Arginine seems to be the new kid on the block when it comes to dentine hypersensitivity, but what does the research say?

Arginine is an amino acid which occurs naturally in saliva. It provides naturally protective oral health benefits in relation to dental caries and dentinal tubule occlusion. The molecular formula of Arginine is C₆H₁₄N₄O₂. Kleinberg reported on Arginine in 1999 and 2002 when describing the SensiStat product. SensiStat contains Arginine Bicarbonate and Calcium Carbonate. This complex can plug and seal open dentinal tubules. The Arginine component is highly soluble and along with the Calcium Carbonate can adhere to the dentinal tubule walls, blocking the tubules from those elements that stimulate fluid movement and lead to the sensation of pain. In addition, if acid is to dissolve any of the Calcium Carbonate within the plug, Arginine is released which bacteria use to produce an alkaline environment.

This concept has been used to develop Pro-Argin ™. Research is suggesting that the Arginine and Calcium Carbonate complex binds to the negatively charged dentine surface forming a calcium rick layer, plugging and sealing the tubules. This plug is able to remain even after exposure to acids, providing a long term solution to dentine sensitivity.

Colgate Sensitive Pro-Relief ™ is a range of products containing the Pro-Argin ™ technology.

In 2009 the American Journal of Dentistry produced a special issue containing research on Pro-Argin™. One study observed the effect of an 8% Arginine and Calcium Carbonate medicament used in surgery to treat dentine hypersensitivity. The medicament was applied to the sensitive teeth using a prophylaxis cup in a contra-angled handpiece on slow speed and medium pressure which should occlude the dentinal tubules with the material. The studies reported in this special edition were conducted by The Colgate-Palmolive Company. Schiff et al (2009) saw statistically significant improvements in hypersensitivity when compared with the control group. In this study subjects had the surfaces prone to hypersensitivity cleaned with the paste straight after professional tooth cleaning and then 4 weeks later.

Further studies have looked at the effects an 8% Arginine toothpaste has on dentine hypersensitivity against another desensitising toothpaste containing Potassium. Ayad et al (2009) reported on a study where a total of 77 adults aged 18-66 years were involved. After 8 weeks those using the Arginine based toothpaste saw a reduction in tactile and air blast stimuli. The overall conclusion was that patients with dentine hypersensitivity would see greater relief at 2, 4 and 8 weeks by using the Arginine and Calcium Carbonate toothpaste when compared to the Potassium and Sodium Fluoride toothpaste. However, again this study was conducted by The Colgate-Palmolive Company so conflict of interest could be an issue.

Docimo et al (2009) compared the clinical efficacy of an Arginine containing toothpaste against Potassium based desensitising toothpaste over 8 weeks. The double-blind randomised study involved 80 subjects with ages ranging between 19-69 years. These subjects suffered from dentine hypersensitivity from at least two teeth. Subjects brushed their teeth for at least 1 minute twice a day with the allocated toothpaste. Reviews were undertaken at 2, 4 and 8 weeks where sensitivity assessments were undertaken. The Arginine toothpaste, when used for the 8 week period, reduced dentine hypersensitivity when compared with the Potassium based toothpaste. This article was published in the peer reviewed Journal of Clinical Dentistry. However, three authors may have conflicts of interest as they are employed by the Colgate-Palmolive Company.

In vitro studies have also taken place. Petrou et al (2009) investigated the action of the Arginine and Calcium Carbonate toothpastes. The results of the study experiments demonstrated that the Arginine and Calcium Carbonate matrix with an alkaline pH, occludes the dentinal tubules. The study was undertaken at the Colgate-Palmolive Technology Center in New Jersey, USA.

Cummins (2009) produced a paper which brought together all of the recent research and clinical evidence in the effectiveness of the Arginine based toothpastes, mainly describing the Pro-Argin™ technology. Within the article there is an acknowledgement that Cummins is an employee of the Colgate-Palmolive Company and that Colgate-Palmolive sponsored the review of the literature.

Sharif et al (2013) conducted a systematic review observing the effectiveness of Arginine containing toothpastes in treating dentine hypersensitivity. Various databases were searched for relevant studies. After a review of the data the authors conclude that there may be a role for Arginine containing toothpastes in the management of dentine hypersensitivity. The systematic review highlighted that those studies which have taken place involve small numbers of subjects. Whilst dentine hypersensitivity has been observed to have reduced in the short term, none of the studies provided any follow-up for the medium and long term effectiveness of Arginine containing toothpastes. They recommend that further ‘well designed RCTs’ take place.

