Journal of J Lasers Med Sci 2019 Winter;10(1):1-11 Review Article

Lasers
in Medical Sciences http://journals.sbmu.ac.ir/jlms doi 10.15171/jlms.2019.01

Laser Effects on the Prevention and Treatment of

Dentinal Hypersensitivity: A Systematic Review
Fahimeh Rezazadeh1, Paria Dehghanian2, Dana Jafarpour3*
Oral and Dental Disease Research Center, Oral & Maxillofacial Medicine department, School of Dentistry, Shiraz
1

University of Medical Sciences, Shiraz, Iran

2
Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
3
Research Associate, Biomaterials Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran

*Correspondence to
Dana Jafarpour, School of Dentistry, Abstract
Shiraz University of Medical Introduction: Dentinal hypersensitivity (DH) is an acute intensive tooth pain which can lead to
Sciences, Shiraz, Iran. dental annoyances during eating and drinking. Stimulating exposed dentinal tubules by either kind
Tel: 09125100698;
of thermal, tactile, chemical and/or osmotic stimuli is believed to be the cause of this pain. It is
Email: djafarpur@yahoo.com
hypothesized that dentinal tubules’ orifice occlusion (DOO) can help relieve such dental irritations.
Thus, this systematic review was conducted to evaluate the effectiveness of laser application as a
prevention and treatment modality on DH reduction.
Methods: Electronic databases (MEDLINE, SCOPUS) were searched among randomized clinical
trials from January 2007 to December 2016. The extraction of data and quality assessments were
Published online 15 December 2018 carried out by different independent observers.
Results: A total of 499 items were found of which3 9 relevant articles were extracted. The profound
findings proved lasers’ effectiveness as a treatment of DH. Although some of the researches
reported no significant difference between laser and other desensitizing agents, most of the studies
suggested that better results (both rapid and long-lasting) were obtained in combined modalities.
Furthermore, the preventive role of this new technology has been emphasized as well. Nd-YAG
(neodymium-doped yttrium aluminum garnet) and diode lasers reduce DH after bleaching. Lasers
can also protect cervical restorations from DH due to tubular occlusion. Moreover, it is suggested
to apply lasers in relief of DH following scaling and root planning. Nevertheless, a few researchers
dispute its beneficence as a result of placebo effect.
Conclusion: The results obtained from several studies in the present review revealed that the
application of lasers is effective not only in terms of treatment of DH, but also in the prevention
of this intensive tooth pain. Among various types of lasers, the application of Nd:YAG laser has
shown the best results in DH treatment.
Keywords: Dentinal hypersensitivity; Laser; Treatment; Prevention.

Introduction following excessive or parafunctional habits, abrasion

Dentinal hypersensitivity (DH) is defined as a fairly subsequent to incorrect brushing technique, and
specific acute intensive tooth pain which cannot be microfractures or abfractures caused by heavy eccentric
qualified as any other type of dental pathology. Stimulating occlusal forces have been suggested as common
exposed dentinal tubules by either kind of thermal, tactile, predisposing factors. Moreover, erosion due to exposure
chemical and/or osmotic stimuli is believed to be the cause to chemical products, medication and endogenous acids
of this pain.1 Dentine hypersensitivity is a very common from reflux or regurgitation of stomach acid will make
clinical symptom which has increased in prevalence dentin prone to sensitivity.10-12 Even gingival recessions due
through the past few years.2-6 Epidemiological researches to abrasion, dehiscences and fenestrations, frenum pulls
have shown that the prevalence of DH varies from 2.8% in and orthodontic movement, root exposure following age
a cross-sectional study of patients visiting general dental advances, postdental bleaching, and exposure of dentinal
practitioners7 to 98% in a population of patients referred tubules following the removal of supra and/or subgingival
to a specialist periodontology department.8,9 Meanwhile, calculi could predispose teeth to hypersensitivity.11,12 Most
different diagnostic criteria and selection bias in the often, a combination of these conditions results in dentin
enrollment of the study samples could be the potential hypersensitivity rather than one factor merely.13
explanations for this vast range of DH prevalence.8 Several theories have been introduced to explain
DH may be initiated under several conditions. Attrition the physiologic mechanisms occurring in DH.12 The

Please cite this article as follows: Rezazadeh F, Dehghanian P, Jafarpour D. Laser effects on the prevention and treatment of dentinal
hypersensitivity: a systematic review. J Lasers Med Sci. 2019;10(1):1-11. doi:10.15171/jlms.2019.01.
 All obtained papers were evaluated and selected based on the following inclusion criteria (Figure
1): RCTs and in vivo studies conducted in the recent 10 years.

