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  • 1. Non caries tooth loss Dental erosion<br />Chu CH<br />Faculty of Dentistry<br />The University of Hong Kong<br />
  • 2. Non caries tooth loss<br /><ul><li>Erosion is the loss of enamel and dentine by chemical means not involving bacteria.
  • 3. Abrasion is the loss of enamel and dentine by wear from surfaces other than teeth (e.g. tooth brushing).
  • 4. Attrition is the loss of enamel and dentine caused by wear of tooth against tooth.</li></li></ul><li>Dental erosion<br />Dental erosion, or erosive tooth wear, is now recognized as a major cause of tooth wear.<br />(Smales and Kaidonis, 2006)<br />
  • 5. Dental erosion<br />Effects:<br /> Enamel thinning with exposure of dentin<br /> Unsightly appearance of teeth<br /> Tooth hypersensitivity<br /> Reduced chewing function.<br />5. Pulpal involvement in advanced cases<br />
  • 6. Dental erosion<br />Significance:<br />Aging population with more elderly retaining their teeth,<br />Change in dietary habits (Cola drinks, red or white wine and fruit juices)<br />
  • 7. Dental erosion<br />Prevalence<br />Limited longitudinal data are available<br />5% Finnish (Jarvinen et al., 1991)<br />7% Nigerians (Oginni and Olusile, 2002)<br />13% Swedish (Lussi et al., 1991)<br />15% Norwegian (Myklebust et al., 2003)<br />46% Chinese adults (Hou et al., 2005)<br />6%Chinese prechildren (Luo et al., 2005) <br />No data in Hong Kong<br />
  • 8. Dental erosion<br />Questionnaire telephone survey (2008)<br />Faculty of Dentistry & Social Science Research Center, University of Hong Kong<br />Chinese adults<br />Website http://hkupop.hku.hk/<br />
  • 9. Age<br />Successful Samples:514<br />
  • 10. 92% Respondents aged 25-45 had symptoms of Dental Erosion<br />Successful Samples:570; Age range: 25-45<br />
  • 11. 72% Respondents reported their teeth turned yellow<br />Successful Samples:520 (multiple responses)<br />
  • 12. Q: How often would you consume non-water beverage and food like soft drinks, coffee, snacks, fruits, dessert, etc. in a day?<br />36%<br />Successful Samples:494<br />36% Respondents* ate at least 6 times per day (Average 5.4 Times )<br />
  • 13. 68% Respondents had dental check-upat least once every year<br />Q: On average, how often do you go for dental check up in a year ? <br />Average: 0.92 times<br />SD:0.03<br />Base:499<br />Successful Samples:519<br />
  • 14. Dental erosion<br />73% did not know symptoms of erosion<br />70% had never heard about erosion<br />53% could not differentiate erosion and caries<br />This lack of public knowledge about erosion has also been reported in the UK<br />(Dugmore and Rock, Community Dent Health; 20:223-7)<br />
  • 15. Dental erosion<br />Sources:<br />1. endogenous (eg gastric)<br />2. exogenous (eg dietary)<br />
  • 16. Dental erosion<br />Sources: endogenous<br /> Bullimia<br />
  • 17. Dental erosion<br />Sources: endogenous<br /> GI reflux<br />
  • 18. Dental erosion<br />Sources: exogenous<br /> Coke Zero over indulgence<br />
  • 19. Dental erosion<br />Sources: exogenous<br /> Red wine drinker<br />
  • 20. Dental erosion<br />Sources: exogenous<br /> Seafood lovers<br />
  • 21. Dental erosion<br />Sources: exogenous<br /> Preserved Snacks<br />
  • 22. Dental erosion<br />Sources: exogenous<br /> GI reflux<br />
  • 23. Dental erosion<br />All carbonated drinks, including soda and some energy drinks, contain a lot of acid such as citric, phosphoric and carbonic acids which can rapidly dissolve enamel on teeth.<br />
  • 24. Early erosive tooth wear<br />Prevention<br /> Patient Education<br />
  • 25. Prevention of erosion<br /><ul><li>Dietary acids and drinking habits
  • 26. Reflux and referral to gastroenterologists
  • 27. Preventing erosion
  • 28. Fluoride
  • 29. Dentine bonding agents
  • 30. The relationship between sensitivity and erosion</li></li></ul><li>Mild cases of tooth wear<br /><ul><li>Dietary advice
  • 31. Fluoride toothpaste
  • 32. Low abrasive toothpaste
  • 33. Dentine bonding agents
  • 34. Avoid placing restorations</li></li></ul><li>Moderate erosion<br /><ul><li>Prevent and Patient education
  • 35. Consider restorations only when concerns for appearance or sensitivity </li></ul>Composites, Onlays, Crowns<br />
  • 36. Severe erosion<br />Refer to specialist<br />
  • 37. Dental erosion<br />Regular Review is important<br />
  • 38.
