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PubMed1993

Sealing of human dentinal tubules by XeCl 308-nm excimer laser.

Root hypersensitivity occurs as a result of exposed dentinal tubules. Various methods and materials have been tried in an attempt to occlude these tubules. The purpose of this investigation was to study by scanning electron microscope the effects of XeCl excimer laser on exposed dentinal tubules of human extracted teeth. Fifteen 3-mm-thick slices were cut at the cementoenamel junction from 15 extracted human teeth by an electric saw. By using a diamond bur to remove the cementum layer the dentinal tubules were exposed. Each slice was scored by a permanent marker into four equal quadrants. Three of the quadrants were lased for 4 s by XeCl excimer laser with fluences ranging from 0.5 to 7.0 J/cm2 and pulse repetition of 25 Hz. The unlased quadrant served as control. The specimens were mounted on a stub, sputter coated by gold, and examined by scanning electron microscope. Nonlased surfaces showed numerous exposed dentinal tubules. In contrast, all specimens lased at fluences of up to 1 J/cm2 showed the presence of melted dentin which closed the dentinal tubules. At fluences of 4 J/cm2 and higher, rupture of molten materials and exposure of dentinal tubules were noted. The results indicate the application of XeCl excimer laser at specific fluences can cause melting of dentin and closure of exposed dentinal tubules.

Dentin↗
PubMed1990

Clinical considerations of microleakage.

Most dental materials permit the microleakage of bacteria and bacterial products from oral fluids to reach dentin. Thus, an understanding of the clinical consequences of microleakage demands that we analyze the permeability characteristics of dentin. The more dentin surface that is exposed during tooth preparation, the greater the potential for microleakage. Thicker dentin is less permeable than thin dentin. Dentin over pulp horns is more permeable than central dentin. Similarly, the dentin making up axial walls is more permeable than dentin forming the pulpal floor of cavities. Coronal dentin is much more permeable than root dentin. In addition to the number of tubules per unit area, tubule diameter, and the location of the dentin in a tooth, another extremely important variable is the presence or absence of a smear layer. When smear layers are created, grinding debris are forced into each tubule to form a smear plug. Smear plugs are usually 1- to 2-microns long but may be 10-microns long. They are much longer than the smear layer thickness and they reduce dentin permeability more than the overlying smear layer. Smear layers constitute a natural cavity liner that reduces the permeability of dentin far more than any cavity varnish. However, its presence limits the strength of dentin bonding agents because of the relatively low cohesive forces holding the smear layer together and to dentin. If it is removed, the bond strengths of dentin adhesive resins increases, but removal also increases the potential liability for pulpal inflammation if the bond is not uniformly perfect.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Cements↗
PubMed1990

Effects of injury and inflammation on pulpal and periapical nerves.

Several studies dealing with the reactions of dental nerve fibers to injury and inflammation are reviewed in this article. The subgroup of dental nerve fibers that contains calcitonin gene-related peptide (CGRP) was examined by immunocytochemistry at various times (1 to 35 days) after one of three degrees of injury: (a) Mild: Four days after making shallow cavities into cervical dentin of first molars of anesthetized adult rats, we found that CGRP fibers had sprouted into the subjacent odontoblast layer and dentin, and then returned to normal by 3 wk. (b) Intermediate: If the cervical cavities were acid etched, we found damage to the odontoblast layer, microabscess formation, and sprouting of CGRP fibers near the abscess, with subsequent formation of reparative dentin and healing. (c) Severe: If the pulp was exposed, a variety of reactions could occur, the most prevalent of which was a severe necrosis leading to development of periapical lesions. Analysis of the progressive stages of pulpal abscess and necrosis showed sprouting CGRP nerve fibers (a) at the retreating interface between abscess and vital pulp; (b) in periapical areas during onset of lesions; and (c) around chronic abscesses in granulomatous periodontal tissues. These studies are discussed in relation to various dental clinical problems such as hypersensitive teeth, episodic toothache, early onset of periapical lesions, dental anesthesia, and possible roles for sensory fibers and neuropeptides in tissue defense and healing.

Animals↗
PubMed1991

A clinical and morphological study of cervical hypersensitivity.

