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Morphological characterization of hypersensitive human radicular dentin and the effect of a light-curing resin liner on tubular occlusion.

A dentin biopsy technique was employed to compare the morphological features of hypersensitive and non-sensitive human radicular dentin. Specimens sampled from different areas in the same root surface displaying hypersensitivity or non-sensitivity were prepared for examination in the scanning electron microscope (SEM). Before analysis some specimens were exposed to surface demineralization and digestion of collagen to allow observation of subsurface portions of the dentinal tubules. In another set of observations the potential of a light-curing resin liner to penetrate root dentin in vitro and to maintain tubular occlusion over time following treatment of hypersensitive radicular dentin were examined. Orifices of many dentinal tubules were open in hypersensitive regions while non-sensitive areas generally displayed tubules occluded with mineralized material. SEM-images of HCl-collagenase treated specimens demonstrated the frequent presence of membrane-like structures in tubules of hypersensitive dentin. In non-sensitive dentin these structures were sparse. Topical application of a light-curing resin liner to wedge shaped defects prepared in radicular dentin of extracted human teeth resulted in a surface coating with a resin thickness of 20-50 microns. Resin penetrated dentinal tubules to a depth of more than 5 microns. Dentin biopsies examined 6 months after treatment with the liner showed presence of resin-like material in a majority of the tubules in dentin where hypersensitivity was no longer perceived. In none of the specimens did the liner remain as a surface coating. In areas of recurrent hypersensitivity more than half of the tubules presented with open orifices.(ABSTRACT TRUNCATED AT 250 WORDS)

Acid Etching, Dental↗

Dentine hypersensitivity--a review. Aetiology, symptoms and theories of pain production.

The exposure of cervical dentine has a multifactorial aetiology and pain may frequently be elicited by a number of stimuli. Management of the condition, dentine hypersensitivity, tends to be empirical because of the lack of knowledge concerning the mechanism of pain transmission through dentine. The pulpal changes associated with the condition and any modulating effect on symptoms are by no means clearly established. Evidence suggests that exposed dentine which is sensitive exhibits patent tubules. The question of how pain is initiated across the dentine has received considerable attention but still remains somewhat debatable. The literature reviewed indicates that, at most, nerve fibres only penetrate a limited distance along some dentinal tubules. The theories that either the odontoblasts and their processes act as dentinal receptors or the nerves in the pulp are the pain receptors, are discussed. Evidence for the stimulation of pulp nerve fibres by a hydrodynamic mechanism would appear the most likely mechanism. Nevertheless, whichever theory proves to be correct, occlusion of dentinal tubules would appear an essential prerequisite for an effective desensitising agent.

Dentin↗

Treatment of anterior tooth wear with gold palatal veneers.

We report the treatment of a case of acute sensitivity of the maxillary incisor teeth caused by chronic regurgitation of gastric contents. The resultant erosive lesions on the palatal surfaces involved extensive tooth surface loss with exposure of dentine. Palatal coverage of these teeth was achieved using gold alloy veneers and resulted in complete eradication of the symptoms. The procedures involved in the preparation and placement of the restorations are described.

Adolescent↗

Incidence of tooth sensitivity after home whitening treatment.

BACKGROUND: A potential side effect of dentist-dispensed home tooth-whitening systems is tooth sensitivity. The authors conducted a randomized prospective double-blind study to determine the incidence of tooth sensitivity after home whitening treatment. METHODS: Fifty adult subjects used a gel containing 15 percent carbamide peroxide and 0.11 percent fluoride ion; an additional 50 adult subjects used a placebo gel daily for four weeks. Each subject's plaque index score, gingival recession status, caries status, current dentifrice and smoking history were recorded at baseline. The researchers evaluated sensitivity weekly by interview for four weeks. RESULTS: Fifty-four percent of subjects in both test and control groups reported mild sensitivity; 10 percent of test subjects and 2 percent of control subjects reported moderate sensitivity; 4 percent of test subjects and no control subjects reported severe sensitivity. Sensitivity decreased with time; by the second week, no severe sensitivity was reported, and by the fourth week, no moderate sensitivity was reported. The authors found a statistically significant positive correlation between reported sensitivity and gingival recession. They found no statistically significant correlations between sensitivity and any of the other recorded parameters. CONCLUSIONS: Mild tooth sensitivity can be expected in approximately one-half of patients who undergo home whitening treatment using the gel studied. Approximately 10 percent of patients may experience moderate sensitivity, and 4 percent of patients may experience severe sensitivity for one to two weeks. Patients with gingival recession appear more likely to experience tooth sensitivity during home whitening treatment. CLINICAL IMPLICATIONS: Patients considering home whitening treatment should be advised that mild tooth sensitivity is a common side effect and that severe tooth sensitivity occasionally occurs. If gingival recession is present, the probability of tooth sensitivity increases, and tooth sensitivity tends to decrease as treatment progresses.

