Journal of Oral Rehabilitation

Journal of Oral Rehabilitation 2011 38; 348–358

Review Article
Effectiveness of laser therapy and topical desensitising agents
in treating dentine hypersensitivity: a systematic review
S. HE, Y. WANG, X. LI & D. HU Department of Preventive Dentistry, West China College of Stomatology, Sichuan
University, Chengdu, China

SUMMARY The aim of this systematic review was to not performed. Half of the included studies com-
compare the effectiveness of laser therapy with that pared GaALAS laser with topical desensitising
of topical desensitising agents in treating dentine agents, but the findings were conflicting. The
hypersensitivity. A secondary objective was to remaining studies involved Nd:YAG laser, Er:YAG
determine the safety of laser application according laser and CO2 laser, and all showed that the three
to the relevant studies. A systematic search was types of lasers were superior to topical desensitising
performed in the MEDLINE, EMBASE, the Cochrane agents, but the superiority was slight. A systematic
Central Register of Controlled Trials, the National review of the literature indicates the likelihood that
Research Register, the Cochrane Oral Health laser therapy has a slight clinical advantage over
Group’s Trials Register database to retrieve all topical medicaments in the treatment of dentine
articles that were about randomised controlled hypersensitivity. More large sample-sized, long-
trials involving the application of laser desensitising term, high-quality randomised controlled clinical
procedures and topical desensitising agents in the trials are needed before definitive conclusions were
treatment of dentine hypersensitivity. A total of made.
eight trials that met all inclusion criteria involving KEYWORDS: laser therapy, topical desensitising agents,
234 participants were reviewed. Based upon the effectiveness, dentine hypersensitivity, systematic
‘quality’ of evidence, one study was classified as A review
level, five as B level and two as C level. Owing to the
heterogeneity of the studies, a meta-analysis was Accepted for publication 28 November 2010

hydrodynamic theory that was first proposed by Bränn-

Introduction
ström and Aström (8). Based on this theory, the ideal
Dentine hypersensitivity is a common oral complaint treatment of dentinal hypersensitivity should be able to
characterised by ‘short, sharp pain arising from exposed reduce fluid flow in dentinal tubules or block pulpal
dentin in response to stimuli typically thermal, evap- nerve response or both (1, 9). A surprisingly large
orative, tactile, osmotic or chemical and which cannot number of desensitising methods including dentifrices
be ascribed to any other form of dental defect or containing various compounds [e.g. potassium salts (10,
pathology’ (1). Both dentine hypersensitivity and den- 11), zinc–CHA nanocrystals (12)], topical desensitising
tal erosion have increased in prevalence over the last agents [e.g. fluoride (13)], adhesives and resins (14),
few decades (2–7) and appear to be linked in terms of etc. have been proposed. However, most of these
causality (5–7). The prevalence rate of dentinal hyper- desensitising agents are either ineffective or effective
sensitivity has been reported to be as great as 74% (2). for only a short period of time (15). As a result, the ideal
The physiologic mechanisms of pain production material or technology that does not irritate to the pulp
because of dentine hypersensitivity have not been but is relatively painless and easy to use as well as
fully elucidated. The most accepted hypothesis is the effective for a long period has yet to be discovered (6).

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 LASER THERAPY VERSUS TOPICAL DESENSITIZING AGENTS FOR DH 349

In recent years, lasers have been widely used in ‘lasers’, ‘laser’. In addition, hand search involving the
treating endodontic and periodontal diseases (16, 17). following relevant journals from 2000 to 2010 was
Laser therapy was first applied for treating dentine performed: Lasers in Medical Sciences, Lasers in Surgery and
hypersensitivity by Matsumoto et al. (18). Since then, Medicine, Photomedicine and Laser Surgery, Photodiagnosis
numerous studies (19–22) involving the application of and Photodynamic Therapy, Journal of Oral Rehabilitation,
laser in the treatment of dentine hypersensitivity have Journal of Periodontology, Journal of Clinical Periodontology,
been reported. To date, four types of lasers (Nd:YAG Journal of Endodontics,Clinical Oral Investigations, Journal
laser, Er:YAG laser, CO2 laser and GaALAS laser) are of Dental Research, Journal of Oral Laser Applications,
commonly used in the treatment of dentine hypersen- Journal of Periodontal Research and Periodontology 2000.
sitivity, and their effectiveness ranges from 5Æ2% to Furthermore, the reference lists of relevant trials
100%, depending on the laser type and parameters were obtained.
used (19). Laser therapy has been a hot topic in the
treatment of dentine hypersensitivity, especially with
Inclusion an exclusion criteria
regard to its reliable, immediate and reproducible
analgesic effect (19, 23). Although some in vitro and Inclusion criteria were as follows:
in vivo studies had demonstrated its effectiveness for 1 Type of study: only randomised control trials (RCTs)
treating dentine hypersensitivity (19–21), some reports were eligible for the study.
obtained from laser therapy were still equivocal (24, 2 Participants: patients had at least two or more
25). Other randomised controlled trials suggested that hypersensitivity teeth confirmed by evaporative
there was no significant difference in reduction stimulus or tactile hypersensitivity assessment.
between laser therapy and placebo or positive controls 3 Interventions: the trial groups received laser therapy,
(25, 26). On the other hand, the cost-effectiveness and and the control groups received other topical desen-
complex treatment modality as well as its potential sitising agents, such as fluoride varnish, dentin
dental pulp damage must be taken into consideration bonding agents and so on.
(27). Thus, to date, the value of using laser therapy to 4 Outcome measures: clinical performance and ⁄ or
treat dentine hypersensitivity is uncertain. The purpose patients’ self-assessment.
of this study was to systematically evaluate existing 5 Study was published in English language.
evidence to verify whether laser therapy provided a Exclusion criteria were as follows:
better performance compared to other desensitising 1 Studies with a greater than 20% loss in follow-ups.
agents for treating dentine hypersensitivity. 2 The studies that had confusing data or probable
errors.
3 The literature – editorials letters, case reports,
Materials and methods
reviews, personal views were also excluded.

