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PubMed1999

Dealing with sensitive teeth.

Dental pain is extremely common in the UK and can severely reduce the quality of life when it is associated with eating, drinking or speech. Patients often present complaining of a short, sharp, stabbing pain from hot or cold air, foods or drinks: while this may be caused by tooth decay, failing fillings or cracks in teeth, a major cause is sensitivity from exposed dentine. Treatment varies from dietary control, desensitising toothpastes to protection with dentine-bonding agents and glass ionomers. In extreme cases elective devitalisation is necessary.

Dentin Permeability↗
PubMedDate not supplied

Amalgam restorations: postoperative sensitivity as a function of liner treatment and cavity depth.

The purpose of this clinical study was to assess the sensitivity reported by patients following the insertion of class 1 or class 2 amalgam restorations in the treatment of primary carious lesions of different depths. Ninety subjects with previously untreated teeth requiring restorations due to caries lesions were selected: 32 teeth had lesions that were clinically and radiographically judged to be located in the outer one-third of dentin, 30 were located in the middle one-third of dentin, and 28 were located in the inner one-third of dentin. Four different lining regimens were employed: Group 1--no linear; Group 2--two coats of Copalite liner; Group 3--a dentin adhesive resin liner (Scotchbond Multi-Purpose); Group 4--a resin-modified glass ionomer (Fuji Bond LC). Patients were contacted on days 2 and 7 postoperatively and questioned regarding the presence or absence of sensitivity, the stimuli that created the sensitivity, if any, the duration of any sensitivity, and the intensity of any sensitivity using a rating from None to Severe. If sensitivity was experienced on day 7, patients were also contacted on days 14, 30, and 90 to assess the sensitivity at those intervals. The chi-square test of independence showed no significance at the 0.05 level between the different dentin treatments and cavity depths. By day 2, 19% of lesions located in the outer one-third, 27% of lesions located in the middle one-third, and 29% of lesions located in the inner one-third of dentin were sensitive. On day 30, four teeth were still sensitive, two located in the middle one-third and two located in the outer one-third of dentin. On day 90 all teeth were without sensitivity.

Adolescent↗
PubMed1999

Treating hypersensitivity with fluoride varnish.

Dentinal hypersensitivity results when stimulation causes the fluid in open dentinal tubules to undergo pressure changes, which activates mechanoreceptor nerves and results in pain. Treatment with fluoride varnish forms a protective layer of calcium fluoride that prevents this fluid flow, thereby reducing dentinal sensitivity.

Calcium Fluoride↗
PubMed2001

Clinical dentin hypersensitivity: understanding the causes and prescribing a treatment.

Dentin hypersensitivity is a common condition of transient tooth pain associated with a variety of exogenous stimuli. There is substantial variation in the response to such stimuli from one person to another. Except for sensitivity associated with tooth bleaching or other tooth pathology, the clinical cause of dentin hypersensitivity is exposed dentinal tubules as a result of gingival recession and subsequent loss of cementum on root surfaces. The most widely accepted theory of how the pain occurs is Brännström's hydrodynamic theory of dentin hypersensitivity. Dentinal hypersensitivity must be differentiated from other conditions that may cause sensitive teeth prior to treatment. Three principal treatment strategies are used. Dentinal tubules can be covered by gingival grafts or dental restorations. The tubules can be plugged using compounds that can precipitate together into a large enough mass to occlude the tubules. The third strategy is to desensitize the nerve tissue within the tubules using potassium nitrate. Several over-the-counter products are available to patients to treat this condition.

Dental Cementum↗
PubMedDate not supplied

Dentin/enamel adhesives: review of the literature.

This paper describes the development of dentin bonding systems, and describes the current strategies for bonding composite resin materials to dentin. Two main strategies are available--total-etch or self-etch--and each has unique advantages and disadvantages. For each category, simplified systems that reduce the number of application steps are available. Currently, the market is moving towards self-etching materials, largely because these are associated with less post-operative tooth sensitivity. However, the clinical performance of most of these materials is not yet proven.

Acid Etching, Dental↗
PubMed2002

Clinical evaluation of the role of glutardialdehyde in a one-bottle adhesive.

