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ORIGINAL ARTICLE
Year : 2018  |  Volume : 12  |  Issue : 2  |  Page : 56-62

Diode laser in the treatment of dentinal hypersensitivity: A reliable approach


Department of Periodontology, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India

Date of Web Publication19-Dec-2018

Correspondence Address:
Dr. R Vinaya Kumar
Department of Periodontology, Rajarajeswari Dental College and Hospital, #14, Ramoholli Cross, Kumbalgodu, Mysore Road, Bengaluru - 560 074, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdl.jdl_13_18

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  Abstract 

Aim: The purpose of this prospective clinical study was to compare the clinical efficacy of diode laser and topical 0.4% stannous fluoride (SnF2) gel in the management of dentinal hypersensitivity (DH). Materials and Methods: A total of 8 patients contributing 200 teeth with DH were enrolled in the study. The sensitive teeth were randomly allocated into 4 groups of 50 each: Group I teeth were treated with 0.4% SnF2 only; Group II with 0.4% SnF2 and diode laser irradiation in continuous, noncontact mode; Group III with diode laser only in continuous, noncontact mode; and Group IV with SnF2 and diode laser in continuous, contact mode. Pain/sensitivity was recorded using the visual analog scale before treatment, 10 min after treatment and 7, 15, and 30 days posttherapy.Results: All the groups showed significant reduction in DH. However, the use of both 0.4% SnF2 and diode laser in contact and noncontact mode showed statistically significant reduction in sensitivity (P < 0.001) when compared to SnF2 gel and diode laser alone. Conclusion: The adjunctive use of diode laser with SnF2 appears to be a promising treatment alternative in alleviating sensitivity.

Keywords: Dentinal hypersensitivity, diode laser, stannous fluoride gel, visual analog scale


How to cite this article:
Bilichodmath R, Kumar R V, Bilichodmath S, Sameera U. Diode laser in the treatment of dentinal hypersensitivity: A reliable approach. J Dent Lasers 2018;12:56-62

How to cite this URL:
Bilichodmath R, Kumar R V, Bilichodmath S, Sameera U. Diode laser in the treatment of dentinal hypersensitivity: A reliable approach. J Dent Lasers [serial online] 2018 [cited 2019 May 26];12:56-62. Available from: http://www.jdentlasers.org/text.asp?2018/12/2/56/248000


  Introduction Top


Dentinal hypersensitivity (DH) is one of the most common problems encountered in dental practice, which causes pain and discomfort to individuals.[1] It is characterized by short, sharp pain arising from exposed dentin in response to stimuli; typically, thermal, evaporative, tactile, osmotic, or chemical and which cannot be attributed to any other dental defect or pathology.[2] Hypersensitive dentin is a sensitive or painful response of exposed dentin to an irritant. It is one of the most painful, common, and least satisfactorily treated chronic problems of teeth. It is a symptom complex rather than a disease and a persisting problem that affects about 4%–57% of the population. This condition is most prevalent in a large portion of individuals aged 20–40 years with higher prevalence in females than males and ranging between 60% and 98% in patients with periodontal disease.[3],[4]

DH is the most widespread oral problem with the cervical area of teeth being the most common site of involvement. Studies have reported that premolars[1] and mandibular incisors were most commonly affected and facial surfaces of teeth were the most hypersensitive areas.[5] The common factors responsible for dentin hypersensitivity are abrasion, abfraction, erosion, parafunctional habits or occlusal disequilibrium, and cavity preparations that expose the dentin.[6] It is often a major problem for patients suffering with periodontitis who often have exposed root surfaces and gingival recession. One practical issue related to DH is its evaluation since pain being a highly subjective sensation. Through literature, it is known that there is no single therapy that can reduce pain to satisfactory levels. Desensitizing agents and lasers have been widely used for the treatment of DH. An ideal desensitizing agent should not irritate the pulp, should be relatively painless on application, easy to use, rapid in action, effective for a longer duration, and not discolor the tooth.[7] At present, no tried and tested regimens prove superior to others and there is no “gold standard” by which one can assess treatment results. Thus, combination of different protocols has been tried and tested to achieve the best therapeutic benefit.[8]

Conventional therapies for DH are based on the topical use of desensitizing agents either at home or professionally.[9] The most commonly used agents are protein precipitants such as formaldehyde and silver nitrate; tubule occluding agents such as sodium fluoride, stannous fluoride (SnF2), calcium hydroxide, and potassium nitrate; tubule sealants such as resins and adhesives; and lasers. One of the most commonly used tubules occluding agent is SnF2. Its mechanism is based on the mechanical occlusion that is achieved by precipitation of insoluble calcium fluoride crystals within the tubules without any adhesion.[10] Advances in the field of laser technology over the last few decades and its wide applications in dentistry have given an additional therapeutic option for the treatment of DH. Different types of low output (Diode, He-Ne) and middle output (Nd:YAG, CO2) lasers have been used for hypersensitivity reduction.[11],[12],[13] Low-level lasers have also shown anti-inflammatory effects.[14] Diode lasers are the most widely used lasers in the treatment of DH. Different wavelengths have been used in various studies and have shown the best results in several clinical trials even in severe cases of DH.[15],[16],[17]

