Efficiency of desensitizing materials in xerostomic patients with head and neck cancer: a comparative clinical study

Abstract

Objectives

To assess the clinical effectiveness of four desensitizing materials in patients who are xerostomic due to radiotherapy for head and neck cancer (HNC) in comparison to a healthy group with normal salivation.

Methods and materials

The study was conducted as a split-mouth randomized clinical trial. Forty HNC patients (group A) and 46 healthy patients (group B) suffering from dentin hypersensitivity (DH) were included. Salivary flow was determined through a scialometric test. Hypersensitivity was assessed with air stimulus and tactile stimulus. The materials used as desensitizing agents were Vertise Flow, Universal Dentin Sealant, Clearfil Protect Bond, and Flor-Opal Varnish. The response was recorded before application of the materials, immediately after, and at 1 week, 4 weeks, and 12 weeks.

Results

Salivary flow rates in groups A/B were 0.15/0.53 mL/min (unstimulated) and 0.54/1.27 mL/min (stimulated), respectively. In group A, 100 hypersensitive teeth were included. Application of the desensitizing agents significantly decreased the hypersensitivity immediately and throughout the 4-week follow-up (p < 0.001). However, after the 12-week timepoint, a loss of efficacy was detected in all agents (p = 0.131). In group B, 116 hypersensitive teeth were included. The materials performed a more stable action, although a loss of effectiveness was detected at 12-week control (p = 0.297).

Conclusion

The efficiency of the desensitizing agents after the first application was similar in both groups. In the radiated group, this effect lasted for shorter periods than in healthy controls.

Clinical relevance

HNC patients with hyposalivation may be a new risk group for DH.

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References

  1. 1.

    Furness S, Worthington HV, Bryan G, Birchenough S, McMillan R (2011) Interventions for the management of dry mouth: topical therapies. Cochrane Database Syst Rev 7:CD008934. https://doi.org/10.1002/14651858.CD008934.pub2

    Article  Google Scholar 

  2. 2.

    Pinna R, Campus G, Cumbo E, Mura I, Milia E (2015) Xerostomia induced by radiotherapy: an overview of the physio-pathology, clinical evidence and management of the oral damage. The Clin Risk Manag 4:171–188. https://doi.org/10.2147/TCRM.S70652

    Article  Google Scholar 

  3. 3.

    López-Jornet MP, García-Teresa G, Viñas M, Vinuesa T (2011) Clinical and antimicrobial evaluation of a mouthwash and toothpaste for xerostomia: a randomized, double-blind, crossover study. J Dent 39:757–763. https://doi.org/10.1016/j.jdent.2011.08.007

    Article  PubMed  Google Scholar 

  4. 4.

    Hahnel S, Schwarz S, Zeman F, Schäfer L, Behr M (2014) Prevalence of xerostomia and hyposalivation and their association with quality of life in elderly patients in dependence on dental status and prosthetic rehabilitation: a pilot study. J Dent 42:664–670. https://doi.org/10.1016/j.jdent.2014.03.003

    Article  PubMed  Google Scholar 

  5. 5.

    Chambers MS, Rosenthal DI, Weber RS (2007) Radiation-induced xerostomia. Head Neck 29:58–63

  6. 6.

    Epstein JB, Robertson M, Emerton S, Phillips N, Stevenson-Moore P (2001) Quality of life and oral function in patients treated with radiation therapy for head and neck cancer. Head Neck 23:389–398

    Article  Google Scholar 

  7. 7.

    Miller EH, Quinn AI (2006) Dental considerations in the management of head and neck cancer patients. Otolaryngol Clin N Am 39:319–329

    Article  Google Scholar 

  8. 8.

    Ben-Aryeh H, Miron D, Berdicevsky I, Szargel R, Gutman D (1985) Xerostomia in the elderly: prevalence, diagnosis, complications and treatment. Gerodontology 4:77–82

    Article  Google Scholar 

  9. 9.

    Almståhl A, Wikström M (1998) Oral microflora in subjects with reduced salivary secretion. J Dent Res 78:1410–1416

    Article  Google Scholar 

  10. 10.