  • 39. Dentine HypersensitivityOpportunities for an optimized, evidence based management<br />
  • 40. Definition of Dentine Hypersensitivity<br />Dentine hypersensitivity is characterized by short, sharp pain arising from exposed dentine in response to external stimuli which cannot be ascribed to any other form of dental defect or disease.<br />Correct differential diagnosis is key for management success!<br />Addy M.,Int. Dent.J, 2002, Canadian Advisory Board, J of Can.Dent.Assoc., 2003<br />
  • 41. Aetiology - Mechanism of Hypersensitivity <br /> Explained by Brännström’s Hydrodynamic Theory<br /> Short sharp pain associated with A-beta and A-delta nerve fibers stimulation<br /> Two phases* development:<br /> Lesion Localisation<br /> Lesion Initiation <br />GINGIVAL RECESSION<br />LOSS OF ENAMEL<br />LESION LOCALISATION<br />Exposure of dentine<br />LESION INITIATION<br />Opening of dentine tubules<br /> (removal of cementum or smear layer)<br />*Dababneh et all. Br Dent J, 1999<br />
  • 42. Aetiology - Mechanism of Hypersensitivity <br />GINGIVAL RECESSION<br />LOSS OF ENAMEL<br />Abrasion<br />Attrition<br />Abfraction <br />Erosion<br />Fracture<br />Incorrect tooth-brushing or flossing<br />Periodontitis<br />Periodontal procedures<br />Gingival trauma (picking, hard foods)<br />Crown preparation<br />
  • 43. Dentine Hypersensitivity treatment options<br />Occluding the dentine tubules<br />Desensitising the nerves<br />
  • 44. Desensitising of nerves – mechanism and clinical evidence* <br />Buffering of membrane potential with potassium (K+) ions<br />Symptomatic action <br />Potassium salts delivered in at home products (toothpastes)<br />Potassium nitrate (5%)<br />Potassium citrate (5,5%)<br />Potassium chloride (3,75%)<br />Reduction in yield sensitivity measures – minimum 2 weeks of 2/day use<br />Pain relief - 4-8 weeks of 2/day use<br />Equivocal data on actual efficacy <br />* Literature review in Cummins, J Clin Dent, 2009<br />
  • 45. Dentine tubule occlusion - mechanism and clinical evidence* <br />At home use (Toothpaste) - precipitation of insoluble metal compounds.<br />Strontium chloride – reported less effective than potassium salts**<br />Stannous fluoride – secondary effects (staining)**<br />In office use <br />Established desensitisers with HEMA or oxalate seal<br />Desensitising pastes with calcium sodium phosphosilicate or CPP-ACP technologies<br />High fluoride containing products with sensitivity relief as secondary benefit only (varnishes, toothpastes and gels)<br />*Literature review in Orchardson, JADA, 2006; ** Cummins, J Clin Dent 2009 <br />
  • 46. Dentine Hypersensitivity treatment options - Current State <br />2 widely used mechanisms* **<br /> desensitising toothpaste recognized as the “first option” recommendation – effective but slow (4-8 weeks) pain relief * **<br /> In office treatment approached usually for “severe cases”* **<br /> Stated need for new tested treatment options that should effectively occlude dentine tubules and mimic the natural desensitising process***.<br />*Orchardsson, JADA, 2006, ** Cummins, J Clin Dent 2009, ***Markowitz, J of Oral Rehab., 2007<br />
  • 47. Dentine Hypersensitivity treatment options - Current Needs<br />Efficacy – fast, reliable action and long term effect<br />Action based upon natural process of desensitisation<br />Compatible with other active compounds<br />No staining or other side effects <br />Good taste<br />Safe<br />
  • 48. Introducing a new technology <br />Over several decades, the State University of New York (SUNY) studied the role of saliva in oral health under the leadership of Dr. Israel Kleinberg. <br />Arginine was identified as a key component of saliva and important to oral health<br />Ortek Company, in collaboration with SUNY, developed a novel technology for dentine hypersensitivity associating arginine with calcium carbonate<br />Colgate acquired the technology from Ortek in July 2007, and further developed the formulation by including sodium fluoride<br />
  • 49. What is the Pro-Argin™ Technology? <br /><ul><li>Pro-Argin™ is a special technology consisting of Arginine and calcium carbonate
  • 50. It is proprietary to Colgate</li></li></ul><li>Carbon <br />Hydrogen <br />Oxygen <br />Nitrogen<br />What is Arginine?<br />Arginine is a natural amino acid and is an essential element in many biological processes<br /> Arginine is naturally found in saliva<br /> Arginine is compatible with fluoride<br /> US Food and Drug Administration has categorised arginine as safe in food.<br />
  • 51. -<br />+<br />How does Pro-Argin™ Technology work against Dentine Hypersensitivity? <br />+<br />-<br />Arginine<br /><ul><li> Arginine is a bipolar molecule having both positively and negatively charged groups. Arginine ispositively charged at physiological pH</li></li></ul><li>How does Pro-Argin™ Technology work against Dentine Hypersensitivity? <br />-<br />-<br />+<br />-<br />-<br />-<br /> Like most natural surfaces, tooth surface, including the dentine, is negatively charged.<br /> At physiological pH in saliva, Arginine interacts with the calcium carbonate and adheres to the walls of dentine tubules and the dentine surface.<br />-<br />+<br />Arginine<br />-<br />Dentine<br />
