The prevalence of dentine hypersensitivity in the general population in China

Summary Dentine hypersensitivity (DH) is a common condition that is frequently encountered in dental practice. The aim of this multi‐centre and cross‐sectional study was to establish the prevalence of DH in the general population in China. A total of 6843 subjects were questioned and examined using a triple syringe with a blast of cold air to confirm the diagnosis of DH. The sensitive surface, loss of attachment and gingival recession of sensitive teeth were measured and recorded. Of the 2932 subjects reporting hypersensitive symptoms, 2363 subjects were further diagnosed as DH, giving an overall prevalence of 34·5%. The greatest number of subjects with DH were within the 50–59 years age group (P < 0·01). The most commonly affected teeth were the premolars and the most provoking factor was the presence of a cold stimulus. The prevalence of DH in a representative sample of the general population in China was 34·5%, indicating that DH is a common oral problem. Therefore, the recognition of the condition and subsequent treatment by the dentist is therefore essential if the condition is to be managed correctly.     

Association of gingival recession and other factors with the presence of dentin hypersensitivity

Dentin hypersensitivity (DH) may be present in association with gingival recession. The aim of this study was to determine quantitatively the association of gingival recession and other factors with the presence of DH. One hundred and four Japanese subjects with or without gingival recession were randomly selected. Intact canines and/or first premolars in both maxillary and mandibular quadrants were analyzed. Gingival recession was measured as a vertical length at the buccal site of the teeth. DH was recorded as an ordered categorical variable registering four increasing levels of pain after cold stimulation; from no discomfort to severe pain during and after stimulation (DH1, 2, 3, and 4). Association of DH with periodontal parameters and daily lifestyle was also investigated. Tooth-based analysis of 446 teeth from 104 subjects revealed that DH level was significantly higher in recessive teeth (1, 2, 3, and 4–8 mm) than in non-recessive teeth (0 mm). DH-positive rate in non-recessive teeth was only 18 % (DH1; 14 %, DH2; 3 %, and DH3; 1 %). Highest DH level was observed in teeth with severe recession (4–8 mm), showing DH0; 21 %, DH1; 33 %, DH2; 31 %, and DH3; 15 %. Recession-dependent increase in DH was observed, showing 18, 49, 52, 60, and 79 % DH-positive in teeth with 0, 1, 2, 3, and 4–8 mm recession, respectively. Plaque-free teeth showed a higher DH level than plaque-stained teeth, suggesting that good plaque control may be associated with the presence of DH. There were no significant differences in DH of teeth on the basis of smoking, probing depth, and bleeding on probing. Multiple logistic regression analysis revealed that gingival recession [odds ratio (OR) = 10.2, 95 % confidence interval (CI) = 5.5–18.9] and plaque deposition (OR = 0.3, 95 % CI = 0.2–0.5) were significant contributors to DH. Multilevel modeling analysis revealed that not only gingival recession and plaque deposition but also V-shaped cervical notch and tooth brushing frequency were associated with DH. These results demonstrate that the progression of gingival recession, plaque-free teeth, V-shaped cervical notch, and frequent brushing may be significant predictors of DH in canines and first premolars.     

A randomised clinical trial on the efficacy of 5% fluorocalcium phosphosilicate‐containing novel bioactive glass toothpaste

Dentine hypersensitivity (DH) is a common and harrowing dental condition. A novel BioMin‐F technology that contains 5% fluorocalcium phosphosilicate bioactive glass has been introduced. It forms fluorapatite, which is more stable towards acid erosion. There is a lack of literature with the utility of this toothpaste in treating DH. Therefore, the authors of this randomised clinical trial have aimed to compare and evaluate the efficacy of 5% fluorocalcium phosphosilicate with an 8% arginine and calcium carbonate and placebo toothpaste. A total of 75 patients clinically diagnosed with DH were randomly divided into three groups: Group A, 5% fluorocalcium phosphosilicate; Group B, 8% arginine and calcium carbonate; and Group C, placebo. The DH was evaluated by tactile and evaporative stimuli, and a visual analogue scale (VAS) was used for evaporative stimuli at pre‐baseline, baseline (15 days) and post‐baseline (1 month). The results showed symptoms of DH were reduced in all three groups. However, Group A showed a better reduction of DH than the other two groups. The toothpaste containing 5% fluorocalcium phosphosilicate was reported to be more efficacious than the other two toothpastes in managing DH. This novel development opens up a unique opportunity in the prevention and management of DH and may also be beneficial in preventing acid erosion of the tooth surface and in the maintenance of oral hygiene by reducing the effects of plaque accumulation and gingival inflammation.     

