Dentin hypersensitivity is a common occurrence and is often a chief concern among patients. The pain associated with dentin hypersensitivity is usually 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.

 

 

 

     Many methods have been used to evaluate the clinical effectiveness on dentin sensitivity of dental formulations. These include assessments utilizing a cold air stimulus, response to a tactile stimulus using an electronic pressure sensitive probe (Yeaple probe), and a visual analog scale (VAS). Among these methods, the tactile measurement of sensitivity is an established and well documented procedure to quantify the stimulus required to elicit a sensitive response on a tooth. A number of studies have utilized the Yeaple probe. The Yeaple probe utilizes an electromagnetic device to control the amount of force applied. Force corres-ponding to 70 g with no pain is considered non-sensitive. The force is increased in 5 g intervals with care taken not to apply too much scratching pressure as more problems may ensue. However, limitations of

 

 

efficiency seen with the Yeaple probe include tedious daily calibration, loosening of probe tip during evalu-ation, unit breakdown, dependency on operator and the effects of ambient conditions during examinations.

     A recent device, the Jay Sensitivity Sensor Probe, has been introduced. The Jay Sensitivity Sensor Probe is an instrument that evaluates tactile sensitivity in clinical settings. This instrument includes a microprocessor-controlled evaluation of force limits in pre-set increments, audible beeps for each programmed force limit, digital readout of the force eliciting patient responses, factory calibration to preclude additional daily calibration, and foot control for operator’s ease.

     This Special Issue of the American Journal of Dentistry presents the results of studies using the Jay Sensitivity Probe to clinically and objectively measure dentin hypersensitivity.

     We hope you will find these papers interesting and educational.

 

 

 

 

Franklin García-Godoy, DDS , MS, PhD, PhD

Editor

 

 

 

 

A diagnostic device to record dentin hypersensitivity

 

Franklin García-Godoy, dds, ms, phd, phd  &  Richard D. Trushkowsky, dds

 

Mail: Dr. Franklin García-Godoy, College of Dentistry, University of Tennessee Health Science Center, 875 Union Avenue, Memphis, TN  38168, USA.  E-mail: fgarciagodoy@gmail.com                                                                               (Am J Dent 2013;26 Sp Is B:3B-4B)

 

 

Introduction

 

      Several studies have reported the prevalence of DH to range between 2-57% in routine practice with a higher incidence following periodontal therapy.^1-7

      Dentin hypersensitivity (DH) is characterized by short stimuli typically thermal, evaporative, tactile, osmotic or chemical and which cannot be ascribed to any other form or dental defect or pathology.¹ Common symptoms of DH include a short sharp pain from the exposed dentin in response to stimuli which cannot be attributed to other dental defects or pathology.^7-10

      Various methods have been described to evaluate the clinical effectiveness of dental formulations.^11-21 These include assessments utilizing a cold air stimulus,^11,12 response to a tactile stimulus^12-14 using an electronic pressure sensitive probe (Yeaple^a probe), and a visual analog scale (VAS).¹² Among these methods, the tactile measurement of sensitivity is an established and well documented procedure to quantify the stimulus required to elicit a sensitive response on a tooth. A number of studies have utilized the Yeaple probe.^11-14,17,21 The Yeaple probe utilizes an electromagnetic device to control the amount of force applied. Force corresponding to 50 g with no pain is considered non-sensitive. The force is increased in 10 g intervals with care taken not to apply too much scratching pressure. However, limitations of efficiency seen with the Yeaple probe include tedious daily calibration, loosening of probe tip during evaluation, unit breakdown, dependency on operator, and the effects of ambient conditions during examinations.¹⁴

 

      A recent device, the Jay Sensitivity Sensor Probe (Jay Probe),^b is an instrument that evaluates tactile sensitivity in clinical settings.¹⁵ The Jay Probe includes a microprocessor-controlled evaluation of force limits in pre-set increments, audible beeps for each programmed force limit, digital readout of the force eliciting patient responses, factory calibration to preclude additional daily calibration, and foot control for operator ease.^14,15

 

      The present Special Issue presents the results of clinical studies using the Jay Probe to clinically and objectively measure DH.

