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Original Article

Diode Laser in the Treatment of Dentinal Hypersensitivity: A Reliable

Approach
Rekha Bilichodmath, R. Vinaya Kumar, Shivaprasad Bilichodmath, Ume Sameera

Department of Aim: The purpose of this prospective clinical study was to compare the clinical

Abstract
Periodontology, Rajarajeswari
Dental College and Hospital,
Bengaluru, Karnataka, India
efficacy of diode laser and topical 0.4% stannous fluoride  (SnF2) gel in the
management of dentinal hypersensitivity (DH). Materials and Methods: A total of
8 patients contributing 200 teeth with DH were enrolled in the study. The sensitive
teeth were randomly allocated into 4 groups of 50 each: Group  I teeth were
treated with 0.4% SnF2 only; Group II with 0.4% SnF2 and diode laser irradiation
in continuous, noncontact mode; Group  III with diode laser only in continuous,
noncontact mode; and Group  IV with SnF2 and diode laser in continuous, contact
mode. Pain/sensitivity was recorded using the visual analog scale before treatment,
10  min after treatment and 7, 15, and 30  days posttherapy. Results: All the
groups showed significant reduction in DH. However, the use of both 0.4% SnF2
and diode laser in contact and noncontact mode showed statistically significant
reduction in sensitivity  (P  <  0.001) when compared to SnF2 gel and diode laser
alone. Conclusion: The adjunctive use of diode laser with SnF2 appears to be a
promising treatment alternative in alleviating sensitivity.

Keywords: Dentinal hypersensitivity, diode laser, stannous fluoride gel, visual

analog scale

Introduction Studies have reported that premolars[1] and mandibular

D entinal hypersensitivity  (DH) is one of the most
common problems encountered in dental practice,
which causes pain and discomfort to individuals.[1] It is
characterized by short, sharp pain arising from exposed
dentin in response to stimuli; typically, thermal,
evaporative, tactile, osmotic, or chemical and which
cannot be attributed to any other dental defect or
pathology.[2] Hypersensitive dentin is a sensitive or
painful response of exposed dentin to an irritant.
It is one of the most painful, common, and least
satisfactorily treated chronic problems of teeth. It is a
symptom complex rather than a disease and a persisting
problem that affects about 4%–57% of the population.
This condition is most prevalent in a large portion of
individuals aged 20–40  years with higher prevalence in
females than males and ranging between 60% and 98%
in patients with periodontal disease.[3,4]
DH is the most widespread oral problem with the cervical
area of teeth being the most common site of involvement.
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incisors were most commonly affected and facial surfaces
of teeth were the most hypersensitive areas.[5] The
common factors responsible for dentin hypersensitivity
are abrasion, abfraction, erosion, parafunctional habits
or occlusal disequilibrium, and cavity preparations that
expose the dentin.[6] It is often a major problem for
patients suffering with periodontitis who often have
exposed root surfaces and gingival recession. One
practical issue related to DH is its evaluation since pain
being a highly subjective sensation. Through literature, it
is known that there is no single therapy that can reduce
pain to satisfactory levels. Desensitizing agents and
lasers have been widely used for the treatment of DH.
An ideal desensitizing agent should not irritate the pulp,
Address for correspondence: Dr. R. Vinaya Kumar,
Department of Periodontology, Rajarajeswari Dental College and
Hospital, #14, Ramoholli Cross, Kumbalgodu, Mysore Road,
Bengaluru ‑ 560 074, Karnataka, India.
E‑mail: drrvinayakumar@gmail.com
This is an open access journal, and articles are distributed under the terms of the Creative
Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to
remix, tweak, and build upon the work non-commercially, as long as appropriate credit is
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For reprints contact: reprints@medknow.com

How to cite this article: Bilichodmath R, Kumar RV, Bilichodmath S,

DOI: 10.4103/jdl.jdl_13_18 Sameera U. Diode laser in the treatment of dentinal hypersensitivity:
A reliable approach. J Dent Lasers 2018;12:56-62.

