J Clin Periodontol 2015; 42 (Suppl. 16): S256–S302 doi: 10.1111/jcpe.

12336

Management of dentine Nicola X. West, Joon Seong and

Maria Davies
Periodontology, Clinical Trials Unit, Bristol

hypersensitivity: efficacy of Dental School, Bristol, UK

professionally and
self-administered agents
West NX, Seong J, Davies M. Management of dentine hypersensitivity: efficacy of
professionally and self-administered agents. J Clin Periodontol 2015; 42 (Suppl.
16): S256–S302. doi: 10.1111/jcpe.12336.

Abstract
Context: The gold standard treatment modality for dentine hypersensitivity has
not yet been established. This review examines the effectiveness of self and
professionally applied treatments for the reduction in pain from dentine
hypersensitivity.
Materials and Methods: Electronic (three databases) and hand searches were
performed 14–21 July 2014 to identify randomized controlled trials for the
treatment of dentine hypersensitivity.
Results: This systematic review provided numerous treatment modalities for den-
tine hypersensitivity. Eleven agents and 105 Randomized Controlled Trials were
robust enough to be included. The studies varied considerably in design, observa-
tion period, active agents, formulation of the whole agent, negative and positive
controls and comparator products investigated. The stimuli used were predomi-
nantly airblast and tactile or thermal. Due to the heterogeneity between the stud-
ies and lack of direct comparison between agents there was insufficient data to
undertake a meta-analysis to compare agents for meaningful conclusions. Best
available evidence for each treatment agent has been documented as a narrative.
Conclusions: Treatments including stannous fluoride, arginine, calcium sodium
Key words: dentine hypersensitivity;
phosphosilicate and strontium toothpaste appear to be clinically effective for the professionally applied; RCT; self
treatment of dentine hypersensitivity compared to comparators and controls. administered; sensitivity; therapy; toothpaste
There is limited evidence to confirm the relative effectiveness of individual
professionally applied agents. Accepted for publication 9 November 2014

Dentine hypersensitivity (DH) is a
common, transient oral pain condi-
tion, the pain resulting immediately
on stimulation of exposed dentine
Conflict of interest and source of
funding statement
The authors declare that they have no
conflict of interests.
No funding was received for this sys-
tematic review.
S256
and resolving on stimulus removal
(Holland et al. 1997). The pain is
short, sharp and of arresting nature,
affecting quality of life (Boiko et al.
2010), 28% of a study population of
3000 stating that DH affected them
importantly or very importantly
(West et al. 2013b). Prevalence fig-
ures range widely depending on how
the data were collected, a recent
study demonstrating 42% of 18–35-
year olds have sensitivity (West et al.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
2013b). Risk factors include gingival
recession particularly associated with
toothbrushing and periodontal dis-
ease. Furthermore, a healthy erosive
diet and lifestyle are linked to tooth
wear and dentine hypersensitivity,
most noticeably in young adults
(West et al. 2013b). As life expec-
tancy of the population is rising and
people are retaining more vital or
minimally restored teeth (Nuttall
et al. 2001) prone to tooth wear,

dentine hypersensitivity is likely to
become a more frequent occurrence.
The effectiveness of the myriad of
available treatment agents for DH
needs to be assessed and compared
to aid the clinician’s management of
this oral pain condition.
Over many years numerous prod-
ucts have been suggested for the
relief of dentine hypersensitivity,
working on treatment mechanisms
to reduce the stimulus-induced fluid
flow in the dentinal tubules and con-
sequent nociceptor activation in the
pulp/dentine border area (N€ ahri
et al. 1992, Matthews et al. 2000).
For dentine hypersensitivity to
occur, the dentine surface of a tooth
must be exposed with enamel or
cementum removal, this being
termed “lesion localization.” Fur-
thermore, a number of dentine
tubules, in close proximity to each
other, must be patent from the pulp
to the oral environment, this being
termed “lesion initiation” (Addy
2002). These two conditions must be
present in order for the individual to
experience pain (Absi et al. 1987,
N€ahri et al. 1992). This explains the
concept of why tubular occlusion
treatment, of whatever nature, is
thought to reduce hypersensitivity
pain, and is the most favoured cur-
rent mode of treatment action.
Treatment effectiveness depends on
the resistance to occlusion removal
by oral acidic challenges of day-to-
day activity. An alternative mecha-
nism for reducing pain is modifica-
tion or blocking of pulpal nerve
response. Desensitizing agents such
as potassium ions may reduce intra-
dental nerve excitability by diffusing
along the tubules and raising the
concentration of local extracellular
potassium ions, hence blocking
intra-dental nerve function (N€ ahri
et al. 1992). Prior to advocating
treatment regimens it is important
to consider changing aetiological
causative agents to prevent the per-
petuation of the condition for either
mode of treatment action to be suc-
cessful.
The majority of treatment is self
administered utilizing toothpaste
products, with professionally applied
agents usually reserved for more
severe or non-responding cases. It
has been difficult to prove effective-
ness of one product over another
due to disparities in trial design,
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Management of dentine hypersensitivity
method of pain evaluation and con-
stituents of the agent as a whole, e.g.
the contribution of silica abrasive
agents to tubule occlusion. An active
agent may be tested against a nega-
tive control, the agent minus the
active ingredient, a conventional
fluoride benchmark agent, a compar-
ator agent or a positive control,
making comparisons of active agents
difficult. More recently trial design
has been more comparable but as
yet, one treatment modality has not
been found completely effective, and
superior to all others. The aim of
this systematic review was to evalu-
ate the effectiveness of self adminis-
tered and/or professionally applied
treatment modalities for the reduc-
tion in pain from dentine hypersensi-
tivity.
Materials and Methods
Literature search
The PRISMA checklist was followed
to present this review (Moher et al.
2009) and the protocol was designed
to answer the focused question (Nee-
dleman 2002): What is the effective-
ness of desensitizing agents, both self
administered and professionally
applied, for relieving the pain of DH
compared to placebo and/or bench-
mark control and/or other active
agents?
Search strategy
An extensive literature search was
conducted using electronic databases
(PubMed, Medline, and The Cochra-
ne Database Trials Register) for
studies published in peer-reviewed
journals. The search was limited to
“English language.” Searches were
conducted between 14th and 21st
July 2014, and all papers previous to
this were considered for inclusion in
this review.
Search terms
Pubmed
Terms that were searched for
were “hypersensitivity” OR “sensi-
tivity” AND “dentin” AND one
of the following treatments: argi-
nine, NovaMinâ (GlaxoSmithKline,
Brentford, UK) (CSPS), oxalates,
potassium, PVM copolymer, stan-
nous, strontium, casein, Glumaâ
S257
(Heraeus Kulzer GmbH, IN 46614
USA), laser, Seal and Protectâ
(Dentsply, GL103GB), Duraphatâ
(Colgate Palmolive, Guildford, Sur-
rey GU2 8J2), Bifluoridâ (Voco
27472 Cuxhaven, Germany), resin,
varnish and glass ionomer. Search
terms and MeSH terms for each
treatment and the number of articles
they yielded are detailed in Tables 1
and 2.
Medline
Terms that were searched for were
“treatment.mp” and “dentine hyper-
sensitivity.mp or *Dentin sensitiv-
ity.” These search terms were
combined and the number of articles
they yielded were reviewed for inclu-
sion, and detailed in Table 3. This
search was compared with the Pub-
med searches and relevant articles
that had not already been identified
by the Pubmed searches were added
to the list for further review.
Cochrane clinical trials database
Terms that were searched for were
(sensitivity Or hypersensitivity) AND
dentin, and the search limited to ‘tri-
als’. The number of articles this
search yielded that were reviewed for
inclusion are included in Table 3.
This search was compared with the
Medline and Pubmed searches and
relevant articles that had not already
been identified by the Medline or
Pubmed searches added to the list
for further review.
Criteria for considering publications for
this study
Inclusion criteria
Studies were only considered which
(a)were randomized clinical trials
that recruited human subjects,
(b)were parallel or split-mouth
design
(c)compared the test agent with a
negative control/placebo or compar-
ator agent (negative controls were
true placebos, i.e. the test agent
without the active ingredient or a
conventional benchmark agent with
no ingredients considered to reduce
dentine hypersensitivity, e.g. conven-
tional benchmark fluoride paste.
Positive controls were comparator
products for which efficacy of reduc-
ing dentine hypersensitivity had
already been demonstrated).
S258 West et al.

Table 1. Searches completed in Pubmed 14–21st July 2014

Search Search terms as entered into PubMed (all searches restricted to English language) Number of Number of
items found relevant articles*

Arginine hypersensitivity OR sensitivity AND dentin AND arginine 63 30

Casein 17 5
1 hypersensitivity OR sensitivity AND dentin AND Casein 8
2 hypersensitivity OR sensitivity AND dentin AND CPP NOT Casein 6
3 hypersensitivity OR sensitivity AND dentin AND ACP NOT Casein

Seal & Protect hypersensitivity OR sensitivity AND dentin AND Seal & Protect 17 4
Duraphat hypersensitivity OR sensitivity AND dentin AND Duraphat 19 8
Bifluorid hypersensitivity OR sensitivity AND dentin AND Bifluorid 0 0
Gluma hypersensitivity OR sensitivity AND Gluma AND dentin 78 22
PMV copolymer hypersensitivity OR sensitivity AND dentin AND PVM AND copolymer 11 6
Varnish hypersensitivity OR sensitivity AND varnish AND dentin* 65 18
Resin Sensitivity OR hypersensitivity AND dentin AND resin 527 28
Strontium Sensitivity OR hypersensitivity AND dentin AND strontium 97 20
Potassium hypersensitivity OR sensitivity AND dentin AND Potassium 180 65
Oxalate hypersensitivity OR sensitivity AND dentin AND oxalate 98 15
NovaMin 23 12
1 hypersensitivity OR sensitivity AND dentin AND NovaMin (23 results) 5
2 hypersensitivity OR sensitivity AND dentin AND calcium sodium
phosphosilicate NOT NovaMin (5 results)

Stannous hypersensitivity OR sensitivity AND dentin AND stannous 50 22

Laser hypersensitivity OR sensitivity AND dentin AND laser NOT caries 172 41
Glass ionomer hypersensitivity OR sensitivity AND dentin AND glass ionomer NOT resin 61 1

*See Inclusion and Exclusion criteria (102 articles appeared in more than one PubMed search).

(d)tested the efficacy of agents in
the treatment of dentine hypersensi-
tivity.
Exclusion criteria
Studies not meeting the inclusion cri-
teria and:
agreed upon by both authors were
obtained, and further screened for
meeting the inclusion and exclusion
criteria (Figure 1). The full text of
the selected articles was then
obtained and assessed for study
inclusion and disagreements were
resolved by discussion. The number
2 weeks or more. These definitions
reflect the fact that studies examin-
ing the efficacy of products at
2 weeks were trying to determine
longer term (not immediate effects).
Assessment quality

(a) reviews
(b) case reports
(c) letters
(d) editorials
(e) conference abstracts
(f) articles in publications that are
not available on line
(g) in vitro studies and in situ studies
(studies involving intra-oral
appliances holding tooth samples
in the mouth which are investi-
gated for desensitizing properties
such as tubule occlusion)
were excluded.
Selection of studies
Titles derived from these broad
searches were independently screened
by two authors based on the inclu-
sion and exclusion criteria. Disagree-
ments were resolved by discussion.
Following this, abstracts of all titles
of articles assessed at each selection The methodological quality and risk
point and details of how those of bias of the papers was assessed as
selected were grouped for review are follows:
shown in Table 4.
Description of study design
The study design should include
Data extraction
details of:
Data from the selected articles were
• randomization
extracted to excel spread sheets for
• blinding
direct comparison of study method-
ologies and results. • eligibility criteria
Data were only extracted for
studies in which the outcome mea- Intervention
sure was the reduction in dentine The study should include
hypersensitivity pain in response to
tactile, evaporative (airblast) or ther- • details of administration of the
mal stimulation. product
Short-term studies were defined • a positive control/comparator
as those measuring relief of dentine product
hypersensitivity immediately after • a negative control/placebo
intervention and at time points up to
1 week, and long-term studies were Outcome Measures
defined as those measuring relief
from dentine hypersensitivity at The study should

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 2. MeSH terms for searches completed in Pubmed 14–21st July 2014
Search MeSH terms as entered into PubMed Number of Number
items found of relevant
articles*

Arginine (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND “specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR 63 30
“sensitivity”[All Fields]) OR (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
(“arginine”[MeSH Terms] OR “arginine”[All Fields]) AND English[lang]
Casein 18 5
1 (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All 8
Fields] AND “specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms] 6
OR “dentin”[All Fields]) AND (“caseins”[MeSH Terms] OR “caseins”[All Fields] OR “casein”[All Fields]) AND English[lang]
2 (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All
Fields] AND “specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms]
OR “dentin”[All Fields]) AND (“3-(2-carboxypiperazin-4-yl)propyl-1-phosphonic acid”[Supplementary Concept] OR “3-(2-carboxypiperazin-
4-yl)propyl-1-phosphonic acid”[All Fields] OR “cpp”[All Fields]) NOT (“caseins”[MeSH Terms] OR “caseins”[All Fields] OR “casein”[All
Fields]) AND English[lang]
3 (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All
Fields] AND “specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms]
OR “dentin”[All Fields]) AND (“Aust Community Psychol”[Journal] OR “acp”[All Fields] OR “Atmos Chem Phys”[Journal] OR “acp”[All
Fields] OR “Appl Cogn Psychol”[Journal] OR “acp”[All Fields] OR “Appl Cardiopulm Pathophysiol”[Journal] OR “acp”[All Fields] OR
“Ann Coloproctol”[Journal] OR “acp”[All Fields]) NOT (“caseins”[MeSH Terms] OR “caseins”[All Fields] OR “casein”[All Fields]) AND
English[lang]

Seal & Protect (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND 17 4

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
“specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
(“seals, earless”[MeSH Terms] OR (“seals”[All Fields] AND “earless”[All Fields]) OR “earless seals”[All Fields] OR “seal”[All Fields]) AND Protect[All Fields]
AND English[lang]
Duraphat (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND 19 8
“specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
(“sodium fluoride topical preparation”[Supplementary Concept] OR “sodium fluoride topical preparation”[All Fields] OR “Duraphat”[All Fields]) AND
English[lang]
Bifluorid (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND 0 0
“specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
Bifluorid [All Fields] AND English[lang]
Gluma (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND 78 22
“specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“Gluma”[Supplementary Concept] OR “Gluma”[All
Fields] OR “Gluma”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND English[lang]
PMV copolymer (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND 11 6
“specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
PVM[All Fields] AND copolymer[All Fields]
Management of dentine hypersensitivity
S259
 Table 2. (continued)
Search MeSH terms as entered into PubMed Number of Number
S260

items found of relevant

articles*

Varnish (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND 65 18
“specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“paint”[MeSH Terms] OR “paint”[All Fields] OR
“varnish”[All Fields]) AND (dentin[All Fields] OR dentin’[All Fields] OR dentin’allom’anyban[All Fields] OR dentin’s[All Fields] OR dentina[All Fields] OR
dentinabdichtende[All Fields] OR dentinablagerung[All Fields] OR dentinabrieb[All Fields] OR dentinadhaesiver[All Fields] OR dentinadhasiv[All Fields] OR
West et al.

dentinadhasivanwendung[All Fields] OR dentinadhasiven[All Fields] OR dentinadhesive[All Fields] OR dentinaira[All Fields] OR dentinaire[All Fields] OR
dentinaires[All Fields] OR dentinal[All Fields] OR dentinale[All Fields] OR dentinales[All Fields] OR dentinalgia[All Fields] OR dentinali[All Fields] OR
dentinallomanyanak[All Fields] OR dentinally[All Fields] OR dentinals[All Fields] OR dentinan[All Fields] OR dentinanasthesie[All Fields] OR dentinanbau[All
Fields] OR dentinar[All Fields] OR dentinara[All Fields] OR dentinare[All Fields] OR dentinaria[All Fields] OR dentinarias[All Fields] OR dentinario[All
Fields] OR dentinarios[All Fields] OR dentinary[All Fields] OR dentinas[All Fields] OR dentinbehandling[All Fields] OR dentinbehandlung[All Fields] OR
dentinbereich[All Fields] OR dentinbestandes[All Fields] OR dentinbildung[All Fields] OR dentinbildungen[All Fields] OR dentinbinder[All Fields] OR
dentinbindere[All Fields] OR dentinbinding[All Fields] OR dentinbloc[All Fields] OR dentinbond[All Fields] OR dentinbonding[All Fields] OR dentinbuild[All
Fields] OR dentincharakterisierung[All Fields] OR dentincomposite[All Fields] OR dentindesinfektion[All Fields] OR dentindurchdringungsfahigkeit[All Fields]
OR dentindysplalsie[All Fields] OR dentindysplasie[All Fields] OR dentine[All Fields] OR dentine’[All Fields] OR dentine’s[All Fields] OR dentinebehandeling
[All Fields] OR dentinedysplasie[All Fields] OR dentinegevoeligheid[All Fields] OR dentinehechtlakken[All Fields] OR dentinei[All Fields] OR dentinelaesies[All
Fields] OR dentinelvaltozasanak[All Fields] OR dentinema[All Fields] OR dentinents[All Fields] OR dentinephtys[All Fields] OR dentines[All Fields] OR
dentinesurfaces[All Fields] OR dentinet[All Fields] OR dentinets[All Fields] OR dentinetubuli[All Fields] OR dentinfehlbildung[All Fields] OR
dentinfehlbildungen[All Fields] OR dentinfeuchtigkeit[All Fields] OR dentinflachen[All Fields] OR dentinfor[All Fields] OR dentinformen[All Fields] OR
dentinfraktur[All Fields] OR denting[All Fields] OR dentinge[All Fields] OR dentingenically[All Fields] OR dentinger[All Fields] OR dentingewebe[All Fields]
OR dentinhaft[All Fields] OR dentinhaftmittel[All Fields] OR dentinhaftmitteln[All Fields] OR dentinhaftung[All Fields] OR dentinhaftvermittler[All Fields]
OR dentinhaftvermittlern[All Fields] OR dentinho[All Fields] OR dentinhyperaesthesi[All Fields] OR dentinhyperaesthesie[All Fields] OR dentinhyperasthesie
[All Fields] OR dentinhyperasthesis[All Fields] OR dentinhypermineralization[All Fields] OR dentinhypersensibilitat[All Fields] OR dentinhypoplasie[All Fields]
OR dentini[All Fields] OR dentinigenesis[All Fields] OR dentinimpragnation[All Fields] OR dentinin[All Fields] OR dentininnervation[All Fields] OR
dentinisolierenden[All Fields] OR dentinites[All Fields] OR dentinitis[All Fields] OR dentinkanaelchen[All Fields] OR dentinkanal[All Fields] OR
dentinkanalchen[All Fields] OR dentinkapillargeruest[All Fields] OR dentinkaries[All Fields] OR dentinkavitaten[All Fields] OR dentinkaviteter[All Fields] OR
dentinkepzo[All Fields] OR dentinklaeber[All Fields] OR dentinkonditionierung[All Fields] OR dentinkontakt[All Fields] OR dentinkronen[All Fields] OR
dentinkronenrelief[All Fields] OR dentinlike[All Fields] OR dentinliquor[All Fields] OR dentinliquors[All Fields] OR dentinnogo[All Fields] OR dentinnoi[All
Fields] OR dentinnye[All Fields] OR dentinnykh[All Fields] OR dentino[All Fields] OR dentinoalveolar[All Fields] OR dentinoameloblastoma[All Fields] OR
dentinoberflache[All Fields] OR dentinoberflachen[All Fields] OR dentinoblast[All Fields] OR dentinoblastos[All Fields] OR dentinoblasts[All Fields] OR
dentinoblasts’[All Fields] OR dentinocemental[All Fields] OR dentinocementum[All Fields] OR dentinoclast[All Fields] OR dentinoclastic[All Fields] OR
dentinoclastlike[All Fields] OR dentinoclasts[All Fields] OR dentinoenamel[All Fields] OR dentinofacial[All Fields] OR dentinogenese[All Fields] OR
dentinogeneses[All Fields] OR dentinogenesi[All Fields] OR dentinogenesis[All Fields] OR dentinogenesisimperfecta[All Fields] OR dentinogenetic[All Fields]
OR dentinogenetica[All Fields] OR dentinogeneza[All Fields] OR dentinogenezei[All Fields] OR dentinogenezy[All Fields] OR dentinogenic[All Fields] OR
dentinogenically[All Fields] OR dentinogenom[All Fields] OR dentinogensis[All Fields] OR dentinogingival[All Fields] OR dentinoid[All Fields] OR dentinok
[All Fields] OR dentinoklastische[All Fields] OR dentinol[All Fields] OR dentinom[All Fields] OR dentinoma[All Fields] OR dentinomas[All Fields] OR
dentinome[All Fields] OR dentinoobrazovanii[All Fields] OR dentinopenia[All Fields] OR dentinophilic[All Fields] OR dentinophosphophoryns[All Fields] OR
dentinoplastic[All Fields] OR dentinopulpal[All Fields] OR dentinopulpar[All Fields] OR dentinosarcoma[All Fields] OR dentinosarcomas[All Fields] OR
dentinosklovinna[All Fields] OR dentinous[All Fields] OR dentinova[All Fields] OR dentinove[All Fields] OR dentinovych[All Fields] OR dentinpermeabilitat
[All Fields] OR dentinpost[All Fields] OR dentinposts[All Fields] OR dentinpraparationen[All Fields] OR dentinproducing[All Fields] OR dentinpulp[All Fields]
OR dentinq[All Fields] OR dentinreaktioner[All Fields] OR dentinresten[All Fields] OR dentinretention[All Fields] OR dentins[All Fields] OR
dentinschadigungen[All Fields] OR dentinschliff[All Fields] OR dentinschutz[All Fields] OR dentinsialophosphoprotein[All Fields] OR dentinska[All Fields] OR
dentinske[All Fields] OR dentinskih[All Fields] OR dentinsklerose[All Fields] OR dentinskog[All Fields] OR dentinsku[All Fields] OR dentinsplittern[All Fields]
OR dentinstitute[All Fields] OR dentinstoffwechsel[All Fields] OR dentinstoffwechselstudien[All Fields] OR dentinstoffwechselstudlen[All Fields] OR
dentinstruktur[All Fields] OR dentinstrukturak[All Fields] OR dentinstrukturen[All Fields] OR dentintransparenz[All Fields] OR dentintubules[All Fields] OR
dentinu[All Fields] OR dentinuber[All Fields] OR dentinuberempfindlichkeit[All Fields] OR dentinum[All Fields] OR dentinund[All Fields] OR dentinusur[All
Fields] OR dentinveranderungen[All Fields] OR dentinverbandes[All Fields] OR dentinwachstum[All Fields] OR dentinwandung[All Fields] OR
dentinwiderstandsmessung[All Fields] OR dentinwunde[All Fields] OR dentinwundverband[All Fields] OR dentinwundverbande[All Fields] OR
dentinwundverbanden[All Fields] OR dentinzuwachsrate[All Fields]) AND English[lang]

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 2. (continued)
Search MeSH terms as entered into PubMed Number of Number
items found of relevant
articles*

Resin (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND “specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR 527 28
“sensitivity”[All Fields]) OR (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
(“resins, plant”[MeSH Terms] OR (“resins”[All Fields] AND “plant”[All Fields]) OR “plant resins”[All Fields] OR “resin”[All Fields]) AND English[lang]
Strontium (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND “specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR 97 20
“sensitivity”[All Fields]) OR (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
(“strontium”[MeSH Terms] OR “strontium”[All Fields]) AND English[lang]
Potassium (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND “specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR 180 65
“sensitivity”[All Fields]) OR (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
potassium[Title/Abstract] AND English[lang]
Oxalate (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND 98 15
“specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
(“oxalates”[MeSH Terms] OR “oxalates”[All Fields] OR “oxalate”[All Fields]) AND English[lang]
NovaMin (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND 23 12
“specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
(“NovaMin”[Supplementary Concept] OR “NovaMin”[All Fields] OR “NovaMin”[All Fields]) AND English[lang]
(“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND 5
“specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
((“calcium”[MeSH Terms] OR “calcium”[All Fields]) AND (“sodium, dietary”[MeSH Terms] OR (“sodium”[All Fields] AND “dietary”[All Fields]) OR
“dietary sodium”[All Fields] OR “sodium”[All Fields] OR “sodium”[MeSH Terms]) AND phosphosilicate[All Fields]) NOT (“NovaMin”[Supplementary
Concept] OR “NovaMin”[All Fields] OR “NovaMin”[All Fields]) AND English[lang]
Stannous (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND 50 22

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
“specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
stannous[All Fields] AND English[lang]
Laser (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND 172 41
“specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
(“lasers”[MeSH Terms] OR “lasers”[All Fields] OR “laser”[All Fields]) NOT (“dental caries”[MeSH Terms] OR (“dental”[All Fields] AND “caries”[All Fields])
OR “dental caries”[All Fields] OR “caries”[All Fields]) AND English[lang] AND English[lang]
Glass ionomer (“hypersensitivity”[MeSH Terms] OR “hypersensitivity”[All Fields]) OR (“sensitivity and specificity”[MeSH Terms] OR (“sensitivity”[All Fields] AND 61 1
“specificity”[All Fields]) OR “sensitivity and specificity”[All Fields] OR “sensitivity”[All Fields]) AND (“dentin”[MeSH Terms] OR “dentin”[All Fields]) AND
(“glass ionomer”[Supplementary Concept] OR “glass ionomer”[All Fields]) NOT (“resins, plant”[MeSH Terms] OR (“resins”[All Fields] AND “plant”[All
Fields]) OR “plant resins”[All Fields] OR “resin”[All Fields]) AND English[lang]
*
See Inclusion and Exclusion criteria (102 articles appeared in more than one pubmed search).
Management of dentine hypersensitivity
S261
S262 West et al.

