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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Clinical Evaluation of Pro-Argin and Low Level Laser Therapy in the Treatment of Dentinal Hypersensitivity: A Split-mouth Randomised Clinical Trial
Correspondence Address :
KSV Ramesh,
Associate Professor, Department of Periodontics and Implantology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India.
E-mail: rameshksv@vdc.edu.in
Introduction: Dentinal Hypersensitivity (DH) is the most prevalent condition that causes patients discomfort for patients, leading them to frequently visit dental offices. A wide range of methods and therapeutic procedures have evolved for pain alleviation have evolved. In recent decades, desensitising therapy has been coupled with newer therapies such as Pro-Argin and Low-Level Laser Therapy (LLLT). Pro-Argin therapy occludes the openings of dentinal tubules, while Diode Lasers (DL) cause a melting effect, crystallisation of dentine inorganic components, and coagulation of fluids trapped inside the dentinal tubules, thereby reducing the hypersensitivity.
Aim: To compare the efficacy of Pro-Argin and LLLT -475 nm (Bluelase) in providing immediate relief in the treatment of dentinal hypersensitivity.
Materials and Methods: This was a double-blind randomised split-mouth clinical trial involving from December 2021 to March 2022, including 12 patients (120 teeth) with bilateral hypersensitivity. They were divided into Group A (Pro-Argin) and Group B (LLLT-475 nm) both with 12 patients and 60 teeth each. Hypersensitivity was recorded using the Schiff cold air sensitivity scale and the Visual Analog Pain Scale (VAS) at baseline and at 15 minutes after desensitising therapy.
Results: The study included 12 subjects with bilateral dentinal hypersensitivity, categorised into Group A (Pro-Argin) (Colgate Sensitive Pro-relief) and Group B (LLLT at 475 nm), with 60 teeth each. The Results were assessed using the independent t-test for inter-group comparison and the t-test for intra-group comparison. On inter-group comparison of the Schiff cold air sensitivity score, there was a statistically significant reduction in dentinal hypersensitivity in both the groups (p<0.001) with no statistical significance in VAS scores. However, on intra-group comparison; there was a statistically significant reduction in VAS scores in Group B (p≤0.001).
Conclusion: LLLT has provided a significant reduction in dentinal hypersensitivity when compared with Pro-Argin.
Desensitisation, Diode lasers, Visual analogue pain scale
The DH is a “short, acute discomfort resulting from exposed dentin in reaction to stimuli” (1). Canines and first premolars are the most affected, followed by incisors and second premolars, and finally molars. The buccal surface of the teeth is most commonly affected. It worsens between the ages of 20 and 30, then again in the 50s (2). Although the prevalence of DH ranges from 4 to 57% in healthy people, it has been observed to be between 60 and 98% in those with periodontitis (3). Females tend to experience it more than males, owing to greater general healthcare and dental hygiene knowledge. Cold is the most prevalent source of discomfort in individuals with dentinal hypersensitivity (3),(4).
According to Brännström’s hydrodynamic hypothesis, mechanical displacement of nerve terminals at the pulp/dentin interface creates a painful sensation (5). There are two unique therapeutic strategies i.e., nerve impulse suppression by direct neurological contact or mechanical blockage of dentinal tubules. The latter is the most essential therapeutic strategy in the treatment of dentinal hypersensitivity (2). Desensitising agents and lasers are being widely used to treat the hypersensitivity (6). DH is a highly subjective perception, and there is no “gold standard” for assessing the treatment outcomes.
Orchardson and Gillam have shown that DH mostly affects the vestibule-cervical region of teeth. Cervical DH most likely has a complex aetiology, and its painful manifestation is caused by multiple factors. Therefore, numerous therapies must be combined to reduce DH to acceptable levels (7). Lasers have been used to complement desensitising chemical treatments by generating changes in the neural transmission network within the tooth pulp, rather than the visible dentin surface as seen in most therapies. The formation of secondary dentin, which allows for physiological occlusion of the dentinal tubules and stimulation of endorphin release from nerve terminal synapses located in the dentinal tubules, is also a bio-stimulating effect (8).
