Calcium sodium phosphosilicate for dentine hypersensitivity?

Dentine hypersensitivity (DH) is characterised by a short sharp pain from exposed dentine in response to a stimulus. This is usually, thermal, tactile osmotic or chemical. It is common and prevalence rates as high as 75% have been reported. A wide range of agents have been used for treatment of DH and while most have been shown to demonstrate some degree of effectiveness no one treatment stands out.

Recent studies have suggested that calcium sodium phosphosilicate (CSPS) is more effective than potassium nitrate, which has been widely used. CSPS is a bioactive glass That reacts on exposure to body fluids and deposits hydroxycarbonate apatite (HCA), a mineral chemically similar to that in enamel and dentine. The aim of this review is to assess the effectiveness of CSPS in the treatment of dentine hypersensitivity.

Methods

Searches were conducted in the PubMed, CENTRAL, Embase, Web of Science, Chinese Biomedical Literature Database, ClinicalTrials.gov, the National Research Register, OpenGrey, and the World Health Organization’s International Clinical Trial Registry Platform.

Randomized controlled trials (RCTs) in patients with dentine hypersensitivity treated with calcium sodium phosphosilicate (CSPS) containing desensitising formulations in any format (eg toothpaste, mouth rinse, and prophylaxis paste) were considered. Two reviewers selected studies and independently completed a risk of bias assessment using the Cochrane tool.

Results

11 RCTs were included all compared CSPS with a negative control.
5 studies were considered to be at low risk of bias, 5 at unclear risk and 1 at high risk of bias.
Follow up times ranged from 15 days to 8 weeks.
4 studies were concerned with post-periodontal therapy sensitivity
5% CSPS containing toothpaste showed a better desensitizing effect at both 2 and 6 weeks regardless of the applied stimuli:-

Evaporative stimuli

Mean difference (95%CI)

Thermal stimuli

Mean difference (95%CI)

2 weeks:

-0.68 (-1.15 to -0. 20)

-0.59 (-1.33 to 0.14)

6 weeks:

-1.69 (-1.86 to -1.52)

-1.70 (-2.17 to -1.23)

Prophylaxis paste containing 15% CSPS showed a better desensitizing effect on post-periodontal therapy DH pain than a negative control, immediately after prophylaxis and at 4 weeks, as determined using evaporative or tactile stimuli.

Conclusions

The authors concluded:

Within the limitations of this systematic review, the evidence suggests that 5% CSPS-containing toothpaste is effective for use as an at-home treatment to relieve DH. Prophylaxis paste containing 15% CSPS is also favored over a negative control at reducing post-periodontal therapy hypersensitivity. The levels of evidence for these findings are classified as “moderate” and “low”, respectively. In addition, whether high CSPS concentrations (i.e., more than 5%) have more side effects remains unclear; however, high concentrations should be used with caution in products for home use. In the future, more high-quality, non-industry-supported clinical studies in this area should be conducted before any definitive recommendations can be made.

Comments

This new review focuses on the use a single agent, Calcium Sodium Phosphosilicate for DH. We have previously discussed a number of other reviews of agents to treat DH. Most of these have also focused on single agents, although the two most recent (see links) have considered several agents. These two reviews suggested that most agents provide some benefit, although the quality of the evidence is not high.

A further challenge in determining the most effective agent is that there have been few if any direct comparisons and the reviews highlight concerns that have been expressed about what is an appropriate control to use in trials. There is also some debate about what is the most appropriate follow up period for DH studies. Seven of the included studies received funding from manufacturers or included authors were also employees of the companies. In addition only a small number of studies contributed to the meta-analysis consequently the findings should be interpreted cautiously.