56 © 2018 Journal of Dental Lasers | Published by Wolters Kluwer - Medknow

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Bilichodmath, et al.: Treating dentin hypersensitivity with diode laser
should be relatively painless on application, easy to
use, rapid in action, effective for a longer duration, and
not discolor the tooth.[7] At present, no tried and tested
regimens prove superior to others and there is no “gold
standard” by which one can assess treatment results.
Thus, combination of different protocols has been tried
and tested to achieve the best therapeutic benefit.[8]
Conventional therapies for DH are based on the topical use
of desensitizing agents either at home or professionally.[9]
The most commonly used agents are protein precipitants
such as formaldehyde and silver nitrate; tubule occluding
agents such as sodium fluoride, stannous fluoride (SnF2),
calcium hydroxide, and potassium nitrate; tubule sealants
such as resins and adhesives; and lasers. One of the most
commonly used tubules occluding agent is SnF2. Its
mechanism is based on the mechanical occlusion that is
achieved by precipitation of insoluble calcium fluoride
crystals within the tubules without any adhesion.[10]
Advances in the field of laser technology over the last
few decades and its wide applications in dentistry have
given an additional therapeutic option for the treatment
of DH. Different types of low output  (Diode, He‑Ne)
and middle output (Nd:YAG, CO2) lasers have been used
for hypersensitivity reduction.[11‑13] Low‑level lasers have
also shown anti‑inflammatory effects.[14] Diode lasers
are the most widely used lasers in the treatment of DH.
Different wavelengths have been used in various studies
and have shown the best results in several clinical trials
even in severe cases of DH.[15‑17]
A combination of laser irradiation with application of
specific desensitizing agents for the management of DH
could be an additional therapeutic option with a specific
goal of achieving a cumulative beneficial effect from
both the treatments. Various clinical trials have been
conducted with a combination of different types of lasers
with chemical agents such as SnF2 and sodium fluoride
with beneficial results and effectiveness more than the
treatment with laser alone.[18,19]
The aim of this prospective clinical study was to evaluate
and compare the clinical efficacy of diode laser alone
and in combination with topical 0.4% SnF2 gel in the
management of DH.
Materials and Methods
This single‑center, prospective clinical study was
carried out in the Department of Periodontics,
Rajarajeswari Dental College and Hospital, Bangalore.
The patients recruited for this study were selected from
the outpatient department. Eight systemically healthy
patients, previously untreated for DH,  (5  males and
3  females) aged between 35 and 60  years  (mean age:
48  years) with a chief complaint of DH, contributing
Journal of Dental Lasers  ¦  Volume 12  ¦  Issue 2  ¦  July-December 2018
200 teeth were enrolled for the study. Written informed
consent was obtained from patients who were willing
to participate voluntarily. This randomized controlled
trial with split‑mouth design was carried out from April
2016 to September 2016 with a follow‑up period of
1 month.
Inclusion criteria
Patients in good systemic health with clinically elicitable
dentin hypersensitivity who were reliable in their
response to test measurements and who were not treated
earlier for DH were included in the study.
Exclusion criteria
Patients with any systemic conditions, those who were
on any analgesics/anti‑inflammatory drugs at the time
of the study and those who had used any desensitizing
paste or mouthwash during the last 6  months, were
excluded from the study. Cracked teeth, large carious
lesions, or restored teeth were also excluded from the
study.
The 200 sites from 8  patients enrolled were randomly
divided into four groups of 50 sites each. Before
treatment, all the patients received phase I periodontal
therapy in the form of scaling and root planing followed
by oral hygiene instructions. The degree of sensitivity
to evaporative stimulus before and after treatment was
determined qualitatively with an air stimulus. To check
the cold air stimulus, the selected tooth was isolated,
dried, and a jet of cold air was applied from a distance
of 1  cm for 1 s and response to air stimuli was recorded
according to the visual analog scale  (VAS)  [Figure  1].
Air stimulus recordings were assessed before treatment,
15  min after treatment, 1  week, 2  weeks, and at 30  days
after treatment.
Treatment procedures
Group 1: 0.4% stannous fluoride gel only
Selected teeth were isolated with cotton rolls and
0.4% SnF2 gel  (Gel‑Kam, Colgate‑  Palmolive India
Ltd.) was applied with a cotton tip applicator onto the
affected area and left in place for 1 min. The teeth were
evaluated 15  min after the treatment and VAS score
recorded.
Group  2: 0.4% stannous fluoride+  diode laser
(noncontact mode)
Selected teeth were isolated with cotton rolls and 0.4%
SnF2 gel  (Gel‑Kam) was applied and left in place for
1  min  [Figure  2]. Diode laser  (Zolar Technology and
Mfg., Canada) having a wavelength of 810  nm was
irradiated in noncontact, continuous mode with a power
of 0.7 W for 1 min on the selected sites [Figure 3]. Each
site received three applications of 1  min each and VAS
score recorded.
57
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Bilichodmath, et al.: Treating dentin hypersensitivity with diode laser
Figure 1: Cold air blast test
Figure 2: Irradiation with diode laser
Figure 3: Diode laser therapy to treat dentinal hypersensitivity
Group 3: Laser only
After isolating the sites with cotton rolls, diode laser was
irradiated in noncontact, continuous mode with a power
of 0.7 W for 1 min was applied. Each site received three
applications of 1 min each and VAS score recorded.
58 Journal of Dental Lasers  ¦  Volume 12  ¦  Issue 2  ¦  July-December 2018
Group 4: 0.4% stannous fluoride+ diode laser (contact
mode)
After isolating the sites with cotton rolls, 0.4% SnF2
gel  (Gel‑Kam) was applied and left in place for 1  min.
Diode laser was irradiated in contact, continuous mode with
a power of 0.7 W for 1 min was applied. Each site received
three applications of 1 min each and VAS score recorded.
Recall visits
Patients were recalled after 1 and 2  weeks and 1  month.
At each visit, the above‑mentioned procedure was
repeated and VAS score was recorded. Oral hygiene
instructions were reinforced at each visit. However,
no oral prophylaxis was performed at any of the recall
visits until the end of evaluation phase. Subjective signs
such as allergic reaction, burning sensation, ulceration,
and taste alterations along with objective signs such as
redness of mucosa and staining of teeth were checked
with none being reported.
Statistical analysis
The statistical analysis was carried out using one‑way
analysis of variance test. Data were entered in Microsoft
Excel and analyzed using statistical package for
social science (SPSS) version 10.5 software (IBM,
California, USA) Tukey test was used for pair‑wise
comparison between the group/visit. The results were
averaged  (mean  ±  standard deviation) for continuous
data. P < 0.05 was considered as statistically significant.
Results
Among all the 4 groups evaluated, statistically significant
difference in the baseline VAS scores was noted between
Group 1 and Group 3, Group 2 and Group 3, and Group 3
and Group 4. Moreover, all the groups showed a significant
difference at all the time intervals when the relevant test
agent was applied (P < 0.001) [Table 1 and Graph 1].
Among all the 4 groups evaluated, Group  2 and Group  4
showed the greatest reduction in VAS scores when
compared to baseline at the 1‑month recall (Group 2 = 8.10
and Group 4 = 7.54). Group 3 showed a greater reduction
in the mean VAS score  (6.38) when compared to
Group 1 (4.16) at 1‑month recall [Table 2 and Graph 2].
Similarly, when the percentage change from baseline
to 1  month was assessed in all the groups, Group  2
showed the greatest reduction  (90.61%) followed by
Group  4  (83.89%), Group  3  (78.57%), and finally,
Group 1 (47.96%) [Table 3 and Graph 3].
Discussion
DH is experienced as a sharp pain caused by several
different stimuli and generally reported by the patient
as a chief complaint. This painful response varies
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Bilichodmath, et al.: Treating dentin hypersensitivity with diode laser

