Dentine hypersensitivity (DH) is defined as a pain derived from exposed dentin, in response to chemical, thermal, tactile or osmotic stimuli, which cannot be ascribed to any other form of dental effect or disease. The prevalence of DH is reported to be between 4-73%. A wide range of treatment approaches are used including mouthwashes, toothpastes, oxalates, lasers, casein phosphopeptide-amorphous calcium phosphate, bonding agents, glass ionomers and bioglass. Duraphat® (Colgate Oral Pharmaceuticals, New York) and Gluma® Desensitizer (Heraeus Kulzer, Hanau, Germany) are two commonly in-surgery applied agents.
The aim of this trial and meta-analysis was to compare the effectiveness of Gluma and Duraphat in the treatment of dental hypersensitivity.
Methods
RCT – 38 patients with a minimum of 2 non-carious hypersensitive teeth were randomised to receive Gluma® or Duraphat® Sensitivity was recorded at baseline, 5 minutes and 7 days post treatment using a VAS (visual analog scale) with the Oral health-related quality of life (OHIP) questionnaire being administered at 7 days.
Review – Searches were conducted in the Medline, Cochrane central register of clinical trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and Google Scholar with no limits on date but restricted to English. Only randomised controlled trials (RCTs) were considered. Two reviewers independently selected studies and abstracted data. Study quality was assessed using the Cochrane tool and a random effects meta-analysis was carried out. (GRADE) Grading of Recommendations, Assessment, Development and Evaluation was used
Results
- RCT-
- 18 patients received Gluma® 20 patients Duraphat®. 3 patients in the Duraphat® arm and 1 in the Gluma® arm were lost to follow up.
- All study patients showed an improvement at 5 mins and 7 days there were no significant differences in sensitivity, VAS or OHIP scores.
- Review-
- 3 studies and the data from this trial were included
- 1 of the 3 studies was considered to be at low risk of bias.
- A statistically significant reduction in VAS scores in favour of Gluma® was only seen at 7 days.
| Post treatment VAS score | No of studies | No of patients | VAS Score (95%CI) |
| 5mins | 2 | 234 | 0.49 [− 0.50, 1.48] |
| 24 hrs | 2 | 84 | 0.12 [0.44, 0.69] |
| 7 days | 4 | 158 | 0.64 [0.11, 1.17] * |
Conclusions
The authors concluded: –
Gluma produces significant reduction in hypersensitivity at 7 days post treatment compared with Duraphat. There is definite lack of evidence on the long-term effect of these agents.
Comments
This paper includes a small RCT in addition to a systematic review of the area. While key details of the RCT are provided there is not enough detailed to properly assess the quality of the study and a risk of bias assessment was not included in the review section with the reviews other included RCTs. The RCT suffered from a 10.5% drop out despite the short (7-day) follow up period.
The review was registered on PROSPERO and followed a good methodological approach searching 3 main databases only identifying 4 studies in total involving only a small number of studies only one of which was considered to be at low risk of bias. In addition, the studies were small and only the reported outcome at 7-days was shown to be statistically significant.
A wide range of treatments have been suggested for hypersensitivity (Dental Elf Hypersensitivity blogs) with many of them demonstrating effectiveness (Dental Elf – 30th April 2015). However, there are challenges with diagnosis and assessment of hypersensitivity the fact that it is self-limiting in many patients and the short-term nature of many of the studies. These challenges pose problems when assessing the effectiveness and comparative effectiveness of treatments for hypersensitivity.
Links
Primary Paper
Sivaramakrishnan G, Sridharan K. Fluoride varnish versus glutaraldehyde for hypersensitive teeth: a randomized controlled trial, meta-analysis and trial sequential analysis. Clin Oral Investig. 2018 Apr 2. doi:10.1007/s00784-018-2428-8. [Epub ahead of print] PubMed PMID: 29610982.
Other references
Dental Elf – Hypersensitivity blogs
Dental Elf – 30th April 2015