A cross‐sectional study of dentine hypersensitivity in China

Objective : To carry out a cross‐sectional study of the prevalence of dentine hypersensitivity and related risk factors in Chengdu City, China. Methods : A total of 1,320 subjects were distributed equally in six communities in Chengdu City and of all age groups (10 years for an age group) including the same number of male and female subjects in each community. Each subject completed a structured interview and the subjects who reported hypersensitivity were examined further using a triple syringe to administer a blast of cold air to confirm the diagnosis of dentine hypersensitivity. Periodontal attachment loss and gingival recession of all sensitive teeth were measured. Results : The prevalence of dentine hypersensitivity was 25.5% in the oral test. Only 16.6% of subjects who reported hypersensitivity symptoms had received desensitising treatment. 50–59 year age group was the cohort with the greatest number of subjects with DH and the premolar was the most commonly affected tooth. Low education level, gingival recession, and attachment loss were related to dentine hypersensitivity. Conclusions : The prevalence of dentine hypersensitivity in an urban adult population in Chengdu City was 25.5%.     

Cervical wear and occlusal wear from a periodontal perspective

Summary The aim of this study was to investigate whether cervical wear was associated with occlusal wear and clinical periodontal parameters in relatively older adults. A total of 30 patients, with multiple non‐carious cervical lesions (NCCLs) and without a disease or condition that could cause heavy tooth wear, were included in the study. The periodontal parameters including plaque index, probing pocket depth, gingival recession (GR) and tooth mobility were obtained from 641 teeth of which 475 (74·1%) displayed NCCLs. The levels of cervical wear and occlusal wear were determined according to a tooth wear index. Premolars were more likely to develop cervical wear than canines, molars and incisors. Cervical wear was significantly associated with less plaque accumulation and the presence of shallow pockets. The teeth with advanced GR and without increased mobility were 2·583 and 1·715 times more likely to develop deeper cervical lesions, respectively. Age and the level of occlusal wear were not linked to the bucco‐lingual depth of cervical wear. In conclusion, the significant association of advanced cervical wear with the relatively healthy periodontal status suggested the role of abrasion and its possible combined action with erosion in the aetiology of NCCLs. The rate of GR and the lack of tooth mobility could constitute predisposing factors for the progression of cervical wear because the exposed root surfaces could be more susceptible to abrasion and/or erosion, and the non‐mobile teeth resisting strongly against frictional forces, thus abrasive effects, could possibly develop cervical wear.     

Tooth brushing,tooth wear and dentine hypersensitivity — are they associated?

Evidence suggests that patients suffer the painful symptoms of dentine hypersensitivity when dentine is exposed and the dentinal tubule system is opened to the oral cavity to allow stimuli to trigger a neural response in the pulp via a hydrodynamic mechanism. The processes needed to localise lesions of dentine hypersensitivity include loss of enamel and/or gingival recession. Whilst tooth brushing with or without toothpaste appears to cause minimal wear to enamel (in the absence of acids), circumstantial evidence implicates tooth brushing with gingival recession and exposure of dentine. Other tooth wear processes notably attrition and acid erosion cause loss of enamel and can expose dentine. Therefore sensitivity may result. How lesions of dentine hypersensitivity are initiated is a matter of conjecture and based on extrapolating data from studies, mainly in vitro, to affect in vivo. Again this circumstantial type of evidence suggests that abrasion by some toothpastes and erosion by dietary acid could open the tubule system. Little is known about the actual effect of desensitising toothpastes on lesions of dentine hypersensitivity even though they are formulated to either occlude dentinal tubules or block the neural response in the pulp. Clinical studies have produced contradictory findings for the efficacy of products and there have been extremely few evidence based reviews. In conclusion, available evidence supports a probable link of tooth brushing, with or without toothpaste and an acidic diet to both tooth wear and dentine hypersensitivity, and suggests also that dentine hypersensitivity is a tooth wear phenomenon. Although there is a need for more direct clinical and scientific evidence for these associations, it is recommended that they be taken into consideration when planning management strategies for the dentine hypersensitivity sufferer.     

