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The effect of pro-argin technology on patients with dentin hypersensitivity.

Introduction

Dentin hypersensitivity (DHS) is a common oral health problem affecting one or more teeth of many adult individuals. DHS is characterized by short sharp pain arising from exposed dentin in response to stimuli typically thermal, tactile or chemical that cannot be ascribed to any other dental defect or disease. (1)

In a normal tooth, dentin is covered in the crown by enamel and in most areas of the root by a thin layer of cementum. The primary causes of dentin hypersensitivity are enamel loss on tooth crown and gingival recession exposing the tooth root. Enamel loss can result from aggressive and/or incorrect toothbrushing or overconsumption of acidic foods like athletic beverages, fruit juice and soft drinks. Gingival recession due to periodontal disease or certain surgical procedures will expose the root. The cementum covering the root can then be removed easily, thus causing dentin hypersensitivity. In addition, tooth bleaching can also cause tooth sensitivity. (2)

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Management

Tooth sensitivity can be managed either at home or in-office. At home, dietary changes and behavior modifications such as decreasing the intake of acid-containing foods or carbonated drinks are usually one of the recommendations. In addition, correct toothbrushing techniques or appropriate use of toothbrushing appliances can also be considered. The use of desensitizing toothpaste can also decrease and/or eliminate dentin hypersensitivity. However, it takes about four to eight weeks to achieve a positive result. Many toothpaste products, such as GlaxoSmithKline's Sensodyne and Crest's Pro-Health, have been developed to relieve sensitivity. A new toothpaste, Colgate Sensitive Pro-Relief, which contains 5 percent potassium nitrate and 0.24 percent sodium fluoride, was launched into the U.S. marketplace in summer 2011. This toothpaste has both anti-sensitivity and anti-cavity effects.

A 2009 Canadian clinical trial on home-use desensitizing toothpaste showed that brushing with a toothpaste containing 8 percent arginine-calcium carbonate is effective in reducing dentine hypersensitivity. (3) In-office professional care also employs arginine and calcium carbonate as components in a desensitizing-paste for managing dentin hypersensitivity.

Arginine is a naturally occurring amino acid. It combines with calcium carbonate to form a deposit that seals the opened dentinal tubules. A clinical study on 390 patients found that professional prophylaxis by dentists and dental hygienists using arginine-calcium carbonate paste could significantly reduce dentin hypersensitivity. (4)

Pro-Argin Technology

A novel technology for dentin hypersensitivity associating arginine with calcium carbonate was originated by the Ortek Therapeutics Company, a private pharmaceutical company based in Roslyn Heights, N.Y., founded in 1998. One of its products, ProClude, was a desensitizing dental paste cleared by the FDA as a medical device in 2000. Colgate-Palmolive Company acquired the Ortek's desensitizing technology in 2007 and re-named it pro-argin technology after further developing the formulation. The product, Colgate Sensitive Pro-Relief Desensitizing Paste, which uses this technology, can now provide instant and lasting dentin hypersensitivity relief for four weeks according to the manufacturer.

Pro-Argin desensitizing technology works by plugging the tubules that allow conduction of impulses to the nerve, blocking potential sensitivity. The mechanism has been verified by Petrou, et al. and Cummins. (5), (6) Also, the finding of instant dentin hypersensitivity relief during professional dental prophylaxis or cleaning is supported by various clinical studies in the U.S. and Canada, such as Schiff, et al. and Hamlin, et al. (7), (8)

The Study

Aim

This study seeks to confirm and replicate the reports in a diverse population of patients visiting the New York City College of Technology Dental Hygiene Clinic.

Method

After the Institutional Review Board (IRB) approval was obtained, potential participants for this study were recruited from new or recall patients visiting the Dental Hygiene Clinic at New York City College of Technology, the City University of New York, for dental hygiene service. All adults (18 years or older) who could communicate effectively in English were recruited to participate in this study. After seating the patient, the student surveyed the patient about tooth sensitivity. The study protocol and study purpose were explained to the potential participants. Written consent was obtained from those who agreed to participate before the clinical trial. The student then proceeded to the standard treatment protocol routinely given to all new or recall patients at the clinic.

Before receiving any dental hygiene services, patients were asked to identify the sensitive teeth, which were then stimulated by air blast from the three-in-one syringe of the dental unit for one second. The Colgate Sensitive Pro-Relief Desensitizing Paste was applied on the teeth surfaces in accordance with product instructions. (9) The selected teeth were restimulated as prior to treatment, and post relief assessment was performed to evaluate the outcome on the same day dental hygiene appointment. Two teeth per patient were selected for the reliability of data analysis.

