Pro Argin: A promising technology for dental hypersensitivity

Transcription

1

2 Review Article Pro Argin: A promising technology for dental hypersensitivity ABSTRACT Dentin hypersensitivity is a common occurrence and is often a chief concern among patients. The successful management of dentin hypersensitivity is often very challenging for the dental professional as the cause of the pain and the description of the discomfort varies. There are traditional methods that have been clinically evaluated and found to be effective, but a more effective, faster acting, and long lasting treatment is required. Hence, Pro Argin technology is considered to be a promising treatment for dentin hypersensitivity and stain removal. Key words: Arginine; calcium carbonate; dentin hypersensitivity; Pro Argin technology; tubule occlusion Background Dentin hypersensitivity is defined by the International Workshop on Dentine Hypersensitivity (1983) as dentine hypersensitivity is characterized by short, sharp pain arising from exposed dentine in response to stimuli typically thermal, evaporative, tactile, osmotic, or chemical and which cannot be ascribed to any other form of dental defect or pathology. [1] It is characterized by a rapid onset, sharp burst of the pain of short duration (seconds or minutes) associated with A beta and A delta nerve responses to stimuli. [1 3] Many oral conditions can cause dental pain, such as untreated caries, a split tooth, or a cracked cusp, the correct attribution of dental pain to dentin hypersensitivity is important to know the correct treatment options. It usually affects adults in the age group of years. The regions commonly involved are the cervical areas of the facial surfaces. Canines and premolars are most commonly involved. [1] The aetiology may be enamel loss due to following reasons: [1,2] Occlusal wear, toothbrush abrasion, dietary erosion, abfraction, parafunctional habits or loss of cementum due to gingival recession, periodontal disease, root planning and periodontal surgery. Experts have concluded that gingival recession, rather than cervical enamel loss, is the key predisposing factor for dentin hypersensitivity. [1] There are three theories to explain the cause of dentin hypersensitivity. [3] They are Direct innervations theory Odontoblast deformation theory/transducer theory Hydrodynamic theory. Most commonly accepted is Brannstroms hydrodynamic theory of nerve stimulation due to movement of the dentinal fluid. The relationship between dentin hypersensitivity and Website: Access this article online Quick Response Code This is an open access article distributed under the terms of the Creative Commons Attribution NonCommercial ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non commercially, as long as the author is credited and the new creations are licensed under the identical terms. For reprints contact: reprints@medknow.com DOI: / How to cite this article: Halappa M, Roy P, Bharateesh JV, Kashinath KR. Pro-Argin: A promising technology for dental hypersensitivity. Indian J Multidiscip Dent 2015;5: Mythri Halappa, Prasun Roy 1, Bharateesh JV, Kashinath KR 1 Department of Public Health Dentistry and 1 Department of Prosthodontics, Sri Siddhartha Dental College, Tumkur, Karnataka, India Address for correspondence: Dr. Mythri Halappa, Department of Public Health Dentistry, Sri Siddhartha Dental College, Tumkur, Karnataka, India. E mail: drmythripcd@gmail.com Indian Journal of Multidisciplinary Dentistry Published by Wolters Kluwer - Medknow

3 the patency of dentin tubules in vivo has been established, and occlusion of the tubules seems to decrease that sensitivity. The hydrodynamic theory of dentin hypersensitivity, as this mechanism has become known, requires that dentin tubules are open at the dentin surface and patent to the pulp. Scanning electron microscopy (SEM) has shown that tubules in clinically characterized sensitive exfoliated teeth are 8 times more numerous and 2 times larger in diameter and are open, whereas tubules in nonsensitive teeth are fewer, smaller, and usually blocked. Dentin fluid flow rate is proportional to the fourth power of the tubule radius, so the difference in tubule diameter between sensitive and nonsensitive teeth is, almost certainly, of clinical relevance to the treatment of dentin hypersensitivity. [4] Differential diagnosis may be fractured