Table 3. Search terms for Medline and Cochrane trials database searches completed 14– of the body of evidence, the balance
21st July 2014 of benefits and risks and public pref-
Database Search Relevant articles erences.
added

Medline Database: Medline 1950 to present Bifluorid (1) Results

Search Strategy: Casein (1) All papers discussed are tabulated in
1 treatment.mp. (3,115,747) Laser (1)
Table 5 for each agent.
2 dentine hypersensitivity.mp. or *Dentin Sensi- Resin (1)
tivity/(1361) Varnish (2)
3 limit 2 to English language (1137) Arginine and calcium carbonate (A/C)
4 1 and 2 and 3 (559) This review included consideration of
63 papers of which 30 fulfilled the rel-
evant criteria. The RCT studies all
• 153 relevant original articles (per inclusion/ assessed efficacy of the active ingredi-
exclusion criteria)
• 406 excluded based on inclusion and exclu- ent arginine/calcium carbonate in the
reduction in pain of dentine hypersen-
sion criteria
sitivity, the outcome variable. The
Cochrane Cochrane Central Register of Controlled Trials: Laser (1) majority of studies involved the appli-
Issue 7 of 12, July 2014 cation of self-administered products;
There are 646 results from 800,283 records for toothpastes (20) and mouthrinses
your search on #1 – (hypersensitivity which also contained PVM/MA and
or sensitivity) and dentin in Trials in the fluoride (3). The remainder was pro-
strategy currently being edited fessionally applied products, prophy-
• 171 relevant original articles (per inclusion/ laxis pastes (7).
exclusion criteria) The effectiveness of arginine in
• 475 excluded based on inclusion and exclu- the reduction of pain from dentine
sion criteria
hypersensitivity, the outcome vari-
able, was most frequently assessed in
a toothpaste formulation, 20 RCT’s
being evaluated in this systematic
• describe the method by which den- aspect of the study will not be
considered weak).
review. All studies were parallel in
design apart from 1, crossover study
tine hypersensitivity is stimulated
• describe the method by which • Balanced treatment groups (Schiff et al. 2011). The designs all
dentine hypersensitivity is scored • The number of participants who used an airblast stimulus and all but
• score dentine hypersensitivity and completed the study and were
included in the analysis
2 (He et al. 2011a,c), had a second
stimulus, a tactile stimulus for evalu-
elicited by more than one method
of stimulation ation.
Studies including all of the above Nine studies incorporated a
in each category were considered to benchmark or negative control of
Statistics have a low risk of bias, those includ- fluoride as a toothpaste (Ayad et al.
The study should include the follow- ing at least two criteria in each cate- 2009a, Fu et al. 2010, Que et al.
ing: gory were considered to have a 2010, Docimo et al. 2011, Li et al.
moderate risk of bias, with the 2011, Kakar et al. 2012a, Hegde
• Justification of the number of remainder considered have a high et al. 2013, Kakar et al. 2013,
study participants to demonstrate risk of bias. Sowinski et al. 2013). Fourteen stud-
the study is adequately powered Due to the heterogeneity of the ies incorporated a positive control
(The standard of reporting of study methodology, it was not possi- allowing direct comparisons between
power calculations unfortunately ble to perform a meta-analysis. The agents to be made, these being stron-
remains rather poor in dentistry results, therefore, are descriptive in tium acetate (6) (Hughes et al. 2010,
but has improved over the years. nature. Docimo et al. 2011, Li et al. 2011,
Power calculations are not pre- The body of evidence, deemed Schiff et al. 2011, Orsini et al. 2013,
cise, are usually conducted in high, moderate, low or very low was West et al. 2013a); stannous fluoride
advance of the study, and are determined by taking into consider- (2) (He et al. 2011a,c); or potassium
based on outcomes that are per- ation the risk of bias of the studies (mainly nitrate) (6), (Ayad et al.
ceived to be reasonably plausible as assessed above, the directness of 2009a,b, Docimo et al. 2009a,b,
in view of the state of knowledge the comparisons made between Nathoo et al. 2009, Kakar et al.
at the time. The reviewers there- products, the consistency of findings 2012b). All studies had a moderate
fore accept that if the numbers of between studies, the precision of the risk of bias with the exception of
subjects in a study have been results and publication bias. Recom- Sowinski et al. (2013) which had a
determined by a power calcula- mendations for effectiveness of an high risk of bias.
tion, even if they look low com- agent were based on the results of Results were consistently in
pared to comparable studies, this the studies supported by the quality favour of arginine being signifi-
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

(a)
(b)
(c)
Fig. 1. Flow chart of searches using (A) Pubmed, (B) Medline and (C) Cochrane data-
base.
cantly more effective than a fluo-
ride control, seven studies showing
long-term effects evaluated after
2 weeks or longer. Similarly, in
studies where arginine was com-
pared to potassium, arginine was
always significantly superior in effi-
cacy, over long-term evaluation.
Comparing strontium acetate to
arginine divulged three studies
being equivocal, one paste not
showing superiority over the other
(Hughes et al. 2010, Orsini et al.
2013, West et al. 2013a), and three
studies (Docimo et al. 2011, Li
et al. 2011, Schiff et al. 2011),
showed arginine significantly more
effective than strontium. These six
studies were fairly equally divided
over immediate and long-term
assessments. Stannous fluoride was
shown in two studies (He et al.
2011a,c) to be significantly superior
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Management of dentine hypersensitivity
to arginine in both the short and
long-term assessment.
Three RCT’s investigated argi-
nine in a mouthrinse formulation,
for efficacy in pain reduction. The
analyses were complicated in that
another agents were often included,
e.g. PVM/MA, arginine toothpaste.
The studies were parallel in design
and used the same assessments. Two
studies used a potassium positive
control (Elıas Boneta et al. 2013a,b)
and one also incorporated a conven-
tional fluoride negative control mou-
thrinse (Elıas Boneta et al. 2013a),
and a third used only a conventional
fluoride negative control (Hu et al.
2013). One study had a low number
of subjects (Elıas Boneta et al.
2013a), but included a power calcula-
tion. All studies had a moderate risk
of bias. Results were consistently in
favour of the arginine/PVM/MA-
S263
based mouthrinse assessed long term
between 2 and 8 weeks compared to
the control products. There was het-
erogeneity between these few studies.
Arginine applied professionally as
a prophylaxis paste to reduce den-
tine hypersensitivity was reviewed in
seven RCT’s, six being parallel stud-
ies (Hamlin et al. 2009, Schiff et al.
2009, Hamlin et al. 2012, Tsai et al.
2012, Collins et al. 2013, Chu & Lo
2014) and one split mouth (Kapferer
et al. 2013). Cold air was assessed in
seven studies accompanied by tactile
assessment in four of the seven stud-
ies (Hamlin et al. 2009, 2012, Schiff
et al. 2009, Kapferer et al. 2013). Six
studies used a benchmark/negative
control only and one, a positive con-
trol, potassium nitrate toothpaste
(Chu & Lo 2014). All studies had a
moderate risk of bias as defined in
the assessment methodology. Results
were consistently in favour of the
arginine prophylaxis paste in the
seven studies, six showing immediate
effects and two also long-term effi-
cacy (Schiff et al. 2009, Hamlin
et al. 2012).
PVA/MA – Polymers
This review included consideration
of 11 papers, of which six fulfilled
the relevant criteria of including a
polymer as an active ingredient and
measuring its efficacy in reducing the
pain of dentine hypersensitivity. The
PVA/MA product formulations were
combined with arginine (3) (Elıas
Boneta et al. 2013a,b, Hu et al.
2013), Triclosan (1) (Chaknis et al.
2011) and potassium (2) (Ayad et al.
1994, Schiff et al. 1994) and were in
the form of self-administered mouth-
rinses for arginine, and toothpaste
for triclosan and potassium. The
trial designs were all parallel, utilized
airblast and tactile stimuli and had a
moderate risk of bias. Of the three
RCT’s investigating PVA/MA with
arginine in a mouthrinse formula-
tion, two studies used a potassium
control and one a negative control
as well, and the third a conventional
fluoride control only (Hu et al.
2013). Results were consistently in
favour of the arginine/PVM/MA-
based mouthrinse. With regards to
the PVA/MA combined with potas-
sium nitrate in toothpaste formula-
tion, one study directly tested the
product against a positive control,
S264 West et al.

Table 4. Searches as they are grouped in the results

Results section Search Number of items

Total initial Following review Following review

search of title and abstract of whole
article and included
in the results*

Arginine and Calcium Arginine (PM) 63 30 30

carbonate
PVA/MA -polymers PMV copolymer (PM) 11 6 6
Potassium Potassium (PM) 180 65 25
Casein Derivatives Casein (PM + 1 Medline) 32 6 3
(amorphous calcium
phosphate (ACP) and casein
phosphopeptide (CPP))
Strontium Strontium (PM) 97 20 18
Stannous Fluoride Stannous (PM) 50 22 17
Calcium Sodium NovaMin (PM) 28 12 12
Phosphosilicate (CSPS)
Oxalates Oxalates (PM) 98 15 9
Resin-based materials Resins (PM + 1 Medline) 528 29 1
Seal & Protect 17 4 2
Glass ionomer 61 1 0
Gluma 78 22 6
Varnishes Varnish (PM + 2 Medline) 67 20 5
Bifluorid (Medline) 1 1 1
Duraphat 19 8 1
Lasers Laser (PB + 1 Medline + 1 Cochrane) 174 43 8

PM = PubMed.
*
Articles may appear in more than one section of the results.

potassium, results being equivocal
(Ayad et al. 1994) and the other study
tested the agent against a negative
control demonstrating superiority to
a placebo toothpaste (Schiff et al.
1994). The PVA/MA product with
triclosan was evaluated to reduce the
pain of sensitivity against a negative
control fluoride product and a stan-
nous comparator product, results
demonstrating efficacy against the
negative and to some degree the posi-
tive control (Chaknis et al. 2011).
Potassium
This review included consideration
of 180 papers, of which 25 fulfilled
the relevant criteria. The RCT stud-
ies all assessed the efficacy of the
active ingredient potassium for the
treatment of pain from dentine
hypersensitivity, the outcome mea-
sure, but in many different forms
and over many years, nitrate (18)
(Silverman et al. 1996, West et al.
1997, Schiff et al. 1998, Wara-
aswapati et al. 2005, Ayad et al.
2009a, Docimo et al. 2009a,b, Nat-
hoo et al. 2009, Ni et al. 2010, Pra-
deep & Sharma 2010, Sharma et al.
2010, Liu & Hu 2012, Kakar et al.
2012b, Pradeep et al. 2012, Elıas
Boneta et al. 2013a,b, Sowinski et al.
2013, Veitz-Keenan et al. 2013), cit-
rate (4) (Chesters et al. 1992, Yates
et al. 1998b, Docimo et al. 2007,
Prasad et al. 2010), chloride (2)
(Docimo et al. 2007, Ayad et al.
2009b), binoxalate (1) (Talesara
et al. 2014) and iodide (1) (Craig
et al. 2012). The majority of studies
involved the application of self-
administered potassium products;
toothpastes (21), mouthrinses (2)
(Elıas Boneta et al. 2013a,b) and the
remainder (2) evaluated profession-
ally applied products (Craig et al.
2012, Talesara et al. 2014). Studies
were parallel in design apart from 2,
crossover studies (Craig et al. 2012,
Talesara et al. 2014). The designs all
used an airblast stimulus, bar 1
(Craig et al. 2012) which utilized
only thermal stimulus evaluation,
and all products were investigated
over a long-term period. All studies
had a moderate risk of bias except
for that by Talesara et al. (2014) and
Sowinski et al. (2013) which had a
high risk of bias.
The most frequent salt investi-
gated for effectiveness was potassium
nitrate. This was studied in direct
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
comparison to the positive control
arginine in seven studies, five with
toothpaste (Ayad et al. 2009a,
Docimo et al. 2009a,b, Nathoo et al.
2009, Kakar et al. 2012b), and two
combining mouthrinse and tooth-
paste in the design (Elıas Boneta
et al. 2013a,b). Of the seven studies,
three had a negative control product
included in the design as well. Results
were consistently in favour of argi-
nine in all cases, results for potassium
not that dissimilar to those obtained
for the negative control.
Potassium was found to provide
inferior pain reduction in dentine
hypersensitivity when directly com-
pared to resins, a positive control (1)
(Veitz-Keenan et al. 2013) and infer-
ior to a sealant, the second com-
parator product; and in other studies
to Calcium Sodium Phosphosilicate
(CSPS) another positive control (2)
(Pradeep & Sharma 2010, Sharma
et al. 2010). The study by Pradeep &
Sharma (2010) also incorporated a
negative control product. Potassium
was also found inferior when com-
pared with stannous fluoride as a
positive control for pain reduction,
(2) (Ni et al. 2010, Sharma et al.
2010), these studies having no nega-
 Table 5. Studies evaluated for all treatment modalities
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Arginine and Calcium Carbonate (A/C)*

Chu & Lo 2014 Multiple-centre, 303 8% arginine calcium 5% potassium Professional Immediate Airblast A total of 303 patients were recruited by 65 participating
(2014) practitioner- carbonate nitrate, 1450 ppm prophylaxis dentists. The mean age of the patients was 40.1, and 59%
based, parallel toothpaste fluoride were female. The median pre-treatment SS of Groups 1
group, and 2 were both 7, whereas the post-treatment SS were 3
randomized study and 4 respectively (p < 0.001). The median percentage
reductions in sensitivity scores of Groups 1 and 2 were
57.14% and 38.75% respectively (p < 0.001).
Collins et al. 2013 Single-centre, 50 8% arginine and Fluoride-free Professional Immediate Airblast All subjects completed the study. At the post-
(2013)† double-blind, calcium carbonate, prophylaxis paste prophylaxis hypersensitivity examination, subjects assigned to the Test
parallel group, fluoride free Paste group and Control Paste group both exhibited
randomized study toothpaste statistically significant (p = 0000) reductions (compared to
baseline), to airblast hypersensitivity of 44.7% and 25.6%
respectively. At the post-hypersensitivity examination,
subjects in the Test Paste group exhibited a statistically
significant (p = 0.005) reduction of 24.4% in mean
airblast hypersensitivity scores as compared to the
Control Paste group.
Elıas Boneta 2013 Single-centre, 69 8% arginine, PVM/ 0.05% sodium 2.4% potassium Self-administered 30 min, 2, 4, Tactile, airblast Seventy-five subjects were enrolled; 69 subjects completed
et al. double-blind, MA copolymer, fluoride nitrate, 0.022% mouthrinse 6 weeks the study. There were no differences after 30 min of a
(2013a)† parallel group, pyrophosphates, sodium fluoride single use, among the three groups with respect to mean
randomized study 0.05% sodium tactile and airblast hypersensitivity scores compared to
fluoride, alcohol free potassium nitrate and negative control mouthwashes
(p < 0.05). The arginine group presented a statistically
significant improvement in the mean tactile scores
compared to potassium nitrate and negative control
groups after 2, 4 and 6 weeks (p < 0.001) of product use;
the arginine group showed a statistically significant
enhancement in airblast hypersensitivity mean scores

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
compared to potassium nitrate and negative control
groups after two (p = 0.001), four (p < 0.001) and 6 weeks
(p < 0.001) of product use.
Elıas Boneta 2013 Single-centre, 118 Toothpaste: 8% Toothpaste: Toothpaste: 5% Self-administered 2, 4, 8 weeks Tactile, airblast 120 subjects were enrolled, 118 completed the study. The
et al. double-blind, arginine and containing potassium nitrate toothpaste/ Tactile hypersensitivity mean scores showed statistically
(2013b)† parallel group, 1450 ppm sodium 1450 ppm fluoride and 1450 ppm mouthrinse significant improvement at two, four and eight (p ≤ 0.001)
randomized study MFP, calcium in dicalcium base sodium fluoride, weeks in the arginine regime; the potassium regime did
carbonate + silica base not show significant (p ≥ 0.05) improvement. Airblast
+ Mouthwash: + Hypersensitivity scores had a statistically significant
Mouthwash: 0.8% fluoride/arginine Mouthwash: decrease at two (p = 0.006), four (p = 0.006) and eight
arginine, PVM/MA free 0.51% potassium (p = 0.002) weeks in arginine and potassium regimes
copolymer, chloride and (p ≤ 0.05). The most effective treatment proved to be
pyrophosphates and 230 ppm sodium arginine (p ≤ 0.05) compared to the potassium regime.
0.05% sodium fluoride, alcohol
fluoride, alcohol free base
Hegde et al. 2013 Double-blind, 86 8% arginine, calcium 1000 ppm sodium Self-administered 2, 4, 8 weeks Tactile, airblast 86 subjects (35 males and 51 females) complied with the
(2013) parallel group, carbonate and MFP toothpaste study protocol and completed the entire study. At each
randomized study 1000 ppm sodium recall visit, both treatment groups demonstrated
MFP significant reductions in dentin hypersensitivity from their
corresponding baselines (p < 0.05). Subjects assigned the
8% arginine, calcium carbonate and 1000 ppm fluoride
dentifrice demonstrated statistically significant reductions
in responses to tactile stimuli, airblast and VAS responses
in comparison to those using the dentifrice containing
1000 ppm fluoride after 2, 4 and 8 weeks respectively.
Hu et al. 2013 Single-centre, 90 8% arginine, PVM/ 0.05% sodium Self-administered 2, 4, 8 weeks Tactile, airblast Ninety (90) subjects entered and completed the 8 week
(2013)† double-blind, MA copolymer, fluoride, alcohol mouthrinse study. After 2, 4 and 8 weeks of product use, subjects in
parallel group, pyrophosphates, free the Arginine Mouthwash group exhibited statistically
randomized study 0.05% sodium significant (p < 0.05) improvements in mean tactile and
fluoride, alcohol free airblast hypersensitivity scores as compared to the
Negative Control Mouthwash
Management of dentine hypersensitivity
S265
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S266

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

Kakar et al. 2013 Single-centre, 93 8% arginine, calcium Fluoride toothpaste Self-administered 2, 4, 8 weeks Tactile, airblast At the end of the 8-week period, the results showed a
(2013)† double-blind, carbonate and toothpaste significant improvement in dentin hypersensitivity in the
parallel group, 1000 ppm MFP Test group as compared to the Negative control group.
randomized study The mean tactile hypersensitivity scores at the 8-week
examinations were 39.67 and 38.33 by the Yeaple and Jay
West et al.

Probes, respectively, for the Test group and 15.72 and

15.00 for the Negative control group. These observations
were consistent with the other hypersensitivity
examinations by airblast and VAS.
Kapferer et al. 2013 Double-blind, split- 29 (58 8% arginine and Calcium carbonate Professional Immediate, 4, Tactile, airblast A statistically significant difference in airblast (p = 0.001)
(2013) mouth, teeth) calcium carbonate prophylaxis 12 weeks and tactile (p = 0.047) hypersensitivity reduction over time
randomized study was observed between the two therapy modes. After 12-
weeks, statistically significant differences were indicated
between the test and control group with respect to
baseline-adjusted mean tactile (41.94%; p = 0.038) and
airblast hypersensitivity scores (46.5%; p = 0.017).
Orsini et al. 2013 Single-centre, 85 8% arginine, calcium 8% strontium Self-administered 3 days Tactile, airblast, The final sample consisted of 85 individuals: 29 received the
(2013) double-blind, carbonate and acetate and toothpaste thermal arginine-based dentifrice (group 1), 27 the strontium
parallel group, 1450 ppm sodium 1040 ppm sodium acetate-based dentifrice (group 2), and 29 the dentifrice
randomized study MFP fluoride based on zinc-carbonate hydroxyapatite (group 3). All
30% zinc dentifrices were mostly effective to reduce DH: the
substituted- percentage of score reduction from baseline to 3 days was
carbonate >30% for all tests (except for subjective test of group 2).
hydroxyapatite The comparison among the three dentifrices showed that,
nanocrystals after 3 days, there was an improvement in airblast (mean
percentage of reduction, 39.2% in group 1, 42.0% in
group 2, and 39.2% in group 3), cold water (41.5%,
51.8% and 50%), tactile (50.3%, 40.1% and 33.8%) and
subjective (33.1%, 17.4% and 31.4%) test scores, with
differences being significant for cold water and subjective
tests. For airblast and tactile tests, there were no
significant differences across groups at 3 days. Moreover,
no significant differences at any test were observed in a
subset of patients that were followed up to 8 weeks: all
dentifrices were all highly efficacious.
Sowinski et al. 2013 Double-blind, 100 8% arginine, calcium Fluoride toothpaste Self-administered Intervals up to Tactile, airblast Consistent with results from previous studies, subjects
(2013)† parallel group, carbonate toothpaste 8 weeks assigned dentifrices formulated with potassium nitrate or
randomized study 8% arginine/calcium carbonate demonstrated
improvements in Yeaple, airblast and VAS responses in
comparison to those assigned the fluoride dentifrice
(p < 0.05). Jay Probe responses correlated significantly
with all other sensitivity measures (p < 0.05). Differences
between these treatments were observed at all post-
treatment evaluations using these methods.
West et al. 2013 Single-centre, 80 8% arginine, calcium 8% strontium Self-administered Immediate, 3 days Tactile, airblast All 80 subjects completed the study. Results confirm that
(2013a)† single-blind, carbonate with acetate, silica with toothpaste for both treatments, pain was reduced immediately and
parallel group, 1450 ppm sodium 1040 ppm sodium relief was sustained after 3 days use. For all 3 measures,
stratified and MFP fluoride benefit was similar between the two pastes, with no
randomized study statistical or clinical difference demonstrated, apart from
response to evaporative stimulus at 3 days, where Schiff
scores were significantly lower in the arginine group,
p = 0.02.
Hamlin et al. 2012 Single-centre, 95 8% arginine and Pumice prophylaxis Self-administered Immediate, 8, Tactile, airblast Immediately after professional product application, and
(2012)† double-blind, calcium carbonate paste and toothpaste and 24 weeks after 8 and 24 weeks, subjects assigned to the Test Group
parallel group, with 1450 ppm 1450 ppm MFP Professional demonstrated statistically significant improvements in
stratified and MFP toothpaste prophylaxis dentin hypersensitivity compared to subjects assigned to
randomized study the Negative Control Group in tactile (49.8%, 57.5% and
32.9% respectively) and airblast (26.0%, 38.4% and
34.3% respectively) sensitivity scores. The instant
reductions in dentin hypersensitivity provided by the
single professional application of a desensitizing paste for
in-office use, containing 8% arginine and calcium
carbonate were maintained by twice daily brushing with
the 8% arginine, calcium carbonate toothpaste with
1450 ppm fluoride as MFP and the Colgate Sensitive Pro-
Relief toothbrush for at least 24 weeks.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Kakar et al. 2012 Single-centre, 88 8.0% arginine calcium 2% potassium Self-administered 2, 4, 8 weeks Tactile, airblast Subjects who brushed with the new dentifrice containing
(2012b)† double-blind, carbonate and nitrate toothpaste 8.0% arginine, calcium carbonate, and 1000 ppm MFP
parallel group, 1000 ppm sodium exhibited statistically significant reductions (p < 0.05) in
randomized study MFP dentin hypersensitivity in response to tactile (36.2%,
33.1% and 29.7%) and airblast (16.4%, 31.1%, 58.8%)
stimuli when compared with the subjects who brushed
with the 2% potassium ion as potassium nitrate dentifrice
after 2, 4 and 8 weeks respectively.
Kakar et al. 2012 Single-centre, 74 8% arginine, calcium 1000 ppm sodium Self-administered 2, 4, 8 weeks Tactile, airblast Subjects who brushed with the new dentifrice containing
(2012a)† double-blind, carbonate, MFP toothpaste 8.0% arginine, calcium carbonate, and 1000 ppm MFP
parallel group, 1000 ppm sodium exhibited statistically significant (p < 0.05) greater
randomized study MFP reductions in dentin hypersensitivity in response to tactile
(81.9%, 90.5% and 116.7%) and airblast (39.5%, 56.7%,
76.7%) stimuli than subjects assigned the 1000 ppm MFP
dentifrice after 2, 4 and 8 weeks respectively.
Tsai et al. 2012 Single-centre, 66 8% arginine–calcium Non-fluoridated Professional Immediate Airblast Following the post-cleaning airblast hypersensitivity
(2012)† double-blind, carbonate paste pumice-based prophylaxis examination, there was a significant decrease of 83.94% in
parallel group, prophylaxis paste the hypersensitivity of subjects using the Test paste. The
randomized study group using the Control paste showed a 13.43%
desensitization. There was a statistically significant
difference of 79.65% between the two groups. Subjects in
the age groups 41–50, 51–60 and 61–70 years of age
showed the most reduction in dentin hypersensitivity.
Docimo et al. 2011 Single-centre, 150 8% arginine and Fluoride toothpaste 8% strontium Self- 2, 4, 8 weeks Tactile, airblast After 2, 4 and 8 weeks of daily use of the products, all
(2011)† double-blind, calcium carbonate (Crest cavity acetate, silica with administered three groups showed a statistically significant reduction
parallel group, with 1450 ppm protection) 1040 ppm sodium toothpaste from baseline in tactile and airblast dentin hypersensitivity
randomized study MFP (Colgate fluoride (p < 0.05). Colgate Sensitive Pro-Relief toothpaste
sensitive Pro-Relief) (Sensodyne Rapid produced a significant improvement in mean tactile and
Relief) airblast dentin hypersensitivity scores, and was more

