[Downloaded free from http://www.jcd.org.in on Wednesday, July 1, 2020, IP: 27.61.139.

244]

Original Article

Comparative evaluation of a low‑level laser and

topical desensitizing agent for treating dentinal
hypersensitivity: A randomized controlled trial
R. Praveen, Sophia Thakur1, M. Kirthiga2, M. Narmatha2
Departments of Conservative Dentistry and Endodontics and 2Pedodontic and Preventive Dentistry, Indira Gandhi Institute of Dental
Sciences and Hospital, Puducherry, 1Department of Conservative Dentistry and Endodontics, Bapuji Dental College and Hospital,
Davangere, Karnataka, India

Abstract
Aim: The aim of this randomized, controlled, double‑blinded, clinical study is to evaluate and compare the clinical effectiveness
of low‑level diode GaAlAs laser and glutaraldehyde‑based topical desensitizing agent on cervical dentin hypersensitivity with
the help of visual analog scale (VAS).
Materials and Methods: Fifty teeth of patients aged between 20 and 50 years were included, and VAS was used to assess the
dentin hypersensitivity. The teeth were randomly allocated to either Group 1 or 2 using flip coin technique. Group 1 received
glutaraldehyde desensitizer and Group 2 received 905 nm low‑level laser. The sensitivity scores were recorded, immediately,
after1 week and 3 months after therapy. Data was analyzed using Mann-Whitney U test for intergroup comparison and
Friedman’s test for intragroup comparison.
Results: There was a significant reduction in pain in both the groups at 3 months evaluation (P = 0.001).However, Group 2
showed a significant decrease in mean VAS scores when compared with Group 1 at both the one week and three month follow
ups (P = 0.04, P = 0.03, respectively).
Conclusion: Although topical desensitizer and Low Level Laser are both effective in reducing dentinal hypersensitivity, Low Level
Lasers are comparatively more effective at the studied time intervals.
Keywords: Desensitizing agent; low‑level laser therapy; randomized controlled trial; visual analog scale

INTRODUCTION stimuli and result in hypersensitivity. Among many

theories proposed regarding the mechanism of dentin
Dentin hypersensitivity is defined as “short, sharp pain hypersensitivity, Brannstroms hydrodynamic theory
arising from exposed dentin in response to stimuli typically is the most widely accepted theory, which states that
thermal, evaporative, tactile, osmotic, or chemical and external stimuli cause fluid movement inside the dentinal
which cannot be ascribed to any other form of dental defect tubules either in the inward or outward direction and
or pathology.” It is often referred to as the “common cold promote mechanical deformation of nerve endings at the
of dentistry,” due to its high prevalence which ranges from pulp/dentin. It will be transmitted as a painful sensation.[4]
2.8% to 74%.[1‑3] When the protective enamel/cementum
is lost, the dentinal tubules will be exposed to external Based on the Brannstroms hydrodynamic theory, the two
chief methods of treating dentin hypersensitivity are tubular
Address for correspondence: occlusion and blockage of nerve activity.[5] Popularly, topical
Dr. M. Kirthiga, Department of Pedodontic and Preventive
Dentistry, Indira Gandhi Institute of Dental Sciences, desensitizing agents such as glutaraldehyde, resin‑based
Pillayarkuppam, Puducherry, India. desensitizing solutions, and fluoride varnishes are used to
E‑mail: kirthi487@gmail.com
This is an open access journal, and articles are distributed under the terms
Date of submission : 24.05.2018 of the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0
Review completed : 30.05.2018 License, which allows others to remix, tweak, and build upon the work
Date of acceptance : 06.07.2018 non‑commercially, as long as appropriate credit is given and the new
Access this article online creations are licensed under the identical terms.
Quick Response Code: For reprints contact: reprints@medknow.com
Website:
www.jcd.org.in
How to cite this article: Praveen R, Thakur S, Kirthiga M,
Narmatha M. Comparative evaluation of a low-level laser and
DOI: topical desensitizing agent for treating dentinal hypersensitivity:
10.4103/JCD.JCD_197_18
A randomized controlled trial. J Conserv Dent 2018;21:495-9.

