Volume 22, Special Issue A, March, 2009

Introducing Pro-Argin^TM/MC
A Breakthrough Technology Based upon Arginine and Calcium
for In-Office Treatment of Dentin Hypersensitivity

Contents

Editorial

Dentin hypersensitivity: Beneficial effects of an arginine-calcium carbonate desensitizing paste.
F. García-Godoy

Introduction

Dentin hypersensitivity: Effective treatment with an in-office desensitizing paste containing 8% arginine and calcium carbonate.
F. Panagakos, T. Schiff & A. Guignon

Research Articles

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.
T. Schiff, E. Delgado, Y.P. Zhang, D. Cummins, W. DeVizio & L.R. Mateo

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.
D. Hamlin, K. Phelan Williams, E. Delgado, Y.P. Zhang, W. DeVizio & L.R. Mateo

Effect of a desensitizing paste containing 8% arginine and calcium carbonate on the surface roughness of dental materials and human dental enamel.
F. García-Godoy, A. García-Godoy & C. García-Godoy

Dentin hypersensitivity: Beneficial effects of an arginine-calcium carbonate desensitizing paste

Dentin hypersensitivity is a common occurrence and is often a chief concern among patients. The pain associated with dentin hypersensitivity is caused by some type of external stimulus and the sensitivity can range in its intensity from patient to patient. The successful management of dentin hypersensitivity is often very challenging for the dental professional. The cause of the pain and the description of the discomfort reported by the patient can vary.

This Special Issue of the American Journal of Dentistry presents the results of studies performed testing an 8% arginine-calcium carbonate desensitizing paste, which is based on Pro-Argin^TM/MC technology, a combination of arginine and insoluble calcium compound. The Introduction paper is an overview of dentin hypersensitivity. One paper is a double-blind, stratified, randomized clinical study showing the beneficial effects of the 8% arginine calcium carbonate desensitizing paste used immediately after dental scaling procedures and its sustained relief over 4 weeks. Another paper presents the results of a double-blind, stratified, randomized clinical study showing the successful desensitizing effect of the 8% arginine-calcium carbonate paste tested, when applied as a preprocedure to professional dental cleaning.

This Special Issue also includes a study conducted in vitro, testing the effect of the desensitizing paste on the surface roughness of common dental materials and human enamel. The outcome revealed no significant alterations on the surfaces of the enamel and the materials tested.

We hope you will find these papers interesting and educational. The Journal thanks Colgate-Palmolive Company, the manufacturer of the arginine-calcium carbonate desensitizing paste, for sponsoring this Special Issue.

Franklin García-Godoy, DDS, MS
Editor

Dentin hypersensitivity: Effective treatment with an in-office desensitizing paste containing 8% arginine and calcium carbonate

Fotinos Panagakos, DMD, PhD, Thomas Schiff, DMD & Anne Guignon, RDH, MPH

Dentin hypersensitivity is a common occurrence and concern among patients. 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 ascribed to any other dental defect or disease.^1,2 The diagnosis of dentin hypersensitivity can be very challenging for the dental professional. The cause of the pain can vary and the patient's description of the discomfort may be insufficient to make a definitive diagnosis. The dental professional must perform differential diagnosis to exclude all other dental defects and diseases that might give rise to similar presentations^1,3 A thorough examination is essential to help the dental professional make a definitive diagnosis and rule out other possible causes of the pain, such as a split or broken tooth, dental caries or periodontal disease. By correctly diagnosing dentin hypersensitivity, the professional is able to develop and implement an appropriate treatment plan to address the problem effectively.^3,4

Structurally, dentin is composed of hydroxyapatite mineral and organic components.⁵ Formed by the odontoblasts during tooth development, dentin is uniquely differentiated from other mineralized tissues in the body because it contains thousands of tubules which run perpendicular to the pulp chamber. The tubules are formed as the odontoblasts migrate away from the dentin-enamel junction during dentin formation. The tubule contains not only the odontoblastic process, but also fluid surrounding the process.⁶

The dentin is normally covered by enamel or cementum. As teeth erupt into the oral cavity, the gingival margin seals the teeth leaving the coronal portion exposed in the oral cavity, and the root portion of the tooth protected from the external environment. To be hypersensitive, dentin must be exposed and the exposed tubules must be open and patent to the pulp.^1,7 The processes of exposure and opening are complex and multifactorial. Nonetheless, current evidence^1,7-9 suggests that gingival recession, resulting from abrasion or periodontal disease, is the primary route through which the underlying dentin becomes exposed, and acid erosion is an important factor in opening exposed dentin tubules (Fig. 1). Once a patient has dentin hypersensitivity, any external stimulus, such as physical pressure or air movement, can cause discomfort for the patient. The external stimulus is usually transitory, and the discomfort is typically present when the stimulus is present and subsides shortly thereafter.

The hydrodynamic theory is now accepted by the dental community as the mechanism by which dentin hypersensitivity occurs.^1,7 The theory suggests that an external stimulus triggers a pressure change in the dentin fluid. As a consequence, fluid movement transmits a signal to the odontoblast process, thereby carrying the stimulus from the tooth surface toward the afferent nerve ending in the dentin tubule, resulting in pain.¹⁰ It is, therefore, understandable that the pain caused by this change is transient — once the stimulus is removed or dissipates, the pressure within the tubule returns to normal and the pain subsides.

Sensitivity triggers and behavioral considerations

Some patients suffer from chronic sensitivity every time their teeth are exposed to specific stimuli. Others experience intermittent, unpredictable discomfort that can be difficult to pinpoint. One or more stimuli, such as tactile, osmotic (sweet), thermal (particularly cold) or evaporative (air movement), can initiate a painful response. Certain clinical activities initiate or heighten dentin hypersensitivity. These include routine examination with a metal explorer, drying the tooth with compressed air, hand scaling a root surface and water temperature changes from the air/water syringe or a power scaler.

Patients who have long-standing, unresolved sensitivity often exhibit a variety of behavioral or postural clues. Behaviors include avoiding needed treatment, insisting on anesthesia for simple procedures, reluctance to schedule a procedure or a vague concern about discomfort. Postural clues include tense facial muscles, rigid torso, clenched hands, crossed arms or awkward head position.

Undiagnosed or untreated dentin hypersensitivity can create barriers to effective dental visits. Patients want to be free from pain and discomfort, but may find it difficult to describe specific clinical symptoms. Clinicians who appear indifferent to vague symptoms, or who do not take the time to establish a dialogue, may miss valuable diagnostic clues. It is important to be empathetic and establish trust. When a dental professional is truly concerned about comfort, patients will be willing to participate in a dialogue that results in effective diagnosis and treatment.

Identifying dentin hypersensitivity and understanding risk factors

Some patients can describe the exact location or the specific trigger that initiates an episode of dentin hypersensitivity. Others, who have lived with untreated sensitivity for years, may think that sensitivity or pain is normal, especially during a dental appointment. Rather than dismiss or devalue a patient's sensitivity, a series of simple questions about the trigger stimulus, frequency, duration, location and type of discomfort can help guide the diagnosis. Continued...