Table 1: Comparison of mean difference of hypersensitivity between the visit by treatment group actual value
Group Comparison Mean difference SEM difference t P
Group 1 Baseline versus immediate laser 1.56 0.115 13.54 <0.001
Baseline versus week 1 2.48 0.125 19.80 <0.001
Baseline versus week 2 3.04 0.134 22.64 <0.001
Baseline versus month 1 4.16 0.150 27.80 <0.001
Immediate laser versus week 1 0.92 0.118 7.79 <0.001
Immediate laser versus week 2 1.48 0.144 10.25 <0.001
Immediate laser versus month 1 2.60 0.145 17.92 <0.001
Week 1 versus week 2 0.56 0.123 4.56 <0.001
Week 1 versus month 1 1.68 0.154 10.89 <0.001
Week 2 versus month 1 1.12 0.149 7.51 <0.001
Group 2 Baseline versus immediate laser 3.44 0.115 29.87 <0.001
Baseline versus week 1 4.66 0.125 37.21 <0.001
Baseline versus week 2 5.16 0.134 38.43 <0.001
Baseline versus month 1 8.10 0.150 54.13 <0.001
Immediate laser versus week 1 1.22 0.118 10.34 <0.001
Immediate laser versus week 2 1.72 0.144 11.91 <0.001
Immediate laser versus month 1 4.66 0.145 32.12 <0.001
Week 1 versus week 2 0.50 0.123 4.07 <0.001
Week 1 versus month 1 3.44 0.154 22.30 <0.001
Week 2 versus month 1 2.94 0.149 19.72 <0.001
Group 3 Baseline versus immediate laser 2.12 0.115 18.41 <0.001
Baseline versus week 1 4.14 0.125 33.06 <0.001
Baseline versus week 2 5.20 0.134 38.73 <0.001
Baseline versus month 1 6.38 0.150 42.64 <0.001
Immediate laser versus week 1 2.02 0.118 17.11 <0.001
Immediate laser versus week 2 3.08 0.144 21.33 <0.001
Immediate laser versus month 1 4.26 0.145 29.37 <0.001
Week 1 versus week 2 1.06 0.123 8.64 <0.001
Week 1 versus month 1 2.24 0.154 14.52 <0.001
Week 2 versus month 1 1.18 0.149 7.91 <0.001
Group 4 Baseline versus immediate laser 2.72 0.115 23.62 <0.001
Baseline versus week 1 4.60 0.125 36.73 <0.001
Baseline versus week 2 6.00 0.134 44.69 <0.001
Baseline versus month 1 7.54 0.150 50.39 <0.001
Immediate laser versus week 1 1.88 0.118 15.93 <0.001
Immediate laser versus week 2 3.28 0.144 22.72 <0.001
Immediate laser versus month 1 4.82 0.145 33.23 <0.001
Week 1 versus week 2 1.40 0.123 11.41 <0.001
Week 1 versus month 1 2.94 0.154 19.06 <0.001
Week 2 versus month 1 1.54 0.149 10.33 <0.001
SEM=Standard error of mean