      In the first paper, Kakar et al¹⁴ compared the Jay Probe, to other well accepted methods used to evaluate sensitivity, the Yeaple Probe, air blast (Schiff scale), and patient responses by Visual Analog Scale (VAS). In particular, two clinical examiners compared the repeatability of the Jay Probe and the Yeaple Probe. A second evaluation of both probes along with air blast and VAS measurements was conducted during two independent parallel design clinical studies each enrolling 100 subjects with DH. The initial study showed low inter-examiner variability with no significant differences between replicate measurements (P> 0.05) observed with the Jay Probe. Consis-tent with results from previous studies, subjects assigned tooth-pastes formulated with potassium nitrate or 8% arginine/ calcium carbonate demonstrated improvements in Yeaple, air blast and VAS responses in comparison to those assigned the fluoride dentifrice (P< 0.05). Jay Probe responses correlated significantly with all other sensitivity measures (P< 0.05). Differences between these treatments were observed at all post-treatment evaluations using these methods.

 

 

      In the paper by Kakar et al²² subjects with DH participated in an 8-week study, comparing a new tactile hypersensitivity testing device(Jay Probe) to three currently available methods of hypersensitivity testing: tactile hypersensitivity by the Yeaple probe, air blast (Schiff’s Scale), and visual analog scores (VAS). Subjects used either a dentifrice containing 8% arginine, calcium carbonate, and 1,000 ppm MFP or a com-mercially available fluoride toothpaste. The results demon-strated significantly greater relief from DH by the dentifrice containing 8% arginine, calcium carbonate, and 1,000 ppm MFP in comparison to the commercially available fluoride toothpaste. The results also indicated that the Jay Probe per-formed reliable measurements to evaluate DH.

 

 

 

      Kakar et al²³conducted a randomized 8-week clinical study comparing relief from DH after use of dentifrices formulated with potassium nitrate or fluoride. Dentin hypersensitivity evaluations were conducted with the Jay Probe, along with three other methods: Yeaple probe, air blast, and the Visual Analog Scores (VAS). Subjects were randomly assigned a dentifrice formulated with 5% potassium nitrate and 1,000 ppm fluoride (as sodium monofluorophosphate - MFP) or a commercially available fluoride dentifrice with 1,000 ppm fluoride as MFP. Results demonstrated greater relief from DH using a dentifrice formulated with potassium nitrate than a fluoride toothpaste. These results also indicated that the Jay Probe is an effective instrument for evaluating tactile sensitivity in a clinical setting.

 

 

 

      Finally, in the study by Hegde et al²⁴ DH relief was evaluated in patients from the Mangalore, India area using the Jay Probe, air blast and VAS methods. Dentin hypersensitivity was measured at baseline and after 2, 4, and 8 weeks’ use of either a dentifrice formulated with 8% arginine, calcium carbonate and 1,000 ppm fluoride as MFP or a commercially available dentifrice containing 1,000 ppm fluoride as MFP. At each recall visit, both treatment groups demonstrated significant reductions in DH from their corresponding baselines (P< 0.05). Subjects assigned the 8% arginine, calcium carbonate and 1,000 ppm fluoride toothpaste demonstrated statistically significant reductions in responses to tactile stimuli, air blast, and VAS responses in comparison to those provided the toothpaste containing 1,000 ppm fluoride after 2, 4, and 8 weeks, respectively.

      Taken together,  the  results  from  these  studies  suggest     the use of the Jay Sensitivity Sensor Probe in clinical evaluations of DH. The Jay Probe offered advantages for evaluating tactile sensitivity in the clinical setting: ease of use, objectivity regarding pressure, and the ability to generate reliable, repro-ducible data, proving to be a robust instrument in the clinician’s armamentarium to evaluate DH.