Results

A total of 35 healthy patients (14 males and 21 females) aged 18-64 with no untreated dental caries and no periodontitis participated. Among the 70 teeth identified as hypersensitive, 35 had 0 mm gingival recession and 35 had more than 1 mm gingival recession; 47 were maxillary and 23 mandibular. After applying the Colgate Sensitive Pro-Relief Desensitizing Paste on the teeth surfaces according to product instructions, the selected teeth were re-stimulated as prior to treatment, and post relief assessment was performed to evaluate the outcome. The results showed that 23 teeth had total relief of hypersensitivity and 33 teeth had improved hypersensitivity. However, 14 teeth had no improvement of hypersensitivity at all.
                     Results

35 patients                             70
aged 18-64                       Hypersensitive
participated                     teeth were
                                 identified

Male: 14 (40%)   Female:         Upper teeth: 47   Lower Teeth:
                 21(60%)         (67%)             23 (33%)

Gingival                         Total relief 23
recession                        (33%)

0 mm: 35 (50%)   [greater than   Improved: 33      No
                 or equal to]    (47%)             improvement:
                 1mm: 35 (50%)                     14 (20%)


Discussions

This study is only testing the instant relief of Colgate Sensitive Pro-Relief Desensitizing Paste and did not collect follow-up results at four weeks post treatment, so the claim of the product for that effect cannot be verified. Also, the study survey did not include toothbrushing methods, dietary habits and tooth whitening experience, which would have provided a more comprehensive overview of patient's hypersensitivity history.

Conclusion

The finding of this study supports the claim that Colgate Sensitive Pro-Relief Desensitizing Paste with Pro-Argin Technology can provide instant reduction of dentin hypersensitivity for the majority of affected teeth (80 percent) after just one application for the diverse population of patients visiting the New York City College of Technology Dental Hygiene Clinic.

Disclosure

The authors have no commercial interest in the product tested in this study.

Acknowledgment

Thanks to my mentor, Professor Anty Lam, for her support and dedication.

References

(1.) Addy M, Urquhart E. Dentine hypersensitivity: Its prevalence, aetiology and clinical management. Dent Update. 1992; 19(10): 407-12.

(2.) Chu CH, Lam A, Lo ECM. Dentin hypersensitivity and its management, Gen Dent. 2011; 59(2): 115-22.

(3.) Ayad F, Ayad N, Delgado E et al. Comparing the efficacy in providing instant relief of dentin hypersensitivity of a new toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride to a benchmark desensitizing toothpaste containing 2% potassium ion and 1450 ppm fluoride, and to a control toothpaste with 1450 ppm fluoride: A three-day clinical study in Mississauga, Canada. J Clin Dent. 2009; 20(4): 115-22.

(4.) Chu CH, Lau KP, Lui KS, et al. Effects of 8% arginine-calcium carbonate desensitizing paste on hypersensitivity teeth. J Dent Res. 2010; 89(B): 442.

(5.) Petrou I, Heu R, Stranick M, et al. A breakthrough therapy for dentin hypersensitivity: how dental products containing 8c1/0 arginine and calcium carbonate work to deliver effective relief of sensitive teeth. J Clin Dent. 2009; 20(1): 23-31.

(6.) Cummins D. Recent advances in dentin hypersensitivity: clinically proven treatments for instant and lasting sensitivity relief. Am J Dent. 2010; 23 Spec No A: 3A-13A.

(7.) 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 Spec No A: 8A-15A.

(8.) Hamlin D, Williams KP, Delgado E et al. Clinical evaluation of the efficacy of a desensitizing paste containing 8% arginine and calcium carbonate for the in-office relief of dentin hypersensitivity associated with dental prophylaxis. Am J Dent. 2009; 22 Spec No A: 16A-20A.

(9.) Colgate Sensitive Pro-Relief Desensitizing Paste Product Insert. Colgate Oral Pharmaceuticals, Inc. - A subsidiary of Colgate-Palmolive Company. New York, N.Y. 10022 USA. P10001282. Rev 04/09.

By Laura Duran, RDH

Laura Duran, RDH, graduated in June 2012 from New York City College of Technology (NYCCT), Brooklyn, New York, receiving an associate in applied science in dental hygiene. She also completed two years of dental school in the Dominican Republic. She is currently working towards her BA in Health Service Administration, with her ultimate aspiration of attaining her master's degree in nutrition.

The faculty mentor for this project is Anty Lam, RDH MPH, associate professor, Dental Hygiene Department at NYCCT.
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Title Annotation:strive
Author:Duran, Laura
Publication:Access
Geographic Code:1USA
Date:Sep 1, 2012
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