Efficacy of bioactive glass-based desensitizer compared to other desensitizing agents or techniques in dentin hypersensitivity: a systematic review

Abstract

Objectives

The objective of this systematic review was to evaluate the effectiveness of home and professional single-application desensitizers that contain bioactive glass in comparison to other desensitizing methods and agents or negative controls in randomized controlled trials.

Methods

Two reviewers searched the electronic databases Cochrane Central Library, PubMed, Scopus, and Web of Science using specific keywords. The randomized controlled clinical trials (RCTs) that focused on the use of bioactive glass-based desensitizers to treat dentin hypersensitivity (DH) through December 2024 were included. Data extraction, selection, and screening were completed. Descriptive analyses were conducted, and the Critical Appraisal Skills Programme (CASP) and updated Cochrane tools were used to evaluate the quality assessment and risk of bias, respectively.

Results

A total of 30 studies were involved in this evaluation, and all of them were assessed as low risk of bias except one that had some concerns. Pain responses of 2845 patients with an age range of 17–75 years were assessed in this review. The efficacy of bioactive glass-based desensitizers in reducing sensitivity pain was superior compared to baseline and to various desensitizing agents and placebo. The follow-up assessment time was varied, and accordingly, the long-term efficacy of bioactive glass was similar to other agents.

Conclusions

With the limitation of this review, the bioactive-glass-based desensitizing agent used in-office or at home is effective to reduce DH response in the immediate, medium, or long term up to 12 weeks. The efficacy of this agent is comparable to most of the available desensitizers in the long term; however, it is more effective in the immediate to medium term, up to 4 weeks.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-025-06288-5.

Introduction

Dentin hypersensitivity (DH) refers to a condition marked by sharp and immediate pain caused by exposed dentin in response to thermal, evaporative, tactile, osmotic, or chemical triggers, and it is not linked to any other dental issues. There is a general belief that the number of DH instances is greater than those have been documented [1]. Exposed dentinal tubules, gingival recession, and loss of tooth structure, such as cementum or enamel, are the risk factors for DH [2].

Different theories were suggested to explain the DH pain, which include the classic hydrodynamic odontoblast transducer theory, direct trigger to innervated exposed dentin, neuroplasticity and sensitization of nociceptors, sensory receptors via odontoblasts, and algoneurons [2].

Eliminating the etiological causes is the first step in treating DH. Desensitizing toothpaste or dentifrices are then applied non-invasively to stop nerve conduction or block the dentinal tubules [3]. A variety of desensitizing agents, such as calcium sodium phosphosilicate, potassium nitrate, strontium acetate, arginine, and calcium carbonate, have been employed. Moreover, professional application of desensitizers, cervical restoration, root canal treatment, and surgical or laser treatment are other options for treatment [4].

In-office single application of desensitizing agent provides an advantage over at-home use of desensitizing toothpaste, as they do not require multiple applications or patient compliance, and a higher concentration of the desensitizing agent can be used that provides better relief from sensitivity [5].

Calcium phosphosilicate, also referred to as bioactive glass (BAG), is used to block the dentinal tubules and start the development of a mechanically strong layer of hydroxyapatite on the dentin’s surface that can withstand the deterioration brought on by frequent acid challenges [6].

The antibacterial, biocompatible, and bioactive properties of BAG render it widely used as biomaterial in dental applications. Larry Hench developed the inaugural bioactive glass in 1969, which was later named Bioglass 45S5^® [7]. The composition of Bioglass 45S5^® consists of SiO₂, Na₂O, CaO, and P₂O₅, which together make up 46.1 mol% of the total composition. Specifically, sodium oxide accounts for 24.4 mol%, calcium oxide accounts for 2.6 mol%, and phosphorus pentoxide accounts for 2.6 mol% ⁶.

The evidence supporting the effectiveness of bioactive glass on DH was examined in a few systematic reviews. A systematic evaluation of randomized controlled trials (RCTs) utilizing bioactive glass and bioactive glass-ceramic (Biosilicate^®) was carried out by Freitas et al. [8]. A meta-analysis comparing the impact of employing bioactive glass to a placebo/negative control was also conducted by Zhu et al. [9]. Furthermore, a recent review included bioactive glass with or without fluoride and excluded bioactive glass-ceramics. However, it was reviewed for a period from 2018 to 2022 [10]. The present review is designed to evaluate the efficacy of professional single applications and home desensitizers containing bioactive glass with control groups (other desensitizing agents and techniques or negative) in randomized controlled trials from 2010 to 2024.

