Effectiveness of an in-office

arginine-calcium carbonate
paste on dentine hypersensitivity
in periodontitis patients
 DENTIN
HYPERSENSITIVITY
THIS IS TEST
DEFINITION

THE INTERNATIONAL WORKSHOP ON DENTIN

HYPERSENSITIVITY(1983) HAS PROPOSED THE FOLLOWING
DEFINITION FOR THIS CONDITION:
“ IT IS CHARACTERISED BY SHORT,SHARP PAIN
ARISING FROM EXPOSED DENTIN IN RESPONSE TO
STIMULI TYPICALLY
THERMAL,EVAPORATIVE,TACTILE,OSMOTIC OR
CHEMICAL AND WHICH CANNOT BE ASCRIBED TO
ANY OTHER FORM OF DENTAL DEFECT OR
PATHOLOGY”
ORAL ANATOMY AND DENTAL
TISSUES
 ETIOLOGY
ENAMEL LOSS CEMENTAL LOSS
• OCCLUSAL • GINGIVAL RECESSION
WEAR • PERIODONTAL DISEASE
• TOOTH BRUSH • ROOT PLANING
ABRASION
• PERODONTAL SURGERY
• DIETARY
EROSION
• ABFRACTION
• PARAFUNCTION
AL HABITS
GINGIVAL RECESSION
 ETIOLOGY

ABFRACTION TOOTH BRUSH ABRASION

THEORIES OF DENTIN HYPERSENSITIVITY

1. DIRECT INNERVATION THEORY

2. ODONTOBLAST DEFORMATION
THEORY/TRANSDUCER THEORY
3. HYDRODYNAMIC THEORY
DIRECT INNERVATION THEORY

• FIRST THEORY TO BE PUT

FORWARD
• NERVE FIBERS PRESENT
WITHIN DENTINAL
TUBULES INTIATE
IMPULSES WHEN THEY ARE
INJURED AND CAUSES
DENTINAL
HYPERSENSITIVITY.
 DIRECT INNERVATION THEORY

DISPUTES ABOUT THIS THEORY:

• NERVE FIBERS ARE PRESENT ONLY IN THE
PREDENTIN AND INNER DENTINAL ZONES
• WHEN PAIN INDUCING SUBSTANCES LIKE
POTTASIUM CHLORIDE,ACETYLCHOLINE ARE
APPLIED TO EXPOSED DENTIN,THEY FAIL TO
ELICIT PAINFUL RESPONSE.
 ODONTOBLAST DEFORMATION THEORY

• ODONTOBLAST OR THEIR PROCESSES ARE DAMAGED

WHEN EXTERNAL STIMULI ARE APPLIED TO EXPOSED
DENTIN.
• THEY CONDUCT IMPULSES TO THE NERVES IN THE
PREDENTIN AND UNDERLYING PULP AND THEN TO CNS.
• DISFAVOURED AS THE ODONTOBLASTIC PROCESSES
EXTEND ONLY PARTLY THROUGH THE DENTIN AND
NOT UPTO DEJ.
• ODONTOBLASTIC MEMBRANE POTENTIAL IS TOO
LOW TO PERMIT TRANSDUCTION.
• THERE ARE NO DEMONSTRABLE
NEUROTRANSMITTERS IN THE NEURAL
TRANSMISSION OF THE PULP.
HYDRODYNAMIC THEORY

THE MOST WIDELY ACCEPTED

MECHANISM OF ACTION OF DENTIN
HYPERSENSITIVTY , THE
HYDRODYNAMIC THEORY WHICH WAS
PROPOSED BY GYSI IN 1900 AND
VALIDATED BY BRANNSTROM IN 1996
 MECHANISM:

WHENEVER DENTIN IS EXPOSED

AND STIMULATED BY
TACTILE,CHEMICAL,THERMAL
OR OSMOTIC STIMULI THERE IS
RAPID MOVEMENT OF FLUID
THROUGH TUBULES.
THIS CAUSES:
• DIRECT STIMULATION OF LOW
THRESHOLD A- DELTA NERVE
FIBERS
• INDIRECT STIMULATION OF A-
DELTA NERVE FIBERS IN PULP
BY DISPLACING
ODONTOBLASTIC CELL
BODIES.
MECHANISM
 DIAGNOSIS

COMPLETE HISTORY CLINICAL RADIOGRAPHIC

EXAMINATION EXAMINATION
SIGNS AND SYMPTOMS VISUAL ASSESMENT RULE OUT PERI APICAL
LESION
INTENSITY PHYSICAL ASSESMENT
FREQUENCY AND DEPTH OF
DURATION PERIODONTAL POCKET
DEPTH
DIETARY CHANGES PERCUSSION TESTING
RESPONSE TO COLD
AIR
 DIFFERENTIAL DIAGNOSIS

1. FRACTURED RESTORATIONS
2. FRACTURED ENAMEL EXPOSING DENTIN
3. DENTAL CARIES
4. POST RESTORATION SENSITIVITY
5. CRACKED TOOTH SYNDROME
6. BLEACHING SENSITIVITY
 PREVENTION

1. DIET COUNSELLING REGARDING

CONSUMPTION OF ACIDIC FRUITS AND
BEVERAGES
2. CORRECTION OF BRUSHING TECHNIQUE
3. CARE DURING OPERATIVE PROCEDURES
4. CARE DURING PERIODONTAL PROCEDURES
 MANAGEMENT
1. DESENSITISATION BY OCCLUDING DENTINAL TUBULES
A)FORMATION OF SMEAR LAYER OVER EXPOSED DENTIN
B)USE OF TOPICAL AGENTS TO OCCLUDE EXPOSED
TUBULES
CALCIUM HYDROXIDE PASTE
CALCIUM PHOSPHATE PASTE
SILVER NITRATE
FLUORIDES
FLUORIDE IONTOPHRESIS
POTASSIUM NITRATE
VARNISHES
DENTIN ADHESIVES
 MANAGEMENT