A combination of laser irradiation with application of specific desensitizing agents for the management of DH could be an additional therapeutic option with a specific goal of achieving a cumulative beneficial effect from both the treatments. Various clinical trials have been conducted with a combination of different types of lasers with chemical agents such as SnF2 and sodium fluoride with beneficial results and effectiveness more than the treatment with laser alone.[18],[19]

The aim of this prospective clinical study was to evaluate and compare the clinical efficacy of diode laser alone and in combination with topical 0.4% SnF2 gel in the management of DH.


  Materials and Methods Top


This single-center, prospective clinical study was carried out in the Department of Periodontics, Rajarajeswari Dental College and Hospital, Bangalore. The patients recruited for this study were selected from the outpatient department. Eight systemically healthy patients, previously untreated for DH, (5 males and 3 females) aged between 35 and 60 years (mean age: 48 years) with a chief complaint of DH, contributing 200 teeth were enrolled for the study. Written informed consent was obtained from patients who were willing to participate voluntarily. This randomized controlled trial with split-mouth design was carried out from April 2016 to September 2016 with a follow-up period of 1 month.

Inclusion criteria

Patients in good systemic health with clinically elicitable dentin hypersensitivity who were reliable in their response to test measurements and who were not treated earlier for DH were included in the study.

Exclusion criteria

Patients with any systemic conditions, those who were on any analgesics/anti-inflammatory drugs at the time of the study and those who had used any desensitizing paste or mouthwash during the last 6 months, were excluded from the study. Cracked teeth, large carious lesions, or restored teeth were also excluded from the study.

The 200 sites from 8 patients enrolled were randomly divided into four groups of 50 sites each. Before treatment, all the patients received phase I periodontal therapy in the form of scaling and root planing followed by oral hygiene instructions. The degree of sensitivity to evaporative stimulus before and after treatment was determined qualitatively with an air stimulus. To check the cold air stimulus, the selected tooth was isolated, dried, and a jet of cold air was applied from a distance of 1 cm for 1 s and response to air stimuli was recorded according to the visual analog scale (VAS) [Figure 1]. Air stimulus recordings were assessed before treatment, 15 min after treatment, 1 week, 2 weeks, and at 30 days after treatment.
Figure 1: Cold air blast test

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Treatment procedures

Group 1: 0.4% stannous fluoride gel only

Selected teeth were isolated with cotton rolls and 0.4% SnF2 gel (Gel-Kam, Colgate- Palmolive India Ltd.) was applied with a cotton tip applicator onto the affected area and left in place for 1 min. The teeth were evaluated 15 min after the treatment and VAS score recorded.

Group 2: 0.4% stannous fluoride+ diode laser (noncontact mode)

Selected teeth were isolated with cotton rolls and 0.4% SnF2 gel (Gel-Kam) was applied and left in place for 1 min [Figure 2]. Diode laser (Zolar Technology and Mfg., Canada) having a wavelength of 810 nm was irradiated in noncontact, continuous mode with a power of 0.7 W for 1 min on the selected sites [Figure 3]. Each site received three applications of 1 min each and VAS score recorded.
Figure 2: Irradiation with diode laser

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Figure 3: Diode laser therapy to treat dentinal hypersensitivity

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Group 3: Laser only

After isolating the sites with cotton rolls, diode laser was irradiated in noncontact, continuous mode with a power of 0.7 W for 1 min was applied. Each site received three applications of 1 min each and VAS score recorded.

Group 4: 0.4% stannous fluoride+ diode laser (contact mode)

After isolating the sites with cotton rolls, 0.4% SnF2 gel (Gel-Kam) was applied and left in place for 1 min. Diode laser was irradiated in contact, continuous mode with a power of 0.7 W for 1 min was applied. Each site received three applications of 1 min each and VAS score recorded.

Recall visits

Patients were recalled after 1 and 2 weeks and 1 month. At each visit, the above-mentioned procedure was repeated and VAS score was recorded. Oral hygiene instructions were reinforced at each visit. However, no oral prophylaxis was performed at any of the recall visits until the end of evaluation phase. Subjective signs such as allergic reaction, burning sensation, ulceration, and taste alterations along with objective signs such as redness of mucosa and staining of teeth were checked with none being reported.

Statistical analysis

The statistical analysis was carried out using one-way analysis of variance test. Data were entered in Microsoft Excel and analyzed using statistical package for social science (SPSS) version 10.5 software (IBM, California, USA) Tukey test was used for pair-wise comparison between the group/visit. The results were averaged (mean ± standard deviation) for continuous data. P < 0.05 was considered as statistically significant.


