Hipersensibilidade dentinária: prevalência, fatores de risco e protocolos de tratamento - uma avaliação laboratorial, transversal, clínica e revisões sistemáticas da literatura

Abstract

Dentin hypersensitivity (DH) is a condition with high prevalence and incidence rates, which influences the quality of life of the world population. The proposal of this study was to assess the prevalence and risk factors involved in the development of DH, as well as, the perception of Brazilian dentists about this condition and the efficacy of desensitizing clinical protocols. This study was divided into six chapters; chapter 1: to systematically review cross-sectional studies to estimate the prevalence of DH in various populations and to investigate factors that might influence variation in the prevalence; chapter 2: to evaluate, by means of a crosssectional study, the risk factors associated with noncarious cervical lesions (NCCLs), DH, gingival recession, and the relationship among these conditions in a specific Brazilian sample population; chapter 3: to investigate by means of a questionnaire, the perception and the clinical routine for DH management among Brazilian dentists; chapter 4: to conduct a systematic review to evaluate the desensitizing effect of galliumaluminium- arsenide (GaAlAs) lasers compared to placebo / no treatment or topical agents applied in the office, considering different follow-up times; chapter 5: to evaluate, by means of a randomized clinical study, the efficacy of different concentrations of potassium oxalate (5 and 10%) in the relieving of DH, after a protocol of four sessions; chapter 6: to evaluate the influence of desensitizing agents on bond strength of self-etch adhesives to dentin submitted to acid-abrasive challenge, using the microtensile bond strength test and analysis of the failure mode. After analyzing the results, it can be concluded that the best estimate of DH prevalence was 11.5% (95%CI:11.3%-11.7%) and the average from all studies was 33.5% (95%CI: 30.2%-36.7%). The NCCLs and gingival recession (GR) distributions increased with age; NCCLs, DH, and GR had positive correlation and were influenced by factors as age, gender, gastric disease, and occlusal trauma. Regardless of clinical experience, dentists in Brazil still considered the management of DH a challenge in their daily dental practice. In addition, the results suggest a need for the development of guidelines to disseminate the current knowledge about this condition.Available evidence suggests that the use of GaAlAs lasers promote better outcome for in-office treatment of DH than placebo/no treatment (regardless the follow-up period) and fluoride-based agents (for short, mid and long-term follow-ups). Both concentrations of potassium oxalate (10 and 5%) tested can be considered an effective treatment for DH for at least 6 months. However, after 9 months of follow-up, the higher concentration presented better results. The desensitizing agent type seems to be a determining factor to promote changes in bond strength of self-etch adhesives to dentin. Thus, the results of this thesis suggest that it is possible to perform a successful management of DH. Therefore, it is necessary to control the etiological factors and to use specific desensitization protocols, in order to achieve longevity for the treatment.