Clinical and scanning electron microscopy evaluation of the Er,Cr:YSGG laser therapy for treating dentine hypersensitivity: short‐term,randomised, controlled study

Er,Cr:YSGG laser is a rising treatment option for dentine hypersensitivity (DH). However, there is no data available concerning the scanning electron microscope (SEM) evaluation of the clinical application of Er,Cr:YSGG laser in the treatment of DH. The aim of this study was to evaluate and compare the desensitising and tubule occlusion effects of Er,Cr:YSGG laser with different power settings. Twenty patients (60 teeth) participated in this study. For each patient, teeth were randomised to 3 groups. In groups 1 and 2, patients were treated with Er,Cr:YSGG laser at 0·25 and 0·5 W, respectively. In control group, same laser was applied without laser emission. DH was assessed for all groups with a visual analogue scale (VAS). When compared with the baseline data and control group, in both active treatment groups laser irradiation provided a desensitising effect immediately after treatment (P < 0·001). In group 2, VAS scores were significantly lower than group 1. The tubule diameters in the both laser groups were significantly smaller than the control group (P < 0·01). When group 1 compared with group 2, group 2 showed significantly smaller tubule diameters (P < 0·001). Both 0·25 and 0·5 W laser irradiation were effective for the treatment of DH; however, 0·5 W laser irradiation showed best results for the decrease in VAS scores. The SEM findings of the reduction in number/patency of dentine tubules seem to be related to the clinical findings, which were associated with improvement in treatment efficacy.     

Clinical features and factors associated with non‐carious cervical lesions and dentin hypersensitivity

Determining the factors associated with NCCLs and DH in populations could guide the implementation of specific preventive measures. This study evaluated the clinical features and factors associated with non‐carious cervical lesions (NCCLs) and dentin hypersensitivity (DH) in a Brazilian population. The participants were 118 patients at the Dentistry Clinic of our dental school. They completed an interview to obtain personal information and determine the possible factors associated with NCCLs and DH. Clinical examination was undertaken to record the NCCLs, shape of the lesion and certain occlusal factors. DH was diagnosed by air and probe tests. Data were analysed with the multilevel Poisson regression and prevalence ratios, and the respective 95% confidence intervals were calculated. The prevalence of NCCLs and DH among patients was 67·8% and 51·7%, respectively. Of a total number of 2902 teeth examined, 9·65% had NCCLs and 5·82% were sensitive to air. The most affected teeth for both conditions were the premolars. Most of the NCCLs were wedge‐shaped and located in the maxilla. The factors associated with NCCLs and DH were age and presence of premature occlusal contacts. NCCLs were also significantly associated with consumption of wine and alcoholic beverages, and DH with consumption of acidic fruits and juices. NCCLs were a common finding, with higher frequency in more advanced age groups, the maxilla and premolars. A significant association occurred between NCCLs, premature contacts and consumption of wine and alcoholic beverages. DH was associated with NCCLs, premature contacts and with the consumption of acidic fruits and juices.     