C)PLACEMENT OF RESTORATIONS
GLASS IONOMER CEMENTS
COMPOSITE RESINS
D)USE OF LASERS
CO2 LASER
Nd:YAG,Er:YAG LASER
He:Ne LASER
2. DESENSITIZING BY BLOCKING PULPAL SENSORY
NERVES
A)POTASSIUM NITRATE TOOTHPASTE
 AIM

The aim of this single-centre, two-cell, double-blind, randomized

controlled clinical study was to evaluate the effectiveness of an in-office
desensitizing paste containing 8% arginine and calcium carbonate in
providing relief on dentine hypersensitivit immediately after scaling and
root planing and its sustained relief over a 6-week period.
 MATERIALS AND METHODS

The patient sample was selected from February 2012 to October 2012 from
the patients of the Department of Periodontology, School of
Dentistry,University of Athens, Greece .
 INCLUSION CRITERIA

age from 18 to 70 years,

free medical history,
without medical conditions that would contraindicate periodontal
treatment,
with a diagnosis of moderate to severe periodontitis (Armittag 1999), who
were to be treated with non-surgical periodontal treatment(scaling and root
planing) in one session,
satisfactory dental restorations and no caries in all of the teeth
pre-existing dentine hypersensitivity at least two teeth, as assessed
according to the criteria described below and
not using agents to treat hypersensitivity in the past 6 months
 EXCLUTION CRITERIA

subjects with gross oral pathology, chronic disease, extremely advanced

periodontal disease, periodontal treatment within the last 12 months.
hypersensitive teeth with mobility greater than one
teeth with extensive (implicating equal or more than 2/3 of the crown)
and/or defective restorations, suspected pulpitis, caries or cracked enamel.
subjects with removable appliances, such as removable partial dentures or
orthodontic retainers.
subjects taking anticonvulsants, antihistamines, antidepressants, sedatives,
tranquilizers, anti-inflammatory drugs or daily analgesics within 1 month
prior to enrollment to the study or if they started taking them during the
course of the study.
pregnant or lactating women.
subjects who were participating in any other clinical study or who had
participated in a desensitizing toothpaste study or who used a desensitizing
toothpaste within the last 3 months, or had a dental prophylaxis within 2-
weeks prior to the projected date of the screening visit.
subjects with unbalanced diet.
 PATIENT MANAGEMENT

Each subject was asked to use a specific toothpaste non-containing

desensitizing agents for 2 weeks prior to baseline evaluation.
Baseline evaluation included oral, peri-oral, periodontal and air-blast
hypersensitivity evaluation(baseline measurements).
Baseline periodontal examination was performed for all teeth and included
full mouth plaque score(FMPS) (O’Leary et al. 1972)
bleeding on probing (BOP),
Clinical attachment level (CAL),
probing pocket depth (PD) and
gingival recession (GR
Baseline hypersensitivity evaluation was performed for all teeth.
Each tooth was thoroughly dried with gauze. Then, the hypersensitivity
level was determined by assessing the response to air-blast stimuli (a dental
unit air-syringe emitting air (60 5 psi) at 20–23° was used,
the air was directed at the exposed buccal surface for 1-s from a distance
of 1 cm, the adjacent teeth were isolated with a cotton roll in order not to
affect the assessment).
Each subject recorded his/her perceived hypersensitivity for each tooth
using the Schiff Cold Air Sensitivity scale (Schiff et al. 1994), which was
scored
from 0 to 3
0: did not respond;
1: responded but did not request stimulu discontinuation;
2: responded and requested discontinuation or moved from stimulus;
3: responded, considered stimulus painful) and
Visual Analogue Scale (VAS) (Huskisson 1974), which was scored from 0
(no
pain) to 100 (intense pain).
Immediatelyafter, each patient was subjected to hypersensitivity (Schiff and
VAS)evaluation (post-application evaluation).

Patients were provided with acommercially available 1450 ppmfluoride

toothpaste and a soft-bristled toothbrush. They were asked tobrush using
only the products provided for 6 weeks.

Thereafter, each patient was subjected to follow-up hypersensitivity(Schiff

and VAS) evaluations at 2, 4,and 6 weeks.
 RESULTS

Fifty patients (25 patients in each group) completed the 6-week period.
The groups were statistically comparable for patient age and gender.
Baseline FMPS, BOP, CAL, PD, GR, bop,cal, pd, gr Schiff and VAS scores
The 6-week periodontal measurements (FMPS, BOP, CAL, PD, bop, cal,
pd) were statistically significantly reduced for both groups and they did not
statistically significantly differ between the groups.

GR and gr at 2, 4 and 6 weeks were statistically significantly different from

baseline for both groups and they did not statistically significantly differ
between the groups
The intergroup % hypersensitivity difference was greatest at 6 weeks with
both methods (mean values CI: 0.573 0.354–0.791 and 23.29 10.59–
36.00 for Schiff and VAS methods, respectively).
 CONCLUSION

Within its limits, this study demonstrated that the single in-office
application of the 8% arginine–calcium carbonate desensitizing paste after
scaling and root planing provided significant immediate reduction in
dentine hypersensitivity.

The significant desensitizing effect of the single in-office application of

the 8% arginine–calcium carbonate desensitizing paste sustained over a 6-
week period without relapse and the dentine hypersensitivity continued to
get further reduced up to at least 6 weeks.