One-hundred five teeth with clinically diagnosed cervical hypersensitive dentin were studied using scanning electron microscopy on replica models and electrical impedance. Thirty-two percent of the teeth were in male patients in their 40s. Maxillary premolars comprised 31%; maxillary incisors, 27%; mandibular premolars, 17%; and mandibular incisors, 15%. Scanning electron microscopy of the models of hypersensitive spots showed enlarged dentinal tubules, agglutinated dentinal tubules, belt-like groups of agglutinated dentinal tubules, and tubule morphology not clearly visible. The electrical impedance of the cervical hypersensitive dentin ranged from 15 to 150 ohms, with an average of 54 ohms. There was a significantly high correlation between the dentinal tubule morphology and dentin hypersensitivity.

Adult↗
PubMed1997

Cytotoxicity of Ketac Silver cement.

The aim of this experiment was to investigate the effect of a glass ionomer cement with silver particles (Ketac Silver) on pulp tissue. Class V cavities were prepared in 60 healthy teeth scheduled for extraction for orthodontic reasons. A base of Dycal was placed in each cavity. Thirty teeth were filled with Ketac Silver and 30 with ZOE. Ten teeth of each group were extracted 15, 30, and 60 days later. At 15 days, the pulps in the Ketac group showed vacuolization and disruption of the odontoblastic layer, edema, vasodilation, chronic inflammatory infiltrate (CII), and necrosis. At 30 days, a necrotic odontoblastic layer, severe CII, and extensive areas of necrosis were seen. At 60 days, pulp tissue was almost completely necrotic. The ZOE control group showed a slight CII at 15 days. Our results suggest that under these experimental conditions, this cement is highly toxic and induces irreversible pulpal damage.

Cermet Cements↗
PubMed1997

Sealing depth of Nd:YAG laser on human dentinal tubules.

Dentin permeability and hypersensitivity are both reduced when the dentinal tubules are occluded. Previous scanning electron microscopic studies showed that Nd:YAG laser could cause melting of dentin and closure of exposed dentinal tubules without dentin surface cracking. Therefore, the aim of the present study was to evaluate the sealing depth of Nd:YAG laser on human dentinal tubules. Thirty-six dentin specimens with exposed dentinal tubule orifices were used in this study. Samples were randomly divided into three groups. Groups A and B were lased by Nd:YAG laser at energy of 30 mJ with 10 pulses/s for a stroke along the dentin surface. Group C was not lased and served as a control. Subsequently, group B was frozen in liquid nitrogen and split by a sharp chisel. Under SEM observation, nonlased specimens showed numerous exposed dentinal tubule orifices, and lased specimens showed melting of dentin and closure of exposed dentinal tubule orifices. The sealing depth of Nd:YAG laser on human dentinal tubules was approximately 4 microns.

Dentin↗
PubMed2001

Gingival recession-its significance and management.

OBJECTIVES: To review the prevalence and current concepts of the mechanisms and aetiology of gingival recession and present the principles of assessment and management of the patient with gingival recession. DATA AND SOURCES: The literature was searched for review and original research papers relating prevalence, mechanisms, aetiology, assessment, and treatment of gingival recession using Medline and manual tracing of references cited in key papers otherwise not elicited. STUDY SELECTION: Studies with gingival recession as focus and pertinent to key aspects of review. RESULTS: Gingival recession is a common condition and its extent and prevalence increase with age. Many factors including trauma and periodontal disease have a role in its aetiology. The patient may develop signs and symptoms including pain from exposed dentine, root caries and aesthetic concerns. Management of gingival recession requires thorough patient assessment, identification of aetiological factors, and recording and monitoring of the extent and severity of the condition. Treatment should be directed at prevention of further progression and the control of symptoms and disease. The patient's aesthetic concerns should be appreciated. Surgical treatment of recession may be indicated to cover exposed root surfaces. Many surgical techniques have been described with varied reported clinical effectiveness. CONCLUSIONS: Gingival recession should be thoroughly assessed and evaluated in order to offer the most suitable management.

Aging↗
PubMed2003

The prevalence of dentine hypersensitivity in a hospital clinic population in Hong Kong.

OBJECTIVES: Dentine hypersensitivity is a common clinical finding with a wide variation in prevalence values. The aim of this study was to establish the prevalence of dentine hypersensitivity and to examine some associated aetiological factors in a cross-sectional study of patients visiting the Periodontology and Oral Hygiene Clinic at Prince Phillip Dental Hospital, Hong Kong over a three-week period. METHODS: 226 patients were examined over a three-week period using a triple syringe to administer a blast of cold air to confirm the diagnosis of dentine hypersensitivity. Additional factors such as smoking habits, initiating stimuli, gingival recession and cervical tooth surface loss were noted. RESULTS: 153 patients were diagnosed as having dentine hypersensitivity, giving a prevalence figure of 67.7%. The commonest teeth affected were the lower incisors and the commonest initiating factor was cold drinks. CONCLUSIONS: The prevalence of dentine hypersensitivity in a hospital periodontology clinic population in Hong Kong was 67.7%.

