A wide variety of agents have been incorporated into toothpastes to help manage dentine hypersensitivity and previous reviews have suggested that all have a better effect than negative controls.
The aim of this network meta-analysis was to compare different desensitising toothpastes and placebo in terms of their effects on dentine hypersensitivity (DH) at 2, 4, and 8 weeks.
Searches were conducted in the Medline, Embase, Cochrane CENTRAL, Web of Science, ClinicalTrials.gov, the International Clinical Trials Registry Platform, the ProQuest Dissertation Abstracts and Thesis database, and the System for Information on Grey Literature in Europe Databases. Randomised controlled trials (RCTs) that compared the effect of different desensitising toothpastes or placebo on dentine hypersensitivity were considered. Only English language studies were included.
Two reviewers independently selected studies extracted data and assessed risk of bias using the Cochrane tool. Disagreements were resolved by discussions with a third reviewer. A traditional pair-wise meta-analysis was carried out using a random effects model. The results were expressed as mean differences (MDs) with 95% confidence intervals (CIs) . A network meta-analysis was also conducted.
- 30 RCTs were included.
- The studies involved the following toothpastes potassium-containing (K), strontium-containing (Sr), stannous fluoride-containing (SnF2), potassium- and stannous fluoride- containing (K + SnF2), calcium sodium phosphosilicate-containing (CSPS), arginine-containing (Ar), nano-hydroxyapatite-containing (n- HA), and fluoride-containing (F).
- 2 studies were considered to be at low risk of bias, 20 at unclear risk and 8 at high risk of bias.
- Results of the pairwise meta-analyses suggest that Ar was significantly superior to K and F toothpastes and SnF2 was significantly superior to F toothpastes, at all three follow-up times ( 2, 4 and 8 weeks).
- According to the network of desensitisation effects the cumulative probability of being the most efficacious treatment was in the order of: –
- n-HA toothpastes (60%) followed by SnF2, Ar, CSPS, K, Sr, placebo, and F toothpastes at 2 weeks,
- n-HA toothpastes (67%) followed by Ar, K + SnF2, CSPS, SnF2, K, Sr, placebo, and F toothpastes at 4 weeks.
- Ar toothpastes (54%) followed by K+SnF2, Sr, K, SnF2, CSPS, and F toothpastes and placebo at 8 weeks.
The authors concluded: –
there was no significant difference in the desensitisation effect among CSPS, K, and Sr containing toothpastes. In addition, there was no significant difference between F containing toothpastes and placebo, K containing toothpastes and placebo. Furthermore, a significant placebo effect on DH was found in this study, which support the importance of including a placebo group in future studies. Moreover, n-HA containing toothpastes may be the best desensitizing toothpaste for the treatment of DH, followed by Ar toothpastes. Therefore, n-HA containing toothpastes might be a recommended desensitising toothpaste considering the treatment of DH.
This network-meta-analysis has been conducted by the same group that published an earlier traditional meta-analysis on the dentine hypersensitivity (Dental Elf – 20th Jul 2018). The earlier review identified 53 RCTs compared with the current review which only includes 30 RCTs suggesting more stringent inclusion criteria. For example, only studies using the Schiff Cold Air Sensitivity Scale were included in this review. This review only includes studies published in English so some relevant studies may have been excluded. The authors note that a placebo effect was evidence in this study, and they raise the issues of the subjectivity of pain which they also highlight the variation in the concentrations of desensitising toothpastes across the studies and the lack of information on patient compliance in the included studies. The authors also note that a majority of the studies received company sponsorship with some studies being authored by company employees. There is also a concern regarding the limited size of some of the studies for assessing the rellative effectiveness of some of the agents, consequently the findings should be viewed cautiously.
Hu ML, Zheng G, Lin H, Yang M, Zhang YD, Han JM. Network meta-analysis on the effect of desensitizing toothpastes on dentine hypersensitivity. J Dent. 2019 Sep;88:103170. doi: 10.1016/j.jdent.2019.07.008. Epub 2019 Jul 17. Review. PubMed PMID: 31325467.
Dental Elf – 20th Jul 2018