When all their efforts

for relief from

Dentin Hypersensitivity fail..

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 7 Role of Fluorides

8 Enamel remineralizing agents and challenges in enamel remineralization

1 Importance of Dental Health

9 Bioglass—Material suitability as remineralization agent

2 Introduction to Dentin Hypersensitivity (DH)

10 Fluoride-containing BG Dentifrice
3 Prevalence of DH

11 Benefits of BioMin

4 Etiology

12 Clinical studies of BioMin

12.1 Clinical comparison of 5% fluoro calcium phoshosilicate versus 5%
5 Etiopathogenesis
5.1 Anatomy of the dentin-pulp complex Calcium Sodium Phosphosilicate in the treatment of Dentin Hypersensitivity
5.2 Pathogenesis 12.2 Treating the Twinge – BioMin
5.3 Mechanism of DH 12.3 Comparative Evaluation of Fluoro Calcium Phosphosilicate, Calcium Sodium Phosphosilicate,
and Strontium Chloride Hexahydrate containing Dentifrice for the Treatment of
Dentin Hypersensitivity: A Randomized Single-Blind Study

6 Process of Tooth Sensitivity 12.4 Comparison of Clinical Efficacy Of Four Dentifrices In the Management Of
Dentin Hypersensitivity
12.5 Comparative assessment of effectiveness of Biomin, NovaMin, herbal, and potassium nitrate
desensitizing agents in the treatment of hypersensitive teeth: A clinical study
Oral hygiene is the practice of maintaining your mouth clean It is a brief, sharp pain that arises from exposed dentin.2 BioMin is a BG-containing dentifrice with a composition of
and disease-free1. Dentin Hypersensitivity (DH) has been Bioglass (BG) induces apatite formation on the calcium, phosphate, and fluoride.3 Gradually dissolving over
defined as The primary cause of dentin hypersensitivity is loss of external surface of the enamel in the presence a period of up to 12 hours, it slowly releases calcium,
enamel on the tooth crown and gum recession exposing the
of saliva or other physiological fluids. fluoride and phosphate ions at a therapeutically effective
tooth root, with subsequent loss of cementum.2
level.4,5 These work in concert with saliva in the mouth to
The process of tooth sensitivity involves three major form fluorapatite, which is ten times more resistant to acids
processes: than hydroxyapatite.4,5 BioMin clearly shows itself from other
BG toothpastes with formation of fluorapatite in combination
1. Mineralization (Enamel formation occurs in a with the calcium and phosphate released from the glass.3
well-coordinated array of the events of protein Calcium phosphate release is initiated by a
Biomin demonstrates controlled fluoride release to
solution-mediated dissolution.
“Pain derived from
self-assembly, proteolysis, and crystallization). strengthen teeth against acid attack and decrease Dentin
2. Demineralization (At lower pH, the calcium and phosphate Hypersensitivity, including scaling and post-bleaching

exposed dentin in ions are leeched out from the enamel by the action of sensitivity, a problem that reduces patient acceptance of this
acids, resulting in the dissolution of the inorganic matrix). highly profitable revenue stream.4,5 With an average particle
size of 5 micron, these tiny particles are so fine, that a
response to 3. Remineralization (Supplementing inorganic calcium and
phosphate deposition from the external environment onto
As the process of dissolution continues, the
dissolution products lead to a change in the
patient cannot experience them.4,5 In fact, patients frequently
report that their teeth feel smoother and cleaner, that they
the demineralized enamel).3
chemical, thermal Fluoride ions have a proven caries preventive action, by
chemical composition and pH. notice an absence of background oral sensitivity and that
their gums are healthier and less susceptible to bleeding.4,5

tactile or osmotic stabilizing the hydroxyapatite (HA) crystals. This is mediated

by lowering the solubility of HA, which in turn occurs by the
It bonds to the teeth and enters the dentinal tubules to
occlude them.4,5

stimuli which cannot

formation of fluorapatite. Bioglass is an inorganic, Fluoro calcium phosphosilicate is efficacious and provides
amorphous, calcium, sodium phospho-silicate material, In a highly fluidic milieu of the oral cavity better treatment response for the management of Dentin
which contains five-fold ratio of Ca/P. It has a comparatively Hypersensitivity as compared to other toothpaste formula.6
be explained as lesser SiO2 level and increased Na2O and CaO levels and
more CaO/P2O5 ratio, which facilitates enhanced reaction
due to the presence of saliva, sodium ions
are released from BG particles and will be

arising from any with biological fluids.3 exchanged with hydrogen ions (H+ or
H3O+), resulting in an increase in pH.
References:
1. Oral Hygiene. Available at: https://my.clevelandclinic.org/health/treatments/16914-oral-hygiene As accessed on:
Bioglass is an inorganic, amorphous, calcium, sodium
other dental defect
05/12/2023.