significantly from one person to the other. It generally
involves the facial surfaces of teeth near the cervical
region and is very common in premolars, canines, and
mandibular incisors and a slightly higher incidence in
females than males between the age group of 20 and
40  years, which could be due to overall health‑care and
oral hygiene awareness.[20,21] Brannstrom’s hydrodynamic
theory is the most widely accepted theory as to how
the fluid movement within the dentinal tubules causes
pain.[22] A variety of diagnostic techniques will exclude
the condition from other conditions causing sensitive
teeth. Cost effective and efficacious treatment for most
of the patients is a dentifrice containing a desensitizing
active ingredient such as SnF2 or potassium nitrate.
SnF2 gel  (Gel‑Kam) has proven to be effective in the
dental caries prevention, plaque formation reduction,
and breath malodor suppression[23] Standard error of
mean studies have shown that SnF2 itself can occlude
dentinal tubules and is effective in the management
of DH.[24] Miller et al. reported that a tin‑rich surface
deposit forms in vitro and in situ with 2‑week use of
anhydrous 0.4% SnF2 gel, providing near‑complete

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Bilichodmath, et al.: Treating dentin hypersensitivity with diode laser

Table 2: Comparison of mean hypersensitivity between

the treatment groups by visit actual value
Group Visit Mean SE
Group 1 Baseline 8.82 0.121
Immediate laser 7.26 0.134
Week 1 6.34 0.147
Week 2 5.78 0.148
Month 1 4.66 0.151
Group 2 Baseline 8.98 0.121
Immediate laser 5.54 0.134
Graph 1: Comparison of mean change from baseline hypersensitivity Week 1 4.32 0.147
between treatment groups by visit Week 2 3.82 0.148
Month 1 0.88 0.151
Group 3 Baseline 8.02 0.121
Immediate laser 5.90 0.134
Week 1 3.88 0.147
Week 2 2.82 0.148
Month 1 1.64 0.151
Group 4 Baseline 9.06 0.121
Immediate laser 6.34 0.134
Week 1 4.46 0.147
Week 2 3.06 0.148
Month 1 1.52 0.151
SE=Standard error

