钙钠磷硅酸和硝酸钾牙膏抗牙本质敏感效果的系统评价和Meta分析

目的 系统评价钙钠磷硅酸（CSPS）与硝酸钾牙膏抗牙本质敏感效果的临床疗效。方法 计算机检索The Cochrane Library（2017年6期）、PubMed、Embase、WanFang Data、CBM和CNKI数据库,查找CSPS与硝酸钾牙膏对牙本质敏感症状疗效的随机对照试验（RCT）,检索时限均为从建库至2017年6月。由2名评价员独立筛选文献、提取资料和评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。 结果 共纳入8个RCT,包括411例患者,其中试验组203例,对照组208例。Meta分析结果显示：试验组2、4、6、8周吹气敏感值优于对照组[SMD=-1.85,95%CI（-2.89,-0.81）,P=0.000 5,I²=93%],[SMD=-1.61,95%CI（-1.96,-1.26）,P<0.000 01,I²=49%], [SMD=-3.79,95%CI（-7.18,-0.40）,P=0.03,I²=98%],[SMD=-2.13,95%CI（-2.69,-1.58）,P<0.000 01]。试验组12周吹气敏感值与对照组差异无统计学意义[SMD=-0.63,95%CI（-1.47,0.20）,P=0.14,I²=71%]。试验组2、4、6、8、12周冷水刺激敏感值优于对照组[SMD=-1.07,95%CI（-1.48,-0.66）,P<0.000 01,I²=69%],[SMD=-1.29,95%CI（-1.81,-0.76）,P<0.000 01,I²=64%],[SMD=-1.20,95%CI（-1.57,-0.83）,P<0.000 01,I²=86%],[SMD=-1.30,95%CI（-2.51,-0.08）,P=0.04,I²=82%],[SMD=-0.79,95%CI（-1.27,-0.31）,P=0.001]。试验组1周冷水刺激敏感值与对照组差异无统计学意义 [SMD=0.00,95%CI（-0.62,0.62）,P=1]。试验组2、4、8周探诊敏感值优于对照组[SMD=-1.31,95%CI（-2.00,-0.62）,P=0.000 2,I²=67%],[SMD=-1.37,95%CI（-1.74,-0.99）,P<0.000 01,I²=23%],[SMD=-1.33,95%CI（-1.82,-0.84）,P<0.000 01]。试验组1周探诊敏感值与对照组差异无统计学意义[SMD=-0.32,95%CI（-0.94,0.31）,P=0.32]。结论 CSPS比硝酸钾牙膏更有效地降低牙本质敏感。受纳入研究的数量和质量限制,上述结论尚需更多高质量、大样本RCT予以验证。     

精氨酸脱敏牙膏治疗牙本质敏感的Meta分析

目的：采用Meta分析方法进行系统评价并比较精氨酸脱敏牙膏与常用脱敏牙膏治疗牙本质敏感的疗效。方法计算机检索万方、PubMed、Web of Science和Cochrane图书馆等数据库,并辅以手工检索,搜集精氨酸脱敏牙膏治疗牙本质敏感的随机对照试验（randomized controlled trial ,RCT）,数据的提取和质量评价由两个评价者独立完成。采用RevMan 5.3软件进行Meta分析。结果共纳入7项RCT,所有的结果通过触压敏感测试及冷空气喷吹检测评估,使用随机效应模型分析各治疗组的均数和标准差。Meta分析结果显示,精氨酸脱敏牙膏与含钾脱敏牙膏的疗效差异有统计学意义（触压评估：SMD=1.83,95％CI[1.07,2.58],P<0.05;冷空气评估：SMD=?1.19,95％CI[?1.69,?0.69],P<0.05）;精氨酸脱敏牙膏与含锶脱敏牙膏的疗效差异无统计学意义（触压评估：SMD=0.68,95％CI[?1.59,2.96],P>0.05;冷空气评估：SMD=?0.94,95％CI[?2.28,0.40],P>0.05）。结论精氨酸脱敏牙膏治疗牙本质敏感的效果优于含钾脱敏牙膏,但与含锶脱敏牙膏无明显差异。     

含5%硝酸钾牙膏抗牙本质敏感的临床研究

目的:评价含5%硝酸钾牙膏减轻牙本质敏感症状的临床效果。方法:根据随机、双盲、平行设计的试验原则,将63名受试者随机分为试验组(含5%硝酸钾牙膏)和对照组(普通牙膏)进行试验,试验周期为4周。采用视觉模拟疼痛评分法(VAS)分别记录基线和4周后受试牙的牙敏感指数。采用SPSS13.0软件包对数据进行非参数检验。结果:使用牙膏4周后,试验组牙本质敏感VAS值显著低于基线(P<0.05)。与对照组相比,试验组使用牙膏前后牙本质敏感VAS记分之差显著高于对照组(P<0.05)。结论:含5%硝酸钾牙膏具有显著的抗牙本质敏感效果,可改善患者的整体舒适度。     