phospho-silicate material, which contains fivefold ratio of 2. Parakh S, Shiraguppi V, Deosarkar B, et al. DENTINAL HYPERSENSITIVITY–A REVIEW. Journal of Interdisciplinary
Dental Sciences. 2019 Jan;8(1):01-5.
Ca/P. It shows the following mechanism of action:3
or disease”
3. Ramadoss R, Padmanaban R, Subramanian B. Role of bioglass in enamel remineralization: Existing strategies and
future prospects—A narrative review. Journal of Biomedical Materials Research Part B: Applied Biomaterials. 2022
Jan;110(1):45-66.

Exchange of these ions allows Ca2+ and 4. BioMin F. BioMin F: Who needs 5000 ppm or 1450 ppm for that matter?. British Dental Journal. 2022 Mar 11;232(5):345.

5. The American Ceramic Society. Ceramic Tech Today. Bioactive glass toothpaste is on the way. [Internet]. [Accessed
phosphate (PO4 3-) to be released from December 29, 2023]. Available from:
https://ceramics.org/ceramic-tech-today/biomaterials/bioactive-glass-toothpaste-is-on-the-way

particles, eventually forming a silica-rich 6. Saurabh S Prithyani., et al. “Treating the Twinge - BIOMIN”. Acta Scientific Dental Sciences 3.1 (2019): 45-49.

layer (silanol Si OH) on the BG surface.

01 02
 Dentinal Hypersensitivity (DHS) has been defined as “pain experienced

1 Importance of 3 Prevalence
from exposed dentin in response to chemical, thermal tactile or osmotic
stimuli which cannot be explained as arising from any other dental defect 5 Etiopathogenesis
dental health
or disease”.1 It is brief, sharp pain arising from exposed dentin.2

of DH
The primary root of dentin hypersensitivity is loss of enamel on the tooth
crown and gum recession exposing the tooth root, with subsequent loss 5.1 Anatomy of the dentin-pulp complex 5.2 Pathogenesis
of cementum2
Oral hygiene is the practice of maintaining your mouth clean and Tooth sensitivity, which
In patients with DHS, theisaffected
clinicallyteeth
termed to assensitive
become Dentin Hypersensitivity
to generally • Dentin is made up of hard tissues such as enamel or cementum.7 Dentin’s sensitivity to stimuli does not result in any problem while it is
disease-free. It consists of brushing and flossing teeth as well as visiting (DH), is becoming increasingly more 3 common in dental practice. At least
non-harmful environmental stimuli. covered with protective tissues; enamel and cementum. DH developed in
the dentist regularly for dental X-rays, exams, and cleanings.1 one in 10 individuals in the general population affects from DH, which
•leadsGentle touch, mild • Dentin itself is an essential tissues. It consists of dentinal tubules, two phases:9
Oral hygiene is a preventative care. This means one can stop oral health to discomfort andcold
painorand
hot,compromises
chemical (acidic or sweet
quality of life.fruits,
The foods, and is naturally sensitive because of extensions of odontoblasts and
drinks) and air-flow stimuli can induce short sharp pain
prevalence of DH might vary from as low as 1.3% to as high as 92.1%, that may
problems — such as cavities, gum disease, bad breath (halitosis) and formation of dentin–pulp complex (Figure18).7
interfere with daily activities including eating, drinking,
depending on sociodemographic characteristics, recruitment strategies, speaking and
other issues — by taking good care of your teeth and gum.1 Lesion localization Lesion initiation
and number of study sites involved. DH is more prevalent in adults and • Pulp is integrally connected to dentin, meaning that physiologic
Oral health is also linked to whole-body health. For example, if an imposes significant impacts on social and financial aspects for patients
infection is there in one’s mouth, the bloodstream can carry the bacteria and/or pathologic reactions in one of the tissues will also affect the
and society at large.4 other.7 • Dentinal tubules, due to loss • For the exposed dentin to
to other areas of the body, leading to other health concerns like heart of enamels, are exposed by be sensitized, the tubular
disease and stroke. Keeping teeth and gums healthy is an essential part Generally, it is noted that people of age group 30-50 years, especially
females, are more affected by dentin hypersensitivity. It affects all teeth • Dentin involves small canal like spaces, dentinal tubules.7 attrition, abrasion, erosion, plugs and the smear layer
of long-lasting overall health.1 and abfraction. are removed and
but is more commonly seen in canines and premolars. Most patients
show Dentin Hypersensitivity following scaling and/or root planing. • These tubules occupied by odontoblastic processes. The consequently, dentinal
odontoblastic processes are the extensions of odontoblasts, which • Not all the exposed dentins tubular and pulp are
Some people also show sensitivity even when teeth are dried with air
are the major cells of pulp–dentin complex.7 are sensitive. exposed to the external
spray or slightly scratched with a probe or explorer. Cavity preparation
environment.