Table 3: Comparison of mean hypersensitivity between

Graph  2: Comparison of mean hypersensitivity between treatment the treatment groups by visit‑percentage change from
groups by visit baseline
Group Visit Mean SE
Group 1 Immediate laser −18.10 1.285
Week 1 −28.55 1.386
Week 2 −34.89 1.444
Month 1 −47.96 1.533
Group 2 Immediate laser −38.38 1.293
Week 1 −52.36 1.393
Week 2 −57.70 1.452
Month 1 −90.61 1.540
Group 3 Immediate laser −25.23 1.350
Week 1 −50.82 1.446
Graph  3: Comparison of mean percentage change from baseline
Week 2 −64.14 1.502
hypersensitivity between the treatment groups by visit Month 1 −78.57 1.588
Group 4 Immediate laser −30.38 1.300
surface coverage and occlusion of the tubules. When Week 1 −51.26 1.400
Week 2 −67.00 1.457
the tubules are blocked, stimulation of pain receptors
Month 1 −83.89 1.546
does not occur, thereby preventing the pain response.[24]
SE=Standard error
Thrash et al. supported the theory that the time required
for a decrease in sensitivity is between 2 and 4  weeks Matsumoto et al. and Yamaguchi et al. have reported
from initiation of treatment. They compared 0.4% decrease in hypersensitivity by 85% and 60%,
SnF2 gel to an aqueous 0.717% fluoride solution and a respectively, in teeth treated with laser.[14,15] Gerschman et
placebo at 2‑, 4‑, 8‑, and 16‑week intervals following a al., in a double‑blind study, found significant reduction
twice‑daily application. The results indicated participants of sensitivity to thermal and tactile stimuli by 67% and
who applied 0.4% SnF2 reported significantly less 65%, respectively.[16] Umberto et al. reported a very high
sensitivity during the 4–8  week period. The effect capability to improve immediately the DH‑related pain,
continued throughout the 16‑week assessment period.[25] both alone and even better in combination with sodium

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Bilichodmath, et al.: Treating dentin hypersensitivity with diode laser
fluoride gel.[26] Ranjan et al.  obtained better results with
combined intervention of laser and SnF2 gel therapy in
the management of DH. The laser‑induced superficial
melting permitting longer tubular occlusion by SnF2 gel
emphasizes the reduction of DH‑related pain.[27] Kumar
and Mehta reported that the combination of Nd:YAG
laser and 5% sodium fluoride varnish seems to show an
impressive efficacy when compared to each treatment
alone.[17]
The added advantages of combining dental laser with
SnF2 has been reported by Moritz et al. suggesting
that combined laser treatment and fluoridation result in
permanent integration of fluoride in the dentin surface.[28]
Brugnera et al. showed the immediate analgesic effect
using a diode laser.[29] The diode laser appears to be
the most widely used in day‑to‑day practice by dental
professionals.
In this conducted research, it was observed that teeth
which presented exacerbated sharp pain during the
cold air blast showed a decrease in painful sensation
immediately after 15  min of the first application of
the diode laser. Results of our study are similar to
findings by Miller et al. in 1969, who reported less
hypersensitivity posttreatment in SnF2 group as compared
to placebo gel and have shown that addition of fluoride
with laser had significant reduction of DH.[30] Inter‑visit
comparison shows greatest change in VAS scores from
baseline to 15  min after laser application in all the
groups. Further, reduction in VAS score was statistically
significant  (P  <  0.001) in all the groups at all the time
intervals. This result might be due to the synergistic
effect of fluoride when used along with the diode laser
application.
Conclusion
The diode laser has to be preferred for DH treatment
owing to its safety and beneficial clinical results. Within
the scope of this study, we conclude that the combined
use of SnF2 and diode laser appears to be a promising
treatment alternative in alleviating sensitivity when
compared to the traditional treatment modalities.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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62 Journal of Dental Lasers  ¦  Volume 12  ¦  Issue 2  ¦  July-December 2018