Methods

Protocol registration

The protocol was created, registered in PROSPERO (CRD42024580580) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards for reporting for the review [11]. It is available from: (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=580580).

The AMSTAR 2 technique was used to evaluate the methodology quality of this systematic review [12] (supplementary file).

Search strategy

In August 2024, two examiners (AA and NA) independently conducted a comprehensive electronic search within the pertinent published literature that was limited to the English language. The search was updated in December 2024. The databases that were used were the Cochrane Central Library (clinicaltrials.gov, US National Library of Medicine), Web of Science, ScienceDirect, and MEDLINE via PubMed (National Library of Medicine). To find any further research that could be included, the grey literature and full-text article references were manually searched. The keywords used are as follows: “dentin hypersensitivity” AND “bioactive glass” OR “phosphosilicate”OR”Novamin” AND “clinical trial”. The records obtained were transferred to an EndNote^® library to remove any duplication.

Screening and study selection

Randomized controlled trials (RCTs) only were encompassed in this review. PICO was used as follows: Participation of patients diagnosed with dentin hypersensitivity in one or more teeth and Intervention: Bioactive glass-based desensitizer as toothpaste or single topical application. Comparison: any other desensitizing agents, techniques, or placebos and Outcome: pain or sensitivity score. The studies omitted were case-study clinical trials, case reports, case series, studies without a control group, animal studies, in vitro experimental studies, and randomized clinical trials that assessed DH due to bleaching, restoration, or post-surgery.

Titles, abstracts and full-text evaluations were completed by two separate reviewers (AA, NA) based on the determined eligibility criteria; a kappa score of > 0.90 was discovered between them. Reviewers’ disagreements were resolved through discussion with a third reviewer (AM) to consensus. Both reviewers extracted data and presented it in consistent tables.

Data extraction

The data was collected following the guidelines from the Cochrane Handbook for Systematic Reviews of Interventions [13]which included clinical outcomes and details about the study. The extracted data included study ID, study setting/design, number and age of patients, tested and comparison materials, assessment methods, timing of assessments, and clinical outcomes.

Quality assessment

The certainty of evidence in the included studies was independently appraised by two reviewers (AFA and AM). The evaluation was performed using the Critical Appraisal Skills Programme (CASP) tool [14]which considers various dimensions of study quality, including research design, methodological soundness, results interpretation, and practical relevance. Based on CASP criteria, the certainty of evidence was graded as high, moderate, low, or very low.

Each study was assessed for methodological rigour, consistent findings, precision in effect size estimates, relevance to the research question, and potential bias. Decisions regarding the certainty of evidence were supported by detailed footnotes, providing clarity on the assessment process. Additional comments were included to enhance reader comprehension of the findings and their broader implications. All assessments were systematically documented to ensure transparency and facilitate reproducibility.

Study risk of Bias assessment

The updated Cochrane Risk of Bias Tool for Clinical Randomized Trials (RoB 2.0) was used to assess bias. The following domains were evaluated: measurement of the stated result, overall bias, missing outcome data, deviations from the intended interventions, and the randomization method. The chosen research was divided into three categories: minimal risk of bias, some concerns, and high risk of bias [13].

Two independent reviewers (AFA and AM) applied the tool to each included study, thoroughly documenting supporting information and justifications for their risk of bias assessments within all five domains. Discrepancies in assessments or underlying rationales were resolved through discussion, with a third reviewer (AA) serving as an arbitrator when required. The overall risk of bias for each study corresponded to the highest level of bias detected across any of the evaluated domains.

Results

Study selection

Figure 1 illustrates the flowchart detailing the selection, inclusion, and exclusion of studies following PRISMA guidelines. The search provided 408 hits. 301 hits out of duplication, and the remaining 98 studies were screened. A total of 30 attained in full text and included in this review [5, 15–43]. Three articles were excluded due to unavailability of full texts [44–46].

Fig. 1.

PRISMA 2020 flow diagram for new systematic reviews which included searches of databases, registers and other sources

Characteristics of the included studies

Table 1 represents the characteristics of the involved studies. A total of 30 studies were included; 22 of them were home-based brushing [15–20, 22, 23, 25, 26, 28–31, 36–40, 42, 43, 47]and 8 were single topical applications in clinic by professions [21, 24, 27, 32–35, 41]. The study design of all study was parallel except for Kim et al. which was a split-mouth design [27]. A total of 2845 patients completed the assessment, and their ages varied between 18 and 75 years old.

