Background: dentin hypersensitivity (DH) largely affects adults, with increasing prevalence between 30 to 40 years of age. Home use of desensitizing toothpastes can be an inexpensive self-management option for controlling the pain arising from DH.
Objectives: to compare the effectiveness of toothpaste formulations to treat dentin hypersensitivity (DH).
Methods: we conducted a search across seven databases to February 2018. Pairs of independent reviewers screened studies, extracted data and performed risk of bias (RoB) assessments using the Cochrane 'Risk of bias' tool 2.0. The primary outcome was pain, measured through air, tactile and cold stimuli. We performed a random Bayesian network meta-analysis to combine direct and indirect evidence for each outcome. We calculated standardized mean differences (SMD) and their credible intervals (Crl) for each outcome. We calculated summary under the cumulative curve (SUCRA) values and assessed the certainty of evidence through GRADE (Grading of Recommendations, Assessment, Development & Evaluation).
Results: we included a total of 125 randomized controlled trials (RCTs) (13,113 participants with mean age of 39.6 years). Most trials were from North America (36%), Asia (36%) or Europe (21%), and were published after 2010 (62.4%); they included 21 types of interventions. For tactile stimulus, the best active ingredients to reduce pain according to SUCRA were: potassium+ stannous fluoride (SnF2) (87.5%, low certainty), arginine (81.2%, low certainty), potassium+hydroxyapatite (73.5%, high to moderate certainty), and calcium sodium phosphosilicate (CSP) (68.2%; high to moderate certainty). For cold stimulus, the best treatments were CSP (93.3%, moderate to low certainty), strontium (60.4%, low certainty), hydroxyapatite (58.4%, low certainty), and arginine (55.7%, low to very low certainty). For air stimulus, the best treatments were arginine (78.3%, low to very low certainty), potassium+hydroxyapatite (78.2%, high to moderate certainty), potassium+SNF2 (77.7%, low certainty), CSP (71.4%, moderate certainty).
Conclusions: most interventions showed evidence of superiority against placebo or fluoride (amine fluoride, sodium monofluorophosphate (MFP) or sodium fluoride) in reducing DH. With varying moderate to very low certainty of evidence, isolated active ingredients arginine and CSP seem to be the best interventions. Potassium combined either with SnF2 or hydroxyapatite seems to be the best combination interventions with high to low certainty of evidence.
Patient or healthcare consumer involvement: this was the first systematic review that compared all types of toothpaste formulations, focusing on comparisons between different active ingredients. We ranked the best active ingredients to treat each type of pain, ether tactile, cold or air stimulus. The choice of the best treatment should be a shared-decision between the clinician and the patient according to the patient’s values and preferences.
Funding: CCM received a post doctoral fellowship by CAPES; Brazil.