King of Pain

“My teeth are sensitive to cold.” “I hate having my teeth cleaned since they are so sensitive.

For more on this topic, go to www.dentaleconomics.com and search using the following key words: dentinal sensitivity, remineralization, desensitizing, prophylaxis, Dr. Paul Feuerstein.

“My teeth are sensitive to cold.” “I hate having my teeth cleaned since they are so sensitive.” “My teeth stay sensitive for days after the cleaning.”

These are the mantras of many patients with areas of recession, abrasion, abfraction, and postsurgical exposure that dentists and hygienists face daily. Dentinal hypersensitivity is a highly prevalent condition, affecting up to 57% of people worldwide. The cold air, a hot drink or a sweet dessert can trigger acute sensetivitiy pain.

Likewise, the touch of a dental instrument can make routine dental visits very uncomfortable. This discomfort may lead sensitivity sufferers to avoid regular checkups, a neglect that can result in a progression of oral care problems.

According to an article by Drs. Kugel and Mehta at Tufts University, dentinal sensitivity is caused by the inward and outward movement of fluid in the dentinal tubules that activate pulpal nerve fibers. To make the scaling and prophy visit more tolerable, there are topical anesthetics, such as Cetacaine and Oraqix, that have small syringes for spot delivery. A new product also has appeared from Colgate that can yield instant desensitization with the applicaton of a densensitizing paste with a prophy cup.

Sensodyne has been here for 40 years, and is still recommended for dentinal sensitivity. Patients are instructed to brush twice daily until sensitivity is reduced. The newer formula uses potassium nitrate.

Recaldent (casein phosphopeptide and amorphous calcium phosphate or CPP–ACP) is becoming prevalent in professional and over–the–counter products. A large body of study is available from the GC Corporation, since this is the key ingredient in MI Paste and MI Paste Plus. Recaldent also shows up in home products, including Trident gum.

In 2002, a new product was developed at my alma mater, SUNY Stony Brook, based on arginine bicarbonate and calcium carbonate. The arginine product helps the calcium carbonate rapidly adhere to the dentin surface, resulting in almost immediate relief. This technology, called ProClude, was used to prevent tooth sensitivity by applying the product during prophylaxis treatment performed by a dental hygienist. According to the original studies, if used at the start of a visit, the product worked rapidly and lasted at least 28 days.

The product was applied using a slow–speed handpiece with medium pressure to burnish the material into exposed dentinal tubules. In 2007, Colgate purchased the rights to this technology and began research to improve ProClude.

Colgate's exclusive Pro–Argin™ technology is comprised of an amino acid, arginine, and an insoluble calcium compound, calcium carbonate, to seal open dentin tubules and help block stimuli of pain receptors within teeth. This new system triggers occlusion of the dentin tubules that remain intact even after exposure to acids. This helps to block pain–producing stimuli.

At the recent ADA meeting in Hawaii, Colgate introduced Sensitive Pro–Relief™ desensitizing paste with the Pro–Argin™ technology that offers patients comfort and convenience without compromising treatment.

The dentist or dental hygienist uses the product simply by applying the desensitizing paste to the teeth by using a prophylaxis cup on a prophy angle with enough force to cause the material to burnish into the dentinal tubules. This seals the tubules. A series of articles in the American Journal of Dentistry (March 2009) makes for fascinating reading about the product. More information is available from Colgate.

Several double–blind studies show that there is a significant decrease in sensitivity to tactile and air blasts immediately after burnishing dentinal tubules with this product. Studies also verified this result four weeks later, and SEM studies clearly show the occlusion of dentin tubules. This modality should provide a simple, pain–free procedure with instantaneous results that can greatly improve the comfort of patients who suffer from sensitivity.

This is just a partial review of desensitizing products and processes. There will be a followup on DentistryIQ.com, but this might be a good time to try some Internet searches to get more information, as well as references.

Google is a great search engine but dig deeper by trying Google Scholar (scholar.google.com). This tool locates only results of books, articles, and abstracts, so start with “tooth desensitization” and see where you go from there. Although I have drifted somewhat from my normal high–tech discussion, I hope this information will help in your clinical practice.

Dr. Paul Feuerstein installed one of dentistry's first computers in 1978. For more than 20 years, he has taught technology courses. He has been named 2010 “Clinician of the Year” at Yankee Dental Congress. A general practitioner in North Billerica, Mass., since 1973, Dr. Feuerstein maintains a Web site (www.computersindentistry.com) and can be reached by e–mail at drpaul@toothfairy.com.

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