  • 52. How does Pro-Argin™ Technology work against Dentine Hypersensitivity? <br />Arginine promotes precipitation of calcium and phosphate ions to form a calcium-rich layer that plugs and seals the opening of dentine tubules.<br /> The plug shields dentine fluid from exposure to external stimuli.<br />-<br />-<br />-<br />Graphical representation, for illustration purposes only<br />Pro-Argin™ Technology thus addresses the cause of dentine hypersensitivity.<br />
  • 53. Pro-Argin™ Technology Documentation<br />Mode of Action<br />How the technology works<br />In vitro tests<br />Clinical Efficacy<br />Hypersensitivity clinical studies<br />Surface roughness study<br />
  • 54. High powered microscope visualization<br />Confocal Laser Scanning Microscopy (CLSM)<br />Scanning Electron Microscopy (SEM)<br />Atomic Force Microscopy (AFM)<br /> Chemical Analysis<br /><ul><li>Electron Spectroscopy for Chemical Analysis (ESCA)
  • 55. Energy dispersive X-ray spectroscopy (EDX)</li></ul>Confocal Dye Binding Experiments<br />Acid Resistance<br />Hydraulic conductance<br />Pro-Argin™ Technology – Mode of Action Documentation – Dentine Occlusion<br />
  • 56. Pro-Argin™ Technology – Mode of Action High powered microscope visualization<br />Dentine tubules have diameter ~1 to 5 microns<br />High powered microscopes are used to visualize the tubules<br />Confocal Laser Scanning Microscope (CLSM)<br />Scanning Electron Microscope (SEM)<br />
  • 57. Pro-Argin™ Technology – Mode of Action High powered microscope visualization<br />Arginine and CaCO3 are required for efficacy<br />Compared occlusion of<br /> CaCO3<br /> 8% Arginine/CaCO3/1450 ppm MPF<br /> 8% Arginine/Dical/1450 ppm MPF <br /> 8% Arginine/CaCO3<br />
  • 58. Pro-Argin™ Technology – Mode of Action High powered microscope visualization: Confocal LSM<br />CaCO3<br />8% Arginine/dical/1450 ppm MPF<br />8% Arginine/CaCO3<br />8% Arginine/CaCO3/1450 ppm MPF<br />
  • 59. Pro-Argin™ Technology – Mode of Action High powered microscope visualization (SEM)<br />Dentine Occlusion – 8.0% Arginine/CaCO3<br />Treated<br />Baseline<br />SEM Images – 10,000x Magnification<br />
  • 60. AFM used to evaluate dentine surface<br /> Untreated dentine shows tubule completely open and helical structure of dentine collagen<br /> Treated dentine shows no helical structure – sign of protective layer at the surface of dentine<br />Collagen<br />Open Tubule<br />Pro-Argin™ Technology – Mode of Action Atomic Force Microscopy<br />
  • 61. Pro-Argin™ Technology – Mode of Action Atomic Force Microscopy<br />Untreated Dentine Multiple Tubules <br />Treated dentine Multiple Tubules <br />Dentine tubule completely occluded and sealed by 8% Arg/CaCO3<br />
  • 62. Open Tubule<br />Untreated Dentine– Single Tubule<br />Pro-Argin™ Technology – Mode of Action Atomic Force Microscopy<br />Treated Dentine– Single Tubule<br />
  • 63. Pro-Argin™ Technology – Mode of Action Chemical Analysis - ESCA<br />ESCA is a surface analysis technique used for obtaining chemical information about the surfaces of solid materials<br />Utilizes an x-ray beam to excite a solid sample resulting in the emission of photoelectrons<br />Energy analysis of these photoelectrons provides chemical information about a sample surface  <br />ESCA has a sampling depth of approximately 30 Å <br />
  • 64. Pro-Argin™ Technology – Mode of Action Chemical Analysis - ESCA<br />Elementary analysis (by ESCA) of surface layer showed: <br />Before treatment: high levels of carbon, oxygen and nitrogen, and low levels of calcium and phosphorus, consistent with demineralization of dentine and exposure of collagen matrix.<br />After treatment: Increase in calcium, phosphorus and carbonate content confirms the composition of occluding layer deposited after application of the Pro-Argin™ Technology<br />Decrease in nitrogen is due to coverage of collagen-containing dentine surface by occluding layer<br />Increase in silicon is evidence that some silica from Pro-Relief™ Desensitising Polishing paste formula is deposited at the surface of dentine<br />
  • 65. Pro-Argin™Technology– Mode of Action Chemical Analysis - ESCA<br />16<br />Legend<br />14<br />Before application<br />12<br />After application<br />10<br />Atomic %<br />8<br />6<br />4<br />2<br />0<br />CO3<br />Ca<br />P<br />N<br />Silica<br />Chemical Analysis of Coating – ESCA = Electron Spectroscopy for Chemical Analysis*<br />
  • 66. After evaluation of tubule occlusion by SEM, samples were analysed by EDX analysis in order to qualitatively determine the elemental composition of the occluding material as the sampling depth is higher than ESCA<br /> Analysis performed on occluded and a freeze-fractured face of the treated dentine disks<br />Pro-Argin™ Technology – Mode of Action Chemical analysis - EDX<br />
  • 67. Pro-Argin™ Technology – Mode of Action Chemical analysis - EDX<br />Energy dispersive X-ray spectroscopy <br />
  • 68. Pro-Argin™ Technology – Mode of Action Chemical analysis - EDX<br />Energy dispersive X-ray spectroscopy <br />
  • 69. Energy dispersive X-ray spectroscopy <br />Pro-Argin™ Technology – Mode of Action Chemical analysis - EDX<br /> EDX analysis provided qualitative confirmation of the ESCA results<br /> Tubules occluded with arginine, calcium, carbonate, phosphate and silica<br />Increase in silicon is evidence that some silica from Colgate® Sensitive Pro-Relief™ Desensitising Polishing Paste formula is deposited within the occluding layer<br />
  • 70. Confocal Laser Scanning Microscope has two modes of operation<br /> Reflectance<br />Shows hard surfaces<br /> Fluorescence<br />Discloses substrate that binds fluorescent dye<br />Used FITC dye that binds to amines<br />(Functional group on arginine)<br />Pro-Argin™ Technology – Mode of Action Dentine Occlusion<br />