In the next stage, the following exclusion criteria were applied: any data missed during the
experiment, case reports, case series, letters to editor, in vitro studies, reviews and systematic
Rezazadeh et al reviews, studies with confusing or irrelevant data, and any conference proceedings.

most commonly accepted hypothesis is the classic

hydrodynamic theory which was first developed by
Brannstrom and Astrom in 1972. In this mechanism, Selection criteria

basically, the stimulation of exposed dentinal tubules by

certain stimuli leads to an increase in the fluid flow within
dentinal tubules. Formerly, the movement of fluid creates Inclusion criteria Exclusion criteria

a pressure change across the entire dentine which can • RCTs and in vivo studies • Data missed during the experiment

stimulate individual intrapulpal nerves. Therefore, the • Studies conducted in the

recent 10 years
• Case reports, case series, letters to
editor, in vitro studies, reviews and

ability to block dentinal tubules and reduce the movement systematic reviews
• Studies with confusing or irrelevant
of fluid in dentinal tubules or/and block pulpal nerve are data
• Any conference proceedings
considered among the necessities of the ideal treatment of
DH.14-16 Moreover, the optimal treatment technique must
have fast and long-lasting effects in the absence of any Figure 1. Selection Criteria. Figure 1. Selection criteria

pulpal irritation and tooth pain.8,17

Many agents and treatment approaches have been used for
prevention and treatment of dentine hypersensitivity. In vivo studies conducted in the recent 10 years.
this respect, the desensitizing methods are implemented In the next stage, the following 4 exclusion criteria were
either by the patient for home use, usually in the form of applied: any data missed during the experiment, case
a dentifrice containing potassium salt, or professionally reports, case series, letters to editor, in vitro studies,
by a dentist using in-office topical desensitizing agents or reviews and systematic reviews, studies with confusing or
very sophisticated equipment such as laser.17,18 irrelevant data, and any conference proceedings.
Laser therapy was first applied for treating dentine
hypersensitivity by Matsumoto et al in 1985.18 Since then, Study Selection
numerous studies investigating the effectiveness of lasers Out of 499 results, 39 relevant literatures were selected
in the treatment of dentine hypersensitivity have been (Figure 2). The abstracts were reviewed by two independent
reported. 12,19,20
Reviewing the literature, it was shown that observers. After the screening and accomplishment of
low power lasers such as gallium/aluminum/arsenide the admissibility criteria, the article was admitted if an
(GaAlAs) diode laser reduce sensitivity following their agreement was reached. If any disparity was seen between
effect on the nervous level, whereas the medium power the opinions, a third author was invited to discuss the
lasers, including CO2, Nd:YAG, and Er:YAG lasers article. Only those works that fulfilled all criteria were
Study Selection
cause desensitization due to dentinal tubules’ orifice included in the study.
occlusion (DOO).13 A combination of laser therapy and
Out of 499 results, 39 relevant literatures were selected (Figure 2). The abstracts were review
desensitizing agents’ application has also been suggested Data Extraction
by two independent observers. After the screening and accomplishment of the admissibility
to improve the treatment results.17 A standard chart form of the obtained data was prepared
Furthermore, the preventive role of this sophisticated separately including authors’ names, publication date,
Figure 2. Flowchart for literature search and study selection
technology has been emphasized as well. For example, Nd-
YAG and diode lasers are used to reduce DH subsequent
to bleaching. Lasers can also protect cervical restorations •Electerical search of Pubmed/Medline, Scopus using keywords
from DH due to DOO. Moreover, it is suggested to
apply lasers in relief of DH following scaling and root N= 499
•Number of papers excluded by filter of publication date: last 10
planning.21-23 years n= 197
Therefore, the objective of this article is to assess the
efficiency of the various types of lasers used in dentistry N= 302
for prevention and treatment of DH. •Number of papers excluded by filter:
PUBMED: randomized clinical trial n=97
SCOPUS: articles, dentistry n= 77

Methods N= 128 •Number of papers excluded by:

Search Strategies Omittance of duplications n=38
assesment of relevance by title and abstract n=19
The electronic databases (MEDLINE, SCOPUS) were
searched by 2 independent researchers from January 2007 N= 71
to December 2016 using the following keywords: “dentin •Number of papers excluded by: assesment of relevance by full
text n=32
sensitivity”[All Fields] OR “dentinal sensitivity”[All
Fields] OR “dentin hypersensitivity”[All Fields] OR N=39
“dentinal hypersensitivity”[All Fields] AND (“laser”[All
Fields] OR “lasers”[All Fields]).
criteria,
All obtained papers were evaluated and selected based on the article was admitted if an agreement was reached. If any disparity was seen betw
the following inclusion criteria (Figure 1): RCTs the
andopinions,
in aFigure 2. Flowchart
third author for Literature
was invited to discussSearch
the and Study
article. Selection.
Only those works that fulfilled
criteria were included in the study.
2 Journal of Lasers in Medical Sciences Volume 10, Number 1, Winter 2019
 Laser and Dentinal Hypersensitivity