Table 1.

Characteristics of the included studies

Study ID	Study setting/ desgin	Patients No	Age	Material Tested	Compotator	Assessment Method/ Stimuli	Assessment time	Clinical Outcomes
Du et al., 2008 [22]	Home-based / Parallel	71	21–56	5% Novamin	Strontium chloride and placebo	VAS*/ Evaporative and thermal	Baseline, 2 weeks and 6 weeks	Novamin toothpaste was more successful in decreasing DH* than both a commercial toothpaste and a placebo.
Litkowski & Greenspan 2010 [30]	Home-based / Parallel	66	-	2.5% and 7.5% Novamin	Placebo	VAS/ Tactile and thermal air	Baseline, 2, 4 and 8 weeks	Incorporation of Novamin into products reduced DH
Narongdej et al., 2010 [34]	In Office-Single use /Parallel	60	26–70	7.5% Novamin with 100% CSPS* Powder OR Placebo powder of 7.5% Sodium bicarbonate	5% potassium nitrate and Sodium flouride.	VAS / Cold water and tactile	Baseline, Immediate,1,2, and 4 weeks	Novamin performed better than potassium nitrate. The use of 100% Novamin powder improved the efficacy of the Novamin.
Pradeep and Sharma., 2010 [38]	Home-based/ Parallel	111	20–60	5% CSPS* with fused silica	5% potassium nitrate	VAS / Air and cold water	Baseline, 2 and 6 weeks	All treatments showed lower sensitivity values compared with baseline, the CSPS showed comparable reduction in DH to potassium nitrate
Salian et al., 2010 [40]	Home-based/ Parallel	30	20–50	5% Novamin	5% potassium nitrate and SMFP* (1,000 ppm fluoride)	VAS / Tactile, air blast, and cold water	Baseline, 2 and 4 weeks.	5% Novamin offered quick and considerably greater relief from DH in 4 weeks than other products.
Sharma et al., 2010 [42]	Home-based/ Parallel	120	20–50	7.5%Novamin	5% potassium nitrate, and 0.4% stannous fluoride	VAS/Cold water and air blast	Baseline,2, 4, and 12 weeks.	All three items proved to be effective. Nonetheless, Novamin offered more considerable and noteworthy enhancements at the initial time points.
Ananthakrishna et al., 2012 [15]	Home-based/ Parallel	40	20–50	7.5%Novamin	10% strontium chloride	VAS/ Cold water and air blast	Baseline and at 2, 4, and 6 weeks	Both dentifrices exhibited significant reduction in DH with Novamin exhibiting significantly higher reduction in DH.
Milleman et al., 2012 [33]	In Office-Single use/ Parallel	139	> 18	NUPRO Sensodyne with 15%Novamin with or without fluoride.	NUPRO Classic without fluoride	Schiff score and questionnaire /Tactile and airblast	Baseline, Immediate, After 28 days	Novamin with and without fluoride Significantly reduced DH.
Pradeep et al., 2012 [37]	Home-based/ Parallel	149	20–60	5% CSPS* with fused silica	5% potassium nitrate, 3.85% amine fluoride, and a placebo.	VAS/Air and cold water	Baseline, 2 and 6 weeks	All therapies demonstrated reduced pain relative to the baseline, and CSPS exhibited improved outcomes when compared to either fluoride or potassium nitrate.
Acharya et al., 2013 [47]	Home-based/ Parallel	20	18–65	CSPS*	Potassium nitrate	VAS/Cold and air evaporative	Baseline, 2, 4 and 8 weeks	CSPS demonstrated a more significant decrease in DH than potassium nitrate at an earlier time (2 weeks).However, the two toothpastes’ long-term impacts were similar.
Neuhaus et al., 2013 [35]	In Office-Single use/ Parallel	149	18–70	NUPRO Sensodyne with 15%Novamin with or without fluoride.	NUPRO Classic without fluoride	Schiff score/ Tactile and air evaporating.	Baseline, immediate and 28 days	The use of either fluoridated or non-fluoridated prophylaxis pastes with 15% Novamin significantly decreased DH.
Rao et al., 2014 [39]	Home-based/ parallel	80	18–70	5% Novamin	ProArgin	VAS/Airblast	Baseline and 15 days	5% Novamin provided a significant reduction in DH.
Shivaprasad et al., 2014 [5]	In Office-Single use/ Parallel	60	-	Novamin powder With or without SRT*	No treatment (negative control)	VAS/Air evaporative and cold water	Baseline, immediate, 1 h and 8 days	The chairside use of CSPS, either with or without scaling, can serve as a therapeutic addition to offer instant relief for DH.
Jena & Shashirekha, 2015 [26]	Home-based/ Parallel	45	18–50	5% Novamin	8% arginine and 15% hydroxyapatite nanoparticles	VAS& Schiff Score/ Tactile and Air blast	Baseline, immediately, 1 and 4 weeks	Toothpaste with 15% n-HA was shown to be the most effective, succeeded by 8% arginine and 5% Novamin.
Samuel et al., 2015 [41]	In Office-Single use/ Parallel	49	20–50	Novamin	ProArgin™ paste, Gluma Desensitizer	VAS& Schiff Score/Tactile and Air blast	Baseline, immediate, 15 and 30 days	A one-time application of ProArginTM paste is considerably more effective than of Gluma and Novamin paste in providing immediate relief from DH and over a span of 30 days.
