It has been estimated that around 15% of the population with dentine hypersensitivity (DH) and a wide variety of agents have been used for treatment. These include fluoride varnish, Gluma® desensitising agent, resin desensitisation agents lasers and a broad range of desensitising toothpastes.
The aim of this review was to evaluate the desensitising effect of toothpastes that contain ingredients that act against dentine hypersensitivity (DH) and to compare this effect with negative controls.
Methods
Searches were conducted in the PubMed,Embase, Web of Science, CENTRAL (Cochrane Library), and the Chinese Biomedical Literature Database with no limitations. Randomised controlled trials (RCTs) with intervention and negative control groups in adults and evaluated the effect of desensitizing toothpaste on DH were considered.
Two reviewers independently selected studies, abstracted data and assessed risk of bias using the Cochrane tool. The quality of evidence for the main outcomes was assessed using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Inverse variance random-effects meta-analyses of standardized mean differences (SMD) and 95% confidence intervals (CIs) were calculated.
Results
- 53 RCTs involving 4796 patients (2396 intervention, 2400 control) were included.
- Follow up periods ranged from 3days – 12 weeks.
- 18 reported t effects of potassium-containing, 13 of arginine-containing, 9 of stannous fluoride-containing, 7 of strontium-containing, 6 of calcium sodium phosphosilicate-containing, 3 of potassium- and strontium-containing or potassium and stannous fluoride-containing, 2 of nano- hydroxyapatite-containing and amorphous calcium phosphate-containing toothpastes.
- 3 studies were considered to have a low risk of bias, 44 a moderate risk and 6 a high risk.
- All toothpastes containing active desensitisation ingredients, except for those containing strontium and amorphous calcium phosphate, had a better effect on DH than negative controls.
| Type of toothpaste | No. of studies | Standard mean difference (95%CI) |
| potassium-containing | 19 | -1.27 ( -1.77 to -0.77) |
| arginine-containing, | 13 | -2.52 (-3.20 to -1.34) |
| stannous fluoride-containing | 9 | -2.34 (-3.39 to -1.23) |
| strontium-containing | 7 | -0.34 (-1.04 to 0.37) |
| calcium sodium phosphosilicate-containing | 6 | -2.01 (-3.05 to -0.95) |
| potassium- and strontium-containing | 3 | -2.42 (-4.00 to -0.23) |
| potassium and stannous fluoride-containing | 3 | -2.50 (-4.10 to -0.91) |
| nano-hydroxyapatite-containing | 2 | -2.19 (-2.61 to -1.76) |
| amorphous calcium phosphate-containing | 2 | -0.54 ( -1.40 to 0.33) |
Conclusions
The authors concluded: –
….. desensitizing tooth- pastes containing potassium, stannous fluoride, potassium and strontium, potassium and stannous fluoride, calcium sodium phospho- silicate, arginine, and nano-hydroxyapatite are effective in relieving DH compared to negative controls, but do not suggest that those containing strontium or amorphous calcium phosphate should be used for DH. In future research, more high-quality DH clinical trials with non-company funding should be performed to obtain more accurate conclusions on the effects of desensitizing toothpastes.
Comments
There are a number of problems with assessing the efficacy of treatment for DH, The labile nature of the condition, the subjectivity of pain and placebo effects. There is also variation in the follow up period for studies which range from as short as an immediate assessment to 12 weeks the type of pain scores and the testing method used (cold air, water, thermal or tactile stimuli). In this review the air-blast test was used to reduce variation. While 5 major databases were searched only studies in English of Chinese were included which may have excluded some studies. A number of included studies only involved a small number of participants and the majority of studies were sponsored in whole or in part by manufacturers.
In 2015 we looked at a review by Bae et al (Dental Elf -20th Jan 2015) which included 31 RCTs so this new review adds an additional 22 studies producing broadly similar results. In all the included studies the desensitising toothpastes were compared against negative controls so the relative effectiveness of the various products is unclear. Further well-conducted and reported studies are needed using common outcomes sets and follow up periods to clarify the evidence in this area.
Links
Primary Paper
Hu ML, Zheng G, Zhang YD, Yan X, Li XC, Lin H. Effect of desensitizing toothpastes on dentine hypersensitivity: A systematic review and meta-analysis. J Dent. 2018 May 19. pii: S0300-5712(18)30129-5. doi:10.1016/j.jdent.2018.05.012.[Epub ahead of print] Review. PubMed PMID: 29787782.
Original Review Protocol on PROSPERO
Other references
Dental Elf – 20th Jan 2015
Dentine hypersensitivity: most desensitising toothpastes provided benefit finds review
Dental Elf – Dentine Hypersensitivity Blogs