Search strategy
Literature screening, quality assessment
A literature search was performed in the following
databases: To select eligible trials, two reviewers (S.L. and D.Y.)
1 MEDLINE (1970–1 January 2010), independently screened the literature and assessed
2 EMBASE (1977–1 January 2010), their quality using a standardised extraction form. If
3 the Cochrane Central Register of Controlled Trials any different opinion occurred, it was resolved through
(CENTRAL), discussion. The quality of the trials was assessed
4 the Cochrane Oral Health Group’s Trials Register (to 1 according to the Cochrane Handbook for Systematic
January 2010) and Reviews of Interventions and based on the following
5 the National Research Register. criteria – randomisation, allocation concealment, blind-
Only English language publication trials were selected ing, reporting loss to follow-up ⁄ withdrawal and com-
in the study. The following terms were adopted alone or parability of baseline (Table 1) (28, 29). If all of the
in combination: ‘dentin sensitivity’, ‘dentine sensitiv- items of a trial was ‘A’, it was considered to be a high
ity’, ‘dentinal sensitivity’, ‘dentin hypersensitivity’, quality one and rated as grade A; if the items were ‘A’
‘dentine hypersensitivity’, ‘dentinal hypersensitivity’, or ‘B’ and no item was ‘C’, the trial was considered to be

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350 S . H E et al.

Table 1. Grade scale for quality assessment of randomised controlled trials

Grade

Criterion A B C

Randomisation Adequate Unclear (reported randomisation Inadequate (quasi-random

but method not described) method of allocation, such as
alternation, date of birth, case
record number)
Allocation Adequate Unclear (not mentioned) Clearly inadequate
concealment concealment ⁄ not used
Blinding Adequate (double-blind or Partly blinded ⁄ unclear Not used (‘open-label’ or
blinding the outcomes (single-blind or not mentioned) ‘unmask’)
evaluators)
Loss to follow-up ⁄ Adequate reporting (including Partly reported Not reported
withdrawal numbers and causes)
Comparability Comparable (at least including Unclear Not comparable
of baseline age)
Overall grade Low risk of bias Moderate risk of bias High risk of bias

a moderate quality one and rated as grade B; and if any rated as B level evidence (26, 31–34), and two trials
item was ‘C’, then the trial was considered to be a low were classified as C level evidence (35, 36). Only two
quality one and rated as grade C. studies clearly described the randomise method (30,
31). One study used a randomising table (31), the other
used a computer-generated randomisation list (30).
Data extraction
Blinding was performed in three of the eight trials (30,
A standard form was used to extract the characteristics 32, 34), two studies were double-blinded (30, 32), one
of each included trial, including year of publication, study was single-blinded (34). The masking system used
number of patients, age, inclusion and exclusion was clearly described in only one of the eight studies
criteria, type of laser, laser parameters, details of topical (30), the remaining seven trials were unclear about it
desensitising agents, pain-provoking stimulus, out- (26, 31–36). None of the included trials reported
comes evaluated and follow-up periods. For the clinical withdrawals and the baseline of them were comparable.
outcomes, data were extracted at baseline and the
longest follow-up period.
Description of studies

Tables 2–5 summarise the characteristics of included

Results
studies. The systematic review included 234 patients,
Figure 1 summarised the details of the study selection and the number of them varied from 20 to 70 patients.
process and the reasons for exclusion. A total of 176 The follow-up period was up to 6 months. The treat-
potential relevant titles, abstracts and articles found, of ment procedures and outcomes of included trials were
which 28 were screened for further evaluation by reported in Table 3. All eight studies compared one kind
reading full texts. Finally, we identified eight trials that of laser versus one kind of topical desensitising agents in
met all inclusion criteria involving 234 patients in total. the treatment of dentine hypersensitivity. Table 4 shows
The characteristics of these included trials were listed in the properties of various types of lasers. Of these eight
Tables 2–5. studies, two studies used Nd:YAG laser system (31, 36),
the GaALAs laser system was adopted by four studies
(26, 30, 32, 33), and the remaining trials used Er:YAG
Quality of studies
laser and CO2 laser (34, 35). The visual analog scale
Table 2 showed the quality of the eight trials. One trial (VAS) scores and the criteria proposed by Uchida et al.
was classified as A level evidence (30), five trials were (37) were the most commonly used methods.