Adult↗

Microleakage of castings cemented with glass-ionomer cements.

When metal copings were luted to prepared, extracted teeth with KetacCem, ChemBond, TempBond, and zinc-oxide-eugenol (ZOE), only thermocycled ZOE exhibited severe leakage. It appears unlikely that postcementation microleakage is the cause of tooth sensitivity associated with the use of glass-ionomer cements.

Dental Cements↗

In vitro microhardness studies on a new anti-erosion desensitizing toothpaste.

OBJECTIVE: To evaluate in vitro the efficacy of a new anti-erosion desensitizing toothpaste to inhibit enamel surface softening by a dietary acid, and promote re-hardening of artificial erosive lesions. METHODOLOGY: The ability of the toothpaste to inhibit formation and promote repair of erosive lesions in human enamel has been investigated. In an enamel surface softening study, sound human enamel was pre-treated with one of four toothpaste slurries for two minutes, before exposure to 1.0% citric acid, pH 3.8, for a total of 30 minutes. The surface microhardness (SMH) of the specimens was determined at baseline and at 10-minute intervals using a Struers Duramin-1 microindentor. In an enamel re-hardening study, the erosive lesions were prepared by exposure of the specimens to 1.0% citric acid, pH 3.8, for 30 minutes. After two minutes treatment with a toothpaste slurry, lesion repair was monitored by SMH after 4, 24, and 48 hours incubation in artificial saliva. This remineralizing phase was modified by the addition of an aliquot of the relevant toothpaste slurry, to mimic in vivo carryover of the formulation. RESULTS: The new test formulation, Elmex Sensitive, and Colgate Sensitive exhibited statistically significant inhibition of citric acid-mediated enamel surface softening versus a fluoride-free placebo at all time points. The test toothpaste gave statistically superior protection against the erosive challenge compared to Elmex Sensitive and Colgate Sensitive after 20- and 30-minute exposures. In the remineralization studies, erosive lesions treated with the test toothpaste exhibited statistically superior re-hardening versus lesions treated with Elmex Sensitive and Colgate Sensitive after 24- and 48-hour incubation in the artificial saliva. Lesions treated with Elmex Sensitive re-hardened to a statistically significant extent versus the fluoride-free placebo toothpaste. A re-hardening study, in which a series of the new toothpaste-base formulations containing increasing concentrations of NaF were evaluated, showed a clear fluoride dose response. CONCLUSION: The present microhardness studies show that treatment with fluoride-containing toothpastes helps protect sound enamel from acid-mediated surface softening, and promotes re-hardening of erosive lesions. The new test toothpaste exhibited statistically superior efficacy to Elmex Sensitive and Colgate Sensitive in both in vitro models.

Analysis of Variance↗

Comparison of clinical efficacy and safety of three professional at-home tooth whitening systems.

A three-cell, randomized, parallel, investigator-blinded clinical trial was conducted to compare the efficacy and safety of three professional at-home tooth whitening systems, including Crest Professional Whitestrips (6.5% H2O2), Day White 2 (7.5% H2O2) and Nite White Excel 2 (16% carbamide peroxide equivalent). Ninety subjects were randomly assigned to three groups (30/group). Subjects were instructed to use the assigned whitener following the manufacturers' instructions. Clinical examinations at baseline, and on days 3, 7, 14, and 18 (Day White), or 21 (Crest Professional Whitestrips and Nite White) included the following parameters: 1) oral tissues; 2) tooth shade by the Vitapan Classical shade guide; 3) tooth shade by a chromameter with a jig; and, 4) tooth sensitivity and gingival irritation. The results showed significant shade reductions with time in all three groups. Nite White resulted in significantly greater shade reductions in periods between days 7, 14, or 21 and baseline than did the other two systems. Tooth sensitivity and gingival irritation, which were mostly mild and transient, occurred in all groups. It is concluded that all three whitening systems evaluated are effective and safe. Nite White Excel is superior to the other two systems because it provides a greater whitening efficacy with comparable or lower incidence of tooth sensitivity and gingival irritation.