objectives, number of patients and case selection, laser Ko et al30 tested the efficacy of a low-level laser-emitting
types as well as their parameters, desensitizing agent toothbrush (635 nm, 55 seconds) on the management of
details, group tests, treatment procedures plus their DH. In this double blind randomized clinical trial, VAS
intervals, measurement methods of DH, follow-up was significantly decreased in laser group than LED group.
periods and the results (Table 1). It was concluded that the application of laser emitting
toothbrush is a safe and effective treatment option for the
Results and Discussion management of DH.
The present systematic review attempted to analyze all of In another randomized controlled double-blind split
the randomized clinical trials and comparative works to mouth clinical study,32 the desensitizing effects of
evaluate the effectiveness of laser therapy in prevention Er,Cr:YSGG and GaAlAs lasers have been compared
and treatment of dentine sensitivity. After final appraisals, with placebo on DH. The authors concluded that both
39 studies were involved for the final analysis (Table 1). Er,Cr:YSGG and GaAlAs lasers were effective in the
Previous researches evaluating the desensitizing effect treatment of DH following a single application.
of lasers have used different approaches which makes it Yimaz et al33 also reported that the Er,Cr:YSGG laser
difficult to compare their effectiveness. is effective in the treatment of DH compared with the
In this systematic review, studies were divided into four placebo treatment.
groups; each group consists of those that: Another study that compared the dentin desensitizing
Group 1: investigated laser application as a preventive effect of 3 type of lasers (diode, Nd:YAG and Er:YAG)
procedure. with placebo on teeth with gingival recessions concluded
Group 2: compared laser with placebo. that lasers can be used for DH reduction.34
Group 3: compared laser with desensitizing agents. The effect of low-level laser toothbrushes in reduction of
Group 4: examined different types of lasers. dentin hypersensitivity was evaluated by Yaghini et al,36
In group 1, the preventive effect of laser therapy was and concluded that laser toothbrushes reduce dentin
assessed.21,22,24,25 hypersensitivity more than conventional toothbrushes.
The study by Pesevska et al21 compared the effect of low- However, studies conducted by Aranha et al37 (compared
level laser and topical fluoride treatment on DH following the effect of different types of erbium laser with placebo)
scaling and root planing. It was concluded that the and Kossatz et al28 (examined diode laser against placebo)
reduction of DH by laser was superior to fluoride varnish. did not show any significant effective results. Therefore,
Therefore, laser can be successfully used for treatment of lasers might have shown a placebo effect but mostly
DH following scaling and root planing. Another study limited to a short time.
on different light-activated in-office bleaching systems Group 3: Based on our review, most of the researchers
concluded that bleaching with diode laser resulted in studied the treatment effect of lasers versus desensitizer
less tooth sensitivity than the other bleaching systems.22 chemical agents.
Moosavi et al25 also evaluated the efficacy of low-level laser Some trials reported that laser was more effective than
therapy on reducing DH after composite filling. Although chemical agents. Sicilia et al38 evaluated the immediate
both laser and placebo groups experienced a substantial efficacy of diode laser (810 nm) and potassium nitrate
improvement in pain reduction during the follow-up bioadhesive gel (10%) in the reduction of DH. A significant
periods, VAS scores were significantly less in the laser immediate response was observed in the laser group.
group. However, the results obtained from some of the Kara et al39 compared the effects of the Nd:YAG laser and
researches24,26-28 have discarded the potential protective fluoride varnish on DH in a similar study, and concluded
role of lasers in DH prevention following bleaching as no that Nd:YAG laser is a suitable treatment for immediate
significant decrease in tooth sensitivity has been shown reduction of DH and leads to a better patient satisfaction.
after LED/laser treatment. The same results were concluded by Lee et al on the
Most of the researches were conducted on the evaluation immediate effect of Er,Cr:YSGG laser in DH reduction.40
of the therapeutic effect of lasers in tooth sensitivity. Raichur et al41 also examined the efficacy of diode laser
Among these studies, many reported that laser therapy versus stannous fluoride and potassium nitrate gels in
alone or in combination with different modalities was the treatment of DH. There was a statistically significant
significantly more effective than the placebo treatment. decrease in all groups but the greatest difference in the
In group 2, eight articles directly compared laser treatment DH scores was reported in the laser group which showed
with placebo28-35; 6 of which reported significant reduction immediate relief as compared to the other methods.
in tooth hypersensitivity. In a study by Yilmaz et al,42 GaAlAs laser was found
The effect of 30 seconds application of Er,Cr:YSGG on DH more effective, faster and more comfortable than the
in one session was examined in a clinical trial by Yilmaz traditional DH treatment approach (NaF). This result is
et al.29 The authors concluded that the laser irradiation concurrent with Soares’ findings on the superior effects
provided a significantly higher desensitizing effect of Nd:YAG and GaAIAs laser in comparison to neutral
compared with the placebo, immediately after treatment. fluoride gel.43 Pesevska et al21 reported that low-power

Journal of Lasers in Medical Sciences Volume 10, Number 1, Winter 2019 3

4
Table 1. Characteristics of 39 studies were involved for the final analysis
Study, Year, TX. Pain DH Follow-up
ID Sample Size Treatment Groups and Specifications Results
Country Interval Stimulation Measurement Period
810-nm LLIL was significantly more effective than
I. Placebo that of the 660-nm laser in DH reduction at 24 h after
Moosavi et al
1 66 patients II. LLRL Diode laser (660 nm InGaAlP, 200 mW, 15 s) 1 _ VAS 48 hours bleaching, although both laser groups experienced
Rezazadeh et al