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 LASER THERAPY VERSUS TOPICAL DESENSITIZING AGENTS FOR DH 351

Potentially relevant trials identified and

screened for retrieval (n = 176) GaALAS laser versus control group
Trials were not RCTs (n = 148) Sicilia et al. (30) evaluated the immediate desensitising
Potentially appropriate RCTs for more efficacy of applying a GaALAS laser (810 nm), a 10%
detailed evaluation (n = 28)
potassium nitrate bioadhesive gel, and included a
RCTs excluded (n = 20)
placebo group. Patient responses to evaporative stimu-
– Lasers combined with other desensitizing agents lus or tactile stimulation were recorded by the verbal
– Interventions did not meet the inclusion criteria
– Duplicating reporting rating scale (VRS). After 60 days, GaALAS laser
– Not in the English language
achieved a reduction in evaporative stimulus’ VRS
scores of 65Æ7% (2Æ33  0Æ49 to 0Æ80  0Æ56) and tactile
Potentially appropriate RCTs for include stimulation’ VRS scores of 92% (0Æ87  1Æ06 to
In the study (n = 8)
0Æ07  0Æ26) versus bioadhesive gel with a reduction
RCTs withdrawn (n = 0) in evaporative stimulus’ VRS scores of 30Æ4%
(2Æ40  0Æ51 to 1Æ67  0Æ90) and tactile stimulation’
RCTs with usable information,
by outcome (n = 8)
VRS scores of 89% (1Æ27  0Æ88 to 0Æ13  0Æ35). The
authors concluded that GaALAS laser had a signifi-
Fig. 1. Flow diagram of the included and excluded studies. cantly greater immediate response for treating dentin
hypersensitivity. In the study, none of patients showed
secondary effects.
Vieira et al. (32) compared the immediate and
Nd:YAG laser versus control group
3-month desensitising effects of a GaAlAs laser
Kara et al. (31) carried out a prospective controlled (660 nm), a 3% potassium oxalate gel and a placebo
clinical trial to compare the effectiveness of Nd:YAG gel. The outcomes of air blast and tactile stimuli were
laser (1Æ064 nm) against that of fluoride varnish in assessed using VAS scores. At the end of this 3-month
treating dentine hypersensitivity. Immediately after trial, GaALAS laser achieved a reduction in air blast’ VAS
treatment, the VAS scores of the Nd:YAG laser group scores from baseline of 6Æ20  2Æ48 to 2Æ11  2Æ69 at
were reduced significantly from 7Æ02  1Æ01 to 2Æ34  3 months and tactile stimuli’ VAS scores from baseline of
0Æ99, whereas the fluoride varnish reduction in sensi- 3Æ85  3Æ26 to 1Æ28  2Æ19 at 3 months versus potassium
tivity from 7Æ09  0Æ98 to 2Æ09  1Æ15 after 2 weeks. oxalate gel with a reduction in air blast’ VAS scores from
Although at the end of this 4 weeks trial, the fluoride baseline of 6Æ41  2Æ43 to 2Æ53  3Æ03 and tactile stimuli’
varnish group showed a lager overall reduction in VAS VAS scores from baseline of 3Æ67  3Æ31 to 1Æ31  2Æ35 at
scores when comparable with laser group, the authors 3 months. The authors concluded that both groups had
concluded that Nd:YAG laser was still a suitable option significant reductions in dentinal hypersensitivity. How-
with shorter treatment time and better patient satis- ever, there was no significant difference among the two
faction. In the meantime, the authors reported no groups. Complications were not observed.
adverse reactions or any detectable complications. Tengrungsun et al. (33) adopted procedures similar to
Kumar et al. (36) reported on the short-term desen- Corona et al. (26) using the same laser (GaALAS laser),
sitising effects of a Nd:YAG laser, a 5% sodium fluoride the same criteria to evaluate outcomes, and the same
varnish and a combination of the two. The assessment follow-up period. Both studies recorded the degree of
of dentine hypersensitivity was according to the VAS sensitivity according to a 0–3 degree scale devised by
scores and a scale of 0–3 degree. In this 2-h comparison, Uchida et al. (37) Tengrungsun et al. (33) compared
Nd:YAG laser group achieved a reduction in VAS scores GaALAS laser to dentin bonding. At end of the 30-day
of 44% (32Æ70  6Æ95)and of cold air blast test scores of trial, the number of hypersensitivity teeth of laser
50% (1Æ20  0Æ42) versus fluoride varnish group with group from 0 to 3 degrees was 21, 14, 35, 0, respec-
a reduction in VAS scores of 33% (24Æ60  3Æ47) tively, versus dentin bonding group from 0 to 3 degrees
and of cold air blast test scores of 43% (1Æ00  0Æ67). was 66, 4, 0, 0. They found that the reduction in dentin
The authors concluded that Nd:YAG laser was supe- hypersensitivity by dentin bonding agent was signifi-
rior to fluoride varnish in treating dentine hypersen- cantly superior to GaAlAs laser treatment. Corona et al.
sitivity. (26) compared GaALAS laser with fluoride varnish. In

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Table 2. Characteristics of included studies

Years of No. of Ages Methodological

Study publication Country patients (T ⁄ C) (years) Inclusion criteria quality

Kara et al. (31) 2009 Turkey 10 ⁄ 10 Not clear Two or three hypersensitive teeth B
Sicilia et al. (26) 2009 Spain 15 ⁄ 15 19–70 Above 18 years of age showed a A
DH level of 2 or higher on the
VRS following the application of
ES to at least one tooth
Vieira et al. (32) 2009 Brazil 10 ⁄ 10 24–68 Have good oral hygiene and at B
least three hypersensitive teeth.
Ipci et al. (35) 2009 Turkey 10 ⁄ 10 23–62 Patients with dentine C
hypersensitivity
Tengrungsun 2008 Thailand 35 ⁄ 35 20–60 Patients with dentine B
et al. (33) hypersensitivity
Kumar et al. (36) 2005 India 10 ⁄ 10 20–60 Patients had at least one tooth of C
Grade III mobility with clinically
dentin hypersensitivity
Corona et al. (26) 2003 Brazil 12 ⁄ 12 20–30 More than two teeth with B
dentinal hypersensitivity.
Schwarz et al. (34) 2002 Germany 15 ⁄ 15 23–56 At least two hypersensitive teeth with B
exposed dentine at cervical surfaces.

the 30-day comparison, the number of hypersensitivity respectively, whereas the sodium fluoride only achieved
teeth of laser group from 0 to 3 degrees was 16, 12, 2, 0, 23Æ31  17Æ87. The authors concluded that both the CO2
respectively, versus fluoride varnish group from 0 to 3 and Er:YAG lasers had promising potential in treating
degrees was 16, 9, 4, 1. The authors concluded that the dentine hypersensitivity. In the meanwhile, Schwarz et al.
two desensitising methods showed similar overall per- (34) and Ipci et al. (35) reported that no complications
formance. were observed during the 6 months.