Introduction
for restoration or crown preparation involving vital teeth from the
• However, their calcified
2
The dentinal fluid occupies around 22% of total volume of dentin. It

2
crown/bridge also causes teeth sensitivity till restoration is complete.5 •
is an ultrafiltrate of blood from the pulp via dentinal tubules and smear layer, as compared to • Plug and smear layer on
The prevalence of DH in the Indian population is 20.6%, with a higher forms a communication medium between the pulp (via the non-sensitive dentin, is thin the surface of exposed

to Dentin prevalence of DH in the age cohort 36–45 years and in female subjects.6 odontoblastic layer) and outer regions of the dentin.7 and this leads to an
increase in the fluid
movement and
dentin are composed of
elements of protein and
sediments which are

Hypersensitivity consequently the pain

response.
derived from salivary
calcium phosphates and
seal the dentinal tubules

Dentin Hypersensitivity (DH) has been defined as “pain experienced from

exposed dentin in response to chemical, thermal tactile or osmotic
4 Etiology • Another cause for lesion
localization is gingival
recession which can be due
inconsistently and
transiently.9

stimuli which cannot be explained as arising from any other dental defect to toothbrush abrasion,
or disease”.2 It is a brief, sharp pain arising from exposed dentin.2 The primary root cause of Dentin Hypersensitivity is loss of enamel on pocket reduction surgery,
the tooth crown and gum recession exposing the tooth root. The most tooth preparation for crown,
The primary root of Dentin Hypersensitivity is loss of enamel on the tooth excessive flossing or
crown and gum recession exposing the tooth root, with subsequent loss common clinical root cause for exposed dentinal tubules is gingival
recession which in turn may be caused by:2 secondary to periodontal
of cementum2 diseases.7,9
In patients with DH, the affected teeth become sensitive to generally
non-harmful environmental stimuli.3 Pocket
Inadequately reduction
• Gentle touch, mild cold or hot, chemical (acidic or sweet fruits, foods, Toothbrush
attached periodontal
drinks) and air-flow stimuli can induce short sharp pain that may abrasion
gingiva surgery
interfere with daily activities including eating, drinking, speaking and
tooth brushing.3
• More severe DH can last more than 6 months and can become a Gingival
consistent annoyance, inducing psychological and emotional Excessive loss secondary
Crown
distractions.3 tooth cleaning to specific diseases, Figure 1: Anatomy and physiology of the tooth
preparation
and flossing i.e., NUG,
• It is also known that the oral health related quality of life in patients
periodontitis
with DH can be improved after DH has been treated successfully.3