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
effective than Sensodyne Rapid Relief toothpaste and
Crest Cavity Protection toothpastes (p < 0.05).
He et al. 2011 Single-centre, 78 0.454% stannous 8% arginine, Self-administered Immediate, 3 days, Airblast 40 subjects in the SnF2 dentifrice group and 38 subjects in
(2011a)† examiner-blind, fluoride calcium toothpaste 2 weeks the control group completed all study procedures. Both
parallel group, carbonate, dentifrice groups showed significant sensitivity relief
randomized study 1450 ppm sodium relative to baseline (p < 0.01). The SnF2 dentifrice
MFP provided a statistically significant (p = 0.005) 7.4%
reduction in sensitivity relative to the positive control
dentifrice immediately after first use and an even more
significant (p = 0.001) 20% reduction at Week 2 based on
the Schiff air sensitivity scale. Based on the VAS, the
SnF2 dentifrice provided statistically significant
(p < 0.0001) reduction in sensitivity relative to the positive
control dentifrice immediately after first use, at Day 3,
and Week 2, with percent reductions of 7.2%, 15.8% and
28.2% respectively. No adverse events were reported with
either dentifrice.
He et al. 2011 Single-centre, 81 Stannous-containing 8% arginine, Self-administered Immediate, 3 days Airblast Forty subjects in the experimental group and 41 subjects in
(2011c)† examiner-blind, 1450 ppm sodium calcium toothpaste the positive control group completed all study procedures.
parallel group, fluoride carbonate, On the Schiff Air Sensitivity Scale, the experimental
randomized study 1450 ppm sodium dentifrice provided statistically significant (p < 0.001)
MFP reductions of 14.8% and 54.1% in sensitivity relative to
the positive control dentifrice immediately after first use
and at Day 3 respectively. On the pain VAS, the
experimental dentifrice provided statistically significant
(p < 0.001) reductions of 22.3% and 74.1% in sensitivity
relative to the positive control dentifrice immediately after
first use and at Day 3 respectively. No adverse events
were reported for any subject.
Management of dentine hypersensitivity
S267
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S268

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

Li et al. 2011 Double-blind, 150 8% strontium acetate, 1100 ppm fluoride 8% arginine, Self-administered Immediate, 7 days Tactile, airblast All 150 subjects complied with the protocol and completed
(2011)† parallel group, silica, 1040 ppm as NaF in a silica calcium toothpaste the study. The positive control toothpaste containing
randomized study sodium fluoride base carbonate, 8.0% arginine and 1450 ppm fluoride as MFP in a
1450 ppm sodium calcium carbonate base provided statistically significant
MFP improvements in mean tactile and airblast dentin
West et al.

hypersensitivity scores compared to the negative control

toothpaste containing 1100 ppm fluoride as NaF in a
silica base (p < 0.05). The toothpaste containing 8.0%
arginine and 1450 ppm fluoride as MFP in a calcium
carbonate base (positive control) also provided
statistically significant improvements in mean tactile and
airblast dentin hypersensitivity scores compared to the test
toothpaste containing 8% strontium acetate and
1040 ppm fluoride as NaF in a silica base. The test
toothpaste and the negative control toothpaste were not
significantly different from each other.
Schiff et al. 2011 Double-blind, 121 8% arginine, calcium 8% strontium Self-administered Product 1 (phase Tactile, airblast 121 subjects complied with the study protocol and
(2011)† crossover, carbonate, acetate, silica, toothpaste 1): 8 weeks, completed the study. Study Phase I: Subjects who brushed
randomized study 1450 ppm sodium 1040 ppm sodium product 2 (phase twice daily for 8 weeks with the arginine/calcium
MFP fluoride 2): 2, 8 weeks carbonate dentifrice experienced statistically significant
improvements in mean tactile and airblast hypersensitivity
scores (51.3% and 39.4% respectively) relative to that
experienced by subjects who brushed with the strontium
acetate dentifrice. Study Phase II: Subjects who brushed
with the arginine/calcium carbonate dentifrice for the first
8 weeks of the study and then switched to brush with the
strontium acetate dentifrice for the second 8 weeks of the
study, did not exhibit further improvements in mean
tactile or mean airblast hypersensitivity scores after two
and eight weeks of switch-over product use. However,
subjects who brushed with the strontium acetate dentifrice
for the first 8 weeks of the study and then switched to
brush with the arginine/calcium carbonate dentifrice
exhibited statistically significant improvements in mean
tactile and airblast hypersensitivity scores 2 weeks (35.2%
and 29.9% respectively) and 8 weeks (40.3% and 35.3%
respectively) after product switch-over. Relative to the
subjects who switched from twice daily brushing with the
arginine/calcium carbonate dentifrice to brush with the
strontium acetate dentifrice, those who switched from
brushing with the strontium acetate dentifrice to brush
with the arginine/calcium carbonate dentifrice exhibited
statistically significant improvements in mean tactile
hypersensitivity scores (10.3%) and in mean airblast
hypersensitivity scores (16.3%) 8 weeks after product
switch-over.
Fu et al. 2010 Double-blind, 122 8% arginine, high Calcium carbonate, 8.0% arginine, Self-administered Immediate, 3 days Tactile, airblast All one hundred and twenty-two (122) subjects complied
(2010)† parallel group, cleaning calcium 1450 ppm calcium toothpaste with the study protocol and completed the study. There
randomized study carbonate, fluoride, carbonate, was good balance among the three groups at baseline.
1450 ppm fluoride, 1450 ppm fluoride The mean tactile sensitivity scores for the new Pro-Argin
formula dentifrice, the previously validated Pro-Argin
formula dentifrice, and the control dentifrice were at
baseline 14.88, 14.76 and 14.38, and after direct
application were 28.90, 29.02 and 15.88, and after 3 days
of brushing were 34.51, 33.41 and 16.00 respectively. The
mean airblast scores at baseline were 2.11, 2.12 and 2.15,
and after direct application were 1.21, 1.18 and 2.06, and
after 3 days of brushing were 0.80, 0.83 and 1.93
respectively. Immediately after direct application and after
3 days of brushing, for both the tactile and airblast
sensitivity scores, the differences between the two
dentifrices containing 8.0% arginine and the control were
statistically significant. There were no statistically
significant differences between the two 8.0% arginine
dentifrices immediately after direct application and after
3 days of brushing.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Hughes et al. 2010 Examiner-blind, 77 8% strontium acetate, 8% arginine, Self-administered 2, 4, 8 weeks Tactile, airblast Seventy-seven subjects completed this clinical study. Both
(2010)† parallel group, 1040 ppm sodium calcium toothpaste subject groups exhibited significant cumulative reductions
randomized study fluoride carbonate, from baseline to Days 14, 28 and 56 in dentin
1450 ppm sodium hypersensitivity as measured by Schiff, Yeaple and VAS
MFP (for the 8% strontium acetate group, p ≤ 0.0001 for all
time points; for the 8% arginine–calcium carbonate
group, p = 0.0031 for Yeaple at Day 14, p = 0.0015 for
VAS at Day 14 and p < 0.0001 for all remaining measures
and time points). No significant differences (p > 0.05)
were observed between treatments for any of the time
points and measures except for tactile sensitivity at Day
56, for which the 8% strontium acetate-based dentifrice
was statistically superior (p = 0.0391) to the control 8%
arginine/calcium carbonate dentifrice.
Que et al. 2010 Double-blind, 121 8% arginine, high Calcium carbonate, 8% arginine, Self-administered 2, 4, 8 weeks Tactile, airblast This clinical study demonstrated that the new Pro-Argin
(2010)† parallel group, cleaning calcium 1450 ppm fluoride calcium toothpaste formula toothpaste provided a significant reduction in
stratified, carbonate system, as MFP. carbonate, dentin hypersensitivity when used over a period of
randomized study 1450 ppm sodium 1450 ppm fluoride 8 weeks. The study also showed that the new toothpaste
MFP as MFP provided significantly greater reductions (p < 0.05) in
dentin hypersensitivity in response to tactile (64.4%,
71.1% and 61.0%) and airblast (40.7%, 58.8% and
74.4%) stimuli than the negative control toothpaste
containing 1450 ppm fluoride after 2, 4 and 8 weeks of
product use respectively. The results for the new
toothpaste did not differ significantly from those of the
positive control toothpaste at all time points in the study.
Ayad et al. 2009 Double-blind, 120 8% arginine, calcium Toothpaste 2% potassium ion Self-administered Immediate, 3 days Tactile, airblast 120 subjects complied with the protocol and completed the
(2009a)† parallel group, carbonate, containing dosed as 5% toothpaste study. Relative to the desensitizing toothpaste and the
randomized study 1450 ppm MFP 1450 ppm sodium potassium nitrate, control toothpaste groups, the 8.0% arginine toothpaste

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
MFP 1450 ppm sodium group exhibited statistically significant (p < 0.05)
fluoride reductions in dentin hypersensitivity on both tactile and
airblast measures immediately after completion of the first
phase of the study. Reductions in sensitivity for the 8.0%
arginine toothpaste, compared to the benchmark
desensitizing toothpaste and the control toothpaste, were
130.7% and 139.5% (tactile), and 43.8.0% and 49.6%
(airblast) respectively. Relative to the benchmark
desensitizing toothpaste and control toothpaste groups,
the 8.0% arginine group also exhibited statistically
significantly (p < 0.05) reductions in sensitivity after
completion of the second phase of the study, of 104.9%
and 136.1% (tactile), and 44.5% and 53.2% (airblast)
respectively. There was no loss of the instant relief effects
in the 8.0% arginine group after the brushing period.
Ayad et al. 2009 Double-blind, 77 8% arginine, calcium 2% potassium ion, Self-administered 2, 4, 8 weeks Tactile, airblast This clinical study demonstrated that the new toothpaste,
(2009b)† parallel group, carbonate, dosed as 3.75% toothpaste containing 8.0% arginine and 1450 ppm MFP in a
stratified, 1450 ppm sodium potassium calcium carbonate base, provided a significant reduction
randomized study MFP chloride, in dentin hypersensitivity when used over a period of 8
1450 ppm sodium weeks. The study also showed that this new arginine
fluoride toothpaste provided significantly greater reductions
(p < 0.05) in dentin hypersensitivity in response to tactile
(16.2%, 22.4% and 21.4%) and airblast (16.2%, 29.2%
and 63.4%) stimuli than the benchmark commercial
toothpaste containing 2% potassium ion and 1450 ppm
NaF in a silica base, after 2, 4 and 8 weeks of product
use respectively.
Management of dentine hypersensitivity
S269
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S270

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

Docimo et al. 2009 Single-centre, 80 8% arginine, calcium 2% potassium ion, Self-administered 2, 4, 8 weeks Tactile, airblast This clinical study showed that the new toothpaste,
(2009b)† parallel-group, carbonate, dosed as 3.75% toothpaste containing 8.0% arginine and 1450 ppm fluoride as MFP
double-blind, 1450 ppm sodium potassium in a calcium carbonate base provided a significant
stratified MFP chloride, reduction in dentin hypersensitivity when used over a
randomized study 1450 ppm sodium period of 8 weeks. The study also showed that this new
West et al.

fluoride arginine toothpaste provided significantly greater

reductions (p < 0.05) in dentin hypersensitivity in response
to tactile (37.0%, 30.0% and 12.2%) and airblast (23.9%,
32.0% and 29.3%) stimuli than the commercial sensitive
toothpaste containing 2% potassium ion and 1450 ppm
fluoride as NaF in a silica base, after 2, 4 and 8 weeks of
product use respectively.
Docimo et al. 2009 Single-centre, 80 8% arginine, calcium 2% potassium ion, Self-administered 1, 2, 4, 8 weeks Tactile, airblast This clinical study demonstrated that the new toothpaste,
(2009a)† double-blind, carbonate, dosed as 5.0% toothpaste containing 8.0% arginine and 1450 ppm fluoride as MFP
parallel group, 1450 ppm sodium potassium nitrate, in a calcium carbonate base, provided a significant
stratified, MFP 1450 ppm sodium reduction in dentin hypersensitivity when used over a
randomized study fluoride period of 8 weeks. The study also showed that the new
arginine toothpaste provided significantly greater
reductions (p < 0.05) in dentin hypersensitivity in response
to tactile (38.9%, 28.8% and 11.6%) and airblast (16.8%,
26.4% and 33.8%) stimuli than the benchmark
commercial desensitizing toothpaste containing 2%
potassium ion and 1450 ppm fluoride as NaF in a silica
base, after 2, 4 and 8 weeks of product use respectively.
Hamlin et al. 2009 Single-centre, 45 8% arginine, calcium Pumice prophylaxis Professional Immediate Tactile, airblast 45 subjects completed the study. At the final
(2009)† double-blind, carbonate paste prophylaxis hypersensitivity examinations, conducted immediately
parallel group, after the completion of the dental cleaning procedure,
stratified, subjects assigned to the test group exhibited statistically
randomized study significant improvements from baseline with respect to
baseline-adjusted mean tactile (132.1%) and airblast
hypersensitivity scores (48.6%). In addition, subjects
assigned to the control group exhibited a statistically
significant hypersensitivity improvement from baseline
with respect to baseline-adjusted mean airblast
hypersensitivity scores (13.9%). The hypersensitivity
improvement from baseline indicated for the control
group for mean tactile hypersensitivity scores (21.7%) was
not statistically significant. At the final hypersensitivity
examinations, statistically significant differences were
indicated between the test group and the control group
with respect to baseline-adjusted mean tactile (110.0%)
and airblast hypersensitivity scores (41.9%).
Nathoo et al. 2009 Single-centre, 125 8% arginine, calcium 2% potassium ion Self-administered Immediate, 3 days Tactile, airblast One hundred and twenty-five subjects complied with the
(2009)† double-blind, carbonate, dosed as 5% toothpaste study protocol and completed the study. Relative to the
parallel group, 1450 ppm sodium potassium nitrate, benchmark desensitizing toothpaste and the control
stratified, MFP 1450 ppm sodium toothpaste groups, the 8.0% arginine toothpaste group
randomized study fluoride exhibited statistically significant (p < 0.05) reductions in
dentin hypersensitivity on both tactile and airblast
hypersensitivity scores immediately after direct
application. Reductions in sensitivity for the 8.0%
arginine toothpaste compared to the benchmark
desensitizing toothpaste and control toothpaste were
161.2% and 180.2% (tactile), and 59.8% and 58.0%
(airblast) respectively. Relative to the benchmark
desensitizing toothpaste and control toothpaste groups,
the 8.0% arginine group exhibited statistically significant
(p < 0.05) reductions in sensitivity after the subsequent 3
days of twice daily regular toothbrushing of 147.1% and
181.2% (tactile), and 70.1% and 70.9% (airblast)
respectively.
i-
t-

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Schiff et al. 2009 Single-centre, 68 8% arginine, calcium Pumice prophylaxis Professional Immediate, 4, Tactile, airblast 68 subjects completed the 12-week study. No statistically
(2009)† double-blind, carbonate paste paste prophylaxis 12 weeks significant differences from baseline scores were indicated
parallel group, at the Post-Scaling Examinations for either the Test Paste
stratified, or Control Paste groups. Immediately following product
randomized study application and 4 weeks after product application,
subjects assigned to the Test Paste group exhibited
statistically significant improvements from baseline with
respect to baseline-adjusted mean airblast (44.1% and
45.9% respectively) and mean tactile hypersensitivity
scores (156.2% and 170.3% respectively). At the same
time points, subjects assigned to the Control Paste group
exhibited statistically significant improvements from
baseline with respect to baseline-adjusted mean airblast
(15.1% and 8.9% respectively) and mean tactile
hypersensitivity scores (43.1% and 8.3% respectively).
Immediately following application of the assigned paste
and 4 weeks later, the Test Paste group demonstrated
statistically significant reductions in dentin
hypersensitivity with respect to baseline-adjusted mean
airblast (34.1% and 40.6% respectively) and mean tactile
hypersensitivity scores (79.0% and 149.6% respectively),
compared to the Control Paste group. No statistically
significant differences were exhibited between paste groups
at the Post-Scaling and 12-week examinations with respect
to mean tactile and baseline-adjusted mean airblast
hypersensitivity scores
PVA/MA – Polymers
Elıas Boneta 2013 Single-centre, 118 Toothpaste: 8% Toothpaste: Toothpaste: 5% Self-administered 2, 4, 8 weeks Tactile, airblast 120 subjects were enrolled, 118 completed the study. The
et al. double-blind, arginine and containing potassium nitrate toothpaste/ Tactile hypersensitivity mean scores showed statistically

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
(2013b)† parallel group, 1450 ppm sodium 1450 ppm fluoride and 1450 ppm mouthrinse significant improvement at two, four and eight (p ≤ 0.001)
randomized study MFP, calcium in dicalcium base sodium fluoride, weeks in the arginine regime; the potassium regime did
carbonate + + fluoride/ silica base + not show significant (p ≥ 0.05) improvement. Airblast
Mouthwash: 0.8% arginine free mouthwash Hypersensitivity scores had a statistically significant
arginine, PVM/MA mouthwash. 0.51% potassium decrease at two (p = 0.006), four (p = 0.006) and eight
copolymer, chloride and (p = 0.002) weeks in arginine and potassium regimes
pyrophosphates and 230 ppm sodium (p ≤ 0.05). The most effective treatment proved to be
0.05% sodium fluoride, alcohol arginine (p ≤ 0.05) compared to the potassium regime.
fluoride, alcohol free base Arginine regimen provided the greatest reduction in
Tactile and Airblast dentine hypersensitivity compared to
potassium and negative control regimens; and provides
faster dentine hypersensitivity relief than potassium
regimen.
Elıas Boneta 2013 Single-centre, 69 8% arginine, PVM/ 0.05% sodium 2.4% potassium Self-administered 30 min, 2, 4, Tactile, airblast Seventy-five subjects were enrolled; 69 subjects completed
et al. parallel group, MA copolymer, fluoride nitrate and mouthrinse 6 weeks the study. There were no differences after 30 min of a
(2013a)† double-blind, pyrophosphates, 0.022% sodium single use, among the three groups with respect to mean
randomized study 0.05% sodium fluoride tactile and airblast hypersensitivity scores compared to
fluoride, alcohol free potassium nitrate and negative control mouthwashes
(p < 0.05). The arginine group presented a statistically
significant improvement in the mean tactile scores
compared to potassium nitrate and negative control
groups after 2, 4 and 6 weeks (p < 0.001) of product use;
the arginine group showed a statistically significant
enhancement in airblast hypersensitivity mean scores
compared to potassium nitrate and negative control
groups after two (p = 0.001), four (p < 0.001) and 6 weeks
(p < 0.001) of product use.
Hu et al. 2013 Single-centre, 90 8% arginine, PVM/ 0.05% sodium Self-administered 2, 4, 8 weeks Tactile, airblast Ninety (90) subjects entered and completed the 8 week
(2013)† double-blind, MA copolymer, fluoride, alcohol mouthrinse study. After 2, 4 and 8 weeks of product use, subjects in
parallel group, pyrophosphates, free the Arginine Mouthwash group exhibited statistically
randomized study 0.05% sodium significant (p < 0.05) improvements in mean tactile and
Management of dentine hypersensitivity

fluoride, alcohol free airblast hypersensitivity scores as compared to the

Negative Control Mouthwash.
S271
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S272

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

Chaknis et al. 2011 Single-centre, 118 0.3% triclosan, 0.243% sodium 0.454% stannous Self-administered 4, 8 weeks Tactile, airblast 118 subjects complied with the protocol, and completed the
(2011)† double-blind, 2.0% PVM/MA fluoride in a silica fluoride in a silica toothpaste 8-week study. At baseline, the mean tactile sensitivity
parallel group, copolymer base base with sodium scores for toothpastes (1), (2) and (3) were 13.6, 14.1 and
randomized study toothpastes, 0.243% hexameta 13.1; at 4 weeks 28.75, 20.13 and 20.00; and after 8 weeks
sodium fluoride and phosphate and 33.1, 24.0 and 20.5 respectively. The mean airblast scores
West et al.

specially designed zinc lactate for toothpastes (1), (2) and (3) at baseline were 2.5, 2.5
silica and 2.4; at 4 weeks 1.25, 1.50 and 1.85; and after 8 weeks
0.99, 1.36 and 1.5 respectively. At all time points after the
baseline examination, for both tactile and airblast
sensitivity scores, the differences between Test Dentifrice 1
and the Negative Control Dentifrice were statistically
significant (p < 0.05). The differences between Test
Dentifrice 1 and Test Dentifrice 2 were statistically
significant (p < 0.05) at 4 and 8 weeks after baseline
examination for tactile sensitivity scores and at 8 weeks
after baseline examination for airblast sensitivity scores.
Ayad et al. 1994 Parallel group, 97 5% potassium nitrate, 5% potassium Self-administered 6, 12 weeks Tactile, airblast After 6 weeks’ use of the assigned dentifrices, there were no
(1994)† stratified, 1.3% soluble nitrate, 0.76% toothpaste statistically significant differences between dentifrice
randomized study pyrophosphate, sodium MFP in a groups in any of the parameters assessed (tactile, cold
1.5% PVM/MA dicalcium airblast and visual analogue scale). After 12 weeks’ use of
copolymer, 0.243% phosphate the assigned products, there were no statistically
sodium fluoride in a dihydrate base significant differences between dentifrice groups in any of
silica base the parameters assessed (tactile, cold airblast and visual
analogue scale).
Schiff et al. 1994 Parallel group, 67 5% potassium nitrate, 1.3% soluble Self-administered 6, 12 weeks Tactile, thermal, After 6 weeks’ use of their assigned products, those subjects
(1994)† stratified, 1.3% soluble pyrophosphate, toothpaste airblast in the potassium nitrate/copolymer/pyrophosphate
randomized study pyrophosphate, 1.5% PVM/MA dentifrice group demonstrated statistically significant
1.5% PVM/MA copolymer, improvements (p < 0.01), as compared to the placebo
copolymer, 0.243% 0.243% sodium dentifrice, in the following parameters: 1) tactile; 2)
sodium fluoride in a fluoride in a silica thermal (threshold and pain); and 3) airblast. After
silica base base 12 weeks’ use of their assigned products, those subjects in
the potassium nitrate/copolymer/pyrophosphate dentifrice
group again demonstrated statistically significant
improvements (p < 0.01), in tactile, thermal (threshold
and pain) and airblast sensitivity, as compared to the
placebo dentifrice.
Potassium‡
Talesara et al. 2014 Single-centre, split- 20 (80 Potassium binoxalate Nd:YAG laser Professional Immediate, 3, 6, Airblast, thermal Both treatment modalities were effective in reducing dentine
(2014)† mouth, study teeth) gel application 9 months hypersensitivity. However, Nd:YAG laser was better when
intra-group comparison was made at 9 months post
treatment. Nd:YAG lasers is better in long-term treatment
(up to 9 months) owing to the melting of dentinal tubules.
However, due to depth of penetration of microcrystals,
gel was better when ease of the procedure is considered.
Nevertheless, both treatment modalities resulted in
recurrence.
Veitz-Keenan 2013 Multi-centre, 293 Potassium nitrate Resin restoration Self-administered 1, 3, 6 months Airblast Lesion depth and pre-treatment sensitivity (mean, 5.3 on a
et al. (2013) parallel group, dentifrice sealant toothpaste, 0- to 10-point scale) were balanced across treatments, as
stratified, professionally was sleep bruxism (present in 42.2% of participants). The
randomized study applied 6-month participant recall rate was 99%. Treatments
restoration/ significantly reduced mean sensitivity (p < 0.01), with the
sealant sealant and restoration groups displaying a significantly
higher reduction (p < 0.01) than did the dentifrice group.
The dentifrice group’s mean (standard deviation)
sensitivity at 6 months was 2.1 (2.1); those of the sealant
and restoration groups were 1.0 (1.6) and 0.8 (1.4)
respectively. Patient-reported sensitivity (to cold being
most pronounced) paralleled clinical measurements at
each evaluation.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Elıas Boneta 2013 Single-centre, 118 Toothpaste: 8% Toothpaste: Toothpaste: 5% Self-administered 2, 4, 8 weeks Tactile, airblast The Tactile hypersensitivity mean scores showed statistically
et al. double-blind, arginine and containing potassium nitrate toothpaste/ significant improvement at two, four and eight (p ≤ 0.001)
(2013b)† parallel group, 1450 ppm sodium 1450 ppm fluoride and 1450 ppm mouthrinse weeks in the arginine regime; the potassium regime did
randomized study MFP, calcium in dicalcium base sodium fluoride, not show significant (p ≥ 0.05) improvement. Airblast
carbonate + + Mouthwash: silica base + Hypersensitivity scores had a statistically significant
Mouthwash: 0.8% fluoride/arginine Mouthwash: decrease at two (p = 0.006), four (p = 0.006) and eight
arginine, PVM/MA free 0.51% potassium (p = 0.002) weeks in arginine and potassium regimes
copolymer, chloride and (p ≤ 0.05). The most effective treatment proved to be
pyrophosphates and 230 ppm sodium arginine (p ≤ 0.05) compared to the potassium regime.
0.05% sodium fluoride, alcohol
fluoride, alcohol free base
Sowinski et al. 2013 Double-blind, 100 Potassium nitrate Fluoride toothpaste Self-administered Intervals of up to Tactile, airblast Consistent with results from previous studies, subjects
(2013)† parallel group, toothpaste 8 weeks assigned dentifrices formulated with potassium nitrate or
randomized study 8% arginine/calcium carbonate demonstrated
improvements in Yeaple, airblast and VAS responses in
comparison to those assigned the fluoride dentifrice
(p < 0.05). Jay Probe responses correlated significantly
with all other sensitivity measures (p < 0.05). Differences
between these treatments were observed at all post-
treatment evaluations using these methods.
Kakar et al. 2012 Single-centre, 88 8% arginine calcium 2% potassium Self-administered 2, 4, 8 weeks Tactile, airblast Subjects who brushed with the new dentifrice containing
(2012b)† parallel group, carbonate nitrate toothpaste 8.0% arginine, calcium carbonate, and 1000 ppm MFP
double-blind, exhibited statistically significant reductions (p < 0.05) in
stratified dentin hypersensitivity in response to tactile (36.2%,
randomized study 33.1% and 29.7%) and airblast (16.4%, 31.1%, 58.8%)
stimuli when compared to the subjects who brushed with
the 2% potassium ion as potassium nitrate dentifrice after
2, 4 and 8 weeks respectively.
Elıas Boneta 2013 Single-centre, 69 8% arginine, PVM/ 0.05% sodium 2.4% potassium Self-administered 30 min, 2, 4, Tactile, airblast There were no differences after 30 min of a single use,