Adult↗

Sensitivity and tooth whitening agents.

PURPOSE: Three commercially available dentist-prescribed home-applied bleaching systems were evaluated to identify the incidence of sensitivity and to compare the efficacy of whitening the maxillary anterior teeth of 18 patients. METHODS: NiteWhite Excel 2Z (Discus Dental), fx (Challenge Products), and Rembrandt Xtra-Comfort (DenMat Corp.) were randomly assigned to six patients each. The fx product was used as a control since it was not advertised as a zero sensitivity product. The manufacturers' instructions for tray fabrication and use were followed while the patients bleached for 2 weeks. The patients kept a diary and were recalled at 1 week, 2 weeks, and 4 weeks. The shade change and the presence or absence of any sensitivity were evaluated at each recall. RESULTS: NiteWhite Excel 2Z was used for 83 days of treatment with the following percentage of positive sensitivity reported: 0% hot and cold, 2.4% throat sensitivity, 2.4% tongue sensitivity, and 25.3% gingival sensitivity. Rembrandt Xtra-Comfort was used for 84 days with 0% hot and cold, 0% throat, 11.9% tongue, and 27.4% gingival sensitivity reported. The fx product was used for 83 days and resulted in 14.5% hot and cold, 3.6% throat, 1.2% tongue, and 16.9% gingival sensitivity. All products lightened the teeth an average of eight shade tabs on the Vita guide. There was a statistically significant difference between the groups when comparing the presence of sensitivity (chi-squared test, p < .001) but not when comparing the shade tab change. CLINICAL SIGNIFICANCE: Of the products tested, all produced similar change in shade tab value, none were sensitivity free, but NiteWhite Excel 2Z and Rembrandt Xtra-Comfort did not produce thermal sensitivity.

Carbamide Peroxide↗

Microabrasion of teeth with discoloration resembling hypomaturation enamel defects: four-year follow up.

Microabrasion with 18% HCl and pumice to remove enamel dysmineralization and improve esthetics is an accepted and effective treatment. This technique can probably be extended even to generalized defects resembling hypomaturation amelogenesis imperfecta that appear on all erupted teeth. Five children aged 9 to 11 with two types of enamel-hypomaturation probably due to developmental defects were treated successfully by microabrasion, with marked improvement of the discoloration. The patients were followed for up to four years. During this period, no tooth-sensitivity or staining was noted. The teeth looked healthier and shinier.

Amelogenesis Imperfecta↗

Comparison of pulpal sensitivity between a conventional and two resin-modified glass ionomer luting cements.

This clinical study compared handling and any short-term tooth sensitivity associated with using one conventional and two resin-modified glass ionomer cements marketed for luting gold and ceramometal crowns. The patient's response to a 10-second blast of air applied to the vital tooth was scored pre-operatively and again within a one-to-four week post-cementation recall period. A score was also recorded for any sensitivity present at the time of cementation of the crown on the unanesthetized tooth. All three cements were easy to mix and place. Most of the teeth had no response to pulpal stimulation pre-operatively, associated with the cementation procedure or post-cementation, and there were no instances of severe sensitivity recorded. For all cements, the level of post-cementation tooth sensitivity was similar, and less than that found pre-operatively.

Adult↗

Clinical study to compare two in-office (chairside) whitening systems.