 

 

a.    Yeaple Research, Pittsford, NY, USA.

b.   Global Health Research Group, New Delhi, India.

 

 

Disclosure statement: The authors declared no conflict of interest.

 

 

Dr. Garcia-Godoy is Professor, Senior Executive Associate Dean for Research, and Director, Bioscience Research Center, College of Dentistry, University of Tennessee, Memphis, Tennessee, USA and Senior Clinical Investigator, The Forsyth Institute, Cambridge, Massachusetts, USA; Dr. Trushkowsky is Co- Director, Advanced Programs for International Dentists in Esthetic Dentistry, College of Dentistry, New York University, New York, NY, USA.

 

 

References

 

 

  1. Addy M. Dentine hypersensitivity: New perspectives on an old problem. Int Dent J 2002;52 (Suppl):367-375.

  2. Pashley DH, Tay FR, Haywood VB, Collins MC, Drisko Cl. Dentin hypersensitivity: Consensus based recommendations for the diagnosis and management of dentin hypersensitivity. Inside Dent 2008;4(Sp Is):1-35.

  3. West NX. Dentine hypersensitivity. Monogr Oral Sci 2006;20:173-189.

  4. Dababneh RH, Khouri AT, Addy M. Dentine hypersensitivity. An enigma? A review of terminology, mechanisms, aetiology and management. Br Dent J 1999;187:606-611.

  5. Drisko CH: Dentine hypersensitivity. Dental hygiene and periodontal considerations. Int Dent J 2002;52:385-393.

  6. Draenert ME, Jakob M, Kunzelmann K-H, Hickel R. The prevalence of tooth hypersensitivity following periodontal therapy with special reference to root scaling. A systematic review based on literature. Am J Dent 2013;26:21-27.

  7. Dowell P, Addy M. Dentine hypersensitivity. A review. Aetiology, symptoms and theories of pain production. J Clin Periodontol 1983; 10:341-350.

  8. Holland GR, Narhi MN, Addy M, Gangarosa L, Orchardson R. Guidelines for the design and conduct of clinical trials on dentine hypersensitivity. J Clin Periodontol 1997;24:808-813.

  9. Canadian Advisory Board on Dentin Hypersensitivity. Consensus-based recommendations for the diagnosis and management of dentin hypersen-sitivity. J Can Dent Assoc 2003;69:221-226.

10. Bissada NF. Symptomatology and clinical features of hypersensitive teeth. Arch Oral Biol 1994;39 (Suppl):31S-32S.

11. Schiff T. Efficacy of a dentifrice containing potassium nitrate, soluble pyrophosphate, PVM/MA copolymer, and sodium fluoride on dentinal hypersensitivity: A twelve-week clinical study. J Clin Dent 1994;5 (Sp Is):87-92.

12. Ayad F, Ayad N, Delgado E,  Zhang YP,  DeVizio W,  Cummins D,                 Mateo LR. Comparing the efficacy in providing instant relief of dentin hypersensitivity of a new toothpaste containing 8.0% arginine, calcium carbonate and 1450 ppm fluoride to a benchmark desensitizing toothpaste containing 2% potassium ion and 1450 ppm fluoride, and to a control toothpaste with 1450 ppm fluoride: a three-day clinical study in Mississauga, Canada. J Clin Dent 2009;20:115-122.

13. Docimo R, Montesani L, Maturo P, Costacurta M, Bartolino M, Zhang YP, DeVizio W, Delgado E, Cummins D, Dibart S, Mateo LR. Com-paring the efficacy in reducing dentin hypersensitivity of a new toothpaste containing 8.0% arginine, calcium carbonate and 1450 ppm fluoride to a benchmark commercial densensitizing toothpaste containing 2% potassium ion: An eight week clinical study in Rome, Italy. J Clin Dent 2009;20:137-143.