Er:YAG laser ⁄ CO2 laser versus control group Discussion

Schwarz et al. (34) evaluated the effects of an Er:YAG
Meta-analysis
laser and Dentin Protector in treating dentine hyper-
sensitivity. The outcomes of air blast stimulus were Mostly, systematic reviews will perform a meta-analysis
assessed according to a four-point pain scale. At the end that aims to summarise data from a group of trials and
of the 6-month comparison, Er:YAG laser achieved a contribute more to the outcome. However, meta-analysis
reduction in degree of air blast stimulus from 3Æ6  0Æ2 may not be so appropriate in several situations (38).
to 1Æ7  0Æ5 versus the Dentin Protector group from Owing to the high heterogeneity among the studies,
3Æ5  0Æ4 to 3Æ2  0Æ4. The authors concluded that such as a lack of randomised controlled trials, small
Er:YAG laser’s desensitising efficacy was more durable sample size, different types of lasers and follow-up
than Dentin Protector that maintained even 6 months periods, as well as the different ways to evaluate
following the initial irradiation. outcomes, we did not attempt to conduct a meta-analysis
Ipci et al. (35) evaluated the desensitising efficacy of to summarise the data of included studies and only
CO2 (10Æ6 lm) and Er:YAG laser (2Æ94 lm)alone and in provide a descriptive evaluation of the included data.
combination with topical sodium fluoride for treating
dentine hypersensitivity. The outcomes of evaporative
Laser therapy versus control group
stimulus were assessed according to a four-point pain
scale. At the end of the 6-month comparison, CO2 and Numerous related articles (19–22) had been reported
Er:YAG laser achieved a reduction in degree of evapo- the effectiveness of laser therapy for treating dentine
rative stimulus of 58Æ83  16Æ63 and 59Æ33  15Æ33, hypersensitivity. Nevertheless, to date, acceptance of

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 Table 3. Treatment procedures in included studies

Study Laser groups Intervention groups Pain-provoking stimulus Outcomes evaluated Follow-up period

Kara et al. (31) Nd:YAG laser Fluoride varnish* An air blast 1 cm from the tooth surface VAS scores Baseline, immediately,
until reaction or up to a maximum of 1-week, 2-week, 3-week,
10 s 4-week
Sicilia et al. (26) GaALAS laser NK10% gel 1. ES was used a dental syringe from a VRS scale and a scale of Days 2, 4, 7, 14, 30 and 60
distance of 1 cm for 1 s. 0–5 points

ª 2011 Blackwell Publishing Ltd

2. TS was applied by scraping the
exposed radicular surface of the tooth
by means of periodontal probing
Vieira et al. (32) GaALAS laser 3% potassium 1. The probe stimulus was applied under VAS scores Baseline immediately,
oxalate gel† slight manual pressure in the 3-month
mesio-distal direction on the cervical
area of the tooth.
2. The air blast was performed with an
air syringe for 1 sec at a distance of
1 cm from the tooth surface.
Ipci et al. (35) CO2 ⁄ Er:YAG 2% sodium fluoride An air syringe of the dental unit was The criteria proposed by Before treatment, 1 week,
laser used, and a 1-sec cold air blast was Uchida et al. (37) 1 month, 6 month
blown 2 mm from the site
Tengrungsun GaALAS laser Dentin bonding‡ An air blast from a three-way dental The criteria proposed by Immediately, 15 days,
et al. (33) syringe was directed to the exposed Uchida et al. (37) 30 days.
area for 5 s
Kumar et al. (36) Nd:YAG laser 5% sodium fluoride A 1-second blast from the air syringe of VAS scores and a scale of Baseline 2 h
varnish§ the dental unit. The air pressure 0–3 degree
(3 kg cm)2), temperature (27 C), and
distance (3 mm) between the tooth
surface to the tip of the air syringe.
Corona et al. (26) GaALAS laser Fluoride varnish¶ An air blast from a three-way dental The criteria proposed by Immediately, 15 days,
syringe was directed to the exposed Uchida et al. (37) 30 days
area for 5 s
Schwarz et al. (34) Er:YAG laser Dentin protector** A 3-s air blast at a distance of 2 mm An arbitrary pain scale in 4 Baseline, 1-week 2-week,
from each site degrees 6-months

*Fluoride varnish; VOCO, Cuxhaven, Germany.

†
3% Potassium Oxalate Gel; Kota Import’s Ltd., São Paulo, Brazil.
‡
Dentin bonding; 3M Dental Products, St. Paul, MN, USA.
§
5% sodium fluoride varnish; Pharmascience Inc., Montreal, Canada.
¶
Fluoride varnish; Inpharma A.S., Drammen, Norway.
**Dentin protector; Vivadent, Germany.
LASER THERAPY VERSUS TOPICAL DESENSITIZING AGENTS FOR DH
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Table 4. Laser parameters