© 2018 Journal of Conservative Dentistry | Published by Wolters Kluwer - Medknow 495

[Downloaded free from http://www.jcd.org.in on Wednesday, July 1, 2020, IP: 27.61.139.244]
Praveen, et al.: Evaluation of a low‑level laser and topical desensitizing agent
treat dentinal hypersensitivity, which occludes the tubules
by cross‑linking of dentinal proteins.
The advent of dental lasers has given us an interesting
treatment option for dentinal hypersensitivity and has
become a research interest in the last decade. The middle
output power lasers such as ND:YAG lasers and CO2 lasers
have enjoyed significant success in treating this condition.
However, they are very expensive and bulky to lug around.
Low‑level lasers such as He‑Ne lasers and GaAlAs lasers are
relatively unexplored in dentistry.[6] The low‑level or “soft”
lasers provide low‑energy emissions with little temperature
increase of <0.1°C. These wavelengths are believed to
stimulate circulation and cellular activity and to provide
various effects such as anti‑inflammatory, vascular, analgesic,
and tissue healing.[7] According to physiological experiments
using the GaAlAs laser at 830 nm, analgesic effect is caused
by blocking the depolarization of C‑fiber afferents. Some
studies have compared middle output power lasers with
low‑level lasers, and the results were inconsistent.[8,9] Very
few studies have compared the 904 nm diode laser with
topical desensitizing agents on dentinal hypersensitivity. In
the studies conducted the results were controversial, or the
appropriate study design which is a randomized controlled
trial was not used. Moreover, to the best of our knowledge,
there are no clinical trials comparing the desensitizing efficacy
of a low‑level diode laser with glutaraldehyde‑based topical
desensitizing agents.
Hence, the aim of this study is to compare the
clinical effectiveness of low‑level diode laser and
glutaraldehyde‑based topical desensitizing agent on
cervical dentin hypersensitivity with the help of visual
analog scale (VAS).
MATERIALS AND METHODS
Before the study, ethical clearance was obtained from the
Institutional Review Board. In addition, written consent from
the patients was also obtained. The present double‑blinded
randomized controlled trial included patients in the age
group of 20–50 years, visiting the Outpatient Department
of Conservative Dentistry and Endodontics with cervical
dentinal hypersensitivity.
Inclusion criteria
• Dentinal hypersensitivity caused by gingival recession
or cervical abrasion/erosion
• Preoperative VAS score of ≥2
• Systemic health of the patient is good
• Minimum two teeth present in two different quadrants
were included (for eg: 16 and 26).
Exclusion criteria
• Teeth with caries, defective restorations, occlusal
restorations, and chipped teeth
496 Journal of Conservative Dentistry | Volume 21 | Issue 5 | September-October 2018
• Deep periodontal pockets  (probing depth  >6  mm),
periodontal surgery within the previous 3 months, and
subjects with orthodontic appliances or bridge work
• Cervical defect >2 mm horizontally[10]
• Use of desensitizing toothpaste in the last 3 months
• Patients allergic to ingredients used in the study
• Any gross oral pathology
• Systemic diseases such as eating disorders, chronic
diseases, pregnancy and lactation, acute myocardial
infarction within the past 6 months, use of pacemaker,
uncontrolled metabolic disease, major psychiatric
disorder, heavy smoking, or alcohol abuse.
Sample size determination
The sample size was estimated based on the data obtained
from a previous study.[11]
The pooled standard deviation (S) and mean expected
difference (d) were obtained from the same article.
Considering pooled standard deviation (S) = 1.4 cm with
mean expected difference (d) = 1 cm, the sample size
was estimated to be 21 per group. The sample size was
increased by 15% to adjust for any loss to follow‑up. Hence,
the final sample size is 25 per arm.
Diagnosis was made based on the patient’s history,
clinical examination, and pulp vitality tests. To assess
tooth sensitivity, a controlled air stimulus (evaporative
stimulus) and cold water (thermal stimulus) were used.
Sensitivity was measured using a 10‑cm VAS score, with
a score of zero being a pain‑free response and a score
of 10 being excruciating pain or discomfort. Scoring of
tooth sensitivity was done using controlled air pressure
from a standard three‑way dental syringe on a fixed
dental chair at 40–65 psi at ambient temperature,
directed perpendicularly and at a distance of 1–3 mm
from the exposed dentin surface, while adjacent teeth
were protected with cotton rolls to prevent false‑positive
results [Figure 1]. This was followed by scoring of tooth
sensitivity using 10 ml of ice‑cold water applied to the
exposed dentin surface, while neighboring teeth were
isolated during testing using the operator’s fingers and
cotton rolls. A period of at least 5 min was allowed
between the two stimuli on each tooth.
Hence, for the 50 teeth that were included in the study,
the first scores (baseline) were recorded and the subjects
were randomly assigned to one of the treatment groups
by coin flip technique. The group allocation was done by
a neutral operator to overcome selection bias. Following
which, the teeth were assigned either one of the following
treatments – topical desensitizing therapy or laser therapy
to either left or right side of the arch.
• Group  1: Glutaraldehyde‑based topical desensitizing
agent (Heraeus Kulzer, Germany)
[Downloaded free from http://www.jcd.org.in on Wednesday, July 1, 2020, IP: 27.61.139.244]

