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CONTINUING PROFESSIONAL DEVELOPMENT
Table 1. Agents used in dentine hypersensitivity
Proposed mechanism of action and evidence
Examples of products*
Potassium nitrate Most evidence is available for the nitrate salt. It is hypothesised that potassium nitrate
in toothpastes raises extracellular potassium levels thus depolarising nerve cells.
This stops the nerves from ‘firing’ (i.e. numbs them) and makes them unresponsive to
A 2006 Cochrane review of six randomised controlled trials (RCTs)13 concluded that
there was no clear evidence to support the efficacy of potassium nitrate for DH.
However, it did state that any statistically significant differences noted were in favour of
treatment with potassium nitrate toothpaste. A 2015 review concluded that evidence
for potassium is limited.
Potassium nitrate may take 2–4 weeks to produce a significant reduction in DH.
Sensodyne Daily Care, Macleans
Sensitive, and Oral B Pro-sensitive
Dentine tubule-occluding agents
Strontium is postulated to create a seal on the dentine surface and/or strengthen the
dentine by acting as a replacement for calcium in the hydroxyapatite.
It may also
stabilise nerve cells.
The original chloride salt is largely now replaced by the acetate
salt, as the latter has improved clinical efficacy and is more compatible with fluoride.
A 2015 systematic review concluded that the quality of evidence with strontium chloride
salts was low, but the acetate salt had moderate quality evidence for relieving DH.
Sensodyne Original and Sensodyne
Stannous fluoride has been used to relieve DH.6,7
Sodium fluoride and sodium
monofluorophosphate in higher strengths are available from dentists. It has been
postulated that these either create calcium fluoride or calcium phosphate crystals,
which block the dentine tubules, or they deposit fluoride salts within tubules,
which blocks transmission of stimuli.
Clinical data suggests that fluoride,
particularly in combination with other desensitising agents, can reduce DH.
Fluoride also prevents caries, by promoting tooth remineralisation. Higher
concentration fluoride toothpastes are more effective than standard fluoride
toothpastes for preventing root caries.
Fluoride is a co-ingredient with
desensitising agents in a variety
of OTC toothpaste brands, e.g.
Colgate Sensitive range, Sensodyne
Rapid Relief, Sensodyne Daily Care,
and Oral-B Pro-Health range
Higher concentration fluoride
toothpastes (e.g. Neutrafluor 5000
Plus) are indicated for people
at high risk of dental caries.
Neutrafluor 5000 Plus is a Pharmacist
Only medicine and should be
recommended by a dentist.
Calcium phosphate technologies (CPT )
NovaMin contains calcium, sodium and phosphosilicate. When it combines with saliva,
the sodium ions are exchanged with hydrogen ions in saliva.
This raises the pH of
the local area which causes calcium, phosphate and silica to precipitate into a strong
hard mineral layer similar to hydroxyapatite. This forms a protective layer over exposed
dentine, blocking the tubules. A 2015 systematic review of RCTs suggests calcium
sodium phosphosilicate is effective for DH.
Sensodyne Repair and Protect and
Sensodyne Complete Care (also
Pro-Argin consists of arginine (a naturally-occurring amino acid) and calcium
carbonate. Pro-Argin seals dentin tubules with a plug that contains arginine, calcium,
16 This plug reduces dentine fluid flow and decreases sensitivity.
Systematic reviews of controlled clinical trials have suggested arginine-containing
toothpastes reduce DH.
Colgate Sensitive Pro-Relief range
CPP-ACP is a combination of casein phosphopeptide (a protein derived from milk),
calcium and phosphate, and acts as a reservoir for calcium and phosphate. It promotes
tooth remineralisation and can slow the progression of caries.
19 However, there are
very few published clinical trials of CPP-ACP for DH.6,20
A 2015 systematic review found there was insufficient evidence for effectiveness of
casein derivatives for DH.
GC Mousse or GC Mousse Plus
Recaldent chewing gum
TCP is another specialised calcium product which enhances the availability of calcium
fluoride for teeth mineralisation and reducing DH.
It is a relatively new addition to
CPT and is designed to boost remineralising effects of fluoride. A RCT published in
2015 found that TCP enhanced the ability of fluoride in toothpaste to reduce DH.
Further research is needed for this agent.
Clinpro tooth crème, mainly
available through dentists
*Read the label for a list of active ingredients
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