Desensitizing Toothpastes for Dentin Hypersensitivity: A Network Meta-analysis

Abstract

The goal of this systematic review and network meta-analysis was to compare the relative effects of toothpaste formulations for dentin hypersensitivity (DH), tested in randomized controlled trials (RCTs). We searched 7 databases to February 2019. Paired reviewers independently screened studies, extracted data, and performed risk of bias assessment. The outcome of interest was painful response measured through tactile, cold, and air stimuli. We conducted a random-effects Bayesian network meta-analysis using standardized mean difference (SMD) and their credible intervals (CIs) as the measure of effect for each pain stimuli. We assessed certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. We included 125 RCTs (12,541 patients). For tactile stimulus, the following active ingredients showed large beneficial effects compared to fluoride with moderate certainty of evidence (SMD; 95% CI): potassium + stannous fluoride (SnF2) (3.05; 1.69–4.41), calcium sodium phosphosilicate (CSP) (2.14; 0.75–3.53), SnF2 (2.02; 1.06–2.99), potassium + hydroxyapatite (2.47; 0.3–4.64), strontium (1.43; 0.46–2.41), and potassium (1.23; 0.48–1.98). For cold stimulus, CSP showed large beneficial effects compared to fluoride (3.93; 0.34–7.53) with moderate certainty; for air stimulus, arginine (2.22; 1.45–2.99), potassium + hydroxyapatite (2.44; 0.33–4.55), potassium + SnF2 (2.28; 0.87–3.69), CSP (1.98; 0.99–2.98), and SnF2 (1.9; 1.03–2.77) showed large beneficial effects compared to fluoride with moderate to high certainty. Most toothpaste formulations showed evidence of superiority against placebo or fluorides (amine fluoride, sodium monofluorophosphate, or sodium fluoride). CSP was most beneficial for all 3 stimuli with high to moderate certainty. SnF2 alone and potassium combined with SnF2 or hydroxyapatite were beneficial for tactile and air stimulus with high to moderate certainty. Arginine was beneficial for air stimulus, and strontium and potassium were beneficial for tactile stimulus, with moderate certainty.

Comparative efficacy of BioMin-F, Colgate Sensitive Pro-relief and Sensodyne Rapid Action in relieving dentin hypersensitivity: a randomized controlled trial

“…Participants analyzed per group were more than thirty fulfilling the requirement of Holland's guidelines for conducting clinical trials for the management of DH [ 42 ]. Published literature [ 16 , 31 , 43 ] has determined that all previous trials on treating DH were conducted on smaller samples, which might have prevented the results from being extrapolated on the general population.…”

“…Moreover, FCPS as a new bioactive material revealed promising potency of sustainable management of DH in a previously conducted trial by Ashwini et al in 2018 [ 17 ]. A head-to-head comparative evaluation of these most effective bioactive agents, such as arginine and BAG-based desensitisers, was suggested by Martins et al [ 18 ] in a meta-analysis in 2020. Hence, the effectiveness of clinically available formulations of FCPS in OTC dentifrices needs further exploration for the permanent management of DH.…”

Evaluating the efficacy of desensitizing dentifrices on dentinal hypersensitivity management: A scanning electron microscopic analysis

“…Furthermore, SnF2-based formulations seem to be more effective than regular-fluoride toothpastes to manage DH due to tactile and air stimuli with high-to-moderate certainty. [ 31 ] Another systematic review of 74 articles suggested marked long-term reduction in DH with agents such as potassium nitrate, arginine, glutaraldehyde with hydroxyethyl methacrylate (HEMA), hydroxyapatite, adhesive systems, glass ionomer cements, and LASER, whereas short-term relief (1 week) was seen by the use of glutaraldehyde with HEMA, glass ionomer cements, and laser, and intermediate DH reduction (up to 1 month) was seen in stannous fluoride, glutaraldehyde with HEMA, hydroxyapatite, glass ionomer cements, and laser groups. Moreover, in-office treatments were more efficacious for immediate DH reduction and at-home treatments are recommended for long-time effects.…”

Preemptive analgesia in dental implant surgery: A systematic review and meta-analysis of randomized controlled trials

“…Each outcome was tabulated in a Summary of Finding (SoF) Table using GRADEpro. For the magnitude of the effect, we used the Cohen’s effect sizes for SMD: from -0.2 to 0.2 representing a trivial or no effect; -0.5 to -0.2 or 0.2 to 0.5 representing a small effect; -0.8 to -0.5 or 0.5 to 0.8 representing a moderate effect; and < -0.8 or > 0.8 representing a large effect ( 10 ). The interpretation of the results was based on an integrated approach of the magnitude of the effect based on Cohen’s effect size and the certainty of the evidence ( 11 ).…”