The Erbium-doped Yttrium Aluminium Garnet (Er:YAG), Neodymium-doped Yttrium Aluminium Garnet (Nd:YAG), Carbon Dioxide (CO2) and Digital Laser Source (DLS are among those employed (6). There is an extraordinary efficacy in using DLs in the treatment of dentinal hypersensitivity among the published works. Until now, DLs with wavelengths of 810, 940, and 980 nm have been used to treat dentinal hypersensitivity (9). A new potential in the realm of medicine and dentistry, a DL device generating blue light was introduced as a potential innovation in the field of medicine and dentistry. This Bluelase system has several advantages, including high working efficacy at low power levels and a low depth of light absorption at 475 nm, which causes less harm to the pulpal tissues (10).
At physiological pH, arginine and calcium carbonate interact and bind to the negatively charged dentine surface to form a calcium-rich layer, according to the most current Pro-Argin Technology research. This causes dentin tubules to become blocked, which remains intact even after acid exposure, preventing the transmission of pain-producing sensations (11). As a result, several regimens have been explored and evaluated in order to provide the optimal therapeutic benefit.
There is a dearth of evidence comparing desensitising paste to DL 475 nm (Bluelase) in delivering immediate relief from dentinal hypersensitivity. The purpose of the present study was to determine the effectiveness of desensitising toothpaste containing Pro-Argin and LLLT-475 nm (Bluelase) in providing immediate alleviation of dentinal hypersensitivity.
This was a double-blinded, split-mouth randomised clinical trial, conducted in the Department of Periodontology, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India, from December 2021 to March 2022. The study received Institutional Ethics Committee approval (VDC/IEC/2021/UG01/PI/IVV/56) and was registered in Clinical Trials Registry India (CTRI/2021/09/036746). The study was conducted in accordance with the guidelines of the Declaration of Helsinki.
Inclusion criteria: Systemically healthy subjects aged rage between 32-60 with a complaint of dentinal hypersensitivity and history of no previous use of desensitising agents were included.
Exclusion criteria: Patients with any carious lesions, cracked teeth, or those using analgesics/anti-inflammatory medications at the time of the study were excluded.
Sample size calculation: The sample size was calculated using G-Power 3.1 software, with an effect size of 0.94, and an α-value of 0.05, and a desired power of 0.80. The estimated sample size was 10 patients. Considering a 20% loss of follow-up, 12 patients were included in the study (6).
Procedure
A total of 46 patients of hypersensitivity were assessed for inclusion in the study and councelled regarding the treatment procedure. After discussing the treatment procedure, the participants provided a written informed consent. Finally, study included 12 subjects with bilateral dentinal hypersensitivity, who were divide into Group A (Pro-Argin) (Colgate Sensitive Pro-relief) and Group B (LLLT at 475 nm) with 60 teeth (5-6 teeth in each group). Only teeth with dentinal hypersensitivity were randomly assigned using a simple coin toss method and received the respective treatment. All the subjects had received oral prophylaxis before the desensitising therapy (Table/Fig 1).
Evaluation of dentinal hypersensitivity: Prior to the evaluation, the surrounding teeth were isolated with cotton, except for the test tooth/teeth, to prevent false-positive results. Dentinal hypersensitivity was measured in both groups using evaporative stimuli. This was done accomplished by directing an air syringe at a right angle to the exposed affected tooth site, at a distance of 1-3 mm from the exposed significantdentin surface (5). The subjective perception of the patients was assessed using the Schiff cold air sensitivity scale (12) and a Visual Analog Scale (VAS) score before and after the desensitising treatment.
