Dentine hypersensitivity is a common problem with some studies suggesting around 15% of the population suffer, although some estimates suggest that this may be are as high as 73%.

A wide range of agents have recommended for treatment of this condition and the aim of this systematic review was to evaluate the effectiveness of self-administered and/or professionally applied treatment modalities for the reduction in pain from dentine hypersensitivity.

Methods

Searches were conducted in the PubMed/Medline and Cochrane Database Trials Register databases. Parallel or split mouth randomised clinical trials (RCTs) comparing a test agent with against a negative control or a placebo were considered. Two reviewers independently selected the studies and study quality was assessed. Studies up with up to 1 week of follow up were considered short-term those ≥ 2 weeks were considered long-term.

Results

• A total of 11 agents and 105 RCTs were included in this review and narrative summary for each agent provided.
• Due to the heterogeneity between the studies and lack of direct comparison between agents there was insufficient data to undertake a meta-analysis to compare agents.
  • Arginine and calcium carbonate – (30 studies included) the majority involved toothpastes (20), with 3 testing mouthwashes and 7 professionally applied prophylaxis pastes.
  • PVA/MA – Polymers – (6 studies included) – the polymers were combined with a range of agents (arginine, triclosan, potassium).
  • Potassium – (25 studies)
  • Casein derivatives (amorphous calcium phosphate (ACP) and casein phosphopeptide (CPP) – 3 studies
  • Strontium – 18 studies
  • Stannous fluoride – 17 studies
  • Calcium sodium phosphosilicate (CSPS) – 12 studies
  • Oxalates – 9 studies
  • Resin-based materials – 9 studies
  • Varnishes – 7 papers
  • Lasers – 8 papers.

Conclusions

The authors concluded:

Treatments including stannous fluoride, arginine, calcium sodium phosphosilicate and strontium toothpaste appear to be clinically effective for the treatment of dentine hypersensitivity compared to comparators and controls. There is limited evidence to confirm the relative effectiveness of individual professionally applied agents.

Comments

Despite searching a limited number of databases this review has pulled together a large number of RCTs assessing various agents for dentine hypersensitivity. A number of systematic reviews have previously looked at single agents to assess their effectiveness, potassium, oxalates, arginine and desensitising toothpastes in general (see links). Some of these earlier reviews have undertaken meta-analysis, which were not done for this review.

The desensitising toothpaste review had similar conclusions to this review finding the majority of agents beneficial although there were different opinions regarding the effects of strontium containing pastes. This current review used quite short follow up periods whereas the 2006 Cochrane review only included studies with outcomes at 6 and 8 weeks which will have impacted on the number of studies included.

The authors highlight the fact that few direct comparisons between the various agents were carried out. The limited quality of the evidence in particular the number of short-term studies and the challenges assessing pain as an outcome make recommending specific products difficult.

Links

West NX, Seong J, Davies M. Management of dentine hypersensitivity: efficacy of professionally and self-administered agents. J Clin Periodontol. 2015 Apr;42 Suppl 16:S256-302. doi: 10.1111/jcpe.12336. PubMed PMID: 25495777.

Dental Elf – 20^th Jan 2015 – Dentine hypersensitivity: most desensitising toothpastes provided benefit finds review

Dental Elf – 11^th June 2012 – Limited evidence for the use of oxalates for treating dentine hypersensitivity

Dental Elf – 18^th Feb 2014 – Little evidence available for the effectiveness of arginine-containing toothpastes in managing dentine hypersensitivity

Poulsen S, Errboe M, Lescay Mevil Y, Glenny AM. Potassium containing toothpastes for dentine hypersensitivity. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD001476. DOI: 10.1002/14651858.CD001476.pub2.