  • 71. Fluorescence<br />Overlay<br />Reflection<br />Dentine Tubules 100% Open – Top view<br />Pro-Argin™ Technology – Mode of Action Confocal Dye Binding<br />Fluorescein isothiocyanate as dye<br />
  • 72. Open tubules<br />Overlay<br />Reflection<br />Fluorescence<br />Dentine Tubules 100% Open – Side view<br />Pro-Argin™ Technology – Mode of Action Confocal Dye Binding<br />
  • 73. Pro-Argin™ Technology – Mode of Action Confocal Dye Binding<br />Dye concentrated<br />In tubule<br />Fluorescence<br />Reflection<br />Overlay<br /> Treated Dentine – Top view<br />
  • 74. Dye concentrated<br />In tubule<br />No open tubules<br />Overlay<br />Fluorescence<br />Reflection<br /> Treated Dentine – Side view<br />Pro-Argin™ Technology – Mode of Action Confocal Dye Binding<br />
  • 75. Pro-Argin™ Technology – Mode of Action Confocal Dye Binding – Acid resistance <br />Treatment of dentine surfaces with Colgate® Sensitive Pro-Relief™Desensitising Polishing Paste<br />Subsequent treatment of occluded dentine samples with acidic soft drink<br />Visualisation of dentine surface by 2 methods<br />Confocal Laser Scanning Microscopy (CLSM) in reflectance mode<br />CLSM using a fluorescent dye that adheres to surfaces, side view<br />
  • 76. Pro-Argin™ Technology – Mode of Action Confocal Dye Binding – Acid resistance <br />Before treatment<br />Treated with Pro-Argin™ Technology 5xs<br />2nd Acid Challenge (24 hours later)<br />1 minute Acid Challenge<br />
  • 77. Pro-Argin™ Technology – Mode of Action Confocal Dye Binding – Acid resistance <br />Open tubules<br />Open tubules<br />Overlay<br />Reflection<br />Fluorescence<br />
  • 78. Pro-Argin™ Technology – Mode of Action Confocal Dye Binding – Acid resistance <br />Treated with 8.0% Pro-Argin™ Technology 5x<br />Untreated<br />Open tubules<br />Acid Challenge- <br />treated with <br />Acidic drink for 1 min<br />Second Acid Challenge (24 hours later) - treated with <br />Acidic drink for 1 min<br />Tubule occlusion by the Pro-Argin™ technology is resistant<br />to acid from common beverages<br />
  • 79. Pro-Argin™ Technology – Mode of Action Hydraulic Conductance<br /> Hydraulic conductance (Pashley et al) is used to measure inhibition of fluid flow in dentine tubules<br /> Effective occlusion agents reduce flow<br /> Hydraulic conductance experiments were conducted with Colgate Sensitive Pro-Relief™ Desensitising Polishing Paste (Pro-Argin™ formula)<br />
  • 80. Pro-Argin™ Technology – Mode of Action Hydraulic conductance<br />Pro-Argin™ Technology significantly reduced fluid flow in dentine tublules<br />
  • 81. Pro-Argin™ Technology – Mode of Action Summary<br />The arginine interacts with the calcium carbonate at physiological pH to form a positively charged agglomerate which is attracted by electrostatic forces to negative surfaces, including dentine<br /> This agglomerate promotes the formation of a calcium-rich mineral layer on the dentine surface to occlude the tubules.<br />The occlusion protects dentinal fluid from exposure to external stimuli, thus stopping fluid movement in the tubules.<br />This blocking of the fluid movement addresses the cause of pain and discomfort.<br />The occluding layer resists acid attacks, such as provoked by certain acid beverages.<br />
  • 82. Pro-Argin™ Technology Documentation<br />Mode of Action<br />How the technology works<br />In vitro tests<br />Clinical Efficacy<br />Hypersensitivity clinical studies<br />Surface roughness study<br />
  • 83. Pro-Argin™ Technology Clinical Documentation<br />Hypersensitivity Measurements Methodology<br />In-Office desensitising (Prophylaxis) Paste containing 8% Arginine and Calcium Carbonate<br /> Colgate supported independent Clinical Documentation <br /> Ortek Clinical Documentation<br /> Toothpaste formula containing arginine and 1450 ppm fluoride as MFP in a calcium carbonate base<br />
  • 84. Hypersensitivity Measurements Methodology<br /> Dentine Hypersensitivity (DHS) improvements for a tested product are usually compared to negative &/or positive controls in order to establish product efficacy.<br />Double-blind randomized parallel groups<br />DHS is generally may be measured following the application of stimuli of known intensity:<br />Tactile<br />Air blast<br />Thermal<br />
  • 85. Hypersensitivity Measurements Methodology<br />Tactile stimulation<br />Pressure stimulation based assessment<br />Electronic Force Sensing Probe (Yeaple Probe) calibrated once daily <br />Explorer tip stroked perpendicular to surface beginning at pre-set force of 10g and increasing by 10g increments until patient expresses discomfort.<br /> Scored as force (g) required to elicit discomfort<br />Non-sensitive if no discomfort upon 50g of force.<br />
  • 86. Hypersensitivity Measurements Methodology<br />Air blast stimulation<br />Evaporative stimulus-based assessment<br />One second of air delivered at 1cm distance from the surface <br />From standard dental unit syringe at 60psi (±5) and 70°F(±3)<br />Examiner scores subject response using Schiff Cold Air Sensitivity Scale, where:<br />“0” No subject response to stimulus <br /> “1” responds but will continue<br /> “2” responds and moves or requests discontinuation<br /> “3” Painful response to stimulus, discontinuation requested<br />
