Dentin hypersensitivity and dental dear: epidemiological approach, on self-perception and knowledge, physical and biological characterization and in situ study of tooth wear and tubular occlusion of desensitizers and / or anti-erosive toothpastes

Author(s)

Raquel Marianna Lopes Gaona

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Odontologia (FO/SDO)
• Defense date: 2019-04-03

Examining board members

Ana Cecilia Corrêa Aranha; Taís Scaramucci Forlin; Sabrina Feitosa Sochacki; Cecilia Pedroso Turssi

• Advisor: Ana Cecilia Corrêa Aranha

Abstract

This doctoral thesis consists of three chapters. Chapter I investigated the selfperception and knowledge of dental erosion through a questionnaire. Questions about socio-demographic data, oral health history, self-perception and knowledge about erosion, and a diet diary with frequent intake of food / drinks were. A total of 211 patients were interviewed, 89% had caries, 70% had 4 meals a day, in addition to the main ones. In the frequency, it was verified that 90% drink water, 24% consume fruit and 16% juice. When asked if they had noticed changes in teeth, 55% said they had experienced changes that may be related to erosion. Although 35% had attended dental exams at least once a year, 50% had never heard of dental erosion, 13% did not know the symptoms of erosion and 47% mix up the concept of dental erosion with caries. In the qualitative analysis, patients aged between 36 and 55 years had smoother teeth according to their self-perception (p = 0.005), women reported greater sensitivity than men (p = 0.002), and groups that had heard of erosion were people with income between one and three minimum wages (p = 0.005). Conclusion: Knowledge and self-perception of erosion are influenced by social determinants of health. The aim of the chapter II was to evaluate the physical and chemical characteristics of five commercially available desensitizing and / or anti-erosive toothpastes as a negative control, without fluoride (C, 0 ppm fluoride); fluoride as a positive control (F; 1450 ppm fluoride with sodium monofluorophosphate [MFP], Colgate Maximum Anti-caries Protection); arginine as a desensitizer (A: 1450 ppm fluorine as MFP and arginine + calcium carbonate, Colgate Sensitive Pro-Relief); calcium phosphosilicate as a desensitizer (FSC, 1426 ppm fluoride as MFP, Sensodyne Repair and Protect (Novamin®)); and calcium silicate as anti-erosive (SC, 1450 ppm fluoride as MFP and calcium silicate + sodium phosphate, Regenerate). The viscosity (V), cytotoxicity (C), determination of fluoride (F) and available calcium (Ca) were performed in each group and in triplicate. FSC presented higher V (p <0.05); all toothpastes presented cytotoxicity and the group without toothpaste exposure differed significantly (p <0.05); F and A presented higher fluoride values and differed from the others (p <0.05) and all fluoride toothpastes had the same amount of Ca, differing statistically from the control group (p <0.05). It can be concluded that although all toothpastes presented low cell viability and the same amount of calcium, F and A with higher amounts of Fluor and FSC showed higher viscosity, which may result in better performance in the treatment of dentin hypersensitivity. Finally, Chapter III was a fivestage blind and cross-site in-situ study that evaluated the effects of desensitizing and / or anti-erosive toothpastes used in Chapter II, tooth wear and tubular occlusion. Sixty samples of root dentin were placed in removable intraoral appliances of 15 volunteers. During the cycling, erosion / abrasion cycles (immersion in 1% citric acid solution pH 2.3, 6x / day for 2 minutes and brushing 2x / day for 5 seconds) were applied. At the conclusion of the experiment, the surface loss (SL) was evaluated in optical profilometry. The number of open dentinal tubules (ODT) were counted in the pre and post-cycling time using Image J. The SL did not differ significantly between the groups (p = 0.468). The number of pre-cycling ODT did not differ between groups (p = 0.768). For all groups, ODT were higher at pre-cycling time than post-cycling time (p <0.001). The post-cycling ODT were significantly lower for the FSC and SC groups (p <0.05) than for the C and F groups, and lower for the A group than for the control group (p <0.05) ). Groups A and F did not differ from each other. It can be concluded that the toothpastes tested caused similar grades of tooth wear. However, FSC and SC occluded a greater number of ODT and may have a potentially more promising effect for the treatment of HD. The results of these three studies allow us to conclude that a greater awareness of the causes and deleterious effects of dental wear in the population is necessary and that desensitizing and / or anti-erosive toothpastes may be recommended for the relief of HD, but not to prevent the wear. (AU)

• FAPESP's process: 15/15629-7 - Analysis of dentine structure loss and tubule occlusion after erosive and abrasive challenge with toothpastes containing desensitizing agents: a randomized in situ study
• Grantee: Raquel Marianna Lopes Gaona
• Support Opportunities: Scholarships in Brazil - Doctorate