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Taking aim at dentin hypersensitivity

Dr Fotinos S. Panagakos is director of clinical research relations and strategy within the Research and Development division of Colgate-Palmolive Co.
Fred Michmershuizen, DTA

Fred Michmershuizen, DTA

Thu. 11 February 2010

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In an interview with Dental Tribune, Dr Fotinos S. Panagakos, director of clinical research relations and strategy within the Research and Development division of Colgate-Palmolive Co., discusses dentin hypersensitivity, its effect on patients and the dentists who treat them — and a new product that can help alleviate the condition.

How did you get interested in the area of dentin hypersensitivity?
The Colgate-Palmolive Co. has been very interested in the area of dentin hypersensitivity for many years. We have had a potassium-based sensitivity toothpaste available in most countries for consumers to alleviate the pain associated with dentin hypersensitivity. Recently, Colgate launched a new dentin sensitivity product, Colgate Sensitive Pro-Relief Paste, based on the Pro-Argin technology. The Pro-Argin technology consists of arginine, a naturally occurring amino acid, and insoluble calcium, in the form of calcium carbonate. These ingredients are delivered in a prophy paste containing a mild abrasive system and can be applied with a prophylaxis cup or a cotton tipped applicator to teeth that exhibit dentin hypersensitivity. Mechanism of action studies have shown that this technology physically seals dentin tubules with a plug that contains arginine, calcium carbonate and phosphate. This plug, which is resistant to normal pulpal pressures and to acid challenge, effectively reduces dentin fluid flow and, thereby, reduces sensitivity.

A number of studies have been published recently supporting the launch of this new product. Laboratory tests demonstrating the product’s mode of action, as well as clinical trails demonstrating instant and long lasting relief of dentin hypersensitivity, have been presented to the dental profession as evidence that the Pro-Argin technology provides instant and lasting relief of dentin hypersensitivity. The reader can access the full range of research studies on the Colgate dental professional web site, located at www.colgateprofessional.com.

Can you please explain what causes dentin hypersensitivity and, specifically, what is going on with a patient biologically?
Dentin is normally covered by enamel or cementum. Due to any number of factors, including abrasion or periodontal disease causing gingival recession, or erosion removing the enamel, the underlying dentin and dentin tubules can become exposed. An external stimulus, such as a change in external temperature, air movement, or physical stimulus can cause discomfort for the patient. The external stimulus is usually transitory, and the discomfort subsides shortly after the stimulus is removed.

The accepted theory of how dentin hypersensitivity pain is transmitted suggests that pressure or ionic changes in the fluid that exists in the dentin tubules stimulates the pain experienced by the patient. This is often referred to as the “hydrodynamic theory.” Inside the dentin tubule, a change in osmotic pressure causes fluid movement, which is transmitted as a stimulus to the odontoblastic process and fires the afferent nerve ending in the dentin tubule.

Please describe how this condition affects patients — and how it affects the dentists who treat them.
Dentin hypersensitivity is growing in incidence and is often a chief concern among patients. Dentin hypersensitivity’s main effect on individuals is the impact on quality of life. Patients have to avoid certain foods and beverages that may trigger a painful response, thus reducing the type of foods and drinks one can enjoy. In the dental office, what is normally a routine visit may end up being a very uncomfortable appointment for a patient with dentin hypersensitivity. Simple procedures, such as scaling and a prophylaxis, may be painful. And, at times, the pain associated with dentin hypersensitivity may cause a patient to skip dental appointments.

The diagnosis of dentin hypersensitivity often poses a challenge for the dental professional. The cause and description of the pain reported by the patient can vary and is often not adequate to make a definitive diagnosis. The dental professional often needs to perform a thorough exam, as well as additional tests, to determine why the pain is occurring. The exam and test can help develop a definitive diagnosis, which allows the dental professional to rule out other possible causes of the pain (periodontal disease, caries, etc) and then implement an appropriate treatment plan for addressing the problem. Once the diagnosis is made, treating the problem can also be a challenge. Many products today do not work instantly or last following application, or may take time, sometimes up to weeks, for an effect to be felt by the patient.

What are some of the ways that dentists can diagnose and treat dentin hypersensitivity today? How is this different from, say, five or ten years ago?
The treatment and prevention of dentin hypersensitivity, for many years, has focused on the eliminating the ability of the causative agent to stimulate discomfort. This has resulted in the development of two major classes of products — agents that occlude dentinal tubules and desensitizing agents that interfere with transmission of nerve impulses.