  • 87. Pro-Argin™ Technology Clinical DocumentationHypersensitivity Clinical Research Methodology<br />Fully compliant with American Dental Association Acceptance Guidelines for approval of desensitising products <br />Reviewed by the US Food and Drug Administration (FDA)<br />Also utilized in published research testing the effectiveness of desensitising products<br />
  • 88. Pro-Argin™ Technology Clinical DocumentationHypersensitivity Clinical Research Methodology<br />Colgate Sensitive Pro-Relief™ Desensitising Polishing Paste with Pro-Argin™ Technology<br />8% arginine in a calcium carbonate/silica prophy base <br />No fluoride<br />Toothpaste formula containing arginine and 1450 ppm fluoride as MFP in a calcium carbonate base<br />
  • 89. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – In office product <br />Study design for post-scaling application1<br />Objectives<br />Compare the efficacy in reducing hypersensitivity after a single post scaling application, as the final polishing step in a dental prophylaxis<br />Assess the duration of relief over 4 and 12 weeks. <br />Methodology<br />Study conducted in San Francisco, California<br />68 subjects (50% female) <br />Test: Colgate Sensitive Pro-Relief™ Paste n=32 <br />Negative Control: Nupro n=36<br />Mean age 36 years (24-56)<br />Double blind, parallel group controlled study<br />Tactile and air blast scores at baseline, immediate after product application, at 4 and 12 weeks.<br />All used Crest anti cavity toothpaste and soft brush for duration of study.<br />1 Schiff T et al , (2009) Am.J of Dent, 22, Special Issue A, 8A-15A<br />
  • 90. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – In office product <br />Post-scaling application - Tactile results1<br />p < 0.05<br />p < 0.05<br />Yeaple Probe Pressure<br />Test product<br />Control product<br />1 Schiff T et al , (2009) Am.J of Dent, 22, Special Issue A, 8A-15A<br />
  • 91. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – In office product<br />Post-scaling application - Air Blast Results1<br />p < 0.05<br />p < 0.05<br />Schiff Scores <br />Test product<br />Control product<br />1 Schiff T et al , (2009) Am.J of Dent, 22, Special Issue A, 8A-15A<br />
  • 92. Post-scaling application1<br />Conclusions:<br />Colgate® Sensitive Pro-Relief™ desensitising paste provides a statistically significant reduction in dentine hypersensitivity as compared to a control prophylaxis paste immediately after a single application following dental scaling. This relief lasts for 4 weeks.<br />Pro-Argin™ Technology Clinical Documentation Clinical Research Results – In office product <br />1 Schiff T et al , (2009) Am.J of Dent, 22, Special Issue A, 8A-15A<br />
  • 93. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – In office product<br />Study design for pre-scaling application2<br />Objective<br />Compare the efficacy in reducing hypersensitivity when applied before professional prophylaxis<br />Methodology<br />Study conducted in Langhorn, Pennsylvania<br />45 subjects (33 female) <br />Test: Colgate Sensitive Pro-Relief ™ Paste n=22 <br />Negative Control: Nupro n=23<br />Mean age 45 years (23-66)<br /> Double blind, parallel group controlled study <br /> Tactile and air blast scores at baseline, <br /> Two 3 second applications of test or control product with prophy cup <br /> Reassess sensitivity after completion of scaling and polishing with Nupro prophy paste<br />2 Hamlin D et al, (2009) Am J of Dent, 22, Special Issue A, 16A-20A<br />
  • 94. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – In office product <br />Pre-scaling application - Tactile Results2<br />p < 0.05<br />Yeaple Probe Pressure<br />Test product<br />Control product<br />2 Hamlin D et al, (2009) Am J of Dent, 22, Special Issue A, 16A-20A<br />
  • 95. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – In office product<br />Pre-scaling application - Air Blast Results2<br />p < 0.05<br />Schiff Scores <br />Test product<br />Control product<br />2 Hamlin D et al, (2009) Am J of Dent, 22, Special Issue A, 16A-20A<br />
  • 96. Conclusions:<br />When applied prior to a scaling, Colgate® Sensitive Pro-Relief™ desensitising paste with 8 % arginine and calcium carbonate provides a statistically significant reduction in dentine hypersensitivity measured after scaling compared to a control prophylaxis paste.<br />Pro-Argin™ Technology Clinical Documentation Clinical Research Results – In office product <br />Pre-scaling application2<br />2 Hamlin D et al, (2009) Am J of Dent, 22, Special Issue A, 16A-20A<br />
  • 97. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – In office product <br />ORTEK Sponsored Studies<br /> Immediate Relief<br /> Negative controlled Study <br />Reductions in sensitivity after dental prophylaxis procedure<br />Tactile: 53% improvement compared to 2% for the negative control<br />Air blast: 37% improvement compared to 6% for the negative control<br />Thermal: 37% improvement compared to 13% for the negative control<br />2. Immediate and Lasting (28 days) Relief <br />Monadic-design Study<br />Reductions in sensitivity immediately after dental prophylaxis procedure<br />Tactile: 84% improvement from baseline<br />Air blast: 72% improvement from baseline<br />Reductions in sensitivity 28 days after dental prophylaxis procedure<br />Tactile: 88% improvement from baseline<br />Air blast: 68% improvement from baseline<br />
  • 98. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – In office product<br />In vitro testing3 of surface roughness <br />Composite<br />Porcelain<br />Amalgam<br />Gold<br />Enamel<br />No significant alteration of surfaces <br />3 Garcia-Godoy F et al, (2009) Am J of Dent, 22, Special Issue A, 21A - 24A<br />