Recording the parameters: After the oral prophylaxis, baseline hypersensitivity scores were recorded. Group A received the desensitising agent with a fingertip application by one examiner directly on the buccal cervical surface of the hypersensitive tooth, followed by rinsing with water after 5 minutes (Table/Fig 2). Similarly, Group B received a LLLT (475 nm), a frequency of 15 Hz, and a power of 0.7 W in a continuous mode for one minute on the hypersensitive tooth surfaces (6) (Table/Fig 3). Post-treatment hypersensitivity scores (Schiff cold air and VAS) were recorded in both the groups after 15 minutes.
Instructions on oral hygiene were provided. Patients were instructed to use a soft-bristled toothbrush with desensitising toothpaste twice a day for three minutes and to brush using the modified bass method.
Statistical Analysis
The acquired data were statistically analysed using Statistical Package for Social Sciences (SPSS) version 21.0. Descriptive statistics were expressed as mean±standard deviation. The results were statistically assessed using the independent t-test for intergroup comparison and the paired t-test for intragroup comparison. A p-value of <0.05 was considered statistically significant, and a p-value of <0.001 was considered statistically highly significant.
Out of 46 subjects screened 12 patients (7 males and 5 females) were included in the study based on inclusion and exclusion criteria mentioned. The mean age of the patients was 45±3 years. No adverse effects were observed in any of the cases during the study.
In intra-group comparison, the mean score of the Schiff cold air blast test was 2.80±0.40 at baseline and 1.40±0.49 after 15 minutes of therapy in Group A (p<0.001). In Group B, the mean score was 2.53±0.50 at baseline and 0.86±0.34 after 15 minutes of therapy (p<0.001). Both groups showed highly significant improvement (Table/Fig 4).
In intergroup comparison, the baseline mean score of the Schiff cold air blast test for Group A and Group B was 2.80±0.40 and 2.53±0.50, respectively, with no statistical significance (p=0.069). After 15 minutes of therapy, the scores were 1.40±0.49 for Group A and 0.86±0.34 for Group B, and the difference was statistically highly significant (p<0.001) (Table/Fig 5).
In intragroup comparison, the VAS mean score was 8.33±0.80 at baseline and 5.00±1.43 after 15 minutes of therapy in Group A (p<0.001). In Group B, the mean score was 8.50±0.62 at baseline and 1.13±1.43 after 15 minutes of therapy (p<0.001). Both groups showed highly significant improvement (Table/Fig 6).
In intergroup comparison, the baseline VAS mean score for Group A and Group B was 8.33±0.80 and 8.50±0.62, respectively, with no statistical significance (p=0.374). After 15 minutes of therapy, the scores were 5.00±1.43 for Group A and 1.13±1.43 for Group B, and the difference was statistically highly significant (p<0.001) (Table/Fig 7).
In the present study, the effectiveness of desensitising toothpaste containing Pro-Argin and LLLT in reducing dentinal hypersensitivity instantaneously was observed. Although both Pro-Argin and low-level laser are beneficial in decreasing dentinal hypersensitivity, low-level lasers are more effective at the investigated time intervals.
Desensitising treatments can be performed at home by the patient using dentifrice or professionally by a dentist using in-office topical desensitising compounds or lasers (11). Various agents such as protein precipitants (formaldehyde and silver nitrate), tubule occluding agents (sodium fluoride, stannous fluoride, calcium hydroxide, and potassium nitrate), tubule sealants (resins and adhesives), and lasers are commonly used (6). While both methods are effective in reducing hypersensitivity, the duration of relief can vary greatly. To address the need for materials that chemically interact with the tooth surface to diminish dentinal hypersensitivity, novel technologies like Pro-Argin technology have been developed (2).