Majji& Murthy K, 2016 [31]	Home-based/ Parallel	160	20–60	5% Novamin	5% potassium nitrate, 10% strontium chloride and herbal formulation.	VAS/Tactile, Airblast and Cold water	Baseline, 2 weeks, 1 month, and 2 months.	All treatments showed lower sensitivity compared with baseline. CSPS showed significantly better results compared to others in reducing DH.
Sufi et al., 2016 [43]	Home-based/ Parallel	137	18–55	5% CSPS* with 1500 ppm SMFP*	Matched placebo (0% CSPS) with additional abrasive silica, 1000 ppm SMFP and 1100 ppm SF*	VAS, Schiff score & questionnaire /Tactile and evaporative	Baseline, 4 and 8 weeks	Both the experimental and placebo more effective than the control groups for lowering DH.
Athuluru et al., 2017 [18]	Home-based/ Parallel	68	18–75	5%CSPS*	5% Potassium nitrate, OR 3.85% Amine fluoride OR Placebo.	VAS/ Evaporative	Baseline, 6 and 12 weeks	CSPS was found to be more effective in reducing DH
Bansal& Mahajan, 2017 [19]	Home-based/ parallel	45	20–50	5%Novamin	8% Arginine OR herbal formulation	VAS/tactile and air	Baseline, 2 and 4 weeks	All the groups showed lower DH compared to baseline, with CSPS showed better reduction in DH in long term.
Hall et al., 2017 [25]	Home-based/ Parallel	135	18–60	5% CSPS* with 1450 ppm SMFP*	8%arginine/calcium carbonate with 1450 ppm SMFP and regular fluoride toothpaste with 1400 ppm SMFP	VAS &Schiff score/ Tactile & evaporative	Baseline, 1,2,4,6 & 11weeks	The longer-term efficacy of a 5% CSPS indicated similar benefits to a commercially available 8% arginine/calcium carbonate formulation.
Ashwini et al., 2018 [17]	Home-based/ Parallel	60	> 18	5% FSPS* and 5% CSPS*	Standard dentifrice containing fluoride	VAS/Subjective & thermal	Baseline, immediately after SRP, at 15, 30, and at 60 days	All desensitizers were effective with FSPS was significantly reduced DH after SRP.
Maximiano et al., 2018 [32]	In Office-Single use/ Parallel	70	18–65	15% Novamin	Nd: YAG laser irradiation and Placebo	VAS/Tactile and airblast	Baseline, immediate, 1, and 4 weeks	No statistically significant differences in DH reduction among all groups.
Fu et al., 2019 [23]	Home-based/ Parallel	147	18–60	2.5% CSPS* (ca. 4 μm particle-size)	8% arginine and 1400 ppm fluoride as SMFP	VAS&Schiff score/ Evaporative air and tactile	Baseline and after 1, 2, 4 and 8 weeks	No statistically significant differences were found between both dentifrices in decrease DH.
Gallob et al., 2019 [24]	In Office-Single use/ Parallel	120	20–63	Dissolvable polymer strip with 15% CSPS*	No treatment (negative control)	Schiff score &questionnaire /Evaporative air& tactile.	Baseline and10min,2 h and 4 h	A dissolvable strip containing 15% CSPS showed significantly greater DH reductions compared with no treatment. Strips were well-liked and tolerated by participants.
Patel et al., 2019 [6]	Home-based/ Parallel	75	18–70	5% FCPS*	8% Arginine and Calcium carbonate and Placebo	VAS/Tactile& evaporative stimuli	Pre-baseline, Baseline, at 15 days and 1 month.	All three groups showed a reduction in DH, however, only FCPS showed a maximal reduction in DH and appeared more efficacious than two groups.
Arshad et al., 2021 [16]	Home-based/ Parallel	128	18–50	FCPS*	8.0% arginine and 1450 ppm fluorides, 8% strontium acetate, 1040 ppm fluorides, and Sodium fluoride with 1150 ppm fluorides.	VAS &Schiff score/ Air blast, tactile, & water jet.	Baseline, Immediate, 1 day, 2,3,4&6, weeks.	Pro-argin™ and strontium acetate are effective for immediate pain relief from DH, and FCPS provided the best treatment for long term management of DH.
Bhowmik et al., 2021 [20]	Home-based/ Parallel	30	> 18	7.5% CSPS*	Fluorinol-containing Elgydium	VAS& questionnaire/ Tactile, evaporative & cold water	Baseline,2, 3 and 4 weeks	Fluorinol was more effective than CSPS, toothpaste in lowering DH.
Kim et al., 2024 [27]	In Office-Single use/Split-mouth.	44	18–65	Hi-bond universal With Mesoporous bioactive glass (MBG)	MS coat ONE	VAS/Evaporative, Cold Thermal	Baseline, immediate, 1 and 2 week.	The universal adhesive with MBG showed potential for DH relief, indicating efficacy that is equal to or better than that of a specific desensitizing agent.
Li J et al., 2024 [28]	Home-based/ Parallel	90	18–70	Novamin	HX-BGC bioactive glass ceramic and negative toothpaste	Yealep& Schiff score /Tactile & air blast.	Baseline, 2, 4, and 6 weeks	Both HX-BGC and Novamin demonstrated more significant effects in combating DH.
Li R et al., 2024 [29]	Home-based/ Parallel	197	18–70	5% CSPS*	0.454% stannous fluoride and 1150 ppm of NaF	Yealep, Schiff score & Questionnaire. Tactile & evaporative air	Baseline, 4 and 8 weeks.	All of the dentifrices demonstrated significant effects in lowering DH, however there were no statistically significant differences between them.

