Dentine hypersensitivity is a common problem. It presents in healthy vital teeth as a short, sharp, arresting oral pain condition that resolves as soon as the stimulus is removed. Expose dentine with patent tubules for oral to pulp surface are required to experience dentine hypersensitivity. A number of professional and self-administered treatment are available, and a number of reviews have been undertaken no network meta-analyses.
The aim of this review and network meta-analysis (NMA) was to assess the effectiveness of self-applied dentifrices in the management of dentine hypersensitivity.
Methods
A review protocol was registered on the PROSPERO database. Searches were conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid Embase Ovid Medline and PubMed/Medline. Parallel design randomised controlled trials (RCTs) assessing short- term (<2 weeks) and longer-term (> 2 weeks) efficacy of home-use dentifrice for dentine hypersensitivity (DH) using at least two recognised stimuli were considered. The main outcome was change in DH using validated pain measures using at least two of, evaporative Air blast (Schiff, VAS, verbal pain scores), tactile (Yeaple, dental explorer probe, VAS) or cold thermal (VAS). Two reviewers independently selected studies with data being extracted by a single reviewer with risk of bias being assessed using the Cochrane risk of bias tool (RoB2) A NMA was conducted and, the quality of the evidence was assessed for each of the outcomes for the network meta-analysis using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group approach.
Results
- 62 papers reporting on 68 studies were included, with 44 studies having two arms and 24 studies involving ≥3 treatment methods.
- 4 studies were considered to be at low risk of bias, 12 at high risk with 52 studies having some concerns.
- 34 papers describing 39 studies contributed to the narrative review.
- 32 studies reporting on 35 studies contributed to the meta-analyses.
- For outcomes shorter than 2 weeks and longer than 2 weeks a narrative review showed positive impacts on dentine hypersensitivity for a number of dentifrice formulations.
- Statistical analysis was on undertaken for 2-week outcomes with 108 study arms (4638 Patients) contributing to a NMA.
- Patients had an average age of 39 years and 67%:33% female to male ratio.
- For air blast VAS scores there was a trend towards individual products showing improvements in sensitivity, but this was not statistically significant (see table below).
- Using the Schiff scale there were statistically significant improvements in sensitivity for arginine and potassium without stannous formulation (see table below).
- With the Yeaple probe there were statistically significant improvements in tactile sensitivity for arginine, potassium + stannous formulations and stannous formulations compared to the negative control (see table below).
| Dentifrice | Mean difference(95%CI) | ||
| Air Blast VAS | Schiff Scale | Yeaple Probe | |
| Arginine | −1.99
(−5.11 to 1.14) |
−0.95
(−1.26 to −0.65) * |
11.75
(2.25 to 21.26) * |
| Calcium Sodium Phosphosilicate (CSPS) | −1.28
(−7.22 to 4.66) |
−0.025
(2.25 to 2.20) |
0.83
(− 4.52 to 6.18) |
| Potassium + Stannous | NA | −0.71
(−2.94 to 1.52) |
14.70
(7.97 to 21.43) * |
| Potassium without Stannous | −0.46
(−1.55 to 0.63) |
−0.54
(−0.84 to −0.24) * |
6.01
(−15.14 to 27.16) |
| Stannous formulations | −2.40
(−3.09 to 2.61) |
−1.18
(−2.73 to 0.36) |
24.77
(0.25 to 49.29) * |
| Strontium Acetate formulations | −0.08(
−2.97 to 2.36) |
NA | 3.34
(−2.96 to 9.64) |
| Strontium non acetate formulations | −0.28
(−2.97 to 2.41) |
−0.37
(−2.57 to 1.83)
|
0.65
(−18.06 to 19.35) |
*Statistically significant
Conclusions
The authors concluded: –
… dentifrices with formulations including stannous, potassium +/- stannous, and arginine result in significant short (<2 weeks; meta-analysis and narrative re- views) and long-term (>2 weeks; narrative review) improvements in DH pain relief measured with air blast (Schiff) and tactile (Yeaple probe) stimuli, when compared to negative controls. It was not possible to determine which active ingredient is most effective, so it would be pragmatic to work with DH patients to choose an efficacious product that suits their needs. Most study protocols involve twice daily self- application of desensitising dentifrices and some rubbing the dentifrice on the sensitive area of the tooth, which should be reflected in treatment recommendations. It is difficult to recommend products containing CSPS or strontium acetate for the management of DH based on the evidence included. Methodology for DH clinical studies needs to be standardised.
Comments
The reviewers have adopted a sound methodological approach to this NMA. A protocol was registered on PROPERO, and 3 major databases searched for relevant RCTs, however only a single reviewer undertook data extraction and included studies were restricted to the English language so some potentially relevant studies could have been excluded. While 68 studies reported in 62 papers were included only 4 were considered to be at low risk of bias. The reviewers looked to collect data at various time points, day 1, day 3, week 1, week 2, week 4, week 8, and week 12 although lack of data restricted analyses to 2-weeks which needs to be taken into consideration when interpreting the findings. The authors note that only 7 of the 62 studies were independently funded with many involving industry representatives as authors. The studies are very heterogeneous employing a range of time points various comparators negative/benchmark/placebo and positive control dentifrices. Consequently, while the review found low to moderate quality evidence that the active ingredients arginine, potassium +/- stannous, and stannous formulations lead to significant reduction in DH compared to negative control in short term studies (<2 weeks) the findings should be interpreted cautiously.
Links
Primary Paper
Pollard AJ, Khan I, Davies M, Claydon N, West NX. Comparative efficacy of self-administered dentifrices for the management of dentine hypersensitivity – A systematic review and network meta-analysis. J Dent. 2023 Feb 6;130:104433. doi: 10.1016/j.jdent.2023.104433. Epub ahead of print. PMID: 36753794.
Other references
Dental Elf – Dental Hypersensitivity blogs
Picture Credits
By Pinkmanggis – Own work, CC BY-SA 4.0,