restorations, Fractured enamel exposing dentine, dental caries, post restoration sensitivity, cracked tooth syndrome and bleaching sensitivity. [5] Prevention can be done by diet counseling, correction of brushing techniques, care during operative procedures and care during periodontal procedures. [6] To meet the need of individuals, the dental professionals recommend the use of desensitizing toothpaste as this significantly reduces the sensitivity. When the use of desensitizing toothpaste is insufficient, a second step may be the use of fluoride products at home, which can offer additional benefits. Professionally, applied in office products may be suitable for patients with additional treatment needs. [6] Management by traditional methods can be desensitization by blocking pulpal sensory nerves by using potassium nitrate toothpastes, desensitization by occluding dentinal tubules: by using formation of smear layer, use of topical agents, placements of restorations and use of LASERs. [6,7] Desensitization by Blocking Pulpal Sensory Nerves Clinical evidence of the effectiveness of potassium based toothpaste has been shown to interrupt the neural response to pain stimuli. In fact, they are the only ingredients that have been validated for the relief of sensitivity via this mechanism. The majority of desensitizing toothpastes in global toothpaste market contain a potassium salt to numb the pain of dentin hypersensitivity. [3] In most countries, potassium nitrate (5%), potassium chloride (3.75%), and potassium citrate (5.5%) are used interchangeably as each of these salts provides 2% potassium ion, which is the clinically proven active entity for sensitivity relief. Clinical studies support that toothpaste formulations containing potassium nitrate, potassium chloride, and potassium citrate are significantly more effective in reducing dentin hypersensitivity than regular fluoride toothpaste. [4,8] The clinical studies have also shown that it takes at least 2 weeks of twice daily use to show measurable reductions in sensitivity and longer time periods, generally 4 8 weeks, to demonstrate significant levels of pain relief. [8] Occlusion of Exposed and Open Dentin Tubules to Block the Hydrodynamic Mechanism of Pain Stimulation The principle of occluding dentin tubules to block the hydrodynamic mechanism of pain stimulation is a straightforward one. [2,4] They are by: Creation of a natural smear layer Deposition of a thin film coating Deposition of a layer of fine particles Induction of natural mineral formation in situ New technologies such as NovaMin bioactive glass, Portland cement, Casein phosphopeptide amorphous calcium phosphate, and Pro Argin. Studies [9 12] have shown evidence for the effect of dentifrice components on the creation and destruction of smear layers and confirmed that creation of smear layers and a deposition of a thin layer of fine particles are neither discrete nor mutually exclusive routes to potentially occlude dentin tubules. Tubule Occlusion through Deposition of a Layer of Fine Particles Clinical evidence of the effectiveness of strontium based toothpaste, stannous based toothpaste, and silica abrasive shown that there is no added advantage of using silica abrasives when the activity of strontium chloride is concerned. Literature suggests three potential mechanisms of action for strontium chloride. Literature suggests three potential mechanisms of action for strontium salts. First, as indicated above, nerve depolarization is possible. Second, because of its chemical similarity to calcium, strontium could, in principle, replace lost calcium in the hydroxyapatite lattice to strengthen demineralized enamel and/or dentin. Third, strontium salts may deposit a layer of fine particles to occlude dentin tubules. The new understanding that underpins the latest researches are that not all silica abrasives and formulations containing them are equal. [4,10,11] Tubule Occlusion by Induction of Natural Mineral Formation in Situ Novel biomaterials in the form of calcium phosphor silicates have also been shown to have the potential to release calcium Indian Journal of Multidisciplinary Dentistry / Jul-Dec 2015 / Volume 5 / Issue 2 69