03 04
 6 Process of 7 Role of fluorides 10

5.3 Mechanism of DH
tooth sensitivity 10

Three major mechanisms of Dentin Hypersensitivity have been proposed Mineralization Fluoride ions have a proven caries preventive action, by stabilizing the
in the literature (Figure 29)7: HA crystals. This is mediated by lowering the solubility of HA, which in
turn occurs by the formation of fluorapatite. Fluorapatite provides
• Enamel formation occurs in a well-coordinated array of the events thermodynamic stability, which results in structural and functional
Theories Description Theories Description of protein self-assembly, proteolysis, and crystallization. advantages over HA by serving as a stimulant in facilitating
• The process of biomineralization in the enamel occurs as a remineralization. Crystalline conversion during fluorapatite formation
continuum with a constant exchange of calcium ions. leads to displacement of hydroxide resulting in a solid-state solution with
• Nerve endings penetrate dentin and • The response of pulpal nerves, HA and adsorbs strongly to the surface of carbonated apatite crystals,
Direct innervation
extend to the dentino-enamel mainly Aδ intradentinal afferent which confers a potent protection mechanism. This serves to improve the
theory
junction. fibers, depends upon the pressure resistance against lactic acid released by oral microbes. (Figure 4).
applied, i.e., intensity of stimuli. Demineralization Recharging the natural ionic reserves of fluoride is one of the important
• There is lack of evidence that outer approaches in remineralization strategies and is commonly attempted
dentin, which is usually the most • It has been observed that stimuli with the application of topical fluoride agents.
• At lower pH, the calcium and phosphate ions are leeched out from
sensitive part, is innervated. which tend to move the fluid away
the enamel by the action of acids, resulting in the dissolution of
from the pulp–dentin complex
the inorganic matrix (Figure 3).
produce more pain.
Odontoblast receptor • It states that odontoblasts act as • Exogenous acids in food substances play an important role in
theory receptors themselves, and relay • The “hypersensitive” dentin has demineralization. pH ranges 1, 2–4, and 4.5–6.9 present with
the signal to a nerve terminal. more widely open tubules and differential demineralization effects ranging from surface etching,
thin/under calcified smear layer as nanoscale surface softening, to subsurface dissolution. Ca2+ Ca2+
• But majority of studies have compared with “non-sensitive”
• A lower pH in any concentration causes the alteration of the Ca2+ OH
shown that odontoblasts are dentin. The wider tubules increase F
the fluid movement and thus the hydroxyapatite (HA) surface. Ca2+
matrix forming cells and hence Ca2+ Ca2+
they are not considered to be pain response.
excitable cells, and no synapses Ca2+
Ca2+
have been demonstrated between Remineralization Ca2+
F
OH
odontoblasts and nerve terminals. Ca2+
Ca2+ Ca2+
• The enamel remineralization process targets to replenish the lost
Fluid • It was proposed that dentinal pain ionic component of the enamel through a multitude of methods.
Ca2+ Ca2+
movement/hydrodynamic is due to hydrodynamic • The process supplements the inorganic calcium and phosphate Ca 2+
Peritubular OH
theory mechanism, i.e., fluid force. dentin
deposition from the external environment onto the demineralized F
Intertubular Ca2+
dentin
enamel. (Figure 3). Ca2+ Ca2+
• This theory is based on the Predentin
presence and movement of fluid
inside the dentinal tubules. This
centrifugal fluid movement, in
turn, activates the nerve endings
at the end of dentinal tubules or at Figure 4: Hydroxyapatite and fluoroapatite structure schema
the pulp–dentine complex.
A B C

Figure 2: The schematic picture of the propped theories on Remineralization by supplementation of Demineralization - dissolution of
calcium and phosphate ions calcium and phosphate ions in the presence of acid
DH. A. Direct Innervation (DI) Theory. B. Odontoblast Receptor (OR)
Theory. C. Fluid Movement/Hydrodynamic Theory
Figure 3: Process of remineralization and demineralization

05 06
 8 Enamel remineralizing 9 Bioglass — Material BIOGLASS
FLUORO CALCIUM PHOSPHO SILICATE

F Ca P Si
agents and challenges suitability as an
in enamel remineralization
Antimicrobial High net gain in
property-Cation-doped mineral content and
(Ag, Mg, Sr, Zn, improved lesion
and Ga) depth reduction HPO43- F F HPO43-

remineralization agent Ca2+

F
F
F
Ca2+
Reduction in
organic content of Ca2+ Ca2+
With a monumental shift towards minimal invasive dentistry over the It is an inorganic amorphous, calcium, sodium phospho-silicate material, enamel with
increased rate of HPO4 3-

past decades, remineralization procedures are the most preferred and which contains fivefold ratio of Ca/P. It has a comparably lesser SiO2 level mineralization
optimal way of regeneration of the lost tooth structure. Enamel and increased Na2O and CaO levels and more CaO/P2O5 ratio, which
reconstruction is highly challenging and difficult, as it has a complex, facilitates enhanced reaction with biological fluids (Figure 6).10 Ca10(PO4)6F2

organized hierarchical microstructure.10

Enamel mineralization attempts to produce increased mineral content Figure 6: Remineralizing characteristics of Bioglass (BG)
Figure 7: BioMin results in the formation of fluorapatite in combination with the
from 45 wt% to 96–98 wt% with a high Ca:P molar ratio. This formulation Bioglass (BG) induces apatite formation on the external calcium and phosphate released from the glass
has been evidenced to produce profound mineralization. Ionic exchange surface of the enamel in the presence of saliva or other
at the surface of the enamel is determined by the rate of calcium physiological fluids.10
10 Fluoride-containing
11 Benefits of BioMin
phosphate solubility. The unique combination of strength, stiffness, 11,12