Praveen, et al.: Evaluation of a low‑level laser and topical desensitizing agent

• Group  2: Low‑level diode laser  (904  nm)
(QuantaPulse Pro 904 nm – Superpulsed, Rikta,
Kvantmed, Russia).
For Group 1, the glutaraldehyde desensitizer was
manipulated according to the manufacturer’s instructions
and painted with a disposable brush at cervical region,
after which the laser delivery tip was placed without
activation [Figure 2]. The patients were instructed not to
eat for 1 h following the desensitizer application.
Intergroup comparison of baseline or preoperative VAS
scores shows no significant difference between Group 1
and Group 2 (P = 0.91). Similarly, immediate postoperative
VAS scores show no significant difference between the
groups (P = 0.12) although both the groups have shown
reduction in the pain scores compared to baseline. At
1‑week and 3‑month follow‑up, a significant difference in
mean VAS score was observed between the two groups,
with the Group 2 showing a greater reduction compared to
Group 1 (P = 0.04, P = 0.03, respectively) [Table 2].

Moreover, in Group 2, the cervical area was irradiated with DISCUSSION

a low‑level GaAlAs laser, emitting a 904 nm wavelength. The
cone tip (beam converging) was used as close as possible Despite the available traditional methods, dentin
with the tooth surface without contact, resulting in a spot hypersensitivity remains a chronic dental problem with a
size of 0.8 cm2. Laser beam was directed perpendicular to different treatment conduct and an uncertain prognosis.
tooth surface at three points: one apical and two cervical Pain resulting from dentin hypersensitivity can be treated
points (one mesiobuccal and one distobuccal). Each area by blocking the nerve endings of odontoblastic process
was irradiated for 1 min (total of 3 min per tooth). With and by occluding or narrowing of the dentinal tubules,
an average power output of 60 mW at 4000 Hz, 9 J/cm2 of thereby reducing the fluid movement inside the dentinal
fluence was received by each tooth. canaliculi.[4] The traditional method for treating dentin
hypersensitivity is based on the application of topical
After recording sensitivity scores at baseline, patients desensitizing agents. However, it has some disadvantages
were advised to use the toothpaste with soft bristle tooth such as repeated application, longer treatment time, and
brushing twice a day. Patients were directed to refrain patient compliance. Use of newer treatment modalities for
from any other dentifrice or mouth rinse during the trial hypersensitivity such as LASERs has increased rapidly in the
but were allowed to continue their normal oral hygiene last two decades.[4,5]
practice. The sensitivity scores were recorded, immediately
and 1 week and 3 months after the therapy by the blinded Although low‑level lasers and glutaraldehyde‑based topical
patients, which were then evaluated by a neutral blinded desensitizing agents present distinct modes of action in
evaluator. the present study, both treatments provided a significant
overall relief in dentin hypersensitivity. Most experimental
Statistical considerations and clinical studies regarding the effectiveness of low‑level
Normality of the data distribution was checked using
Shapiro–Wilk test. Since nonnormal distribution was Table 1: Intragroup comparison of pain over time
period for thermal stimuli
attained, nonparametric tests were used. For the
Groups Time n Mean VAS score (SD) χ2 P
comparison between two groups at any given time
Laser Preoperative 25 58.76 (20.2) 45.63 0.001*
interval, Mann–Whitney U‑test was used. For within‑group Postoperative 25 26.40 (21.37)
comparison, Friedman’s test was used. 1 week 25 22.00 (21.18)
3 months 25 15.20 (18.2)
Gluma Preoperative 25 58.24 (16.92) 32.38 0.001*
RESULTS Postoperative 25 32.52 (19.05)
1 week 25 29.36 (17.63)
Of the 212 patients screened, 23 patients (50 teeth) 3 months 25 22.80 (17.2)
were recruited for the study based on the inclusion and P*<0.05 is statistically significant, SD: Standard deviation, VAS: Visual analog
scale
exclusion criteria. The pain scores for both groups were
recorded, and both intra‑ and inter‑group comparisons
Table 2: Intergroup comparison of pain
were done. The mean VAS scores for Group 1 recorded
were 58.24 (16.92), 32.52 (19.05), 29.36 (17.63), and Time n Mean VAS score (SD) Z P
22.80 (17.2) at baseline, immediate postoperatively, 1‑week Laser Gluma
postoperatively, and 3‑month postoperatively, respectively. Preoperative (baseline) 25 58.76 (20.2) 58.24 (16.9) −0.11 0.91
Postoperative 25 26.40 (21.4) 32.52 (19.1) −1.54 0.12
For Group 2, the scores were 58.76 (20.2), 26.40 (21.37), 1 week post 25 22.00 (21.2) 29.36 (17.6) −2.02 0.04*
22.00 (21.18), and 15.20 (18.2). There was a significant 3 months 25 15.20 (18.2) 22.80 (17.2) −2.6 0.03*
reduction in pain in both the groups over the evaluation P*<0.05 is statistically significant, SD: Standard deviation, VAS: Visual analog
period of 3 months (P = 0.001) [Table 1]. scale