(2016), Iran
III. LLIL Diode laser (810 nm GaAIAs, 200 mW, 15 s) significantly lower pain level than the placebo after
48-h.
I. Placebo
All treatments provided adequate pain reduction
Soares et al 23 patients II. 2% neutral fluoride gel for 60 s.
2 1 _ VAS 1 week immediately, but laser treatments resulted in
(2016), UK (89 teeth) III. Nd:YAG laser (1, 10 Hz, 60 s)
significantly greater reductions in pain intensity.
IV. GaAlAs laser (40 mW; 4 J/cm2, 60 s)
In spite of DH reduction in both treatment groups,
I. Positive control: strontium chloride dentifrice (SC)
Lee et al Tactile VAS laser had a superior desensitizing effect at the initial
3 102 patients II. 20% nano-carbonate apatite (n-CAP) 2 weeks
(2015), Korea evaporative ABS stage, whereas the n-CAP maintained its effect for a
III. Er,Cr:YSGG laser
relatively longer time.
I. Placebo
II. Low-level laser (LLL) (685 nm diode laser, 25 mW, 100 s) The application of either LLL or DP was effective in
Bal et al 21 patients
4 III. Desensitizing paste (DP) 8% arginine-calcium carbonate 1 Evaporative VAS 90 days decreasing DH. However, their combined use did not
(2015), Turkey (156 teeth)
IV. Laser followed by DP (LLL+ DP) improve the efficacy.
V. DP followed by laser (DP+ LLL)
I. 5% NaF
In spite of DH reduction in all groups, 5% NaF varnish
Suri et al 30 patients II. Diode laser (980 nm GaAlAs) Tactile
5 VAS 2 months with DL showed the best results (P<0.001).
(2016), India (20 teeth) III. Group I + group II 1 evaporative
G3>G2>G1
IV. Placebo
In spite of DH reduction in both groups at last,
Dantas et al I. Fluoride varnish Tactile VAS
6 86 teeth 4 72 hours the short term tx with Fluoride was more effective
(2016), Brazil II. Diode laser (GaAlAs laser at a 4 J/cm2 dose) thermal
(P<0.001).

Yaghini et al I. Laser toothbrush In spite of DH reduction in both groups, laser

7 40 patients 4 Thermal VAS 2 months
(2015), Iran II. Non-laser toothbrush toothbrush was more effective (P <0.05).

I. Low-power red laser (630 nm, 28 mW, continuous wave, Significantly greater DH reduction (P <0.05) in the

Journal of Lasers in Medical Sciences Volume 10, Number 1, Winter 2019

Moosavi et al 31 patients
8 60 s, 1.68 J) before resin composite restoration 1 Thermal VAS 30 days laser than the placebo group was observed suggesting
(2015), Iran (62 teeth)
II. Placebo + resin composite restoration LLLT a suitable approach in class V restoration.

I. Gluma
II. Infrared Low-power laser (30 mW, 10 J/cm(2), 4 points, 9 1
All groups showed a reduction in DH (P<0.001).
s per point, 810 nm) 3 Evaporative
Lopes et al 27 patients Gluma presented immediate effects. The combination
9 III. Infrared Low-power laser (100 mW, 90 J/cm(2), 2 points, 3 tactile VAS 2 months
(2015), Brazil (55 teeth) of protocols is an interesting alternative in the
11 s per point, 810 nm) 3
treatment of cervical dentin hypersensitivity.
IV. Group I+ group II 3
V. Group I + group III
Both laser groups were effective for the tx of FH
Yilmaz & I. Er,Cr:YSGG laser at 0·25 W
20 patients (P<0.001) according to VAS scores and tubuli
10 Bayindir. II. Er,Cr:YSGG laser at 0.5 W 1 Evaporative VAS Immediate
(60 teeth) occlusion in SEM; however, 0.5 W laser irradiation
(2014), Turkey III. Placebo
showed best results.
 Table 1. Continued

84
I. 635 nm per 6 mW laser-emitting toothbrush In spite of DH reduction in both groups (P<0.05), this
Ko et al (2014), (3 times a
11 96 patients II. Placebo: 635 nm per 12·9 μW light-emitting diode (LED) Evaporative VAS 4 weeks decrease was significantly greater in the test group with
South Korea day for 4
toothbrush no noticeable side effects.
weeks)

Hashim et al 5 patients I. Diode laser (810 nm) with exposure duration of 30 s Tactile Diode laser was effective for the reduction of dentine
12 2 VAS 7 days
(2014), Sudan (14 teeth) II. Diode laser (810 nm) with exposure duration of 1 min hypersensitivity (P<0.001).

De Almeida LED-laser treatment was not able to prevent or reduce

I. LED
13 Farhat et al 16 patients 2 _ VRS 6 months the sensitivity of teeth (P>0.05) and did not improve
II. LED-laser (300 mW/cm2)
(2014), Brazil the efficacy of bleaching.

I. Diode laser All groups showed a reduction in DH (P= 0.0020). DL

Raichur et al
14 45 patients II. 0.4% stannous fluoride gel Evaporative 6 months was not only the most effective, but also brought about
(2013), India
III. 5% potassium nitrate gel improved immediate relief.