The objective of this clinical study was to compare the whitening/bleaching efficacy of two marketed in-office whitening systems: Discus Dental Zoom! Chairside System (25% hydrogen peroxide whitening gel) and Opalescence Xtra Boost Kit (38% hydrogen peroxide whitening gel), using the Vita Shade Guide and chromameter measurements. The study was an examiner-blind, parallel group, randomized and controlled clinical trial conducted in a dental setting. All subjects signed a study consent form prior to admission and were given Crest Regular Toothpaste and an Oral-B 40 straight-handle toothbrush to use during the study. Subjects received a supragingival prophylaxis followed by a screening eligibility Vita Shade assessment from which 22 subjects were selected. At baseline, all six maxillary anterior teeth were assessed with the Vita Shade Guide. Chromameter measurements were taken on either the right maxillary central or left maxillary central (tooth No. 8 or tooth No. 9). Subjects were assigned to one of two treatment groups, and had three applications of their assigned product. Following completion of the treatment phase, and on post-treatment Days 2 and 7, a visual examination of the condition of the oral soft tissues, together with a Vita Shade assessment on maxillary anterior teeth, a chromameter reading and a questionnaire regarding tooth sensitivity were completed. At the termination of the study, the statistical analysis of the Vita Shade scores indicated that both products significantly (p < 0.0001) lightened the color of the teeth. The average improvement was between 6 and 9 shade changes. Additionally, the Zoom! Chairside System was significantly better than the Opalescense Xtra Boost Kit at all time points: post-treatment (p < 0.0001); Day 2 (p < 0.004); Day 7 (p < 0.003). This difference was between 1 and 2 shade changes. The chromameter readings showed a significant difference in the overall color change (delta E) to a lighter color for both the Zoom! Chairside System and the Opalescence Xtra Boost Kit. Using delta E, the Zoom! Chairside System was directionally better than the Opalescense Xtra Boost Kit at Day 2 (p < 0.08), and significantly better at Day 7 (p < 0.025). Analysis of the composite parameters of delta E (L*, a*, b*) showed that no differences could be detected in the a* (redness) parameter. Changes were observed in the L* (brightness) and b* (yellow) parameters which paralleled the delta E differences. There were no significant differences in induced sensitivity between whitening systems at any time point.

Color↗

A clinical evaluation of two in-office bleaching products.

This half-mouth design, two-week treatment phase, combined with an 11-week evaluation double-blinded randomized clinical trial was conducted to compare two in-office bleaching products, StarBrite (35% hydrogen peroxide) with Opalescence Xtra Boost (38% hydrogen peroxide), for degree of color change of teeth, any relapse effect (darkening) associated with discontinued use and gingival irritation and tooth sensitivity associated with use. The degree of color change and relapse was evaluated by using a colorimeter, shade guide and color slide photographs. Participants self-evaluated their gingival irritation and tooth sensitivity. They recorded daily the level of gingival irritation and tooth sensitivity experienced during the first three weeks of the study. The results of this study showed no statistical difference between products during active treatment periods and any follow-up visits using the three-color evaluation methods. Color relapse began after the bleaching treatments were finished and continued until the fifth week, after which no further significant changes appeared. Also, there was no statistical difference in gingival irritation and tooth sensitivity between the products.

Adult↗

Postoperative sensitivity in Class I composite resin restorations in vivo.

PURPOSE: This study evaluated the postoperative sensitivity of posterior Class I composite resin restorations, restored with a self-etching or a total-etch one-bottle adhesive system. MATERIALS AND METHODS: One hundred four restorations were replaced by one clinician in 52 patients. Each patient received two restorations. After cavity preparations were completed under rubber-dam isolation, they were restored using Clearfil SE Bond or Single Bond and a resin-based restorative material (Filtek Z250). Sensitivity was evaluated at 0 and 7 days and 6 months using cold stimuli, and recorded using a visual analogue scale. If sensitivity was experienced on day 7, patients were also contacted on days 14 and 30 to assess the degree of sensitivity. The scores were analyzed as nonparametric data by means of the Friedman and Wilcoxon tests. RESULTS: No statistically significant differences in sensitivity were found between the two adhesives systems at days 0 and 7 or at 6 months. No spontaneous postoperative sensitivity was reported. CONCLUSIONS: The adhesives systems used in this study showed no differences in postoperative sensitivity, and did not show spontaneous sensitivity after 6 months.

Acrylic Resins↗

NaF iontophoresis, an alternative to cavity lining--an in vivo study.

The study carried out on 30 teeth in 28 patients of 12-16 years to assess NaF iontophoresis as an alternative to cavity lining revealed that out of 25 cavities which were sensitive to air, water jet and exploration (14 mild, 9 moderate and 2 severe), in 20 cavities the sensitivity decreased to nil, in 9 to mild and in one to moderate following iontophoresis. It was found that in all the cases, the first application of iontophoresis decreased the sensitivity by 50-60 percent and the second by 70-90 percent. Immediately after silver filling there was no sensitivity in 25 teeth, whereas 4 were mildly and one moderately sensitive. After a six month follow up in 24 patients who reported, all the teeth were comfortable.

Adolescent↗