Study Wavelength Power output Energy Frequency Irradiation time Energy density

Kara et al. (31) 1Æ064 nm (P) 2W 100 mJ 20 Hz 60 s NR

Sicilia et al. (26) 810 nm 1Æ5–2Æ5 mw NR NR 1 min NR
Vieira et al. (32) 660 nm 30 mw NR NR 120 s 4 J cm)2
Ipci et al. (35) CO2 laser: CO2 laser: NR CO2 laser: CO2 laser: NR
10Æ6 lm (CW) 1w NR 10 s
Er:YAG laser Er:YAG laser Er:YAG laser: Er:YAG laser
2Æ94 lm (P) 60 mJ 30 Hz 10 s
Tengrungsun 790 nm 30 mw NR NR 1 min NR
et al. (33)
Kumar NR NR 30 mJ 10 Hz 2 min NR
et al. (36)
Corona 660 nm (CW) 15 mw NR NR 30 s 4 J cm)2
et al. (26)
Schwarz NR NR 80 mJ 3 Hz 2 min NR
et al. (34)

P, pulsed; NR, not reported; CW, continuous wave.

this technology by clinicians is still limited, not only The other study (31) indicated that fluoride varnish
because its cost-effectiveness is low and its mechanisms group caused a larger overall reduction in the hyper-
are still unclear, but also the potential thermal effects sensitivity. However, Nd:YAG laser had shorter treat-
may induce thermal damage to temperature-sensitive ment time and better patient satisfaction. In addition, it
pulpal tissues (39, 40). Most of these researches were should also be noted that fluoride varnish must be
based on experimental studies. However, randomised applied three times during the study whereas laser be
controlled trials involving laser therapy were a limited applied once. Of interest, the wavelength of Nd:YAG
number. Holland et al. (1) suggested that a randomised, laser was only 1Æ064 nm, and it may be corrected for
blinded and controlled trial was the gold standard for 1064 nm.
determining efficacy. Therefore, it is necessary to The desensitising effectiveness of Er:YAG laser had
provide evidence-based medicine of laser therapy in been demonstrated in two trials (34, 35). One study
treating dentine hypersensitivity. This systematic (34) indicated that Er:YAG laser’s desensitising efficacy
review was designed to compare the effectiveness of was more durable than Dentin Protector that main-
laser therapy with that of topical desensitising agents in tained even 6 months following the initial irradiation.
treating dentine hypersensitivity. The authors speculated that Er:YAG laser emission
In this systematic review, eight trials met the rigorous wavelength could produce a deposition of insoluble
inclusion criteria. Four types of lasers were involved in salts that lead to obstruct the open dentinal tubules.
these studies, including Nd:YAG laser, GaALAs laser, Furthermore, the potential anti-bacterial characteristic
CO2 laser and Er:YAG laser. may be also contributed to the desensitising effects (44).
Nd:YAG laser had been reported to be successful in The authors observed that the desensitising effects of
treating dentine hypersensitivity (31, 41) and was Dentin Protector decreased after 2 months. It may be
probably because of its thermal effect leading to the attributed to the removal of the protective intrinsic
occlusion of dentinal tubules as well as the potential barrier by tooth brushing.
pulpal analgesia (23, 42, 43). Two studies (31, 36) were Significant clinical improvements were also demon-
reported on the clinical effect of Nd:YAG laser. The first strated when the Er:YAG laser was compared with
study (36) demonstrated a rapid significant reduction in sodium fluoride in the second study (35). The desen-
VAS scores in laser group in comparison with the sitising effect of sodium fluoride relied on the new
fluoride varnish after 2 h. For the mechanism of fluoride calcium fluoride crystals that formed in dentinal
varnish, the authors found that the fluoride varnish tubules. The authors speculated that the results may
could form a calcium fluoride that prevented fluid flow. be attributed to these crystals were too small to

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 LASER THERAPY VERSUS TOPICAL DESENSITIZING AGENTS FOR DH 355

Table 5. Outcomes in included studies

The longest Laser ⁄ intervention Outcomes at baseline and the

Study Outcomes evaluated follow-up period groups longest follow-up period

Kara et al. (31) Mean  s.d. 1 month Nd:YAG laser 7Æ02  1Æ01 fi 2Æ40  0Æ80
VAS scores Fluoride varnish 7Æ09  0Æ98 fi 2Æ04  0Æ80
Sicilia et al. (26) Mean  s.d. 60 days GaALAS laser ES:RED 1Æ53  0Æ74 65Æ7%
ES: a 0–3 degree VRS scale TS:RED 0Æ80  1Æ15 92%
TS :a scale of 0–5 points NK10% gel ES:RED 0Æ73  1Æ1 30Æ4%
TS:RED 1Æ13  0Æ83 89%
Vieira et al. (32) Mean  s.d. 3 months GaALAS laser ES: 6Æ20  2Æ48 fi 2Æ11  2Æ69
VAS scores TS: 3Æ85  3Æ26 fi 1Æ28  2Æ19
3% potassium ES: 6Æ41  2Æ43 fi 2Æ53  3Æ03
oxalate gel TS: 3Æ67  3Æ31 fi 1Æ31  2Æ35
Ipci et al. (35) Mean  s.d. 6 months CO2 or Er:YAG laser CO2 laser RED: 58Æ83  16Æ63
The criteria proposed by Er:YAG laser: RED: 59Æ33  15Æ33
Uchida et al. (33) 2% sodium fluoride 23Æ31  17Æ87
Tengrungsun No. of hypersensitivity 30 days GaALAS laser 0 degree: 0 fi 21 1 degree: 16 fi 14
et al. (33) teeth 2 degree: 44 fi 35 3 degree: 10 fi 0
Dentin bonding 0 degree: 0 fi 66 1 degree: 16 fi 4
2 degree: 44 fi 0 3 degree: 10 fi 0
Kumar et al. (36) Mean  s.d. 2h Nd:YAG laser ES:RED 1Æ20  0Æ42 50%
VAS scores VAS:RED 32Æ70  6Æ95 44%
ES: a scale of 0–3 degree 5% sodium fluoride ES:RED 1Æ00  0Æ67 43%
varnish VAS:RED 24Æ60  3Æ47 33%
Corona et al. (26) No. of hypersensitivity 30 days GaALAS laser 0 degree: 0 fi 16 1 degree: 10 fi 12
teeth 2 degree: 13 fi 2 3 degree: 7 fi 0
Fluoride varnish 0 degree: 0 fi 16 1 degree: 11 fi 9
2 degree: 13 fi 4 3 degree: 6 fi 1
Schwarz et al. (34) Mean  s.d. 6 months Er:YAG laser 3Æ6  0Æ2 fi 1Æ7  0Æ5
A scale in 4 degrees Dentin protector 3Æ5  0Æ4 fi 3Æ2  0Æ4