4 and phosphate upon exposure to an aqueous environment to deliver relief of sensitivity. Bioglass particles in a specially formulated dentifrice were shown to occlude dentin tubules, whereas other formulations with the same ingredient were shown to be ineffective. [13] While these preliminary results appear promising, significantly more research is required on each technology. Pro Argin It is a breakthrough in dentine hypersensitivity relief It is based on a natural process of tubule occlusion that addresses the cause of sensitive teeth to provide instant an lasting hypersensitivity relief The essential components of this new technology are arginine, bicarbonate, and calcium carbonate This technology, called Pro Argin, has been shown to physically plug and seal exposed dentine tubules and to effectively relieve dentine hypersensitivity. Mechanism of action [4] are, esearch has revealed that arginine provides naturally protective oral health benefits. Saliva plays a role in naturally reducing dentin hypersensitivity by transporting calcium and phosphate into dentin tubules to induce tubule plugging and by forming a surface protective layer of salivary glycoprotein. Latest research suggests that at physiological ph, arginine, and calcium carbonate interact and bind to the negatively charged dentine surface to form a calcium rich layer on the dentine surface and in the dentine tubules to plug and seal them. [14] As alkaline ph favors these processes, salivary factors that maintain slightly alkaline ph in vivo have been suggested to favor occlusion. Investigations of the science underpinning the mechanisms of natural occlusion have resulted in the development of a new saliva based composition comprising arginine, an amino acid which is positively charged at physiological ph, bicarbonate, which is a ph buffer, and calcium carbonate, which is a source of calcium. Hence, Pro Argin technology triggers an occlusion of the dentin tubules that remains intact even after exposure to acids, preventing transmission of pain producing stimuli. [15,16] Advantages Arginine and calcium carbonate in the Pro Argin bind to the teeth surface This helps to attract a calcium rich layer into the dentine tubules to effectively plug and seal them The layer resists acids, such as low ph beverages It delivers instant and lasting relief for 4 weeks after one application Fast and easy application with a rotary cup. Clinical studies [4,14,15] have shown that this desensitizing prophylaxis paste is effective in providing instant sensitivity relief when burnished onto sensitive teeth following scaling and root planning procedures. An innovative technology has combined the key components, arginine, and calcium carbonate with fluoride to provide a significant advance in everyday treatment of dentin hypersensitivity. [17] In all the studies, the new arginine containing toothpaste provided highly significant reductions in sensitivity from baseline after 2, 4, and 8 weeks of product use. This shows that arginine significantly reduces sensitivity immediately following direct application and that the relief is maintained with continued twice daily brushing. [17 19] The fact that the arginine containing toothpaste provides instant relief, whereas the others do not, is a real breakthrough for consumers suffering from this condition. Several state of the art imaging methods, including confocal laser scanning microscopy, SEM, and atomic force microscopy, have provided insight into the mechanism of action of the Pro Argin technology confirming that the technology effectively plugs and seals dentin tubules and that the occlusion achieved is resistant to acid challenge. Hydraulic conductance has shown that the occlusion achieved with arginine containing toothpaste results in reduced dentin fluid flow and inhibition of the hydrodynamic mechanism. [20] A new whitening variant of this desensitizing toothpaste, containing the Pro Argin technology, [15] fluoride, and a high cleaning calcium carbonate abrasive system, has now been developed and validated in a series of scientific and clinical studies. This new desensitizing toothpaste with gentle whitening action works by the same mechanism of action as its nonwhitening counterpart. The Pro Argin technology offers unique opportunities to both dental professionals and their patients alike. The in office desensitizing product is clinically proven to provide instant sensitivity relief prior to and after dental procedures, such as scaling and root planning, while two dentifrice variants, one with whitening benefits, are clinically proven to provide instant and lasting relief of dentin hypersensitivity and superior relief of hypersensitivity compared to toothpastes containing 2% potassium ion as the active ingredient. [15] Conclusion Dentine hypersensitivity is a matter of growing concern in the present times due to the increased life expectancy and consequent longer retention of natural teeth by the patients The ultimate goal in treating this condition is to provide immediate and long lasting relief of the associated painful symptoms 70 Indian Journal of Multidisciplinary Dentistry / Jul-Dec 2015 / Volume 5 / Issue 2