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
et al. parallel group, MA copolymer, fluoride nitrate, 0.022% mouthrinse 6 weeks among the three groups with respect to mean tactile and
(2013a)† double-blind, pyrophosphates, mouthwash. sodium fluoride airblast hypersensitivity scores compared to potassium
randomized study 0.05% sodium nitrate and negative control mouthwashes (p < 0.05). The
fluoride, alcohol free arginine group presented a statistically significant
improvement in the mean tactile scores compared to
potassium nitrate and negative control groups after 2, 4
and 6 weeks (p < 0.001) of product use; the arginine
group showed a statistically significant enhancement in
airblast hypersensitivity mean scores compared to
potassium nitrate and negative control groups after two
(p = 0.001), four (p < 0.001) and 6 weeks (p < 0.001) of
product use.
Craig et al. 2012 Double-blind, split- 19 38% diamine silver Oxalic acid-based Professionally 1 week Thermal The mean difference between VAS at baseline and 7 days
(2012)† mouth, fluoride, saturated preparation applied for teeth treated with diamine silver fluoride/potassium
randomized study solution of containing iodide was greater than that for teeth treated with the
potassium iodide potassium oxalic acid-based preparation (p = 0.0134). The subjects’
subjective assessment of changes in dentine
hypersensitivity indicated that more obtained relief with
the diamine silver fluoride/potassium iodide treatment
(p = 0.0129).
Pradeep et al. 2012 Single-centre, triple- 150 5% potassium nitrate Placebo 5% calcium sodium Self-administered 2, 6 weeks Airblast, thermal All groups showed a reduction in sensitivity scores at
(2012)† blind, parallel phosphosilicate toothpaste 2 weeks and 6 weeks. The calcium sodium phosphosilicate
group, fused silica. group was found to be significantly better compared to
randomized study 3.85% amine the other groups at the end of 6 weeks.
fluoride
Management of dentine hypersensitivity
S273
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S274

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

Liu & Hu 2012 Single-centre, 79 2% strontium Dentifrice Self-administered Immediate, 3 days Tactile, airblast A total of 81 patients were enrolled (40 in the experimental
(2012) double-blind, chloride, 5% containing the toothpaste group; 41 in the control group), of whom 79 (55 women;
parallel-group, potassium nitrate, same silica base 24 men) completed the study. After topical use, the
randomized study silica base without any experimental group had a significantly higher mean (SD)
active ingredient tactile hypersensitivity score (19.47 [14.69] vs 14.27 [5.76];
West et al.

p = 0.047) and a significantly lower mean airblast

hypersensitivity score (1.93 [0.51] vs 2.22 [0.60]; p = 0.026)
than did the control group. After 3 days, the experimental
group had a significantly higher mean tactile
hypersensitivity score (19.87 [14.95] vs 14.51 [6.00];
p = 0.045) and a significantly lower airblast
hypersensitivity score (1.80 [0.56] and 2.13 [0.60];
p = 0.014) than the control group. After topical use and
after 3 days, the experimental group had increases from
baseline in tactile scores of 54.04% and 56.67%
respectively (both, p = 0.001) and reductions from
baseline in airblast scores of 18.51% and 24.21% (both,
p < 0.001); the control group had increases in tactile
scores of 21.14% and 21.54% (p = 0.022 and p = 0.007)
and reductions in airblast scores of 10.24% and 13.41%
(p = 0.001 and p < 0.001). No adverse events were
reported throughout the study.
Ni et al. 2010 Single- 58 Stannous- Potassium Self- 4, 8 Tactile, Fifty-eight subjects completed all evaluations. Both the
(2010)† centre, containing nitrate admini weeks airblast experimental stannous-containing and positive control
double- sodium stered dentifrices provided significant (p < 0.05) reductions in
blind, fluoride toothpaste both tactile and thermal dentin hypersensitivity compared
parallel dentifrice to baseline at both Weeks 4 and 8. There were no
group, significant differences in Yeaple Probe or Schiff Air Index
strati results between the dentifrices with either efficacy
fied, measurement at Week 4 and Week 8 (p ≥ 0.5375).
rando
mized
study
Sharma et al. 2010 Single-centre, 120 5% potassium nitrate 7.5% calcium Self-administered 2, 4, 12 weeks Airblast, thermal All three products significantly reduced sensitivity versus
(2010)† double-blind, toothpaste sodium toothpaste baseline at each time point, although the calcium sodium
parallel group, phosphosilicate phosphosilicate (NovaMinâ) dentifrice reduced sensitivity
stratified, toothpaste significantly more than the others at the 2- and 4-week
randomized study 0.4% stannous time points. At the 2-week time point, for air and water,
fluoride gel respectively, the dentifrice containing NovaMinâ reduced
sensitivity 45% and 49%, the stannous fluoride gel 30%
and 26%, and the potassium nitrate dentifrice 35% and
34%. At the 12-week time point, the dentifrice containing
NovaMinâ reduced sensitivity 87% and 91%, stannous
fluoride gel 87% and 85%, and potassium nitrate
dentifrice 84% and 79%.
Pradeep & 2010 Single-centre, triple- 110 5% potassium nitrate Toothpaste with 5% calcium sodium Self-administered 2, 6 weeks Airblast, thermal All three groups showed reduction in sensitivity scores at
Sharma blind, parallel fused silica, no phosphosilicate toothpaste 2 weeks and 6 weeks for air stimulus and cold water. The
(2010)† group, calcium sodium with fused silica calcium sodium phosphosilicate group, however, was
randomized study phosphosilicate found to be significantly better in reducing the visual
analogue scale score compared to the potassium nitrate
group and the placebo group at any time point for both
measures of sensitivity.
Prasad et al. 2010 Single-centre, 60 Potassium citrate, 0.3% triclosan, 2% Self-administered 6, 12 weeks Tactile, thermal The two teeth that were selected in each patient were
(2010)† examiner-blind, sodium MFP, copolymer, toothpaste designated as two different sets. The 12th-week scores as
parallel group, sodium fluoride advanced silica compared to baseline scores for tactile, heat and cold tests
randomized study system in the test group showed a reduction in tooth
hypersensitivity by 36.67% (p < 0.01), 20.35% (p < 0.01)
and 53.64% (p < 0.01), respectively, in the first set of
teeth and 43.75% (p < 0.01), 24.48% (p < 0.01) and
59.78% (p < 0.01), respectively, in the second set of teeth.
The 12th-week scores as compared to baseline scores for
tactile, heat and cold tests in the control group showed a
reduction in tooth hypersensitivity by 42.86% (p < 0.01),
13.02% (p < 0.01) and 45.14% (p < 0.01), respectively, in
the first set of teeth and 40% (p < 0.01), 16.59%
(p < 0.01) and 44.16% (p < 0.01), respectively, in the

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
second set of teeth.
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Docimo et al. 2009 Single-centre, 80 8% arginine, calcium 2% potassium ion, Self-administered 1, 2, 4, 8 weeks Tactile, airblast This clinical study demonstrated that the new toothpaste,
(2009b)† double-blind, carbonate, dosed as 5.0% toothpaste containing 8.0% arginine and 1450 ppm fluoride as MFP
parallel group, 1450 ppm sodium potassium nitrate, in a calcium carbonate base, provided a significant
stratified, MFP 1450 ppm sodium reduction in dentin hypersensitivity when used over a
randomized stud fluoride period of 8 weeks. The study also showed that the new
arginine toothpaste provided significantly greater
reductions (p < 0.05) in dentin hypersensitivity in response
to tactile (38.9%, 28.8% and 11.6%) and airblast (16.8%,
26.4% and 33.8%) stimuli than the benchmark
commercial desensitizing toothpaste containing 2%
potassium ion and 1450 ppm fluoride as NaF in a silica
base, after 2, 4 and 8 weeks of product use respectively.
Nathoo et al. 2009 Single-centre, 125 8% arginine, calcium 2% potassium ion Self-administered Immediate, 3 days Tactile, airblast One hundred and twenty-five subjects complied with the
(2009)† double-blind, carbonate, dosed as 5% toothpaste study protocol and completed the study. Relative to the
parallel group, 1450 ppm sodium potassium nitrate, benchmark desensitizing toothpaste and the control
stratified, MFP 1450 ppm sodium toothpaste groups, the 8.0% arginine toothpaste group
randomized study fluoride exhibited statistically significant (p < 0.05) reductions in
dentin hypersensitivity on both tactile and airblast
hypersensitivity scores immediately after direct
application. Reductions in sensitivity for the 8.0%
arginine toothpaste compared to the benchmark
desensitizing toothpaste and control toothpaste were
161.2% and 180.2% (tactile), and 59.8% and 58.0%
(airblast) respectively. Relative to the benchmark
desensitizing toothpaste and control toothpaste groups,
the 8.0% arginine group exhibited statistically significant
(p < 0.05) reductions in sensitivity after the subsequent 3
days of twice daily regular toothbrushing of 147.1% and
181.2% (tactile), and 70.1% and 70.9% (airblast)

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
respectively.
Ayad et al. 2009 Double-blind, 120 8% arginine, calcium Toothpaste 2% potassium ion Self-administered Immediate, 3 days Tactile, airblast Relative to the desensitizing toothpaste and the control
(2009a) parallel group, carbonate, containing dosed as 5% toothpaste toothpaste groups, the 8.0% arginine toothpaste group
randomized study 1450 ppm MFP 1450 ppm sodium potassium nitrate, exhibited statistically significant (p < 0.05) reductions in
MFP 1450 ppm sodium dentin hypersensitivity on both tactile and airblast
fluoride measures immediately after completion of the first phase
of the study. Reductions in sensitivity for the 8.0%
arginine toothpaste, compared to the benchmark
desensitizing toothpaste and the control toothpaste, were
130.7% and 139.5% (tactile), and 43.8.0% and 49.6%
(airblast) respectively. Relative to the benchmark
desensitizing toothpaste and control toothpaste groups,
the 8.0% arginine group also exhibited statistically
significantly (p < 0.05) reductions in sensitivity after
completion of the second phase of the study, of 104.9%
and 136.1% (tactile), and 44.5% and 53.2% (airblast)
respectively. There was no loss of the instant relief effects
in the 8.0% arginine group after the brushing period.
Docimo et al. 2009 Single-centre, 80 8% arginine, calcium 2% potassium ion, Self-administered 2, 4, 8 weeks Tactile, airblast This clinical study showed that the new toothpaste,
(2009a)† parallel-group, carbonate, dosed as 3.75% toothpaste containing 8.0% arginine and 1450 ppm fluoride as MFP
double-blind, 1450 ppm sodium potassium in a calcium carbonate base provided a significant
stratified MFP chloride, reduction in dentin hypersensitivity when used over a
randomized study 1450 ppm sodium period of 8 weeks. The study also showed that this new
fluoride arginine toothpaste provided significantly greater
reductions (p < 0.05) in dentin hypersensitivity in response
to tactile (37.0%, 30.0% and 12.2%) and airblast (23.9%,
32.0% and 29.3%) stimuli than the commercial sensitive
toothpaste containing 2% potassium ion and 1450 ppm
fluoride as NaF in a silica base, after 2, 4 and 8 weeks of
product use respectively.
Management of dentine hypersensitivity
S275
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S276

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

Ayad et al. 2009 Double-blind, 77 8% arginine, calcium 2% potassium ion, Self-administered 2, 4, 8 weeks Tactile, airblast This clinical study demonstrated that the new toothpaste,
(2009b)† parallel group, carbonate, dosed as 3.75% toothpaste containing 8.0% arginine and 1450 ppm MFP in a
stratified, 1450 ppm sodium potassium calcium carbonate base, provided a significant reduction
randomized study MFP chloride, in dentin hypersensitivity when used over a period of 8
1450 ppm sodium weeks. The study also showed that this new arginine
West et al.

fluoride toothpaste provided significantly greater reductions

(p < 0.05) in dentin hypersensitivity in response to tactile
(16.2%, 22.4% and 21.4%) and airblast (16.2%, 29.2%
and 63.4%) stimuli than the benchmark commercial
toothpaste containing 2% potassium ion and 1450 ppm
NaF in a silica base, after 2, 4 and 8 weeks of product
use respectively.
Docimo et al. 2007 Double-blind, 75 5.5% potassium 3.75% potassium Self-administered 2, 4 weeks Tactile airblast There was no statistically significant difference in tactile
(2007)† parallel group, citrate chloride toothpaste sensitivity scores and airblast sensitivity scores between
stratified, the tested toothpastes at baseline, 2 weeks and 4 weeks.
randomized study Both toothpastes provided statistically significant
improvement in tactile sensitivity scores and airblast
sensitivity scores after 2 weeks of use and 4 weeks of use
as compared to baseline scores.
Wara-aswapati 2005 Double-blind, 102 5% potassium nitrate, 0.76% sodium 5% potassium Self-administered 4, 12 weeks Tactile, airblast Overall, the GBI scores were significantly reduced
et al. (2005)† parallel group, 0.3% triclosan, MFP nitrate, 0.76% toothpaste compared with baseline in all groups (p < 0.01). However,
randomized study 0.76% sodium MFP SMFP there was no significant difference in GBI score among
the three comparison groups. The PI score decreased in
the test group and benchmark group from baseline to the
end of study, whereas there was no significant change in
the control group. Post hoc comparison indicated that the
PI score was not statistically different between the three
groups. There was a significant difference between the
three treatment groups for sensitivity. For both the tactile
and air stimuli, the reductions in VAS sensitivity scores
for the test group and the control group were significantly
greater compared with the benchmark group. Although
the sensitivity score for air stimulus decreased more
rapidly from baseline to week 4 in the test group, there
was no overall difference between the test group and the
control group.
Schiff et al. 1998 Parallel group, 48 5.0% potassium Placebo without Self-administered 4, 8 weeks Tactile, airblast After 4 weeks’ use of their assigned products, those subjects
(1998)† randomized study nitrate, 1500 ppm potassium nitrate toothpaste in the potassium nitrate/PCC dentifrice group
sodium MFP in a demonstrated statistically significant improvements
precipitated calcium (p < 0.0001), as compared to the placebo dentifrice
carbonate base without potassium nitrite, in tactile and thermal
sensitivity. After 8 weeks’ use of their assigned products,
those subjects in the potassium nitrate/PCC dentifrice
group again demonstrated statistically significant
improvements (p < 0.0001), in tactile and thermal
sensitivity, as compared to the placebo dentifrice without
potassium nitrate.
Yates et al. 1998 Single-centre, 83 2% tripotassium Placebo mouthrinse Self-administered 28, 56 days Tactile, airblast Both groups showed highly significant improvements in
(1998b)† double-blind, citrate monohydrate, without active toothpaste/ tooth sensitivity. The pattern was for greater
parallel group, 0.5% ingredients + mouthrinse improvement in the test compared to the control group
randomized study cetylpyridinium standard (statistically significant for the plaque score), whereas
chloride, 0.05% toothpaste bleeding scores, already low, showed no change in either
sodium fluoride (1000 ppm group. By definition, the placebo rinse could not have
mouthrinse + fluoride) exerted any therapeutic action; the study therefore
standard toothpaste provides clear direct evidence as to the magnitude (30%–
(1000 ppm fluoride) 40%) of the little studied, but assumed, placebo response
in dentine hypersensitivity trials.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

West et al. 1997 Single-centre, 112 Potassium nitrate, Sodium MFP Strontium acetate, Self-administered 2, 6 weeks Tactile, airblast All 3 toothpaste groups showed reductions in sensitivity
(1997)† double-blind, sodium fluoride sodium fluoride toothpaste over the 6 weeks; however, no significant differences were
parallel group, found between the three products at any given time.
randomized study Interestingly, there was no significant change in sensitivity
between wash-in baseline and treatment baseline for the
cold air stimulus with the fluoride-only based paste.
However, for the group using the same fluoride
toothpaste, there was significant improvement between
wash-in baseline and week 6, and treatment baseline and
week 6 for this stimulus, suggesting a substantial placebo
effect occurred.
Silverman 1996 Multi-centre, 220 5% potassium nitrate, Placebo (0% 10% strontium Self-administered 2, 4, 8 weeks Tactile, airblast Results demonstrated that after 4 weeks, participants who
et al. (1996)† double-blind, 0.243% sodium potassium nitrate, chloride toothpaste used the new dentifrice formulation experienced
parallel group, fluoride 0% strontium 5% potassium significant decreases in dentinal sensitivity compared to
randomized study chloride, 0% nitrate the placebo group for all measured indexes.
sodium fluoride)
Chesters et al. 1992 Double-blind, 111 Potassium citrate, Sodium MFP Potassium nitrate, Self-administered 3, 8 weeks Tactile, airblast, All 3 dentifrice groups showed statistically significant
(1992)† parallel group, sodium MFP placebo sodium MFP toothpaste electrical reductions in sensitivity over the 8 weeks. However, the
randomized study potassium citrate-SMFP dentifrice was significantly more
effective than either the control SMFP dentifrice, or the
potassium nitrate-SMFP dentifrice, at reducing sensitivity
after 3 weeks, and this difference plus further sensitivity
reduction with all 3 dentifrices was observed after
8 weeks.
Casein Derivatives (Amorphous calcium phosphate (ACP) and casein phosphopeptide CPP)
Torwane et al. 2013 Single-centre, 13 (74 30% ethenolic extract Warm distilled RecaldentTM (casein Professional Immediate, 7, 14, Tactile, airblast Both the 30% Indian propolis and RecaldentTM showed
(2013) double-blind, teeth) of Indian propolis water phosphopeptide- prophylaxis 21 days significant reduction in DH. RecaldentTM was found to be
split-mouth, amorphous significantly better in reducing the DH compared to
randomized trial calcium propolis and sterile water (p < 0.01)

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
phosphate)
Geiger et al. 2003 Parallel group, 30 Amorphous calcium 1.0 mol/L aqueous Professional 7, 28, 180 days Tactile, airblast The results showed that both the experimental and placebo
(2003) randomized study phosphates (ACP) solution of KCl prophylaxis treatments resulted in a reduction in hypersensitivity at
180 days. However, the ACP treatment group showed a
much more rapid reduction in hypersensitivity over time.
The change in sensitivity was much more apparent using
the air stimulus than the tactile stimulus.
Yates et al. 1998 Single-centre, 36 Calcium chloride + Water Professional 2, 7, 14, 21, 28, 56, Tactile, airblast, Overall sensitivity decreased considerably and to a similar
(1998a)† double-blind, potassium prophylaxis 84 days thermal degree in test and control teeth with no consistent
split-mouth, phosphate (ACP) significant treatment difference. Plaque scores also
randomized trial decreased through the study period.
Strontium§
Orsini et al. 2013 Single-centre, 85 8% strontium acetate, 8% arginine, Self-administered 3 days Tactile, airblast, The final sample consisted of 85 individuals: 29 received the
(2013)† double-blind, 1040 ppm sodium calcium carbonate toothpaste thermal arginine-based dentifrice (group 1), 27 the strontium
parallel group, fluoride and 1450 ppm acetate-based dentifrice (group 2), and 29 the dentifrice
randomized trial sodium MFP based on zinc-carbonate hydroxyapatite (group 3). All
30% zinc dentifrices were mostly effective to reduce DH: the
substituted- percentage of score reduction from baseline to 3 days was
carbonate >30% for all tests (except for subjective test of group 2).
hydroxyapatite The comparison among the three dentifrices showed that,
nanocrystals after 3 days, there was an improvement in airblast (mean
percentage of reduction, 39.2% in group 1, 42.0% in
group 2, and 39.2% in group 3), cold water (41.5%,
51.8% and 50%), tactile (50.3%, 40.1% and 33.8%), and
subjective (33.1%, 17.4% and 31.4%) test scores, with
differences being significant for cold water and subjective
tests. For airblast and tactile tests, there were no
significant differences across groups at 3 days. Moreover,
no significant differences at any test were observed in a
subset of patients that were followed up to 8 weeks: all
dentifrices were all highly efficacious.
Management of dentine hypersensitivity
S277
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S278

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

West et al. 2013 Single-centre, 80 8% strontium acetate, 8% arginine, Self-administered Immediate, 3 days Tactile, airblast All 80 subjects completed the study. Results confirm that
(2013a)† single-blind, silica with 1040 ppm calcium carbonate toothpaste for both treatments, pain was reduced immediately and
parallel group, sodium fluoride with 1450 ppm relief was sustained after 3 days use. For all 3 measures,
stratified and sodium MFP benefit was similar between the two pastes, with no
randomized study statistical or clinical difference demonstrated, apart from
West et al.