氟化亚锡牙膏对牙本质敏感症脱敏作用的Meta分析

目的 对有关含氟化亚锡牙膏治疗牙本质敏感症的随机对照试验（RCT）进行Meta分析,评价其治疗牙本质敏感症的疗效。方法依照Cochrane系统评价员手册（5.1.0版本）指导进行分析,包含检索策略、纳入排除标准、数据提取及质量评价。通过计算机检索CNKI、CBM、PubMed、Embase数据库和Cochrane Library,查找有关含氟化亚锡牙膏治疗牙本质敏感症的RCT,检索时间截至2015年1月。由2位研究者独立根据纳入与排除标准进行文献筛选、资料提取和质量评价后,采用RevMan 5.3软件进行Meta分析。结果共纳入6个RCT,包括494例患者（试验组247例,对照组247例）。氟化亚锡脱敏牙膏治疗牙本质敏感的Meta分析结果显示,触压探诊敏感测试（SMD=1.41,95%可信区间为0.74~2.09）及冷空气喷吹测试（SMD=-1.16,95%可信区间为-1.84~-0.48）的差异均有统计学意义（P<0.000 01）,氟化亚锡脱敏牙膏治疗牙本质敏感症的效果较好。结论现有证据表明,氟化亚锡脱敏牙膏治疗牙本质敏感症的效果较好;但纳入研究的语种、地区及质量有一定局限性,且样本量较小,仍需更多高质量、大样本的RCT以进一步验证。     

含5.53%柠檬酸钾牙膏抗牙本质敏感的临床研究

目的：评价含5.53%柠檬酸钾牙膏减轻牙本质敏感症状的效果。方法：试验遵照随机、双盲、对照试验原则,将65名受试者随机分成试验组（含5.53%柠檬酸钾牙膏）和对照组（普通含氟牙膏）,两组受试者每天刷牙2次共4周。采用视觉模拟评分法（VAS）记,牙敏感症状。数据采用非参数检验进行统计分析。结果：与基线相比,使用牙膏4周后,试验组牙本质敏感VAS记分显著降低（P〈0.05）。与对照组相比,试验组4周后的牙本质敏感VAS记分明显低于对照组（P〈0.01）。83.9%的受试者认为使用该牙膏能缓解牙本质敏感症状;77.4%的受试者愿意继续使用该牙膏脱敏。结论：含5.53%柠檬酸钾牙膏具有显著的抗牙本质敏感效果。     

硝酸钾——牙周塞治法治疗牙本质敏感症临床效果观察

本文报告应用硝酸钾——牙周塞治法治疗牙根面外露及线状楔损所致的牙本质敏感症127例(286颗牙),总有效率91.3％。通过本组病例分析,表明本法具有方法简单、疗效好、牙不染色、不损伤软组织等优点。本文分析了与疗效有关的因素,并探讨了脱敏机理。     

8％精氨酸牙膏降低牙本质敏感的临床试验

目的 评价含8％精氨酸的抗敏牙膏控制牙本质敏感的效果.方法 采用随机、对照、双盲的研究方法,牙本质敏感的评价采用冷空气喷吹法,在常温下距离牙面1 cm处用气枪吹压缩空气,由受试者确认是否敏感,采用数字化疼痛评判法(visual analogue scale,VAS)记录受试者的敏感程度.按照纳入和排除标准纳入受试者,基线时共纳入受试者88人,按照性别和年龄将受试者分层随机分为试验组和对照组,每组44人.试验组使用含8％精氨酸的抗敏牙膏,对照组使用含5.53％柠檬酸钾的抗敏感牙膏.基线调查后,用棉签将1 cm长的牙膏涂抹于敏感牙表面并按摩1 min,进行敏感检测.受试者使用分派的牙膏和牙刷每天刷牙2次,每次至少1 min,分别在第3天和1周时接受回访.结果 所有受试者均完成了1周的临床试验研究.试验组和对照组受试者基线时的冷空气喷吹敏感VAS值(分别为55.51 ±8.48、56.67±10.22)和自我评价敏感VAS值(分别为43.75±6.65、41.98±8.53)差异均无统计学意义(P＞0.05).局部涂抹牙膏并按摩1 min,刷牙3d和1周后试验组冷空气喷吹敏感VAS值和自我评价敏感VAS值均较基线时显著下降(P＜0.01),对照组虽有下降但差异均无统计学意义(P＞0.05).与基线相比,试验组冷空气喷吹敏感VAS值和自我评价敏感VAS值的减少程度在3个时间点均显著高于对照组(P＜0.05).结论 含8％精氨酸的抗敏牙膏在单次局部涂抹后能即刻缓解牙本质敏感,刷牙1周后可有效缓解牙本质敏感.     