More recent studies have been observing the effect of Arginine containing mouthwashes for the treatment of dentine hypersensitivity. Elías Boneta et al (2013) compared ‘the efficacy of 0.8% Arginine, Potassium Nitrate and Sodium Fluoride mouthwash on dentine hypersensitivity reduction’. There were 69 participants who were randomised into three groups: mouthwash containing 0.8% Arginine, mouthwash containing 2.4% Potassium Nitrate and a control mouthwash containing 0.05% Sodium Fluoride. Tactile and air blast sensitivity scores were analysed at 30 minutes post rinsing and 2, 4 and 6 weeks after twice daily used of the mouthwash. No differences were noted after 30 minutes with any mouthwash. The authors noted that the Arginine mouthwash provided statistically significant improvements in tactile and air blast scores when compared with the other mouthwashes at 2, 4 and 6 weeks. Some of the authors were from the Colgate-Palmolive Company and this study involved only a small sample size and was of short duration.

Mello et al (2013) reported on a study outlining the mode of action of the Arginine containing mouthwashes, in particular the 0.8% mouthwash. The experiments showed that a ‘formation of a hydrated layer on exposed dentine tubules upon the application of the Arginine mouthwash’. Penetration of these tubules was also observed.

Advancing technology is providing the clinician and patient with more options for dental treatment. Initial studies have provided promising results for the use of Arginine within dental products. However further studies involving more participants and of longer duration and utilising follow-up are required to provide sound statistical and clinical evidence of its effectiveness. Impartial studies would also be useful to avoid conflict of interest.

References

Ayad F, Ayad N, Zhang YP, Cummins D, DeVizio W, Mateo LR. (2009) Comparing the Efficacy in Reducing Dentin Hypersensitivity of a New Toothpaste Containing 8.0% Arginine, Calcium Carbonate, and 1450 ppm Fluoride to a Commercial Sensitive Toothpaste Containing 2% Potassium Ion: An Eight-Week Clinical Study on Canadian Adults. Journal of Clinical Dentistry. 20: (Spec Iss) 10-16

Cummins D. (2011) Clinical evidence for the superior efficacy of a dentifrice containing 8.0% Arginine and Calcium Carbonate in providing instant and lasting relief of dentin hypersensitivity. Journal of Clinical Dentistry. 22: (Spec Iss) 97­99

Docimo R, Montesani L, Maturo P, Costacurta M, Bartolino M, DeVizio W, Zhang YP, Cummins D, Dibart S, Mateo LR. (2009) Comparing the Efficacy in Reducing Dentin Hypersensitivity of a New Toothpaste Containing 8.0% Arginine, Calcium Carbonate, and 1450 ppm Fluoride to a Commercial Sensitive Toothpaste Containing 2% Potassium Ion: An Eight-Week Clinical Study in Rome, Italy. Journal of Clinical Dentistry. 20: (Spec Iss) 17-22

Elías Boneta AR, Galán Salás RM, Mateo LR, Stewart B, Mello S, Arvanitidou LS, Panagakos F, DeVizio W. (2013) Efficacy of a mouthwash containing 0.8% arginine, PVM/MA copolymer, pyrophosphates, and 0.05% sodium fluoride compared to a commercial mouthwash containing 2.4% potassium nitrate and 0.022% sodium fluoride and a control mouthwash containing 0.05% sodium fluoride on dentine hypersensitivity: A six-week randomized clinical study. Journal of Dentistry, http://dx.doi.org/10.1016/j.jdent.2012.11.004

Mello SV, Arvanitidou E, Stranick MA, Santana R, Kutes Y, Huey B. (2013) Mode of action studies of a new desensitizing mouthwash containing 0.8% arginine, PVM/MA copolymer, pyrophosphates, and 0.05% sodium fluoride. Journal of Dentistry, http://dx.doi.org/10.1016/j.jdent.2012.11.001

Petrou I, Heu R, Stranick M, Lavendar S, Zaidel L, Cummins D, Sullivan RJ. (2009) A breakthrough therapy for dentin hypersensitivity: how dental products containg 8% Arginine and Calcium Carbonate work to deliver effective relief of sensitive teeth. Journal of Clinical Dentistry 20: (Spec Iss) 23-31

Schiff T, Delgado E, Zhang YP, Cummins D, DeVizio W, Mateo LR. (2009) Clinical evaluation of the efficacy of an in-office desensitizing paste containing 8% arginine and calcium carbonate in providing instant and lasting relief of dentin hypersensitivity. American Journal of Dentistry. 22: (Spec Iss)

Useful links

http://www.colgateprofessional.co.uk/products/Colgate-Sensitive-Pro-Relief-Toothpaste/details#howitworks

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3523144/

http://www.colgateprofessional.co.uk/professionaleducation/Pro-Argin-Technology-Mode-Of-Action/article

http://www.colgateprofessional.com/dental-indications/dentin-hypersensitivity

Updated July 2013

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