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Choosing a Toothpaste: What’s the Big Deal?

Course Number: 565

Dentinal Hypersensitivity

“Pain derived from exposed dentin in response to chemical, thermal, tactile or osmotic stimuli which cannot be explained as arising from any other dental defect or disease.” 106 Dentinal hypersensitivity is a common problem that may impact as many as 74% of adults at some point, and an even greater proportion of periodontitis patients.107,108 Exposed dentin can be the result of enamel loss (from physical or chemical sources), or from gingival recession that exposes the root.109 This exposure results in sharp, transitory pain commonly in response to thermal (e.g., cold air), chemical, and tactile triggers. The condition is uncomfortable and can cause sufferers to avoid thorough toothbrushing or professional dental care for fear of pain.

Desensitizing agents that can be delivered via the dentifrice vehicle are an excellent first-line strategy for anti-sensitivity treatment. The two most commonly used agents are stannous fluoride (a third therapeutic benefit of SnF2 beyond caries and gingivitis prevention) and potassium nitrate (KNO3). The former, SnF2, forms a smear layer that occludes dentinal tubes. Potassium nitrate acts by disrupting the nerve impulse transmission to the pulp.110 Two large meta-analyses of anti-sensitivity toothpastes with various agents encompassing 178 clinical trials concluded that they provide significant benefits relative to a placebo, with the exception of strontium-based dentifrices.111,112Additionally, a 2021 meta-analyses by West et al., of 1287 subjects in randomized anti-sensitivity dentifrice clinical trials found 57% and 142% greater thermal and tactile benefits, respectively, for SnF2 toothpastes compared to negative control pastes. Compared to positive controls (KNO3 or arginine), SnF2 toothpastes gave a 22 % advantage for thermal sensitivity reduction.113

When choosing an anti-sensitivity toothpaste, in the US and Canada, clinicians and patients can select from stannous fluoride options found in stabilized SnF2 multi-benefit dentifrices. Examples include Colgate Total Plaque Pro-Release, Crest Pro-Health Gum and Sensitivity, Parodontax, and Sensodyne Sensitivity and Gum. An advantage of the SnF2 paste choice for dentinal hypersensitivity is that SnF2 provides other concurrent benefits (e.g., anti-caries, anti-gingivitis, anti-erosion) in one product.

Per Figure 3, dentinal hypersensitivity sufferers also have the option of sodium fluoride-based toothpastes with 5% potassium nitrate. Some marketed choices include Colgate Sensitive, Crest Pro-Health Sensitivity, and Aquafresh Sensitive.