舒适达速效抗敏牙膏治疗牙本质敏感的临床疗效

目的观察舒适达速效抗敏牙膏冶疗牙本质敏感的临床疗效。方法采用随机分组对照试验,以75%氟化钠甘油为对照分别观察治疗组和对照组的即时疗效和半年疗效,并进行统计学分析。结果治疗组的即时疗效与半年疗效总有效率分别为96.27%和90.30%,明显高于对照组的62.28%和42.98%,具有显著性差异(P<0.01)。结论舒适达速效抗敏牙膏治疗牙本质敏感具有良好疗效。     

舒适达牙膏治疗活髓基牙预备后牙本质敏感症的疗效观察

目的：探讨舒适达牙膏治疗活髓基牙预备后牙本质敏感症的疗效。方法：采用自身配对设计将63例患者126颗基牙随机分为舒适达牙膏治疗组和普通牙膏对照组,观察即刻、10d后、3个月后的临床疗效。结果：实验组各阶段的治疗有效率均显著高于对照组（P〈0.05）。结论：舒适达牙膏能有效缓解活髓基牙预备后的牙本质敏感症状。     

The dentine remineralization activity of a desensitizing bioactive glass-containing toothpaste: an in vitro study

Background: Dentine hypersensitivity occurs easily on exposed dentine. This study aimed to evaluate the effectiveness of a novel bioactive glass‐containing toothpaste on dentine permeability and remineralization. Methods: Thirty dentine discs were divided into three groups of 10 specimens each. The groups corresponded to the following brushing treatments: no brush, distilled water, and bioactive glass‐containing toothpaste (Novamin). The toothpaste was applied twice a day for 7 days. Dentine permeability was measured after ethylene‐diamine‐tetraacetic acid (EDTA) etching, initial application, 3‐day application, 7‐day application and citric acid challenge, respectively. The dentine morphology was investigated using scanning electron microscopy (SEM). Attenuated total reflection Fourier transform infrared (ATR/FTIR) spectroscopy was performed to monitor the mineral variation on demineralized dentine. Qualitative information of elemental variation before and after treatments on completely demineralized dentine was detected by energy dispersive X‐ray (EDX) analysis. Results: The bioactive glass‐containing toothpaste significantly reduced dentine permeability after the 7‐day treatment and showed, under SEM, excellent resistance to acid challenge compared to the other groups. ATR/FTIR and EDX revealed increased mineral content after treatment with Novamin. Conclusions: As the innovative bioactive glass‐containing toothpaste occlude dentinal tubules and resist acid challenge, it may be useful for the treatment of dentine hypersensitivity and dentine remineralization.     

低摩擦抗敏牙膏与非抗敏牙膏菌斑清除效率的比较

目的 评价低摩擦抗敏牙膏与非抗敏牙膏在控制菌斑方面的效果。方法 本试验采用双盲、随机对照方法,选取符合纳入标准的50名受试者,每位受试者随机选取左右一侧使用1号牙膏,另一侧使用2号牙膏,后期揭盲1号牙膏为含8%精氨酸的低摩擦抗敏牙膏,2号牙膏为非抗敏牙膏。记录左右侧分别刷牙15 s、30 s、60 s、120 s时的左右半口牙菌斑指数,统计分析使用2种牙膏后的菌斑指数,评价低摩擦抗敏牙膏在控制菌斑方面的效果。结果 在单侧刷牙60 s内非抗敏牙膏菌斑清除效率高于低摩擦抗敏牙膏,但在120 s后两者菌斑清除效率无统计学差异。结论 使用低摩擦抗敏牙膏刷牙超过120 s,可以达到与非抗敏牙膏相同的菌斑清除效果。     

The effect of a new toothpaste containing potassium nitrate and triclosan on gingival health, plaque formation and dentine hypersensitivity