  • 99. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – In office productConclusions<br />Significant immediate and lasting (28 days) tactile and air blast dentine hypersensitivity relief when applied as a single treatment after tooth scaling procedure, as the final polishing step in a dental prophylaxis. <br /> Significant tactile and air blast dentine hypersensitivity relief when applied as a single treatment before professional prophylaxis (scaling and polishing) procedure.<br />No significant effect on surface roughness on the following substrates: resin composite, porcelain, amalgam, gold and human dental enamel. <br />
  • 100. Study design4<br />Objectives<br />Compare the efficacy in reducing hypersensitivity after brushing application after 2, 4 and 8 weeks.<br />Methodology<br />Study conducted in private practice, Rome, Italy<br />80 patients (24 males, 56 females) <br />40 subjects in each group<br /> mean age of 42.2 y (± 10.6y)<br /> Test products:<br />Test Formula: 8% Arginine/CaCO3/1450 ppm fluoride (as MFP)<br />Positive Control: 3.75%KCl / 1450 NaF<br />Double blind, parallel group controlled study<br />Tactile and air blast scores at baseline, 2, 4 and 8 weeks<br />Pro-Argin™ Technology Clinical Documentation Clinical Research Results – Test Formula<br />4 Docimo R et al (2009) J Clin Dent 20 (Spec Iss): 17-22<br />
  • 101. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – Test Formula<br />Tactile Stimulation Results4<br />p < 0.05<br />p < 0.05<br />p < 0.05<br />Yeaple Probe Pressure<br />Test formula<br />Control product<br />4 Docimo R et al (2009) J Clin Dent 20 (Spec Iss): 17-22<br />
  • 102. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – Test Formula<br />Air Blast Stimulation Results4<br />p < 0.05<br />p < 0.05<br />Schiff Scores<br />p < 0.05<br />Test formula<br />Control product <br />4 Docimo R et al (2009) J Clin Dent 20 (Spec Iss): 17-22<br />
  • 103. Docimo R et al 4<br />Conclusions:<br />Pro-Argin™ Technology was shown to effectively reduce tactile and air blast hypersensitivity compared to both the baseline values and to a positive control toothpaste* containing 3.75% KCl when used twice daily for two, four and eight weeks.<br />Pro-Argin™ Technology Clinical Documentation Clinical Research Results – Test Formula<br />* Sensodyne Total Care F toothpaste<br />4 Docimo R et al (2009) J Clin Dent 20 (Spec Iss): 17-22<br />
  • 104. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – Test Formula <br />Study Design5<br />Objectives<br />Compare the efficacy in reducing hypersensitivity after brushing application after 3 days, 2, 4 and 8 weeks.<br />Methodology<br />Study conducted in clinical research centre, Mississauga, Canada.<br />77 patients (25 males, 52 females) <br />38 test and 39 control subjects<br />mean age of 35.2 y ± 10.6) <br /> tested products<br /> Test formula: 8% Arginine /CaCO3/ 1450 ppm Fluoride (MFP) <br /> Positive Control: 3.75%KCl / 1450 NaF<br />Double blind, parallel group controlled study<br />Tactile and air blast scores at baseline, 3 days, 2, 4 and 8 weeks<br />5 Ayad F et al (2009) J Clin Den (Spec Iss) 10-16.<br />
  • 105. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – Test Formula<br />Tactile Stimulation Results5 <br />p < 0.05<br />p < 0.05<br />p < 0.05<br />Yeaple Probe Pressure<br />Test formula<br />Control product<br />5 Ayad F et al (2009) J Clin Den (Spec Iss) 10-16.<br />
  • 106. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – Test Formula<br />Air Blast Stimulation Results5<br />p < 0.05<br />p < 0.05<br />p < 0.05<br />Schiff Scores<br />Test formula<br />Control product<br />5Ayad F et al (2009) J Clin Den (Spec Iss) 10-16.<br />
  • 107. Ayad et al5<br />Conclusions:<br /> Pro-Argin™ Technology was shown to effectively reduce tactile and air blast hypersensitivity compared to both the baseline values and to a positive control toothpaste* containing 3.75% KCl when used twice daily for two, four and eight weeks. <br />Pro-Argin™ Technology Clinical Documentation Clinical Research Results – Test Formula<br />* Sensodyne Total Care F toothpaste<br />5 Ayad F et al (2009) J Clin Den (Spec Iss) 10-16.<br />
  • 108. Pro-Argin™ Technology Clinical Documentation Clinical Research Results – Test Formula : Summary<br />Clinical data from two independent clinical trials showed show that the Pro-Argin™ Technology was shown to effectively deliver a sensitive benefit as compared to a leading desensitising toothpaste containing 2% potassium ion as the desensitising agent.<br />
  • 109. 100<br />Pro-Argin™ Technology Conclusions<br /> Pro-Argin™ Technology is an innovative and proprietary technology combining the key ingredients Arginine, an amino acid, and insoluble calcium carbonate. <br /> Occludes tubules rapidly and effectively to treat the cause of tooth sensitivity. Tubule occlusion is calcium rich and acid resistant. <br /> Provides fast relief and long lasting protection from hypersensitivity. <br /> Is compatible with fluoride and provides no secondary unpleasant effects. <br /> Provides clinically superior sensitivity relief compared to other leading desensitising technologies (3.75% potassium chloride equivalent to 2% potassium). <br /> Represents a reliable solution for treatment of dentine hypersensitivity of various aetiology.<br />
  • 110.