response to evaporative stimulus at 3 days, where Schiff

scores were significantly lower in the arginine group,
p = 0.02.
Liu & Hu 2012 Single-centre, 79 2% strontium Dentifrice Self-administered Immediate, 3 days Tactile, airblast A total of 81 patients were enrolled (40 in the experimental
(2012) double-blind, chloride, 5% containing the toothpaste group; 41 in the control group), of whom 79 (55 women;
parallel-group, potassium nitrate, same silica base 24 men) completed the study. After topical use, the
randomized study silica base without any experimental group had a significantly higher mean (SD)
active ingredient tactile hypersensitivity score (19.47 [14.69] vs 14.27 [5.76];
p = 0.047) and a significantly lower mean airblast
hypersensitivity score (1.93 [0.51] vs 2.22 [0.60]; p = 0.026)
than did the control group. After 3 days, the experimental
group had a significantly higher mean tactile
hypersensitivity score (19.87 [14.95] vs 14.51 [6.00];
p = 0.045) and a significantly lower airblast
hypersensitivity score (1.80 [0.56] and 2.13 [0.60];
p = 0.014) than the control group. After topical use and
after 3 days, the experimental group had increases from
baseline in tactile scores of 54.04% and 56.67%
respectively (both, p = 0.001) and reductions from
baseline in airblast scores of 18.51% and 24.21% (both,
p < 0.001); the control group had increases in tactile
scores of 21.14% and 21.54% (p = 0.022 and p = 0.007)
and reductions in airblast scores of 10.24% and 13.41%
(p = 0.001 and p < 0.001). No adverse events were
reported throughout the study.
Schiff et al. 2011 Double-blind, 121 8% strontium acetate, 8% arginine, Self-administered Product 1 (phase Tactile, airblast One hundred and twenty-one subjects complied with the
(2011)† crossover, silica, 1040 ppm calcium toothpaste 1): 8 weeks, study protocol and completed the study. Study Phase I:
randomized study sodium fluoride carbonate, product 2 (phase Subjects who brushed twice daily for 8 weeks with the
1450 ppm sodium 2): 2, 8 weeks arginine/calcium carbonate dentifrice experienced
MFP statistically significant improvements in mean tactile and
airblast hypersensitivity scores (51.3% and 39.4%
respectively) relative to that experienced by subjects who
brushed with the strontium acetate dentifrice. Study Phase
II: Subjects who brushed with the arginine/calcium
carbonate dentifrice for the first 8 weeks of the study and
then switched to brush with the strontium acetate
dentifrice for the second 8 weeks of the study, did not
exhibit further improvements in mean tactile or mean
airblast hypersensitivity scores after 2 and 8 weeks of
switch-over product use. However, subjects who brushed
with the strontium acetate dentifrice for the first 8 weeks
of the study and then switched to brush with the arginine/
calcium carbonate dentifrice exhibited statistically
significant improvements in mean tactile and airblast
hypersensitivity scores 2 weeks (35.2% and 29.9%
respectively) and 8 weeks (40.3% and 35.3% respectively)
after product switch-over. Relative to the subjects who
switched from twice daily brushing with the arginine/
calcium carbonate dentifrice to brush with the strontium
acetate dentifrice, those who switched from brushing with
the strontium acetate dentifrice to brush with the
arginine/calcium carbonate dentifrice exhibited statistically
significant improvements in mean tactile hypersensitivity
scores (10.3%) and in mean airblast hypersensitivity
scores (16.3%) 8 weeks after product switch-over.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Docimo et al. 2011 Single-centre, 150 8% strontium acetate, Fluoride toothpaste 8% arginine and Self-administered 2, 4, 8 weeks Tactile, airblast After 2, 4 and 8 weeks of daily use of the products, all
(2011)† double-blind, silica with 1040 ppm (Crest cavity calcium carbonate toothpaste three groups showed a statistically significant reduction
parallel group, sodium fluoride protection) with 1450 ppm from baseline in tactile and airblast dentin hypersensitivity
randomized study (Sensodyne Rapid MFP (Colgate (p < 0.05). Colgate Sensitive Pro-Relief toothpaste
Relief) sensitive Pro- produced a significant improvement in mean tactile and
Relief) airblast dentin hypersensitivity scores, and was more
effective than Sensodyne Rapid Relief toothpaste and
Crest Cavity Protection toothpastes (p < 0.05).
Li et al. 2011 Double-blind, 150 8% strontium acetate, 1100 ppm fluoride 8% arginine, Self-administered Immediate, 7 days Tactile, airblast All 150 subjects complied with the protocol and completed
(2011)† randomized study silica, 1040 ppm as NaF in a silica calcium toothpaste the study. The positive control toothpaste containing
sodium fluoride base carbonate, 8.0% arginine and 1450 ppm fluoride as MFP in a
1450 ppm sodium calcium carbonate base provided statistically significant
MFP improvements in mean tactile and airblast dentin
hypersensitivity scores compared to the negative control
toothpaste containing 1100 ppm fluoride as NaF in a
silica base (p < 0.05). The toothpaste containing 8.0%
arginine and 1450 ppm fluoride as MFP in a calcium
carbonate base (positive control) also provided
statistically significant improvements in mean tactile and
airblast dentin hypersensitivity scores compared to the test
toothpaste containing 8% strontium acetate and
1040 ppm fluoride as NaF in a silica base. The test
toothpaste and the negative control toothpaste were not
significantly different from each other.
Hughes et al. 2010 Examiner-blind, 77 8% strontium acetate, 8% arginine, Self-administered 2, 4, 8 weeks Tactile, airblast Seventy-seven subjects completed this clinical study. Both
(2010)† parallel group, 1040 ppm sodium calcium toothpaste subject groups exhibited significant cumulative reductions
randomized study fluoride carbonate, from baseline to Days 14, 28 and 56 in dentin
1450 ppm sodium hypersensitivity as measured by Schiff, Yeaple and VAS
MFP (for the 8% strontium acetate group, p ≤ 0.0001 for all

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
time points; for the 8% arginine/calcium carbonate group,
p = 0.0031 for Yeaple at Day 14, p = 0.0015 for VAS at
Day 14 and p < 0.0001 for all remaining measures and
time points). No significant differences (p > 0.05) were
observed between treatments for any of the time points
and measures except for tactile sensitivity at Day 56, for
which the 8% strontium acetate-based dentifrice was
statistically superior (p = 0.0391) to the control 8%
arginine/calcium carbonate dentifrice.
Mason et al. 2010 Examiner-blind, 79 8% strontium acetate, 1450 ppm sodium Self-administered Immediate, 3 days Tactile, airblast Seventy-nine subjects completed this clinical study. Both
(2010)† parallel group, 1040 ppm sodium fluoride in a silica toothpaste subject groups exhibited reductions in dentin
stratified, fluoride in a silica base, hypersensitivity directly after a single dab-on application.
randomized study base These reductions were significant across all measures for
the test dentifrice. Between-treatment analyses showed the
test dentifrice to be significantly better at relieving
subjects’ sensitivity across all measures (Schiff p = 0.0003,
tactile p = 0.0003 and VAS p = 0.0077) compared to the
control. After the additional 3 days of twice daily
brushing, between-treatment analyses showed the test
dentifrice to be significantly better at relieving subjects’
sensitivity across all measures (Schiff p = 0.0102, tactile
p = 0.0493 and VAS p = 0.0067) than the control
dentifrice.
Kobler et al. 2008 Multi-centre, 132 Strontium chloride- Placebo Professional 2, 8, 12, 24 weeks Tactile, airblast A reduction in discomfort and pain was observed in 95
(2008)† double-blind, containing varnish application patients (72%) after treatment with SR. Statistical
randomized study desensitizer, analysis showed a significant positive effect of SR
compared to the placebo group (p < 0.05, McNemar test).
Management of dentine hypersensitivity
S279
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S280

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

Du Min et al. 2008 Double-blind, 71 Toothpaste with Placebo toothpaste Toothpaste Self-administered 2, 6 weeks Airblast, thermal The placebo and the NovaMinâ groups showed a
(2008)† parallel group, calcium sodium containing toothpaste statistically significant decrease in sensitivity by both
randomized study phosphosilicate strontium measures after 6 weeks (p < 0.05). The SrCl2 group
chloride showed a statistically significant decrease from baseline at
the 2-week time point, but not at the 6-week time point
West et al.

for the evaporative stimulus. The percent reduction in

sensitivity at 6 weeks for the NovaMinâ test group was
35% for air and 39% for cold water stimulus, versus 11%
for air and 22% for cold water for the SrCl2 paste. The
reductions for the placebo paste were 21% for the air
stimulus and 18% for water. A cross-tabulation measure
of the reduction in sensitivity at each time point for all
three treatments showed that the NovaMinâ product was
more effective than either of the other products. For the
air stimulus in the NovaMinâ group, 58% of subjects
improved at each time point compared with 26% for the
SrCl2 group and 20% for the placebo group.
West et al. 1997 Single-centre, 112 Strontium acetate, Sodium MFP Potassium nitrate, Self-administered 2, 6 weeks Tactile, airblast Of the original 120 subjects, 112 completed the trial. All 3
(1997)† double-blind, sodium fluoride sodium fluoride toothpaste toothpaste groups showed reductions in sensitivity over
parallel group, the 6 weeks; however, no significant differences were
randomized study found between the three products at any given time.
Interestingly, there was no significant change in sensitivity
between wash-in baseline and treatment baseline for the
cold air stimulus with the fluoride-only based paste.
However, for the group using the same fluoride
toothpaste, there was significant improvement between
wash-in baseline and week 6, and treatment baseline and
week 6 for this stimulus, suggesting a substantial placebo
effect occurred.
Gillam et al. 1996 Two-centre, double- 56 8% strontium acetate, 0.75% sodium 3.75% potassium Self-administered 2, 6 weeks Tactile, airblast Results for Yeaple probe scores (Wilcoxon tests) between
(1996)† blind, parallel 0.23% sodium MFP, 0.13% chloride, 0.8% toothpaste 2 weeks and baseline were highly significant for KCl/
group study fluoride calcium glycero sodium MFP MFP, significant for NaMFP and non-significant for
phosphate, SrAc2F; scores between 6 weeks and baseline were,
0.016% sodium however, highly significant for all groups. Subjective
fluoride Yeaple probe VAS scores (paired t-tests) between 6 weeks
and baseline were significant for all groups; significance
was demonstrated in the KCl/MFP group between
2 weeks and baseline. Subjective air visual analogue
scores (paired t-tests) between 2 weeks and baseline were
highly significant for all groups. There were no significant
differences between groups at any time point.
Silverman 1996 Multi-centre, 220 5% potassium nitrate, Placebo (0% 1% strontium Self-administered 2, 4, 8 weeks Tactile, airblast Results demonstrated that after 4 weeks, participants who
et al. (1996)† double-blind, 0.243% sodium potassium nitrate, chloride toothpaste used the new dentifrice formulation experienced
parallel group, fluoride 0% strontium 5% potassium significant decreases in dentinal sensitivity compared to
randomized study chloride, 0% nitrate the placebo group for all measured indexes.
sodium fluoride)
Pearce et al. 1994 Single-centre, 119 10% strontium 0.76% sodium 8% strontium Self-administered 1, 4, 8, 12 weeks Tactile, thermal, There was an overall and progressive reduction in all
(1994)† double-blind, chloride monofluoro acetate, 0.23% toothpaste airblast sensitivity parameters in the three groups with no
parallel group, phosphate, 0.1% sodium fluoride significant differences between the treatments. Plaque and
study sodium fluoride gingivitis scores were already relatively low in this patient
group at baseline but improved further as the study
continued. The improvements, however, were comparable
in the three groups. Under the conditions of this clinical
trial the 2 desensitizing toothpastes showed similar
reductions, but no greater than that observed in the
conventional fluoride toothpaste.
Gillam et al. 1992 Double-blind 40 Strontium chloride Strontium chloride Self-administered 4, 8 weeks Tactile, airblast There was no difference between the dentifrices as regards
(1992b)† parallel group, hexahydrate with hexahydrate with toothpaste reduction in cervical dentinal hypersensitivity at each time
randomized study silica abrasive diatomaceous point. The response to both dentifrices was evident within
earth abrasive 4 weeks of use and the degree of improvement increased
system throughout the 8-week study period. The results support
the conclusion that changing the abrasive component of
SCH dentifrices did not significantly increase or decrease
the (desensitizing) activity of the original product.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Gillam et al. 1992 Double-blind 40 Strontium chloride Strontium chloride Self-administered 12 weeks post Tactile, airblast The results from these methods of assessment demonstrated
(1992a)† parallel group, hexahydrate with hexahydrate with toothpaste treatment regime that 12 weeks following the cessation of 8 weeks’
randomized study silica abrasive diatomaceous controlled use of standard and low abrasive SCH
earth abrasive dentifrices, sensitivity levels reversed on slightly in both
system groups and, overall, sensitivity remained significantly
lower than at baseline. The abrasivity of the dentifrice did
not affect the desensitivity activity.
Minkoff & 1987 Double-blind, 57 10% strontium Placebo Self-administered 2, 4, 8, 12 weeks Tactile, airblast The results from all three methods of assessment indicated
Axelrod parallel group, chloride hexahydrate toothpaste (thermal that the strontium chloride dentifrice, in comparison with
(1987)† randomized study threshold) a placebo, reduced dentinal hypersensitivity to a
significantly greater degree. This therapeutic response to
the active agent was apparent within 2 weeks and
increased continuously thereafter for the length of the
study. One can conclude that the regular at-home use of a
dentifrice containing 10% strontium chloride hexahydrate
is an effective means for reducing the discomfort and pain
engendered by thermal and tactile stimuli in patients with
dentinal hypersensitivity.
Collins & 1984 Single-centre, 89 10% strontium Sodium citrate in Sodium citrate in Self-administered 2, 4, 8 weeks Tactile, airblast The three dentifrices relieved both tactile and thermal
Perkins double-blind, chloride pluronic gel pluronic gel with toothpaste and sensitivity, but there was no statistical difference at
(1984)† parallel group, 0.2% sodium gel 8 weeks between the three agents. There was a difference
randomized study fluoride in the time it took the dentifrices to achieve a statistically
significant reduction in dentin sensitivity.
Stannous fluoride¶
He et al. 2014 Single-centre, 116 0.454% stannous Sodium fluoride Self-administered Immediate, 3 days, airbalst, tactile All 116 enrolled subjects completed all evaluations. The
(2014)† double-blind, fluoride dentifrice toothpaste 2 weeks stannous fluoride dentifrice provided significantly
parallel group, (p < 0.0001) superior dentin hypersensitivity reduction
stratified, compared to the negative control dentifrice at each time
randomized study point and by both evaluation measures: superior mean

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
relative Yeaple Probe (tactile) benefits were 124.5% after
one use, 203.8% after 3 days, and 222.5% after 2 weeks;
and superior mean relative Schiff Air Index (thermal)
benefits were 27.6% after a single use, 44.6% at Day 3,
and 74.2% at Week 2. Both dentifrices were well
tolerated.
Parkinson 2013 Single-centre, 117 0.454% stannous Standard fluoride Self-administered 4, 8 weeks Tactile, airblast 117 subjects completed the clinical study. At the 4- and 8-
et al. (2013)† examiner-blind, fluoride, 1000 ppm toothpaste toothpaste week time points, between-treatment analyses
parallel group, sodium MFP (Colgate Cavity demonstrated the test dentifrice to be significantly better
stratified, anhydrous dentifrice Protection) at relieving subjects’ sensitivity, for both validated clinical
randomized study measures, compared to the negative control (at 4 weeks
Schiff p < 0.0001 tactile threshold p < 0.0001; at 8 weeks
Schiff p < 0.0001; tactile threshold p < 0.0001).
He et al. 2011 Single-centre, 78 0.454% stannous 8% arginine, Self-administered Immediate, 3 days, Airblast 40 subjects in the SnF2 dentifrice group and 38 subjects in
(2011a)† examiner-blind, fluoride calcium toothpaste 2 weeks the control group completed all study procedures. Both
parallel group, carbonate, dentifrice groups showed significant sensitivity relief
randomized study 1450 ppm sodium relative to baseline (p < 0.01). The SnF2 dentifrice
MFP provided a statistically significant (p = 0.005) 7.4%
reduction in sensitivity relative to the positive control
dentifrice immediately after first use and an even more
significant (p = 0.001) 20% reduction at Week 2 based on
the Schiff air sensitivity scale. Based on the VAS, the
SnF2 dentifrice provided statistically significant
(p < 0.0001) reduction in sensitivity relative to the positive
control dentifrice immediately after first use, at Day 3,
and Week 2, with percent reductions of 7.2%, 15.8% and
28.2% respectively. No adverse events were reported with
either dentifrice.
Management of dentine hypersensitivity
S281
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S282

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

Chaknis et al. 2011 Single-centre, 118 0.454% stannous 0.243% sodium 0.3% triclosan, Self-administered 4, 8 weeks Tactile, airblast 118 subjects complied with the protocol, and completed the
(2011)† double-blind, fluoride in a silica fluoride in a silica 2.0% PVM/MA toothpaste 8-week study. At baseline, the mean tactile sensitivity
parallel group, base with sodium base (toothpaste copolymer scores for toothpastes (1), (2) and (3) were 13.6, 14.1 and
randomized study hexameta 3) toothpastes, 13.1; at 4 weeks 28.75, 20.13 and 20.00; and after 8 weeks
phosphate and zinc 0.243% sodium 33.1, 24.0 and 20.5 respectively. The mean airblast scores
West et al.

lactate (toothpaste fluoride and for toothpastes (1), (2) and (3) at baseline were 2.5, 2.5
1) specially designed and 2.4; at 4 weeks 1.25, 1.50 and 1.85; and after 8 weeks
silica (toothpaste 0.99, 1.36 and 1.5 respectively. At all time points after the
2) baseline examination, for both tactile and airblast
sensitivity scores, the differences between Test Dentifrice 1
and the Negative Control Dentifrice were statistically
significant (p < 0.05). The differences between Test
Dentifrice 1 and Test Dentifrice 2 were statistically
significant (p < 0.05) at 4 and 8 weeks after baseline
examination for tactile sensitivity scores and at 8 weeks
after baseline examination for airblast sensitivity scores.
He et al. 2011 Examiner-blind, 111 0.454% stannous 0.76% sodium Self-administered Immediate, 3 days, Tactile, airblast 111 subjects were enrolled and randomized to one of the
(2011b)† parallel group, fluoride MFP toothpaste 2 weeks two treatment groups. Immediately after the first use, the
randomized study SnF, dentifrice provided statistically significant
(p < 0.0001) reductions in sensitivity relative to the
negative control dentifrice of 13.8% for the thermal Schiff
Air Sensitivity Scale and 14.6% for the air VAS. The
SnF, dentifrice also provided statistically significant
(p < 0.0001) reductions in sensitivity relative to the
negative control at Day 3 and at Week 2 based on the
thermal Schiff Air Sensitivity Scale (31.8% and 61.3%
respectively) and the thermal air VAS (34.8% and 66.6%
respectively). For the tactile Yeaple probe, the SnF2
dentifrice demonstrated significantly (p < 0.0001) better
sensitivity scores relative to the negative control at Day 3
and Week 2, with improvements of 186% and 239%
respectively. Both dentifrices were well tolerated.
He et al. 2011 Single-centre, 81 Stannous-containing 8% arginine, Self-administered Immediate, 3 days Airblast Forty subjects in the experimental group and 41 subjects in
(2011c)† examiner-blind, 1450 ppm sodium calcium toothpaste the positive control group completed all study procedures.
parallel group, fluoride carbonate, On the Schiff Air Sensitivity Scale, the experimental
randomized study 1450 ppm sodium dentifrice provided statistically significant (p < 0.001)
MFP reductions of 14.8% and 54.1% in sensitivity relative to
the positive control dentifrice immediately after first use
and at Day 3 respectively. On the pain VAS, the
experimental dentifrice provided statistically significant
(p < 0.001) reductions of 22.3% and 74.1% in sensitivity
relative to the positive control dentifrice immediately after
first use and at Day 3 respectively. No adverse events
were reported for any subject.
Ni et al. 2010 Single-centre, 58 Stannous-containing Potassium nitrate Self-administered 4, 8 weeks Tactile, airblast Fifty-eight subjects completed all evaluations. Both the
(2010)† double-blind, sodium fluoride toothpaste experimental stannous-containing and positive control
parallel group, dentifrice dentifrices provided significant (p < 0.05) reductions in
stratified, both tactile and thermal dentin hypersensitivity compared
randomized study to baseline at both Weeks 4 and 8. There were no
significant differences in Yeaple Probe or Schiff Air Index
results between the dentifrices with either efficacy
measurement at Week 4 and Week 8 (p ≥ 0.5375).
Sharma et al. 2010 Single-centre, 120 0.4% stannous 5% potassium Self-administered 2, 4, 12 weeks Airblast, thermal All three products significantly reduced sensitivity versus
(2010)† double-blind, fluoride gel nitrate toothpaste toothpaste/gel baseline at each time point, although the calcium sodium
parallel group, 7.5% calcium phosphosilicate (NovaMinâ) dentifrice reduced sensitivity
stratified, sodium significantly more than the others at the 2- and 4-week
randomized study phosphosilicate time points. At the 2-week time point, for air and water,
toothpaste respectively, the dentifrice containing NovaMinâ reduced
sensitivity 45% and 49%, the stannous fluoride gel 30%
and 26%, and the potassium nitrate dentifrice 35% and
34%. At the 12-week time point, the dentifrice containing
NovaMinâ reduced sensitivity 87% and 91%, stannous
fluoride gel 87% and 85%, and potassium nitrate
dentifrice 84% and 79%.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Day et al. 2010 Double-blind, 31 Stannous-containing Sodium fluoride Self-administered 2, 4 weeks Airblast Thirty-one subjects were included in the analyses. For the
(2010)† parallel group, sodium fluoride toothpaste two most sensitive teeth, the experimental dentifrice
randomized study dentifrice showed statistically significantly less sensitivity (p < 0.05)
versus the control at weeks two and four and for weeks
two and four combined. The sensitivity reduction ranged
from 24.9% to 28.4% over the control. For all 12 teeth,
the experimental group had statistically significantly
(p < 0.03) lower sensitivity scores versus the control group
at week two and weeks two and four combined.
Schiff et al. 2005 Double-blind, 77 Stabilized 0.454% Sodium fluoride Self-administered 4, 8 weeks Tactile, airblast The mean sensitivity score based on the Schiff Air Index for
(2005)† parallel group, stannous fluoride, toothpaste the experimental group was statistically significantly lower
stratified, sodium hexameta than that of the sodium fluoride control group, at both
randomized study phosphate weeks 4 and 8 (p < 0.0001). The mean sensitivity score
based on the Yeaple Probe Index for the stannous
fluoride/sodium hexametaphosphate group was
statistically significantly higher, indicating a reduction in
sensitivity, than that of the sodium fluoride control group,
at both weeks 4 and 8 (p < 0.0001).
Schiff et al. 2006 Double-blind, 90 Stabilized 0.454% Sodium fluoride Self-administered 4, 8 weeks Tactile, airblast The mean sensitivity score based on the Schiff Air Index for
(2006)† parallel-group, stannous fluoride, toothpaste the stannous fluoride + SHMP group was statistically
stratified, sodium hexameta significantly lower than that of the control group, at both
randomized study phosphate weeks four and eight (p < 0.0001). At week eight, the
stannous fluoride + SHMP dentifrice group had an
adjusted mean 44% lower than that of the control group.
The mean tactile sensitivity score for the stannous fluoride
+ SHMP group was statistically significantly higher,
indicating a reduction in sensitivity, than that of the
control group, at both weeks four and eight (p < 0.0001).

