Q U I N T E S S E N C E I N T E R N AT I O N A L

GENERAL DENTISTRY

The effectiveness of current dentin

desensitizing agents used to treat dental
hypersensitivity: A systematic review
Wellington Luiz de Oliveira da Rosa1/Rafael Guerra Lund, PhD2/
Evandro Piva, PhD2/Adriana Fernandes da Silva, PhD2

Objective: Dentin desensitizing agents are used in the treatment of dentin hypersensitivity,
which is defined as a painful response in the exposed dentin to stimuli that are thermal,
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the clinical effectiveness of current desensitizer with at least 3 months of follow-up. Method
and Materials: Eight electronic databases were searched: MedLine (PubMed), Embase,
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ical trials published from 2000 to 2012 were included. Results: "
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17 had an evaluation time of at least 3-months follow-up and fulfilled the selection criteria.
Conclusion:
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clinical trials are warranted to better compare the different types of treatments and their
effectiveness in the longer term. (Quintessence Int 2013;44:535–546; doi: 10.3290/j.qi.
a29610)

Key words: dentin desensitizing agents, dental materials, dentin sensitivity,

systematic review

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Under normal conditions, dentin is cov-
most common painful conditions affecting ered by enamel or cement and does not
oral comfort and function.1,2 It is also one of suffer direct stimulation. 11
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the least successfully resolved problems of exposure of dentinal tubules due to enamel
the teeth.3
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loss by abrasion, erosion, abfraction, or root
pain or an exaggerated response in surface exposure caused by gingival reces-
exposed dentin to stimuli that are typically sion, periodontal treatment, or a combina-
thermal, evaporative, tactile, osmotic, or tion of both may produce strong dentin sen-
chemical, which cannot be explained as sitivity. 
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arising from other forms of dental defect or lesions may be multifactorial, resulting from
pathology.1,3-8 Primary treatment strategies chronic trauma from tooth brushing, tooth
should undoubtedly aim to eliminate predis- flexure due to abnormal occlusal loading
posing factors, such as abfraction, abra- forces, parafunctional habits, acute and
sion, or erosive components, thereby chronic inflammatory gingivitis, and peri-
preventing recurrence.   odontal diseases. 
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accepted basis for its physiological cause
1
Undergraduate Student, Faculty of Dentistry, Federal Universi- JT
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ty of Pelotas, Pelotas, Brazil.
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2
Professor, Department of Restorative Dentistry, Federal Univer- open dentinal tubules at the tooth surface
sity of Pelotas, Pelotas, Brazil.
permit fluid movement inside the tubules
Correspondence: Adriana Fernandes da Silva, Department of
that leads to sensorial activation of the
Restorative Dentistry, School of Dentistry, Federal University of
Pelotas, 457 Gonçalves Chaves St. #504, Downtown, Pelotas - RS nerve cells in the pulp, thus causing
– Brazil 96015-560. Email: adrisilvapiva@gmail.com pain.  

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Q U I N T E S S E N C E I N T E R N AT I O N A L
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%)13 Extensive
research has been conducted regarding its
treatment, although no single treatment is

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accepted universally.
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chemical agent (eg, potassium nitrate) that
penetrates into the dentinal tubules and
depolarizes the nerve synapse, thereby
reducing sensitivity by preventing the con-
duction of pain impulses, is a method used
in daily use toothpastes.13
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approach is to treat the tooth with a chemi-
cal or physical agent that creates a layer
that mechanically occludes the exposed
dentinal tubules, thus reducing sensitivity
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method is used by prophylaxis pastes and
varnishes.

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have been clinically tested over several
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 Due Search strategies
to the different methodologies employed,
variability of the subjective responses, and
influence of the placebo effect, results have
been variable and to some extent inconclu-

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sive.13,18 For immediate alleviation of mild to
moderate symptoms, occlusion of dentinal

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tubules can be noninvasively achieved with
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or highly concentrated fluoride lacquers or

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varnishes.


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potassium salt formulations that modulate
intradental nerve excitability.21,22 In the case
Selection criteria
Inclusion criteria
t
Clinical trials with patients that presented
dentin hypersensitivity
t
Studies that investigated the effectiveness of
dentin desensitizing agents over time
t
Studies in which it was possible to distinguish
case and control groups
Fig 1 Selection criteria.
 VOLUME 44
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of pronounced severity, a semi-invasive
treatment can block dentin tubules via the
application of a bonding agent or an adhe-
sive restorative material.
modalities have shown variable results over
time.1,11,21,23-28
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ary effects and require multiple applications
to take effect, which explains the large
number of studies evaluating the reduction
of pain in the short-term as well as the lack
of long-term effects associated with these
materials.28-31
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analyze the clinical effectiveness of the
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follow-up.
METHOD AND MATERIALS
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was carried out by two independent review-
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Eight databases – MedLine (Pubmed),
&NCBTF
– were searched using the keywords “den-
tin sensitivity”, “dentine sensitivity”, “dentine
Exclusion criteria
t
Clinical trials with follow-up shorter than 3
months
t
Unclear definition of dentin hypersensitivity
t
No assessment of dentin hypersensitivity
using a scale for pain measurement
t
No definition of selection criteria
t
Studies published in a language other than
English, Portuguese or Spanish
 Q U I N T E S S E N C E I N T E R N AT I O N A L
d a Ro s a e t a l

hypersensitivity”, “desensitizing dentin”, screening and eligibility criteria were indi-