PURPOSE: To evaluate clinically whether the addition of glutardialdehyde to the one-bottle enamel-dentin adhesive Gluma Comfort Bond (GCB) has a desensitizing function, as insinuated by the brand name Gluma Comfort Bond+Desensitizer (GCB+D). MATERIALS AND METHODS: Two pain studies following identical protocols were conducted in Abu Dhabi (A) and Bologna (B). Each of the 60 and 59 patients selected, respectively, had two sensitive cervical tooth sites, characterized by a score three or higher on a five-step pain scale: 1 (no), 2 (slight), 3 (mild), 4 (severe), 5 (very severe) discomfort upon application of a 2-second cold air stimulus. The buccal sensitive sites treated in A were generally small, in B larger and in most cases extending into the proximal tooth area. The patients indicated their discomfort level according to the pain scale prior to and immediately after topical application of GCB and GCB+D, respectively, and then at recalls after 1 week, 1 (A) or 3 (B) months, and 6 months. The data was statistically analyzed by chi2-tests (P < 0.05). RESULTS: With the cumulative scores 1 and 2, the following percentage success rates were found for GCB/GCB+D. A: postoperatively 93/98, 1 week and 1 month 98/98, and at 6 months 92/100. In B, the respective decrease in sensitivity was uniformly 43/100 throughout the entire evaluation period, postoperatively through 6 months. The 33 teeth (57%) of GCB with scores 3 and 4 in the B-study received a rescue treatment with Gluma Desensitizer immediately after the 1 week recall. This regimen reduced the sensitivity instantaneously to scores 1 and 2 until the end of the evaluation after 6 months. In the A-study, GCB+D was significantly more effective than GCB after 1 week, 1 month, and 6 months, in the B-study at all recall sessions. It is hypothesized that a thin film of adhesive applied to a sensitive area may not polymerize and seal the dentin surface adequately due to oxygen inhibition. In particular, proximal sensitive tooth sites with poor access for adhesive application are suspected to remain inadequately sealed with a polymer film and thus sensitive. In this latter case however, glutardialdehyde as a component of the adhesive compound will result in coagulation of peripheral tubular liquid protein and thus desensitization, due to hampering of the liquid shift across the tubules upon excitation of a cold stimulus. In conclusion, glutardialdehyde played an active and effective role as a desensitizing agent, when added to the ethanol-water based one-bottle adhesive Gluma Comfort Bond.

Adult↗
PubMed2002

Calcium phosphate precipitation method for the treatment of dentin hypersensitivity.

PURPOSE: To evaluate the feasibility of the calcium phosphate precipitation (CPP) method as a treatment for dentin hypersensitivity using vital teeth of beagle dogs. Also, gingival tissue response to two types of CPP methods was examined histologically. MATERIALS AND METHODS: Dentin tubules of the dogs' vital teeth were exposed by shallow cavity preparation followed by etching with 50% citric acid to simulate the condition of hypersensitive dentin. After CPP treatment was applied to the vital tooth, the dentin surface and longitudinal sections were observed by SEM to evaluate the occluding ability of the CPP method. The precipitate was also analyzed by energy-dispersive X-ray microanalysis to obtain compositional information. The gingival tissue before and after CPP method was examined histologically with light microscopy. RESULTS: Dentin tubules were occluded homogeneously and completely with an apatitic mineral after application of the CPP treatment in vital teeth. However, the depth of the precipitate in dentin tubules from the dentin surface was approximately half that seen in extracted teeth. No histological change was observed in gingival tissues when NaHCO3 was used as a post-treatment solution of the CPP method, whereas another CPP method using NaOH solution resulted in atrophy and degeneration of the epithelium of gingival tissue.

Analysis of Variance↗
PubMed2002

The effects of outward forced convective flow on inward diffusion of potassium across human dentin.

PURPOSE: To measure the inward flux of potassium across human dentin disks, in vitro, in the absence and then in the presence of a simulated pulpal pressure (PP), before and after brushing with two desensitizing dentifrices. MATERIALS AND METHODS: Dentin discs were made from extracted unerupted third molars and etched with 6% citric acid to remove the smear layers. The hydraulic conductance (Lp or outward fluid movement) of the discs was measured before and after brushing for 2 minutes with two desensitizing dentifrices, Colgate Sensitive Maximum Strength or Sensodyne Fresh Mint, both dentifrices containing 5% potassium nitrate. The potassium flux was measured at a pressure of 0 cm H2O, and a simulated pulpal pressure of 20 cm H2O. RESULTS: The results showed the Colgate-brushed specimens had lower Lp (P < 0.05) than specimens brushed with Sensodyne or with saline. The Colgate-brushed specimens had a corresponding lower K+ flux, at a PP = 0 cm H2O, than specimens brushed with saline, but were not significantly different than specimens brushed with Sensodyne dentifrice. However, when the pressure was increased from 0 to 20 cm H2O, to simulate outward dentin fluid pressure, there were significant decreases in K+ flux across all three treatment groups, but the K+ flux of the Colgate-brushed specimens were affected the least, resulting in the Colgate-brushed specimens having significantly (P < 0.05) greater K+ fluxes than the saline or Sensodyne dentifrice-brushed groups. The magnitude of reduction in K+ flux in going from 0 cm H2O to 20 cm H2O was demonstrated to be linearly related to the magnitude of the Lp of the brushed specimens. Hence, a small Lp corresponded to a small reduction in K+ flux, and a correspondingly large K+ flux at 20 cm H2O. An explanation of this phenomenon is that a decrease in the Lp of dentin, produced by brushing, corresponds to a decreased outward dentin fluid flow. This lowers the outward K+ convective flow and also lowers the inward K+ diffusion. However, since the decrease of the outward K+ convective flow is greater than the decrease of the inward K+ diffusion, and the net flux is the algebraic sum of these two terms, the result is greater net inward K+ flux through the dentin. Therefore, the Colgate-brushed specimens, which exhibited the lowest Lp, provided the greatest inward K+ flux at simulated dentin fluid pressure.