Adolescent↗
PubMed1999

Evaluation of post-treatment solutions for clinical use with the calcium phosphate precipitation method.

OBJECTIVE: We have proposed a calcium phosphate precipitation (CPP) method that occludes dentine tubules with apatitic minerals for the treatment of dentine hypersensitivity. The current CPP method uses 1 mol/l NaOH as the post-treatment solution. However, its high pH is not desirable for clinical use. The aim of this study was to evaluate several solutions, especially buffer solutions, as post-treatment solutions for the CPP method. METHODS: The CPP solution was mixed with several post-treatment solutions at various mixing ratios in test tubes. The precipitates were collected, and freeze-dried in a vacuum. Their weights were measured to evaluate the feasibility of buffer solution for the post-treatment solutions. Among the solutions, we selected one buffer solution and have done further evaluation using human dentine disks. The degree of occlusion of dentine tubules was evaluated by scanning electron microscopic observation and measurement of dentine permeability. Also, the composition of the precipitate was analyzed using energy-dispersive X-ray microanalysis and powder X-ray diffraction. RESULTS: Among the solutions, 1 mol/l NaHCO3 gave sufficient amounts of precipitate at a relatively mild pH, and thus was considered to be a good candidate for a post-treatment solution. Scanning electron microscopic observation showed that dentine tubules were occluded with the precipitate to a depth of approximately 10 microns from the surface when the CPP treatment was done twice, and dentine permeability was reduced to 98.8%. The precipitate was dicalcium phosphate dihydrate (DCPD; CaHPO4-2H2O) when the post-treatment solution was free of NaF. In contrast, the precipitate was an apatitic mineral with CaF2 as a by-product when the post-treatment solution contained NaF. CONCLUSIONS: We concluded that 1 mol/l NaHCO3 containing 0.3 mol/l NaF would be suitable as the post-treatment solution for the CPP method as it has a relatively mild pH and occludes dentinal tubules well.

Adult↗
PubMed1996

The enigma of potassium ion in the management of dentine hypersensitivity: is nitric oxide the elusive second messenger?

We report the development of a 'second-messenger' model in an attempt to re-evaluate the role of K+ as a desensitising agent. Despite unequivocal validation of the effectiveness of potassium-based dentifrices in the management of dentine hypersensitivity, the mechanism(s) of action of K+ remains unclear. Although experimental paradigms of the Nernst equation demonstrate a direct inhibitory effect of K+ ion upon nerve conduction, in vivo considerable constraints can be argued to preclude this mechanism of action. Indeed, measurements of solution velocity within individual dentinal tubules obtained by scanning electrochemical microscopy indicate that outward movement of tubular fluid may represent a far greater barrier to the inward diffusion of K+ ions than previously estimated from measurements of hydraulic conductance across bulk dentine. Despite such probable limited penetration of dentine tubules, K+ ions may desensitise deeply-located nerve terminals through activation of a second-messenger transduction pathway that is capable of controlling the gain of K+-evoked effects which remain physically restricted to the more superficial aspects of the tubule. In addition to a direct effect upon transmembrane potential K+ can also indirectly attenuate neural activity through effects upon levels of the endogenously-synthesised free radical, nitric oxide (NO). Stimulation of the release of NO by K+ has been observed using a variety of cell preparations, which include endothelium, smooth muscle, adrenal medulla, hypothalamus and cerebellum. Importantly, a growing number of studies now report that an increase in the production of NO is associated with analgesia through a modulation of nociceptive input and a downregulation of sensitised nociceptors, most likely achieved through an increase in intraneural content of cGMP. The clinical role of a K+-evoked liberation of NO as a principal mechanism in the management of dentine hypersensitivity is supported by recent findings which include: (1) the localisation of NADPH-diaphorase activity and inducible nitric oxide synthase (iNOS) immunoreactivity within odontoblasts, their processes in dentine, and the subodontoblast layer of the pulp; (2) iNOS causes a sustained release of large (nanomolar) amounts of NO; (3) NO is freely diffusible and capable of displaying remarkably potent effector actions at distant target cells; (4) the actions of NO may be enhanced by endogenous carrier molecules such as S-nitrosothiols; (5) the synthesis of NO can be evoked by concentrations of K+ ion far less (i.e. <1 mM) than those required for direct inhibitory effects upon neural activity.