“dental sensitivity”, “hypersensitivity teeth”, vidually accomplished, the article was
“dentin desensitizing agents”, “teeth desen- included if a consensus was reached. If
sitizer”, and “dental desensitizer”. Only not, a third author was invited to discuss the
those clinical trials that evaluated dentin BSUJDMF
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desensitizing agents over time were ing to the selection criteria (Fig 1). Only
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ated and chosen based on the following admitted.
inclusion criteria (Fig 1): any in vivo study 5IF
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with a protocol for dentin hypersensitivity were contacted by email when it was nec-
with at least 3 months of follow-up. essary to retrieve some missing data or
information. If no answer was received by 2
Study selection weeks after the first email message was
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4UBUFNFOU 32 the sent, then a second email was forwarded. If
abstracts were independently reviewed by no answer was provided by the author 1
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month after the first contact, the missing

Table 1 Demographics of the included studies

Study Year Country Study design Patients Teeth Posttreatment time

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2007 Iran 3$5
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cation
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2011 India 3$5
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et al
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NP
et al cation
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 #SB[JM 3$5
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BMMP- 10 28 
E

E

NP

NP

NP
et al cation
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HSPVQT 120 /4 1 d, 7 d, 1 mo, 3 mo
et al51
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Ipci et al55  5VSLFZ 3$5
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HSPVQT 50  
XL

NP

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NP

NP

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and
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et al
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cation
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cation
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NP

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$$5
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3$5
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Q U I N T E S S E N C E I N T E R N AT I O N A L
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information was not included in this review. 5IF
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When papers from the same group of
authors were identified, with very similar

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databases of patients, materials, methods,

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and outcomes, the authors were also con-
tacted to clarify whether the pool of patients
was indeed the same.
Data extraction
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hoc and filled by reviewers to register data
from the selected studies. Demographic
data (eg, number of patients, country) were
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was considered inappropriate. Decreases
were also recorded. For each study, the
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described in the study.
Assessment of methodologic
quality
Due to the high degree of heterogeneity in
terms of the different studies, the materials
tested, the number of treatment sessions,
and the variety of follow-up periods used, a
meta-analysis among the selected studies

Table 2 Different materials tested in the groups

Studies Materials tested

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control group without any treatment
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control without laser emission
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control group with no treatment

538 VOLUME 44
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 Q U I N T E S S E N C E I N T E R N AT I O N A L
d a Ro s a e t a l

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time, and the results over time from each included studies.

Table 3 Main results of the included studies

Studies Main results

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et al 
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et al cally greater when there was an association with the removal of etiologic factors.
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et al51 hypersensitivity for a longer period of time.
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than baseline, with Protect Liner F being the most effective desensitizer in the study period.
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show better efficacy than either treatment modality alone.
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occurred between evaluation times were not statistically significant.
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and Frencken effect of the glass ionomer continued for 25.2 months.
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efficacy at either the immediate or 3-month evaluations.
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significant differences were identified between the lasers at any follow-up examination.

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TDBMF

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RESULTS included studies were published between


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relevant records were identified from all reported data from people from different
databases. Fig 2 is a flowchart that summa- DPVOUSJFT
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studies that were retrieved for detailed Kulzer) was evaluated in six different clini-
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results over time.
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ials require multiple applications or continu-
3,029 potentially rele- ous use by patients, which does not guar-
Identification

vant records identified antee their effectiveness. Furthermore, most

from database searches studies have evaluated the reduction of
pain of these materials for a period shorter
than 3 months.
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these dentin desensitizers were not
2,744 records after
included in this review.
removal of duplicates
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trials that evaluated dentin desensitizing
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months. It was possible to note that the
majority of selected studies analyzed the

99 full-text articles
of inclusion and/or exclusion decrease of pain for up to 3 months (Fig 3).
assessed for eligibility
criteria Only one clinical trial evaluated the effec-
tiveness of dentin desensitizing agents after

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In relation to posttreatment outcome
17 studies included in
the qualitative synthesis there was no therapy that could be consid-
Included

ered ideal in the management of this com-

0 studies included in the

quantitative synthesis
(meta-analysis)
Fig 2 Search flow (as described in the PRISMA
statement).32

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 Q U I N T E S S E N C E I N T E R N AT I O N A L
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treatment efficacy may be because the resulted in constantly low hypersensitivity
substances used in these treatments are scores compared to before the treatment.
lost in the oral cavity over time.  During these times there was alleviation of
pain, however neither lacquer resulted in
complete removal of the painful condition.
DISCUSSION 5IJT
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directly related to their capacity to promote
desensitizing agents have used different the sealing of dentinal tubules or blocking
approaches, making their effective compar- of nerve activity.   
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effects could occur because of the tempor-
period analyzed in this review that evalu- ary action of the desensitizing agents or the
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evaluated the effectiveness of two fluoride TJPO
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this disease is essential for effective pre-
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6% 3 months
3 to 6 months
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38% 56%

Fig 3 Posttreatment time of the included studies.