Analysis of Variance↗
PubMed2002

A new approach to restoring root-end cavity preparation in surgical endodontic procedures--a scanning electron microscopy study.

While many different restorative materials are now available for filling root-end preparations in surgical endodontic therapy, each one has drawbacks. The current study suggests that a flowable composite resin, cured by a high-power curing light in 10 seconds, may be the material of choice. The significance of coating the resected root surface with a dentin-bonding agent is also discussed.

Apicoectomy↗
PubMed2003

Consensus-based recommendations for the diagnosis and management of dentin hypersensitivity.

These consensus recommendations for the diagnosis and management of dentin hypersensitivity were developed by a broadly constituted board of dentists and dental hygienists drawn from general dental practice, specialist practice, academia and research from across Canada, joined by 2 international dentists with subject matter expertise. The need for consensus recommendations was made evident by the lack of clear and robust evidence in the dental literature, as well as confusion about diagnosis and management demonstrated by an educational needs assessment survey. High prevalence of the condition, underdiagnosis and widespread availability of noninvasive, efficacious and inexpensive preventive treatment further underscored the need for direction. This paper outlines the key elements of the scientific basis for the causes, diagnosis and management of dentin hypersensitivity; where such evidence is deficient, the document relies on the compound experience of the board. A simple algorithm was developed to guide clinicians through the diagnostic process and assist them in determining appropriate case management. Finally, the board makes a series of recommendations to raise awareness, to improve dental education, to develop symbols for charting, to develop an index for case assessment and for further research.

Algorithms↗
PubMed2002

Effects of a potassium nitrate mouthwash on dentinal tubules--a SEM analysis using the dentine disc model.

The concept of tubular occlusion as a method of dentine desensitisation is a logical conclusion from the hydrodynamic hypothesis put forth by Brannström. The aim of this study was therefore to investigate qualitatively by SEM whether a 3% potassium nitrate/0.2% sodium fluoride mouthwash occluded tubule orifices, and by x-ray microanalysis, to characterise the nature of the deposits if any, following application. Following the 'dentine disc model' methodology 1mm thick tooth sections from unerupted molars were obtained. These were treated with the test and control mouthwashes and subjected to scanning electron microscopy. If any deposits were seen, they were to be subjected to elemental analysis using the energy dispersive x-ray analyser. Examination of all the dentine disc surfaces, treated by water (control), active and control mouthwashes demonstrated that none of the treatments, at any of the time intervals, had any visible effect on the dentinal tubule orifices i.e. there was no dentinal tubular occlusion seen. The results suggest that potassium nitrate does not reduce dentinal hypersensitivity, at least by tubule occlusion. This could mean that there is a different mechanism of action, which could not be detected by this in vitro model.

Dentin↗
PubMed2003

Sealing ability of dentin coating using adhesive resin systems.

PURPOSE: To assess the sealing ability of dentin coating using adhesive resin systems to verify its potential in protecting the dentin/pulp from the oral environmental stimuli. MATERIALS AND METHODS: 15 extracted human premolars were prepared for complete crowns and the electrical resistance of their coronal dentin was measured. The prepared teeth were then randomly divided into three groups, and the prepared dentin surface of five teeth in each group was coated using one of three adhesive resin systems (All-Bond 2, Clearfil Liner Bond II, Super-Bond D-Liner) with low viscosity resins. Measurements for electrical resistance of the prepared coronal dentin was repeated after the first and second coat of the low viscosity resins, and at 1 and 4 weeks of storage in a physiological saline solution. Additionally, three prepared teeth were exposed to either cold (37 degrees C --> 4 degrees C) or heat (37 degrees C --> 60 degrees C) stimulus and the temperature change was monitored inside the pulp chamber. Time-temperature curve was obtained before and after the first and the second dentin coating. RESULTS: Before dentin coating electrical resistance of the coronal dentin ranged from 1 to 11 k(omega), and increased significantly after the first coating by 3-15 times, and by 5-185 times after the second coating. Thermal diffusion was significantly smaller in the dentin after the coating. Before coating, the temperature change inside the pulp chamber ranged from 2-5 degrees C at 5 seconds after the thermal stimuli were applied. This decreased significantly to between 0.3-0.5 degrees C after the coating.