    Lingström P, Birkhed D (1993) Plaque pH and oral retention after consumption of starchy snack products at normal and low salivary secretion rate. Acta Odontol Scand 51:379–438

    Article  Google Scholar 

  11. 11.

    Cagetti MG, Mastroberardino S, Milia E, Cocco F, Lingström P, Campus G (2013) The use of probiotic strains in caries prevention: a systematic review. Nutrients 5:2530–2550. https://doi.org/10.3390/nu5072530

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Delaviz Y, Finer Y, Santerre JP (2014) Biodegradation of resin composites and adhesives by oral bacteria and saliva: a rationale for new material designs that consider the clinical environment and treatment challenges. Dent Mater 30:16–32. https://doi.org/10.1016/j.dental.2013.08.201

    Article  PubMed  Google Scholar 

  13. 13.

    Milia E, Pinna R, Filigheddu E, Eramo S (2016) Adhesive restorations and the oral environmental behaviour. In: Rudawska A (ed) Adhesives–applications and properties. Rijeka, InTech, pp 137–165

    Google Scholar 

  14. 14.

    Brännström M (1966) Sensitivity of dentine. Oral Surg Oral Med Oral Pathol 21:517–526

    Article  Google Scholar 

  15. 15.

    Jones SB, Parkinson CR, Jeffery P, Davies M, Macdonald EL, Seong J et al (2015) A randomised clinical trial investigating calcium sodium phosphosilicate as a dentine mineralising agent in the oral environment. J Dent 43:757–764. https://doi.org/10.1016/j.jdent.2014.10.005

    Article  PubMed  Google Scholar 

  16. 16.

    Brännström M, Linden LA, Johnson G (1968) Movement of dentinal and pulpal fluid caused by clinical procedures. J Dent Res 47:679–682

    Article  Google Scholar 

  17. 17.

    Van Loveren C (2013) Exposed cervical dentin and dentin hypersensitivity summary of the discussion and recommendations. Clin Oral Investig 17:S73–S76. https://doi.org/10.1007/s00784-012-0902-2

    Article  PubMed  Google Scholar 

  18. 18.

    Mantzourani M, Sharma D (2013) Dentine sensitivity: past, present and future. J Dent 41:S3–S17. https://doi.org/10.1016/S0300-5712(13)70002-2

    Article  PubMed  Google Scholar 

  19. 19.

    Pashley DH (1986) Dentine permeability, dentine sensitivity and treatment through tubule occlusion. J End 12:465–474

    Article  Google Scholar 

  20. 20.

    Pamir T, Özyazici M, Baloglu E, Önal B (2005) The efficacy of three desensitizing agents in treatment of dentine hypersensitivity. J Clin Pharm Ther 30:73–76

    Article  Google Scholar 

  21. 21.

    Duran I, Sengun A (2004) The long-term effectiveness of five current desensitizing products on cervical dentine sensitivity. J Oral Rehabil 31:351–356

    Article  Google Scholar 

  22. 22.

    Vano M, Derchi G, Barone A, Pinna R, Usai P, Covani (2018) Reducing dentine hypersensitivity with nano-hydroxyapatite toothpaste: a double-blind randomized controlled trial. Clin Oral Investig 22:313–320. https://doi.org/10.1007/s00784-017-2113-3

    Article  PubMed  Google Scholar 

  23. 23.

    Milia E, Castelli G, Bortone A, Sotgiu G, Manunta A, Pinna R, Gallina G (2012) Short-term response of three resin-based materials as desensitizing agents under oral environmental exposure. Acta Odontol Scand 71:599–609. https://doi.org/10.3109/00016357.2012.700063

    Article  PubMed  Google Scholar 

  24. 24.

    Pinna R, Bortone A, Sotgiu G, Dore S, Usai P, Milia E (2015) Clinical evaluation of the efficacy of one self-adhesive composite in dental hypersensitivity. Clin Oral Investig 19:1663–1672. https://doi.org/10.1007/s00784-014-1390-3

    Article  PubMed  Google Scholar 

  25. 25.

