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hygiene tribune Dental Tribune Middle East & Africa Edition | January-February 20152B hold were assigned to the same treatment group. Treatment Regimens Subjects used the assigned prod- ucts for the first time under su- pervision at the clinical site. Sub- jects used the products at home in place of their normal tooth- brush and dentifrice for a period of four weeks. Subjects were in- structed to brush twice daily for two minutes each time. Subjects were instructed not to alter their other oral hygiene habits (e.g., flossing) with the exception that no anti–tooth hypersensitivity products should be used. Air Blast Tooth Specific Sensi- tivity Assessment The thermal sensitivity per- ceived by the subject was meas- ured by the examiner by direct- ing an air blast individually at each of the premolars and ca- nines at baseline, week two, and week four visits. Each tooth was isolated with cotton rolls and the air blast was delivered from a distance of 1.0 centimeter for 1 second. The following scale19 was used by the examiner to as- sess the level of hypersensitivity for each of the 12 teeth exam- ined: • 0 – Absence of pain, but per- ceiving stimulus • 1 – Slight pain • 2 – Pain during application of stimulus • 3 – Pain during application of stimulus and immediately thereafter Statistical Methods For air blast–induced hypersen- sitivity scores, separate analy- ses were performed for the two teeth with the most sensitivity at baseline and for all 12 teeth combined. Analysis of covari- ance (ANCOVA) with treatment as a factor and the baseline score and age as the covariates were used to assess treatment differ- ences in hypersensitivity at the post-baseline visits. Also for the hypersensitivity scores, separate repeated measures models were used to investigate the overall relationship between the treat- ment groups and the post-base- line visits (weeks two and four) with statistical testing for the in- teraction and overall treatment effects using a two-sided 5% sig- nificance level. In this study, the interaction between treatment and week was not statistically significant (p>0.45) for each hy- persensitivity score, and the in- teraction was removed from the repeated measures model. Results Thirty-one subjects were en- rolled at the baseline visit, re- ceived product, and completed the study through week four. Subjects ranged in age from 23 to 65 years with an average of 42 years, and 68% of the subjects were female. The treatment groups were balanced (p>0.86) for all demographic charac- teristics. Mean baseline scores were not significantly differ- ent (p>0.56) between groups at baseline for either the two most sensitive teeth or for all 12 teeth combined. Efficacy Results At the week two and week four post-baseline visits and com- bining weeks two and four, the experimental group had mean air blast scores for two most sensitive teeth that were 28.4%, 24.9%, and 27% lower, respec- tively, than the control group (p<0.05, Figure 1). At week two, mean scores for the experimen- tal and control groups were 1.51 and 2.11, respectively (Table 1). At week four, the experimental group had a mean score of 1.42 compared to 1.89 for the control group. The weeks two and four combined mean score was 1.46 for the experimental group and 2.00 for the control group. At week two and combining weeks two and four, the experi- mental group provided signifi- cantly (p<0.03) lower mean air blast scores for all 12 teeth rela- tive to the control group (Table 2). The experimental group had a mean score of 1.18 at week two while the mean score for the control group was 1.52. The weeks two and four combined score was 1.17 for the experi- mental group and 1.46 for the control. At the week four visit, the experimental group pro- vided directionally (p=0.07) lower mean air blast scores for all 12 teeth relative to the control group (1.16 and 1.40, respec- tively). This difference was not statistically significant using a two-sided 5% significance level. The desensitizing benefit of the experimental dentifrice over the control was 22.4% at week two, 17.1% at week four, and 19.9% for the combined weeks two and four visits (Figure 1). Safety Results One subject in the experimental group had a possible related ad- verse event (desquamation) ob- served by the examiner that was mild in nature. Another subject in the experimental group had a nontreatment-related adverse event (herpetic lesion) reported and observed that was mild in nature. Discussion In this clinical trial, the experi- mental group exhibited a sig- nificantly greater reduction in tooth sensitivity via air blast measurements than the con- trol among the two most sensi- tive teeth (p<0.05) at both post- baseline measurements and the combined weeks two and four visits. The experimental group also demonstrated significantly greater reductions than the control in tooth sensitivity via air blast measurements among all 12 teeth on post-baseline measurements at week two and the combined results for weeks two and four (p<0.03). The as- sessment of all 12 teeth was in- cluded in this trial for compara- tive purposes but is not a widely used measure in sensitivity tri- als since the condition typically does not affect each tooth. These results are aligned with other studies evaluating stan- nous-containing dentifrices. Five trials in the literature evalu- ated the desensitizing effects of a combination of 0.454% stannous fluoride and 5% potassium ni- trate relative to other products; four trials compared the denti- frice to a positive control sensi- tivity toothpaste containing 5% potassium nitrate and the fifth study was versus a commercial nondesensitizing control denti- frice.12–16 The effectiveness of the product containing the combi- nation of stannous fluoride with potassium nitrate was found to be greater than that of the sodium fluoride product with potassium nitrate12–15 and the nondesensitizing control.16 Two published randomized parallel group studies were conducted on a dentifrice containing stan- nous fluoride compared to a so- dium fluoride negative control toothpaste.17,18 In both studies, the sensitivity scores of the stan- nous fluoride