14. Sowinski JA, Kakar A, Kakar K. Clinical evaluation of the Jay Sensitivity Sensor Probe: A new microprocessor-controlled instrument to evaluate dentin hypersensitivity. Am J Dent 2013;26 (Sp Is B): 4B-12B.

15. Kakar A. A novel computer program for visual analogue scale (VAS). J Dent Res 2009;88 (Sp Is A):1952.

16. Orchardson R, Gillam DG. Managing dentin hypersensitivity. J Am Dent Assoc 2006;137:990-998.

17. Milleman JL, Milleman KR, Clark CE, Mongiello KA, Simonton TC, Proskin HM. NUPRO sensodyne prophylaxis paste with NovaMin for the treatment of dentin hypersensitivity: A 4-week clinical study. Am J Dent 2012:25:262-268.

18. Chaknis P, Panagakos FS, DeVizio W, Sowinski J, Petrone D, Proskin H. Assessment of hypersensitivity reduction of a dentifrice containing 0.3% triclosan, 2.0% PVM/MA copolymer, 0.243% NaF and specially-designed silica as compared to a dentifrice containing 0.454% stannous fluoride, sodium hexametaphosphate and zinc lactate and to a dentifrice containing 0.243% NaF on dentin hypersensitivity reduction: An 8-week study. Am J Dent 2011;24 (Sp Is A):14A-20A.

19. Ni LX, He T, Chang A, Sun L. The desensitizing efficacy of a novel stannous-containing sodium fluoride dentifrice: An 8-week randomized and controlled clinical trial. Am J Dent 2010;23(Sp Is B):17B-21B.

20. Hamlin D, Williams KP, Delgado E, Zhang YP, DeVizio W, Mateo LR. 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. Am J Dent 2009;22(Sp Is A):16A-20A.

21. 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% arginine and calcium carbonate in providing instant and lasting relief of dentin hypersensitivity. Am J Dent 2009;22(Sp Is A):8A-15A.

22. Kakar A, Dibart S, Kakar K. Clinical assessment of a new dentifrice with 8% arginine and calcium carbonate on dentin hypersensitivity in an Indian population using a new measuring device: The Jay Sensitivity Sensor Probe. Am J Dent 2013; 26 (Sp Is B) 13B-20B.

23. Kakar A, Kakar K. Measurement of dentin hypersensitivity with the Jay Sensitivity Sensor Probe and the Yeaple Probe to compare relief from dentin hypersensitivity by dentifrices. Am J Dent 2013;26 (Sp Is B) 21B-28B.

24. Hegde S, Sripathi Rao BH, Kakar RC, Kakar A. A comparison of dentifrices for clinical relief from dentin hypersensitivity using the Jay Sensitivity Sensor Probe. Am J Dent 2013;26 (Sp Is B) 29B-36B.

 

 

 

Clinical evaluation of the Jay Sensitivity Sensor Probe: A new

microprocessor-controlled instrument to evaluate dentin hypersensitivity

 

Joseph  A.  Sowinski, dds, ms,  Ashish  Kakar, bds, msc  &  Kanupriya  Kakar, bds

 