Journal of Conservative Dentistry | Volume 21 | Issue 5 | September-October 2018 497

[Downloaded free from http://www.jcd.org.in on Wednesday, July 1, 2020, IP: 27.61.139.244]
Praveen, et al.: Evaluation of a low‑level laser and topical desensitizing agent
Figure 1: Controlled air stimulus  (evaporative stimulus)
1–3 mm from the tooth surface
laser therapy on dentin hypersensitivity were performed
using semiconductor diode lasers with wavelengths in
the range of 635–830 nm and dosages in the range of
2–10 J/cm. None of these laser outputs have shown to
cause any physical changes or damage to dentin. However,
a small fraction of the laser energy at 830 nm wavelength is
transmitted through dental hard tissues to reach the pulp.
Similarly, the 904 nm wavelength used in this study showed
no clinical changes in dentin and reduced the dentinal
hypersensitivity immediately, 1 week after and 3 months
after the first application.
Low‑power laser therapy generally promotes
biomodulatory effects, minimizes pain, and reduces
inflammatory processes.  However, their ability to block
depolarization of nerve fibers and depress neural
transmission seems to play a major role in reducing dentin
hypersensitivity. When applied with a sufficient level of
intensity, it causes an inhibition of action potentials by
forming reversible varicosities (bending of axons) where
there is an approximately 30% neural blockade within 10–
20 min of application.[12] Although precise mechanism of
action is unknown, GaAlAs laser emissions at 904 nm have
a definite analgesic effect.[8]
Besides its immediate analgesic effect, if laser is used
within the correct parameters, it will stimulate the normal
physiological cellular functions. Therefore, at subsequent
appointments, the pulpal tissue would be less injured and
inflamed and the laser would stimulate the production of
sclerotic dentin, thus promoting the internal obliteration
of dentinal tubules. This could explain the extended
reduction in pain scores at 1 week and 3 months after the
first dose.
On the other hand, it has been indicated that desensitizing
agents containing glutaraldehyde and HEMA, such as
Gluma, kill bacteria and coagulate plasma proteins within
498 Journal of Conservative Dentistry | Volume 21 | Issue 5 | September-October 2018
Figure 2: LASER probe with only red LED
light‑activated (placebo)
the dentinal fluids, forming a coagulation plug and thus
reduce hypersensitivity. Its effect lasts up to 9 months.
They also have a positive effect on the resin‑dentin
bonding. Hence, it has been employed as the positive
control in this study. Similar results have been obtained in
this study, where Gluma has shown significant reduction in
pain scores at the end of 3 months.
Regardless of the method and materials employed, the
evaluation of treatments for dentin hypersensitivity is not
simple. In estimating treatment effects on hypersensitive
teeth, investigations may be handicapped by the difficulty
to assess patient’s response objectively and are dependent
upon the patient’s interpretation, which is in turn subjected
to suggestion. Dentinal hypersensitivity may differ for
different stimuli, and it is recommended by Holland et al.[13]
that at least two hydrodynamic stimuli should be used, as
in this study.
Furthermore, placebo effect has been described in clinical
dentin hypersensitivity trials (Wilder‑Smith, 1988). In the
present investigation, the possibility of a placebo effect
was reduced by placing the laser tip without activating
it (only LED lights were switched on) on the sites receiving
the control medication (Gluma group). Furthermore,
