- Email: [email protected]
Dentin tubule occlusion
Stannous fluoride toothpaste is effective in relieving DH pain. This use is supported by high-quality evidence and recommended as a DH treatment modality. When calcium sodium phosphosilicate (CSPS) toothpaste is used, it can relieve the pain of DH effectively, but the evidence for its action is low. Although it can be recommended, clinicians should be aware of the weak evidence that supports this use. Professional applications are also effective against DH pain, but the evidence is insufficient to formulate a recommendation for its use rather than other products. Neither self-applied nor professionally applied oxalates are supported by sufficient evidence of their efficacy in treating DH pain. Resins applied professionally appear to be effective, but the evidence is insufficient to recommend them as pain relief agents. Fluoride varnishes applied professionally show some effectiveness in treating DH pain, but the level of evidence supporting their use is insufficient compared to that supporting other interventions. Similarly, lasers applied professionally may be effective against DH pain, but the evidence for their use is insufficient. Discussion.—The treatment modalities for DH found to be most effective and supported by sufficient evidence
are arginine, stannous fluoride, CSPS, and strontium. With twice daily use, all of the products should provide rapid, noticeable relief from symptoms. The toothpaste forms of these agents are easy to use and readily available. The professionally applied agents have insufficient evidence to recommend one agent over any of the others.
Clinical Significance.—Toothpastes containing stannous fluoride, arginine, CSPS, and strontium are equally effective in relieving the symptoms of DH. Patients should be directed to use these agents if they are experiencing pain from DH; all are available over the counter. Professionally applied agents may be useful but the jury is still out in terms of evidence showing which is the best choice.
West NX, Seong J, Davies M: Management of dentine hypersensitivity: Efficacy of professionally and self-administered agents. J Clin Periodontol 42:S256-302, 2015 Reprints available from N West, Periodontology, Clinical Trials Unit, Bristol Dental School, Lower Maudlin St, Bristol BS1 2LY, UK: e-mail: [email protected]
Dentin tubule occlusion Background.—The mechanisms causing dentin hypersensitivity are believed to be explained by the hydrodynamic theory. Open dentin tubules may allow increased fluid movement, which causes hypersensitivity. This view is supported by the observation that dentin hypersensitivity correlates directly with the number of open dentin tubules present. Various products have been claimed to be effective in closing the open dentin tubules and thereby reducing hypersensitivity reactions. The effectiveness of several different products was evaluated in vitro using qualitative and quantitative means. Methods.—Dentin disks were exposed to a year’s worth of brushing using various experimental toothpastes. In addition, positive and negative controls were prepared for comparison. Lemon juice was applied to half of the disks after tooth brushing. All disks were examined under a scanning electron microscope, and the images were converted to binary black and white images for comparison. Open dentin tubules appeared as black pixels and were counted and evaluated statistically. Half of the disks were then
38
Dental Abstracts
broken and dentin tubule occlusion was evaluated using energy dispersive x-ray spectroscopy (EDS). Results.—Significant differences were noted between the negative control toothpaste and Sensodyne Rapid and Colgate Total Sensitive toothpastes. In addition, the positive control toothpaste differed significantly from all the experimental toothpastes except Elmex Sensitive Professional toothpaste. Lemon juice erosion led to a significant difference in the number of open dentin tubules between the disks polished with the positive control toothpaste and those brushed with Sensodyne Repair, Colgate Total Sensitive, and Dontodent Sensitive. Surface scans showed the dentin surfaces were irregularly covered by silica. Areas near the dentin surface within the open dentin tubules had no silicon. Elmex Sensitive Professional was associated with a scattered thin layer of silicon. The dentin surface and openings of dentin tubules had a clear layer of silicon after Sensodyne Rapid was used to brush the disks. Those brushed with Sensodye
Repair toothpaste had no clear silicon layer present. Several occluded dentin tubules were associated with BioRepair Sensitive. Neither silicon nor occluded tubules were present on disks brushed using Colgate Total Sensitive or Dontodent Sensitive. Discussion.—Certain toothpastes were able to occlude the dentin tubules, which should reduce dentin hypersensitivity. However, the occlusion is shallow and acid can dissolve the protective layer.
tested were able to perfectly occlude all of the open dentin tubules and prevent the mechanism of dentin hypersensitivity. Dentists should evaluate which toothpastes appear to do the best job and encourage patients to use them when dentin hypersensitivity is a problem.