*CSPS: calcium sodium phophosilicate, FCPS: Fluorocalcium phosphosilicate, SMFP: Sodium monofluoro-phosphate, DH: Dentin hypersensitivity, SF; Sodium fluoride. VAS; Visual Analog Scale, SRP scaling & root planning

Most of the studies used CSPS, mainly Novamin, with different concentrations: 2.5% [23, 30], 5% [17–19, 22, 25, 26, 29, 31, 37–39, 43], 7.5% [15,20, 30, 34, 42], and 15% [24, 32, 33, 35]. Novamin powder was experienced as an additives [34] or as a main desansitizer agent [21]. Other additives were evaluated, such as sodium bicarbonate [34] fused silica [38] and fluoride [25, 33, 35, 43]. Combining fluoride as in Fluorosodium phosphosilicate, was used [16, 17, 36] and the efficacy of a bonding agent with bioactive glass was also assessed [27].

Various desansitizers were applied as comparison agents, including mainly 5% Potassium nitrate [18, 31, 34, 37, 38, 40, 42, 47] or 8% arginine [16, 19, 23, 25, 26, 36, 39, 41]strontium chloride or acetate [15, 16, 22, 31]Sodium monoflourophosphate (SMFP) [23, 25, 40, 43]Sodium, Amine or Stannus fluoride [16–18, 29, 34, 37, 42, 43]15% Hydroxyapatite [26]Gluma Desensitizer [41]Nd: YAG laser irridation [32],Calcium carbonate [36]MS coat ONE [27]HX Bioactive glass ceramic [28]NUPRO Classic without fluoride [33, 35]herbal formulation [19, 31]and placebo or negative control wih no treatment [5, 18, 22, 24, 28, 30, 32, 36, 38].

Almost all studies used two or more stimuli to assess the pain score using Visual Analog Scale (VAS) rated from 0 with no pain to 10 with severe pain, Schiff sensitivity score [16, 23–25, 28, 29, 33, 35, 41, 43] that have 4 scores and yealep index for tactile stimulus [28, 29]. Only two studies used one stimulus of evaporative air blast as a testing method [18, 39]. Few studies used experience questionnaires for assessment [20, 24, 29, 33, 43].

Different stimuli were used involving evaporative air blast [5, 15, 16, 18–20, 22–29, 31–33, 35–43, 47]Tactile [16, 19, 20, 23–26, 28–36, 40, 41, 43] and thermal cold water stimuli [5, 15–17, 20, 22, 27, 30, 31, 34, 37, 38, 40, 42, 47].