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
At week eight, the stannous fluoride + SHMP dentifrice
group had a mean desensitizing improvement of 71%
greater than the control.
Schiff et al. 2000 Parallel group, 120 5% potassium nitrate, 0.243% sodium 5% potassium Self-administered 4, 8 weeks Tactile, airblast After 4- and 8-weeks’ use of their assigned products,
(2000b) stratified, 0.454% stannous fluoride in a silica nitrate, 0.243% toothpaste participants in the new dentifrice group demonstrated
randomized study fluoride in a silica base sodium fluoride in statistically significant improvements (p < 0.05) in tactile
base a silica base and airblast sensitivity, as compared to those using the
positive and negative control dentifrices.
Conforti et al. 2000 Single-centre, 66 5% potassium nitrate, 0.243% sodium Self-administered 3, 7, 10, 14 days Tactile, airblast Participants who used the new formulation dentifrice
(2000)† parallel group, 0.454% stannous fluoride in a silica toothpaste containing potassium nitrate/stannous fluoride/silica
stratified, fluoride in a silica base demonstrated a statistically significant improvement in
randomized study base both tactile sensitivity and airblast sensitivity after 10 and
14 days’ use of the dentifrice (p < 0.05), as compared to a
commercially available control dentifrice. It was
concluded that a new dentifrice formulation containing
5.0% potassium nitrate and 0.454% stannous fluoride in a
silica base provided a statistically significant reduction in
dentinal hypersensitivity after only 10 days, as compared
to a commercially available non-desensitizing control
dentifrice.
Sowinski et al. 2000 Double-blind, 109 5% potassium nitrate, 0.243% sodium 5% potassium Self-administered 4, 8 weeks Tactile, thermal The new dentifrice group demonstrated statistically
(2000a)† parallel group, 0.454% stannous fluoride in a silica nitrate, 0.243% toothpaste significant improvements in tactile and thermal sensitivity
stratified, fluoride in a silica base sodium fluoride in over the two control groups.
randomized study base a silica base
Sowinski et al. 2000 Examiner-blind, 97 5% potassium nitrate, 5% potassium Self-administered 4, 8 weeks Tactile, airblast After 4 weeks, subjects assigned to the Colgate Sensitive
(2000b)† parallel group, 0.454% stannous nitrate, 0.76% toothpaste Maximum Strength dentifrice group exhibited a
stratified fluoride in a silica sodium MFP in a statistically significant improvement over the Sensodyne
randomized study base dicalcium dentifrice group with respect to tactile sensitivity scores,
phosphate base and a statistically significant improvement over the
Sensodyne dentifrice group with respect to airblast
sensitivity scores. Correspondingly significant
improvements were presented after 8 weeks.
Management of dentine hypersensitivity
S283
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S284

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

Schiff et al. 2000 Examiner-blind, 101 5% potassium nitrate, 5% potassium Self-administered 4, 8 weeks Tactile, airblast 101 subjects complied with the protocol, and completed the
(2000a) parallel group, 0.454% stannous nitrate, 0.76% toothpaste entire study. After 4 weeks, subjects assigned to the
stratified, fluoride in a silica sodium MFP in a Colgate Sensitive Maximum Strength group exhibited a
randomized study base dicalcium statistically significant improvement over the Fresh Mint
phosphate base Sensodyne dentifrice group with respect to tactile
West et al.

sensitivity scores, and a statistically significant

improvement over the Sensodyne dentifrice group with
respect to airblast sensitivity scores. Correspondingly
significant improvements were presented after 8 weeks.
Sowinski et al. 2001 29 studies, both: Study 1: Both studies: 0.59% Study 1: 0.32% Study 1: None Self-administered 4, 8 weeks Tactile, airblast In study 1, the group using the new dentifrice tolerated
(2001)† double-blind, 81 stannous fluoride, sodium fluoride Study 2: 3.75% toothpaste greater pressure after 4 (34.9 g) and 8 weeks (38.4 g) than
parallel group, Study 0.32% sodium Study 2: None potassium the group using the fluoride dentifrice (22.9 g and 19.0 g
stratified, 2: 105 fluoride, 10% chloride, 0.3% respectively). These differences were statistically significant
randomized potassium nitrate, triclosan, 0.32% (p < 0.001). At 4 and 8 weeks, the mean airblast scores
studies silica sodium fluoride for the group using the new dentifrice (1.39 and 0.83)
were lower than for the group using fluoride dentifrice
(1.78 and 1.76) and were significantly different at 8 weeks
(p < 0.001). In study 2 the group using the new dentifrice
tolerated greater pressure after 4 (40.5 g) and 8 weeks
(43.7 g) than the group using Sensodyne F (27.8 g and
33.2 g respectively). These differences were statistically
significant (p < 0.001). At 4 and 8 weeks, the mean
airblast scores for the group using the new dentifrice (1.10
and 0.67) were significantly lower than the group using
Sensodyne F (1.90 and 1.57) (p < 0.001).
Calcium Sodium Phosphosilicate (CSPS)
Neuhaus et al. 2013 Single-site, double- 149 15% NovaMinâ, Paste without 15% NovaMinâ Professionally Immediate, 28 days Tactile, airblast Subjects having received the test prophylaxis pastes showed
(2013)† blind, parallel 2.7% sodium NovaMinâ, or paste applied statistically lower (anova, p < 0.05) dentine
group, stratified, fluoride paste fluoride prophylaxis hypersensitivity compared with the control group
randomized study immediately after the prophylaxis procedure (Yeaple
Probeâ: Test-A = 20.9  12.6, Test-B = 22.7  12.9,
Control=11.2  3.1; Schiff score: Test-A = 1.1  0.6,
Test-B = 1.1  0.6, Control = 2.0  0.7) and after
28 days (Yeaple probe: Test-A = 21.5  11.9, Test-
B = 20.6  11.3, Control = 11.8  6.0; Schiff score: Test-
A = 1.0  0.6, Test-B = 1.0  0.6, Control = 2.0  0.7).
Acharya et al. 2013 Single-centre, 20 5% calcium sodium 5% potassium Self-administered 2, 4, 8 weeks Airblast The study demonstrated reduction in symptoms for all
(2013)† double-blind, phosphosilicate nitrate toothpaste treatment groups from baseline to 2, 4 and 8 weeks. The
parallel group, calcium sodium phosphosilicate group showed a higher
randomized, degree of effectiveness at reducing hypersensitivity to air
study evaporative stimulus at 2 weeks, than commercially
available potassium nitrate. However, there was no
significant difference in scores of subjects using the
calcium sodium phosphosilicate toothpaste as compared
to potassium nitrate at 4 weeks and 8 weeks.
Milleman 2012 Single-centre, 139 NovaMinâ, NaF Prophy paste, no NovaMinâ, no Professionally Immediate, 28 days Tactile, airblast A total of 139 patients completed the study. Subjects
et al. (2012)† parallel group, paste NaF NaF paste applied having received the NovaMinâ containing prophylaxis
stratified, prophylaxis pastes (Groups A and B) showed statistically lower
randomized study (ANOVA, p < 0.05) dentin hypersensitivity compared to
the control group immediately after the prophylaxis
procedure. Group A tactile improvements were 86%
immediate, and 88% after 28 days; airblast improvements
were 49% immediate, and 50% after 28 days. Group B
tactile improvements were 67% immediate, and 65% after
28 days; airblast improvements were 43% immediate, and
34% after 28 days. Group C experienced little
improvement in tactile and airblast scores, 9% and 4%,
respectively, immediately following treatment, and 10%
and 1%, respectively, after 28 days. At both time points,
the reduction in sensitivity was meaningful and
significantly better than in the group receiving a standard
prophylaxis paste as the comparator (p < 0.05). Both
NovaMinâ pastes were effective and there was no
statistical difference between the pastes with and without
fluoride. There were no adverse events reported during the
course of this study.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Surve et al. 2012 Parallel group, 20 Paste with calcium Paste with Self-administered 2, 4, 8 weeks Tactile Dentifrices were prescribed for all patients and sensitivity
(2012)† randomized study sodium potassium nitrate toothpaste scores were re-evaluated at 2, 4 and 8 weeks. Though
phosphosilicate both groups showed significant reductions in sensitivity
scores, only at 8 weeks was there a marginally significant
difference (p = 0.0551) in sensitivity scores between the
test group and the positive control group.
Pradeep et al. 2012 Single-centre, triple- 150 5% calcium sodium Placebo paste 5% potassium Self-administered 2, 6 weeks Airblast, thermal All groups showed a reduction in sensitivity scores at
(2012)† blind, parallel phosphosilicate, nitrate toothpaste 2 weeks and 6 weeks. The calcium sodium phosphosilicate
group, fused silica 85% amine group was found to be significantly better compared to
randomized study fluoride the other groups at the end of 6 weeks.
Rajesh et al. 2012 Single-centre, 30 5% calcium sodium Paste without Self-administered 6, 8 weeks Airblast, thermal 5% NovaMinâ containing dentifrice significantly reduced
(2012) single-blind, phosphosilicate desensitizing toothpaste DH within 6 th and 8 th week of usage when compared
parallel group, agent to a placebo dentifrice.
randomized study
Sharma et al. 2010 Single-centre, 120 7.5% calcium sodium 5% potassium Self-administered 2, 4, 12 weeks Airblast, thermal All three products significantly reduced sensitivity versus
(2010)† double-blind, phosphosilicate nitrate toothpaste toothpaste/gel baseline at each time point, although the calcium sodium
parallel group, toothpaste 0.4% stannous phosphosilicate (NovaMinâ) dentifrice reduced sensitivity
stratified, fluoride gel significantly more than the others at the 2- and 4-week
randomized study time points. At the 2-week time point, for air and water,
respectively, the dentifrice containing NovaMinâ reduced
sensitivity 45% and 49%, the stannous fluoride gel 30%
and 26%, and the potassium nitrate dentifrice 35% and
34%. At the 12-week time point, the dentifrice containing
NovaMinâ reduced sensitivity 87% and 91%, stannous
fluoride gel 87% and 85% and potassium nitrate
dentifrice 84% and 79%.
Salian et al. 2010 Single-centre, 30 5% NovaMinâ 1000 ppm sodium 5% potassium Self-administered 2, 4 weeks Tactile, airblast, Compared to baseline, there was a significant decrease in
(2010)† double-blind, MFP nitrate toothpaste thermal dentin hypersensitivity in Groups A and B following
parallel group, 4 weeks’ use of the dentifrice containing 5% potassium

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
randomized study nitrate and the dentifrice containing 5% calcium sodium
phosphosilicate (NovaMinâ) respectively. There was a
statistically greater reduction in hypersensitivity at both 2
and 4 weeks following use of the dentifrice containing
NovaMinâ compared with the use of a non-desensitizing
dentifrice, as well as the dentifrice containing potassium
nitrate. Air and cold water scores were significantly lower
following 4 weeks’ use of the potassium nitrate dentifrice
compared to the non-desensitizing dentifrice. Tubule
occlusion was observed in the companion in vitro study
following treatment with 5% NovaMinâ, but not after
treatment with the 5% potassium nitrate or non-
desensitizing dentifrices.
Litkowski & 2010 Double-blind, 66 7.5% NovaMinâ Placebo paste Self-administered 2, 4, 8 weeks Tactile, airblast Comparison of the mean change from baseline among the
Greenspan parallel group, 2.5% NovaMinâ toothpaste three treatment groups indicated a meaningful reduction
(2010)† randomized, in sensitivity scores in the 7.5% group that was significant
study compared to reductions observed in the placebo control
group at all time points.
Narongdej 2010 Single-centre, 60 Paste of NovaMinâ in Placebo paste + 5% Professionally Immediate, 1, 2, Tactile, thermal Groups 1 and 2 showed significant hypersensitivity
et al. (2010)† double-blind, water + 7.5% potassium nitrate applied 4 weeks reduction over baseline at all time points. Group 3
parallel group, NovaMinâ toothpaste prophylaxis + showed significant hypersensitivity reduction at 1 week
randomized study toothpaste (group1) (group3) Self-administered onward. Group 1 showed significant improvement
placebo paste + toothpaste compared with groups 2 and 3, except for response to
7.5% NovaMinâ tactile stimulus at 4 weeks with group 2. Between groups
toothpaste (group 2) 2 and 3, there were significant differences at 2 and 4
weeks.
Pradeep & 2010 Single-centre, triple- 110 5% calcium sodium Toothpaste with 5% potassium Self-administered 2, 6 weeks Airblast, thermal All three groups showed reduction in sensitivity scores at
Sharma blind, parallel phosphosilicate with fused silica, no nitrate toothpaste 2 weeks and 6 weeks for air stimulus and cold water. The
(2010)† group, fused silica calcium sodium calcium sodium phosphosilicate group, however, was
randomized study phosphosilicate found to be significantly better in reducing the visual
analogue scale score compared to the potassium nitrate
Management of dentine hypersensitivity

group and the placebo group at any time point for both
measures of sensitivity.
S285
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S286

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

Du Min et al. 2008 Double-blind, 71 Toothpaste with Placebo toothpaste Toothpaste Self-administered 2, 6 weeks Airblast, thermal The placebo and the NovaMinâ groups showed a
(2008)† parallel group, calcium sodium containing toothpaste statistically significant decrease in sensitivity by both
randomized study phosphosilicate strontium measures after 6 weeks (p < 0.05). The SrCl2 group
chloride showed a statistically significant decrease from baseline at
the 2-week time point, but not at the 6-week time point
West et al.

for the evaporative stimulus. The percent reduction in

sensitivity at 6 weeks for the NovaMinâ test group was
35% for air and 39% for cold water stimulus, versus 11%
for air and 22% for cold water for the SrCl2 paste. The
reductions for the placebo paste were 21% for the air
stimulus and 18% for water. A cross-tabulation measure
of the reduction in sensitivity at each time point for all
three treatments showed that the NovaMinâ product was
more effective than either of the other products. For the
air stimulus in the NovaMinâ group, 58% of subjects
improved at each time point compared with 26% for the
SrCl2 group and 20% for the placebo group.
Oxalates**
Sharma et al. 2013 Single-centre, 56 1.4% potassium Fluoride toothpaste Self-administered Immediate, and Tactile, airblast All sensitivity assessments were similar at baseline in the 56
(2013)† examiner-blind, oxalate rinse + (Colgate Cavity toothpaste and daily for 5 days randomized subjects. By the third day, the Yeaple probe
parallel-group, fluoride toothpaste Protection) mouthrinse sensitivity scores for subjects treated with Colgate
randomized study (Colgate Cavity Fluoride toothpaste plus LADS improved significantly compared to
Protection) toothpaste (Crest Crest toothpaste alone (p < 0.05). By the fifth day, the
Cavity protection) mean scores for subjects treated with Colgate toothpaste
plus LADS were significantly improved compared with
subjects treated with either toothpaste alone (p < 0.05).
The other sensitivity assessments showed that Colgate
toothpaste plus LADS achieved statistically significant
improvements compared with Colgate and/or Crest
toothpaste alone from the third day.
Vora et al. 2012 Split-mouth, 50 (150 Oxalate rinse Water Glutaraldehyde/ Professionally Immediate, day1, Tactile, airblast All subjects completed the trial. Both the two desensitizing
(2012)† randomized study teeth) HEMA rinse applied 1 week, 1, 3, agents and placebo showed significant reduction in
6 months sensitivity at baseline and throughout the 6-month
evaluation. The effects of the three treatments were
significantly different. Pain reduction with GLU was
consistently highest, followed by PLA that was
significantly greater than BIS. VAS scores for the
evaporative stimulus were moderately, but significantly
lower than for tactile stimulation.
Craig et al. 2012 Double-blind, split- 19 38% diamine silver Oxalic acid-based Professionally 1 week Thermal The mean difference between VAS at baseline and 7 days
(2012)† mouth, fluoride, saturated preparation applied for teeth treated with diamine silver fluoride/potassium
randomized study solution of containing iodide was greater than that for teeth treated with the
potassium iodide potassium oxalic acid-based preparation (p = 0.0134). The subjects’
subjective assessment of changes in dentine
hypersensitivity indicated that more obtained relief with
the diamine silver fluoride/potassium iodide treatment
(p = 0.0129).
Camilotti 2012 Single-centre, 42 (252 3% potassium oxalate Water + thickener Duraphat Professionally Immediate (week Tactile, airblast After the second week, statistically significant differences
et al. (2012) participant-blind, teeth) (Oxa-gel = group Fluorniz applied 1), 2, 3 weeks (at were observed for all materials compared with the
split-mouth, G7) Duofluorid XII time of baseline. After 30 days, Group G7 had presented a
randomized study Flutop application) significant gradual reduction along all the evaluated time
Fluorphat 30 days intervals.
All contain NaF
at varying
concentrations
Erdemir et al. 2010 Single-centre, 11 (131 BisBlock (oxalic acid) Pain-Free (2% Professionally Immediate, 1, 2, 3, Tactile, airblast The results of the statistical analysis showed that all VAS
(2010) double-blind, teeth) oxalic acid applied 4 weeks scores at the post-treatment evaluation periods were
split-mouth, solution and reduced significantly compared with those at baseline
randomized study emulsion) (p < 0.05). More teeth were sensitive to air stimuli than to
Seal & Protect tactile stimuli. The mean VAS scores for DH in the
(resin based mandibular teeth were significantly higher than for those
material) in maxillary teeth immediate after treatment (for tactile
stimuli) and 2 weeks after the first application (for air
stimuli) (p < 0.05)

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Vieira et al. 2009 Double-blind, 24 (131 3% potassium oxalate Placebo gel GaAlAs laser Professionally 4 weeks, 3 months Tactile, airblast In both the active and control groups, there were
(2009) parallel group, teeth) gel applied statistically significant reductions in dentinal
randomized hypersensitivity immediate after and 3 months after the
study. treatments, when compared with the hypersensitivity at
baseline. No significant differences among the three
groups could be detected in their efficacy at either the
immediate or 3 month evaluations irrespective of the
stimulus.
Pamir et al. 2007 Double-blind, 60 BisBlock (oxalic acid) Water Seal&Protect (resin Professionally 4 weeks Airblast, thermal The VAS scores of the treatment and placebo groups were
(2007) parallel group, based) applied not different from each other at baseline (p > 0.05), and
randomized study Vivasens thermal stimuli caused higher patient discomfort than
(precipitates evaporative stimuli (p < 0.05). Alleviation effects of the
calcium ions and desensitizing agents were not significantly different from
proteins in dentin each other; however, the placebo was an exception
fluid) (p < 0.05). The differences between the VAS scores at
baseline and after 4 weeks were significant for all three
desensitizing agents (p < 0.05). However, in the placebo
group, the evaporative stimuli led to insignificant pain
variations (p > 0.05).
Merika et al. 2006 Single-blind, 48 Oxalate preparation Fluoride varnish Professionally 4 weeks Tactile, airblast, Both treatments resulted in statistically significant
(2006)† parallel group, (SuperSeal) (Duraphat) applied thermal reductions in VAS scores for all stimuli (p < 0.05).
randomized study However, analysis of covariance failed to identify
statistically significant differences in the magnitude of
reductions in sensitivity achieved by each of the products
(p > 0.05). The treatments had similar efficacy and both
can be considered effective therapies for treating dentine
sensitivity.
Gillam et al. 2004 Double-blind, split- 13 Ferric oxalate Placebo Professionally Immediate, 4 weeks Tactile, airblast, No statistically significant differences were noted between
(2004)† mouth, applied thermal ferric oxalate and placebo preparations at +5 min and

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
randomized study 4 weeks for any of the test stimuli. There was, however, a
clear trend towards immediate reduction (+5 min) in DH
reverting back to baseline values at 4 weeks with the
exception of the Biomat Thermal Probe mean values,
which maintained the reductions in DH compared with
placebo. The results of this study demonstrated that a 1-
min application of ferric oxalate is both rapid and
effective in reducing DH although its long-term
effectiveness still needs to be determined.
Resin-Based Materials
Ding et al. 2014 Double-blind, split- 31 (119 Gluma Dentin Warm water Clinpro XT Professional Immediate, 1, Tactile, airblast For both stimuli, mean TSS was significantly decreased in
(2014) mouth, teeth) Desensitizer Varnish (VXT) prophylaxis 4 weeks the VXT and Gluma groups at all time points (all,
randomized study (Gluma) paste-liquid p < 0.001) compared with baseline. Regarding
comparisons of TSS between treatment groups, the VXT
group had significantly lower mean TSS compared with
the Gluma group (p < 0.05) and placebo control group
(p < 0.05) at all time points after treatment regardless of
stimuli. Group Effect, Time Effect and Group x Time
Effect were all significantly different (all, p < 0.001).
Mehta et al. 2014 Single-centre, 49 MS Coat One F Gluma Desensitizer Professional Immediate, 1 week, Tactile, airblast Forty-nine subjects completed the trial. Pre-operative dentin
(2014)† single-blind, split- (MSC) PowerGel (GLU) prophylaxis 1, 3, 6 months hypersensitivity (DH) for the groups was not significantly
mouth, Nanoseal (NAN) different. All desensitizers reduced DH significantly
randomized study Teethmate throughout the 6-months observation. ANOVA revealed
Desensitizer (TMD) significant differences among VAS scores, obtained with
the desensitizing agents (p < 0.001). Ranking by post hoc
testing was as follows: MSC > NAN > TMD > GLU
(p < 0.05). Upon PS NAN and TMD showed slight but
significant regain of sensitivity after 6 months. For GLU
PS scores immediately after application and after
6 months were not significantly different, whereas recalls
after 1 week, 1 month and 3 months revealed significantly
Management of dentine hypersensitivity

lower scores.
S287
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S288

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

Veitz-Keenan 2013 Multi-centre, 293 Resin restoration Potassium nitrate Self-administered 1, 3, 6 months Airblast Lesion depth and pre-treatment sensitivity (mean, 5.3 on a
et al. (2013) parallel group, dentifrice toothpaste, 0- to 10-point scale) were balanced across treatments, as
stratified, Sealant professionally was sleep bruxism (present in 42.2% of participants). The
randomized study applied 6-month participant recall rate was 99%. Treatments
restoration/ significantly reduced mean sensitivity (p < 0.01), with the
West et al.

sealant sealant and restoration groups displaying a significantly

higher reduction (p < 0.01) than did the dentifrice group.
The dentifrice group’s mean (standard deviation)
sensitivity at 6 months was 2.1 (2.1); those of the sealant
and restoration groups were 1.0 (1.6) and 0.8 (1.4)
respectively. Patient-reported sensitivity (to cold being
most pronounced) paralleled clinical measurements at
each evaluation.
Ehlers et al. 2012 Split-mouth, 22 (150 Glutaraldehyde-based Er:YAG laser Professional Immediate, 1 week, Airblast Both techniques showed an effective reduction in cervical
(2012) randomized study teeth) desensitizing system prophylaxis 1, 3, 6 months dentin hypersensitivity. The subjects experienced equal
(Gluma) improvements compared to their status before and
6 months after treatment with both methods (p < 0.001).
Sethna et al. 2011 Subject-blind, split- 250 Gluma varnish Cervitec varnish Professional Immediate, 4, Tactile, airblast, Statistical analysis indicated that both the desensitizing
(2011) mouth, containing containing prophylaxis 12 weeks thermal varnishes were effective in alleviating dentine
randomized study glutaraldehyde chlorhexidine hypersensitivity at all time intervals compared to baseline.
There was a highly statistically significantly greater
reduction in dentine hypersensitivity to evaporative
stimulus, cold stimulus and tactile stimulus after
application of Cervitec than after Gluma Desensitizer
(p < 0.001). Both the varnishes have a therapeutic
potential to alleviate dentine hypersensitivity at all time
intervals compared to baseline. However, Cervitec varnish
is more efficacious in reducing dentine hypersensitivity
than Gluma varnish at both 4 weeks and 12 weeks post
treatment.
Erdemir et al. 2010 Single-centre, 11 (131 Seal & Protect (resin Pain-Free (2% Professionally Immediate, 1,2, 3, Tactile, airblast The results of the statistical analysis showed that all VAS
(2010) double-blind, teeth) based) oxalic acid applied 4 weeks scores at the post-treatment evaluation periods were
split-mouth, solution and reduced significantly compared with those at baseline
randomized study emulsion) (p < 0.05). More teeth were sensitive to air stimuli than to
BisBlock (oxalic tactile stimuli. The mean VAS scores for DH in the
acid) mandibular teeth were significantly higher than for those
in maxillary teeth immediate after treatment (for tactile
stimuli) and 2 weeks after the first application (for air
stimuli) (p < 0.05)
Pamir et al. 2007 Double-blind, 60 Seal&Protect (resin Water BisBlock (oxalic Professionally 4 weeks Airblast, thermal The VAS scores of the treatment and placebo groups were
(2007) parallel group, based) acid) applied not different from each other at baseline (p > 0.05), and
randomized study Vivasens thermal stimuli caused higher patient discomfort than
(precipitates evaporative stimuli (p < 0.05). Alleviation effects of the
calcium ions and desensitizing agents were not significantly different from
proteins in dentin each other; however, the placebo was an exception
fluid) (p < 0.05). The differences between the VAS scores at
baseline and after 4 weeks were significant for all three
desensitizing agents (p < 0.05). However, in the placebo
group, the evaporative stimuli led to insignificant pain
variations (p > 0.05).
Polderman & 2007 Single-centre, 14 (28 Gluma Desensitizer Low-viscosity Professionally Immediate, Airblast Evaluations in the Gluma group were discontinued after
Frencken split-mouth, teeth, glass ionomer applied 1, 3, 19.2, 3 months. The mean DIS score for hypersensitive teeth in
(2007) randomized study 3 (Fuji VII) 25.2 months the glass ionomer group was statistically significantly
month) lower than that in the Gluma group, immediately after
12 application (p = 0.0005), after 1 month (p = 0.02) and
(24 after 3 months (p = 0.003). After 3 months, 11/14 of the
teeth, hypersensitive teeth in the glass ionomer group and 2/14
19.2 in the Gluma group were free of sensitivity. The mean
month) DIS score for hypersensitive teeth in the glass ionomer
9 (18 group remained low after 19.2 months (0.25: SE = 0.13)
teeth, and 25.2 months (0.22: SE = 0.15). The null-hypothesis
25.2 was rejected. The low-viscosity glass ionomer (Fuji VII) is
month) more effective in treating hypersensitive teeth than Gluma
Desensitizer after 3 months. The positive treatment effect
of the glass ionomer continued until 25.2 months.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Duran & 2004 Single-blind, split- 52 (277 Single Bond Professional Immediate, Airblast Statistical analysis showed that all of the VAS scores at
Sengun mouth, teeth) Health-Dent prophylaxis 10 days, post-treatment evaluation points were significantly
(2004) randomized study Desensitizer 3 months decreased compared with baseline data (p < 0.05). There
Gluma Desensitizer was a significant reduction in mean sensitivity scores in
SE Bond & Protect the Protect Liner F and the Health-Dent Desensitizer
LinerF. groups when compared with Fluoline varnish at the 10-
Fluoline day time point (p < 0.05). At 3 months, the Protect Liner
F group continued to show a significantly reduced
sensitivity level when compared with Health-Dent
Desensitizer, Single Bond, Fluoline and Gluma
Desensitizer (p < 0.05).
Varnishes††
Ding et al. 2014 Double-blind, split- 31 (119 Clinpro XT Varnish Warm water Gluma Dentin Professional Immediate, 1, Tactile, airblast For both stimuli, mean TSS was significantly decreased in
(2014) mouth, teeth) (VXT) paste-liquid Desensitizer prophylaxis 4 weeks the VXT and Gluma groups at all time points (all,
randomized study (Gluma) p < 0.001) compared with baseline. Regarding
comparisons of TSS between treatment groups, the VXT
group had significantly lower mean TSS compared with
the Gluma group (p < 0.05) and placebo control group
(p < 0.05) at all time points after treatment regardless of
stimuli. Group Effect, Time Effect and Group x Time
Effect were all significantly different (all, p < 0.001).
Drebenstedt 2012 Single-centre, 112 Cervitec Plus (C+), Placebo containing Cervitec (C); Professional Day 1, 7, 30, 90 Airblast Thirty days after application of C and C+, all
†
et al. 2012, double-blind, CHX varnish water and ethanol original CHX prophylaxis hypersensitivity decreased significantly in relation to
parallel group, containing thymol only varnish baseline measurements (p < 0.001), with no changes
randomized study CHX diacetate containing thymol taking place in the placebo group. Significant differences
hydrate and CHX diacetate were observed between C and C+ vs placebo (p < 0.001),
ethanol/water as hydrate, and ethyl whereas no significant difference between C and C+ was
solvent) acetate as solvent) seen after 30 days (p = 0.840). After 90 days, the
reduction in hypersensitivity with C+ was still significant