ES, evaporative stimulus; TS, tactile stimulation; RED, dentine hypersensitivity reduction; VRS, verbal rating scale.

completely obstruct the dentinal tubules of hypersen- mance and the GaALAs laser had advantage in dealing
sitive tooth. In the meanwhile, the latter study also with higher degree of sensitivity teeth. The researchers
compared the CO2 laser with the sodium fluoride and speculated that the effective results obtained from
concluded that CO2 laser had promising potential for fluoride varnish might be attributed to formation of
treating dentine hypersensitivity. the calcium fluoride (CaF2) crystals, which would cover
GaALAs laser’s desensitising efficacy was evaluated in the dentinal tubules (22).
four trials (26, 30, 32, 33). Of note, studies showed that In contrast, the second trial (33) showed that GaALAs
the mechanism of GaALAs laser on hypersensitivity laser had less effectiveness compared with dentin
tooth was different from other types of lasers (19). The bonding agent in the treatment of dentine hypersensi-
desensitising effect of it relied on the suppression of tivity.
nerve transmission and production of sclerotic dentine The dentin bonding agent could obstruct fluid flow
(45). by formation protein precipitates transverse septa and
In particular, it showed that the results were con- resin tags in dentinal tubules. However, physical force
flicting. Two of them adopted the similar study proce- (e.g. tooth brushing) would lead to the loss of occluded
dures, such as the same laser system, the same criteria resin. Therefore, a longer observation period may be
to evaluate outcomes and the same follow-up period, required to evaluate the difference of the two groups.
but the control group was different. One trial (26) The remaining two studies (30, 32) also reported the
comparing with fluoride varnish disclosed that the two opposite conclusions. One high-quality trial (30) dem-
desensitising methods showed similar overall perfor- onstrated that GaALAS laser had a significantly greater

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356 S . H E et al.

immediate response in treating dentine hypersensitiv-

Implications for practice and future research
ity. The effect had become obvious at 15 min, and it
remained stable until 2 months. In conclusion, this In this systematic review, four trials (31, 34–36)
study confirmed that GaALAS laser brought about rapid demonstrated that Nd:YAG laser, Er:YAG laser and
reduction and long-term duration of desensitising CO2 laser therapy were superior to topical desensitising
effect. On the contrary, in the second trial (32) showed agents (e.g. fluoride varnish). However, it should be
that there was no significant differences among the two interpreted with caution as the evidence was insuffi-
groups. cient. In addition, GaALAS laser application for this
purpose remained controversial compared with the
control group. Two moderate quality trials (26, 32)
Safety of laser therapy
indicated that GaALAs laser and the control group
The secondary objective of this systematic review was to showed similar overall performance in treating dentine
determine the safety of laser therapy in treating dentine hypersensitivity. Another moderate quality trial (33)
hypersensitivity. With regard to safety, Schwarz et al. demonstrated that the reduction in dentin hypersensi-
(46) recently reported that inappropriate laser use could tivity using dentin bonding agent was significantly
lead to potential tissue damage, giving rise to thermal superior to GaAlAs laser. Of note, recently, a high-
lesions on the radicular surface, gingival tissues, dental quality study showed (30) that GaALAS laser had a
pulp and adjacent bone. In addition, some studies (27) significantly greater immediate and long-term duration
suggested that the diffusion of heat induced by laser desensitising effect in the treatment of dentin hyper-
into the pulp within the control parameters could sensitivity. With regard to this embarrassing situation, it
not lead to irreversible damages of the dental pulp. would therefore be helpful to perform adequately high-
Although compelling evidence in this area is currently quality RCTs to compare GaAlAs laser with other
lacking, strictly and adequately controlled laser para- topical desensitising agents.
meters are imperative. For this reason, it is necessary to Although the systematic review indicated that laser
report relatively adverse side effects when carry out a therapy had a slight clinical advantage over topical
clinical research associated with laser therapy. desensitising agents, clinicians should draw a compre-
Only five of eight studies reported on the safety of hensive evaluation before using them for treating
laser application. One study involved Nd:YAG laser dentine hypersensitivity as it is still an economically
(31), two studies included GaALAs laser (30, 32), and adequate treatment option. In addition, it is still neces-
two studies involved Er:YAG laser (34, 35). All of them sary to get high quality of evidence. Further studies are
reported that there were no detrimental pulpal effects, needed to adopt standard study procedures, which
allergic reactions, or clinically detectable complications should be larger or adequate sample size and include
during the follow-up periods. more characteristics of patients or use strictly outcome
measures. Furthermore, there is a need for longer
observation period of at least 8 weeks (1). Finally,
Limitations of the review
researchers should have a tight control of confounding
However, our systematic reviews presented several factors associated with dentine hypersensitivity.
limitations. First, only one study (30) was the high-
quality study, and the quality of other seven trials was
Conclusion
relatively low: five trials (26, 31–34) were classified as B
level evidence which maybe have moderate risk of bias, Based on the analysis of present systematic review, it
owing to no blinding or allocation concealment; two can be concluded as follows:
trials (35, 36) were even rated as grade C and considered 1 Most of the retrieved studies are moderate quality,
to be a low-quality one, mainly because of unclear and further trials with higher quality designs are
randomisation. Most trials did not present randomisa- needed.
tion procedures, and blinding was unclear. Second, the 2 The results obtained from the eight retrieved studies
sample sizes of included RCTs were relatively small. were conflicting. A major part of them showed the
Finally, this study only included English articles rather positive outcomes. The systematic review of the
than all kinds of paper, which might cause language bias. literature indicates a trend toward a slight clinical