I. Placebo: carbomer 940 gel 4 All groups were able to reduce DH (P<0.001),
Lund et al 13 patients
15 II. 2% sodium fluoride gel 4 Evaporative VAS 90 days including placebo group, with no difference among
(2013), Brazil (117 teeth)
III. Low-level infrared diode laser 3 them.
I. Gluma Tactile All protocols were effective in reducing DH after 6
Lopes &
24 patients II. Nd:YAG Laser 1.5 W, 10 Hz, and 100 mJ, approximately Evaporative months (P<0.001); however, the association of Nd:YAG
16 Aranha (2013), 1 VAS 6 months
(33 teeth) 85 J/cm(2), 60 s and Gluma Desensitizer is an effective treatment
Brazil
III. Group I + group II Thermal strategy that has immediate and long-lasting effects.
Cyanoacrylate is as effective as low-intensity laser
I. (GaAlAs) infrared diode laser (795 nm,120 mW, 2.88 J/
Flecha et al 62 patients in reducing DH. In addition, it is a more accessible
17 cm2, 8 s) 3 Tactile NRS 180 days
(2013), Brazil (434 teeth) and low-cost procedure and can be safely used in the
II. Cyanoacrylate
treatment of DH.
I. NaF In spite of DH improvement in all groups, diode laser
Femiano et al 24 patients II. Diode laser (808 nm-35 W) in association with NaF effectively reduced DH with a
18 3 Thermal VAS 6 months
(2013), Italy (262 teeth) III. Group II + Group III more immediate relief and longer
IV. Gluma desensitizer lasting (P<0.001).
I. Placebo The use of 5% sodium fluoride varnish and laser for
Mogharehabed
9 patients II. 5% sodium fluoride varnish Evaporative treatment of DH is accompanied by a placebo effect.
19 et al (2012), 1 VAS 2 weeks
(60 teeth) III. Nd: YAG laser (1 W, 20 Hz, 120 s) Thermal The association of NaF and laser showed the best
Iran
IV. Group II + group III improvements.
Ehlers et Both laser and glutaraldehyde groups showed an
22 patients I. Glutaraldehyde-based desensitizing system
20 al (2012), Evaporative VAS 6 months effective and equal reduction of cervical dentin
II. Er:YAG laser
Germany hypersensitivity (P<0.001).
I. Home bleaching with 10% carbamide peroxide, 4 h/d 3 weeks
Although all groups led to tooth sensitivity, light
de Almeida et 40 patients II. 35% hydrogen peroxide, 10 minutes 3 sessions Analog scale
21 _ 180 days irradiated techniques showed more sensitivity in terms
al(2012), Brazil III. Quartz−tungsten−halogen light irradiation, 10 min 3 sessions (0-10)
of both duration and intensity.

Journal of Lasers in Medical Sciences Volume 10, Number 1, Winter 2019

IV. LED/laser light irradiation, 10 min 3 sessions
With the evaporative stimulus, group II was associated
I. Placebo
Aranha & with the lowest level of pain. With the mechanical
28 patients II. Er:YAG laser (2 Hz/32.4 mJ/5.9 J/cm(2)) Evaporative
22 Eduardo Cde. 1 VAS 1 month stimulus, group IV showed the most pronounced
III. Er,Cr:YSGG laser treatment (0.25 W/4.4 J/cm(2)) Tactile

5
(2012), Brazil decrease in pain immediately after treatment; however,
IV. Er,Cr:YSGG laser treatment (0.50 W/ 8.9 J/cm(2))
after 4 weeks, pain levels had increased.
Laser and Dentinal Hypersensitivity
6
Table 1. Continued

I. Diode laser (GaAlAs laser at 8.5 J/cm2, 60 s) Compared to the control group, both Er,Cr:YSGG
Yilmaz et al 51 patient II. Er,Cr:YSGG laser (0.25 W, 20 Hz, 0% water and 10% air, and GaAlAs lasers were effective in DH reduction
23 1 Evaporative VAS 3 months
(2011), Turkey (174 teeth) 30 s) immediately after the treatment (P <0.05) with no
Rezazadeh et al

III. No treatment significant difference (P < 0.05).

GaAlAs laser and NaF varnish treatments resulted in

I. GaAlAs laser (810 nm, 500 mW, 60 s, 8.5 J/cm(2))
a significant reduction in the VAS scores immediately
Yilmaz et al 48 patients II. Placebo laser
24 1 Evaporative VAS 6 months after treatments that were maintained throughout the
(2011), Turkey (244 teeth) III. NaF varnish
study when compared to the baseline and placebo
IV. Placebo NaF varnish
treatments.
Er,Cr:YSGG laser had a significantly higher
Yilmaz et al 42 patients I. Er,Cr:YSGG laser (0.25W, 20 kHz, 30 s) VAS + plaque
25 1 Evaporative 3 months desensitizing effect compared with the placebo
(2011), Turkey (146 teeth) II. Placebo index
immediately after treatment (P <0.05).
Pain scores of placebo groups were significantly higher
I. Glutaraldehyde containing dentin desensitizer 1 than those of the desensitizer's and diode lasers (P <
16 patients
Orhan et al II. Low-level Diode laser (25-mW, 655 nm, 4 J/cm(2), 160 s) 6 Thermal 0.05). Significant DH reduction was observed in 7 days
26 64 teeth VAS 7 days
(2011), Turkey III. Distilled water 1 evaporative with the use of the desensitizer and low-level laser
IV. Placebo laser 6 therapy with no statistically significant difference (P >
0.05).
I. Light-activated (LA) (LEDs with wavelength of 470 nm and
The intensity of sensitivity was similar for both groups
three infrared
Kossatz et al immediately after bleaching but significantly higher
27 30 patients II. Laser diodes with 830 nm and light intensity of 200 mW/ 2 _ 0-4 scale 48 hours
(2011), Brazil for the LA group 24 hours after each bleaching session
cm, 1 min for 3 times)
(P=0.001).
III. Non-activated
DH reduction by Laser was superior to Fluoride
Pesevska et 2 Varnish. Complete resolution of pain was achieved in
I. Low-level diode laser (630–670 nm; 100 mW/cm , 20 s)
28 al (2010), (30 teeth) 3 _ VRS 5 days 26.67% of group I, compared to 0 % in group II after
II. Topical Fluoride Varnish (Fluor Protector)
Macedonia the second visit, and 86.67% in group I compared to
26.67% in group II after the third visit.

