Laser Therapy in the Treatment of Dentine Hypersensitivity

Keywords:laser, medical fibers, diffuser fiber,  Time:05-11-2015

The need for clarification regarding the specification of dosimetry parameters for laser irradiation applied in dentine hypersensitivity treatment is increasing due to the large variety of lasers currently available (17). Thus, the purpose of this study was to evaluate the effectiveness of two types of lasers, one with red wavelength of 660 nm and the other with infrared wavelength of 830 nm, as dentine desensitizers as well as the immediate and late effects in adult individuals of different ages.
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MATERIAL AND METHODS

A total of 40 teeth from 20 adult individuals (9 male and 11 female; aged 25 to 45 years) with a diagnosis of odontalgia of dentinal origin and cervical dentine exposure were treated. Approval by the Ethics Committee and informed written consent was obtained at the clinic of otorhinolaryngology discipline of the Escola Paulista de Medicina of UNIFESP. The teeth included in the sample were absent of bacterial infection, were at the prodromal stage of the inflammatory lesion with intense and short positive response to cold nociceptive stimulus of 0°C. The thermal test with cold stimulus was performed by the contact to the cervical dentinal surface with a flexible stick applicator, cooled with EndoFrost® (Roeko, Langenau, Germany). In order to standardize the sample, the criterion for inclusion in the study was a sensitive dentinal response of grade 10, in the 0 to 10 numeric scale for pain evaluation, characterizing cervical dentine hypersensitivity. The treated dental elements were premolars, did not have ample restorations and the individuals included in the sample showed an absence of active periodontal disease, teeth with carious lesions, chronic or debilitating disease with daily pain episodes, no use of analgesic, anticonvulsive, antihistaminic, sedative, tranquilizing or antiinflammatory medications in the 72 h preceding treatment, had not used desensitizer dentrifice in the last 3 months and had not been subjected to periodontal surgery in the last 6 months. The sample was divided into 2 groups of 20 teeth: the red laser group and the infrared laser group. The applied laser device was the Laser Beam DR 500 Power, with two straight-type pens of GaAlAs diode laser; one with nominal wavelength of 660 nm and verified wavelength of 660.14 nm, red, nominal power of 35 mW and verified power of 35.22 mW, focus dimension of 1 mm² with elliptical standard and the other with nominal wavelength of 830 nm and verified wavelength of 830.05 nm, infrared, nominal power of 35 mW and verified power of 35.30 mW, focus dimension of 1 mm² with elliptical standard, manufactured by Laser Beam Indústria e Tecnologia (Niterói, RJ, Brazil). As a study factor, the sample was also divided into 2 subgroups according age, one group consisted of 25-35-year-old individuals and the other of 35-45-yearold individuals. This study was performed by one operator and one assessor responsible for the measurement of the pain level of the patients. The treatments were carried out in 4 sessions, with intervals of 7 days between sessions, during a period of 4 consecutive weeks. The sample was evaluated through the measuring of the dentinal sensitive response to the cold nociceptive stimulus of 0ºC, with a numeric scale from zero to 10. The measurements were performed before each treatment session and at 15 and 30 min after the laser application to verify the capacity, the extent, and the duration of desensitization after irradiation. This result was called immediate effect. Additional measurements were also performed at 15, 30 and 60 days after the conclusion of treatment in order to assess the extent of desensitization obtained at the different wavelengths. This result was called late effect. The dentinal cervical region of the treated teeth exposed to the buccal medium was previously cleaned. Afterwards, relative isolation of the region was carried out with the aid of a cotton roll and the drying of the buccal surface with gauze before each treatment session. The irradiation parameters were identical, except in respect to the wavelength – one of 660 nm and other of 830 nm. The deposited energy density was 4 J/ cm² per dental element with exposition time of 114 seconds, continuous emission form, punctual application in the buccal surface and application with contact on the region of exposed dentinal neck. In the descriptive statistical analysis, all of the studied variables were described in relation to the mean and standard. In order to compare the studied factors, ANOVA was applied for the following factors: a) dependent factor – quantitative numeric pain scale; b) independent factors – age (25-35 years; 36-45 years) and groups (660 nm red laser; 830 nm infrared laser); c) repetitive factors – treatment sessions (first, second, third and fourth), immediate effect (BT – before treatment, 15  and 30 min after irradiation) and late effect (15, 30 and 60 days after conclusion of treatment). The significance level of the test was 5%.

RESULTS

Significant reduction of dentinal sensitivity occurred along all times measured during the four treatment sessions in both groups treated with red and infrared lasers. Comparing the means of the  responses in the 4 treatment sessions of the 2 groups, the red laser group showed a higher degree of desensitization in the age range of 25 to 35 years compared to the group treated with infrared laser.  However, a greater reduction was found between the times BT and 15 min after irradiation with red laser. These results remained stable between 15 and 30 min after irradiation in patients 25-35 years of age, whereas, in the 36-45-year-old group, sensitivity increased slightly after 15 min of irradiation. In the follow-up period of 15, 30 and 60 days after the conclusion of treatment, the age range of 25 to 35 years presented the higher dentinal desensitizing index, giving responses with more significant results in both of the groups. The results of treatment with the 660 nm red laser and the 830 nm infrared laser are reported in Tables 1 and 2. Statistical results are reported in Table 3.

DISCUSSION

The literature is unanimous in demonstrating that, even with several types of treatment for dentine hypersensitivity, there is no treatment that reduces pain to satisfactory levels. According to Landry and Voyer (18), there is no ideal desensitizing agent but any treatment method for dentine hypersensitivity should be effective from the first application and must comply with the following characteristics: does not irritate the pulp or cause pain, easy application, effective on a permanent basis, does not discolor or stain the teeth, does not irritate the soft tissues or the periodontal ligament and has low cost.

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