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Dentine hypersensitivity incidence and treatment by iontophoresis in dental students
Archs oral Bid. Vol. 39, Suppl., p. 1256, 1994 Copyright 0 1994 Elsevier Science Ltd Printed in Great Britain. All rights reserved
0003-9969/94 $7.00 + 0.00
DENTINE HYPERSENSITIVITY INCIDENCE AND TREATMENT BY IONTOPHORESIS IN DENTAL STUDENTS X. CHEN, Department
of Oral Biology
T. MORIHANA
(Pharmacology),
Key words:
Fluoride tization
dentine
sensitivity,
is useful for dentine desensi1983; Carlo, Ciancio and
iontophoresis (Gangarosa,
Seyrek, 1982; Gangarosa and Jeske, 1992) but has not gained general acceptance, possibily because it is considered technique-sensitive and difficult. Here, we report a 4-year study in which junior dental students obtained highly consistent desensitization on their first attempt and found the fluoride iontophoresis techniques easy to learn. The incidence of dentine hypersensitivity in this selected group is also reported. During a 4-h workshop, 184 junior dental students aged 21-39 years, were instructed in fluoride iontophoresis. After a demonstration of diagnostic and treatment methods, they performed fluoride iontophoresis on their partners. For diagnosis, a l-s air blast (60 psi., 22°C) was applied to gingivobuccal surfaces of all teeth at a distance of 2.5 cm, while adjacent teeth were covered with the operator’s fingers. Scratch testing was accomplished by passing a No. 17 explorer at, or below, the cementumenamel junction using a force of about 0.2-0.3 N. Sensitivity scores were recorded using an interval scale for discomfort: 0, no pain; 1, mild; 2, moderate; 3, severe; and 4, intolerable pain. Pretreatment sensitivity scores were used to summarize the incidence in different tooth types. Differences in scores for various tooth types were evaluated by analysis of variance followed by Tukey’s test. Treatment effects were evaluated by comparing pre- and post-treatment scores using a test for bivariate asymmetry (Gangarosa et al., 1989). At least one hypersensitive tooth was found in 91 students (49.5%), who had a total of 284 sensitive teeth. Of these, 246 teeth were sensitive to air only, 38 were sensitive to explorer only and 33 were sensitive to both stimuli. The tooth rankings for sensitivity incidence were as follows (FDI notation): 26 > 16>>@1< 0.001) 15 > 31 > 11, 12, 14, 21, 22, 24, 25, 36, 46, 41, 45 > 32, 35, 37 > 13, 44> 23, 42 > 33 > 27, 34, 43 > 47>>@ < 0.001) 17 > 18, 28, 38, 48. A statistically higher incidence is indicated by Table I. Comparison of pre- and post-treatment sensitivity scores for air stimulation in 160 teeth treated with fluoride iontophoresis Post-treatment Pre-treatment scores
I 2 3 4
and L. P. GANGAROSA
School of Dentistry, GA 30912. U.S.A.
scores
0
I
2
3
4
91 29 10
7 11 3
0 2 4
0 0
0 0
I
0
0
I 1
0 0
incidence,
Medical
fluoride,
Sr
College of Georgia,
Augusta,
iontophoresis.
the >> sign with the p value in parentheses. Because of time limitations, only 188 teeth were treated with 2% NaF iontophoresis. After treatment, 131 of 160 air-sensitive teeth were immediately desensitized to a score of zero; 19 teeth partially improved (some remaining sensitivity); and 10 teeth showed no change. Table 1 summarizes the pattern of airsensitivity scores from pre- to post-treatment. The test for bivariate asymmetry showed that the chance probability for this distribution was p < 0.0001. Results for sensitivity to explorer showed a similar trend: 42 of 64 teeth were immediately desensitized, 18 partially improved and four teeth showed no change. The high incidence of sensitivity in junior dental students differs from other studies, which report an incidence of about 15% (Graf and Galasse, 1977). The highest occurrence of sensitivity was in upper first molars, especially on the left side. Similar findings were reported by Gangarosa et al. (1989), but this pattern differs from that in other studies, which report that premolars and canines were the most frequently sensitive (Graf and Galasse, 1977). The higher incidence in junior dental students may reflect over-enthusiastic oral hygiene procedures that cause abrasion and tend to promote sensitivity. The finding that left upper first molars were the most frequently sensitive supports this possibility, as right-handedness is usually associated with more intensive brushing in the upper left quadrant. It is not clear why premolars and canines were not found to be the most frequently sensitive. This study shows that dental students can learn fluoride iontophoresis after only a brief demonstration. In agreement with other studies (Gangarosa and Jeske, 1992), highly consistent desensitization was noted, with most teeth becoming completely unresponsive to stimulation. REFERENCES
Carlo G. T., Ciancio S. G. and Seyrek S. K. (1982) J. .-lm. dent. Ass. 105, 452-454. Gangarosa L. P. Sr (1983) Iontophoresis in Dental Practice. Quintessence, Lombard, IL. Gangarosa L. P. Sr and Jeske A. H. (1992) C/u&e’s Clinicul Dentistry (Ed. Hardin J. F.), Revised edn. Chap. 32B, pp. l-32. J. B. Lippincott Co, Philadelphia, PA. Gangarosa L.P. Sr. Buettner A. L., Baker W. P.. Buettner B. K. and Thompson W. 0. (1989) J. Gen. Dent. 37, 316-319. Graf H. and Galasse R. (1977) J. dent. Res. 56, (Sp. Issue A), 479.