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 LASER THERAPY VERSUS TOPICAL DESENSITIZING AGENTS FOR DH 357

advantage following laser treatment of dentinal 13. Morris MF, Davis RD, Richardson BW. Clinical efficacy of two
hypersensitivity compared to application of topical dentin desensitizing agents. Am J Dent. 1999;12:72–76.
14. Duran I, Sengun A. The long-term effectiveness of five current
medicaments.
desensitizing products on cervical dentine sensitivity. J Oral
3 Based on the limited available evidence, the applica- Rehabil. 2004;31:351–356.
tion of laser may not lead to adverse effects followed 15. Kerns DG, Scheidt MJ, Pashley DH, Horner JA, Strong SL, Van
adequately controlled parameters in treating dentine Dyke TE. Dentinal tubule occlusion and root hypersensitivity.
hypersensitivity. J Periodontol. 1991;62:421–428.
4 As both of the quantity and quality of the literature are 16. Azarpazhooh A, Shah PS, Tenenbaum HC, Goldberg MB. The
effect of photodynamic therapy for periodontitis: a systematic
limited, the above conclusions need to be verified by
review and meta-analysis. J Periodontol. 2010;81:4–14.
rigorously designed, randomised, controlled clinical 17. Mohammadi Z. Laser applications in endodontics: an update
trials that involve a significant number of subjects. review. Int Dent J. 2009;59:35–46.
18. Matsumoto K, Funai H, Shirasuka T, Wakabayashi H. Effects
of Nd:YAG-laser in treatment of cervical hypersensitive
References dentine. Jpn J Conserv Dent. 1985;28:760–765.
19. Kimura Y, Wilder-Smith P, Yonaga K, Matsumoto K. Treat-
1. Holland GR, Narhi MN, Addy M, Gangarosa L, Orchardson R.
ment of dentine hypersensitivity by lasers: a review. J Clin
Guidelines for the design and conduct of clinical trials on
Periodontol. 2000;27:715–721.
dentine hypersensitivity. J Clin Periodontol. 1997;24:808–813.
20. Birang R, Poursamimi J, Gutknecht N, Lampert F, Mir M.
2. Orchardson R, Collins WJ. Clinical features of hypersensitive
Comparative evaluation of the effects of Nd: YAG and Er: YAG
teeth. Br Dent J. 1987;162:253–256.
laser in dentin hypersensitivity treatment. Lasers Med Sci.
3. Rees JS, Jin LJ, Lam S, Kudanowska I, Vowles R. The
2007;22:21–24.
prevalence of dentine hypersensitivity in a hospital clinic
21. Lan WH, Liu HC. Treatment of dentin hypersensitivity by
population in Hong Kong. J Dent. 2003;31:453–461.
Nd:YAG laser. J Clin Laser Med Surg. 1996;14:89–92.
4. Udoye CI. Pattern and distribution of cervical dentine hyper-
22. Lan WH, Liu HC, Lin CP. The combined occluding effect of
sensitivity in a Nigerian tertiary hospital. Odontostomatol
sodium fluoride varnish and Nd : YAG laser irradiation on
Trop. 2006;29:19–22.
human dentinal tubules. J Endod. 1999;25:424–426.
5. Scheutzel P. Etiology of dental erosion – intrinsic factors. Eur
23. Whitters CJ, Hall A, Creanor SL, Moseley H, Gilmour WH,
J Oral Sci. 1996;104:178–190.
Strang R et al. A clinical-study of pulsed Nd-Yag laser-induced
6. Dababneh RH, Khouri AT, Addy M. Dentine hypersensitivity
pulpal analgesia. J Dent. 1995;23:145–150.
– an enigma? A review of terminology, epidemiology, mech-
24. West NX. Dentine hypersensitivity: preventive and thera-
anisms, aetiology and management. Br Dent J. 1999;187:
peutic approaches to treatment. Periodontol 2000. 2008;48:
606–611.
31–41.
7. Kelleher M, Bishop K. Tooth surface loss: an overview. Br
25. Lier BB, Rosing CK, Aass AM, Gjermo P. Treatment of dentin
Dent J. 1999;186:61–66.
hypersensitivity by Nd : YAG laser. J Clin Periodontol.
8. Brännström M, Aström A. The hydrodynamics of the dentine;
2002;29:501–506.
its possible relationship to dentinal pain. Int Dent J.
26. Corona SAM, Do Nascimento TN, Catirse ABE, Lizarelli
1972;22:219–227.
RFZ, Dinelli W, Palma-DIBB RG. Clinical evaluation of
9. Canadian Advisory Board on Dentin Hypersensitivity. Con-
low-level laser therapy and fluoride varnish for treating
sensus-based recommendations for the diagnosis and man-
cervical dentinal hypersensitivity. J Oral Rehabil. 2003;30:
agement of dentin hypersensitivity. J Can Dent Assoc.
1183–1189.
2003;69:221–226.
27. Birang R, Kaviani N, Mohammadpour M, Abed AM, Gutkn-
10. Sowinski J, Ayad F, Petrone M, DeVizio W, Volpe A,
echt N, Mir M. Evaluation of Nd : YAG laser on partial oxygen
Ellwood R et al. Comparative investigations of the desensi-
saturation of pulpal blood in anterior hypersensitive teeth.
tising efficacy of a new dentifrice. J Clin Periodontol.
Lasers Med Sci. 2008;23:291–294.
2001;28:1032–1036.
28. Juni P, Altman DG, Egger M. Systematic reviews in health
11. Frechoso SC, Menendez M, Guisasola C, Arregui I, Tejerina
care – assessing the quality of controlled clinical trials. Br Med
JM, Sicilia A. Evaluation of the efficacy of two potassium
J. 2001;323:42–46.
nitrate bioadhesive gels (5% and 10%) in the treatment of
29. Higgins JPT, Green S. Cochrane Handbook for Systematic
dentine hypersensitivity. A randomised clinical trial. J Clin
Reviews of Interventions Version 4.2.6. Chichester: The
Periodontol. 2003;30:315–320.
Cochrane Library; 2006.
12. Orsini G, Procaccini M, Manzoli L, Giuliodori F, Lorenzini A,
30. Sicilia A, Cuesta-Frechoso S, Suarez A, Angulo J, Pordomingo
Putignano A. A double-blind randomized-controlled trial
A, De Juan P. Immediate efficacy of diode laser application in
comparing the desensitizing efficacy of a new dentifrice
the treatment of dentine hypersensitivity in periodontal
containing carbonate ⁄ hydroxyapatite nanocrystals and a
maintenance patients: a randomized clinical trial. J Clin
sodium fluoride ⁄ potassium nitrate dentifrice. J Clin Period-
Periodontol. 2009;36:650–660.
ontol. 2010;37:510–517.