Occluding agents act by physically covering or “plugging” the open, exposed dentinal tubules, thus preventing the effect of thermal changes or physical stimuli caused by the movement of dentinal fluid due to osmotic pressure changes. These agents can be applied professionally in the dental office or by the patient through the use of home care products. The second approach recommended by dental professionals to help prevent and/or treat dentinal hypersensitivity is through the use of OTC desensitizing agents. Desensitizing agents work by altering the levels of charged molecules in the dentinal tubule fluid. The most commonly used agent is potassium nitrate, usually delivered in a dentifrice that is applied twice daily by the patient during regularly tooth brushing. The potassium ions enter the dentinal tubule fluid, reducing the excitation caused by the movement of fluid in the dentinal tubules, and blocking the transmission of the stimulus from the odontoblastic process to the nerve in the pulp chamber. Most products require continued use over a four- to eight-week period before relief may be realized by the patient. In addition, the product often needs to be continued in order to maintain the relief afforded by the potassium nitrate.

For those patients who do not positively respond to the use of occluding agents or desensitizing agents, the dental professional may turn to covering the exposed dentin using direct or indirect restorations. Finally, periodontal surgery, involving the grafting of gingival tissue to cover the exposed dentin may be performed.

Colgate Sensitive Pro-Relief paste seeks to address some of the deficiencies seen in the currently available occluding and desensitizing products. Treatment is simple. The paste is gentle to gingival tissues, does not elicit pain when applied and has a pleasant mint flavor. The dental professional applies a small amount of paste to sensitive tooth surfaces with a slowly rotating soft prophy cup. It can also be spot applied using a cotton-tipped applicator. Paste can also be applied to furcations and other hard-to-reach areas with a microbrush. The dental professional should carefully burnish the Colgate Sensitive Pro-Relief paste into all sensitive areas, focusing on the CEJ and exposed cementum and dentin. And, as mentioned previously, clinical research has demonstrated both an instant and long lasting relief of dentin hypersensitivity in patients who have had the product applied, versus a placebo prophy paste.

Is there anything you would like to add?
Dentin hypersensitivity is a common and growing problem among patients. Effective diagnosis is key in the management of this problem. Use of an in office product such as Colgate Sensitive Pro Relief paste provides instant and long lasting relief for the patient and a comfortable, productive dental appointment for both patient and dental professional. As with most things in dentistry, trying a product first before committing to it is essential. I encourage my dental professional colleagues to try a sample of this new product to see for themselves how truly effective it is in managing dentin hypersensitivity, and to consider incorporating it into the office’s patient management process.

Attend a CE-accredited Webinar with Dr Fotinos Panagakos

On Tuesday, 30 March, 2010 at 7 p.m. EST, Dr Fotinos S. Panagakos will offer a free one-hour Webinar, Dentin Hypersensitivity—New Management Approaches, followed by a live question-and-answer session with the online audience.

Dentin hypersensitivity continues to be a problem for patients and practitioners alike. The increase in erosion, patient aging and recessions, and periodontal disease all have resulted in an increased occurrence of dentin hypersensitivity. Correct diagnosis and effective treatment are critical to relieving a problem, which can seriously impact a patient’s quality of life.

At the conclusion of this course, the participant will know and understand the following:

• The biology of dentin hypersensitivity.
• The current methods of treating dentin hypersensitivity.
• Learn about new approaches to treating dentin hypersensitivity.

Attend the Webinar to find out about new management approaches in dentin hypersensitivity!

Participants will receive one ADA CERP C.E. credit. Attendance is free for the live broadcast on March 30. After that, the recorded archive will be available for $95. Attendees only require an online computer with audio capabilities. To register, visit www.DTStudyClub.com and click on Online Courses.

About Prof Panagakos

Dr Fotinos S. Panagakos received his DMD from UMDNJ-New Jersey Dental School and his PhD in biochemistry and molecular biology from UMDNJ-Graduate School of Biomedical Sciences in June 1992. In May 1999, he received his masters in education from Seton Hall University, and in December 2007 he received his master’s in business administration from Lehigh University.

Panagakos served for 14 years as a faculty member at New Jersey Dental School. While at New Jersey Dental School, Panagakos served in a number of administrative positions, including group practice administrator, director of environmental safety and associate dean of academic affairs. Panagakos was active in both the undergraduate and graduate dental teaching programs at NJDS and had an active research program, examining the role of inflammatory proteins on connective tissue biology and function.

In June 2005, Panagakos joined the Colgate Palmolive Oral Care Clinical Research Department as an associate director. His responsibilities included clinical research and development support for the North American Oral Care division and Colgate Oral Pharmaceuticals. In January 2006, Panagakos was promoted to director of professional relations and scientific affairs — North America. In that role, Panagakos served as the primary liaison between Colgate and professional and academic communities in the United States, coordinated all professional education programs and served as the scientific affairs liaison to the professional community. Since April 2009, Panagakos is the director of clinical research relations and strategy within the Research and Development division of Colgate-Palmolive Co. His responsibilities include oversight of clinical studies, scientific communication strategy, and liaison with dental professional organizations.

Pro-Argin is a trademark of Colgate-Palmolive Co.

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