Animals↗
PubMed2006

The combined occluding effects of fluoride-containing dentin desensitizer and Nd-Yag laser irradiation on human dentinal tubules: an in vitro study.

The purpose of the present study was to evaluate the combined occluding effects of fluoride-containing dentin desensitizer and neodymium:yttrium aluminum garnet (Nd-YAG) laser irradiation on human dentinal tubules. All six of the groups of dentin samples (A-F) included in this study received applications of fluoride-containing dentin desensitizer. Groups B, D, and F also received Nd-YAG laser irradiation. Groups A and B served as controls, to allow observations of the occluding effects on the dentinal tubules before and after Nd-YAG laser irradiation. Groups C and D were treated with 0.5 M vitamin C solution, whereas groups E and F underwent brushing with an electric toothbrush. Scanning electron microscopy (SEM) revealed that the fluoridated dentinal tubule-occluding agent (FDTOA) formed a fine crystalline deposit on the dentin surface. After soaking in 0.5 M vitamin C solution for 3 hours, the crystalline deposit of the FDTOA was completely dissolved. Furthermore, brushing of the teeth 3,600 times removed most of the occluding agent. When the application of FDTOA was combined with Nd-YAG laser irradiation, the dentin melted and then recrystallized. The occluding agent was thus 'burned into' the dentinal tubules, and could neither be dissolved by vitamin C solution nor removed by brushing. Therefore, we concluded that the FDTOA combined with Nd-YAG laser irradiation burns the occluding agent into the dentinal tubules, thereby resisting the effects of an acidic diet and brushing, and increasing the duration of the desensitizing effect.

Combined Modality Therapy↗
PubMed1999

Action potential conduction block of nerves in vitro by potassium citrate, potassium tartrate and potassium oxalate.

OBJECTIVES: Potassium salts in desensitising formulations are believed to act by blocking nerve conduction. The aim of this study was to assess the ability of some organic potassium salts to block action potential conduction and to compare their effects with potassium chloride and potassium nitrate. MATERIALS AND METHOD: Potassium citrate, oxalate or tartrate were added to Krebs' solutions to raise the potassium concentration to 8-64 mM. The test solutions were applied to rat spinal nerves in a bath while monitoring the compound action potentials evoked by electrical stimulation. RESULTS: All potassium salts attenuated the compound action potential in a dose-dependent manner. There were no significant differences between the effects of potassium tartrate and potassium citrate solutions (p>0.1) which caused significantly greater compound action potential attenuation than the same concentrations of potassium oxalate (p<0.05). On the basis of the potassium ion concentration required to cause 50% attenuation of the compound nerve action potential, the relative potencies of the potassium salts were: citrate = tartrate> oxalate>chloride =nitrate. CONCLUSION: Potassium citrate and potassium tartrate were more effective than other potassium salts in blocking nerve conduction and may be more effective dentinal desensitising agents.

Action Potentials↗
PubMed2000

Treatment of dentine hypersensitivity by lasers: a review.

BACKGROUND, AIMS: Since the development of the ruby laser by Maiman in 1960, a variety of papers on potential applications for lasers in dentistry have been published. The purpose of this paper is to summarise laser applications for the treatment of dentine hypersensitivity. The effects of laser on pulp tissue and problems on laser treatment are also reviewed. This article reviews the role of lasers for the treatment of dentine hypersensitivity since 1985, summarises many research reports from the last decade, and surmises what the future may hold for lasers in this treatment. METHOD: To date, 4 kinds of lasers have been used for the treatment of dentine hypersensitivity, and the effectiveness ranged from 5.2 to 100%, which was dependent on the laser type and parameters used. The mechanism involved in laser treatment of dentine hypersensitivity are relatively unknown. RESULTS: These require clarification to result in safely effective treatment optimization. In general, the efficiency for the treatment of dentine hypersensitivity using lasers is higher than other methods, but in severe cases, it is less effective. CONCLUSION: It is necessary to consider the severity of dentine hypersensitivity before laser use.

Dental Pulp↗