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Dentin Hypersensitivity Effective treatment with the breakthrough Pro-ArginTM technology.

Fotinos Panagakos, DMD, PhD

Director of Clinical Research Relations and Strategy Colgate-Palmolive, Co Piscataway, New Jersey

Dentin hypersensitivity is growing in incidence and can be a major concern for patients. The pain associated with dentin hypersensi- tivity is usually brought on by an external stimulus, and the intensity can differ from patient to patient. The diagnosis of dentin hyper- sensitivity often poses a challenge for the dental professional. The cause and description of the pain reported by the patient can vary and is often not adequate to make a definitive diagno- sis. The dental professional often needs to perform a thorough examination, as well as additional tests, to determine why the pain is occurring. The examination and tests can help develop a definitive diagnosis, which allows the dental professional to rule out other possible causes of the pain (periodontal disease, caries, etc) and then implement an appropriate treatment plan to ad- dress the problem.

Dentin is normally covered by enamel or cementum. As a result of any number of factors, including abrasion or periodontal disease causing gingival recession, or erosion removing the surface of tooth enamel, the underlying dentin and dentin tubules can be- come exposed (Figure 1). An external stimulus such as a change in external temperature, air movement, or physical stimulus can cause discomfort for the patient. The external stimulus is usually transitory, and the discomfort subsides shortly after the stimulus is removed.

An accepted theory of how dentin hypersensitivity pain is trans- mitted suggests that pressure or ionic changes in the fluid flow that exists in the dentin tubules stimulates the pain experienced by the patient. This is often referred to as the "hydrodynamic theory." Inside the dentin tubule, a change in pressure causes a change in fluid movement, and this is transmitted to the odonto- blastic process and fires the afferent nerve ending in the dentin tubule (Figure 2). It is, therefore, understandable that the pain caused by this change is transient once the stimulus is removed or it dissipates, the pressure within the tubule returns to normal and the pain subsides.

Treatment and Prevention Methods

The treatment and prevention of dentin hypersensitivity has focused on eliminating the ability of the causative agent to stim- ulate discomfort. This has resulted in the development of two major classes of products agents that occlude dentin tubules and desensitizing agents that interfere with the transmission of nerve impulses.

Occluding agents act by physically covering or "plugging" the open, exposed dentin tubules, thus preventing the effect of thermal changes or physical stimuli caused by the movement of dentin fluid resulting from pressure changes. Some of these agents require professional application in the dental office, while others are incorporated in products that are used by the patient at home.

Desensitizing agents work by altering the levels of charged molecules in the dentin fluid. The most commonly used agent is potassium nitrate, usually delivered in a dentifrice that is applied daily by the patient during regular toothbrushing. The potassium ions must pass from the external dentin surface, through the dentin tubule, and into the pulp in order to reduce the excitation caused by the movement of fluid in the dentin tubules. Most products require continued use over a 4 to 8 week period before the patient realizes significant relief. In addition, use of the prod- uct often needs to be continued in order to maintain the relief afforded by the potassium ions/salts.

The pain associated with dentin hypersensitivity is usually brought on by an external stimulus, and the intensity can differ from patient to patient.

Use of Pro-ArginTM

Technology to Treat Dentin Hypersensitivity Although the traditional methods of treating dentin hypersen- sitivity have been found to be somewhat effective in providing relief to patients, dental professionals continue to look for better, more effective, fast acting, and lasting treatments. In 2009, the Colgate-Palmolive Company introduced a new in-office treatment for dentin hypersensitivity called ColgateA Sensitive Pro-ReliefTM desensitizing paste, based on the Pro-ArginTM technology. The Pro-ArginTM technology consists of arginine, a naturally occurring amino acid, and an insoluble calcium compound in the form of calcium carbonate. These ingredients are delivered in a prophy paste containing a mild abrasive, and can be applied with a pro- phylaxis cup to teeth that exhibit dentin hypersensitivity. Mechanism of action studies have shown that this technology physically seals dentin tubules with a plug that contains arginine, calcium, car- bonate, and phosphate. This plug, which is resistant to normal pulpal pressures and to acid challenge, effectively reduces dentin fluid flow, and thereby reduces sensitivity (Figure 3). A number of studies have been published recently supporting the launch of this new product. Laboratory tests demonstrating the product's mode of action, as well as clinical trials demonstrating relief of dentin hypersensitivity immediately and 4 weeks after a single application, have been presented to the dental profession as evidence that the Pro-ArginTM technology provides instant and lasting relief of dentin hypersensitivity. The full range of research studies can be accessed on the Colgate dental professional website, www.colgateprofessional.com. Treatment with ColgateA Sensitive Pro-ReliefTM desensitizing paste is simple and easy to incorporate into everyday practice. The paste is gentle to gingival tissues, does not elicit pain when applied, and has a pleasant mint flavor. The dental professional applies a small amount of paste to sensitive tooth surfaces with a slowly rotating, soft prophy cup. The dental professional should carefully burnish ColgateA Sensitive Pro-Relief TM desensitizing paste into all sensitive areas, focusing on the cemento-enamel junction and exposed dentin. Application of ColgateA Sensitive Pro-ReliefTM desensitizing paste results in immediate relief that lasts for 4 weeks after a single application.1 Clinicians encounter patients with dentin hypersensitivity on a regular basis. While every patient is different, dentin hypersensi- tivity is an indication that can be managed.

REFERENCES

1. Schiff T, Delgado E, Zhang YP, et al. Clinical evaluation of the efficacy of an in-office desensitizing paste containing 8% arginine and calcium carbonate in providing instant and lasting relief of dentin hypersensitivity. Am J Dent. 2009;22(Special Issue A):

8A-15A.

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Date:Dec 30, 2011
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