Arnold WH, PRange M, Naumova EA: Effectiveness of various toothpastes on dentine tubule occlusion. J Dent 43:440-449, 2015
Clinical Significance.—The active ingredient in the toothpaste was the source of protection for dentin tubules. None of the toothpastes
Reprints available from WH Arnold, Dept of Biological and Material Sciences in Dentistry, Alfred Herrhausenstrasse 44, 58455 Witten, Germany; fax: þ49 2302926661; e-mail: [email protected]
Imaging Cone beam computed tomography Background.—Cone beam computed tomography (CBCT) provides volumetric imaging that can visualize the imaged region in essentially any plane. With newer units, dental CBCT has the ability to acquire high-resolution CT scans with relatively low radiation exposure for patients. Dental uses include the assessment of potential dental implant sites, endodontic diagnosis and treatment planning, impacted tooth assessment, craniofacial evaluation for orthodontic and orthognathic surgical treatment planning, evaluation of the TMJ, assessment of the paranasal sinuses, and imaging of intraosseous jawbone disorders. Guidelines have been suggested by various professional organizations based on current evidence to direct the use of CBCT imaging in dentistry. Technical Parameters.—Individual CBCT dental units differ in design, footprint, detector configuration, and protocol selection features. Clinicians must understand that various device- and protocol-specific features can be customized for specific tasks. Protocol optimization impacts spatial resolution, contrast resolution, and ultimately diagnostic quality and patient radiation dose. Factors that influence CBCT image quality and radiation dose include type of detector used, pixel size, image reconstruction algorithm, exposure parameters, field of view (FOV), number of basis projections, and rotational arc. Ideally the x-ray tube voltage and tube current are adjusted for each patient. Optimizing the exposure factors ensures minimal radiation dose to the patient, although the
clinician must bear in mind the balance between radiation dose and image quality, so that dose reduction does not compromise diagnostic quality. FOV can be limited or small (less than 8 cm), medium (8 to 15 cm), or large (over 15 cm). FOV adjustments change anatomic coverage, image resolution, and radiation dose. Clinicians are advised to select the smallest FOV that provides adequate anatomic coverage and image resolution. A small FOV has higher spatial resolution and reduced scatter radiation, yielding an improved image quality. Voxel size typically varies from 0.076 to 0.4 mm, with smaller voxel sizes related to higher spatial resolution. In some CBCT units, voxel size is fixed for specific FOVs. The total number of projections acquired during imaging depends on frame rate, extent of the rotational arc, and rotation times. More projections typically produce greater spatial resolution and higher contrast resolution, but increased patient radiation dose. Several modes are available, including quick-scan mode, high-resolution mode, and rotational arc modification. Endodontic Guidelines.—Radiographs are essential in endodontic diagnosis and treatment planning. The American Association of Endodontists (AEE) and the American Association of Oral and Maxillofacial Radiology (AAOMR) recommend that CBCT imaging should be used only when the diagnostic information obtained through
Volume 61
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39
are arginine, stannous fluoride, CSPS, and strontium. With twice daily use, all of the products should provide rapid, noticeable relief from symptoms. The toothpaste forms of these agents are easy to use and readily available. The professionally applied agents have insufficient evidence to recommend one agent over any of the others.
Clinical Significance.—Toothpastes containing stannous fluoride, arginine, CSPS, and strontium are equally effective in relieving the symptoms of DH. Patients should be directed to use these agents if they are experiencing pain from DH; all are available over the counter. Professionally applied agents may be useful but the jury is still out in terms of evidence showing which is the best choice.