All studies initiated the assessment from baseline to be a reference for furthere assessments. However, various timing were implemented among the included studies. The earlier assessment was immediately or 10 min post-application [5, 16, 17, 24, 26, 27, 32–35, 41] followed by an hour or two up to 4 h [5, 24]. The assessment of the studies with single topical application was not excessding 30 days [32–35, 41] while home-based brushing studies can extend up to 8 weeks/60 days [17, 23, 29–31, 47]. The maximum assessment period was 12 weeks [18] followed by 11 weeks [25]. Assessment after 2 weeks [15–17, 19, 20, 23, 25, 27, 28, 30, 31, 34, 36–40, 42, 47] and 4 weeks [15–17, 19, 20, 23, 25, 26, 28–31, 33–36, 40–43, 47] were the most frequent time of assessment among studies.

Clinical outcomes of the included studies

The majority of the studies demonstarted that tested desansitizers were effective in reducing DH pain compared to the baseline, while CSPS was more effective along the assessment time compared to desansitizer agents or placebo [5, 15–19, 22, 24, 27, 30, 31, 33–37, 39, 40, 42].

Some studies reported that a comparable efficacy of the CSPS in reducing DH to other agents and placebo specifically in long term [23, 25, 28, 29, 32, 38, 43, 47]. Few studies showed CSPS has less efficacy in reducing DH compared to nano-Hydroxyapatite, ProArging and Fluorinol-containing Elgydium [20, 26, 41].

Quality assessment

Table 2 summarizes the quality assessment outcomes, highlighting the studies’ compliance with key CASP domains. Most studies met the majority of the CASP criteria, indicating a generally high methodological quality across the included research. Studies demonstrating a high level of compliance across CASP criteria were deemed to have a lower risk of bias, enhancing their contribution to the systematic review. This rigorous quality assessment ensures a robust foundation for interpreting the findings and identifying potential limitations in the evidence.

Table 2.

Quality assessment of the included studies

Study ID	Section A*			Section B*			Section C*			Section D*
	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10	Q11
Li J et al., 2024	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Kim et al.,2024	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Li R et al.,2024	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Arshad et al.,2021	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Bhowmik et al.,2021	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Gallob et al.,2019	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Fu et al.,2019	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Patel et al. (2019)	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Cannot tell	Yes	Yes
Ashwini et al.,2018	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Maximiano et al.,2018	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Athuluru et al.,2017	Yes	Yes	Yes	Yes	Yes	Yes	Cannot tell	Yes	Yes	Yes	Yes
Bansal & Mahajan, 2017	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Hall et al.,2017	Yes	Yes	Yes	Yes	Cannot tell	Yes	Yes	Yes	Yes	Yes	Yes
Majji& Murthy K, 2016	Yes	Yes	Yes	Cannot tell	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Sufi et al., 2016	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Cannot tell	Yes	Yes
Jena & Shashirekha., 2015	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Samuel et al., 2015	Yes	Yes	Cannot tell	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Rao et al., 2014	Yes	Yes	Cannot tell	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Shivaprasad et al., 2014	Yes	Yes	Yes	Cannot tell	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Acharya et al.,2013	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Neuhaus et al.,2013	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Ananthakrishn et al.,2012	Yes	Yes	Yes	Yes	Yes	Cannot tell	Yes	Yes	Yes	Yes	Yes
Milleman et al., 2012	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Pradeep et al., 2012	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Cannot tell
Narongdej et al., 2010	Yes	Yes	Yes	Yes	Cannot tell	Yes	Yes	Yes	Yes	Yes	Yes
Litkowski & Greenspan, 2010	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Cannot tell	Yes	Yes
Pradeep & Sharma, 2010	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Cannot tell	Yes
Salian et al. 2010	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Sharma et al. 2010	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes	Yes
Du et al., 2008	Yes	Yes	Yes	Yes	Cannot tell	Yes	Yes	Cannot tell	Yes	Yes	Yes

Domain:

Section A: Is the basic study design valid for a randomized controlled trial?

Section B: Was the study methodology sound?

Section B: What are the results?

Section C: Will the results help locally?

Risk of bias assessment

Figure 2 presents the traffic light plot summarizing the risk-of-bias assessment for each study, including an additional column providing a comprehensive overview of the results. A weighted bar plot was generated to determine the overall risk of bias within this systematic review.

