Introduction and Objective: Dentin Hypersensitivity (DH) is one of the common oral conditions that affect adult population and defined as a short, sharp pain arising from exposed dentin in response to stimuli typically thermal, evaporative, tactile, osmotic or chemical and cannot ascribe to any other form of dental pathology or disease. DH development through two distinct but interrelated phases of tooth wear and gingival recession associated with different etiological factors.
Morphological alterations in DH and intradental nerve excitability are the underlying sources that lead to disease progression, pain evocation as well as therapeutic strategies investigations to interrupt pain transmission. Numerous treatment modalities have been used to manage DH. The interventions of DH have been classified based on the mode of delivery (in-office or professionally-applied therapy and over-the-counter (OTC) or at- home therapy). The other classification used based on the mechanism of action and could be divided into two main categories: the dentinal tubules occluding agents to block the hydrodynamic mechanism of pain stimulation and the nerve desensitizers to interrupt the neural response to pain stimuli (neural blocker). The main objective for any dentine-desensitizing agent is to produce a clinically significant reduction in clinical symptoms and minimize or abolish the symptoms of pain or discomfort associated with DH. The variety of products and techniques used for the treatment of DH indicated a doubt among dentists about the best treatment option, as well as dissatisfaction with outcomes of available treatments, which necessitate the conduction of a comparative effectiveness research and a practice analysis to provide dentists and patients with precise scientific information for comparing the effectiveness and safety of alternative treatment options in resolving DH among different available treatment. The aim of the study is to conduct a comparative effectiveness research to find out if In-office desensitizing agents with dentinal tubules occlusion mechanism of action are more effective than self-applied desensitizing toothpaste with a neural stimulus blocker mechanism of action in resolving dentin hypersensitivity.
Methods: Search for systematic reviews, randomized clinical trials and observational studies were done using the National Library of Medicine-PubMed, Cochrane’s library and the American Dental Association (ADA) web Library. The relevance of the identified systematic reviews, clinical trials and observational studies to the study and PICOTS question was assessed using the inclusion and exclusion criteria. The quality of evidence and clinical relevance analysis achieved using validated and reliable instruments by two independent readers, and all disagreements resolved by discussion after establishing the inter-rater reliability of the two readers. The revised Assessment of Multiple Systematic Reviews (R-AMSTAR) instrument utilized to assess and quantify the quality of retained systematic reviews, the quantified Risk of Bias instrument utilized to evaluate the quality of retained clinical trials and the Expansion in the Grading of Recommendations Assessment, Development and Evaluation (Ex-GRADE) was used to evaluate the clinical relevance and the strength of recommendation. Acceptable sampling analysis was done using the Friedman test statistics. Meta-analysis was done on the two highest quality and homogenous clinical trials.
Results: Three out of six systematic reviews were considered as high-quality studies and two out of thirty-one clinical trials were considered as high-quality studies. However, the bibliome was concerned with a body of literature that has a considerable heterogeneity in terms of quality of the evidence, which prevented further work toward establishing the quantitative and qualitative consensus of the best evidence. Therefore, an alternative approach for acceptable sampling was conducted. Whereby the top 20% highest scoring papers in the bibliome were accepted. So, out of thirty-one studies, seven studies included and considered as high-quality studies. The results of the qualitative analysis of this review shows that 5% potassium nitrate toothpaste has inferior effectiveness in DH management as at home intervention, however, the reduction in the hypersensitivity increase with each recall that suggests the slow effectiveness that could be explained by the requisite of maintaining a high level of potassium nitrate to reach the maximum effectiveness. 5% potassium was not effective compared to in-office desensitizing intervention. Although it is difficult to prove or reach a conclusive evidence of the best treatment option, treatment approaches with resin-based composite restoration and glass ionomer liner resulted in statistically significant reduction in sensitivity. Yet, the complicated procedure of application of these restorations might be considered in terms of time and cost in treating dentin hypersensitivity. Furthermore, it considered as technique sensitive owing to the tendency to perform an overhang at the gingival margins, which contribute to the development of gingivitis or jeopardize the biological width of the periodontal tissues. Gluma and fluoride varnishes were effective in reducing DH for up to 6 months with no reported adverse effects aside to the time and cost consideration.
Conclusion: Based on the qualitative analysis of this review, the 5% potassium nitrate toothpaste has inferior effectiveness in DH management as at home intervention, which was not effective compared to in-office desensitizing interventions. Resin-based composite restoration and glass ionomer liner as in-office interventions yielded statistically significant reduction in sensitivity. However, the complicated procedure of application of these restorations might be considered in terms of time and cost in treating dentin hypersensitivity, which suggest that Gluma and fluoride varnishes might be superior treatment options in reducing DH in terms of efficacy and effectiveness. This review highlights the extent of heterogeneity and quality inferiority of clinical trials in this field, which impact the degree of their reliability. Also, it necessitates the future conduction of well-constructed clinical trials that directed to overcome current deficiencies and weaknesses.