West NX, Seong J, Davies M: Management of dentine hypersensitivity: Efficacy of professionally and self-administered agents. J Clin Periodontol 42:S256-302, 2015 Reprints available from N West, Periodontology, Clinical Trials Unit, Bristol Dental School, Lower Maudlin St, Bristol BS1 2LY, UK: e-mail: [email protected]
Dentin tubule occlusion Background.—The mechanisms causing dentin hypersensitivity are believed to be explained by the hydrodynamic theory. Open dentin tubules may allow increased fluid movement, which causes hypersensitivity. This view is supported by the observation that dentin hypersensitivity correlates directly with the number of open dentin tubules present. Various products have been claimed to be effective in closing the open dentin tubules and thereby reducing hypersensitivity reactions. The effectiveness of several different products was evaluated in vitro using qualitative and quantitative means. Methods.—Dentin disks were exposed to a year’s worth of brushing using various experimental toothpastes. In addition, positive and negative controls were prepared for comparison. Lemon juice was applied to half of the disks after tooth brushing. All disks were examined under a scanning electron microscope, and the images were converted to binary black and white images for comparison. Open dentin tubules appeared as black pixels and were counted and evaluated statistically. Half of the disks were then
38
Dental Abstracts
broken and dentin tubule occlusion was evaluated using energy dispersive x-ray spectroscopy (EDS). Results.—Significant differences were noted between the negative control toothpaste and Sensodyne Rapid and Colgate Total Sensitive toothpastes. In addition, the positive control toothpaste differed significantly from all the experimental toothpastes except Elmex Sensitive Professional toothpaste. Lemon juice erosion led to a significant difference in the number of open dentin tubules between the disks polished with the positive control toothpaste and those brushed with Sensodyne Repair, Colgate Total Sensitive, and Dontodent Sensitive. Surface scans showed the dentin surfaces were irregularly covered by silica. Areas near the dentin surface within the open dentin tubules had no silicon. Elmex Sensitive Professional was associated with a scattered thin layer of silicon. The dentin surface and openings of dentin tubules had a clear layer of silicon after Sensodyne Rapid was used to brush the disks. Those brushed with Sensodye
Repair toothpaste had no clear silicon layer present. Several occluded dentin tubules were associated with BioRepair Sensitive. Neither silicon nor occluded tubules were present on disks brushed using Colgate Total Sensitive or Dontodent Sensitive. Discussion.—Certain toothpastes were able to occlude the dentin tubules, which should reduce dentin hypersensitivity. However, the occlusion is shallow and acid can dissolve the protective layer.
tested were able to perfectly occlude all of the open dentin tubules and prevent the mechanism of dentin hypersensitivity. Dentists should evaluate which toothpastes appear to do the best job and encourage patients to use them when dentin hypersensitivity is a problem.
Arnold WH, PRange M, Naumova EA: Effectiveness of various toothpastes on dentine tubule occlusion. J Dent 43:440-449, 2015
Clinical Significance.—The active ingredient in the toothpaste was the source of protection for dentin tubules. None of the toothpastes
Reprints available from WH Arnold, Dept of Biological and Material Sciences in Dentistry, Alfred Herrhausenstrasse 44, 58455 Witten, Germany; fax: þ49 2302926661; e-mail: [email protected]
Imaging Cone beam computed tomography Background.—Cone beam computed tomography (CBCT) provides volumetric imaging that can visualize the imaged region in essentially any plane. With newer units, dental CBCT has the ability to acquire high-resolution CT scans with relatively low radiation exposure for patients. Dental uses include the assessment of potential dental implant sites, endodontic diagnosis and treatment planning, impacted tooth assessment, craniofacial evaluation for orthodontic and orthognathic surgical treatment planning, evaluation of the TMJ, assessment of the paranasal sinuses, and imaging of intraosseous jawbone disorders. Guidelines have been suggested by various professional organizations based on current evidence to direct the use of CBCT imaging in dentistry. Technical Parameters.—Individual CBCT dental units differ in design, footprint, detector configuration, and protocol selection features. Clinicians must understand that various device- and protocol-specific features can be customized for specific tasks. Protocol optimization impacts spatial resolution, contrast resolution, and ultimately diagnostic quality and patient radiation dose. Factors that influence CBCT image quality and radiation dose include type of detector used, pixel size, image reconstruction algorithm, exposure parameters, field of view (FOV), number of basis projections, and rotational arc. Ideally the x-ray tube voltage and tube current are adjusted for each patient. Optimizing the exposure factors ensures minimal radiation dose to the patient, although the
clinician must bear in mind the balance between radiation dose and image quality, so that dose reduction does not compromise diagnostic quality. FOV can be limited or small (less than 8 cm), medium (8 to 15 cm), or large (over 15 cm). FOV adjustments change anatomic coverage, image resolution, and radiation dose. Clinicians are advised to select the smallest FOV that provides adequate anatomic coverage and image resolution. A small FOV has higher spatial resolution and reduced scatter radiation, yielding an improved image quality. Voxel size typically varies from 0.076 to 0.4 mm, with smaller voxel sizes related to higher spatial resolution. In some CBCT units, voxel size is fixed for specific FOVs. The total number of projections acquired during imaging depends on frame rate, extent of the rotational arc, and rotation times. More projections typically produce greater spatial resolution and higher contrast resolution, but increased patient radiation dose. Several modes are available, including quick-scan mode, high-resolution mode, and rotational arc modification. Endodontic Guidelines.—Radiographs are essential in endodontic diagnosis and treatment planning. The American Association of Endodontists (AEE) and the American Association of Oral and Maxillofacial Radiology (AAOMR) recommend that CBCT imaging should be used only when the diagnostic information obtained through
Volume 61
Issue 1
2016
39