Effect of calcium sodium phosphosilicate and potassium nitrate on dentin hypersensitivity: a systematic review and Meta-analysis

doi:10.7518/hxkq.2018.03.014

Abstract

Abstract:

Objective This systematic review and Meta-analysis aimed to compare the efficacy of calcium sodium phos-phosilicate (CSPS) and potassium nitrate as desensitizing agents for the treatment of dentin hypersensitivity (DH). Methods A thorough search in The Cochrane Library, PubMed, Embase, Chinese WanFang Data, CBM, and CNKI were conducted for studies published up to June 2017. Randomized controlled trials (RCTs) of the treatment of DH with CSPS and potassium nitrate toothpaste were included. Quality assessment and data extraction were performed by two reviewers independently, and Meta-analysis was performed by using RevMan 5.3 software. Results Eight RCTs involving 411 patients were included. Experimental group comprised 203 and control group had 208 patients. The Meta-analysis indicated the superior effect of CSPS dentifrice on air blast sensitivity at 2, 4, 6, and 8 weeks of follow-up [SMD=-1.85, 95%CI (-2.89,-0.81), P=0.000 5, I²=93%], [SMD=-1.61, 95%CI (-1.96, -1.26), P<0.000 01, I²=49%], [SMD=-3.79, 95%CI (-7.18, -0.40), P=0.03, I²=98%], and [SMD=-2.13, 95%CI (-2.69, -1.58), P<0.000 01] , respectively. No significant effects were seen at 12 weeks [SMD=-0.63, 95%CI (-1.47, 0.20), P=0.14, I²=71%]. CSPS dentifrice showed a better desensitizing effect at 2, 4, 6, 8, and 12 weeks of follow-up on cold water sensitivity [SMD=-1.07, 95%CI (-1.48, -0.66), P<0.000 01, I²=69%], [SMD=-1.29, 95%CI (-1.81, -0.76), P<0.000 01, I²=64%], [SMD=-1.20, 95%CI (-1.57, -0.83), P<0.000 01, I²=86%], [SMD=-1.30, 95%CI (-2.51, -0.08), P=0.04, I²=82%], and [SMD=-0.79, 95%CI (-1.27, -0.31), P=0.001], respectively. No significant effects at 1 week of follow-up [SMD=0.00, 95%CI (-0.62, 0.62), P=1]. The favorable effect of CSPS dentifrice on tactile sensitivity was more obvious than the control group at 2, 4, and 8 weeks of follow-up [SMD=-1.31, 95%CI (-2.00, -0.62), P=0.000 2, I²=67%], [SMD=-1.37, 95%CI (-1.74, -0.99), P<0.000 01, I²=23%], and [SMD=-1.33, 95%CI (-1.82,-0.84), P<0.000 01], respectively. No significant effects at 1 week of follow-up [SMD=-0.32, 95%CI (-0.94, 0.31), P=0.32] were observed. Conclusion Current evidence indicated that CSPS was more effective than potassium nitrate at reducing DH. The evidence generated by this review was based on a small number of individuals. High-quality and large sample size as well as ideally-designed clinical trials are required in the future before definitive recommendations can be made.

Key words: calcium sodium phosphosilicate, potassium nitrate, dentin hypersensitivity, randomized controlled trial, Meta-analysis, systematic review

CLC Number:

R781.2

Yuan Liu, Long Wu, Fanqi Meng, Xinshan Hou, Jin Zhao. Effect of calcium sodium phosphosilicate and potassium nitrate on dentin hypersensitivity: a systematic review and Meta-analysis[J]. West China Journal of Stomatology, 2018, 36(3): 301-307.