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
compared with baseline measurements (p = 0.001).
However, C was not significantly different compared with
baseline measurements (p = 0.05). Analysis of all
hypersensitive posterior teeth examined showed no
significant difference between C and C+ after 90 days
(p = 0.362). For anterior teeth, the difference between C
and C+ was significant (p = 0.012). Both C and C+ reduce
cervical tooth hypersensitivity, whereas C+ reduces
hypersensitivity for a longer period of time.
Castillo et al. 2011 Multi-centre, 126 Diammine silver Sterile water Professional 24 hours, 7 days Airblast The diammine silver fluoride reduced pain at 7 days at both
(2011)† parallel group, fluoride varnish prophylaxis sites. At the Lima site, the average change in pain scores
stratified, between baseline and day 7 for the silver fluoride group
randomized study was 35.8 (SD = 27.7) mm vs. 0.4 (SD = 16.2) mm for
the control group (p < 0.001). In Cusco, the average
change in pain scores for the silver fluoride group was -
23.4 (SD = 21.0) mm and -5.5 (18.1) mm for the control
group (p = 0.002). No tissue ulceration, white changes, or
argyria was observed. A small number of participants in
the silver fluoride group experienced a mild but transient
increase in erythema in the gingiva near the tooth. No
changes were observed in the Gingival Index.
Sethna et al. 2011 Subject-blind, split- 250 Gluma varnish Cervitec varnish Professional Immediate, 4, Tactile, airblast, Statistical analysis indicated that both the desensitizing
(2011) mouth, containing containing prophylaxis 12 weeks thermal varnishes were effective in alleviating dentine
randomized study glutaraldehyde chlorhexidine hypersensitivity at all time intervals compared to baseline.
There was a highly statistically significantly greater
reduction in dentine hypersensitivity to evaporative
stimulus, cold stimulus, and tactile stimulus after
application of Cervitec than after Gluma Desensitizer
(p < 0.001). Both the varnishes have a therapeutic
potential to alleviate dentine hypersensitivity at all time
intervals compared to baseline. However, Cervitec varnish
Management of dentine hypersensitivity

is more efficacious in reducing dentine hypersensitivity

than Gluma varnish at both 4 weeks and 12 weeks post
treatment.
S289
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
S290

size Placebo Comparator (toothpaste, Timepoints Assessment

Product mouthrinse, gel) or
Professionally
Applied

Yilmaz et al. 2011 Parallel group, 48 (244 NaF varnish Placebo NaF GaAlAs laser Professional Immediate, 1 week, Airblast GaAlAs laser and NaF varnish treatments resulted in a
(2011) randomized study teeth) varnish (saline) prophylaxis 1, 3, 6 months significant reduction in the VAS scores immediately after
Placebo laser treatments that were maintained throughout the study
when compared to the baseline and placebo treatments. In
the NaF group, there was a significant increase in the
West et al.

VAS scores at 3 and 6 months compared to at 1 week

and 1 month. The placebo treatments showed no
significant changes in VAS scores throughout the study
period. Within the limits of the study, GaAlAs laser
irradiation was effective in the treatment of DH, and it is
a more comfortable and faster procedure than traditional
DH treatment.
Corona et al. 2003 Split-mouth study 12 (60 Sodium fluoride (Baseline GaAlAs laser Professional Immediate, 15, Airblast Considering the treatments separately, there was no
(2003) teeth) varnish (Duraphat) assessment) prophylaxis 30 days significant difference for the fluoride varnish at the three
examination periods, and for laser therapy, significant
difference (p < 0.05) was found solely between the values
obtained before the treatment and 30 days after the first
application. It may be concluded that both treatments
may be effective in decreasing cervical dentinal
hypersensitivity. Moreover, the low-level GaAlAs laser
showed improved results for treating teeth with higher
degree of sensitivity.
Kielbassa 1997 Double-blind, split- 25 (50 Bifluorid 12 Sodium fluoride Professional 1, 2, 3, 4 weeks, Airblast Results demonstrated a distinct reduction in hypersensitivity
et al. (1997) mouth, teeth, containing 6% lacquer (6%) prophylaxis 6, 12 months after 1, 2 and 3 weeks in the Bifluorid 12 group. Initially,
randomized at 3 calcium fluoride, 6% no obvious effects could be observed in the control group.
study. weeks) sodium fluoride However, a clear alleviation could be observed after 2 and
21 (42 3 weeks with the control. After 4 weeks, the overall
teeth, sensitivity scores were comparably low, without any
at 12 significant differences between the two fluoride lacquers.
mon In both groups, the effects of treatment were seen over
ths) the 12-month observation period. Bifluorid 12 was
considered at least comparable to the control.
Lasers
Ko et al. 2014 Multi-centre, 86 Laser-emitting LED toothbrush Self-administered 2, 4 weeks Airblast Results demonstrated that the use of both control and test
(2014)† double-blind, toothbrush (wavelength toothbrushing toothbrushes resulted in decreased discomfort after
parallel group, (wavelength 635 nm, 635 nm, output with paste 4 weeks. In the test group, pain intensity scores decreased
randomized study output 6 mW) + 12.9 lW) + from 5.8  1.2 to 2.3  1.6, and in the control group, the
fluoride toothpaste fluoride scores decreased from 6.4  1.3 to 5.5  2.0 (p < 0.05).
toothpaste This decrease was significantly greater in the test group.
There were no significant adverse events or side effects.
Femiano et al. 2013 Split-mouth, 24 (262 Diode laser + 2% 2% sodium fluoride Professional Immediate, 1, Airblast The outcomes showed a significant reduction in discomfort
(2013) randomized study teeth) sodium fluoride solution application 6 months compared to baseline values for teeth of SG-3
solution HEMA-G immediately post treatment (82.6%) (p < 0.001), after
Diode laser only solution 1 month (69.5%) (p < 0.001) and after 6 months (60.8%)
(p < 0.001), respectively, compared with the reduction
scores of 51.6% (p < 0.001), 29.7% (p < 0.05) and 4.7%
(p > 0.05), recorded for SG-1; 72.2% (p < 0.001), 62.5%
(p < 0.001) and 47.2% (p < 0.05), recorded for SG-2;
77.4% (p < 0.001), 56.1% (p < 0.001) and 27.3%
(p < 0.05), recorded for SG-4.
Talesara et al. 2014 Single-centre, split- 20 (80 Nd:YAG laser Potassium Professional Immediate, 3, 6, Airblast, thermal Both treatment modalities were effective in reducing dentine
(2014)† mouth, teeth) binoxalate gel application 9 months hypersensitivity. However, Nd:YAG laser was better when
randomized study intra-group comparison was made at 9 months post
treatment. Nd:YAG lasers is better in long-term treatment
(up to 9 months) owing to the melting of dentinal tubules.
However, due to depth of penetration of microcrystals,
gel was better when ease of the procedure is considered.
Nevertheless, both treatment modalities resulted in
recurrence.
Ehlers et al. 2012 Split-mouth, 22 (150 Er:YAG laser Glutaraldehyde- Professional Immediate, 1 week, Airblast Both techniques showed an effective reduction in cervical
(2012) randomized study teeth) based application 1, 3, 6 months dentin hypersensitivity. The subjects experienced equal
desensitizing improvements compared to their status before and
system 6 months after treatment with both methods (p < 0.001).

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
 Table 5. (continued)
References Year Study design Sample Test product Negative control/ Positive control/ Self-administered Assessment Method of Results
size Placebo Comparator (toothpaste, Timepoints Assessment
Product mouthrinse, gel) or
Professionally
Applied

Flecha et al. 2013 Single-centre, 62 (434 GaAIAs infrared Cyanoacrylate glue Professional 24 hours, 30, 90, Airblast, thermal Both groups had significant reductions in DH. However,
(2013) double-blind, teeth) diode laser application 180 days there was no significant difference between the two groups
split-mouth, ≤6 months. Intra-group analysis showed that the effect of
randomized study cyanoacrylate obtained at 24 hours remained for 90 days
in response to air-jet test and 30 days for cold-spray test.
There was a statistically significant difference between all
other intra-group comparisons at the time intervals
(p < 0.001).
Tengrungsun 2008 Single-centre, split- 70 GaAlAs laser Dentin bonding Professional Immediate, 15, Airblast The reduction in dentin hypersensitivity was observed in
& Sangkla mouth, agent application 30 days both treatments using the GaAlAs laser and dentin
(2008)† randomized study bonding agent. However, a greater reduction was
observed over time up to day 15 and no significant
change was observed between days 15 and 30. Statistically
significant differences in the level of dentin
hypersensitivity between bonding agent and the GaAlAs
laser were found at each observation period (p < 0.05).
Schwarz et al. 2002 Single-centre, split- 30 (104 Er:YAG laser Untreated teeth Dentin Protector Professional Immediate, 1 week, Airblast Both treatment forms resulted in significant improvements
(2002) mouth, pairs of system application 2, 6 months of discomfort immediately after and 1 week post
randomized study teeth) treatment. After 2 months, the discomfort in the Dentin
Protector (R) group increased up to 65% of the baseline
score and even up to 90% after 6 months, whereas the
effect of the laser remained at the same level that was
achieved immediately after treatment. The differences
immediately after, 1 week, 2 and 6 months post treatment
between both groups were statistically high significant
(p ≤ 0.001 respectively). Compared to the untreated
control group, both treatment forms resulted in a
significant reduction in discomfort at each follow-up
examination.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Gerschman 1994 Double-blind, 71 GaAlAs laser Unpowered placebo Professional 1, 2, 8 weeks – Tactile, Airblast In both the tactile and thermal sensitivity groups differences
et al. (1994)† parallel group, laser application following re- (described as between the active and placebo groups were significant
randomized study application of thermal) from the first week and increased further in the second
laser. and eighth weeks. The mean value of thermal sensitivity
decreased 67% (p < 0.001) compared with placebo (17%)
and tactile sensitivity decreased 65% (p = 0.002)
compared with placebo (21%) at 8 weeks. Results
demonstrate that the GaAlAs laser is an effective method
for the treatment of both thermal and tactile dentinal
hypersensitivity. There were no reported adverse reactions
or instances of oral irritation.

*
Arginine Calcium carbonate is either the test or positive comparator control product.
†
Sponsored by industry or donation from industry.
‡
Potassium is either the test or positive comparator control product.
§
Strontium is either the test or positive comparator control product.
Stannous is either the test or positive comparator control product.
**
Oxalate is either the test or positive comparator control product.
††
Varnish is either the test or positive comparator control product.
Management of dentine hypersensitivity
S291
S292 West et al.
ve control. Potassium was found
equivocal to strontium acetate for
dentine hypersensitivity reduction
(West et al. 1997) and strontium
chloride (Silverman et al. 1996), both
studies having negative controls.
With regards to the comparison
of potassium to the negative control,
in some studies potassium reduced
pain to a similar degree to the nega-
tive control (Wara-aswapati et al.
2005, West et al. 1997, Ayad et al.
2009a, Pradeep & Sharma 2010,
Pradeep et al. 2012) while the other
studies showed potassium was supe-
rior (Chesters et al. 1992, Silverman
et al. 1996, Sowinski et al. 2013).
In the four studies assessing
potassium citrate (Chesters et al.
1992, Yates et al. 1998b, Docimo
et al. 2007, Prasad et al. 2010), this
salt was shown to be equal in effi-
cacy to potassium chloride (Docimo
et al. 2007), superior to potassium
nitrate (Chesters et al. 1992) and a
negative control (Chesters et al.
1992), and equivocal to a negative
control (Yates et al. 1998b). There
were equivocal data for comparison
to triclosan (Prasad et al. 2010). The
studies by Docimo et al. (2007) and
Prasad et al. (2010) having no nega-
tive controls and the other two stud-
ies having positive and negative
controls. There was only one study
for binoxalate (Talesara et al. 2014)
and one for iodide (Craig et al.
2012), which showed laser treatment
was superior to potassium profes-
sional treatment and professionally
applied potassium iodide was supe-
rior to a professionally applied oxa-
late preparation, respectively, but no
negative controls were used.
Casein derivatives (amorphous calcium
phosphate (ACP) and casein
phosphopeptide CPP)
This review included consideration
of 32 papers, of which only three
fulfilled the relevant criteria. Of these
three studies one tested ACP-CPP
(Torwane et al. 2013) and the other
two ACP (Yates et al. 1998a, Geiger
et al. 2003). All products were pro-
fessionally applied. Two studies were
split mouth and the other parallel
(Geiger et al. 2003). The ACP-CPP
(Recaldentâ) was applied per the
manufacturer’s instructions, and the
ACP products as solutions. All three
studies evaluated pain with airblast
and tactile stimuli and were of low
(Yates et al. 1998a), moderate
(Torwane et al. 2013) or high (Gei-
ger et al. 2003) risk of bias. One
study used potassium as a direct
comparator (Geiger et al. 2003), a
second study used ethanolic extract
of Indian propolis as a direct com-
parator (Torwane et al. 2013) and
water as a negative control and a
third study simply used a negative
control of water (Yates et al. 1998a).
All products were examined for their
effect on the reduction in dentine
hypersensitivity pain, the outcome
measure, immediately and long term.
In the study by Torwane et al.
(2013) ACP-CPP was found to result
in similar pain reduction as the posi-
tive control and was more efficacious
than the negative control, water.
Yates et al. (1998a) showed that
treatment with ACP was no better
than treatment with water in reduc-
ing pain, and Geiger et al. 2003
showed that it resulted in similar
pain scores as the potassium control.
Strontium
This review included consideration
of 97 papers, of which 18 fulfilled
the relevant criteria. The majority of
strontium chloride papers (8) were
pre and up to 2008 (Collins & Per-
kins 1984, Minkoff & Axelrod 1987,
Gillam et al. 1992a,b, Pearce et al.
1994, Silverman et al. 1996, Du Min
et al. 2008, Kobler et al. 2008), bar
one (Liu & Hu 2012); and the
majority of strontium acetate studies
(7) 2008 onwards (Hughes et al.
2010, Mason et al. 2010, Docimo
et al. 2011, Li et al. 2011, Schiff
et al. 2011, Orsini et al. 2013, West
et al. 2013a), bar 3 (Pearce et al.
1994, Gillam et al. 1996, West et al.
1997). All papers focused on the
medium of toothpaste with no pro-
fessionally applied products evalu-
ated. All articles had a moderate risk
of bias as determined by the assess-
ment criteria.
The consideration of the effective-
ness of strontium in the reduction in
pain of dentine hypersensitivity, the
outcome variable, has been divided
into studies investigating strontium
chloride and those investigating
strontium acetate. Of the eight stud-
ies on strontium chloride dated 2008
and earlier, although all studies
demonstrated an improvement in
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
patients’ perceptions of the pain of
their dentine hypersensitivity, there
was not a consistent significant
improvement in pain reduction
compared to the negative controls or
comparator agents. The more recent
study, Liu & Hu (2012), did observe
a significant reduction in dentine
hypersensitivity compared to a fluo-
ride control, but the test product
had two actives, potassium as well
as strontium, making comparisons
difficult.
Of the seven strontium acetate
RCT’s (2010–2013), all were parallel
in design and used airblast and tac-
tile stimuli. Of these studies, six
compared strontium acetate directly
to arginine (Hughes et al. 2010, Doc-
imo et al. 2011, Li et al. 2011, Schiff
et al. 2011, Orsini et al. 2013, West
et al. 2013a), two with an additional
fluoride negative control (Docimo
et al. 2011, Li et al. 2011). Further
studies investigated strontium acetate
versus a negative control only
(Mason et al. 2010), strontium ace-
tate versus a negative control and a
positive control, potassium (West
et al. 1997) and strontium acetate
versus a negative control and a com-
parator, strontium chloride (Pearce
et al. 1994).
Strontium acetate was shown to
be more effective at reducing pain
than a negative control in two recent
studies (Mason et al. 2010, Docimo
et al. 2011) and comparable in
another study (Li et al. 2011). Com-
paring strontium acetate to arginine,
in three studies the pain reduction
achieved by the two agents was simi-
lar (Hughes et al. 2010, Orsini et al.
2013, West et al. 2013a), and three
showed that arginine was signifi-
cantly more effective at pain reduc-
tion (Docimo et al. 2011, Li et al.
2011, Schiff et al. 2011). These six
studies were fairly equally divided
over immediate and long-term
assessment. Strontium was shown to
reduce pain to a similar degree as
potassium in one study (West et al.
1997).
Stannous fluoride
This review included consideration
of 50 papers, of which 17 fulfilled
the relevant criteria. The RCT’s used
stannous in the form of stannous
fluoride toothpaste, three of the
studies with hexametaphosphate

(Schiff et al. 2005, 2006, Chaknis
et al. 2011), and six studies 2000–
2001 investigated a combination of
stannous fluoride and potassium salts
(Conforti et al. 2000, Schiff et al.
2000a,b, Sowinski et al. 2000a,b,
2001). One study, Sharma et al. 2010
used a self-administered stannous gel.
No studies included professionally
applied stannous salts. All studies
included parallel groups and assessed
pain evaluation to cold air, with only
three not using tactile as a second
stimulus (Day et al. 2010, He et al.
2011a,c). All studies were assessed as
having a moderate risk of bias.
Eleven studies incorporated a
direct benchmark or negative control
fluoride toothpaste (Conforti et al.
2000, Sowinski et al. 2000a, 2001,
Schiff et al. 2000b, 2005, 2006, Day
et al. 2010, Chaknis et al. 2011, He
et al. 2011b, Parkinson et al. 2013,
He et al. 2014). Potassium was often
used as a positive control comparator
product to stannous fluoride (seven
studies) (Schiff et al. 2000a,b, So-
winski et al. 2000a,b, 2001, Ni et al.
2010, Sharma et al. 2010), however,
as discussed elsewhere in this review,
potassium has poor effectiveness.
One study compared stannous gel
(Sharma et al. 2010) to a positive
control, potassium/calcium sodium
phophosilicate (CPSP). Three studies
included a potassium control and a
negative control to evaluate a stan-
nous/potassium formulation (Sowin-
ski et al. 2000a, Schiff et al. 2000b,
Sowinski et al. 2001). One study
compared to a comparator, triclosn
PVM/MA and a negative fluoride
control (Chaknis et al. 2011).
Another two studies incorporated a
positive control, arginine (He et al.
2011a,c). Fifteen studies evaluated
efficacy after 2 weeks or more, cate-
gorized as long-term effects.
The effectiveness for stannous in
the reduction in pain of dentine
hypersensitivity, the outcome vari-
able, was assessed. Comparing stan-
nous agents to negative controls,
seven studies showed superiority for
stannous fluoride over the negative
control and four studies showed
superiority for the stannous/potas-
sium agent over the negative control.
Comparing stannous fluoride to
arginine yielded two studies (He
et al. 2011a,c), which showed stan-
nous to be significantly superior to
arginine in both the short- and long-
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Management of dentine hypersensitivity
term results. One study for NovaM-
inâ which used a stannous gel as the
comparator (Sharma et al. 2010)
generated results which were gener-
ally positive towards NovaMinâ,
and one study which compared
PVM/MA with stannous showed the
former to be superior (Chaknis et al.
2011). In the combined stannous/
potassium paste studies (6), results
always in favour of the stannous
product, being more efficacious than
potassium or negative control,
except (Ni et al. 2010) and this
showed equivocal results.
Generally, the efficacy of the
stannous products in reducing the
pain for dentine hypersensitivity
appears to be measured in the long
term, three studies, which were all
favourable measuring both immedi-
ately and long term, and two studies
short term only.
Calcium sodium phosphosilicate (CSPS)
This review included consideration
of 28 papers, of which 12 fulfilled
the relevant criteria. The majority of
CSPS papers were regarding tooth-
paste (10) (Du Min et al. 2008, Lit-
kowski & Greenspan 2010,
Narongdej et al. 2010, Pradeep &
Sharma 2010, Salian et al. 2010,
Sharma et al. 2010, Pradeep et al.
2012, Surve et al. 2012, Rajesh et al.
2012, Acharya et al. 2013), and the
other two prophylaxis pastes (Mill-
eman et al. 2012, Neuhaus et al.
2013). All studies were parallel in
design, with 10 studies having the
recommended 2 stimuli (Du Min
et al. 2008, Litkowski & Greenspan
2010, Narongdej et al. 2010, Pradeep
& Sharma 2010, Sharma et al. 2010,
Salian et al. 2010, Milleman et al.
2012, Pradeep et al. 2012, Rajesh
et al. 2012, Neuhaus et al. 2013). Of
the studies evaluating toothpaste, five
studies had a high risk of bias as
determined by the assessment criteria
(Salian et al. 2010, Narongdej et al.
2010, Surve et al. 2012, Rajesh et al.
2012, Acharya et al. 2013), the
remainder having a moderate risk of
bias. When assessing the quality of
the body of evidence for profession-
ally applied CSPS agents one study
had a moderate risk of bias (Neuhaus
et al. 2013) and the other a high risk
of bias (Narongdej et al. 2010).
With regards to the studies evalu-
ating toothpastes, three studies
S293
incorporated a positive and negative
control, (Pradeep & Sharma 2010,
Salian et al. 2010, Pradeep et al.
2012). In total six studies evaluated
CSPS agents against a negative con-
trol (Du Min et al. 2008, Litkowski
& Greenspan 2010, Pradeep & Shar-
ma 2010, Salian et al. 2010, Pradeep
et al. 2012, Rajesh et al. 2012). Of
the comparisons to positive controls
CSPS was evaluated against potas-
sium nitrate (7) (Narongdej et al.
2010, Pradeep & Sharma 2010, Sa-
lian et al. 2010, Sharma et al. 2010,
Pradeep et al. 2012, Surve et al.
2012, Acharya et al. 2013), stron-
tium chloride (1) (Du Min et al.
2008) and stannous fluoride gel (1)
(Sharma et al. 2010).
Results were consistently in
favour of CSPS being significantly
more effective than a negative con-
trol, conventional fluoride control
and the potassium salt. The one
study directly comparing CSPS to
stannous showed the former was
more effective. All study products
were assessed long term.
The two studies which evaluated
CSPS agents as prophylaxis pastes
evaluated the agents versus a compar-
ator and negative control (Milleman
et al. 2012, Neuhaus et al. 2013).
Both studies were shown to be
more efficacious than the negative
control.
Oxalates
This review included consideration
of 98 papers, of which nine fulfilled
the relevant criteria. The majority
of oxalate RCT’s (8) (Gillam
et al. 2004, Merika et al. 2006,
Pamir et al. 2007, Vieira et al. 2009,
Erdemir et al. 2010, Camilotti et al.
2012, Craig et al. 2012, Vora et al.
2012) involved professionally applied
products. The other study invo-
lved a self-administered mouthrinse
(Sharma et al. 2013). Clinical study
designs varied between parallel design
(4) (Merika et al. 2006, Pamir et al.
2007, Vieira et al. 2009, Sharma et al.
2013) and split mouth (5) (Gillam
et al. 2004, Erdemir et al. 2010, Cam-
ilotti et al. 2012, Craig et al. 2012,
Vora et al. 2012). The majority of
studies assessed long-term results (7)
(Gillam et al. 2004, Merika et al.
2006, Pamir et al. 2007, Vieira et al.
2009, Erdemir et al. 2010, Camilotti
et al. 2012, Vora et al. 2012) rather
S294 West et al.
than short term (2) (Craig et al. 2012,
Sharma et al. 2013), changes in pain.
Studies all evaluated pain with air-
blast, and all bar one study with tac-
tile stimulus as well. The study by
Camilotti et al. (2012) had a high risk
of bias, the remainder had a moderate
risk of bias as determined by the
assessment criteria.
In all studies the efficacy for oxa-
lates in the reduction in pain in den-
tine hypersensitivity, the outcome
variable, was assessed. The agents
used were commercially available
products such as 3% monohydro-
gen–monopotassium, 30% dipotassi-
um, combination of monohydrogen–
monopotassium, 1.4% potassium
oxalate, ferric and oxalate containing
resin. The oxalate salts were directly
compared to resins, e.g. Glumaâ,
Seal and Protectâ; diamine silver
fluoride, lasers and placebo agents.
One study, Sharma et al. (2013)
evaluated oxalate mouthrinse with
fluoride toothpaste versus fluoride
toothpaste alone, showing superior-
ity for the test agent. Six studies
evaluated oxalates professionally
applied against a negative control,
water being most frequently used
(Pamir et al. 2007, Camilotti et al.
2012, Vora et al. 2012), results being
equivocal. When comparing oxalates
with resins and sealants, results were
inconsistent, showing oxalates
reduced pain less (Camilotti et al.
2012, Vora et al. 2012) in some cases
and to a similar degree in other cases
(Gillam et al. 2004, Merika et al.
2006, Pamir et al. 2007, Erdemir
et al. 2010).
Resin-based materials
Glass ionomer, resin-reinforced glass
ionomer/compomers, adhesive resin
primers and adhesive resin bonding
systems have been used for the
treatment of dentine hypersensitivity
over many years. This group of
materials have been assessed under
the search headings of resins, glass
ionomers, Seal and Protectâ and
Glumaâ.
This review included consider-
ation of 684 papers, of which one
from the resins (Veitz-Keenan et al.
2013), zero from the glass ionomers,
two from the Seal and Protectâ
(Pamir et al. 2007, Erdemir et al.
2010) and six from the Glumaâ
searches (Duran & Sengun 2004,
Polderman & Frencken 2007, Sethna
et al. 2011, Ehlers et al. 2012, Ding
et al. 2014, Mehta et al. 2014) ful-
filled the relevant criteria. In these
studies all products were profession-
ally applied and all evaluated the
agents over long-term assessments
using an airblast stimuli. Studies had
a moderate risk of bias except for
Ding et al. (2014) where the risk of
bias was high.
The majority of studies compared
resins directly with comparator
products and were shown to consis-
tently reduce dentine hypersensitiv-
ity, however, the studies showed
great heterogeneity in study design.
The effectiveness of resins in the
reduction in pain from dentine
hypersensitivity, the outcome vari-
able, demonstrated efficacy in pain
reduction compared to potassium
paste (Veitz-Keenan et al. 2013).
Seal and Protectâ gave similar
results to other commercially avail-
able sealants investigated (Erdemir
et al. 2010). Only two studies evalu-
ated the efficacy of resins against
negative controls (Pamir et al. 2007,
Ding et al. 2014), both showing the
agents tested to be superior in
achieving a reduction in dentine
hypersensitivity pain. The results for
Glumaâ were equivocal when
compared with lasers (Ehlers et al.
2012), both treatments resulting
in decreased hypersensitivity, but
Glumaâ was inferior in efficacy as
compared to other bonding agents
(Sethna et al. 2011, Ding et al. 2014,
Mehta et al. 2014) and glass iono-
mers (Duran & Sengun 2004).
Varnishes
Varnishes and topically applied solu-
tions have also been used for the
treatment of dentine hypersensitivity
over many years. This group of den-
tal materials makes up a disparate,
anomalous group and have been
placed together due to lack of num-
bers of studies on each. The search
has been undertaken on the follow-
ing headings of varnishes, Bifluoridâ
and Duraphatâ.
This review included consider-
ation of 87 papers of which seven
papers, five from the varnishes
(Castillo et al. 2011, Sethna et al.
2011, Yilmaz et al. 2011, Dreben-
stedt et al. 2012, Ding et al. 2014),
one paper from the Bifluoridâ
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
search (Kielbassa et al. 1997) and
one paper from the Duraphatâ
search (Corona et al. 2003) fulfilled
the review inclusion and exclusion
criteria. The articles were all of mod-
erate risk of bias except for Corona
et al. (2003) and Ding et al. (2014)
which have a high risk of bias as
assessed by the assessment criteria.
The group of varnish agents
included Clinpro XTâ (1) (Ding
et al. 2014), Cervitecâ (2) (Sethna
et al. 2011, Drebenstedt et al. 2012),
sodium fluoride (1) (Yilmaz et al.
2011) and diamine silver (1) (Castillo
et al. 2011). Three studies were split
mouth (Castillo et al. 2011, Sethna
et al. 2011, Ding et al. 2014). Four
studies included a negative control,
often water (Castillo et al. 2011,
Drebenstedt et al. 2012, Ding et al.
2014). When compared with either
negative control or baseline sensitiv-
ity scores studies showed that var-
nishes consistently caused a
reduction in the reported pain of
dentine hypersensitivity with the
exception of fluoride varnishes which
were shown to have limited (Yilmaz
et al. 2011) or no efficacy (Corona
et al. 2003). Positive controls where
the efficacy of products could be
compared directly, included a multi-
tude of resins and varnishes and
lasers. Cervitecâ appeared to be
more effective than Glumaâ and
placebo (Sethna et al. 2011, Dreben-
stedt et al. 2012) and similarly Clin-
pro XTâ was more effective than
Glumaâ in one study (Ding et al.
2014), whereas the Bifluoridâwas
superior to the fluoride control, in
another study (Kielbassa et al.
1997).
Lasers
This review included consideration
of 174 papers, of which eight ful-
filled the relevant criteria (Gersch-
man et al. 1994, Tengrungsun &
Sangkla 2008, Schwarz et al. 2002,
Ehlers et al. 2012, Femiano et al.
2013, Flecha et al. 2013, Ko et al.
2014, Talesara et al. 2014). Two
studies included parallel design stud-
ies and six were split-mouth design.
All assessed pain evaluation to cold
air. Two studies were at a high risk
of bias (Tengrungsun & Sangkla
2008, Talesara et al. 2014) with the
remainder at a moderate risk of
bias.