Abstract: Purpose: To compare the Jay Sensitivity Sensor Probe (Jay Probe), a new microprocessor-based, pre-calibrated instrument, with well accepted methods used to evaluate sensitivity, i.e. tactile response to the Yeaple Probe, air blast (Schiff scale), and patient responses by Visual Analog Score (VAS). Methods: Jay Probe assessments were accomplished using several approaches. With a cohort of 12 subjects, two clinical examiners compared the repeatability of the Jay and Yeaple Probes. A second evaluation of both probes was conducted during two independent parallel design clinical studies each enrolling 100 adults with dentin hypersensitivity (DH). In each study, subjects were evaluated for DH responses after twice daily oral hygiene with a negative control fluoride dentifrice or a positive control dentifrice formulated with ingredients proven to reduce sensitivity, i.e. potassium nitrate or 8.0% arginine with calcium carbonate. Tactile evaluations by the Jay and Yeaple Probes were conducted at baseline and recall visits over the 8-week duration of each study. Also evaluated at each visit were responses to air blast and to patient reported DH assessment by VAS. Results: Low inter-examiner variability with no significant differences between replicate measurements (P> 0.05) was observed with the Jay Probe. Consistent with results from previous studies, subjects assigned dentifrices formulated with potassium nitrate or 8% arginine/calcium carbonate demonstrated improvements in Yeaple, air blast and VAS responses in comparison to those assigned the fluoride dentifrice (P< 0.05). Jay Probe responses correlated significantly with all other sensitivity measures (P< 0.05). Differences between these treatments were observed at all post-treatment evaluations using these methods. (Am J Dent 2013;26 Sp Is B:5B-12B).

 

 

Mail: Dr. Ashish Kakar, Global Health Research Group, H 8 Masjid Moth, Gk-2, New Delhi 110048, India; E-mail: ashish@ghrg.org

Clinical assessment of a new dentifrice with 8% arginine and calcium

carbonate on dentin hypersensitivity in an Indian population using a new

measuring device: The Jay Sensitivity Sensor Probe

 

Ashish  Kakar, bds, msc,  Serge  Dibart, dds  &  Kanupriya Kakar, bds 

 

Abstract: Purpose: To compare a new tactile hypersensitivity testing device [Jay Sensitivity Sensor (Jay) Probe] to three currently available methods of hypersensitivity testing: tactile hypersensitivity by the Yeaple probe, air blast (Schiff’s Scale), and their overall hypersensitivity in the absence of any stimuli using the visual analog scores (VAS) during a clini-cal trial comparing the desensitizing potential of a dentifrice containing 8% arginine, calcium carbonate, and 1,000 ppm MFP (Colgate Sensitive Pro-Relief; Test) against a commercially available fluoride dentifrice (Colgate Cibaca; Negative control). Methods: This 8-week clinical study enrolled 100 adults with dentin hypersensitivity (DH) to evaluate the desensitizing potential of a dentifrice with 8% arginine, calcium carbonate, and 1000 ppm MFP against a commercially available fluoride dentifrice, on an Indian population. This study included a new DH testing device (Jay Probe) in addition to the current three methods of dentin hypersensitivity testing. Subjects were randomly assigned a dentifrice and were evaluated for DH after 2-week, 4-week and 8-week use of assigned dentifrice. Results: At the end of the 8-week period, the results showed a significant improvement in dentin hypersensitivity in the Test group as compared to the Negative control group. The mean tactile hypersensitivity scores at the 8-week examinations were 39.67 and 38.33 by the Yeaple and Jay Probes, respectively, for the Test group and 15.72 and 15.00 for the Negative control group. These observations were consistent with the other hypersensitivity examinations by air blast and VAS. (Am J Dent 2013;26 Sp Is B:13B-20B).

 

 

 

 

Mail: Dr. Ashish Kakar, Global Health Research Group, H 8 Masjid Moth, Gk-2, New Delhi 110048, India; E-mail: ashish@ghrg.org

 

 

Measurement of dentin hypersensitivity with the Jay Sensitivity Sensor Probe and the Yeaple Probe to compare relief from dentin hypersensitivity by dentifrices

 

Ashish  Kakar, bds, msc  &  Kanupriya  Kakar, bds 

 