OBJECTIVES: The purpose of this study was to investigate the effect of a new toothpaste containing an antiplaque and antiinflammatory agent (0.3% triclosan), a desensitizing agent (5% potassium nitrate) and an anticaries agent (0.76% sodium monofluorophosphate (SMFP)) on gingival health, plaque formation and dentine hypersensitivity in a 12-week home study. The efficacy of the test toothpaste was compared with that of a control toothpaste containing 5% potassium nitrate and 0.76% SMFP and a benchmark product containing only 0.76% SMFP. MATERIAL AND METHODS: One hundred and two healthy volunteers, who had a minimum of 20 natural permanent teeth with no probing depth >4 mm and at least one sensitive tooth, participated in this study. Following enrollment, the subjects received a dental prophylaxis and instruction in brushing technique. After a 4-week pre-experimental phase, baseline gingival bleeding index (GBI), plaque index (PI) and visual analogue scales (VASs) indicating dentine hypersensitivity levels responding to tactile and air stimuli were assessed. The subjects were then randomly given one of the three toothpastes; test, control, or benchmark toothpaste, and a soft-filamented toothbrush for home use. The GBI, PI and VASs were re-examined at weeks 4 and 12. RESULTS: Overall, the GBI scores were significantly reduced compared with baseline in all groups (p<0.01). However, there was no significant difference in GBI score among the three comparison groups. The PI score decreased in the test group and benchmark group from baseline to the end of study, whereas there was no significant change in the control group. Post hoc comparison indicated that the PI score was not statistically different between the three groups. There was a significant difference between the three treatment groups for sensitivity. For both the tactile and air stimuli, the reductions in VAS sensitivity scores for the test group and the control group were significantly greater compared with the benchmark group. Although the sensitivity score for air stimulus decreased more rapidly from baseline to week 4 in the test group, there was no overall difference between the test group and the control group. CONCLUSIONS: This study demonstrated that the new toothpaste was effective in reducing dentine hypersensitivity. More studies are needed to further determine the potential interaction between triclosan and potassium nitrate in dentifrices.     

Clinical evaluation of diamine silver fluoride/potassium iodide as a dentine desensitizing agent. A pilot study

Background: The aim of the present study was to compare the efficacy of an experimental diamine silver fluoride/potassium iodide product with an oxalic acid‐based preparation in reducing dentine hypersensitivity. Methods: The study was conducted as a double‐blind, randomized clinical trial. A total of 19 subjects with dentine hypersensitivity on both sides of their upper arch were selected. The most sensitive tooth in each quadrant was identified and received a cold stimulus. The response was recorded on a visual analogue scale (VAS). The tooth thus selected was treated with one of the treatment agents. One week later the level of dentine sensitivity was assessed. Participants were also asked for their subjective assessment of treatment effects. Results: The mean difference between VAS at baseline and seven days for teeth treated with diamine silver fluoride/potassium iodide was greater than that for teeth treated with the oxalic acid‐based preparation (p = 0.0134). The subjects’ subjective assessment of changes in dentine hypersensitivity indicated that more obtained relief with the diamine silver fluoride/potassium iodide treatment (p = 0.0129). Conclusions: It was concluded that an experimental diamine silver fluoride/potassium iodide product has potential as a treatment for dentine hypersensitivity.     

In vitro microhardness studies on a new anti-erosion desensitizing toothpaste

OBJECTIVE: To evaluate in vitro the efficacy of a new anti-erosion desensitizing toothpaste to inhibit enamel surface softening by a dietary acid, and promote re-hardening of artificial erosive lesions. METHODOLOGY: The ability of the toothpaste to inhibit formation and promote repair of erosive lesions in human enamel has been investigated. In an enamel surface softening study, sound human enamel was pre-treated with one of four toothpaste slurries for two minutes, before exposure to 1.0% citric acid, pH 3.8, for a total of 30 minutes. The surface microhardness (SMH) of the specimens was determined at baseline and at 10-minute intervals using a Struers Duramin-1 microindentor. In an enamel re-hardening study, the erosive lesions were prepared by exposure of the specimens to 1.0% citric acid, pH 3.8, for 30 minutes. After two minutes treatment with a toothpaste slurry, lesion repair was monitored by SMH after 4, 24, and 48 hours incubation in artificial saliva. This remineralizing phase was modified by the addition of an aliquot of the relevant toothpaste slurry, to mimic in vivo carryover of the formulation. RESULTS: The new test formulation, Elmex Sensitive, and Colgate Sensitive exhibited statistically significant inhibition of citric acid-mediated enamel surface softening versus a fluoride-free placebo at all time points. The test toothpaste gave statistically superior protection against the erosive challenge compared to Elmex Sensitive and Colgate Sensitive after 20- and 30-minute exposures. In the remineralization studies, erosive lesions treated with the test toothpaste exhibited statistically superior re-hardening versus lesions treated with Elmex Sensitive and Colgate Sensitive after 24- and 48-hour incubation in the artificial saliva. Lesions treated with Elmex Sensitive re-hardened to a statistically significant extent versus the fluoride-free placebo toothpaste. A re-hardening study, in which a series of the new toothpaste-base formulations containing increasing concentrations of NaF were evaluated, showed a clear fluoride dose response. CONCLUSION: The present microhardness studies show that treatment with fluoride-containing toothpastes helps protect sound enamel from acid-mediated surface softening, and promotes re-hardening of erosive lesions. The new test toothpaste exhibited statistically superior efficacy to Elmex Sensitive and Colgate Sensitive in both in vitro models.     