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References 34

[1]	Holland GR, Narhi MN, Addy M, et al.Guidelines for the design and conduct of clinical trials on dentine hypersensi-tivity[J]. J Clin Periodontol, 1997, 24(11): 808-813.
[2]	Canadian Advisory Board on Dentin Hypersensitivity. Con-sensus-based recommendations for the diagnosis and mana-gement of dentin hypersensitivity[J]. J Can Dent Assoc, 2003, 69(4): 221-226.
[3]	Kopycka-Kedzierawski DT, Meyerowitz C, Litaker MS, et al.Management of Dentin Hypersensitivity by National Dental Practice-Based Research Network practitioners: results from a questionnaire administered prior to initiation of a clinical study on this topic[J]. BMC Oral Health, 2017, 17(1): 41.
[4]	Amarasena N, Spencer J, Ou Y, et al.Dentine hypersensiti-vity in a private practice patient population in Australia[J]. J Oral Rehabil, 2015, 38(1): 52-60.
[5]	Que K, Ruan J, Fan X, et al.A multi-centre and cross-sectional study of dentine hypersensitivity in China[J]. J Clin Perio-dontol, 2010, 37(7): 631-637.
[6]	Gillam DG, Aris A, Bulman JS, et al.Dentine hypersensitivity in subjects recruited for clinical trials: clinical evaluation, prevalence and intra-oral distribution[J]. J Oral Rehabil, 2002, 29(3): 226-231.
[7]	Palé M, Mayoral JR, Llopis J, et al.Evaluation of the effec-tiveness of an in-office bleaching system and the effect of potassium nitrate as a desensitizing agent[J]. Odontology, 2014, 102(2): 203-210.
[8]	Wara-aswapati N, Krongnawakul D, Jiraviboon D, et al. The effect of a new toothpaste containing potassium nitrate and triclosan on gingival health, plaque formation and den-tine hypersensitivity[J]. J Clin Periodontol, 2005, 32(1): 53-58.
[9]	庄文捷, 曹东. 含5%硝酸钾牙膏抗牙本质敏感的临床研究[J]. 2011, 20(6): 638-640.
	Zhuang WJ, Cao D.Efficacy of a dentifrice containing 5% potassium nitrate on dental hypersensitivity[J]. Shanghai J Stomatol, 2011, 20(6): 638-640.
[10]	Poulsen S, Errboe M, Lescay Mevil Y, et al. Potassium con-taining toothpastes for dentine hypersensitivity[J]. Cochrane Database Syst Rev, 2006(3): CD001476.
[11]	Karim BF, Gillam DG.The efficacy of strontium and potas-sium toothpastes in treating dentine hypersensitivity: a sys-tematic review[J]. Int J Dent, 2013, 2013: 573258.
[12]	Narayana SS, Deepa VK, Ahamed S, et al.Remineralization efficiency of bioactive glass on artificially induced carious lesion an in-vitro study[J]. J Indian Soc Pedod Prev Dent, 2014, 32(1): 19-25.
[13]	Sufi F, Hall C, Mason S, et al.Efficacy of an experimental toothpaste containing 5% calcium sodium phosphosilicate in the relief of dentin hypersensitivity: an 8-week randomized study (Study 2)[J]. Am J Dent, 2016, 29(2): 101-109.
[14]	Milleman JL, Milleman KR, Clark CE, et al.NUPRO sen-sodyne prophylaxis paste with NovaMin for the treatment of dentin hypersensitivity: a 4-week clinical study[J]. Am J Dent, 2012, 25(5): 262-268.
[15]	Salian S, Thakur S, Kulkarni S, et al.A randomized con-trolled clinical study evaluating the efficacy of two desen-sitizing dentifrices[J]. J Clin Dent, 2010, 21(3): 82-87.
[16]	Narongdej T, Sakoolnamarka R, Boonroung T.The effec-tiveness of a calcium sodium phosphosilicate desensitizer in reducing cervical dentin hypersensitivity: a pilot study[J]. J Am Dent Assoc, 2010, 141(8): 995-999.
[17]	Sharma N, Roy S, Kakar A, et al.A clinical study comparing oral formulations containing 7.5% calcium sodium phospho-silicate (NovaMin), 5% potassium nitrate, and 0.4% stannous fluoride for the management of dentin hypersensitivity[J]. J Clin Dent, 2010, 21(3): 88-92.
[18]	Pradeep AR, Sharma A.Comparison of clinical efficacy of a dentifrice containing calcium sodium phosphosilicate to a dentifrice containing potassium nitrate and to a placebo on dentinal hypersensitivity: a randomized clinical trial[J]. J Periodontol, 2010, 81(8): 1167-1173.
[19]	Pradeep AR, Agarwal E, Naik SB, et al.Comparison of effi-cacy of three commercially available dentifrices on dentinal hypersensitivity: a randomized clinical trial[J]. Aust Dent J, 2012, 57(4): 429-434.
[20]	Acharya AB, Surve SM, Thakur SL.A clinical study of the effect of calcium sodium phosphosilicate on dentin hyper-sensitivity[J]. J Clin Exp Dent, 2013, 5(1): e18-e22.
[21]	Majji P, Murthy KR.Clinical efficacy of four interventions in the reduction of dentinal hypersensitivity: a 2-month study[J]. Indian J Dent Res, 2016, 27(5): 477-482.
[22]	Athuluru D, Reddy C, Sudhir KM, et al.Evaluation and com-parison of efficacy of three desensitizing dentifrices on den-tinal hypersensitivity and salivary biochemical characteristics: A randomized controlled trial[J]. Dent Res J (Isfahan), 2017, 14(2): 150-157.
[23]	Low SB, Allen EP, Kontogiorgos ED.Reduction in dental hypersensitivity with nano-hydroxyapatite, potassium nitrate, sodium monoflurophosphate and antioxidants[J]. Open Dent J, 2015(9): 92-97.
[24]	Dowell P, Addy M.Dentine hypersensitivity. A quantitative comparison of the uptake of metal salts and fluoride by den-tine and hydroxyapatite[J]. J Periodont Res, 1984, 19(5): 530-539.
[25]	West NX, Seong J, Davies M.Management of dentine hyper-sensitivity: efficacy of professionally and self-administered agents[J]. J Clin Periodontol, 2015, 42(Suppl 16): S256-S302.
[26]	Markowitz K.The original desensitizers: strontium and potas-sium salts[J]. J Clin Dent, 2009, 20(5): 145-151.
[27]	Bartold PM.Dentinal hypersensitivity: a review[J]. Aust Dent J, 2006, 51(3): 212-218.
[28]	Gendreau L, Barlow AP, Mason SC.Overview of the clinical evidence for the use of NovaMin in providing relief from the pain of dentin hypersensitivity[J]. J Clin Dent, 2011, 22(3): 90-95.
[29]	Zhong JP, Greenspan DC, Feng JW.A microstructural exa-mination of apatite induced by Bioglass in vitro[J]. J Mater Sci Mater Med, 2002, 13(3): 321-326.
[30]	Andersson OH, Kangasniemi I.Calcium phosphate formation at the surface of bioactive glass in vitro[J]. J Biomed Mater Res, 1991, 25(8): 1019-1030.
[31]	Gendreau L, Barlow AP, Mason SC.Overview of the clinical evidence for the use of NovaMin in providing relief from the pain of dentin hypersensitivity[J]. J Clin Dent, 2011, 22(3): 90-95.
[32]	Layer TM.Development of a fluoridated, daily-use tooth-paste containing NovaMin technology for the treatment of dentin hypersensitivity[J]. J Clin Dent, 2011, 22(3): 59-61.
[33]	Amaechi BT, Mathews SM, Mensinkai PK.Effect of theo-bromine-containing toothpaste on dentin tubule occlusion in situ[J]. Clin Oral Investig, 2015, 19(1): 109-116.
[34]	Peacock JM, Orchardson R.Effects of potassium ions on action potential conduction in A- and C-fibers of rat spinal nerves[J]. J Dent Res, 1995, 74(2): 634-641.