    Sreebny LM (1996) Xerostomia: diagnosis, management and clinical complications. In: Edgar WM, O’Mullane DM (eds) Saliva and oral health, 2nd edn. British Dental Association, London, pp 43–66

    Google Scholar 

  26. 26.

    Birang R, Poursamimi J, Gutknecht N, Lampert F, Mir M (2007) Comparative evaluation of the effects of Nd:YAG and Er:YAG laser in dentin hypersensitivity treatment. Lasers Med Sci 22:21–24

    Article  Google Scholar 

  27. 27.

    Ritter AV, de L Dias W, Miguez P, Caplan DJ, Swift EJ Jr (2006) Treating cervical dentin hypersensitivity with fluoride varnish. A randomized clinical study. J Am Dent Assoc 137:1013–1020

    Article  Google Scholar 

  28. 28.

    Wang L, Magalhães AC, Francisconi-Dos-Rios LF, Calabria MP, Araújo D, Buzalaf M, Lauris J, Pereira JC (2016) Treatment of dentin hypersensitivity using Nano-hydroxyapatite pastes: a randomized three-month clinical trial. Oper Dent 41:E93–E101. https://doi.org/10.2341/15-145-C

    Article  PubMed  Google Scholar 

  29. 29.

    Splieth CH, Tachou A (2013) Epidemiology of dentin hypersensitivity. Clin Oral Investig 17:S3–S8. https://doi.org/10.1007/s00784-012-0889-8

    Article  PubMed  Google Scholar 

  30. 30.

    Loh SY, Mcleod RW, Elhassan HA (2017) Trismus following different treatment modalities for head and neck cancer: a systematic review of subjective measures. Eur Arch Otorhinolaryngol. https://doi.org/10.1007/s00405-017-4519-6

  31. 31.

    Rees JS, Addy M (2004) A cross-sectional study of buccal cervical sensitivity in UK general dental practice and a summary review of prevalence studies. Int J Dent Hyg 2:64–69

    Article  Google Scholar 

  32. 32.

    McComb D, Erickson RL, Maxymiw WG, Wood RE (2002) A clinical comparison of glass ionomer, resin-modified glass ionomer and resin composite restorations in the treatment of cervical caries in xerostomic head and neck radiation patients. Oper Dent 27:430–437

    PubMed  Google Scholar 

  33. 33.

    Alghilan MA, Cook NB, Platt JA, Eckert GJ, Hara AT (2015) Susceptibility of restorations and adjacent enamel/dentine to erosion under different salivary flow conditions. J Dent 43:1476–1482. https://doi.org/10.1016/j.jdent.2015.10.007

    Article  PubMed  Google Scholar 

  34. 34.

    Kielbassa AM, Muntz I, Bruggmoser G, Schulte-Monting J (2002) Effect of demineralization and remineralization on microhardness of irradiated dentin. J Clin Dent 13:104–110

    PubMed  Google Scholar 

  35. 35.

    Fränzel W, Gerlach R, Hein HJ, Schaller HG (2006) Effect of tumour therapeutic irradiation on the mechanical properties of teeth tissue. Z Med Phys 16:148–154

    Article  Google Scholar 

  36. 36.

    Wijers OB, Levendag PC, Braaksma MM, Boonzaaijer M, Visch LL, Schmitz PI (2002) Patients with head and neck cancer cured by radiation therapy: a survey of the dry mouth syndrome in long-term survivors. Head Neck 24:737–747

    Article  Google Scholar 

  37. 37.

    Keilbassa AM et al; Grötz KA, Duschner H, Kutzner J, Thelen M, Wagner W (1998) Histographic study of the direct effects of radiation on dental enamel. Mund Kiefer Gesichts Chir 2:85–90

  38. 38.

    Galetti R, Santos-Silva AR, Antunes AN, Alves Fde A, Lopes MA, de Goes MF (2014) Radiotherapy does not impair dentin adhesive properties in head and neck cancer patients. Clin Oral Investig 18:1771–1778. https://doi.org/10.1007/s00784-013-1155-4

    Article  PubMed  Google Scholar 

  39. 39.

    da Cunha SR, Ramos PA, Haddad CM, da Silva JL, Fregnani ER, Aranha AC (2016) Effects of different radiation doses on the bond strengths of two different adhesive systems to enamel and dentin. J Adhes Dent 18(2):151–156. https://doi.org/10.3290/j.jad.a35841

    Article  PubMed  Google Scholar 

  40. 40.

