Researchers from the University of Bologna, Italy, have reported that calcium silicate dervied from Portland cement (DSC) can be used to desensitize dentin. The findings of this study have been published in the recent issue of the Journal of Dentistry.
A team of researchers led by Maria Giovanna Gandolfi evaluated the efficacy of calcium silicate derivatives from Portland cement on dentin permeability and morphology. The dentinal surface was exposed in vitro to calcium silicate paste for 3 minutes and was studied in comparison with the application of other materials such as a professional re-mineralizing treatment (GC Tooth Mousse), a commercial toothpaste (Dentosan S) and two in-office desensitizing agents (D/Sense Crystal and By Sealant) on wet dentin as per the manufacturer’s instructions. A hydrostatic device, working at 6.9kPa, was used to analyze the permeability of the materials through the dentinal tubules (hydraulic conductance). The dentinal morphology and surface deposits were studied based on SEM/EDX analyses, and their association with hydraulic conductance was assessed. Once the treatment was completed, the permeability of the dentin was re-evaluated after immersion in artificial saliva. These samples were exposed to 0.02M citric acid before documenting the final permeability.
The researchers recorded a reduction in the diameter of dentinal tubules due to the formation and precipitation of crystals on the dentinal surface, along with significant decrease in the dentin permeability in the DSC group and the oxalate-based products (D/Sense Crystal and By Sealant). On immersion in artificial saliva and citric acid, dentin permeability increased and the treated surface was partially modified. In the samples treated with Dentosan S and GC tooth Mousse, the dentin permeability was partially decreased and small amounts of precipitates were formed, which were removed on immersion in saliva and citric acid. After the DSC experimental treatment, EDX analysis showed the presence of a calcium-rich layer. The study concluded that as calcium derivatives of Portland cement significantly reduce dentin permeability, this material can be potentially effective in treating the hypersensitive dentin.
Dentinal hypersensitivity can be identified as intense pain on exposure of the tooth to hot/cold drinks or foods. The pathophysiology involves the movement of pulpal fluid through the exposed dentinal tubules caused by the erosion of the enamel. Enamel erosion is most commonly seen in individuals consuming large quantities of acidic or aerated drinks, in people suffering from gastroesophageal reflux disease (GERD) and bulimia, and professional wine tasters. The treatment of hypersensitive tooth involves decreasing the fluid flow by occluding the exposed dentinal tubules, which may aid in reducing the dentinal permeability.
Previously, various materials have been experimented for the treatment of hypersensitive dentin. A study by Zdeňka Zapletalová and colleagues (Photomedicine and Laser Surgery, 2007) documented successful occlusion of the exposed dentinal tubules with pulsed Nd:YAG laser radiation in the presence of erythrosin solution on the dentinal surface. In another study, Toshiyuki Suge and colleagues (Dental Materials, 2008) showed that ammonium hexafluorosilicate significantly decreases the dentinal permeability by occluding the dentinal tubules as it stimulates precipitation of calcium phosphate from the saliva.
The major etiology for enamel erosion is the consumption of soft drinks, especially carbonated drinks. The American Beverage Association (ABA, 2005) estimates that carbonated drinks constitute 28.3% of the total beverage consumption, which is far more than the consumption of bottled water that was about 10.7%. This high incidence in the consumption of carbonated drinks can be directly associated to an increase in cases of dental caries or enamel erosion, necessitating the exploration of alternative treatment modalities. As calcium silicate derivatives from Portland cement were efficient in reducing dentinal permeability, they can be considered for clinical use as a desensitizing agent in the treatment of enamel erosion.
References
1. Gandolfi MG, Silvia F, H PD, Gasparotto G, Carlo P. Calcium silicate coating derived from Portland cement as treatment for hypersensitive dentine. J Dent. 2008 Aug;36(8):565-78. Epub 2008 Jun 6.
2. Sauro S, Gandolfi MG, Prati C, Mongiorgi R. Oxalate-containing phytocomplexes as dentine desensitisers: an in vitro study. Arch Oral Biol. 2006 Aug;51(8):655-64. Epub 2006 Apr 17.
3. Zapletalová Z, Perina J Jr, Novotný R, ChmelÃcková H. Suitable conditions for sealing of open dentinal tubules using a pulsed Nd:YAG laser. Photomed Laser Surg. 2007 Dec;25(6):495-9.
4. Suge T, Kawasaki A, Ishikawa K, Matsuo T, Ebisu S. Ammonium hexafluorosilicate elicits calcium phosphate precipitation and shows continuous dentin tubule occlusion. Dent Mater. 2008 Feb;24(2):192-8. Epub 2007 Jun 1.