0003-9969/94 $7.00 + 0.00
DENTINE HYPERSENSITIVITY INCIDENCE AND TREATMENT BY IONTOPHORESIS IN DENTAL STUDENTS X. CHEN, Department
of Oral Biology
T. MORIHANA
(Pharmacology),
Key words:
Fluoride tization
dentine
sensitivity,
is useful for dentine desensi1983; Carlo, Ciancio and
iontophoresis (Gangarosa,
Seyrek, 1982; Gangarosa and Jeske, 1992) but has not gained general acceptance, possibily because it is considered technique-sensitive and difficult. Here, we report a 4-year study in which junior dental students obtained highly consistent desensitization on their first attempt and found the fluoride iontophoresis techniques easy to learn. The incidence of dentine hypersensitivity in this selected group is also reported. During a 4-h workshop, 184 junior dental students aged 21-39 years, were instructed in fluoride iontophoresis. After a demonstration of diagnostic and treatment methods, they performed fluoride iontophoresis on their partners. For diagnosis, a l-s air blast (60 psi., 22°C) was applied to gingivobuccal surfaces of all teeth at a distance of 2.5 cm, while adjacent teeth were covered with the operator’s fingers. Scratch testing was accomplished by passing a No. 17 explorer at, or below, the cementumenamel junction using a force of about 0.2-0.3 N. Sensitivity scores were recorded using an interval scale for discomfort: 0, no pain; 1, mild; 2, moderate; 3, severe; and 4, intolerable pain. Pretreatment sensitivity scores were used to summarize the incidence in different tooth types. Differences in scores for various tooth types were evaluated by analysis of variance followed by Tukey’s test. Treatment effects were evaluated by comparing pre- and post-treatment scores using a test for bivariate asymmetry (Gangarosa et al., 1989). At least one hypersensitive tooth was found in 91 students (49.5%), who had a total of 284 sensitive teeth. Of these, 246 teeth were sensitive to air only, 38 were sensitive to explorer only and 33 were sensitive to both stimuli. The tooth rankings for sensitivity incidence were as follows (FDI notation): 26 > 16>>@1< 0.001) 15 > 31 > 11, 12, 14, 21, 22, 24, 25, 36, 46, 41, 45 > 32, 35, 37 > 13, 44> 23, 42 > 33 > 27, 34, 43 > 47>>@ < 0.001) 17 > 18, 28, 38, 48. A statistically higher incidence is indicated by Table I. Comparison of pre- and post-treatment sensitivity scores for air stimulation in 160 teeth treated with fluoride iontophoresis Post-treatment Pre-treatment scores
I 2 3 4
and L. P. GANGAROSA
School of Dentistry, GA 30912. U.S.A.
scores
0
I
2
3
4
91 29 10
7 11 3
0 2 4
0 0
0 0
I
0
0
I 1
0 0
incidence,
Medical
fluoride,
Sr
College of Georgia,
Augusta,
iontophoresis.
the >> sign with the p value in parentheses. Because of time limitations, only 188 teeth were treated with 2% NaF iontophoresis. After treatment, 131 of 160 air-sensitive teeth were immediately desensitized to a score of zero; 19 teeth partially improved (some remaining sensitivity); and 10 teeth showed no change. Table 1 summarizes the pattern of airsensitivity scores from pre- to post-treatment. The test for bivariate asymmetry showed that the chance probability for this distribution was p < 0.0001. Results for sensitivity to explorer showed a similar trend: 42 of 64 teeth were immediately desensitized, 18 partially improved and four teeth showed no change. The high incidence of sensitivity in junior dental students differs from other studies, which report an incidence of about 15% (Graf and Galasse, 1977). The highest occurrence of sensitivity was in upper first molars, especially on the left side. Similar findings were reported by Gangarosa et al. (1989), but this pattern differs from that in other studies, which report that premolars and canines were the most frequently sensitive (Graf and Galasse, 1977). The higher incidence in junior dental students may reflect over-enthusiastic oral hygiene procedures that cause abrasion and tend to promote sensitivity. The finding that left upper first molars were the most frequently sensitive supports this possibility, as right-handedness is usually associated with more intensive brushing in the upper left quadrant. It is not clear why premolars and canines were not found to be the most frequently sensitive. This study shows that dental students can learn fluoride iontophoresis after only a brief demonstration. In agreement with other studies (Gangarosa and Jeske, 1992), highly consistent desensitization was noted, with most teeth becoming completely unresponsive to stimulation. REFERENCES
Carlo G. T., Ciancio S. G. and Seyrek S. K. (1982) J. .-lm. dent. Ass. 105, 452-454. Gangarosa L. P. Sr (1983) Iontophoresis in Dental Practice. Quintessence, Lombard, IL. Gangarosa L. P. Sr and Jeske A. H. (1992) C/u&e’s Clinicul Dentistry (Ed. Hardin J. F.), Revised edn. Chap. 32B, pp. l-32. J. B. Lippincott Co, Philadelphia, PA. Gangarosa L.P. Sr. Buettner A. L., Baker W. P.. Buettner B. K. and Thompson W. 0. (1989) J. Gen. Dent. 37, 316-319. Graf H. and Galasse R. (1977) J. dent. Res. 56, (Sp. Issue A), 479.