Dentinal hypersensitivity following scaling and root planing: comparison of low-level laser and topical fluoride treatment
Snezana Pesevska, Martja Nakova, Kiro Ivanovski, Nikola Angelov, Ljilana Kesic, Radmila Obradovic, Sonja Mindova, Salvador Nares
Introduction
Dentin when exposed to the oral environment can lead to dentinal hypersensitivity. There are a variety of ways in which dentin can be exposed, one of which is through root instrumentation. The accepted theory of dentinal tubule stimulation is the Hydrodynamic Theory in which fluid movement within the tubules will stimulate receptors.
The goal of the researchers was to eliminate pain and discomfort due to dentinal hypersensitivity, regardless of the origin of the discomfort (Pesevska, Nakova, Ivanovski, Angelov, Kesic, obradovic, Mindova, Nares, 2010). This study will focus on two different, but current forms of desensitization. The first is to use chemically induced mechanical obstruction of dentinal fluid movement through the use of solutions, adhesives and medications (Pesevska, et al., 2010) and the other is through the use of a low-level diode laser. The aim of the study is to compare these two methods to determine which methods is more successful in reducing dentinal hypersensitivity.
The goal of the researchers was to eliminate pain and discomfort due to dentinal hypersensitivity, regardless of the origin of the discomfort (Pesevska, Nakova, Ivanovski, Angelov, Kesic, obradovic, Mindova, Nares, 2010). This study will focus on two different, but current forms of desensitization. The first is to use chemically induced mechanical obstruction of dentinal fluid movement through the use of solutions, adhesives and medications (Pesevska, et al., 2010) and the other is through the use of a low-level diode laser. The aim of the study is to compare these two methods to determine which methods is more successful in reducing dentinal hypersensitivity.
Materials and Methods
Researchers successfully gathered thirty patients who have reported "strong" pain after root planing procedures. (Pesevska, et al., 2010). Two groups of fifteen were made such that one group received the low-level diode laser (Scorpion D-4057A, Optika Laser, Bulgaria) and the other were treated with a topical fluoride varnish, Fluor Protector. Each tooth that was reported as having strong sensitivity was isolated and kept dry during the treatment. The treatment was given one time a day for a four day period. Each subject's tooth in the laser group was irradiated with the laser for 20 seconds in the area of concern, while each tooth in the topical fluoride group received varnish on a dry tooth surface. Measurements were taken at each visit to determine if there was a change in sensitivity after each treatment application.
Results
Researchers took measurements at exactly the baseline visit, 2 days after and 4 days after. With the low-level diode laser group at baseline visit, all subjects reported strong sensitivity. At the second treatment, four out of fifteen patients experienced complete resolution of pain (Pesevska, et al., 2010). Overall, thirteen patients after the complete treatment experienced the removal of symptoms, showing over 80% of successful dentinal desensitization.
The results in the topical fluoride varnish group were not as profound. All subjects began with strong sensitivity. At the end of the treatment, only four out of fifteen patients experienced a complete lack of symptoms. None of the patients in this group reported lack of symptoms on the second visit.
The results in the topical fluoride varnish group were not as profound. All subjects began with strong sensitivity. At the end of the treatment, only four out of fifteen patients experienced a complete lack of symptoms. None of the patients in this group reported lack of symptoms on the second visit.
Conclusion
According to the study it shows that low-level diode lasers, if administered properly according to proper manufacturer's guidelines, can reduce and for some, completely remove the dentinal hypersensitivity symptoms. Because none of the topical fluoride varnish subjects reported a lack of sensitivity at the second visit, led researchers to believe a variety of explanations. One is that the crystal size of NaF in desensitizing agents are too small to completely occlude the dentinal tubule in one application, such that either a series of consecutive appointments or other treatment options must be utilized. Besides the size of the particles, longer treatment time and patient compliance is believed to play a role. This is because with the topical varnish, instructions include not eating or drinking or brushing teeth for 1 hour.
Researchers believe that for laser therapy, there is the possible stimulation and healing of dentinal tubules (Pesevska, et al., 2010). Because of this long term and complete lack of symptoms was seen in more individuals, showing that this treatment may be more effective than using varnish alone. Overall, the use of low-level diode laser has been shown to be an effective treatment option for prolonged treatment of dentinal hypersensitivity.