纳入研究	例数（T/C）	年龄/岁	干预措施		随访/周	回访/失访		结局指标
纳入研究	例数（T/C）	年龄/岁	T	C	随访/周	T	C	结局指标
Salian 2010^[15]	10/10	20~50	5%CSPS	5%硝酸钾	2,4	10/0	10/0	①②③
Narongdej 2010^[16]	20/20	26~70（44.8）	7.5%CSPS	5%硝酸钾	1,2,4	20/0	20/0	①③
Sharma 2010^[17]	40/40	20~60	7.5%CSPS	5%硝酸钾	2,4,12	40/0	40/0	②③
Pradeep 2010^[18]	40/40	20~60（39.4）	5%CSPS	5%硝酸钾	2,6	36/4	37/3	②③
Pradeep 2012^[19]	40/40	20~60（40.3）	5%CSPS	5%硝酸钾	2,6	36/4	39/1	②③
Acharya 2013^[20]	10/10	18~65	5%CSPS	5%硝酸钾	2,4,8	10/0	10/0	③
Majji 2016^[21]	40/40	20~60（36.9）	5%CSPS	5%硝酸钾	2,4,8	40/0	40/0	①②③
Athuluru 2017^[22]	17/17	18~75（42.95）	5%CSPS	5%硝酸钾	6,12	15/2	15/2	②

纳入研究	随机方法	分配隐藏	患者与研究者盲法	结果评价者盲法	结果完整性	选择性报告	其他偏倚
Salian 2010^[15]	不清楚	不清楚	低风险	不清楚	低风险	低风险	不清楚
Narongdej 2010^[16]	不清楚	不清楚	低风险	低风险	低风险	低风险	不清楚
Sharma 2010^[17]	不清楚	不清楚	低风险	不清楚	低风险	低风险	不清楚
Pradeep 2010^[18]	低风险	低风险	低风险	低风险	低风险	低风险	低风险
Pradeep 2012^[19]	低风险	低风险	低风险	低风险	低风险	低风险	低风险
Acharya 2013^[20]	不清楚	不清楚	低风险	不清楚	低风险	低风险	低风险
Majji 2016^[21]	不清楚	不清楚	低风险	低风险	不清楚	低风险	不清楚
Athuluru 2017^[22]	低风险	低风险	低风险	低风险	低风险	低风险	低风险

随访时	吹气敏感				冷水刺激敏感				探诊敏感
间/周	n	SMD	95%CI	P值	n	SMD	95%CI	P值	n	SMD	95%CI	P值
1	-	-	-	-	1	0.00	（-0.62, 0.62）	1	1	-0.32	（-0.94, 0.31）	0.32
6	4	-3.79	（-7.18,-0.40）	0.03*	2	-1.20	（-1.57,-0.83）	<0.000 01*	-	-	-	-
8	1	-2.13	（-2.69,-1.58）	<0.000 01*	2	-1.30	（-2.51, -0.08）	0.04*	1	-1.33	（-1.82, -0.84）	<0.000 01*
12	2	-0.63	（-1.47,0.20）	0.14	1	-0.79	（-1.27, -0.31）	0.001	-	-	-	-