  • 111.
  • 112.
  • 113. Colgate Sensitive Pro-Relief Desensitizing In-Office Paste<br />
  • 114. Colgate Sensitive Pro-Relief Desensitizing In-Office Paste<br />Clinically proven to deliver instant relief that lasts four weeks after a single application<br />Fast and easy application using a rotary cup<br />
  • 115. With<br />
  • 116. With<br />
  • 117. Reduces sensitivity pain for a comfortable dental procedure<br />With<br />
  • 118. Fast and easy to use<br />Fill a rotary cup with paste.<br />
  • 119. Fill a rotary cup with paste.<br />At low to moderate speed polish whole dentition. On sensitive areas apply product for 3 seconds and then repeat.<br />Fast and easy to use<br />
  • 120. Proof of clinical efficacy<br />
  • 121. Post-procedure instant and lasting relief study<br />Controlled study<br />68 male and female subjects (between 24 and 56 years of age) with established dentin hypersensitivity<br />Schiff T et al. Am J Dent. 2009;22(Spec Iss A):8A-15A.<br />
  • 122. Post-procedure instant and lasting relief study<br />Controlled study<br />68 male and female subjects (between 24 and 56 years of age) with established dentin hypersensitivity<br />Products tested<br />Pro-ArginTM technology desensitizing paste<br />Negative control: pumice prophylaxis paste<br />Schiff T et al. Am J Dent. 2009;22(Spec Iss A):8A-15A.<br />
  • 123. Post-procedure instant and lasting relief study<br />Product A or B<br />Scaling<br />Day 28<br />Day 0<br />(Immediate)<br />Baseline<br />Controlled study<br />68 male and female subjects (between 24 and 56 years of age) with established dentin hypersensitivity<br />Products tested<br />Pro-ArginTM technology desensitizing paste<br />Negative control: pumice prophylaxis paste<br />Product applied after scaling procedure<br />Evaluations at baseline, immediately after application, 28 days, 3 months<br />Schiff T et al. Am J Dent. 2009;22(Spec Iss A):8A-15A.<br />
  • 124. Post-procedure instant and lasting relief study<br />
  • 125. Post-procedure instant and lasting relief study<br />Effects on dentin hypersensitivity<br />Tactile sensitivity scores<br />Test paste<br />Control paste<br />Schiff T et al. Am J Dent. 2009;22(Spec Iss A):8A-15A.<br />
  • 126. Post-procedure instant and lasting relief study<br />Effects on dentin hypersensitivity<br />Tactile sensitivity scores<br />Air blast sensitivity scores<br />Test paste<br />Control paste<br />Test paste<br />Control paste<br />Schiff T et al. Am J Dent. 2009;22(Spec Iss A):8A-15A.<br />
  • 127. Post-procedure instant and lasting relief study<br />Effects on dentin hypersensitivity<br />Tactile sensitivity scores<br />Air blast sensitivity scores<br />149.6%<br />reduction<br />Test paste<br />Control paste<br />Test paste<br />Control paste<br />79%<br />reduction<br />40.6%<br />reduction<br />34.1%<br />reduction<br />Schiff T et al. Am J Dent. 2009;22(Spec Iss A):8A-15A.<br />
  • 128.
  • 129.
  • 130.
  • 131. Plugs and seals open tubules<br />
  • 132. Plugs and seals open tubules<br />
  • 133. Shown to be more effective than the control toothpaste with potassium salt<br />
  • 134. Air blast sensitivity score<br />Shown to be more effective than the control toothpaste with potassium salt<br />Brushing twice daily over a period of 8 weeks with Colgate® Sensitive Pro-Relief™ Toothpaste with Pro-Argin™ Technology is significantly (p<0.05) more effective in reducing sensitivity than using the control toothpaste (with potassium ions).<br />Colgate Sensitive Pro-Relief™ Toothpaste<br />Positive control: Toothpaste with 2% potassium ion<br />Docimo R et al. J Clin Dent. 2009;20(Spec Iss):17-22.<br />
  • 135. Air blast sensitivity score<br />Shown to be more effective than the control toothpaste with potassium salt<br />Sensitivity relief<br />Brushing twice daily over a period of 8 weeks with Colgate® Sensitive Pro-Relief™ Toothpaste with Pro-Argin™ Technology is significantly (p<0.05) more effective in reducing sensitivity than using the control toothpaste (with potassium ions).<br />Colgate Sensitive Pro-Relief™ Toothpaste<br />Positive control: Toothpaste with 2% potassium ion<br />Docimo R et al. J Clin Dent. 2009;20(Spec Iss):17-22.<br />
  • 136.
