Randomised clinical trial to evaluate changes in dentine tubule occlusion following 4\xa0weeks use of an occluding toothpaste

Joon Seong,Nicola X West,Maria Davies,Nicholas C A Claydon,Charles P Parkinson

doi:10.1007/s00784-017-2103-5

Abstract

ObjectivesThe objective of this study is to determine whether a silicone impression material could precisely replicate dentine tubule changes following 4 weeks toothbrushing with occluding or non-occluding toothpaste and whether changes reflected hypersensitivity clinical assessment.Materials and methodsThis was a single site, examiner blind, parallel, two treatment arm, randomised clinical trial. Participants were healthy, ≥18, with ≥1 sensitive tooth with exposed dentine, Schiff sensitivity score ≥2, and patent tubules with dentine occlusion score 4–5 as determined by scanning electron microscopy of replica impressions. Nine participants received Sensodyne® Rapid Relief (occluding toothpaste) and 10 Crest® Decay Prevention (non-occluding toothpaste), and were re-evaluated for sensitivity and occlusion score after two timed minutes and 4 weeks twice-daily home brushing.ResultsOcclusion scores did not correlate significantly with pain scores, but correlations were positive and impressions showed characteristic dentine tubule patency and occlusion. After 4 weeks, thermal VAS was significantly lower than baseline for the non-occluding toothpaste; all other pain scores were significantly lower for both treatments. Dentine occlusion scores also decreased after 4 weeks of either treatment, but did not achieve significance (p = 0.0625).ConclusionsBoth toothpastes reduced clinical sensitivity and increased tubule occlusion. It is hypothesised that during impression, taking some material may have sheared off and occluded tubules resulting in false positives.Clinical relevanceThis study has demonstrated that a silicone impression material can accurately replicate the dentine surface to demonstrate dentine tubular occlusion and patency; however, although the association between occlusion and pain score was positive, this technique needs to be refined before use in future studies.

Highlights

Dentine hypersensitivity (DH) is an unpleasant and relatively common condition in which thermal, evaporative, tactile, osmotic, or chemical stimuli elicit a short sharp pain response [1]
After 4 weeks, thermal VAS was significantly lower than baseline for the non-occluding toothpaste; all other pain scores were significantly lower for both treatments
Clinical relevance This study has demonstrated that a silicone impression material can accurately replicate the dentine surface to demonstrate dentine tubular occlusion and patency; the association between occlusion and pain score was positive, this technique needs to be refined before use in future studies

Summary

Introduction

Dentine hypersensitivity (DH) is an unpleasant and relatively common condition in which thermal, evaporative, tactile, osmotic, or chemical stimuli elicit a short sharp pain response [1]. It is proposed that stimuli such as cold, hot, tactile, or osmotic pressure, when applied to exposed dentine, cause fluid movement within the dentine tubules This fluid movement is thought to activate mechanoreceptors near the base of the tubules and, if certain physiological parameters are met, result in the firing of an action potential and the generation of a pain response. In support of this theory, it has been demonstrated that it is not sufficient for dentine to be exposed to the oral cavity; tubules must be patent from the pulp to the oral environment [9].

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