Analysis of Variance↗
PubMedDate not supplied

Dentin bonding: effect of degree of mineralization and acid etching time.

This in vitro study verifies whether there are differences between bonding to hypermineralized dentin and normal dentin and if longer acid etching can improve the bond strength to this modified substrate without damaging the bond to normal dentin. Forty-two extracted human molars with chronic occlusal caries were transversally cut with a diamond saw under refrigeration. The occlusal surfaces were ground until the carious lesion was removed, exposing the sclerotic dentin in the center and polished to 600/grid. A 35% phosphoric acid (3M) was applied for 15 seconds in 15 specimens. SingleBond (3M) adhesive system was applied and a hybrid resin composite (Filtek Z250, 3M) was inserted in four 1-mm increments and light-cured. The remaining 15 molars were prepared in the same manner, but with an acid etching time of 30 seconds. After 24 hours in water, the specimens were cut in two perpendicular directions to obtain a cross section of approximately 0.7 mm2 (n=25). A visual examination was conducted to select sticks between the two groups: sclerotic dentin (G15S or G30S) and normal dentin (G15N or G30N). Sticks without 100% sclerotic dentin (translucent area) or those with normal areas were not tested. Two-way ANOVA computed the mu-TBS data taking into consideration dentin type and acid etching time. The dentin Knoop hardness number (KHN) of the sticks was verified. A t-test compared the KHN data between sclerotic and normal dentin. Twelve additional molars (n=6) were prepared to observe the interface under a SEM. The mean (+/- SD) microtensile bond strengths (mu-TBS) were: G15S=56.4(+/- 14.9), G15N=69.7(+/- 17.2), G30S=63.2(+/- 15.6) and G30N=67.7(+/- 13.3). Two-way ANOVA showed higher mu-TBS to normal dentin than sclerotic dentin. Duncan's Post Hoc showed G15N had higher mean mu-TBS than G15S. Other comparisons were not significantly different. The t-test showed statistically higher microhardness in sclerotic dentin than in normal dentin (p<0.0001). The hybrid layer (HL) formation was observed in all specimens without gap formation in any region. In sclerotic dentin (G15S), the HL was very thin, with minimal resin tags in the dentinal tubules and, when present, they were shorter. Doubling the etching time (G30S) resulted in more resin tags with an HL formation on peritubular dentin. The HL on normal dentin was thicker when it was acid etched for 30 seconds (G30N). Numerous resin tags were present with both etching times. The results suggest that the higher mineral amount in sclerotic dentin makes it difficult to bond to this substrate, resulting in a lower mu-TBS. However, doubling the etching time resulted in mu-TBS similar to normal dentin.

Acid Etching, Dental↗
PubMed1992

Interfacial morphology of resin composite and shiny erosion lesions.

Ten shiny erosion lesions were divided horizontally, in vivo such that the gingival half was prepared and the incisal half remained unprepared. Both were etched simultaneously with 32% H3PO4 for 20 seconds, rinsed and restored using the All Bond wet technique and P50 composite. The teeth, which were extracted as part of a treatment plan, were sectioned vertically midway through the restorations. Polyvinyl siloxane impressions of the tooth/resin interface were taken and examined by SEM for the presence of gaps. The teeth were then demineralized and the fitting surfaces of the restorations were examined for resin penetration into the dentin. Results showed that there were no gaps present in any of the interfaces. The most proliferative and deep resin penetration occurred in the prepared/etched halves.

Bisphenol A-Glycidyl Methacrylate↗
PubMed2003

Advances in dentin adhesion.

While bonding to enamel has been a dependable technique, bonding to dentin is still an overwhelming task--dentin is a naturally soaked organic tissue. The enamel bonding agents of the 1960s and 1970s progressively evolved into complex multibottle or universal adhesives in the early 1990s. These multibottle systems were formulated to bond to enamel, dentin, composite, amalgam, porcelain, and nonprecious metal. More recently, simplified dentin adhesives were introduced following one of two adhesion strategies: total-etch adhesives that include an acid gel to remove the smear layer and dissolve hydroxyapatite (generally 30% to 40% phosphoric acid for 15 to 30 seconds); and self-etching primers that treat the dentin and enamel with a non-rinsing solution of acidic monomers in water without removing the smear layer. Recent attempts to simplify the bonding procedure have led to the introduction of adhesives that do not use a separate acid-etch step and, therefore, do not etch enamel to the same depth as phosphoric acid-based dental adhesives.

Acid Etching, Dental↗
PubMed1992

Factors affecting adhesion to mineralized tissues.

The objective of this paper is to review the literature concerning factors affecting adhesion to mineralized tissues. Factors related to the physicochemical structure of the adherents and to the inherent properties of composite restorative materials, along with the postulated bonding mechanisms of current adhesive systems, are discussed.

Acid Etching, Dental↗