5 Thus, the clinician must pay proper attention to diagnosis, prevention, and selection of the appropriate treatment modality and Pro Argin looks like a promising option for the same. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. References 1. Bartold P M. Dentinal hypersensitivity a review. Aus Dent J 2006;51 (3): Roberson TM, Roberson TM, Heymann HO, Swift EJ. Sturdevant s Art and Science of Operative Dentistry. 5 th ed. St. Louis, Missouri: Mosby: Cariology: The lesion, etiology, prevention and control; pp Panagakos F, Schiff T, Guignon A, Introducing Pro Argin A Breakthrough Technology Based upon Arginine and Calcium for In Office Treatment of Dentin Hypersensitivity, Am J Dent 2009;22 (Sp Is):3A 7A. 4. F.García Godoy. Dentin hypersensitivity: The effects of an arginine calcium carbonate and fluoride desensitizing dentifrice. Am J Dent. 2010;23(Sp Is): 1A. 5. Ide M. The differential diagnosis of sensitive teeth Review. Dent Update Dec; 25 (10): Scherman A, Jacobsen P L. Managing dentine hypersensitivity. J Am Dent Assoc 1992;123 (4): Markowitz K, Pashley DH: Discovering new treatments for sensitive teeth: The long path from biology to therapy. J Oral Rehabil 2007;35: D.Cummins. Recent advances in dentin hypersensitivity: Clinically proven treatments for instant and lasting sensitivity relief. Am J Dent 2010;23(Sp Is): 2A. 9. Tarbet WJ, Silverman G, Stolman JM, Fratarcangelo PA. Clinical evaluation of a new treatment for dentinal hypersensitivity. J Periodontol 1980;51: Nagata T, Ishida H, Shinuhara H, Kasahara S, Wakano Y, Daigen S, Troullos ES. Clinical evaluation of a potassium nitrate dentifrice for the treatment of dentinal hypersensitivity. J Clin Periodontol 1994;21: Schiff T, Dos Santos M, Laffi S, Yoshioka M, Baines E, DeVizio W, McCool JJ. Efficacy of a dentifrice containing 5% potassium nitrate and 1500 ppm sodium monofluorophosphate in a precipitated calcium carbonate base on dentinal hypersensitivity. J Clin Dent 1998;9: Silverman G. The sensitivity reducing effect of brushing with potassium nitrate sodium monofluorophosphate dentifrice. Compend Contin Educ Dent 1985;6: Gillam DG, Tang JY, Mordan NJ, Newman HN. The effects of a novel Bioglass dentifrice on dentine sensitivity: A scanning electron microscopy investigation. J Oral Rehabil 2002;29: Hamlin D. Clinical evaluation of the efficacy of an in office desensitizing paste containing 8% arginine and calcium carbonate in providing instant and lasting relief of dentine hypersensitivity. Am J Dent 2009;22(Sp Is):8A 15A. 15. Pro Argin Technology: New Research on Superior Dentin Hypersensitivity Relief with Stain Removal. Am J Dent 2010; 23 (Sp Is):1A 40A. 16. Shalini singh. Pro argin: A breakthrough technology for Dentin Hypersensitivity treatment. International J of Scientific study 2010;1 (3): Dentinal hypersensitivity. Available from colgate sensitive pro relief toothpaste/. [Last accessed on 2014 Feb 13]. 18. Schiff T, Delgado E, Zhang YP, Cummins D, DeVizio W, Mateo LR. Clinical evaluation of the efficacy of an in office desensitizing paste containing 8.0% arginine and calcium carbonate in providing instant and lasting relief of dentin hypersensitivity. Am J Dent 2009;22 (Sp Is):8A 15A. 19. Cummins D. Dentin hypersensitivity: From diagnosis to a breakthrough therapy for everyday sensitivity relief. J Clin Dent 2009;20: Petrou I, Heu R, Stranick M, Lavender S, Zaidel L, Cummins D, Sullivan RJ, Hsueh C, Gimzewski JK. A breakthrough therapy for dentin hypersensitivity: How dental products containing 8% arginine and calcium carbonate work to deliver effective relief of sensitive teeth. J Clin Dent 2009;20 (Sp Is): Indian Journal of Multidisciplinary Dentistry / Jul-Dec 2015 / Volume 5 / Issue 2 71