Treatment of dentin hypersensitivity with a low‐level laser‐emitting toothbrush: double‐blind randomised clinical trial of efficacy and safety

Dentin hypersensitivity (DH) is defined as pain derived from exposed dentin in response to chemical, thermal, tactile, or osmotic stimuli that cannot be explained as having arisen from any other dental defect or disease. The aim of this trial was to test the efficacy and the safety of a low‐level laser‐emitting toothbrush on management of DH. A prospective, double blind, randomised clinical trial was designed; 96 individuals with hypersensitive teeth without caries or fracture were selected as subjects. The subjects were randomly allocated to either the test group with the 635 nm per 6 mW laser‐emitting toothbrush, or the control group with the 635 nm per 12·9 μW light‐emitting diode (LED) toothbrush. An air blast was applied with a dental air syringe held 3 mm away from the selected tooth and a visual analogue scale (VAS: 0–10) was used to quantify subjective pain. Assessments were completed at a screening visit and after 2‐week and 4‐week of using a test/control toothbrush. Results demonstrated that the use of both control and test toothbrushes resulted in decreased discomfort after 4 weeks. In the test group, pain intensity scores decreased from 5·8 ± 1·2 to 2·3 ± 1·6, and in the control group, the scores decreased from 6·4 ± 1·3 to 5·5 ± 2·0 (P < 0·05). This decrease was significantly greater in the test group. There were no significant adverse events or side effects. It was concluded that the use of the low‐level laser emitting toothbrush is a safe and effective treatment option for the management of DH.     

A cross‐sectional study: non‐carious cervical lesions,cervical dentine hypersensitivity and related risk factors

The present survey aims to study the prevalence and clinical characteristics of non‐carious cervical lesions (NCCLs) and cervical dentine hypersensitivity (CDH), as well as their possible risk factors in a general population in China. A total of 1023 subjects were included in the present study. Each subject completed a structured interview, and all teeth of each subject were examined by a practitioner to determine NCCLs and CDH. Teeth with NCCLs and CDH were diagnosed according to the tooth wear index and by a blast of air from a triple syringe, respectively. Binary logistic regression was completed by analysing the association of risk factors with the occurrence of NCCLs and CDH. Loss of attachment (LOA) and gingival recession (GR) of teeth with NCCLs and/or CDH were measured using Williams periodontal probe. The diagnoses of NCCLs and CDH established following a clinical assessment yielded an overall prevalence of 61·7% and 27·1%, respectively. The 60–69 age group had the greatest proportion of subjects with NCCLs or CDH. The pre‐molars were the most commonly affected teeth type with NCCLs or CDH. The proportion of teeth with CDH associated with NCCLs increased significantly with age, but the proportion of teeth with CDH only associated with LOA or GR decreased slowly with age. The single variables and interactive effects of variables associated with the occurrence of NCCLs include the following: age group, occupation type, method of toothbrushing, frequency and method of toothbrushing, and method of toothbrushing and duration of a toothbrush used. Gender, age group, occupation type and frequency of toothbrushing were associated with the occurrence of CDH. The current study presented higher prevalence of NCCLs and CDH in a general Chinese population. Both diseases were closely associated with age and periodontal status. The portion of the population with NCCLs or CDH had different risk factors.     

Long‐term tooth loss in periodontally compromised but treated patients according to the type of prosthodontic treatment. A retrospective study