BG dentifrice
toughness, and hardness in the enamel is yet to be matched by external
agents (Figure 5).10
Fluoride ions have been the principle agents used in enamel
remineralization products, the functionality of which relies on the Calcium phosphate release is initiated by a
replacement of leached out ions from the HA lattice network.10 solution-mediated dissolution.10 BioMin is a BG-containing dentifrice with a composition of calcium, • BioMin toothpaste contains a patented fluoro calcium phosphosilicate
phosphate, and fluoride. In addition to calcium and phosphate, fluoride bioactive glass which bonds to the teeth and enters the dentinal
Biomimetic remineralization of enamel strategies deals on the principal ions are incorporated into the glass matrix as a soluble additive. This tubules to occlude them.
of the epitaxial deposition. Ionic calcium and phosphate deposition integration provides a prolonged delivery of fluoride ions into saliva.
requires existing apatite seed crystallites. The absence of seed • Gradually dissolving over a period of up to 12 hours, it slowly releases
Release is sustained for a period of 12hr with the gradual dissolution of
crystallites results in poor remineralization. Remineralizing agents other calcium, fluoride and phosphate ions at a therapeutically effective level.
glass. The combination of the three ions can be experienced in the
than fluoride including nano-HAs, functionalized tricalcium phosphates, As the process of dissolution continues, the dissolution molecular stoichiometric structure of fluorapatite. Also, this formulation • These work in concert with saliva in the mouth to form fluorapatite,
Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and products lead to a change in the chemical composition results in an increased phosphate concentration, which is three times which is ten times more resistant to acids than hydroxyapatite.
chitosan have been said to have significant remineralization abilities and pH.10 more than NovaMin®, creating an optimal environment for the
under in-vitro or in-vivo conditions.10 • This applies even if the patient's toothbrushing technique is erratic and
development of apatite. Fluorapatite formed from BioMinF is more
less efficient.
resistant to the action of extrinsic and intrinsic acids. It is more
advantageous than HA alone, which was produced by the older • So, brushing twice daily with BioMin provides a therapeutically
generation of BG dentifrices.10 effective level of fluoride for up to 24 hours which consequently
In a highly fluidic milieu of the oral cavity due to the strengthens the teeth, aids effective remineralization of the enamel,
BioMinF clearly establishes itself from other BG toothpastes with the
presence of saliva, sodium ions are released from BG and prevents fluid flow through the dentinal tubules (hydraulic
Improves reminerailization formation of fluorapatite in combination with the calcium and phosphate
property of saliva
particles and will be exchanged with hydrogen ions conductivity) to reduce sensitivity.
released from the glass (Figure 7). This formulation also supersedes
Ability to work in (H+ or H3O+), resulting in an increase in pH.10 other conventional fluoride toothpastes in providing a lingering presence • Biomin delivers controlled fluoride release to strengthen teeth against
an acidic pH
in the oral cavity, whereas the existing formulations containing soluble acid attack and reduce dentin hypersensitivity including scaling and
Enamel Controlled delivery of
Ca & P ions fluoride are easily washed away and become less effective within few post-bleaching sensitivity.
Remineralization
hours of brushing. The extended presence of BioMinF occurs due to the
Agent Ability to deliver calcium • With an average particle size of 5 micron, these tiny particles are so
and phosphate ions polymer that strengthens the bond between calcium in the BG and
fine, that a patient cannot feel them. In fact, patients frequently report
Exchange of these ions allows Ca2+ and phosphate (PO4 3-) calcium on the enamel. This bonding asserts lesser leaching away of BG.
that their teeth feel smoother and cleaner, that they notice an absence
to be released from particles, eventually forming a Furthermore, BioMinF dissolves in an accelerated manner in the acidic
of background oral sensitivity and that their gums are healthier and
silica-rich layer (silanol Si OH) on the BG surface.10 environment, which is the most fundamental requirement in the oral
less prone to bleeding.
Figure 5: Ideal requisites of an enamel remineralization agent environment that is subject to repeated acidic encounters.10