According to Kleinberg I et al., Pro-Argin physically adsorbs onto the surface of calcium carbonate, resulting in a positively charged agglomeration. This agglomeration adheres to the dentinal surface and tubules (13). Additionally, the pH of this agglomeration is alkaline, allowing for calcium and phosphate mineral deposition on the dentinal surface. The immediate relief provided by Pro-Argin technology is a significant advantage. Lavender SA et al., demonstrated through Confocal Laser Scanning Microscopy (CLSM) and high-resolution Scanning Electron Microscopy (SEM) images that arginine calcium carbonate is highly effective in occluding open dentin tubules and that the occlusion achieved is resistant to acid challenge, resulting in immediate relief (14).
In the present study, the VAS score was used to assess subjective perception (15),(16). Both the Schiff cold air blast test and the VAS scale showed a reduction in sensitivity, with a highly significant difference between the groups. These findings are consistent with Ines Kapferer’s study, which found that a dentifrice containing 8% arginine and calcium carbonate reduced hypersensitivity (17). Pro-Argin dentifrice, when applied to sensitive teeth after scaling and root planing, has been shown to provide instant sensitivity relief (18),(19). Various Pro-Argin trials have resulted in dentinal tubule occlusion, reduced permeability, and improved oral health-related quality of life (19),(20),(21).
LLLT produces alterations inside the nerve transmission network of the tooth pulp rather than directly impacting the exposed dentinal surface. This specific wavelength affects the cell membrane, allowing for increased passage of Ca2+, Na2+, and K+ ions. As a result, the endorphin system and neural cell action potentials increase, while C fiber afferent depolarisation is suppressed, preventing pain information from reaching the central nervous system. Nd:YAG, Er,Cr:YSGG, and CO2 lasers, on the other hand, can melt peritubular dentin and partially or completely occlude dentinal tubules, providing relief from hypersensitivity symptoms in patients (11).
In the current study, the use of low-level lasers resulted in immediate alleviation of hypersensitivity as measured by the Schiff cold air blast test and the VAS score. When comparing a desensitising dentifrice with low-level laser desensitisation, a decrease in sensitivity was observed, consistent with numerous previous studies that evaluated the same and achieved similar results (6),(11). Similarly, after non-surgical periodontal treatment with lasers (685 nm and 660 nm) on exposed dentinal tubules, an immediate decline in dentinal hypersensitivity was observed, with long-term therapeutic benefits for teeth with gingival recession (22),(23).
In clinical investigations, Garcia-Delaney C et al., Bal MV et al., Hashim NT et al., Tabatabaei MH et al., reported that low-level lasers were effective in providing immediate relief from hypersensitivity (23),(24),(25),(26). Silicia A et al., investigated the immediate effectiveness of an 810 nm low-level laser and a 10% potassium nitrate bioadhesive gel (NK10%) in reducing dentinal hypersensitivity. Observations revealed a reduction in hypersensitivity of 36.9% (0.86) following an Evaporative Stimulus (ES) after 15 minutes, which was three times greater than the control group (0.23). The results observed were comparable to those found in our study (27).
In the present study, although Pro-Argin and LLLT showed reduction in dentinal hypersensitivity, LLLT provided immediate relief. This is in accordance with studies by Pandey R et al., and Shan Z et al., where LLLT demonstrated greater and more positive immediate, interim, and persistent reduction in dentinal hypersensitivity (28),(29).
Srivastava S et al., reported in their study that 8% arginine and calcium carbonate significantly occluded dentinal tubules, but when used in conjunction with low-level laser therapy, it was found to be more effective in reducing hypersensitivity, which is similar to the results obtained in the present study (30).
Limitation(s)
In the present study, the long-term and persistent effects of Pro-Argin and LLLT in providing desensitisation were not evaluated.
Based on the results of this clinical study, it can be inferred that while both Pro-Argin and low-level laser are effective in reducing dentinal hypersensitivity, low-level lasers are more successful in providing immediate relief.
I would like to acknowledge all the patients who participated in the study.
DOI: 10.7860/JCDR/2023/63513.18334
Date of Submission: Feb 15, 2023
Date of Peer Review: Apr 07, 2023
Date of Acceptance: Apr 20, 2023
Date of Publishing: Aug 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
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