If prosthodontic treatment is considered after periodontal therapy, the questions arise i) does prosthodontic treatment affect the treatment outcome of the dentition in general and ii) which type of prosthesis is related to best treatment outcome of abutment teeth? Our goal was to compare long‐term tooth loss after comprehensive periodontal therapy in patients with or without prosthodontic treatment. Ninety patients' charts with a total of 1937 teeth who had received comprehensive periodontal treatment 5–17 years ago by the same periodontist were retrospectively evaluated. Sixty‐five patients received fixed dental prostheses (FDP; n = 29) and/or removable partial dentures anchored with clips (RPDC; n = 25) or double crowns (RPDD; n = 25). Twenty‐five patients were also periodontally compromised but treated without prosthodontic treatment and served as a control group. A total of 317 teeth and 70 abutment teeth were lost during 9·7 ± 4·1 years of observation. Thereof, 273 teeth and 48 abutment teeth were lost due to periodontal reasons. Mean tooth loss amounted to 1·2 ± 1·5 (controls) and 4·4 ± 3·4 (partial dentures). Abutment tooth loss was 0·4 ± 1·1 (FDP), 1·0 ± 1·2 (RPDC) and 1·3 ± 1·0 (RPDD). Poisson regressions identified prosthodontic treatment, age, socio‐economic status, diabetes mellitus, mean initial bone loss and aggressive periodontitis as factors significantly contributing to tooth loss. Age, diabetes and non‐compliance contributed to abutment tooth loss. Not considering biomechanical factors, patients with prosthodontic reconstructions under long‐term supportive periodontal therapy were at higher risk for further tooth loss than patients without prostheses. Not only the type of partial denture but also the patient‐related risk factors were associated with abutment tooth loss.     

Prevalence of tooth erosion and associated factors in 11‐14‐year‐old Brazilian schoolchildren

Objective: Prevalence data about tooth erosion has attracted increasing attention in the dental community; however, population‐based studies that assessed the impact of demographic, socioeconomic, and dietetic predictors on tooth erosion are scarce. This investigation assessed the prevalence of this condition of a sample of 11‐14‐year‐old schoolchildren and the etiological factors. Method: A cross‐sectional study in a multistage random sample of 944, 11‐14‐year‐old Brazilian schoolchildren was conducted in Santa Maria, Brazil. We recorded the prevalence and severity of tooth erosion, dental caries, and dental enamel hypoplasia. Socioeconomic and habits/dietetic data were collected by a structured questionnaire. Data were analyzed using Poisson regression model taking into account the cluster sample. Results: Prevalence of tooth erosion was low (7.2%). The most affected teeth were the maxillary incisors. Labial surfaces were more often affected than palatal ones. All the erosive lesions observed were confined to the enamel. Older children [prevalence ratio (PR) = 1.71; 95% confidence interval (CI): 1.06‐2.76] with dental enamel hypoplasia (PR = 1.98; 95% CI: 1.21‐3.22) were more likely to have tooth erosion. No significant association was observed between tooth erosion, dental caries, habits and dietary patterns, and socioeconomic factors. Conclusion: The data suggest that tooth erosion was associated with age and presence of hypoplasia. It may indicate the need of strategies to diagnose in early stages and to minimize consequences.     

Gingival recession associated with predisposing factors in young vietnamese: a pilot study

Aims: Several studies have shown a large diversity in the prevalence, extent and severity of gingival recession as well as controversial conclusions of its associated factors. Therefore, the aim of this pilot study was to evaluate gingival recession with predisposing factors in young Vietnamese. Methods: A cross-sectional study using clinical examination was performed in 120 dental students. Oral hygiene status, tooth malposition and fraenal attachment were recorded. The width of keratinised gingiva was measured after mucosa staining with Lugola??s iodine solution. Measurements of gingival recession were performed on labial tooth surfaces. Chisquare test, t-test and Pearsona??s correlation were used for data analysis. Results: The prevalence of gingival recession was 72.5% of the studied population. The extent of affected teeth was 11.1% of the examined teeth. The proportion of root-surface exposure was statistically higher (P<0.05) in the maxilla (12.5%) than in the mandible (9.6%). Premolars and right canines were the teeth most frequently and most seriously associated with gingival recession, respectively. There was a strong negative correlation between narrow width of keratinised gingiva and gingival recession (P<0.001). The recession was statistically associated with tooth malposition (P<0.001) but it was not related to high fraenal attachment and gender. Conclusions: A high prevalence of gingival recession was found in Vietnamese dental students. Gingival recession was associated with narrow width of keratinised gingiva, tooth malposition and maxillary teeth. Further studies performed in larger populations with more extended age groups are needed to confirm these findings.     