Fig. 2.

Risk of bias assessment

In Domain 1, two studies [29, 47] were identified as having “some concerns”, while the remaining studies were classified as “low risk.” All studies demonstrated “low risk”. in Domain 2. Domain 3 revealed that several studies [16, 20, 23, 25, 27–29, 32, 33, 36, 40] were categorized as having “some concerns”. Conversely, all studies exhibited “low risk” in Domain 4 whereas in Domain 5, some studies had some concerns [5, 37, 40, 41].

Despite the noted concerns in Domains 3 and 5 for specific studies, the collective assessment indicated a “low risk of bias” for all of the included studies except one study that has some concern [40]. Figure 3 showed the overall risk of bias.

Fig. 3.

Overall risk of bias

Discussion

Dentin hypersensitivity is a prevalent and clinically important issue that influences adults and affects their quality of life [48]. The best estimation for DH prevalence was 11.5% with an average of 33.5% from a different population [49]. DH is mainly a subjective phenomenon; therefore, quantifying the intensity of the pain is difficult [41]. Dentists are encountering the challenge of reducing DH’ pain and to selecting the optimum desensitizing agents. Bioactive glass-based desensitiser is introduced as a very desirable material that is resistant to mechanical and chemical stress and has the ability to completely occlude the dentinal tubules [50].

The findings of this systematic review demonstrated a high efficacy of bioactive glass–based desensitising agents in reducing DH pain compared to different desensitizers and placebo. This is in agreement with previous systematic reviews [9, 51]. These findings could be attributed to the ability of bioactive to induce continuous calcium and phosphate ions deposition and a localised rise in pH. Dentinal tubule occlusion results from encouraging the production of hydroxycarbonate apatite-like substance over the dentine and inside the tubules; this effect intensifies with continued use [52, 53]. While some studies reported an equivalent efficiency to bioactive glass and comparison agents (potassium nitrate, arginine, Nd: YAG laser and placebo) to improve the sensitivity with no statistically significant difference among them [23, 25, 28, 29, 32, 38, 43, 47]. This interaction can be elucidated by the proven efficacy and operation of these substances to reduce the DH.

Potassium nitrate was the most common comparator used in this review, and its mechanism in reducing DH is via depolarization of the nerve impulse and inhibiting the conduction of pain sensation [54]. ProArgin™ (arginine and calcium carbonate) has an ability to generate an alkaline environment that encourage calcium and phosphate ions from saliva to deposit and occlude the dentinal tubules [55]. The way Nd: YAG laser works to reduce DH involves both the blockage of dentinal tubules and the disruption of sodium and potassium ion release mechanisms, modifying cell permeability, and affecting the sensory nerve endings of the axons [56]. The reduction of DH with placebo is unsurprising as the contribution of the placebo and/or Hawthorne effect was established in different studies. The placebo effect is a physiological response to administration of a non-active desensitizing agent, while the Hawthorne effect involves the behavioural and emotional modifications of the patients as a result to their knowledge of participating in the trial [51, 57, 58].

Few studies demonstrated a lesser effect of bioactive glass-based agent in comparison to nano-hydroxyapatite, ProArgin™ and flourinoe to reduce DH pain [20, 26, 41]. Regarding hydroxyapatite, the efficacy of this desensitier is accredited to its mechanism of occluding the dentinal tubules and remineralization of the dentin that is similar to CSPS [59, 60]. Jena & Shashirekha [26] did not use cold water stimulus, and this could intensify the desensitizing agents’ efficiency to reduce the pain. It was noted that hydroxyapatite exhibited a notable desensitizing impact against tactile and evaporative stimuli, though not against cold stimuli [60].

Fluorinol toothpaste contains both fluoride and chlorhexidine digluconate, and a combination of two effective agents may enhance its efficacy to reduce DH pain [20]. Lawson et al., concluded sequential use of chlorhexidine and sodium fluoride is significantly reduced DH pain compared to solo use of these agents [61]. The mechanism of fluoride action is to form precipitates that occlude the dentinal tubule [62] while chlorhexidine has antibacterial and antiseptic effects [20].

All the included studies in this review used parallel-armed designs except for one study that employed a split-mouth [27]. It was established that a split-mouth design has an advantage over a parallel-arm trial, as the bulk of patient outcome variability is omitted from the intervention effect estimate, potentially enhancing statistical power, because each subject acts as its control. When a different intervention is given to a different person, the responses could be subjected to patient preferences [63, 64].