group after four and eight weeks of product us- age were statistically significant- ly lower than the control tooth- paste group, demonstrating the effectiveness of the stannous fluoride toothpaste in reducing dentinal hypersensitivity. In addition, the significant re- ductions in dentinal hypersensi- tivity demonstrated by the stan- nouscontaining sodium fluoride dentifrice, now marketed in parts of Europe and China, are consistent with outcomes of other research on this particu- lar formulation. An eight-week, randomized, parallel group, two treatment, double-blind study was conducted among gener- ally healthy adults with moder- ate thermal and tactile dentinal hypersensitivity.20 Subjects were stratified at baseline according to age, gender, and thermal den- tinal sensitivity scores and ran- domly assigned to one of the two treatments: the new stannous- containing sodium fluoride den- tifrice or a marketed potassium nitrate control (Crest® Sensi- tivity Protection, The Procter & Gamble Company, Cincinnati, OH, USA) for twice daily usage. Hypersensitivity was assessed via Yeaple Probe and cold Air Blast/Schiff Air Index for tac- tile and thermal assessments respectively, at baseline, week four, and week eight. Fifty-eight subjects completed all evalua- tions. Both treatments produced significant (p<0.05) reductions in hypersensitivity compared to baseline at both week four and week eight time points. There were no significant differences between the two treatments at either week four or week eight (p>0.534) for either assessment. One advantage of this stannous- containing sodium fluoride den- tifrice formulation relative to other desensitizing treatments is its effectiveness against other common oral conditions. A re- cent study by He and colleagues evaluated its plaque preven- tion efficacy relative to a posi- tive (Colgate®Total®, Colgate- Palmolive, New York, NY, USA) and negative (Crest® Cavity Protection, The Procter & Gam- ble Company, Cincinnati, OH, USA) control dentifrice.21 Fol- lowing a dental polish, subjects brushed lingual surfaces only, then swished with a slurry of the dentifrice over the entire denti- tion twice per day over a four- day period. At baseline and after four days, plaque levels were assessed by the Turesky Modi- fication of the Quigley–Hein plaque index (TMQHPI). The whole mouth TMQHPI plaque scores after treatment for both the experimental and the posi- tive control dentifrices were sta- tistically significantly lower than those for the negative control by 11.4% and 8.4%, respectively (p<0.0001). Another recent study showed the benefit of this stannous- containing sodium fluoride dentifrice against extrinsic stain.22 While many stannous luoride products can produce minor extrinsic tooth stain, this formulation uses a polychela- tion technology to stabilize the stannous-fluoride complex and prevent stain. The study also included an experimental stannous-containing dentifrice, a nonstaining marketed den- tifrice (Colgate® Total®), and a stannous fluoride dentifrice (Crest® Gum Care, The Procter & Gamble Company, Cincinnati, OH, USA) previously established to induce extrinsic stain. Fol- lowing a baseline Lobene stain examination, subjects received a prophylaxis on the 12 anterior teeth to remove extrinsic stain and tartar. Subjects were ran- domly assigned based on base- line stain scores to receive one of the four treatments and to use them twice daily over a five- week period. Results showed that there was significantly less stain after product use in the new stannous-containing so- dium fluoride dentifrice group, the experimental stannous-con- taining sodium fluoride denti- frice group, and the Colgate To- tal group compared to the Crest Gum Care group (p<0.0001). There were no other statistically significant treatment differences between the two stannous-con- taining sodium fluoride groups and the Colgate Total group at either time point for any Lobene measures (p>0.145). Further research is warranted on this formulation to demon- strate the full breadth, as well as magnitude, of benefits. Conclusion The stannous-containing sodi- um fluoride dentifrice provides statistically significant benefits for dentinal hypersensitivity and should be considered as a home care option for patients who ex- perience this condition. Clinical Significance This stannous-containing sodi- um fluoride dentifrice provides an effective treatment for pa- tients with dentinal hypersensi- tivity. References 1. Rees JS, Addy M. A cross-sec- tional study of buccal cervical sensitivity in UK general dental practice and a summary review of prevalence studies. Int J Dent Hyg. 2004; 2(2):64-9. 2. Irwin CR, McCusker P. Preva- lence of dentine hypersensitivity in a general dental population. J Ir Dent Assoc. 1997; 43(1):7-9. 3. Jacobsen PL, Bruce G. Clini- cal dentin hypersensitivity: un- derstanding the causes and pre- scribing a treatment. J Contemp Dent Pract. 2001; 2(1):1-12. 4. Rosenthal MW. Historic re- view of the management of tooth hypersensitivity. Dent Clin North Am. 1990; 34(3):403-27. 5. Brännström M, Aström A. The hydrodynamics of the den- tine; its possible relationship to dentinal pain. Int Dent J. 1972; 22(2):219-27. 6. Kramer IRH. The relationship between dentine sensitivity and movements in the contents of the dentinal tubules. Br Dent J. 1955; 98: 391-2. 7. Miller S, Truong T, Heu R, Stranick M, Bouchard D, Gaffar A. Recent advances in stannous fluoride technology: antibacte- rial efficacy and mechanism of action towards hypersensitiv- ity. Int Dent J. 1994; 44(1 Suppl 1):83-98. 8. Ellingsen JE, Rölla G. Treat- ment of dentin with stannous fluoride—SEM and electron microprobe study. Scand J Dent Res. 1987; 95(4):281-6. Full list of references available from the publisher. < Page 1B Table 1. Between treatment compar- ison of air blast score for two most sensitive teeth Figure 1. Overall results pooling weeks two and four from the repeated measures analysis. Table 2. Between treatment com- parison of air blast score for all 12 teeth. Article “Oral Probiotics - Over- wiew” published in Hygiene Tribune Nov-Dec 2014 edition is written by Dr. JJ Smith, Dr. John Nosti, Shirley Gutkowski and Victoria Wilson.