Journal of Lasers in Medical Sciences Volume 10, Number 1, Winter 2019

I. Bleaching twice without light activation
II. Bleaching with a diode laser (810 nm, 10 W) activation
for 3 times
Gurgan et al Group II showed significantly lower tooth and gingival
29 40 patients III. Bleaching treatment with a plasma arc lamp (400-490 1 _ VAS Immediate
(2010), Turkey sensitivity scores than did the other groups (P<0.001).
nm, 2800 mV/cm(2)) for 3 times
IV. Bleaching twice with a light emitting diode (LED) lamp
(400–500 nm)
I. Er:YAG (2940 nm) & CO2 lasers (10600 nm) + fluoride
There were statistically significant differences between
gel
groups I and II. There were no statistically significant
Genovesi et al II. Placebo 1
30 15 patients Evaporative VAS Immediate differences between groups III and IV. Er:Yag and
(2010), Italy III. Er:YAG & CO2 lasers
CO2 lasers together with fluoride gel are useful in the
IV. Fluoride gel + Placebo
treatment of dentine hypersensitivity.
I. GaAIAs Diode laser (100mw, 25 s, 808 nm) + desensitizer
GaAIAs Diode laser plus desensitizer toothpaste group
Dilsiz et al 13 patients toothpaste
31 3 Evaporative VAS 60 days showed a higher degree of desensitization in teeth than
(2010), turkey (52 teeth) II. Desensitizer toothpaste
did the control group (P<0.001).
 Table 1. Continued

I. Er:YAG laser (2,940 nm, 60 mJ/pulse, 2 Hz, 20 s) Significant reduction of DH occurred at all times for
Dilsiz et al 24 patients II. Nd:YAG laser (1,064 nm, 100 mJ/pulse, 15 Hz, 100 s) all groups. Nd:YAG laser was proved more effective
32 3 Evaporative VAS 60 days
(2010), turkey (96 teeth) III. Diode laser (808 nm, 100 mW, 20 s) in treatment of DH than the Er:YAG and diode lasers
IV. Placebo especially in 3-months results (P<0.001).
The DL and NK10% gel were proven effective in the
I. Diode laser (810 nm) + placebo gel
Sicilia et al treatment of DH. DL has shown efficacy in rapid and
33 45 patients II. Placebo laser + 10% potassium nitrate bio adhesive gel 1 Evaporative VRS 60 days
(2009), Spain long-lasting DH reduction compared with placebo
III. Placebo laser + placebo gel
laser in periodontal patients.
Laser treatment resulted in significant improvements
of discomfort immediately after treatment and after
Kara & Orbak. I. Nd:YAG laser (100 mJ, 20 Hz) 1 week (P<0.001). However, the VAS scores at the
34 20 patients 1 Evaporative VAS 4 weeks
(2009), Turkey II. Fluoride varnish 4-week examination were significantly lower in the
fluoride group compared with those in the laser group
(P<0.05).

I. 2% NaF VRS scores were significantly lower for the other

II. CO(2) laser (1 W, 10 s) four treatments than for NaF gel alone (P +/- 0.001).
Ipci et al 50 patients Thermal
35 III. Er:YAG laser (30 Hz, 60 mJ,10 s) 1 VRS 6 months No superiority was found for desensitization among
(2009), Turkey (420 teeth) Evaporative
IV. Group I + group II the CO(2), Er:YAG, CO(2) + NaF, and Er:YAG + NaF
V. Group I + group III groups.

I. Glumma Desensitizer 1 OG and LILT showed significantly higher sensitivity

II. Seal & Protect (SP) 1 immediately compared to Gluma Desensitizer and
Aranha et al Thermal
36 (101 teeth) III. Oxa-gel (OG) 1 VAS 6 months SP (P=0.0165). However, after 6 months, all therapies
(2009), Brazil Evaporative
IV. Fluoride (F) 1 showed lower sensitivity compared with baseline
V. Low intensity laser- LILT (660 nm/3.8 J/cm2/15 mW) 3 presenting no statistically significant differences.

Tengrungsun (0-4 degree A significant DH reduction after both treatments at all

& Sangkla. 70 patients I. GaAlAs laser (30 mW, 1 min) Tactile, scale) times was observed (P< 0.05). DH reduction by dentin
37 1 30 days
(2008), (140 teeth) II. Dentin bonding agent thermal (Uchida bonding agent was significantly superior to GaAlAs
Thailand criteria) laser (P< 0.05).

The recorded tooth sensitivity was similar in the

I. 35% Hydrogen Peroxide (HP) number of patients and intensity. Tooth sensitivity
Marson et al 40 patients II. 35% HP + Halogen Curing Light XL 3000 (3M/ESPE) occurred immediately following bleaching, but a
38 2 _ VRS 6 months
(2008), Brazil III. 35% HP + Demetron LED (Kerr) higher degree of sensitivity was recorded after the
IV. 35% HP + LED/LASER (Bio-art) second bleaching session, independent of the group
evaluated.

Both lasers, in spite of a placebo effect at short time,

I. Nd:YAG laser (1 W, 15 Hz, 60 s, 2 times)
Birang et al 9 patients were so effective to decrease DH. Nd:YAG laser
39 II. Er:YAG laser (100 mJ, 3 Hz, 60 s, 2 times) 1 Tactile VAS 6 months
(2007), Iran (63 teeth) was more effective than Er:YAG laser in reduction of
III. Placebo
patients’ pain (P<0.0005).