    Lieshout HF, Bots CP (2014) The effect of radiotherapy on dental hard tissue--a systematic review. Clin Oral Investig 18:17–24. https://doi.org/10.1007/s00784-013-1034-z

    Article  PubMed  Google Scholar 

  41. 41.

    Bernard C, Villat C, Abouelleil H, Gustin MP, Grosgogeat B (2015) Tensile bond strengths of two adhesives on irradiated and nonirradiated human dentin. Biomed Res Int 2015:798972. https://doi.org/10.1155/2015/798972

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Vogl V, Hiller KA, Buchalla W, Federlin M, Schmalz G (2016) Controlled, prospective, randomized, clinical split-mouth evaluation of partial ceramic crowns luted with a new, universal adhesive system/resin cement: results after 18 months. Clin Oral Investig 20(9):2481–2492. https://doi.org/10.1007/s00784-016-1779-2

    Article  PubMed  Google Scholar 

  43. 43.

    Milia E, Cumbo E, Cardoso RJ, Gallina G (2012) Current dental adhesives systems. A narrative review. Curr Pharm Des 18:5542–5552

    Article  Google Scholar 

  44. 44.

    Kleverlaan CJ, Feilzer AJ (2005) Polymerization shrinkage and contraction stress of dental resin composites. Dent Mater 21:1150–1157

    Article  Google Scholar 

  45. 45.

    Kermanshahi S, Santerre JP, Cvitkovitch DG, Finery Y (2010) Biodegradation of resin–dentin interfaces increases bacterial microleakage. J Dent Res 89:996–1001. https://doi.org/10.1177/0022034510372885

    Article  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Spencer P, Ye Q, Misra A, Goncalves SE, Laurence JS (2014) Proteins, pathogens, and failure at the composite-tooth interface. J Dent Res 93:1243–1249. https://doi.org/10.1177/0022034514550039

    Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Milia E, Pinna R, Castelli G, Bortone A, Marceddu S, Garcia-Godoy F, Gallina G (2012) TEM morphological characterization of a one-step self-etching system applied clinically to human caries-affected dentin and deep sound dentin. Am J Dent 25:321–326

    PubMed  Google Scholar 

  48. 48.

    Pinna R, Maioli M, Eramo S, Mura I, Milia E (2015) Carious affected dentine: its behaviour in adhesive bonding. Aust Dent J 60:276–293. https://doi.org/10.1111/adj.12309

    Article  PubMed  Google Scholar 

  49. 49.

    Zhang SC, Kern M (2009) The role of host-derived dentinal matrix metalloproteinases in reducing dentin bonding of resin adhesives. Int J Oral Sci 1:163–176

    Article  Google Scholar 

  50. 50.

    Kalk WW, Vissink A, Spijkervet FK, Bootsma H, Kallenberg CG, NieuwAmerongen AV (2001) Sialometry and sialochemistry: diagnostic tools for Sjögren's syndrome. Ann Rheum Dis 60:1110–1116

    Article  Google Scholar 

  51. 51.

    Gillam DG (2013) Current diagnosis of dentin hypersensitivity in the dental office: an overview. Clin Oral Investig 17:S21–S29. https://doi.org/10.1007/s00784-012-0911-1

    Article  PubMed  Google Scholar 

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The authors declare that no financial relationships exist regarding any of the products involved in this study.

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Correspondence to Roberto Pinna.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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The study followed CONSORT guidelines and was registered at the US National Institutes of Health (ClinicalTrials.gov) # NCT02766127.

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Pinna, R., Milia, E., Usai, P. et al. Efficiency of desensitizing materials in xerostomic patients with head and neck cancer: a comparative clinical study. Clin Oral Invest 24, 2259–2269 (2020). https://doi.org/10.1007/s00784-019-03081-x

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Keywords

  • Dry mouth
  • Hyposalivation
  • Dentin hypersensitivity
  • Radiation therapy
  • Head and neck cancer