Abstract: Purpose: To compare relief from dentin hypersensitivity (DH) after use of dentifrices formulated with potassium nitrate or fluoride. For the study, DH evaluations were conducted with the Jay Sensitivity Sensor Probe (Jay Probe), a novel tactile hypersensitivity instrument, in conjunction with three other DH methods, i.e. Yeaple probe (tactile), air blast, and the Visual Analog Scale (VAS). Methods: Adults (n= 100) who presented two teeth with DH and met study criteria were enrolled for this double-blind, randomized, parallel, controlled clinical trial conducted in an outpatient setting. DH evaluations at baseline were conducted by the tactile, air blast, and VAS methods. Subjects were randomly assigned a dentifrice formulated with 5% potassium nitrate and 1,000 ppm fluoride (as sodium monofluorophosphate) (Colgate Sensitive toothpaste; Test) or a commercially available fluoride dentifrice with 1,000 ppm fluoride as sodium monofluorophosphate (Colgate Cibaca toothpaste; Negative control). Subjects were recalled for DH evaluations after 4 and 8 weeks of product use. Results: 85 subjects completed the entire study with evaluable results. Both treatments resulted in significant reductions in DH from baseline to all recall visits. In comparison to the Negative control, subjects in the Test group demonstrated significantly greater reductions for all DH evaluations at both 4 and 8 weeks (P< 0.05). Average tactile DH scores at week 8 for the Test and Negative control groups were 36.25 and 15.24 with the Yeaple probe and 35 and 12.43 with the Jay probe. Correspondingly, subjects in the Test group demonstrated significantly greater reductions in air blast and VAS responses for DH than those in the Negative control group (P< 0.05). (Am J Dent 2013;26 Sp Is B:21B-28B).

 

 

 

 

Mail: Dr. Ashish Kakar, Global Health Research Group, H 8 Masjid Moth, Gk-2, New Delhi 110048, India; E-mail: ashish@ghrg.org

 

 

A comparison of dentifrices for clinical relief from dentin hypersensitivity

using the Jay Sensitivity Sensor Probe

 

Shashikanth  Hegde,  bds, mds,  B.H.  Sripathi  Rao, bds, mds,  Ravish  Chander  Kakar, bds, mds 

&  Ashish  Kakar, bds, msc 

 

Abstract: Purpose: To evaluate the clinical relief from dentin hypersensitivity among subjects provided with a dentifrice formulated with 8% arginine, calcium carbonate and 1,000 ppm fluoride [sodium monofluorophosphate (MFP)] in comparison to those issued a commercially available dentifrice containing 1,000 ppm fluoride [as sodium monofluorophosphate (MFP)]. Clinical evaluations for hypersensitivity were performed with a novel tactile hypersensitivity measuring instrument – the Jay Sensitivity Sensor (Jay) Probe – in conjunction with evaporative triggers by air blast (Schiff scale) and Visual Analog Scores (VAS). Methods: Qualified adults from the Mangalore, India area who presented two teeth with dentin hypersensitivity were enrolled for this double-blind, randomized, parallel, controlled clinical trial conducted in an outpatient clinical setting. At baseline, dentin hypersensitivity was evaluated by the Jay Probe (tactile), air blast and VAS methods. Subjects were randomly issued a study dentifrice and instructed to brush their teeth for 1 minute twice daily with the provided dentifrice. Clinical evaluations for hypersensitivity were repeated after 2, 4 and 8 weeks of product use. Results: 86 subjects (35 males and 51 females) complied with the study protocol and completed the entire study. At each recall visit, both treatment groups demonstrated significant reductions in dentin hypersensitivity from their corresponding baselines (P< 0.05). Subjects assigned the 8% arginine, calcium carbonate and 1,000 ppm fluoride dentifrice demonstrated statistically significant reductions in responses to tactile stimuli, air blast, and VAS responses in comparison to those using the dentifrice containing 1,000 ppm fluoride after 2, 4, and 8 weeks, respectively. (Am J Dent 2013:26 Sp Is B:29B-36B).

 

 

Mail: Dr. Ashish Kakar, Global Health Research Group, H 8 Masjid Moth, Gk-2, New Delhi 110048, India;  E-mail: ashish@ghrg.org