Journal of Lasers in Medical Sciences Volume 10, Number 1, Winter 2019

7
Laser and Dentinal Hypersensitivity
Rezazadeh et al

laser treatment was more effective than topical fluoride the treatment of DH was evaluated. It was suggested that
for relieving dental hypersensitivity following scaling and cyanoacrylate is as effective as laser in reducing DH. This
root planning. is to say that cyanoacrylate is a more accessible and low-
In most of the researches, the combination of laser and cost procedure and can be safely used in DH treatment.
desensitizer agents was more effective44-50 for example, It is worth to note that some researchers have shown
Suri et al44 compared the effectiveness of GaAlAs laser multifaceted results. For instance, Aranha et al31 compared
alone and combined with the NaF varnish in treatment the effect of different desensitizers (Gluma, fluoride) with
of DH. Even though both of them showed significant low-level laser on DH for a period of 6 months. They
reduction in DH, the combination of fluoride varnish concluded that both therapies demonstrated lower VAS
with diode laser led to the best results.44 In another study, compared with the baseline. However, LLLT (GaAlAs)
Genovesi et al45 also reported that there were no significant presented a gradual reduction in DH while Gluma showed
differences among Er:Yag and CO2 laser groups as well as immediate effect on hypersensitivity.
the fluoride gel and placebo group. However, Er:YAG and Lund et al,56 in their study assessing the effectiveness
CO2 lasers together with fluoride gel were proved to be of sodium fluoride gel and diode laser (infrared) for
useful in the treatment of dentine hypersensitivity. Ipci dentin hypersensitivity, proposed that there was no
et al46 in a similar study concluded that lasers (CO2 and difference among the groups. In a similar study, Ehlers
Er:YAG) in combination with NaF gel showed a better et al57 reported that both Gluma and Er:YAG laser have
efficacy for DH relief compared to each treatment alone. shown an equal effective reduction of cervical DH. Orhan
A significant effect of combined desensitizer toothpaste et al58 also suggested that low-level laser therapy and
and diode laser therapy was also shown in the treatment desensitizer application have presented similar reduction
of DH in gingival recessions.47 In a similar work that in moderate DH.
assessed different treatment protocols of Nd:YAG Laser, Group 4: The lasers used for dental treatment are usually
Gluma et al showed that all of the protocols were effective divided into 2 groups: low- power lasers (He-Ne and
in reducing DH; however, the dual application of laser GaAlAs lasers), and high-power lasers (Nd:YAG ,
and Gluma Desensitizer was an effective treatment which Er:YAG, Er,Cr:YSGG and CO2 lasers). Different studies
had immediate and long-lasting effects.48 have assessed various types of lasers for DH treatment.
Femiano et al49 also evaluated the desensitizing efficacy of Aranha et al37 compared two types of high-power laser
sodium fluoride solution, diode laser, and their association (Er:YAG and Er,Cr:YSGG lasers) on DH and concluded
together with a solution of hydroxylethylmethacrylate that although none of the lasers could eliminate pain
and glutaraldehyde (HEMA-G: Gluma desensitizer) completely, both lasers were suitable for the treatment of
in cervical dentin hypersensitivity. The best result was DH. Another work reported that no significant difference
reported for the combined treatment. Mogharehabed was found between Er,Cr:YSGG and GaAlAs laser at
et al50 reported that the application of sodium fluoride follow-up sessions although both were effective after
varnish and Nd:YAG for the treatment of dentin single application.32 Comparison of the desensitizing
hypersensitivity is accompanied by a placebo effect; effect of Er:YAG, Nd:YAG, and GaAlAs (diode) lasers on
however, this positive effect was more noticeable for DH has shown that Nd:YAG laser is more effective than
the combined group (fluoride-laser) compared to the Er:YAG and diode laser.34 A similar research on the effect
other groups. In spite of preceding conclusions, Bal et of Nd:YAG and Er:YAG lasers on teeth sensitization,
al51 reported that the combination of low-level laser and concluded that Nd:YAG laser is more effective than Er:YAG
arginine-calcium carbonate desensitizing paste did not laser.35 Another study also reported that both CO2 and
improve the efficacy of DH reduction beyond what was Er:YAG lasers are effective in the management of DH.46
attainable with either treatment alone. Ladalardo et al18 conducted a research on the effectiveness
In contrast, as few researches have shown, chemical agents of 2 types of low-power lasers (660 nm wavelength red,
were more effective than laser. Tengrungsun et al52 made and 830 nm wavelength infrared) on DH. Their results
a comparison between the efficacy of the GaAlAs laser showed that the red diode laser was more effective than
and dentin bonding agent in DH treatment and reported the infrared laser and most of the desensitizing effects
that the dentin bonding agent had more desensitizing were observed within 15 and 30 minutes after irradiation.
efficacy compared to the GaAlAs laser. Dantas et al53 Moosavi et al59 in contrast reported opposing assumption
also showed that a short time treatment with fluoride that infrared laser was significantly more effective.
was more effective than GaAlAs laser for DH reduction. With respect to the increasing prevalence of DH, a
Lopes et al54 compared low-power laser, Gluma (as a comprehensive survey on the modern therapeutic methods
desensitizing agent), and their combination effect on such as laser therapy was demanding. Despite various
dentin hypersensitivity treatment. The authors concluded treatment modalities, few valid studies are available in
that all of the methods were efficient in reducing pain this area. Diagnostic criteria are less reliable and mostly
but Gluma showed immediate effects. In another study,55 count on patients’ report. Also, the use of different
the effectiveness of cyanoacrylate and low-power laser in types of lasers, different methods and wavelengths, and