Fig 4 Clinical case illustrating a patient with DH

due to gingival recession in the teeth 15, 23, 34, 35,
43, and 44 (FDI tooth-numbering system). (a) Ante-
a rior view. (b) Right lateral view. (c) Left lateral view .

b c

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Q U I N T E S S E N C E I N T E R N AT I O N A L
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4PNF
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patients submitted to periodontal therapy the study period.52
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Only one study included in the present
defined as short and sharp pain arising review evaluated the decrease of hypersen-
from exposed dentin which cannot be TJUJWJUZ
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ascribed to any other form of dental defect hypersensitive teeth were treated with low-
or disease,   many authors have consid- WJTDPTJUZ
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come and can be described only as NPSF
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temporary sensitivity. While there is no con- after 3 months and its effect continued for
sensus on the definition of this disease, the BCPVU

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studies included in this review evaluated glass ionomer was retained longer and still
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covered dentin tubules after many episodes
procedures. On the other hand, clinical of plaque removal using a toothbrush.
studies which evaluated the sensitivity after In relation to current treatments, ionto-
dental bleaching were not included in this phoresis is another therapy that has gained
review because this sensitivity seems to be some popularity. It is a technique in which
a transient outcome after the bleaching pro- fluoride can be transferred under electrical
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ing bleaching procedures complain of post- tubules.    It may cause calcium fluo-
operative sensitivity, there is a lack of ride precipitation when used with sodium
clinical investigations correlating the altera- nVPSJEF
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tions of the dentin-pulp complex with tooth movement in dentin tubules, thereby reduc-
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ing. 5IFTF
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ions react with calcium in the hydroxyapa-
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tite to form fluorapatite, which blocks the
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dentinal tubules.  
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a potential treatment modality.  
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because of better adhesion of the varnish. the studies evaluated in the present review
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included laser therapy. With its growing utili-
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more efficacious after 1 and 3 months. have occurred in both the quality and quan-
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tity of available laser types.   In the
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tect Liner F (Kuraray), and Fluoline (PD comparisons between studies become diffi-
Dental) in another clinical trial52 included in cult. Furthermore, compared with conven-
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tional approaches, in-office laser treatment
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showed lower sensitivity values compared cost, complexity of use, and decreasing
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effectiveness over time, all of which limit its
contain colloidal silica, which has consider- clinical utility. 
able treatment potential, especially in terms Various laser types are used, including
of tubule blockage. It may have been this neodymium or erbium-doped yttrium alumi-
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$02,

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 Q U I N T E S S E N C E I N T E R N AT I O N A L
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)F/F
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which can be applied at various energy set- NPOUIT
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tings and wavelengths ranging from potential effectiveness of laser therapy for

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(wavelength 2,780 nm) has recently been firm its effectiveness.
tested and its use showed a stable effect From these studies, it can be under-
for at least 3 months.31,57 It is important to stood that although many therapies aim to
consider that the clinical effect of low-level USFBU
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obliteration of dentinal tubules by tertiary SFNPWBM
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dentin, the latter of which is due to important factor that was little reported in all
increased metabolic activity of odonto- selected studies and should be taken into
blasts.   
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consideration by researchers, since it can
mechanism of action are controversial become a bias in the study design if not
because of the lack of information related to PCTFSWFE
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the irradiation protocol and the subjectivity this review, therapies involving laser and
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pared five different treatment modalities they are more expensive than other modali-
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ties and they have not been directly com-
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was demonstrated that laser did not pro- Protect Liner F also seem to have efficacy
vide an immediate reduction of sensitivity. VOUJM

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treatment evaluation over 3 months are
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%)
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lar clinical trial28 showed that after 3 months these treatments for longer periods. Fur-
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QMB- may be achieved when the desensitizing
cebo gel also showed similar effectiveness agent induces the biomineralization of den-
over time. Further, in a randomized clinical tin tubules and results in a biological
trial 55
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response of the tooth, thereby obliterating
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the tubules and directly addressing the
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etiologic factors is required, since current
the decrease in sensitivity has been verified therapies have led to recurring sensitivity.
in these studies, neither treatment resulted
in complete remove of dentin sensitivity.
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not statistically significant or different from 5IFSF
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the placebo group (non-activated laser) in different types of dentin desensitizing
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noted in another study
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F, laser, and iontophoresis have shown sat-
patients who received treatment with isfactory posttreatment results between 3
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were removed. In another clinical trial trials are warranted to better compare the
using the same laser it was demonstrated different types of treatments and their effec-
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tiveness in the longer term.

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hydroxyapatite nanocrystals and a sodium fluoride/
potassium nitrate dentifrice. J Clin Periodontol
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Int Dent J 1972;22:219–227.
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