07 08
 12 Clinical studies
• This unique feature provides a unique challenge in terms of designing 12.1 CLINICAL COMPARISON OF 5% FLUORO CALCIUM PHOSPHOSILICATE 12.2 Treating the Twinge – BioMin14 Parameter Mean Diff SD t DF P
the bioactive glass, because simply mixing the ions together would VERSUS 5% CALCIUM SODIUM PHOSPHOSILICATE IN THE
result in formation of fluorapatite in the toothpaste rather than on the TREATMENT OF DENTINAL HYPERSENSITIVITY13 Airblast 1.66667 .66089 13.813 29 0.00*
tooth’s surface. So BioMin is designed with the fluoride into the glass Cold Water Spray 1.96667 .71840 14.994 29
amorphous matrix so that it can be slowly released as the bioactive
Objective To compare the clinical efficacy of a new Tactile Sensation .86667 .73030 6.500 29
glass dissolves (Figure 8).
Objective Aimed to comparatively evaluate the clinical desensitizing agent fluoro calcium phospho
Table 2: Intragroup comparision of sensitivity in group B using Paired t test
• BioMin, has higher phosphate content—about three times as much—as desensitizing efficacy of dentifrice containing silicate (BioMin) to two other dentifrices
NovaMin, along with a lower silica content. BioMin’s bioactive glass also 5% fluoro-calcium phosphosilicate (BioMin) already available in the market in the
has smaller particle sizes, which allow them to fit better within the versus 5% calcium sodium phosphosilicate management of dentinal hypersensitivity. Parameter Mean Diff SD t DF P
tubules to control access to the tooth nerve. (Figure 9). (Novamin) in participants with sensitive teeth.
Airblast 1.06667 .25371 23.028 29 0.00*
• The smaller size of BioMin’s particles also mean that the toothpaste
Cold Water Spray 1.13333 .34575 17.954 29
itself is less abrasive. BioMin has a low relative dentin abrasion value, Study Design A comparative study - 90 patients recruited for
below the level that would cause abrasion of the tooth surface. Study Design A single‑center, interventional randomized the study; patients were divided into three Tactile Sensation .73333 .63968 6.279 29
controlled clinical trial involving sixty patients groups: Table 3: Intragroup comparision of sensitivity in group C using Paired t test
20 Other Desensitizing 1. Group A - Toothpaste containing fluoro
Toothpastes
18 Exponential calcium phospho silicate (BioMin)
16 Decrease in Results: Toothpaste containing fluoro calcium phosphosilicate (BioMin) has
Available
Armour for Teeth TOOTHPASTE
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2. Group B - Tooth paste containing

14 Fluoride shown better results in reducing dentinal hypersensitivity in
Fluoride (% ppm)

• Efficacy of fluoro calcium phosphosilicate was significantly better in Proarginine

12
3. Group C - Toothpaste containing Potassium comparison to other two commercially available toothpastes, i.e.,
10
Sustained release
reducing VAS scores than the calcium sodium phosphosilicate and
of fluoride ions
Nitrate toothpaste containing proarginie and potassium nitrate. Hence it can
8
for a period of
fluoride at 15, 30, and 60 days. (Figure 10).
be used as a potent desensitizing agent.
6 VAS scores were recorded at baseline based
4 HOURS
on the following parameters:
2 Therapeutic Concentration
0 9 a. Tactile Sensation
0 100 200 300 400 500 600
12.3 Comparative Evaluation of Fluoro Calcium Phosphosilicate,
8 7.59 b. Cold Water Spray
Time (mins) Calcium Sodium Phosphosilicate (CSPS), and Strontium Chloride
7 Hexahydrate containing Dentifrice for the Treatment of Dentin
6.56 c. Airblast (30 psi)
Hypersensitivity: A Randomized Single-Blind Study15
Mean VAS Score