8 Journal of Lasers in Medical Sciences Volume 10, Number 1, Winter 2019

 Laser and Dentinal Hypersensitivity

conflicting findings were the restricting factors in terms 3. Gronseth G, Cruccu G, Alksne J, et al. Practice
of reaching a decisive conclusion. Furthermore, a great parameter: the diagnostic evaluation and treatment of
variation in types of desensitizing agents, the sample trigeminal neuralgia (an evidence-based review): report
size and the number of patients in each group, follow-up of the Quality Standards Subcommittee of the American
Academy of Neurology and the European Federation of
periods, and assessment protocols were also among the
Neurological Societies. Neurology. 2008;71(15):1183-1190.
limitations of this systematic review.
doi:10.1212/01.wnl.0000326598.83183.04
With regard to the results of the present review, it 4. Walker J. Relief from chronic pain by low power laser
seems that laser is useful not only for the treatment, but irradiation. Neurosci Lett. 1983;43(2-3):339-344.
also as prevention of DH. Furthermore, based on the 5. Cruccu G, Finnerup NB, Jensen TS, et al. Trigeminal
experimental studies, laser application leads to tubuli neuralgia: New classification and diagnostic grading for
orifice occlusion and decreases the dentine hydraulic practice and research. Neurology. 2016;87(2):220-228.
conductance but has no effect on the mineral composition. doi:10.1212/wnl.0000000000002840
High-power lasers (Nd:YAG and Er:YAG lasers) result in 6. Falaki F, Nejat AH, Dalirsani Z. The Effect of Low-level
the reduction of dentine permeability mostly by sealing Laser Therapy on Trigeminal Neuralgia: A Review of
opened tubules; however, low- power lasers (diode lasers) Literature. J Dent Res Dent Clin Dent Prospects. 2014;8(1):1-
affect DH probably by decreasing the dentinal fluid flow. 5. doi:10.5681/joddd.2014.001
7. Zakrzewska JM, Akram H. Neurosurgical interventions
Finally, laser treatment could reduce DH but its efficacy
for the treatment of classical trigeminal neuralgia.
may be the same as desensitizing agents. Nevertheless,
Cochrane Database Syst Rev. 2011(9):Cd007312.
a few researchers dispute its beneficence as a result of doi:10.1002/14651858.CD007312.pub2
placebo effect. Irrespective of the fact that laser has several 8. Montano N, Papacci F, Cioni B, Di Bonaventura R,
advantages such as long-lasting analgesic effects and Meglio M. What is the best treatment of drug-resistant
seems to be safe, due to its high cost, it is not considered trigeminal neuralgia in patients affected by multiple
as a first choice of treatment. sclerosis? A literature analysis of surgical procedures. Clin
The results attained in the present study are in consistent Neurol Neurosurg. 2013;115(5):567-572. doi:10.1016/j.
with Lin et al’s meta-analysis,60 which suggested that lasers clineuro.2012.07.011
were significantly more effective than placebo in reducing 9. Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM.
DH. However, this study did not consider the different Efficacy of low-level laser therapy in the management
of neck pain: a systematic review and meta-analysis of
types of lasers. The present results are in contrast with the
randomised placebo or active-treatment controlled trials.
systematic review of Sgolastra et al20 conducted in 2011.
Lancet. 2009;374(9705):1897-1908. doi:10.1016/s0140-
This difference could be related to the very few numbers 6736(09)61522-1
of studies evaluated in their study. 10. Jiang JA, Chang WD, Wu JH, Lai PT, Lin HY. Low-level
laser treatment relieves pain and neurological symptoms
Conclusion in patients with carpal tunnel syndrome. J Phys Ther Sci.
Although the results obtained from 39 studies appraised 2011;23(4):661-665. doi:10.1589/jpts.23.661
in this systematic review were conflicting, most of them 11. Konstantinovic LM, Cutovic MR, Milovanovic AN,
verified the clinical efficacy of laser in prevention and et al. Low-level laser therapy for acute neck pain with
treatment of DH symptoms. Some of the researches have radiculopathy: a double-blind placebo-controlled
reported no significant difference between laser and other randomized study. Pain Med. 2010;11(8):1169-1178.
doi:10.1111/j.1526-4637.2010.00907.x
desensitizing agents, and most of the studies proposed
12. Asnaashari M, Moeini M. Effectiveness of lasers in the
better results (both rapid and long lasting) in combined
treatment of dentin hypersensitivity. J Lasers Med Sci.
modalities. Moreover, it was concluded that among 2013;4(1):1-7.
various types of lasers, the application of Nd:YAG laser 13. Biagi R, Cossellu G, Sarcina M, Pizzamiglio IT, Farronato
has shown the best results in DH treatment. G. Laser-assisted treatment of dentinal hypersensitivity: a
literature review. Ann Stomatol (Roma). 2015;6(3-4):75-80.
Ethical Considerations doi:10.11138/ads/2015.6.3.075
Not applicable. 14. Kingsley JD, Demchak T, Mathis R. Low-level laser therapy
as a treatment for chronic pain. Front Physiol. 2014;5:306.
Conflict of Interests doi:10.3389/fphys.2014.00306
The authors declare no conflict of interest. 15. Alfredo PP, Bjordal JM, Dreyer SH, et al. Efficacy of low level
laser therapy associated with exercises in knee osteoarthritis:
a randomized double-blind study. Clin Rehabil.
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