the sites receiving the laser irradiation was rubbed with
saline using a microbrush. In this study, the reduction in
immediate postoperative pain was almost similar for both
the groups (P = 0.12), which could suggest that placebo
did not play an influential role.
For more effective treatment, further investigation is
required to increase the understanding of the mechanisms
and etiology of dentinal pain. The findings that revealed
by both laboratory and clinical research are extremely
important to support the development or improvement of
therapies that may acutely contribute to the treatment of
dentinal hypersensitivity sufferers.
[Downloaded free from http://www.jcd.org.in on Wednesday, July 1, 2020, IP: 27.61.139.244]
Praveen, et al.: Evaluation of a low‑level laser and topical desensitizing agent
CONCLUSION
Based on the findings of this clinical evaluation, it may be
concluded that low‑level GaAlAs laser and Gluma topical
desensitizer showed similar immediate decrease in cervical
dentin hypersensitivity. Low‑level laser showed improved
results at 1‑week and 3‑month intervals compared to the
topical agent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
1. Taani SD, Awartani F. Clinical evaluation of cervical dentin
sensitivity (CDS) in patients attending general dental clinics (GDC)
and periodontal specialty clinics (PSC). J Clin Periodontol
2002;29:118‑22.
2. Rees JS, Addy M. A cross‑sectional study of buccal cervical sensitivity in
UK general dental practice and a summary review of prevalence studies.
Int J Dent Hyg 2004;2:64‑9.
3. Liu HC, Lan WH, Hsieh CC. Prevalence and distribution of cervical dentin
Journal of Conservative Dentistry | Volume 21 | Issue 5 | September-October 2018
4.
hypersensitivity in a population in Taipei, Taiwan. J Endod 1998;24:45‑7.
Yilmaz HG, Kurtulmus‑Yilmaz S, Cengiz E, Bayindir H, Aykac Y. Clinical
evaluation of Er, Cr: YSGG and GaAlAs laser therapy for treating
dentine hypersensitivity: A randomized controlled clinical trial. J Dent
2011;39:249‑54.
5. Trushkowsky RD, Oquendo A. Treatment of dentin hypersensitivity. Dent
Clin North Am 2011;55:599‑608, x.
6. Corona SA, Nascimento TN, Catirse AB, Lizarelli RF, Dinelli W,
Palma‑Dibb RG, et al. Clinical evaluation of low‑level laser therapy and
fluoride varnish for treating cervical dentinal hypersensitivity. J  Oral
Rehabil 2003;30:1183‑9.
7. Gerschman JA, Ruben J, Gebart‑Eaglemont J. Low level laser therapy
for dentinal tooth hypersensitivity. Aust Dent J 1994;39:353‑7.
8. Kimura Y, Wilder‑Smith P, Yonaga K, Matsumoto K. Treatment of dentine
hypersensitivity by lasers: A review. J Clin Periodontol 2000;27:715‑21.
9. Flecha OD, Azevedo CG, Matos FR, Vieira‑Barbosa NM, Ramos‑Jorge ML,
Gonçalves PF, et al. Cyanoacrylate versus laser in the treatment of
dentin hypersensitivity: A controlled, randomized, double‑masked and
non‑inferiority clinical trial. J Periodontol 2013;84:287‑94.
10. Allen EP. Noncarious cervical lesions: Graft or restore? J Esthet Restor
Dent 2005;17:332‑4.
11. Yilmaz HG, Kurtulmus‑Yilmaz S, Cengiz E. Long‑term effect of diode
laser irradiation compared to sodium fluoride varnish in the treatment
of dentine hypersensitivity in periodontal maintenance patients:
A randomized controlled clinical study. Photomed Laser Surg
2011;29:721‑5.
12. Cotler HB, Chow RT, Hamblin MR, Carroll J. The use of low level laser
therapy (LLLT) for musculoskeletal pain. MOJ Orthop Rheumatol 2015;2.
pii: 00068.
13. Holland GR, Narhi MN, Addy M, Gangarosa L, Orchardson R. Guidelines
for the design and conduct of clinical trials on dentine hypersensitivity.
J Clin Periodontol 1997;24:808‑13.
499