6 6.01 5.91
Figure 8: BioMin bioactive glass incorporates fluoride into the glass structure to
achieve slow release over time, whereas toothpastes that incorporate soluble fluoride generate 5.32 Flouride
5 4.92
high initial fluoride levels that decrease quickly after brushing. 4.4
4 Novamin
3.8 Objective To evaluate and compare the clinical
3.66 Results:
3 BioMin effectiveness of dentifrices containing fluoro
2.7
1. Intragroup comparison showed a statistically significant improvement calcium phosphosilicate, CSPS, and strontium
2
Tubular occlusion with BioMin from baseline to 15 days in all the three groups (Table 1,2 and 3). chloride hexahydrate for the treatment of DH,
1 over a period of four weeks, when applied
2. Intergroup comparison revealed that patients in Group 1 showed
0 twice daily.
statistically significant results in all-time intervals as compared to the
Baseline 15 days 30 days 60 days
other two groups for air blast and cold water.
Study Design A single-center, interventional, single-blind,
Figure 10: Changes in mean Visual Analog Scale (VAS) scores for subjective sensitivity over time Parameter Mean Diff SD t DF P randomized controlled clinical study with study
Before Brushing Single Brushing + 1 hr in After acid challenge
artifical saliva duration of 4 weeks. Participants (n = 93) were
Airblast 2.70000 1.26355 11.704 29 0.00*
randomly allocated to one of the following
Flouro calcium phosphosilicate is a promising agent for the Cold Water Spray 4.00000 1.43839 15.232 29 groups: Group 1 – fluoro calcium
Figure 9: Micrographs showing open dentine tubules that cause tooth sensitivity (left) are management of dentinal hypersensitivity phosphosilicate (BioMin™), Group 2 – calcium
blocked after brushing with bioactive glass toothpaste (middle), and the protection remains Tactile Sensation 2.33333 1.53877 8.305 29
after an acid challenge to simulate what happens in the mouth (right). sodium phosphosilicate (NovaMin®), and Group
Table 1: Intragroup comparision of sensitivity in group A using Paired t test
3 – strontium chloride hexahydrate

09 10
08
 12 Clinical studies 12.5 Comparative assessment of effectiveness of Biomin, NovaMin, herbal,
and potassium nitrate desensitizing agents in the treatment of
The Biomin group showed significantly better results compared
with either NovaMin, herbal, and potassium nitrate toothpastes
hypersensitive teeth: A clinical study17 in the treatment of Dentin Hypersensitivity symptoms.

Results: 12.4 Comparison of Clinical Efficacy of Four Dentifrices in the Management of

Dentin Hypersensitivity16 Objective To compare the efficacy of four commercially Summary
• A significant (P < 0.0001) reduction in symptoms based on VAS scores available toothpastes in the treatment of Dentin Hypersensitivity (DH) has been defined as “pain derived from exposed
from baseline to weeks 2 and 4 was noted in all treatment groups. Dentin Hypersensitivity (DH). dentin in response to chemical, thermal tactile or osmotic stimuli which cannot be
explained as arising from any other dental defect or disease”. It is a brief, sharp
• At week 2, percentage reduction in VAS score was higher in Group 1
To compare the clinical efficacy of four pain arising from exposed dentin.2
(mean [SD]: –4.03[1.84]; 95% CI: –4.74: –3.33) as compared with Group Objective Study Design In a single‑centered clinical trial, a total of 160
2 and Group 3(Figure 11). different commercially available dentifrices in patients were divided equally into four groups: BioMin is a BG-containing dentifrice with a composition of calcium, phosphate, and
the management of Dentin Hypersensitivity. Group 1 – a toothpaste containing 5% fluoro
fluoride.10 In addition to calcium and phosphate, fluoride ions are incorporated into
• A significant reduction (P < 0.0001) in VRS scores was observed in all the glass matrix as a soluble additive.10 This integration establishes a prolonged
the three groups at weeks 1, 2, and 4 as compared with baseline. calcium sodium phosphosilicate with fused delivery of fluoride ions into saliva.10 Gradually dissolving over a period of up to 12
silica (Biomin); Group 2 – a toothpaste hours, it slowly releases calcium, fluoride and phosphate ions at a therapeutically
• At weeks 1 and 2, percentage reduction in verbal rating scale score containing 5% CSPS (NovaMin); Group 3 –
Study Design A parallel double blind randomised control trial effective level.11,12 These work in concert with saliva in the mouth to form
was higher in Group 1 (week 1: 34.48%; week 2: 58.19%) as compared herbal formulation; and Group 4 – a toothpaste fluorapatite, which is ten times more resistant to acids than hydroxyapatite.11,12
with Group 2 (week 1: 27.07%; week 2: 47.16%) and Group 3 (week 1: was conducted. A total of 160 patients clinically
containing 5% potassium nitrate.
30.00%; week 2: 49.05%). diagnosed with Dentin Hypersensitivity Toothpaste containing fluoro calcium phospho silicate (BioMin) has shown better
participated in this study. The participants results in reducing dentinal hypersensitivity in comparison, being a suitable
were randomly divided into four groups: treatment option for the management of dentinal hypersensitivity.14
Results:
Group 1 - toothpaste containing 5% potassium • Group 1 (BioMin) resulted in more improvement with statistical
60 References
58.19
nitrate; significance difference at all‑time intervals compared with the other
1. Oral Hygiene. Available at: https://my.clevelandclinic.org/health/treatments/16914-oral-hygiene As
58 Group 2 - toothpaste containing 5% fluoro groups for tactile and air blast methods. accessed on: 05/12/2023.