ª 2011 Blackwell Publishing Ltd

358 S . H E et al.

31. Kara C, Orbak R. Comparative evaluation of Nd:YAG laser and 40. Launay Y, Mordon S, Cornil A, Brunetaud JM, Moschetto Y.
fluoride varnish for the treatment of dentinal hypersensitivity. Thermal effects of lasers on dental tissues. Lasers Surg Med.
J Endod. 2009;35:971–974. 1987;7:473–477.
32. Vieira AHM, Passos VF, de Assis JS, Mendonca JS, Santiago 41. Yonaga K, Kimura Y, Matsumoto K. Treatment of cervical
SL. Clinical Evaluation of a 3% potassium oxalate gel and a dentin hypersensitivity by various methods using pulsed
GaAlAs laser for the treatment of dentinal hypersensitivity. Nd : YAG laser. J Clin Laser Med Surg. 1999;17:205–
Photomed Laser Surg. 2009;27:807–812. 210.
33. Tengrungsun T, Sangkla W. Comparative study in desensitiz- 42. Lan WH, Lee BH, Liu HC, Lin CP. Morphologic study of Nd :
ing efficacy using the GaAlAs laser and dentin bonding agent. YAG laser usage in treatment of dentinal hypersensitivity.
J Dent. 2008;36:392–395. J Endod. 2004;30:131–134.
34. Schwarz F, Arweiler N, Georg T, Reich E. Desensitizing effects 43. Ciaramicoli MT, Carvalho RCR, Eduardo CP. Treatment of
of an Er : YAG laser on hypersensitive dentine – a controlled, cervical dentin hypersensitivity using neodymium: Yttrium-
prospective clinical study. J Clin Periodontol. 2002;29:211– aluminum-garnet laser. Clinical evaluation. Laser Surg Med.
215. 2003;33:358–362.
35. Ipci SD, Cakar G, Kuru B, Yilmaz S. Clinical evaluation of 44. Hibst R, Stock K, Gall R, Keller U. Controlled tooth surface
lasers and sodium fluoride gel in the treatment of dentine heating and sterilization by Er:YAG laser radiation. Laser
hypersensitivity. Photomed Laser Surg. 2009;27:85–91. applications in medicine and dentistry. In: Ashuler GB, Chiesa
36. Kumar NG, Mehta DS. Short-term assessment of the Nd : YAG F, Geschwind HJ, Hibst R, Krasner N, Laffitté F, Maira G,
laser with and without sodium fluoride varnish in the Neumann R, Pini R, Reidenbach H, Roggan A, Serra i Mila M,
treatment of dentin hypersensitivity - A clinical and scanning eds. Proc. SPIE. 1996;2922:119–126.
electron microscopy study. J Periodontol. 2005;76:1140–1147. 45. Walsh LJ. The current status of low level laser therapy in
37. Uchida A, Wakano Y, Fukuyama O, Miki T, Iwayama Y, Okada dentistry .2. Hard tissue applications. Aust Dent J.
H. Controlled clinical evaluation of a 10% strontium chloride 1997;42:302–306.
dentifrice in treatment of dentin hypersensitivity following 46. Schwarz F, Aoki A, Becker J, Sculean A. Laser application in
periodontal surgery. J Periodontol. 1980;51:578–581. non-surgical periodontal therapy: a systematic review. J Clin
38. Deeks JJ. Systematic reviews in health care – systematic Periodontol. 2008;35:29–44.
reviews of evaluations of diagnostic and screening. Br Med J.
2001;323:157–162. Correspondence: Dr. Xue Li, Department of Preventive Dentistry, West
39. Kimura Y, Goto Y, Kimura H. Hydrogen sulfide enhances the China College of Stomatology, Sichuan University, No. 14, Section 3,
production of glutathione from the limited amounts of intra- Road Renminnan, Wuhou District, Chengdu, China.
cellular cysteine in neurons. Neurosci Res. 2008;61:S166–S. E-mail: gardonlixue@sina.com

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