Calcium hydroxide and potassium nitrate as desensitizing agents for hypersensitive root surfaces.

The purpose of this investigation was to evaluate calcium hydroxide and potassium nitrate individually as densensitizing agents for hypersensitive root surfaces. The apparatus used in the experiment to measure hypersensitivity was (a) a thermo-electric stimulating device to measure hot and cold stimulation quantitatively and (b) a mechanical stimulating device to measure scratch stimulation quantitatively. The conclusions drawn from the study were: 1. Calcium hydroxide was more consistently effective in decreasing sensitivity then was potassium nitrate or the control. 2. Calcium hydroxide as compared to the control was statistically (99% level of significance) more effective in reducing sensitivity to mechanical, hot and cold stimulation immediately and at the conclusion of the experiment (3 months). 3. It appears that calcium hydroxide could be used as a desensitizing agent initially following periodontal surgery to reduce pain from hypersensitive roots in order that proper oral hygiene could be reestablished.     

Desensitizing efficacy of a new toothpaste containing 5.5% potassium citrate: a 4-week clinical study

PURPOSE: To evaluate the desensitizing capabilities of a new toothpaste containing 5.5% potassium citrate (Colgate Sensitive Multi Protection Toothpaste) to another toothpaste containing 3.75% potassium chloride (Sensodyne Total Care F Toothpaste). METHODS: A 4-week clinical study was conducted in 75 subjects at the University of Rome, at Tor Vergata, in Rome, Italy, using a double blind, stratified, two treatment design. Tactile sensitivity as well as air blast sensitivity assessment was used to compare the efficacy of the two products. RESULTS: There was no statistically significant difference in tactile sensitivity scores and air blast sensitivity scores between the tested toothpastes at baseline, 2 weeks and 4 weeks. Both toothpastes provided statistically significant improvement in tactile sensitivity scores and air blast sensitivity scores after 2 weeks of use and 4 weeks of use as compared to baseline scores.     

Efficacy of a 3% potassium nitrate desensitizing mouthwash in the treatment of dentinal hypersensitivity.

BACKGROUND: Potassium nitrate has been used previously in a dentifrice or gel to alleviate dentinal hypersensitivity. The aim of this study was to compare a 3% potassium nitrate/0.2% sodium fluoride mouthwash with a 0.2% sodium fluoride control mouthwash in a 6-week double-blind study. METHODS: Fifty subjects were evaluated using 2 tactile methods and cold air sensitivity (dental air syringe), along with subjective perception of pain (0 to 10 scale) at baseline and at 2 and 6 weeks. RESULTS: There was a general decrease in dentinal hypersensitivity levels in both groups over the 6-week study period as demonstrated by all 4 methods of assessment. There was also a statistically significant difference in decrease in sensitivity between the groups. CONCLUSIONS: This study showed that a 3% potassium nitrate/0.2% sodium fluoride mouthwash appears to have therapeutic potential to alleviate dentinal hypersensitivity.     

Effects of a potassium nitrate mouthwash on dentinal tubules--a SEM analysis using the dentine disc model

The concept of tubular occlusion as a method of dentine desensitisation is a logical conclusion from the hydrodynamic hypothesis put forth by Brannstr?m. The aim of this study was therefore to investigate qualitatively by SEM whether a 3% potassium nitrate/0.2% sodium fluoride mouthwash occluded tubule orifices, and by x-ray microanalysis, to characterise the nature of the deposits if any, following application. Following the 'dentine disc model' methodology 1mm thick tooth sections from unerupted molars were obtained. These were treated with the test and control mouthwashes and subjected to scanning electron microscopy. If any deposits were seen, they were to be subjected to elemental analysis using the energy dispersive x-ray analyser. Examination of all the dentine disc surfaces, treated by water (control), active and control mouthwashes demonstrated that none of the treatments, at any of the time intervals, had any visible effect on the dentinal tubule orifices i.e. there was no dentinal tubular occlusion seen. The results suggest that potassium nitrate does not reduce dentinal hypersensitivity, at least by tubule occlusion. This could mean that there is a different mechanism of action, which could not be detected by this in vitro model.