  • 137.
  • 138.
  • 139. Shown to provide instant relief with direct application and continued relief with subsequent twice-daily brushing<br />
  • 140. Shown to provide instant relief with direct application and continued relief with subsequent twice-daily brushing<br />3<br />2<br />Air blast sensitivity scores<br />1<br />0<br />Baseline<br />Immediate<br />3-day<br />When applied directly to the sensitive tooth with a fingertip and gently massaged for 1 minute, Colgate® Sensitive Pro-Relief™ Toothpaste provides instant sensitivity relief compared to the positive and the negative control. The relief was maintained after 3 days of twice-daily brushing.<br />Colgate Sensitive Pro-Relief™ Toothpaste<br />Nathoo S et al. J Clin Dent. 2009;20(Spec Iss):123-130.<br />
  • 141. Shown to provide instant relief with direct application and continued relief with subsequent twice-daily brushing<br />3<br />2<br />Air blast sensitivity scores<br />1<br />0<br />Baseline<br />Immediate<br />3-day<br />When applied directly to the sensitive tooth with a fingertip and gently massaged for 1 minute, Colgate® Sensitive Pro-Relief™ Toothpaste provides instant sensitivity relief compared to the positive and the negative control. The relief was maintained after 3 days of twice-daily brushing.<br />Colgate Sensitive Pro-Relief™ Toothpaste<br />Positive control: Toothpaste with 2% potassium ion<br />Nathoo S et al. J Clin Dent. 2009;20(Spec Iss):123-130.<br />
  • 142. Shown to provide instant relief with direct application and continued relief with subsequent twice-daily brushing<br />3<br />2<br />Air blast sensitivity scores<br />1<br />0<br />Baseline<br />Immediate<br />3-day<br />When applied directly to the sensitive tooth with a fingertip and gently massaged for 1 minute, Colgate® Sensitive Pro-Relief™ Toothpaste provides instant sensitivity relief compared to the positive and the negative control. The relief was maintained after 3 days of twice-daily brushing.<br />Colgate Sensitive Pro-Relief™ Toothpaste<br />Positive control: Toothpaste with 2% potassium ion<br />Negative control: Toothpaste with 1450 ppm fluoride only<br />Nathoo S et al. J Clin Dent. 2009;20(Spec Iss):123-130.<br />
  • 143. Shown to provide instant relief with direct application and continued relief with subsequent twice-daily brushing<br />3<br />2<br />Air blast sensitivity scores<br />Sensitivity relief<br />1<br />0<br />Baseline<br />Immediate<br />3-day<br />When applied directly to the sensitive tooth with a fingertip and gently massaged for 1 minute, Colgate® Sensitive Pro-Relief™ Toothpaste provides instant sensitivity relief compared to the positive and the negative control. The relief was maintained after 3 days of twice-daily brushing.<br />Colgate Sensitive Pro-Relief™ Toothpaste<br />Positive control: Toothpaste with 2% potassium ion<br />Negative control: Toothpaste with 1450 ppm fluoride only<br />Nathoo S et al. J Clin Dent. 2009;20(Spec Iss):123-130.<br />
  • 144. Colgate Sensitive Pro-Relief™ Toothpaste<br />
  • 145. Colgate Sensitive Pro-Relief™ Toothpaste<br />Colgate Sensitive Pro-Relief™ Toothpaste is the first toothpaste for at-home use and is clinically proven to provide instant and lasting sensitivity relief <br />
  • 146. Colgate Sensitive Pro-Relief™ Toothpaste<br />Colgate Sensitive Pro-Relief™ Toothpaste is the first toothpaste for at-home use and is clinically proven to provide instant and lasting sensitivity relief <br />Works instantly when applied directly to the sensitive tooth<br />
  • 147. Colgate Sensitive Pro-Relief™ Toothpaste<br />Colgate Sensitive Pro-Relief™ Toothpaste is the first toothpaste for at-home use and is clinically proven to provide instant and lasting sensitivity relief <br />Works instantly when applied directly to the sensitive tooth<br />Contains fluoride for caries prevention<br />
  • 148. A breakthrough in dentin hypersensitivity relief<br />
  • 149. A breakthrough in dentin hypersensitivity relief<br />An in-office treatment for instant sensitivity relief in one fast and easy step<br />
  • 150. A breakthrough in dentin hypersensitivity relief<br />An in-office treatment for instant sensitivity relief in one fast and easy step<br />A daily-use toothpaste as follow-up treatment for long-lasting relief<br />
  • 151. A breakthrough in dentin hypersensitivity relief<br />An in-office treatment for instant sensitivity relief in one fast and easy step<br />A daily-use toothpaste as follow-up treatment for long-lasting relief<br />The first toothpaste to be clinically proven to offer instant relief when applied directly<br />

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