56 calcium phosphosilicate ; • An intragroup comparison showed that all groups recorded a significant 2. Parakh S, Shiraguppi V, Deosarkar B, et al. DENTINAL HYPERSENSITIVITY–A REVIEW. Journal of
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Interdisciplinary Dental Sciences. 2019 Jan;8(1):01-5.

Group 3 - toothpaste containing 10% strontium improvement from baseline to 4 weeks [Figure 12 and 13]. 3. Liu XX, Tenenbaum HC, Wilder RS, et al. Pathogenesis, diagnosis and management of dentin hypersensitivity:
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52.69 chloride; and an evidence-based overview for dental practitioners. BMC oral health. 2020 Dec;20:1-0.
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the other groups for all stimuli (Table 4). 8. Galler KM, Weber M, Korkmaz Y, et al. Inflammatory Response Mechanisms of the Dentine-Pulp Complex and
phosphosilicate phosphosilicate hexahydrate the Periapical Tissues. Int J Mol Sci. 2021 Feb 2;22(3):1480.
Air blast GROUP 1 GROUP 2 GROUP 3 GROUP 4 9. Davari AR, Ataei E, Assarzadeh H. Dentin hypersensitivity: etiology, diagnosis and treatment; a literature
1 7.23+1.24 6.68+1.45 5.40+1.46 2.90+1.5 0.001
spray review. Journal of Dentistry. 2013 Sep;14(3):136-45

Figure 11: Percentage reduction in VAS score 10. Ramadoss R, Padmanaban R, Subramanian B. Role of bioglass in enamel remineralization: Existing strategies
2 7.20+1.45 6.38+1.65 2.28+1.34 0.80+0.45 0.001 Figure 12: Mean Visual Analog Scores at baseline and 4 weeks using the tactile method and future prospects—A narrative review. Journal of Biomedical Materials Research Part B: Applied
3 7.30+1.29 4.38+1.87 4.32+1.25 2.93+0.09 0.001 Biomaterials. 2022 Jan;110(1):45-66.
11. BioMin F. BioMin F: Who needs 5000 ppm or 1450 ppm for that matter?. British Dental Journal. 2022 Mar
4 7.09+1.47 6.26+1.65 5.00+2.03 3.58+0.76 0.001 Base line 4 Weeks 11;232(5):345.
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Cold water 7.08 7.06 7.18 7.24 12. The American Ceramic Society. Ceramic Tech Today. Bioactive glass toothpaste is on the way. [Internet].
desensitizing dentifrice treatment may provide better treatment spray
1 7.65+1.13 6.65+1.34 5.08+1.67 2.95+0.87 0.001 [Accessed December 29, 2023]. Available from:
https://ceramics.org/ceramic-tech-today/biomaterials/bioactive-glass-toothpaste-is-on-the-way.
response for the treatment of DH 2 7.27+1.09 5.34+1.16 3.45+1.35 1.45+0.97 0.001
5 13. Hussain H, Jan SM, Behal R. Clinical comparison of 5% fluoro calcium phosphosilicate versus 5% calcium
4.44 sodium phosphosilicate in the treatment of dentinal hypersensitivity. 2019.
3 7.28+1.32 6.09+1.32 4.42+1.25 3.30+1.08 0.001
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4 7.58+1.23 6.87+1.50 5.45+1.17 3.56+1.18 0.001
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sodium phosphosilicate, and strontium chloride hexahydrate containing dentifrice for the treatment of dentin
Table 4: Intergroup analysis hypersensitivity: A randomized single-blind study. J Int Oral Health 2019;11:404-11
16. Gautam V, et al. Comparison of Clinical Efficacy Of Four Dentifrices In the Management Of Dentinal
The dentifrice containing fluoro calcium phosphosilicate is GROUP 1 GROUP 2 GROUP 3 GROUP 4
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more efficacious in managing Dentin Hypersensitivity. herbal, and potassium nitrate desensitizing agents in the treatment of hypersensitive teeth: A clinical study. J
Figure 13: Mean Visual Analog Scale scores at baseline and 4 weeks using the airblast method NTR Univ Health Sci 2019;8:24-8.

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