  Results Top


Among all the 4 groups evaluated, statistically significant difference in the baseline VAS scores was noted between Group 1 and Group 3, Group 2 and Group 3, and Group 3 and Group 4. Moreover, all the groups showed a significant difference at all the time intervals when the relevant test agent was applied (P < 0.001) [Table 1] and [Graph 1].
Table 1: Comparison of mean difference of hypersensitivity between the visit by treatment group actual value

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Among all the 4 groups evaluated, Group 2 and Group 4 showed the greatest reduction in VAS scores when compared to baseline at the 1-month recall (Group 2 = 8.10 and Group 4 = 7.54). Group 3 showed a greater reduction in the mean VAS score (6.38) when compared to Group 1 (4.16) at 1-month recall [Table 2] and [Graph 2].
Table 2: Comparison of mean hypersensitivity between the treatment groups by visit actual value

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Similarly, when the percentage change from baseline to 1 month was assessed in all the groups, Group 2 showed the greatest reduction (90.61%) followed by Group 4 (83.89%), Group 3 (78.57%), and finally, Group 1 (47.96%) [Table 3] and [Graph 3].
Table 3: Comparison of mean hypersensitivity between the treatment groups by visit-percentage change from baseline

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  Discussion Top


DH is experienced as a sharp pain caused by several different stimuli and generally reported by the patient as a chief complaint. This painful response varies significantly from one person to the other. It generally involves the facial surfaces of teeth near the cervical region and is very common in premolars, canines, and mandibular incisors and a slightly higher incidence in females than males between the age group of 20 and 40 years, which could be due to overall health-care and oral hygiene awareness.[20],[21] Brannstrom's hydrodynamic theory is the most widely accepted theory as to how the fluid movement within the dentinal tubules causes pain.[22] A variety of diagnostic techniques will exclude the condition from other conditions causing sensitive teeth. Cost effective and efficacious treatment for most of the patients is a dentifrice containing a desensitizing active ingredient such as SnF2 or potassium nitrate.

SnF2 gel (Gel-Kam) has proven to be effective in the dental caries prevention, plaque formation reduction, and breath malodor suppression[23] Standard error of mean studies have shown that SnF2 itself can occlude dentinal tubules and is effective in the management of DH.[24] Miller et al. reported that a tin-rich surface deposit forms in vitro and in situ with 2-week use of anhydrous 0.4% SnF2 gel, providing near-complete surface coverage and occlusion of the tubules. When the tubules are blocked, stimulation of pain receptors does not occur, thereby preventing the pain response.[24]

Thrash et al. supported the theory that the time required for a decrease in sensitivity is between 2 and 4 weeks from initiation of treatment. They compared 0.4% SnF2 gel to an aqueous 0.717% fluoride solution and a placebo at 2-, 4-, 8-, and 16-week intervals following a twice-daily application. The results indicated participants who applied 0.4% SnF2 reported significantly less sensitivity during the 4–8 week period. The effect continued throughout the 16-week assessment period.[25]

Matsumoto et al. and Yamaguchi et al. have reported decrease in hypersensitivity by 85% and 60%, respectively, in teeth treated with laser.[14],[15] Gerschman et al., in a double-blind study, found significant reduction of sensitivity to thermal and tactile stimuli by 67% and 65%, respectively.[16] Umberto et al. reported a very high capability to improve immediately the DH-related pain, both alone and even better in combination with sodium fluoride gel.[26] Ranjan et al. obtained better results with combined intervention of laser and SnF2 gel therapy in the management of DH. The laser-induced superficial melting permitting longer tubular occlusion by SnF2 gel emphasizes the reduction of DH-related pain.[27] Kumar and Mehta reported that the combination of Nd:YAG laser and 5% sodium fluoride varnish seems to show an impressive efficacy when compared to each treatment alone.[17]

The added advantages of combining dental laser with SnF2 has been reported by Moritz et al. suggesting that combined laser treatment and fluoridation result in permanent integration of fluoride in the dentin surface.[28] Brugnera et al. showed the immediate analgesic effect using a diode laser.[29] The diode laser appears to be the most widely used in day-to-day practice by dental professionals.

In this conducted research, it was observed that teeth which presented exacerbated sharp pain during the cold air blast showed a decrease in painful sensation immediately after 15 min of the first application of the diode laser. Results of our study are similar to findings by Miller et al. in 1969, who reported less hypersensitivity posttreatment in SnF2 group as compared to placebo gel and have shown that addition of fluoride with laser had significant reduction of DH.[30] Inter-visit comparison shows greatest change in VAS scores from baseline to 15 min after laser application in all the groups. Further, reduction in VAS score was statistically significant (P < 0.001) in all the groups at all the time intervals. This result might be due to the synergistic effect of fluoride when used along with the diode laser application.


  Conclusion Top


The diode laser has to be preferred for DH treatment owing to its safety and beneficial clinical results. Within the scope of this study, we conclude that the combined use of SnF2 and diode laser appears to be a promising treatment alternative in alleviating sensitivity when compared to the traditional treatment modalities.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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  [Full text]  
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    Tables

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