiple applications should be required, as our results
can concur. Since hypersensitive dentin exposed after
periodontal therapy possesses higher number and width of
dentinal tubules than in normal dentine [26], the use of
tubule occlusive agents would require repeated applica-
tions, longer treatment time and patient compliance,
prompting the need for use of alternative treatment
modalities. There are many reports of soft lasers use in
treatment of dentinal hypersensitivity [18, 26–29]. Reduc-
tions of sensitivity to thermal and tactile stimuli as well as
immediate analgesic effects that are lingering for a
prolonged time period have been reported [30]. The
immediate low-level laser effect on dentinal hypersen-
sitivity relies mainly upon induced changes in the neural
transmission networks within the dental pulp (depressed
nerve transmission) rather than alterations in the exposed
dentine surface as observed in other treatment modalities
[28]. Tuner and Hode [31] concluded that laser effects on
endorphin release could be the reason for the immediate
pain relief in patients, but biostimulative effects happens
gradually in probably in few days. Besides the immediate
parameters, may stimulate the normal physiological cellular
functions. Stimulation of odontoblasts, production of
reparatory irregular dentin and obliteration of dentinal
650
tubules provoked by laser are reasons for the prolonged
suppression of pain in dentinal hypersensitivity [31].
Our results show that after treatment with low-level laser
at each site of dentinal hypersensitivity, the examined group
showed decreased dentinal hypersensitivity even after the
second visit with complete resolution of pain in 26.67% of
the patients. This was especially evident after the third
treatment visit, where complete resolution of the sharp pain
was observed in most of the treated patients (13 out of 15 or
86.67%), thus demonstrating excellent efficacy of this
treatment modality, which is in concordance with some
previous reports [26–28]. In the standard treatment group
(topical fluoride) however, only 26.67% of the patients
reported absence of pain after treatment.
The biocompatibility, non-invasiveness and efficiency, as
well as prolonged therapeutic results could be reasons to
include low-level laser therapy as a valid method of choice in
the treatment of dentinal hypersensitivity following peri-
odontal therapy. Additional studies are warranted for
designing the most appropriate treatment protocol, as well
as better understanding of the possible mechanisms of action.
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