Heft M W, Litaker M S, Kopycka-Kedzierawski D T, Meyerowitz C, Chonowski S, Yardic R L, Gordan V V, Mungia R, Gilbert G H
Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Florida, Gainesville, FL, USA.
Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA.
JDR Clin Trans Res. 2018 Jan;3(1):76-82. doi: 10.1177/2380084417742099. Epub 2017 Nov 13.
Dentinal hypersensitivity (DH) can have a significant impact on oral health and functioning, and it is a clinical symptom commonly managed by dentists during routine clinical practice. DH symptoms are typically elicited by otherwise innocuous, nonpainful stimuli applied to exposed dentin (e.g., tactile stimuli, warming or cooling temperatures or air puffs). Treatment approaches have sought to directly target the dentinal pulp tissues or close dentinal tubules via dental office care and treatment services (fluoride varnishes, glutaraldehydes, bonding agents, sealants, oxalates, or lasers) or home care services (toothpastes or dentifrices containing fluoride or potassium nitrate compounds). The purpose of this prospective multicenter cohort study was to assess how community-based dentists from the National Dental Practice-Based Research Network (National Dental PBRN) manage DH and whether the effectiveness of DH treatments can be assessed in those settings. A total of 171 dentists recruited 1862 subjects with DH from their existing patients. Dentists then recommended and provided DH treatment as appropriate. Treatment choice was at the discretion of the dentists. Patients rated their DH pain at baseline and 1, 4, and 8 wk during the course of their treatments. They used pain intensity and unpleasantness visual analog scales and 4 labeled magnitude scales and rated their satisfaction with treatment after 8 wk. Patients were provided reminders postbaseline via email, texting, or voice mail. These patient-centered outcomes served as the principal measures for the assessment of treatment because treatments sought to alleviate DH symptoms. The patients with DH who reported pain reduction from dentist-provided treatments (glutaraldehyde/HEMA [hydroxyethyl methacrylate] compounds, oxalates, and bonding agents), dentists' advice and counseling regarding oral habits and diet, and patient-applied fluoride toothpaste reported a concomitant positive rating of satisfaction with DH treatments. The results from this study support the feasibility of engaging network practices to assess the effectiveness of clinical DH treatments. National Dental PBRN dentists provide a range of procedures to treat dentinal hypersensitivity. In this large nonrandomized study designed to assess clinical care and to capture patient-reported outcomes, about 60% of patients reported improvement in pain. This study demonstrated the feasibility of engaging network dentists and their patients to assess treatment effectiveness. Future studies will explore the feasibility of imposing randomization and measuring patient compliance with treatment in the manner that this treatment is provided.
牙本质过敏症（DH）会对口腔健康和功能产生重大影响，是牙医在日常临床实践中常需处理的一种临床症状。DH症状通常由施加于暴露牙本质的原本无害、无痛的刺激引发（如触觉刺激、温度升或降、吹气）。治疗方法一直致力于通过牙科诊所护理和治疗服务（氟化物清漆、戊二醛、粘结剂、封闭剂、草酸盐或激光）或家庭护理服务（含氟化物或硝酸钾化合物的牙膏或洁齿剂）直接针对牙髓组织或封闭牙本质小管。这项前瞻性多中心队列研究的目的是评估来自国家基于牙科实践的研究网络（国家牙科PBRN）的社区牙医如何处理DH，以及在这些环境中能否评估DH治疗的效果。共有171名牙医从他们现有的患者中招募了1862名患有DH的受试者。然后，牙医酌情推荐并提供DH治疗。治疗选择由牙医决定。患者在治疗过程中的基线、第1、4和8周对其DH疼痛进行评分。他们使用疼痛强度和不愉快视觉模拟量表以及4种标记的数字量表，并在8周后对治疗满意度进行评分。基线后通过电子邮件、短信或语音邮件向患者发送提醒。这些以患者为中心的结果作为评估治疗的主要指标，因为治疗旨在缓解DH症状。那些报告因牙医提供的治疗（戊二醛/甲基丙烯酸羟乙酯[HEMA]化合物、草酸盐和粘结剂）、牙医关于口腔习惯和饮食的建议与咨询以及患者使用含氟牙膏而疼痛减轻的DH患者，对DH治疗的满意度也相应较高。这项研究的结果支持了利用网络实践评估临床DH治疗效果的可行性。国家牙科PBRN的牙医提供一系列治疗牙本质过敏症的程序。在这项旨在评估临床护理并获取患者报告结果的大型非随机研究中，约60%的患者报告疼痛有所改善。这项研究证明了让网络牙医及其患者评估治疗效果的可行性。未来的研究将探索进行随机分组以及按照提供治疗的方式测量患者治疗依从性的可行性。