Researchers believe that for laser therapy, there is the possible stimulation and healing of dentinal tubules (Pesevska, et al., 2010). Because of this long term and complete lack of symptoms was seen in more individuals, showing that this treatment may be more effective than using varnish alone. Overall, the use of low-level diode laser has been shown to be an effective treatment option for prolonged treatment of dentinal hypersensitivity.
Personal Reflection
As an RDH, it is very important to be able to understand the contributing causes to a wide variety of dental concerns especially if the concerns are related to periodontal disease. Dentinal hypersensitivity is a concern that I myself as a patient have experienced. I personally have benefited from the placement of desensitizing drops, gels and fluoride treatment. Though causes of dentinal hypersensitivity can be caused by a wide range of reasons, most popular are abrasion, attrition, recession, and post-instrumentation.
As a hygienist it is important to be aware that when we perform scaling and root planing, that we scale with a purpose and not just a random movement. I believe that hypersensitivity will be a common complaint expressed by patients after scaling and root planing especially if the patient exhibited more attachment loss. Being able to effectively communicate reasons as to why they have sensitivity, as well as to provide a wide range of non-invasive treatment options is very important. This topic is also important as far as patient education goes. Educating the patient as to prevention of hypersensitivity is just as important as the treatment.
Personally I have heard patients complaining that after scaling and root planing they feel the sensitivity. From the research I learned of different methods of treating dentinal hypersensitivity. For the longest time, I believed that topical varnish was the most effective way to treat dentinal sensitivity. As a hygienist, it will be important for me to learn how to perform these services and to receive continuing education and certifications to better improve my skill and knowledge base. After reading about this research, I learned that there are more long term, effective treatments to dentinal hypersensitivity. It is very interesting to read about advances in our field and how treatment options have widened. This research also made me realize how important it is to test these treatments out for effectiveness and longevity of results prior to recommending them to patients.
As a hygienist it is important to be aware that when we perform scaling and root planing, that we scale with a purpose and not just a random movement. I believe that hypersensitivity will be a common complaint expressed by patients after scaling and root planing especially if the patient exhibited more attachment loss. Being able to effectively communicate reasons as to why they have sensitivity, as well as to provide a wide range of non-invasive treatment options is very important. This topic is also important as far as patient education goes. Educating the patient as to prevention of hypersensitivity is just as important as the treatment.
Personally I have heard patients complaining that after scaling and root planing they feel the sensitivity. From the research I learned of different methods of treating dentinal hypersensitivity. For the longest time, I believed that topical varnish was the most effective way to treat dentinal sensitivity. As a hygienist, it will be important for me to learn how to perform these services and to receive continuing education and certifications to better improve my skill and knowledge base. After reading about this research, I learned that there are more long term, effective treatments to dentinal hypersensitivity. It is very interesting to read about advances in our field and how treatment options have widened. This research also made me realize how important it is to test these treatments out for effectiveness and longevity of results prior to recommending them to patients.
Additional Sources
Borges, A., Barcellos, D., Torres, C., Borges, A., Marsilio, A., & Carvalho, C. (2012). Dentin Hypersensitivity--Etiology, Treatment Possibilities and Other Related Factors: A Literature Review. World Journal Of Dentistry, 3(1), 60-67. doi:10.5005/jp-journals-10015-1129. Retrieved February 8, 2012, from EbscoHost database.
Strassler, H., & Serio, F. (2009). Dentinal hypersensitivity: etiology, diagnosis and management. Rdh, 29(11), 1-11http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=12d85ca5-ab7a-4e45-bb1a-69db0ce0eddb%40sessionmgr14&vid=62&hid=26. Retrieved February 8, 2012, from EbscoHost database.
Strassler, H., & Serio, F. (2009). Dentinal hypersensitivity: etiology, diagnosis and management. Rdh, 29(11), 1-11http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=12d85ca5-ab7a-4e45-bb1a-69db0ce0eddb%40sessionmgr14&vid=62&hid=26. Retrieved February 8, 2012, from EbscoHost database.
References
Pesevska, S., Nakova, M., Ivanovski, K., Angelov, N., Kesic, L., Obradovic, R., & ... Nares, S. (2010). Dentinal hypersensitivity following scaling and root planing: comparison of low-level laser and topical fluoride treatment. Lasers In Medical Science, 25(5), 647-650. doi:10.1007/s10103-009-0685-0. Retrieved February 8, 2012, from EbscoHost database.
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Dental Associates of Farmington, CT. Dentin Hypersensitivity. July 10, 2012. Retrieved February 8, 2012 from http://dentalassociatesdmd.blogspot.com/2012_07_01_archive.html.