The trials included Nd:Yag laser,
a laser-emitting toothbrush and
GaAIAs laser. All studies utilized
professionally applied products, and
were evaluated over long-term
assessments. Of the eight studies,
seven compared efficacy with com-
parator products with only Gersch-
man et al. (1994) using only a
negative control. Laser treatment
consistently decreased the pain of
dentine hypersensitivity, however,
studies demonstrated minimal supe-
riority over comparator agents,
which were of many types.
Discussion
This systematic review has investi-
gated the effectiveness of both self-
applied and professionally adminis-
tered agents for the alleviation of
pain from dentine hypersensitivity.
Dentine hypersensitivity being a
painful oral condition affecting the
quality of life (Boiko et al. 2010) for
many people (West et al. 2013b).
Evaluation of treatment for the relief
of pain has always been fraught with
difficultly due to the subjective opin-
ion of the patient, pan perception
being dependent on many factors.
Over the years, an abundance of
agents have been advocated for the
alleviation of dentine hypersensitiv-
ity, both self-applied and profession-
ally administered, but as yet the gold
standard agent for treatment of this
condition has not been ascertained.
Ideally a treatment for dentine
hypersensitivity should follow Gross-
man’s principles (Grossman 1935), of
being easy to administer, effective,
safe, fast acting and having long-last-
ing treatment effects. The time period
for evaluation of dentine hypersensi-
tivity varied considerably on review-
ing the studies. Traditional studies
examined the long-term effects of
active agents, usually testing efficacy
after 2, 4 and 8 weeks, and some
after periods of up to 6 months to a
year. However, the majority of recent
studies have focused on achieving
immediate reduction in pain, some
trials being of only a couple of days
in duration. The products tested in
these short-term studies being
designed to be used regularly, e.g.
twice daily toothpaste application,
and hence able to maintain pain
reduction over long-term periods. In
this review, studies were classified
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Management of dentine hypersensitivity
into those that assessed efficacy
immediately after product applica-
tion and up to 1 week; and those that
assessed long-term effects of 2 weeks
and over. This is in accordance with
the researchers aiming to prove
immediate efficacy or efficacy starting
after a couple of weeks, which is the
time needed, e.g. for potassium to
have an effect.
Potassium salts have been used
over many years, being investigated
as active agents and more recently
being used as positive controls, as
can be seen in this review. It also
appears that potassium is often
added to the treatment product in
addition to the active ingredient, “an
extra active.” The effectiveness of
potassium in the reduction in DH
pain is, however, questionable, and
it can be argued that this agent is far
from ideal as a positive control in
RCTs. If used, study conclusions
need to reflect potassium’s lack of
proven effectiveness as a treatment
for dentine hypersensitivity.
A major challenge encountered
when reviewing dentine hypersensi-
tivity studies to evaluate the pain
relief from potential desensitizing
agents, was the large heterogeneity
amongst the trial designs. For prod-
uct comparison, studies need to be
well structured according to current
guidance and ideally of similar
design, using clinically relevant stim-
uli, with pain evaluated over similar
time periods. Few guidelines on trial
design exist. Holland et al. set out
guidance in 1997, suggesting e.g. it
was preferable to have two clinically
relevant stimuli to evoke pain such
as an airblast, tactile or thermal
stimulus. This was a factor included
in our assessment criteria for the
quality of the articles reviewed. The
majority of studies used a short, cold
airblast stimulus followed by assess-
ment of pain, and many used a tactile
stimulus as well. Thermal stimulation
was also used and considered a satis-
factory second stimulus.
Assessing the studies in this
review, it was difficult to make con-
clusive statements about relative
treatment effectiveness for a number
of reasons. Many different active
ingredients were evaluated, and fur-
ther a number of different salts of
the active ingredients were tested.
For example potassium was used in
the form of nitrate, chloride, citrate
S295
and in combination with polymers,
stannous and arginine. These agents
were in a variety of formulations
and delivery mechanisms such as
toothpaste, gel, mouthrinse or pro-
fessionally applied agents. They also
may contain a number of additional
ingredients which alone or com-
bined, can have an effect on the
management of dentine hypersensi-
tivity. To directly compare the
effects of each active, a number of
studies with the same formulation
are necessary. More weight was
therefore given where effectiveness
was supported by a greater number
of studies which tested the active in
the same formulation and delivered
by the same mechanism.
All the trials assessed were ran-
domized controlled clinical studies.
No in situ studies were included
although they have value in support-
ing the efficacy of the clinical study,
particularly with respect to the
assessment of tubule occlusion, and
ability of an agent to withstand dis-
solution and removal from the den-
tine tubule due to acidic dietary
challenges. The studies included were
all parallel or split-mouth design,
most being of parallel design to
negate the possibility of carry-over
from the effect of the study product.
It is possible to perform split-mouth
studies if the agent can be controlled
in the oral environment, such as a
varnish or laser therapy. Studies
evaluating toothpaste would be diffi-
cult to undertake in split-mouth
design, and would have to be
assessed very carefully for bias.
The ideal dentine hypersensitivity
study should have a negative con-
trol/placebo/benchmark agent group
and comparator/positive control
agent group, as suggested in the
guidance of Holland et al. (1997).
Interestingly, many of the studies
investigating the efficacy of dentine
hypersensitivity only had one con-
trol. In conducting this review, stud-
ies therefore were assessed as having
a lower risk of bias if they included
both a negative and positive control.
When reviewing the studies
included in this review, it was appar-
ent that the majority were either
sponsored by industry or received a
donation from industry. Only 24
studies did not fall into these catego-
ries out of 105. This could be
perceived as a factor influencing
S296 West et al.
bias, however, in reviewing studies
sponsored by industry, the majority
of recent trials were conducted to
International Conference on Har-
monisation Good Clinical Practice
guidelines (http://www.ich.org/)
many agents being either medicines
or medical devices and the majority
of studies were found to be at mod-
erate risk of bias, satisfying all but
one of our assessment criteria fully.
All studies should be published, irre-
spective of whether results demon-
strate efficacy of the agent tested,
but it was impossible to ascertain if
this was the case. EU ethical regula-
tions now state all studies should be
registered at the time of ethical
approval application, which will give
greater transparency. Industry has
embraced this guidance.
For the reasons explained, a
meta-analysis on the results of this
review was not possible and evidence
has therefore been provided in the
form of descriptive analyses. Recom-
mendations have been suggested for
each agent.
Arginine
The quality of the body of evidence
supporting the conclusion that argi-
nine is more effective at reducing the
pain from dentine hypersensitivity as
compared to a negative control or a
conventional fluoride paste for
immediate and long-term treatment,
was high. Similarly, the quality of
evidence for arginine being more
effective than potassium, was high.
Comparing arginine to strontium,
reviewers concluded that no superi-
ority between these agents could be
confirmed, the evidence being mod-
erate, with further studies required.
Evidence from two studies was high
that arginine was not as effective as
stannous fluoride paste at reducing
the pain of dentine hypersensitivity.
Comparing this systematic review
with two previous systematic reviews
on toothpaste containing arginine
(Sharif et al. 2013, Yan et al. 2013),
one identified 14 studies and the
other only two to fit the inclusion
criteria. The analyses showed the
evidence was moderate that arginine-
containing toothpaste was efficacious
when compared with placebo and
potassium salt-containing toothpaste,
and low in comparison to strontium-
containing toothpaste.
In this systematic review,
although studies supported the effec-
tiveness of arginine as a mouthrinse
to reduce the pain of dentine hyper-
sensitivity, the quality of the evi-
dence was low as its efficacy has not
been investigated directly against a
substantive positive control, and
there are few studies with some
imprecision. Studies also consistently
showed that arginine applied profes-
sionally provided relief from the pain
of dentine hypersensitivity, but with
only one study directly comparing
efficacy against a positive control,
the quality of evidence demonstrat-
ing that this treatment was better
than other treatments for dentine
hypersensitivity, was low.
Recommendations
The review suggests that when argi-
nine is self administered as a tooth-
paste, it is an effective treatment
agent for the pain relief of dentine
hypersensitivity. This is supported
by high-quality evidence, and the
authors recommend its use for the
treatment of dentine hypersensitivity.
The findings of the review suggest
arginine applied professionally is
effective in the treatment of dentine
hypersensitivity, however, there was
insufficient evidence for the authors
to recommend this agent compared
to other professionally applied
agents.
PVA/MA – Polymers
There was limited evidence of effec-
tiveness of PVA/MA mouthrinse for-
mulations per se assessing the studies
included in this review. Many active
agents were combined with other
agents making interpretation difficult.
Overall the quality of evidence that
PVA/MA alone or in combination
with other active ingredients was low
regarding its effectiveness in alleviat-
ing of dentine hypersensitivity.
Recommendations
This review is unable to recommend
the use of PVA/MA polymers in the
treatment of dentine hypersensitivity
at the present time, the evidence
being inconclusive.
Potassium
Considering the studies included in
this review, the quality of the evi-
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
dence that potassium is inferior to
comparator products was high for
arginine, CSPS and stannous for the
long-term treatment of dentine
hypersensitivity. The quality of evi-
dence for potassium being as effective
as other positive control agents, or
more effective than negative controls
was low with further studies required.
From these results effectiveness of
the agent is difficult to confirm.
As discussed above, there is much
debate on the effectiveness of potas-
sium toothpaste, a Cochrane review
(Poulsen et al. 2001, 2006) for potas-
sium nitrate showed that the quality
of evidence supporting the efficacy
of potassium salts was low. This
unproven status for potassium raises
issues as to why potassium has been
used as the positive control in recent
clinical studies, and this lack of good
evidence of effectiveness has also
been highlighted in another recent
systematic review by Pol et al. 2010.
Studies evaluating potassium as the
active agent and studies using potas-
sium as the comparator/positive con-
trol need to be of sufficient length of
time, otherwise the agent will be
ineffective, which one could argue
was occurring in some of the recent
studies.
Previous systematic reviews
include the potassium ion, e.g. the
review on oxalates (Cunha-Cruz
et al. 2011), showing no evidence for
potassium efficacy. The systematic
review on potassium toothpaste
(Karim & Gillam 2013), identified six
papers fitting the inclusion criteria,
and again found minimal evidence
for the effectiveness of potassium in
reducing the pain of dentine hyper-
sensitivity.
Recommendations
Our review demonstrated there is
limited evidence for the effectiveness
of potassium salts for the pain
relief of dentine hypersensitivity
and cannot recommend its use for
the treatment of dentine hypersensi-
tivity.
Casein derivatives
Limited conclusions can be drawn from
the studies reviewed here as the quality
of evidence for the effectiveness of
casein derivatives in the reduction in
pain of dentine hypersensitivity was
very low. There are two systematic

reviews (Azarpazhooh & Limeback
2008, Talioti et al. 2014) that have
also examined the clinical efficacy of
casein derivatives. These reviews
came to similar conclusions.
Recommendations
Our review demonstrated there is
insufficient evidence for effectiveness
of casein derivatives to relieve the
pain of dentine hypersensitivity and
cannot recommend its use for the
treatment of dentine hypersensitivity.
Strontium
In summary, the quality of evidence
supporting strontium chloride salts
as being more effective than negative
controls or comparator actives in
pain reduction in dentine hypersensi-
tivity is low with more studies
needed to indicate whether this salt
is effective.
Strontium acetate showed equivo-
cal effects of pain reduction as com-
pared to arginine, trends showing
arginine was slightly more effective,
the quality of evidence was moderate
with more studies required to con-
firm which agent is the most effec-
tive. Similarly, the quality of
evidence demonstrating that stron-
tium acetate was more effective than
a fluoride control was moderate in
recent studies. Comparing this sys-
tematic review with one previous
systematic review on strontium
toothpastes (Karim & Gillam 2013),
one paper was identified fitting the
inclusion criteria, giving minimal evi-
dence to interpret.
Recommendations
This review showed that when stron-
tium acetate is self administered as a
toothpaste, it is an effective treat-
ment agent for the pain relief of
dentine hypersensitivity. This is sup-
ported by moderate quality evidence,
and the authors recommend its
use for the treatment of dentine
hypersensitivity.
Stannous
The quality of evidence supporting
the effectiveness of stannous salts
alone, or in combination with potas-
sium in reducing the pain of dentine
hypersensitivity as compared to
conventional fluoride pastes was
moderate.
© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Management of dentine hypersensitivity
Even though there are only two
studies where stannous fluoride has
been directly compared with arginine
for the relief of dentine hypersensi-
tivity, the quality of the body of evi-
dence supporting stannous being a
more effective agent, was high.
There are no systematic reviews pub-
lished on stannous fluoride tooth-
paste.
Recommendations
Considering the results together as a
whole, the review suggests when
stannous fluoride is self administered
as a toothpaste, it is an effective
treatment agent for the pain relief of
dentine hypersensitivity. This is sup-
ported by high-quality evidence, and
the authors recommend its use for
the treatment of dentine hypersensi-
tivity.
Calcium sodium phosphosilicate (CSPS)
The RCT’s comparing the efficacy of
CSPS toothpaste with a variety of
positive and negative controls over
long-term assessments showed CSPS
to be consistently more effective in
the treatment of dentine hypersensi-
tivity. Although results were consis-
tently in favour of CSPS, the quality
of the evidence for this finding was
low as some of the studies were at a
high risk of bias. Similarly, CSPS
applied professionally was shown in
two studies to be more effective than
a negative control, for the reduction
in dentine hypersensitivity pain, but
the quality of evidence was also low.
Heterogeneity was found between the
designs of the studies and there was
often a lack of detail, few participants
and a lack of power calculation. A
previous systematic review published
on CSPS toothpaste (Talioti et al.
2014) evaluated three studies with lim-
ited data to support of effectiveness.
Recommendations
This review suggested that when
CSPS is self administered as a tooth-
paste, it is an effective treatment
agent for the pain relief of dentine
hypersensitivity. This was supported
by a low-quality body of evidence,
which was consistently in favour of
effectiveness. The authors recom-
mend its use for the treatment of
dentine hypersensitivity, being mind-
ful of the fact that evidence is not
strong.
S297
The findings of the review sug-
gested CSPS applied professionally is
effective in the treatment of dentine
hypersensitivity, however, there is
insufficient evidence for the authors
to recommend this agent compared to
other professionally applied agents.
Oxalates
The quality of the body of evidence
for effectiveness of oxalates in reduc-
ing the pain of dentine hypersensitiv-
ity was low. It was difficult to
compare the results of studies due to
the huge variation in oxalate prod-
ucts evaluated and multitude of neg-
ative and positive controls employed.
Most studies examined profession-
ally applied agents, however, in the
one study which evaluated a self-
administered agent, a mouthrinse,
Sharma et al. (2013), it was demon-
strated this agent was more effica-
cious than a negative control.
A systematic review by Cunha-
Cruz et al. (2011) failed to show
substantial significance for oxalate
treatment, with the possible excep-
tion of 3% monohydrogen oxalate.
Since this review further studies have
been published, which are included
in our review.
Recommendations
The findings of the review suggest
there is limited evidence for the rec-
ommendation of self-applied or pro-
fessionally administered oxalates in
the treatment of dentine hypersensi-
tivity at present.
Resins
The quality of the body of evidence
for the effectiveness of resins was
low and little interpretation can be
placed on the findings with regards
to resins due to the vast heterogene-
ity of the studies, as compared to
comparator products. Similarly, a
recent systematic review by Lin et al.
(2013) revealed little difference
between a number of professionally
applied products. The authors found
the studies difficult to compare due
to the multitude of different con-
trols, and lack of negative controls,
weakening the interpretation of the
findings and support the systematic
review by Lin et al. (2013). A further
systematic review published in 2013
analysed clinical trials on dentine
S298 West et al.
desensitizing agents identifying five
with satisfactory longer term (up to
6 months) results (da Rosa et al.
2013), however, again, the trial
designs and products were vastly dif-
ferent, giving little meaning to the
interpretation.
Recommendations
The findings of the review suggested
resins applied professionally are
effective in the treatment of dentine
hypersensitivity, however, there was
insufficient evidence for the authors
to recommend these agents com-
pared to other professionally applied
agents.
Varnishes
For all of these varnish products,
their effectiveness was limited to the
duration for which they remained on
the tooth surface. There was limited
evidence of effectiveness as com-
pared to specific comparator treat-
ments due to the low quality of the
body of evidence resulting from the
heterogeneity of the studies and lack
of sufficient controls. Previous sys-
tematic reviews confirm these find-
ings (Lin et al. 2013, da Rosa et al.
2013).
Recommendations
The findings of the review suggest
that with the exception of fluoride
varnishes, these agents applied pro-
fessionally show some effectiveness
in the treatment of dentine hypersen-
sitivity, however, there is insufficient
evidence for the authors to recom-
mend these agents compared to
other professionally applied agents.
Lasers
The quality of the body of evidence
for the effectiveness of lasers in
reducing the pain of dentine hyper-
sensitivity was low. Lasers appear to
have equivocal or weak effectiveness
as compared to dentine bonding
agents, potassium gel and a variety
of controls. Other systematic reviews
(He et al. 2011d, Sgolastra et al.
2011, 2013) on lasers concluded that
there was weak evidence for laser
treatment with a strong placebo
effect. There do not appear to be
enough studies on a particular type
of laser for thorough systematic
analysis at present.
Recommendations
The findings of the review suggested
lasers applied professionally may be
effective in the treatment of dentine
hypersensitivity, however, there is
insufficient evidence for the authors
to recommend this agent compared
to other professionally applied
agents.
Conclusions
This systematic review assessed 11
treatment modalities for dentine
hypersensitivity including self admi-
nistered agents and professionally
applied agents. Based on this review
the authors concluded that arginine,
stannous fluoride, calcium sodium
phosphosilicate and strontium, as
self administered toothpaste, are
effective in pain reduction in dentine
hypersensitivity. These data suggest
that with twice daily use, all four
products would be expected to bring
about rapid and considerable relief
of symptoms during product use.
These toothpastes are easy to use
and readily available over the coun-
ter.
Professionally applied products
appear effective in the treatment of
dentine hypersensitivity, however,
there is insufficient evidence for the
authors to recommend one agent
compared to another.
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periodontal maintenance patients: a rando- Clinical Trials Unit

Clinical Relevance
Scientific rationale: Although many
agents have been used in the man-
agement of dentine hypersensitivity,
no clear agent appears to be supe-
rior. This systematic review assessed
all available treatment agents for
effectiveness.
Principal findings: Self-applied
agents such as toothpaste contain-
ing stannous fluoride, arginine, cal-
cium sodium phosphosilicate and
strontium, are effective at reducing
the pain of dentine hypersensitivity,
being able to occlude dentine tubules
and resist occlusion removal by
dietary acid. Currently there is insuf-
ficient evidence to recommend a
specific professionally applied agent.
Practical implications: Self adminis-
tered effective desensitizing tooth-
paste should be the first choice
treatment for this condition, fol-
lowed by professionally applied
agents. Aetiological factors must
be included in management
strategies.

© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd