© 2016 Yang et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you
hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
Clinical, Cosmetic and Investigational Dentistry 2016:8 1–14
Clinical, Cosmetic and Investigational Dentistry Dovepress
submit your manuscript | www.dovepress.com
Dovepress 1
O r I g I n a l r e s e a r C h
open access to scientific and medical research
Open access Full Text article
http://dx.doi.org/10.2147/CCIDE.S95660
arginine-containing desensitizing toothpaste for the treatment of dentin hypersensitivity: a meta-analysis
Zheng-yan Yang1,2
Fei Wang1,2
Keke lu1,2
Yue-heng li1,2
Zhi Zhou1,2
1Department of Preventive Dentistry, The College of stomatology, 2Department of Preventive Dentistry, The affiliated hospital of stomatology, Chongqing Medical University, Chongqing, People’s republic of China
Correspondence: Zhi Zhou The Affiliated Hospital of Stomatology, Chongqing Medical University, no 426, songshibei road, Yubei District, Chongqing 401147, People’s republic of China Tel +86 130 6238 1906 Fax +86 23 8886 0222 email [email protected]
Objective: To estimate the effect of arginine-containing desensitizing toothpaste on dentin
hypersensitivity (DH).
Methods: Databases including China National Knowledge Infrastructure, VIP Database for
Chinese Technical Periodicals, China Biology Medicine disc, Wangfang Data, PubMed, Web of
Science, and Cochrane Trials Register were searched, and Google was used as a supplementary
tool to search for information through February 2014. Randomized controlled trials (RCTs) of
the treatment of DH with arginine-containing toothpaste were included. Relevant information
was extracted, and a quality evaluation was performed. Meta-analyses were performed using
RevMan 5.2 software.
Results: Eighteen RCTs with 1,423 patients were included. The results of the meta-analyses
demonstrated that at days 0 and 3; weeks 2, 4, and 8; and more than 12 weeks, arginine-
containing toothpaste led to significantly improved results on the tactile sensitivity test
(standardized mean difference [SMD] =1.95, 95% confidence interval [CI] [1.14, 2.76]) and the
air-blast test (SMD =−1.60, 95% CI [−2.14, −1.05]) at 4 weeks and the tactile sensitivity test
(SMD =2.01, 95% CI [1.41, 2.61]) and the air-blast test (SMD =−1.41, 95% CI [−1.83, −0.98])
at 8 weeks compared to toothpastes containing other desensitizing components, thus indicating
a superior therapeutic effect of arginine-containing desensitizing toothpaste. However, no
significant differences between arginine-containing toothpaste and toothpastes containing other
desensitizing components were observed in the air-blast test at days 0 and 3 and week 2 and in
the tactile sensitivity and air-blast tests at more than 12 weeks.
Conclusion: The current evidence indicates that arginine-containing toothpaste is effective for
DH. However, further high-quality, large-sample RCTs are needed.
Keywords: arginine-containing toothpastes, dentin hypersensitivity, meta-analysis, random-
ized controlled trial
IntroductionDentin hypersensitivity (DH) is a frequently reported dental condition that is
typically characterized by brief, sharp pain that cannot be ascribed to any other form
of dental defect or pathology and arises from exposed dentin in response to thermal,
evaporative, tactile, osmotic, or chemical stimuli.1 DH is increasingly recognized as
an important issue to be addressed from both diagnostic and problem-management
perspectives because the improved success of caries prevention and periodontal dis-
ease management measures have resulted in improved oral health status and dentition
function throughout life. The reported prevalence of DH ranges from 2% to 57%
worldwide.2 A commonly supported mechanism for DH is the hydrodynamic theory,
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry 2016:8submit your manuscript | www.dovepress.com
Dovepress
Dovepress
2
Yang et al
which assumes that painful stimulation increases fluid flow
within the dentinal tubules, causing activation of resident
baroceptors.3 Accordingly, the ideal treatment for DH should
reduce fluid flow within the dentinal tubules or block the pulp
nerve response. Dozens of in-office sensitivity treatments
and mass-market sensitivity relief toothpastes are available
worldwide, and fluoride dentifrice is generally accepted.
There are two types of sensitivity relief toothpastes. One
type contains potassium salts; the potassium ions have a
depolarizing effect on electrical nerve conduction, thereby
causing nerve fibers to be less excitable by stimuli4 and,
consequently, reducing the patient’s sensation of pain. The
other type of sensitivity relief toothpaste includes dentifrices
that occlude the exposed dentin tubules to block the hydro-
dynamic mechanism of pain stimulation. Examples include
strontium-containing toothpaste and stannous-containing
toothpaste,5–10 but the effects of these toothpastes are inferior
to potassium-containing toothpastes. Clinical studies have
demonstrated the efficacy of arginine-containing dentifrices
in reducing DH.11–29 To assess whether arginine-containing
dentifrices are efficacious in reducing DH compared with
toothpastes containing potassium, strontium, or fluoride,
a systematic review of the literature is required. We
therefore performed a meta-analysis to assess the efficacy of
arginine-containing dentifrices compared with toothpastes
containing potassium, strontium, or fluoride for future clini-
cal applications.
Materials and methodsAll experimental procedures in this study were approved by
the ethics committee of the Stomatology Hospital Affiliated
to Chongqing Medical University.
eligibility criteria1. Inclusion criteria.
1.1. Research design: randomized controlled trials
(RCTs) published in full; there were no limitations
on language.
1.2. Patient: studies performed on adult humans
(age .18 years) with a clinical diagnosis of DH
caused by cervical dentin exposure.
1.3. Intervention and comparison: the test group used
an arginine-containing dentifrice daily, whereas
the control group used toothpaste containing other
desensitizing components daily.
1.4. Outcome: the results were evaluated based on the
score of the improvement of dentin sensitivity
(tactile sensitivity and air-blast sensitivity).
2. Exclusion criteria: 1) in vitro study; 2) review literature;
3) studies not reporting complete data; and 4) repeated
published literature or papers with duplicate data.
literature search of clinical trialsA thorough literature search of computerized databases,
including PubMed, Cochrane Controlled Clinical Trial
Register (First Journal, 2014), Web of Science, China
National Knowledge Infrastructure, VIP Database for
Chinese Technical Periodicals, China Biology Medicine disc,
and the Wangfang Data, was performed through February
2014 by two independent researchers to identify RCTs of
arginine-containing dentifrices compared with toothpastes
containing other desensitizing components with a cura-
tive effect on DH. To avoid selection bias, no restrictions
were applied with regard to language or year. Moreover,
to identify unpublished literature and further examine
trends in the literature, the Google search engine was used.
The Chinese keywords were arginine (精氨酸), toothpaste
(牙膏), tooth (牙齿), dentin (牙本质), and hypersensitivity
(过敏,敏感). The English keywords were toothpaste, tooth
paste, dentifrice, dentifrices, desensitize, agent, efficacy,
effect, dentin, dentine, tooth, teeth, root, hypersensitivity,
hypersensitive, sensitivity, sensitive, and oversensitive. In
the case of PubMed, the specific retrieval strategy presented
in Figure 1 was used.
literature screening, data extraction, and quality assessmentLiterature reviews were performed by two independent
evaluators to include and exclude literature according to the
literature and to cross-check the details. The title was first
read; if the title met the eligibility criteria, the full text was
read. If the full text met the eligibility criteria, the study was
included. Disagreements were resolved in consultation with
a third researcher.
The data was then extracted to a table and the RCT bias
risk assessment tool recommended by the Cochrane Review-
ers’ Handbook 5.1.030 was used to evaluate the risk of bias
in the included studies.
statistical analysisData were combined for the meta-analysis using a statistical
software package (RevMan software, version 5.2, The Nordic
Cochrane Center, The Cochrane Collaboration, Copenhagen,
Denmark). Continuous outcomes used the standardized
mean difference (SMD) or mean difference (MD) with
95% confidence intervals (CIs) as effect measures, whereas
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry 2016:8
#1 randomized controlled trials
#2 random allocation
#3 #1 or #2
#4 Arginine
#5 (toothpaste or tooth paste or dentifrice or dentifrices or (desensitizer and (agent or efficacy or effect)))
#6 #4 and #5
#7 (dentin or dentine or tooth or teeth)
#8 (hypersensitivity or hypersensitivie or sensitivity or sensitive or over-sensitive)
#9 #7 and #8
#10 (endodont* or whitening or cracked (tooth or teeth) or caries)
#11 #3 and #6 and #9 not #10
Figure 1 Specific retrieval strategy for PubMed searches.Note: *Wildcard symbol for truncation searching.
submit your manuscript | www.dovepress.com
Dovepress
Dovepress
3
arginine-containing desensitizing toothpaste for dentin hypersensitivity
dichotomous outcomes used the risk ratio with 95% CIs
as effect measures. Heterogeneity was assessed using the
χ2-based method and I2 measurement. P-values and 95%
CIs were then calculated. For P,0.1 and I2.50%, the
random-effect model was used; otherwise, the fixed-effect
model was used. Descriptive analysis was performed when
the data could not be combined.
sensitivity analysisSensitivity analysis was performed by removing one result
and performing statistical analysis again. The new result
was compared with the original to explore the effects of
removing the result on the effect size. If no difference was
observed, the results of the meta-analysis were considered
reliable.
grading of the evidenceThe GRADE (Grading of Recommendations Assessment,
Development, and Evaluation) approach was adopted to
evaluate the overall quality of the evidence.31,32 We applied the
following definitions of quality of the evidence.33
• High quality: further research is unlikely to change con-
fidence in the estimate of the effect. There are no known
or suspected reporting biases; all domains are fulfilled.
• Moderate quality: further research is likely to have an
important effect on confidence in the estimate of the effect
and might change the estimate; one of the domains was
not fulfilled.
• Low quality: further research is likely to have an impor-
tant effect on confidence in the estimate of the effect and
is likely to change the estimate; two of the domains were
not fulfilled.
• Very low quality: we are uncertain about the estimate;
three of the domains were not fulfilled.
Resultsliterature searchElectronic and manual searches identified 382 articles. After
step-by-step screening, 18 studies including 1,423 patients
were qualified for inclusion in the meta-analysis. A PRISMA
(Preferred Reporting Items for Systematic Reviews and Meta-
Analyses) flowchart of the complete study-selection process is
illustrated in Figure 2. The basic characteristics of the included
studies are presented in Table 1. The methodological quality
analysis of the included studies is presented in Table 2.
Meta-analysis resultsBased on the interventions evaluated, the included studies were
classified into three types: arginine-containing dentifrice com-
pared with potassium-containing toothpastes, arginine-containing
dentifrice compared with strontium-containing toothpastes,
382 articles were found by the electronic and manual searches:
Records identified through database searching (n=216):
PubMed (n=60), the Cochrane Central Register of Controlled Trials (n=36),
Web of Science (n=25), CBM (n=3), CNKI (n=37), VIP (n=2),
Wanfang Data (n=58)
Records identified through other sources (n=166)
238 repeating documents were removed
110 articles were excluded as they did not meetthe inclusion standards
34 records screened
Full-text articles assessed for eligibility(n=34)
Studies included in quantitativesynthesis (meta-analysis) (n=18)
16 articles excluded accordingto the exclusion criteria (n=16)
Figure 2 PRISMA flowchart of the search strategy.Abbreviations: CBM, China Biology Medicine; CnKI, China national Knowledge Infrastructure; PrIsMa, Preferred reporting Items for systematic reviews and Meta-analyses.
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry 2016:8submit your manuscript | www.dovepress.com
Dovepress
Dovepress
4
Yang et al
Tab
le 1
Bas
ic c
hara
cter
istic
s of
the
incl
uded
stu
dies
Incl
uded
st
udie
sC
ases
(T
/C)
Mea
n co
urse
Cou
ntry
Deg
ree
of s
ensi
tivi
ty
befo
re u
se (
TS
and
AS)
Inte
rven
tion
mea
sure
Det
ecti
on
mea
sure
sD
urat
ion
of
follo
w-u
pR
esul
ts (
TR
and
RR
)
Tes
tC
ontr
olT
acti
leA
ir
schi
ff et
al25
32/3
6n
rU
saT
s 10
–50
g of
forc
e an
d
as
2 or
38%
arg
inin
eFl
uori
de√
√12
wee
ksT
r .
rr
at
imm
edia
tely
, 4, 1
2 w
eeks
(P,
0.05
)
aya
d et
al23
38/3
9n
rC
anad
aT
s 10
–50
g of
forc
e an
d
as
2 or
38%
arg
inin
e2%
pot
assi
um√
√8
wee
ksT
r .
rr
at
3 da
ys (
ns)
T
r .
rr
at
2, 4
, 8 w
eeks
(P,
0.05
)C
umm
ins11
40/3
9n
rn
rT
s 10
–50
g of
forc
e an
d
as
2 or
34%
arg
inin
ePo
tass
ium
/flu
orid
e√
√8
wee
ksT
r .
rr
at
2, 8
wee
ks (
P,0.
05)
Doc
imo
et a
l1340
/40
nr
Italy
Ts
10–5
0 g
of fo
rce
and
a
s 2
or 3
8% a
rgin
ine
5% p
otas
sium
√√
8 w
eeks
Tr
. r
r in
as
at 1
wee
k (n
s)
Tr
. r
r a
t 2,
4, 8
wee
ks (
P,0.
05)
Doc
imo
et a
l1440
/40
nr
Italy
Ts
10–5
0 g
of fo
rce
and
a
s 2
or 3
8% a
rgin
ine
2% p
otas
sium
√√
8 w
eeks
Tr
. r
r a
t 2,
4, 8
wee
ks (
P,0.
05)
Kak
ar e
t al
1646
/42
nr
Indi
aT
s 10
–50
g of
forc
e an
d
as
2 or
38%
arg
inin
e2%
pot
assi
um√
√8
wee
ksT
r .
rr
at
2, 4
, 8 w
eeks
(P,
0.05
)
Kak
ar e
t al
1734
/40
nr
Indi
aT
s 10
–50
g of
forc
e an
d
as
2 or
38%
arg
inin
eFl
uori
de√
√8
wee
ksT
r .
rr
at
2, 4
, 8 w
eeks
(P,
0.05
)
Que
et
al15
40/4
1n
rPe
ople
’s r
epub
lic
of C
hina
Ts
10–5
0 g
of fo
rce
and
a
s 2
or 3
8% a
rgin
ine
Fluo
ride
√√
8 w
eeks
Tr
. r
r a
t 2,
4, 8
wee
ks (
P,0.
05)
Doc
imo
et a
l1950
/50
nr
Usa
Ts
10–5
0 g
of fo
rce
and
a
s 2
or 3
8% a
rgin
ine
8% s
tron
tium
√√
8 w
eeks
Tr
. r
r a
t 2,
4, 8
wee
ks (
P,0.
05)
schi
ff et
al18
61/6
0n
rU
saT
s 10
–50
g of
forc
e an
d
as
2 or
38%
arg
inin
e8%
str
ontiu
m√
√16
wee
ksT
r .
rr
at
8, 1
0, 1
6 w
eeks
(P,
0.05
)
nat
hoo
et a
l2142
/41
nr
Usa
Ts
10–5
0 g
of fo
rce
and
a
s 2
or 3
8% a
rgin
ine
5% p
otas
sium
√√
3 da
ysT
r .
rr
at
imm
edia
tely
, 3 d
ays
(P,
0.05
)
Fu e
t al
2241
/40
nr
Peop
le’s
rep
ublic
of
Chi
naT
s 10
–50
g of
forc
e an
d
as
2 or
38%
arg
inin
eFl
uori
de√
√3
days
Tr
. r
r a
t im
med
iate
ly, 3
day
s (P
,0.
05)
aya
d et
al12
41/4
0n
rC
anad
aT
s 10
–50
g of
forc
e an
d
as
2 or
38%
arg
inin
e5%
pot
assi
um√
√3
days
Tr
. r
r a
t im
med
iate
ly, 3
day
s (P
,0.
05)
ham
lin e
t al
2422
/23
nr
Usa
Ts
10–5
0 g
of fo
rce
and
a
s 2
or 3
8% a
rgin
ine
Fluo
ride
√√
Imm
edia
tely
Tr
. r
r a
t im
med
iate
ly (
P,0.
05)
Kap
fere
r et
al26
29/2
9n
ra
ustr
iaa
s 2
or 3
8% a
rgin
ine
Fluo
ride
√√
12 w
eeks
Tr
. r
r a
t im
med
iate
ly, 4
, 12
wee
ks (
P,0.
05)
li e
t al
2050
/50
nr
Usa
Ts
10–5
0 g
of fo
rce
and
a
s 2
or 3
8% a
rgin
ine
Fluo
ride
√√
1 w
eek
Tr
. r
r a
t im
med
iate
ly, 1
wee
k (P
,0.
05)
ham
lin e
t al
2746
/49
nr
Usa
Ts
10–5
0 g
of fo
rce
and
a
s 2
or 3
8% a
rgin
ine
Fluo
ride
√√
24 w
eeks
Tr
. r
r a
t im
med
iate
ly, 8
, 24
wee
ks (
P,0.
05)
he
et a
l2940
/40
nr
Peop
le’s
rep
ublic
of
Chi
naU
ncle
ar8%
arg
inin
e0.
454%
st
ront
ium
Va
s√
2 w
eeks
Tr
. r
r a
t im
med
iate
ly, 3
day
s, 2
wee
ks (P
,0.
05)
he
et a
l2841
/40
nr
Peop
le’s
rep
ublic
of
Chi
naU
ncle
ar8%
arg
inin
est
ront
ium
Va
s√
3 da
ysT
r .
rr
at
imm
edia
tely
, 3 d
ays
(P,
0.05
)
Abb
revi
atio
ns: T
/C, t
est
dent
ifric
e/co
ntro
l den
tifri
ce; n
r, n
o re
port
; Ts,
tac
tile
hype
rsen
sitiv
ity s
timul
i sco
re; a
s, a
ir-b
last
stim
uli s
core
; Tr
, mea
n pe
rcen
t re
duct
ion
from
bas
elin
e in
the
tes
t de
ntifr
ice
grou
p; r
r, m
ean
perc
ent
redu
ctio
n fr
om b
asel
ine
in t
he c
ontr
ol d
entif
rice
gro
up; V
as,
vis
ual a
nalo
g sc
ale.
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry 2016:8 submit your manuscript | www.dovepress.com
Dovepress
Dovepress
5
arginine-containing desensitizing toothpaste for dentin hypersensitivity
and arginine-containing dentifrice compared with fluoride
toothpastes. We evaluated the tactile and air-blast DH scores
of the arginine-containing dentifrice with control toothpastes at
days 0 and 3; weeks 2, 4, and 8; and more than 12 weeks.
Comparison of instant tactile hypersensitivity between arginine-containing dentifrice group and the control groupInstant tactile hypersensitivity was compared between
the arginine-containing dentifrice group (313 persons)
and the control group (321 persons). A random-effect
model was used in the meta-analysis due to statistical
heterogeneity among the studies. The analysis excluded
Kapferer et al’s study26 (because the 95% CI lines were
invalid vertical lines and the results were not significant).
The mean tactile hypersensitivity scores measured
immediately (0 day) were significantly higher for the
arginine-containing dentifrice group than the control group
(SMD =1.66, 95% CI [1.00, 2.31], P,0.00001), indicat-
ing that the arginine-containing dentifrice was superior
to toothpastes containing other desensitizing components
(Figure 3).
Table 2 Methodological quality analysis of the included studies
Included studies
Sequence generation
Allocation concealment
Blinding participants
Free of incomplete data bias
Free of selective reporting
Other sources of bias
schiff et al25 Unclear Unclear Yes Yes no noayad et al23 Unclear Yes Yes Yes no noCummins11 Unclear Unclear Yes Yes no noDocimo et al13 Unclear Yes Yes Yes no noDocimo et al14 Unclear Yes Yes Yes no noKakar et al16 Unclear Yes Yes Yes no noKakar et al17 Unclear Yes Yes Yes no noQue et al15 Yes Unclear Yes Yes no noDocimo et al19 Unclear Unclear Yes Yes no noschiff et al18 Yes Yes Yes Yes no nonathoo et al21 Unclear Unclear Yes Yes no noFu et al22 Unclear Unclear Yes Yes no noayad et al12 Unclear Yes Yes Yes no nohamlin et al24 Unclear Unclear Yes Yes no noKapferer et al26 Unclear Unclear Yes Yes no noli et al20 Unclear Yes Yes Yes no nohamlin et al27 Unclear Unclear Yes Yes no nohe et al28 Unclear Unclear Yes Yes no nohe et al29 Unclear Unclear Yes Yes no no
ExperimentalStudy or subgroup Mean MeanSD SDTotal Total Weight
Control
1.15.1 Arginine vs potassium: instant
Ayad et al12
Nathoo et al21
Subtotal (95% CI)
Heterogeneity: τ2=2.03; χ2=20.69, df =1 (P<0.00001); l2=95%Test for overall effect: Z=2.63 (P=0.009)
1.15.3 Arginine vs fluoride: instant
Fu et al22
Hamlin et al24
Hamlin et al27
Kapferer et al26
Schiff et al25
Subtotal (95% CI)
Total (95% CI)
Heterogeneity: τ2=0.66; χ2=41.96, df =4 (P<0.00001); l2=90%
Heterogeneity: τ2=0.81; χ2=87.23, df =7 (P<0.00001); l2=92%
Test for subgroup difference: χ2=1.73, df =2 (P=0.42); l2=0%
Test for overall effect: Z=3.35 (P=0.0008)
Test for overall effect: Z=4.97 (P<0.00001)
1.15.2 Arginine vs strontium: instant
Li et al20
Subtotal (95% CI)
Heterogeneity: not applicable
Test for overall effect: Z=6.70 (P<0.00001)
33.17
35.36
29.02
25.62
39.89
1.7
25.62
36.1
14.86
8.07
14.28
5.22
11.57
2
5.22
10.17
41
4283
41
32
46
29
32180
313
5050
40
4181
40
36
49
29
36190
321
5050
12.6%
11.7%24.3%
12.8%
12.3%
12.9%
12.6%
12.3%62.8%
100.0%
12.9%12.9%
1.70 (1.19, 2.21)
3.76 (3.03, 4.49)2.71 (0.69, 4.73)
1.20 (0.73, 1.68)
2.14 (1.54, 2.75)
1.03 (0.60, 1.46)
−0.05 (−0.57, 0.46)
−4 −2Favors (control) Favors (experimental)
0 2 4
2.14 (1.54, 2.75)1.28 (0.53, 2.03)
1.66 (1.00, 2.31)
1.53 (1.08, 1.98)1.53 (1.08, 1.98)
14.38
13.54
15.88
14.31
26.63
1.8
14.31
20
4.11
0.37
5.3
5.22
13.71
1.8
5.22
10.69
Std mean differenceIV, random, 95% CI
Std mean differenceIV, random, 95% CI
Figure 3 Meta-analysis of the comparison of instant tactile hypersensitivity between the arginine-containing dentifrice group and the control group.Abbreviations: SD, standard deviation; CI, confidence interval; Std, standardized; df, degree of freedom.
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry 2016:8submit your manuscript | www.dovepress.com
Dovepress
Dovepress
6
Yang et al
Comparison of instant air-blast hypersensitivity between the arginine-containing dentifrice group and control groupInstant air-blast hypersensitivity was compared between the
arginine-containing dentifrice group (384 persons) and the
control group (388 persons). A random-effect model was used
in the meta-analysis due to statistical heterogeneity among
the studies. Because the total 95% CI lines were invalid
vertical lines and the results were not significant, we con-
cluded that the immediate effects of the arginine-containing
dentifrice and toothpastes containing other desensitizing
components for the treatment of DH did not differ signifi-
cantly (Figure 4).
Comparison of 3-day tactile hypersensitivity between the arginine-containing dentifrice group and control groupThree-day tactile hypersensitivity was compared between the
arginine-containing dentifrice group (162 persons) and the
control group (160 persons). A random-effect model was
used in the meta-analysis due to statistical heterogeneity
among the studies. The mean tactile hypersensitivity scores
were significantly higher in the arginine-containing dentifrice
group than the control group at 3 days (SMD =2.21, 95%
CI [1.13, 3.29], P,0.0001). We thus concluded that the
arginine-containing dentifrice was superior to toothpastes
containing other desensitizing components (Figure 5).
Comparison of 3-day air-blast hypersensitivity between the arginine-containing dentifrice group and control groupThree-day air-blast hypersensitivity was compared between the
arginine-containing dentifrice group (202 persons) and the
control group (200 persons). A random-effect model was used
in the meta-analysis due to statistical heterogeneity among the
studies. Ayad et al’s study23 was excluded because the total
95% CI lines were invalid vertical lines and the results were
not significant. We concluded that the effects of the arginine-
containing dentifrice and the toothpastes containing other
desensitizing components did not differ significantly for the
treatment of DH at 3 days (Figure 6).
Comparison of 2-week tactile hypersensitivity between the arginine-containing dentifrice group and control groupTwo-week tactile hypersensitivity was compared between
the arginine-containing dentifrice group (323 persons) and
the control group (327 persons). A random-effect model was
used in the meta-analysis due to statistical heterogeneity
among the studies. The mean tactile hypersensitivity scores
were significantly higher in the arginine-containing dentifrice
group than the control group at 2 weeks (SMD =1.20, 95%
CI [0.84, 1.57], P,0.00001). We thus concluded that the
arginine-containing dentifrice was superior to toothpastes
containing other desensitizing components (Figure 7).
ExperimentalStudy or subgroup Mean MeanSD SDTotal Total Weight
Control
1.16.1 Arginine vs potassium: instant
Ayad et al12
Nathoo et al21
Subtotal (95% CI)
Heterogeneity: τ2=0.45; χ2=6.80, df =1 (P=0.009); l2=85%Test for overall effect: Z=3.97 (P<0.0001)
1.16.3 Arginine vs fluoride: instant
Fu et al22
Hamlin et al24
Hamlin et al27
Kapferer et al26
Schiff et al25
Subtotal (95% CI)
Total (95% CI)
Heterogeneity: τ2=0.14; χ2=11.63, df =4 (P=0.02); l2=66%
Heterogeneity: τ2=2.30; χ2=296.87, df =9 (P<0.00001); l2=97%
Test for subgroup differences: χ2=5.79, df =2 (P=0.06); l2=65.5%
Test for overall effect: Z=6.13 (P<0.00001)
Test for overall effect: Z=1.26 (P=0.21)
1.16.2 Arginine vs strontium: instant
Li et al20
He et al28
He et al29
Subtotal (95% CI)
Heterogeneity τ2=6.17; χ2=160.42, df =2 (P<0.00001); l2=99%Test for overall effect: Z=1.03 (P=0.30)
1.260.92
1.181.261.45
1.41.37
1.162.332.43
0.750.57
0.520.580.64
0.80.55
0.680.2
0.04
414283
4122462932
170
384
504140
131
404181
4023492936
177
388
504040
130
10.1%10.0%20.0%
10.0%9.9%
10.2%10.0%10.0%50.1%
100.0%
10.1%10.1%9.6%
29.8%
−1.53 (−2.03, −1.03)−2.55 (−3.14, −1.97)−2.03 (−3.03, −1.03)
−1.82 (−2.35, −1.30)−1.54 (−2.21, −0.87)−0.74 (−1.15, −0.32)−1.05 (−1.60, −0.50)−1.28 (−1.80, −0.75) −1.26 (−1.67, −0.86)
−0.62 (−1.57, 0.34)
−1.23 (−1.66, −0.80)1.32 (0.84, 1.80)4.46 (3.62, 5.29)
1.49 (−1.34, 4.33)
2.242.29
2.062.171.96
2.22.08
1.981.912.25
0.490.49
0.430.580.730.7
0.55
0.640.4
0.04
−4 −2Favors (experimental) Favors (control)
0 2 4
Std mean differenceIV, random, 95% CI
Std mean differenceIV, random, 95% CI
Figure 4 Meta-analysis of the comparison of instant air-blast hypersensitivity between the arginine-containing dentifrice group and control group.Abbreviations: SD, standard deviation; CI, confidence interval; Std, standardized; df, degree of freedom.
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry 2016:8 submit your manuscript | www.dovepress.com
Dovepress
Dovepress
7
arginine-containing desensitizing toothpaste for dentin hypersensitivity
ExperimentalStudy or subgroup Mean MeanSD SDTotal Total Weight
Control
1.17.1 Arginine vs potassium: 3-day
Ayad et al23
Ayad et al12
Nathoo et al21
Subtotal (95% CI)
Heterogeneity: τ2=1.80; χ2=20.01, df =1 (P<0.00001); l2=95%
Test for overall effect: Z=2.56 (P=0.01)
1.17.2 Arginine vs fluoride: 3-day
Fu et al22
Subtotal (95% CI)
Heterogeneity: not applicable
Test for overall effect: Z 6.50 (P<0.00001)
13.77
33.29
39.17
33.41 13.06
0
14.69
7.72
41
41
121
162
38
41
42
40
40
120
160
39
40
41
34.0%
34.0%
66.0%
100.0%
34.1%
31.9%
16
13.77
16.25
15.58
5.91
0
4.77
5.47
Not estimable
1.54 (1.04, 2.04)
3.49 (2.79, 4.18)
2.50 (0.59, 4.41)
−4 −2
Favors (control) Favors (experimental)
0 2 4
2.21 (1.13, 3.29)
1.69 (1.18, 2.21)
1.69 (1.18, 2.21)
Std mean differenceIV, random, 95% CI
Std mean differenceIV, random, 95% CI
Total (95% CI)
Heterogeneity: τ2=0.83; χ2=22.34, df =2 (P<0.0001); l2=91%
Test for subgroup differences: χ2=0.63, df =1 (P=0.43); l2=0%
Test for overall effect: Z 4.01 (P<0.0001)
Figure 5 Meta-analysis of the comparison of 3-day tactile hypersensitivity between the arginine-containing dentifrice group and control group.Abbreviations: SD, standard deviation; CI, confidence interval; Std, standardized; df, degree of freedom.
ExperimentalStudy or subgroup Mean MeanSD SDTotal Total Weight
Control
1.18.1 Arginine vs potassium: 3-day
Ayad et al23
Ayad et al12
Nathoo et al21
Subtotal (95% CI)Heterogeneity: τ2=0.98; χ2=31.84, df =2 (P<0.00001); l2=94%
Test for overall effect: Z=2.38 (P=0.02)
1.18.2 Arginine vs fluoride: 3-day
1.18.3 Arginine vs strontium: 3-day
Fu et al22
He et al29
Subtotal (95% CI)
Subtotal (95% CI)
Heterogeneity: not applicableTest for overall effect: Z=8.53 (P<0.00001)
Heterogeneity: not applicableTest for overall effect: Z=8.39 (P=0.00001)
2.64
1.170.6
0.83
2.23
0.06
0.680.47
0.44
0.06 40
41
41
40
202
121
38
41
42
40
40
40
40
200
120
39
40
41
19.9%
19.9%
19.9%
19.9%
100.0%
60.2%
20.1%
20.1%
20.0%
−2.53 (−3.12, −1.94)
−2.53 (−3.12, −1.94)
−1.41 (−2.56, −0.25)
−0.33 (−0.78, 0.12)
−1.59 (−2.09, −1.09)
−2.33 (−2.89, −1.76)
2.07
1.93
2.66
2.11
2.01
0.06
0.42
0.06
0.47
0.71
−4 −2Favors (control)Favors (experimental)
0 2 4
Std mean differenceIV, random, 95% CI
Std mean differenceIV, random, 95% CI
Total (95% CI)Heterogeneity: τ2=3.63; χ2=198.09, df =4 (P<0.00001); l2=98%
Test for subgroup differences: χ2=148.13, df =2 (P<0.00001); l2=98.6%
Test for overall effect: Z=0.96 (P=0.34)
2.64 (2.03, 3.25)
2.64 (2.03, 3.25)
−0.83 (−2.52, 0.86)
Figure 6 Meta-analysis of the comparison of 3-day air-blast hypersensitivity between the arginine-containing dentifrice group and control group.Abbreviations: SD, standard deviation; CI, confidence interval; Std, standardized; df, degree of freedom.
ExperimentalStudy or subgroup Mean MeanSD SDTotal Total Weight
Control
1.3.1 Arginine vs potassium: 2-weekAyad et al23
Docimo et al13
Docimo et al14
Kakar et al16
Docimo et al19
Subtotal (95% CI)Heterogeneity: τ2=0.09; χ2=7.78, df =3 (P<0.05); l2=61%Test for overall effect: Z=5.12 (P<0.00001)
1.3.3 Arginine vs fuoride: 2-weekCummins et al11
Kakar et al17
Que et al15
Subtotal (95% CI)
Total (95% CI)
Heterogeneity: τ2=0.61; χ2=18.78, df =2 (P<0.0001); l2=89%
Heterogeneity: τ2=0.22; χ2=32.64, df =7 (P<0.00001); l2=79%
Test for subgroup differences: χ2=1.44, df =2 (P=0.49); l2=0%
Test for overall effect: Z=3.32 (P=0.0009)
Test for overall effect: Z=6.44 (P<0.00001)
1.3.2 Arginine vs strontium: 2-week
Subtotal (95% CI)Heterogeneity: not applicable
Test for overall effect: Z=5.12 (P<0.00001)
23.12
25.8726.45
25.76
27.2
35.4627.536.5
6.87
8.166.99
5.57
8.76
11.144.64
12.26
38
4040
46164
50
109
50
353440
39
4040
42161
50
116
327
50
354041
12.9%
12.7%12.7%
12.7%51.0%
13.2%
35.8%
100.0%
13.2%
12.4%10.8%12.6%
0.46 (0.01, 0.92)1.08 (0.61, 1.55)1.01 (0.55, 1.48)
1.36 (0.90, 1.83)0.98 (0.60, 1.35)
0.93(0.44, 1.43)2.66 (2.02, 3.29)1.25 (0.77, 1.73)1.59 (0.65, 2.53)
1.20 (0.84, 1.57)
1.10 (0.68, 1.52)1.10 (0.68, 1.52)
323
19.9
18.6319.3
18.92
19.2
24.9715.12
22.2
6.87
4.676.99
4.21
5.19
11.144.59
10.37
−4 −2Favors (control)Favors (experimental)
0 2 4
Std mean differenceIV, random, 95% CI
Std mean differenceIV, random, 95% CI
Figure 7 Meta-analysis of the comparison of 2-week tactile hypersensitivity between the arginine-containing dentifrice group and control group.Abbreviations: SD, standard deviation; CI, confidence interval; Std, standardized; df, degree of freedom.
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry 2016:8submit your manuscript | www.dovepress.com
Dovepress
Dovepress
8
Yang et al
ExperimentalStudy or subgroup Mean MeanSD SDTotal Total Weight
Control
1.4.1 Arginine vs potassium: 2-weekAyad et al23
Docimo et al13
Docimo et al14
Kakar et al16
Docimo et al19
He et al28
He et al29
Subtotal (95% CI)Heterogeneity: τ2=0.00; χ2=1.24, df =3 (P=0.74); l2=0%Test for overall effect: Z=7.13 (P<0.00001)
1.4.3 Arginine vs fluoride: 2-week
Cummins et al11
Que et al15
Subtotal (95% CI)
Total (95% CI)
Heterogeneity: τ2=0.78; χ2=23.96 df =2 (P<0.00001); l2=92%
Heterogeneity: τ2=8.82; χ2=184.10 df =2 (P<0.00001); l2=99%
Heterogeneity: τ2=2.24; χ2=316.73, df =9 (P<0.00001); l2=97%
Test for subgroup differences: χ2=4.43, df =2 (P=0.11); l2=54.8%
Test for overall effect: Z=2.75 (P=0.006)
Test for overall effect: Z=0.31 (P=0.76)
1.4.2 Arginine vs strontium: 2-week
Subtotal (95% CI)
Test for overall effect: Z=1.26 (P=0.21)
1.86
1.591.65
1.73
1.45
2.232
0.86
1.18
0.41
0.590.51
0.45
0.62
0.30.09
1.75
0.56
2.22
1.912.17
2.07
1.93
0.971.6
1.74
1.99
0.41
0.360.51
0.39
0.42
0.50.09
1.75
0.45
−0.87 (−1.34, −0.40)−0.65 (−1.10, −0.20)−1.01 (−1.48, −0.54)
−0.80 (−1.23, −0.36)−0.83 (−1.05, −0.60)
38
4040
46
50
4140
35
40
164 161
131 130
116109
404 407
−0.50 (−0.97, −0.02)
−1.58 (−2.08, −1.08)−1.47 (−2.51, −0.42)
Favors (experimental) Favors (control)
−0.15 (−1.09, 0.79)
2.17 (−1.22, 5.55)
−0.90 (−1.31, −0.49)3.04 (2.39, 3.68)4.40 (3.58, 5.23)
Std mean differenceIV, random, 95% CI
Std mean differenceIV, random, 95% CI
39
4040
42
50
4040
35
41
40.4%
29.6%
30.0%
100.0%
10.1%
10.1%10.1%
10.1%
10.1%
9.9%9.6%
10.1%
10.0%
−4 −2 20 4
Kakar et al17 1.54 0.39 2.55 0.4534 −2.36 (−2.96, −1.76)40 9.9%
Figure 8 Meta-analysis of the comparison of 2-week air-blast hypersensitivity between the arginine-containing dentifrice group and control group.Abbreviations: SD, standard deviation; CI, confidence interval; Std, standardized; df, degree of freedom.
Comparison of 2-week air-blast hypersensitivity between the arginine-containing dentifrice group and the control groupTwo-week air-blast hypersensitivity was compared between
the arginine-containing dentifrice group (404 persons) and
the control group (407 persons). A random-effect model was
used in the meta-analysis due to statistical heterogeneity
among the studies. Because the total 95% CI lines were
invalid vertical lines and the results were not significant,
we concluded that the effects of the arginine-containing
dentifrice and toothpastes containing other desensitizing
components did not differ significantly for the treatment of
DH at 2 weeks (Figure 8).
Comparison of 4-week tactile hypersensitivity between the arginine-containing dentifrice group and control groupFour-week tactile hypersensitivity was compared between
the arginine-containing dentifrice group (349 persons) and
the control group (357 persons). A random-effect model
was used in the meta-analysis due to statistical heterogene-
ity among the studies. Kapferer et al’s study26 was excluded
because the 95% CI lines were invalid vertical lines and the
results were not significant. The mean tactile hypersensitivity
scores were significantly higher in the arginine-containing
dentifrice group than the control group at 4 weeks (SMD
=1.95, 95% CI [1.14, 2.76], P,0.00001). We therefore con-
cluded that the arginine-containing dentifrice was superior
to toothpastes containing other desensitizing components
(Figure 9).
Comparison of 4-week air-blast hypersensitivity between the arginine-containing dentifrice group and control groupFour-week air-blast hypersensitivity was compared between
the arginine-containing dentifrice group (349 persons) and the
control group (357 persons). A random-effect model was used
in the meta-analysis due to statistical heterogeneity among
the studies. Docimo et al’s study13 was excluded because the
95% CI lines were invalid vertical lines and the results were
not significant. The mean air-blast hypersensitivity scores
were significantly higher in the arginine-containing dentifrice
group than the control group at 4 weeks (SMD =−1.60, 95%
CI [−2.14, −1.05], P,0.00001). Thus, we concluded that the
arginine-containing dentifrice was superior to toothpastes
containing other desensitizing components (Figure 10).
Comparison of 8-week tactile hypersensitivity between the arginine-containing dentifrice group and control groupEight-week tactile hypersensitivity was compared between
the arginine-containing dentifrice group (435 persons) and
the control group (440 persons). A random-effect model was
used in the meta-analysis due to statistical heterogeneity
among the studies. The mean tactile hypersensitivity scores
were significantly higher in the arginine-containing dentifrice
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry 2016:8 submit your manuscript | www.dovepress.com
Dovepress
Dovepress
9
arginine-containing desensitizing toothpaste for dentin hypersensitivity
ExperimentalStudy or subgroup Mean MeanSD SDTotal Total Weight
Control
1.6.1 Arginine vs potassium: 4-weekAyad et al23
Docimo et al13
Docimo et al14
Kakar et al16
Docimo et al19
Subtotal (95% CI)Heterogeneity: τ2=0.11; χ2=8.76, df =3 (P=0.03); l2=66%Test for overall effect: Z=4.73 (P<0.00001)
1.6.3 Arginine vs fluoride: 4-week
Que et al15
Schiff et at25
Subtotal (95% CI)
Total (95% CI)
Heterogeneity: τ2=0.89; χ2=31.76 df =3 (P<0.00001); l2=91%
Heterogeneity: not applicable
Heterogeneity: τ2=0.62; χ2=79.28, df =8 (P<0.00001); l2=90%
Test for subgroup differences: χ2=17.22, df =2 (P=0.0002); l2=88.4%
Test for overall effect: Z=4.26 (P<0.0001)
Test for overall effect: Z =5.76 (P<0.00001)
1.6.2 Arginine vs strontium: 4-week
Subtotal (95% CI)
Test for overall effect: Z=8.73 (P<0.00001)
1.09
0.890.92
0.93
1.54
1.211.35
1.35
0.350.370.56
0.38
−1.27 (−1.76, −0.78)−0.50 (−0.94, −0.05)−0.76 (−1.22, −0.31)
−1.32 (−1.79, −0.86)−0.96 (−1.35, −0.56)
0.35
0.820.56
0.24
38
4040
46164 161
Favors (experimental) Favors (control)
Std mean differenceIV, random, 95% CI
Std mean differenceIV, random, 95% CI
39
4040
4245.7%
11.3%11.5%11.5%
11.4%
1
1.40.75
1.33
2.31
2.21.82
2.24
0.380.8
0.38
0.52
−3.58 (−4.33, −2.83)−0.99 (−1.53, −0.44)−2.25 (−2.81, −1.69)
−1.73 (−2.29, −1.17)
0.34
0.80.55
0.52
34
2940
32
40
2941
36
10.%11.1%11.0%
11.0%
0.6 1.44 0.39 −2.25 (−2.75, −1.74)−2.25 (−2.75, −1.74)
0.35 5050 50
5011.2%
−2.11 (−3.08, −1.14)135 146 43.1%
−1.60 (−2.14, −1.05)349 357 100.0%
11.2%
−4 −2 20 4
Kapferer26
Kakar et al17
Figure 10 Meta-analysis of the comparison of 4-week air-blast hypersensitivity between the arginine-containing dentifrice group and control group.Abbreviations: SD, standard deviation; CI, confidence interval; Std, standardized; df, degree of freedom.
ExperimentalStudy or subgroup Mean MeanSD SDTotal Total Weight
Control
1.5.1 Arginine vs potassium: 4-weekAyad et al23
Docimo et al13
Docimo et al14
Kakar et al16
Docimo et al19
Subtotal (95% CI)
Heterogeneity: τ2=0.29; χ2=16.87, df =3 (P=0.0008); l2=82%Test for overall effect: Z=4.75 (P<0.00001)
1.5.3 Arginine vs fuoride: 4-week
Que et al15
Schiff et at25
Subtotal (95% CI)
Total (95% CI)
Heterogeneity: τ2=4.51; χ2=125.85 df =3 (P<0.00001); l2=98%
Heterogeneity: not applicable
Heterogeneity: τ2=1.44; χ2=155.54, df =8 (P<0.00001); l2=95%
Test for subgroup differences: χ2=6.08, df =2 (P=0.05); l2=67.1%
Test for overall effect: Z=2.25 (P=0.02)
Test for overall effect: Z=4.72 (P<0.00001)
1.5.2 Arginine vs strontium: 4-week
Subtotal (95% CI)
Test for overall effect: Z=9.04 (P<0.00001)
36.21
40.7540.98
35.65
6.75
7.37.87
3.59
29.59
31.6231.52
26.78
6.758.047.87
3.79
0.97 (0.50, 1.44)1.18 (0.70, 1.65)1.19 (0.71, 1.67)
2.38 (1.83, 2.94)1.42 (0.83, 2.00)
38
4040
46164 161
357
Favors (experimental) Favors (control)
1.95 (1.14, 2.76)
Std mean differenceIV, random, 95% CI
Std mean differenceIV, random, 95% CI
39
4040
4245.3%
100.0%
11.4%
42.5 5.91 27.9 6.23 2.39 (1.87, 2.90)2.39 (1.87, 2.90)
5050
5050
11.3%
33.82 3.27 17.75 4.66 3.90 (3.10, 4.69)34 40 10.6%1.5 1.9 2.4 2.6 −0.39 (−0.91, 0.13)29 29 11.3%
45.5 6.58 26.59 11.64 1.97 (1.44, 2.51)40 41 11.2%27.03 3.73 10.83 3.73 4.29 (3.41, 5.18)32 36 10.4%
11.3%
2.42 (0.31, 4.53)135
349
146 43.5%
11.3%11.3%
11.2%
−4 −2 20 4
Kapferer26
Kakar et al17
Figure 9 Meta-analysis of the comparison of 4-week tactile hypersensitivity between the arginine-containing dentifrice group and control group.Abbreviations: SD, standard deviation; CI, confidence interval; Std, standardized; df, degree of freedom.
group than the control group at 8 weeks (SMD =2.01, 95%
CI [1.41, 2.61], P,0.00001). Thus, we concluded that the
arginine-containing dentifrice was superior to toothpastes
containing other desensitizing components (Figure 11).
Comparison of 8-week air-blast hypersensitivity between the arginine-containing dentifrice group and control groupEight-week air-blast hypersensitivity was compared
between the arginine-containing dentifrice group (435 per-
sons) and the control group (440 persons). A random-effect
model was used in the meta-analysis due to statistical
heterogeneity among the studies. Cummins’ study11 and
Docimo et al’s study14 were excluded because the 95% CI
lines were invalid vertical lines and the results were not
significant. The mean air-blast hypersensitivity scores were
significantly higher in the arginine-containing dentifrice
group than the control group at 8 weeks (SMD =−1.41,
95% CI [−1.83, −0.98], P,0.00001). Thus, we concluded
that the arginine-containing dentifrice was superior to
toothpastes containing other desensitizing components
(Figure 12).
Comparison of .12-week tactile hypersensitivity and air-blast hypersensitivity between the arginine-containing dentifrice group and control groupTactile hypersensitivity and air-blast hypersensitivity at time
points longer than 12 weeks were compared between the
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry 2016:8submit your manuscript | www.dovepress.com
Dovepress
Dovepress
10
Yang et al
ExperimentalStudy or subgroup Mean MeanSD SDTotal Total Weight
Control Std mean differenceIV, random, 95% CI
Std mean differenceIV, random, 95% CI
1.2.1 Arginine vs potassiumAyad et al23
Docimo et al13
Cummins11
Docimo et al14
Kakar et al16
Subtotal (95% CI)Heterogeneity: τ2=0.31; χ2=25.75, df =4 (P<0.0001); l2=84%Test for overall effect: Z=3.65 (P=0.0003)
1.2.2 Arginine vs strontiumDocimo et al19
Schiff et al18
Heterogeneity: τ2=0.00; χ2=0.25, df =1 (P=0.62); l2=0%Subtotal (95% CI)
Test for overall effect: Z=10.06 (P<0.00001)
1.2.3 Arginine vs fluoride
Que et al15
Subtotal (95% CI)Heterogeneity: τ2=0.63; χ2=18.32 df =2 (P=0.0001); l2=89%Test for overall effect: Z=4.21 (P=0.0001)
Kakar et al17
Hamlin et al27
Total (95% CI)Heterogeneity: τ2=0.40; χ2=70.74, df =9 (P<0.00001); l2=87%
Test for subgroup differences: χ2=4.71, df =2 (P=0.10); l2=57.5%Test for overall effect: Z=6.52 (P<0.00001)
−1.50 (−2.01, −0.99)−0.47 (−0.92, −0.03)
−1.47 (−1.91, −1.02)−1.62 (−2.03, −1.21)−1.55 (−1.85, −1.25)
−1.17 (−1.61, −0.73)−2.53 (−3.15, −1.91)−2.48 (−3.06, −1.89)−2.04 (−2.99, −1.09)
−1.41 (−1.83, −0.98)
−0.70 (−1.15, −0.25)−0.51 (−0.95, −0.06)−1.84 (−2.34, −1.33)−0.99 (−1.53, −0.46)50.4%
20.6%
29.0%
100.0%
10.2%9.9%
10.2%10.2%
10.2%10.4%
10.3%9.2%9.4%
9.9%200
130
440
110
3939
40
5060
494041
4042
0.460.39
0.310.390.29
0.930.760.680.690.85
0.891.67
1.722.152.19
38
204
111
120
435
40404046
0.390.460.340.390.25
0.340.540.450.490.35
1.020.35 0.35 0.38
0.620.450.46
0.450.34
0.81.350.5
0.440.820.56
5061
463440
Favors (experimental) Favors (control)−4 −2 20 4
Figure 12 Meta-analysis of the comparison of 8-week air-blast hypersensitivity between the arginine-containing dentifrice group and control group.Abbreviations: SD, standard deviation; CI, confidence interval; Std, standardized; df, degree of freedom.
ExperimentalStudy or subgroup Mean MeanSD SDTotal Total Weight
Control
1.1.1 Arginine vs potassium: 8-weekAyad et al23
Docimo et al13
Cummins11
Docimo et al14
Kakar et al16
Docimo et al19
Schiff et al18
Subtotal (95% CI)Heterogeneity: τ2=0.78; χ2=49.24, df =4 (P<0.00001); l2=92%
Heterogeneity: τ2=0.00; χ2=0.07, df =1 (P=0.79); l2=0%
Test for overall effect: Z=4.03 (P<0.0001)
1.1.3 Arginine vs fluoride: 8-week
Que et al15
Subtotal (95% CI)
Total (95% CI)
Heterogeneity: τ2=3.25; χ2=69.50 df =2 (P<0.00001); l2=97%
Heterogeneity: τ2=0.86; χ2=123.09, df =9 (P<0.00001); l2=93%
Test for subgroup differences: χ2=1.29, df =2 (P=0.53); l2=0%
Test for overall effect: Z=2.78 (P=0.005)
Test for overall effect: Z =6.55 (P<0.00001)
1.1.2 Arginine vs strontium: 8-week
Subtotal (95% CI)
Test for overall effect: Z=11.24 (P<0.00001)
47.3445.75
38 3939.8740.8840.4733.09
2.46 (1.87, 3.06)0.95 (0.49, 1.42)1.02 (0.55, 1.49)0.92 (0.46, 1.38)3.06 (2.44, 3.68)1.66 (0.85, 2.47)
45.6345.4
42.93200204
Favors (experimental) Favors (control)
Std mean differenceIV, random, 95% CI
Std mean differenceIV, random, 95% CI
3939
4040404046
3.356.113.955.3
3.084042
6.113.35
5.185.33.3
50.7%
10.3%9.9%
10.3%10.3%
9.8%
37.6142.7948.5
23.8819.7530.12
13.284.07
12.57
1.06 (0.63, 1.49)6.10 (4.99, 7.21)1.94 (1.40, 2.47)
12.463.3
4.113446
404049
41
10.4%8.0%
10.1%28.5%
46.634.43
36.322.75
7.27.27
1.76 (1.29, 2.22)1.84 (1.42, 2.27)1.80 (1.49, 2.12)
3.975.17
5061
111 110
5060
20.7%
2.95 (0.87, 5.04)120 130
2.01 (1.41, 2.61)435 440 100.0%
10.3%10.4%
−4 −2 20 4
Kakar et al17
Hamlin et al27
Figure 11 Meta-analysis of the comparison of 8-week tactile hypersensitivity between the arginine-containing dentifrice group and control group.Abbreviations: SD, standard deviation; CI, confidence interval; Std, standardized; df, degree of freedom.
arginine-containing dentifrice group (107 persons) and the
control group (114 persons). A random-effect model was used
in the meta-analysis due to statistical heterogeneity among
the studies. Because the total 95% CI lines were invalid verti-
cal lines and the results were not significant, we concluded
that the effects of the arginine-containing dentifrice and the
toothpastes containing other desensitizing components did
not differ significantly for the treatment of DH at .12 weeks
(Figures 13 and 14).
sensitivity analysisSensitivity analysis in which each study was eliminated indi-
vidually followed by a new meta-analysis demonstrated that
the direction of the effect did not change. Thus, the results
of the meta-analysis were deemed reliable.
Publication bias analysisDue to the difference in the number of included studies, we
generated a funnel plot at 8 weeks. The funnel plot analysis
of the 18 included studies was symmetrical, indicating no
publication bias (Figure 15).
DiscussionDH is a clinically frequent oral health problem in which
eating, breathing, and brushing teeth can cause brief, sharp
pain. DH can affect the quality of daily life. Two mechanisms
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry 2016:8 submit your manuscript | www.dovepress.com
Dovepress
Dovepress
11
arginine-containing desensitizing toothpaste for dentin hypersensitivity
ExperimentalStudy or subgroup Mean MeanSD SDTotal Total Weight
Control Std mean differenceIV, random, 95% CI
Std mean differenceIV, random, 95% CI
1.19.1 Arginine vs fluoride: 12-week
1.19.2 Arginine vs fluoride: 24-week
Total (95% CI) 107 114 100.0%
Heterogeneity: τ2=0.45; χ2=17.63, df =2 (P=0.0001); l2=89%
Test for subgroup differences: χ2=11.41, df =1 (P=0.0007); l2=91.2%
Test for overall effect: Z=0.09 (P=0.93)
0.04 (−0.77, 0.85)
Favors (control) Favors (experimental)
−4 −2 20 4
Test for overall effect: Z=3.65 (P=0.0003)
Subtotal (95% CI)
Subtotal (95% CI)
Kapferer et al26 1.2
10.63 2.11 32 10.83 1.89 36
6561
1.3 29 2.2 1.9 29 32.5%
33.3%
65.8%
Schiff et al25
Hamlin et al27 40 11.79 46 30.1 13.33 49 34.2%
34.2%4946
Heterogeneity: not applicable
0.78 (0.36, 1.20)
0.78 (0.36, 1.20)
Heterogeneity: τ2=0.06; χ2=1.96 df =1 (P=0.16); l2=49%
Test for overall effect: Z=1.34 (P=0.18)
−0.61 (−1.13, −0.08)
−0.10 (−0.58, 0.38)
−0.34 (−0.84, 0.16)
Figure 13 Meta-analysis of the comparison of .12-week tactile hypersensitivity between the arginine-containing dentifrice group and control group.Abbreviations: SD, standard deviation; CI, confidence interval; Std, standardized; df, degree of freedom.
ExperimentalStudy or subgroup Mean MeanSD SDTotal Total Weight
Control Std mean differenceIV, random, 95% CI
Std mean differenceIV, random, 95% CI
1.20.1 Arginine vs fluoride: 12-week
Subtotal (95% CI)
Kapferer et al26
Schiff et al25
Heterogeneity: τ2=0.03; χ2=1.53 df =1 (P=0.22); l2=35%
Test for overall effect: Z=0.55 (P=0.58)
1.20.2 Arginine vs fluoride: 24-week
Test for overall effect: Z=3.31 (P=0.0009)
Subtotal (95% CI)
Hamlin et al27
Heterogeneity: not applicable
Total (95% CI)
Heterogeneity: τ2=0.11; χ2=5.98, df =2 (P=0.05); l2=67%
Test for subgroup differences: χ2=3.56, df =1 (P=0.06); l2=71.9%
Test for overall effect: Z=1.40 (P=0.16)Favors (control)Favors (experimental)
−4 −2 20 4
31.0%29
36
65
0.34
1.21.3291
0.342.73
0.9
1.11 0.81 46 49
49
114
1.69 0.83
46
107
32
61
2.7 33.0%
64.0%
36.0%
36.0%
100.0%
−0.36 (−0.88, 0.16)
−0.12 (−0.56, 0.31)
−0.70 (−1.12, −0.29)
−0.70 (−1.12, −0.29)
−0.33 (−0.80, 0.13)
0.09 (−0.39, 0.56)
Figure 14 Meta-analysis of the comparison of .12-week air-blast hypersensitivity between the arginine-containing dentifrice group and control group.Abbreviations: SD, standard deviation; CI, confidence interval; Std, standardized; df, degree of freedom.
have been proposed for DH: 1) the function of odontoblasts
and their processes in dentinal receptor mechanisms and
2) stimulation of pulp nerves by a hydrodynamic mechanism3
and modulation of nerve impulses in the pulp by the release
of specific polypeptides during pulp injury. The most widely
used and available desensitizing toothpaste ingredients are
potassium compounds. In vitro studies have indicated that
increases in the concentration of potassium ions in the extra-
cellular fluid above physiological levels can induce nerve
cell polarization. Thus, potassium ions may block the action
potential generated in intradental nerves. Many clinical tri-
als have demonstrated that potassium-containing toothpaste
is more effective than fluoride-containing toothpaste for
the treatment of DH.34 A Cochrane systematic review also
demonstrated that potassium-containing toothpaste is more
effective for the treatment of DH.35 Strontium-containing
toothpastes are increasingly used to treat DH. The tooth
enamel and dentin absorb the strontium salt. Dentin has
a high affinity for strontium ions. Strontium carbonate
is generated when the strontium ions react with calcium
carbonate in the teeth, enhancing the acid resistance of the
teeth. Strontium salts can combine with other organic mat-
ter in dentin (such as oxyhemoglobin) and penetrate deeply
into the tooth, significantly reducing the permeability of
hard tissues and contributing to acid desensitization. Stron-
tium chloride can calm the dentin nerve and relieve pain,
slowing the conduction of the odontoblastic process and
accelerating the formation of tertiary dentinogenesis. These
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry 2016:8submit your manuscript | www.dovepress.com
Dovepress
Dovepress
12
Yang et al
effects of strontium contribute to analgesic desensitization.
A toothpaste containing 8% arginine is effective for promot-
ing the closing of dentin tubules, and many clinical trials have
demonstrated a remarkable desensitization curative effect.
superiority of the meta-analysisA randomized, double-blinded, controlled study is the gold
standard of a curative effect evaluation. In this study, we per-
formed a comprehensive, strictly screened, and summarized
classification of RCTs of arginine-containing toothpaste for
DH. We systematically evaluated the research quality of
clinical studies of arginine-containing toothpaste and the treat-
ment effect of arginine-containing toothpaste in the treatment
of DH was compared to a control group in which toothpastes
contain other desensitizing components. We identified evi-
dence supporting the effective treatment of DH by arginine-
containing toothpaste. The measurement of DH is subjective,
and thus it is difficult to objectively measure and evaluate
DH. The responses to various stimuli differ, and stimuli used
to index DH must be measurable and reproducible. To avoid
mutual interference, sufficient time must be allowed for dentin
recovery between stimuli. Thus, studies should use at least two
types of stimuli (Yeaple Electronic Pressure Sensitive Probe
and Air Blast Sensitivity Assessment) to evaluate DH. This
study combined the results according to the time of evalua-
tion and the method of measuring DH. The study sample size
in each group was larger than 30 subjects, which conformed
to the requirement of the DH evaluation test and evaluation
index. Data for the tactile sensitivity scores and air-blast sen-
sitivity scores from days 0 and 3; weeks 2, 4, and 8; and more
than 12 weeks were merged. We determined that the arginine-
containing toothpaste was superior to the control toothpastes
in relieving DH at weeks 4 and 8, but was not significantly
more effective at days 0 and 3 and week 2 as indicated by the
results of the air-blast test and at more than 12 weeks as indi-
cated by the results of the tactile sensitivity and air-blast tests.
Thus, we conclude that over time, the arginine-containing
toothpaste was more effective than the other toothpastes for
the treatment of DH, but beyond 12 weeks, the effects of the
toothpastes were similar.
limitations of the meta-analysisAlthough the baseline of the included literature in this study
was comparable, the results were for subgroup analysis.
Because the data were heterogeneous, a randomization method
was adopted to assign participants to study groups to ensure
that the groups are balanced for known and unknown risk
factors to minimize bias. For the analyses, the main causes of
heterogeneity were as follows. First, there were insufficient
RCTs to evaluate the effect of the arginine-containing tooth-
paste for DH, and evidence of systematic evaluation of its
effectiveness was limited. Second, the quality of the overall
research was not high. According to the evaluation standard
for the quality of clinical trials (Cochrane Collaboration), the
risk of bias was low. The research sites were predominantly
located in the USA, Canada, and Italy, and only four research
studies were performed in the People’s Republic of China.
Thus, data on the effectiveness of arginine-containing tooth-
paste for DH in Chinese populations were insufficient. Thus,
regional differences in results cannot be ruled out. Third, there
were individual differences in subjects, and it was difficult to
treat the subjects similarly for the toothpaste dose and meth-
ods. In addition, subject compliance could not be properly
evaluated. Finally, the research cycle and measurement of
0
0.1
0.2
0.3
0.4
0.5−4 −2 0 2 4
SubgroupsArginine vs potassium Arginine vs strontium Arginine vs fluoride
SMD
SE (SMD)
Figure 15 Funnel plot analysis of the comparison of the 8-week hypersensitivity effect between the arginine-containing dentifrice group and control group.Abbreviations: se, standard error; sMD, standardized mean difference.
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry 2016:8 submit your manuscript | www.dovepress.com
Dovepress
Dovepress
13
arginine-containing desensitizing toothpaste for dentin hypersensitivity
the results differed greatly. Although the clinical trials for DH
treatment were normative (the evaluation results could not
avoid subjective factors completely), the specific designs of
the included studies differed greatly. For the same interven-
tions, the cycle of research and the time of evaluation were
different, and for the same measurement method, the result
index and analysis method also differed. Thus, it was difficult
to obtain a more comprehensive conclusion due to the effects
of quantitatively merging the results. Because most of the
studies were limited to time points of 8 weeks, longer term
effects on sensitivity resistance were not observed.
ConclusionThis study examined 18 RCTs including 1,423 patients. The
results support the efficacy of arginine-containing toothpaste
at 4 and 8 weeks. The effects of arginine-containing tooth-
paste exhibited a superior therapeutic effect compared to
toothpastes containing other desensitizing components as
indicated by the tactile sensitivity test (SMD =1.95, 95%
CI [1.14, 2.76]) and the air-blast test (SMD =−1.60, 95%
CI [−2.14, −1.05]) at 4 weeks and the tactile sensitivity test
(SMD =2.01, 95% CI [1.41, 2.61]) and the air-blast test
(SMD =−1.41, 95% CI [−1.83, −0.98]) at 8 weeks. However,
no significant differences between the arginine-containing
toothpaste and toothpastes containing other desensitizing
components were observed at days 0 and 3 and week 2 in the
air-blast test and more than 12 weeks in the tactile sensitivity
and air-blast tests. However, this meta-analysis is subject to
limitations (heterogeneity, quality of the evidence, limita-
tion of time, and other factors), and stronger evidence of
the superiority of arginine-containing toothpaste for DH for
providing clinical recommendations will require additional
high-quality RCTs with large sample sizes.
AcknowledgmentsThis work was supported by the Key Project of Medical
Research Program of Chongqing Municipal Health Bureau
(Grant Number: 2013-1-032) and the Science and Technol-
ogy Planning Project (Grant Number: 2014-S-013) of Yubei
District, Chongqing, People’s Republic of China.
DisclosureThe authors report no conflicts of interest in this work.
References1. Addy M. Dentine hypersensitivity: new perspectives on an old problem.
Int Dent J. 2002;52(5):367–375.2. Nunn JH. Prevalence and distribution of tooth wear. In: Addy M,
Embery G, Edgar WM, Orchardson R, editors. Tooth Wear and Sensitivity. London, UK: Martin Dunitz; 2000:93.
3. Brännström M. Dentin sensitivity and aspiration of odontoblasts. J Am Dent Assoc. 1963;66(3):366–370.
4. Kim S. Hypersensitive teeth: desensitization of pulpal sensory nerves. J Endod. 1986;12(10):482–485.
5. Blong MA, Volding B, Thrash WJ, Jones DL. Effects of a gel containing 0.4 percent stannous fluoride on dentinal hypersensitivity. Dent Hyg (Chic). 1985;59(11):489–492.
6. Snyder RA, Beck FM, Horton JE. The efficacy of a 0.4% stannous fluo-ride gel on root surface hypersensitivity. J Dent Res. 1985;62(3):237.
7. Thrash WJ, Dodds MW, Jones DL. The effect of stannous fluoride on dentinal hypersensitivity. Int Dent J. 1994;44(1 Suppl 1):107–118.
8. Schiff T, Saletta L, Baker RA, Winston JL, He T. Desensitizing effect of a stabilized stannous fluoride/sodium hexametaphosphate dentifrice. Compend Contin Educ Dent. 2005;26(9 Suppl 1):35–40.
9. Miller S, Truong T, Heu R, Stranick M, Bouchard D, Gaffar A. Recent advances in stannous fluoride technology: antibacterial efficacy and mechanism of action towards hypersensitivity. Int Dent J. 1994; 44(1 Suppl 1):83–98.
10. Walters PA. Dentinal hypersensitivity: a review. J Contemp Dent Pract. 2005;6(2):107–117.
11. Cummins D. Dentin hypersensitivity: from diagnosis to a break-through therapy for everyday sensitivity relief. J Clin Dent. 2009;20(1):1–9.
12. Ayad F, Ayad N, Zhang YP, DeVizio W, Cummins D, Mateo LR. Comparing the efficacy in reducing dentin hypersensitivity of a new toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride to a commercial sensitive toothpaste containing 2% potassium ion: an eight-week clinical study on Canadian adults. J Clin Dent. 2009; 20(1):10–16.
13. Docimo R, Montesani L, Maturo P, et al. Comparing the efficacy in reducing dentin hypersensitivity of a new toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride to a commercial sensitive toothpaste containing 2% potassium ion: an eight-week clinical study in Rome, Italy. J Clin Dent. 2009;20(1):17–22.
14. Docimo R, Montesani L, Maturo P, et al. Comparing the efficacy in reducing dentin hypersensitivity of new toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride to a benchmark commercial desensitizing toothpaste containing 2% potassium ion: an eight-week clinical study in Rome, Italy. J Clin Dent. 2009;20(4): 137–143.
15. Que K, Fu Y, Lin L, et al. Dentin hypersensitivity reduction of a new toothpaste containing 8.0% arginine, a high cleaning calcium carbonate system and 1450 ppm fluoride: a 8-week clinical study in Chengdu, China. Am J Dent. 2010;23(Spec No A):28A–35A.
16. Kakar A, Kakar K, Sreenivasan PK, DeVizio W, Kohli R. Comparison of the clinical efficacy of a new dentifrice containing 8.0% arginine, calcium carbonate, and 1000 ppm fluoride to a commercially available sensitive toothpaste containing 2% potassium ion on dentin hypersensitivity: a randomized clinical trial. J Clin Dent. 2012;23(2):40–47.
17. Kakar A, Kakar K, Sreenivasan PK, DeVizio W, Kohli R. Comparison of the clinical efficacy in reducing dentin hypersensitivity of a new dentifrice containing 8.0% arginine, calcium carbonate, and 1000 ppm fluoride to a commercially available sensitive toothpaste containing 2% potassium ion on dentin hypersensitivity: an eight-week clinical trial on adults in New Delhi, India. J Clin Dent. 2012;23(2):33–39.
18. Schiff T, Mateo LR, Delgado E, Cummins D, Zhang YP, DeVizio W. Clinical efficacy in reducing dentin hypersensitivity of a dentifrice containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride compared to a dentifrice containing 8% strontium acetate and 1040 ppm fluoride under consumer usage conditions before and after switch-over. J Clin Dent. 2011;22(4):128–138.
19. Docimo R, Perugia C, Bartolino M, et al. Comparative evaluation of the efficacy of three commercially available toothpastes on dentin hypersensitivity reduction: an eight-week clinical study. Am J Clin Dent. 2011;22(4):121–127.
20. Li Y, Lee S, Zhang YP, Delagado E, Devizio W, Matco LR. Comparison of clinical efficacy of three toothpastes in reducing dentin hypersensitivity. J Clin Dent. 2011;22(4):113–120.
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1
Clinical, Cosmetic and Investigational Dentistry
Publish your work in this journal
Submit your manuscript here: http://www.dovepress.com/clinical-cosmetic-and-investigational-dentistry-journal
Clinical, Cosmetic and Investigational Dentistry is an international, peer-reviewed, open access, online journal focusing on the latest clini-cal and experimental research in dentistry with specific emphasis on cosmetic interventions. Innovative developments in dental materials, techniques and devices that improve outcomes and patient satisfac-
tion and preference will be highlighted. The manuscript management system is completely online and includes a very quick and fair peer-review system, which is all easy to use. Visit http://www.dovepress.com/testimonials.php to read real quotes from published authors.
Clinical, Cosmetic and Investigational Dentistry 2016:8submit your manuscript | www.dovepress.com
Dovepress
Dovepress
DovepressDovepress
14
Yang et al
21. Nathoo S, Delgado E, Zhang YP, DeVizio W, Cummins D, Mateo LR. Comparing the efficacy in providing instant relief of dentin hypersensi-tivity of a new toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride relative to a benchmark desensitizing toothpaste containing 2% potassium ion and 1450 ppm fluoride, and to a control toothpaste with 1450 ppm fluoride: a three-day clinical study in New Jersey, USA. J Clin Dent. 2009;20(4):123–130.
22. Fu Y, Li X, Que K, et al. Instant dentin hypersensitivity relief of a new desensitizing dentifrice containing 8.0% arginine, a high cleaning calcium carbonate system and 1450 ppm fluoride: a 3-day clinical study in Chengdu, China. Am J Dent. 2010;23(Spec No A):20A–27A.
23. Ayad F, Ayad N, Delgado E, et al. Comparing the efficacy in providing instant relief of dentin hypersensitivity of a new toothpaste contain-ing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride to a benchmark desensitizing toothpaste containing 2% potassium ion and 1450 ppm fluoride, and to a control toothpaste with 1450 ppm fluo-ride: a three-day clinical study in Mississauga, Canada. J Clin Dent. 2009;20(4):115–122.
24. Hamlin D, Williams KP, Delgado E, Zhang YP, DeVizio W, Mateo LR. Clinical evaluation of the efficacy of a desensitizing paste containing 8% arginine and calcium carbonate for the in-office relief of dentin hypersensitivity associated with dental prophylaxis. Am J Dent. 2009; 22(Spec No A):16A–20A.
25. Schiff T, Delgado E, Zhang YP, Cummins D, DeVizio W, Mateo LR. Clinical evaluation of the efficacy of an in-office desensitizing paste con-taining 8% arginine and calcium carbonate in providing instant and last-ing relief of dentin hypersensitivity. Am J Dent. 2009;22(Spec No A): 8A–15A.
26. Kapferer I, Pflug C, Kisielewsky I, Giesinger J, Beier US, Dumfahrt H. Instant dentin hypersensitivity relief of a single topical application of an in-office desensitizing paste containing 8% arginine and calcium carbonate: a split-mouth, randomized-controlled study. Acta Odontol Scand. 2013;71(3–4):994–999.
27. Hamlin D, Mateo LR, Dibart S, Delgado E, Zhang YP, DeVizio W. Comparative efficacy of two treatment regimens combining in-office and at-home program for dentin hypersensitivity relief: a 24-week clinical study. Am J Dent. 2012;25(3):146–152.
28. He T, Chang J, Cheng R, Li X, Sun L, Biesbrock AR. Clinical evaluation of the fast onset and sustained sensitivity relief of a 0.454% stannous fluoride dentifrice compared to an 8.0% arginine-calcium carbonate-sodium monofluorophosphate dentifrice. Am J Dent. 2011; 24(6):336–340.
29. He T, Cheng R, Biesbrock AR, Chang A, Sun L. Rapid desensitizing efficacy of a stannous-containing sodium fluoride dentifrice. J Clin Dent. 2011;22:40–45.
30. Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. London, UK: Cochrane; 2011. Available from: http://www.cochrane-handbook.org. Accessed November 25, 2015.
31. Atkins D, Best D, Briss PA, et al; GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ. 2004; 328(7454):1490.
32. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383–394.
33. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging con-sensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–926.
34. Orchardson R, Gillam DG. The efficacy of potassium salts as agents for treating dentin hypersensitivity. J Orofac Pain. 2000;14(1):9–19.
35. Poulsen S, Errboe M, Lescay Mevil Y, Glenny AM. Potassium contain-ing toothpastes for dentine hypersensitivity. Cochrane Database Syst Rev. 2006;19(3):CD001476.
C
linic
al, C
osm
etic
and
Inve
stig
atio
nal D
entis
try
dow
nloa
ded
from
http
s://w
ww
.dov
epre
ss.c
om/ b
y 13
7.10
8.70
.14
on 2
0-Ja
n-20
20F
or p
erso
nal u
se o
nly.
Powered by TCPDF (www.tcpdf.org)
1 / 1