Comparison of prognosis of separated and non‐separated tooth autotransplantation

The aim of this study was to compare the prognosis of separated and non‐separated tooth autotransplantation of the upper first and second molars with complete root formation undertaken at dental clinics. The participating dentists were requested to provide information on transplantations they had undertaken from 1 January 1990 to 31 December 2010. Data on a total of 708 teeth from 637 patients were collected. This study analysed 35 separated teeth and 22 non‐separated teeth of 47 participants ranging from 27 to 76 years of age (mean age: 55·0 years) after data screening and elimination. The cumulative post‐transplantation survival rate at 10 years was 77·1% for separated teeth and 63·6% for non‐separated teeth as calculated with the Kaplan–Meier method. There were no significant differences between separated teeth and non‐separated teeth in a log rank test (P = 0·687). Separated‐tooth autotransplantation can help fill narrow recipient sites and increase occlusal supporting zones, but the clinical success rate was only 48·6%. Although transplantation of teeth with complete root formation has limited prognosis, transplantation of upper first and second molars, whether separated or non‐separated, is a viable option to replace missing teeth.     

Prevalence and Risk Indicators of Dentin Hypersensitivity in Adult and Elderly Populations From Porto Alegre,Brazil

Background: Dentin hypersensitivity (DH) is a clinical condition with potential implications for patients. However, little is known about its occurrence and determinants in the general population. The aim of this study is to assess the prevalence and risk indicators of DH in Porto Alegre, Brazil. Methods: A representative multistage probability sample of 1,023 adults aged ≥35 years was obtained. Individuals were interviewed and clinically examined in their homes. DH was assessed dichotomously in all present teeth by a blast of air and a manual probe. Teeth restored with crowns and presenting with carious cavitation were excluded. Survey logistic regression using sampling weights was applied to assess demographics and behavioral and clinical determinants. Results: Overall prevalence estimates for DH diagnosed by air and probe were 33.4% and 34.2%. DH affected ≈1 tooth per individual, and approximately 10% of teeth with gingival recession (GR) had DH. In a multivariable model for DH diagnosed with air, females had increased chance of DH (odds ratio [OR] = 2.14; 95% confidence interval [CI] = 1.57 to 2.91). Smoking, periodontal treatment, and GR were also associated with increased DH risk. The chance of DH was lower (OR = 0.47, 95% CI = 0.29 to 0.76) among individuals ≥60 than among those aged 35 to 49 years. Oral hygiene practices, socioeconomic and education status, dental visits, and gingival inflammation were not associated with DH. Conclusions: DH may be considered a concern in a Brazilian general population. Reduction of DH may be achieved by smoking cessation and periodontal health improvements.     

Risk factors affecting third molar autotransplantation in males: a retrospective survey in dental clinics

Summary The aim of this study was to investigate the risk factors affecting long‐term prognosis of autotransplantation of third molars with complete root formation in males at dental clinics. Participating dentists were requested to provide information on transplantations they had undertaken from 1 January 1990 to 31 December 2010. Data on a total of 708 teeth from 637 patients were collected. After data screening and elimination, participants of this study consisted of 183 teeth of 171 males ranging from 20 to 72 years of age (mean age, 44·8 years). The cumulative survival rate was 86·0% at the 5‐year mark, 59·1% at 10 years and 28·0% at 15 years. The mean survival time was 134·5 months, as calculated by the Kaplan–Meier method. Single factor analysis using the log‐rank test showed that the following factors had significant influence (P < 0·05) on survival of transplanted teeth: periodontal disease as the reason for recipient site tooth extraction, fewer than 25 present teeth and Eichner index Groups B1 to C. Cox regression analysis examined five factors: age, smoking habit, recipient site extraction caused by periodontal disease, fewer than 25 present teeth and Eichner index. This analysis showed that two of these factors were significant: fewer than 25 present teeth was 2·63 (95% CI, 1·03–6·69) and recipient site extraction caused by periodontal disease was 3·80 (95% CI, 1·61–9·01). The results of this study suggest that long‐term survival of transplanted teeth in males is influenced not only by oral bacterium but also by occlusal status.