The age range of the patients involved in this review is a wide range from 17 to 75 years. Age-related cervical dentine exposure increased between the ages of 40 and 50, after which it decreased [65]. The decline in DH with age may be caused by alterations in the pulp–dentine complex, including dentinal sclerosis and the deposition of secondary and tertiary dentine [66]. Accordingly, the wide range of ages could affect the outcomes, and a more homogenous and startified age sample would be recommended [51].

Various stimuli were used to assess the pain associated with DH, and the pain were quantified using the VAS or Schiff score. Tactile, evaporative air blast and thermal cold stimuli were used. These stimuli are physiological, experienced in daily life, and are easily managed. Consequently, they are frequently suggested for evaluating DH [67]. A combination of the responses from two or more stimuli could elicit different pain perceptions and precis DH evaluation [68, 69]. In the current review, all of the studies used a combination of two or more stimuli except for two studies [18, 39]. Assessment of the DH was recommended to be done by means of either a stimulus-based assessment or a response-based assessment [69]. In the earlier assessment, the pain is constant while the intensity of stimuli is varied, while in the laster the pain is varied based on constant stimuli [70].

VAS is a horizontal line of 10 cm that starts with “no pain” on the left and “worst possible pain” on the right, and numerical rating of the pain intensity from 0 to 10 was also used [71]. In this review, VAS was used almost in all of the studies, and it was used interchangeably with the numerical rate scale.

The Schiff scale assesses the level of DH pain based on the patient’s. It has 4 scores, from 0 to 3, based on the patient’s tolerance to the stimuli, it starts with; 0 - no respond to stimulus; 1– there is a response to stimulus, but no request to discontinue the stimulus; 2– there is a response to stimulus and request to discontinue or move away from stimulus; 3– there is a respose to stimulus, considers it to be painful, and request to discontinue of the stimulus [72].

VAS was reported to be accurate, reproducible, practical and understood by participant [73]. Whereas the Schiff score demonstrated more sensitivity and specificity values in the diagnosis of DH, and it was suggested to be the proper scale to assess DH [74]. The Yeaple index was also used in some studies [28, 29]. This method is an example of stimulus-based assessment, and it was demonstarted that a sensitivity change as a result of repeating the stimuli lead to the patient anticipating the pain that can affect the outcome [70].

In this review, the follow-up assessments were varied between studies. Some studies had a short-time assessment that commenced immediately up to 2 weeks [5, 24, 27, 39]. The majority of the studies had a medium follow-up period, which was up to 4 weeks [15–17, 19, 20, 23, 25, 26, 28–31, 33–36, 40–43, 47]. These assessment time could be suitable for single topical application-office based whereas a long term assessment was preferred for home-based treatment [51]. Furthermore, long-term follow-up assessment could allow the manifestation of the extreme efficiency of the desensitizing agent while reducing the placebo or Hawthorne effect [38].

One of this review’s limitations is to restrict the language of publication to English due to unavailability of translation expertise from different languages, which could have led to some data being missed. Heterogeneity in the comparative desensitising agent, assessment stimulus, assessment procedure, and follow-up assessment duration across all included trials is another issue. This makes it difficult to perform the meta- analysis and, subsequently, draw a certain conclusion, as the variations in study design affects the clinical outcomes. For future studies, the following suggesion can be made to aid in updating the existence evidence regarding DH: standarization of the design of the clinical trial, particularly the range of ages, as more homogeneous age samples should be evaluated. Standarize the assessment method and apply a long -term follow-up of six months or even more. Furthermore, a split-mouth design is preferred to enable assessing the same person’s response to DH treatment.

Conclusions

The bioactive glass-based desensitizers had a superior performance in reducing DH pain. Notably, the bioactive glass-based agents demonstrate pronounced benefits in the immediate- to medium-term intervals spanning up to four weeks compared to baseline and other desensitizers.

However, the variability in assessment methods, stimuli, and comparative agents among the included studies poses challenges to drawing uniform conclusions about their long-term efficacy. Continued research and methodological standardization will enhance evidence-based recommendations for their optimal use in dental practice.

Electronic supplementary material

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Abbreviations

DH

Dentin hypersensitivity

Author contributions

AA, NA, AFA and AAM contributed to the concept of the research, study design, data collection, supervision, statistical analysis, writing the original draft, and reading and editing the final paper. Every author evaluated and approved the final manuscript.

Funding

This project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

All data generated or analysed during this study are included in this published article [and its supplementary information files].

Declarations

Ethics approval and consent to participate

Not Applicable.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.