1. Photomed Laser Surg. 2011 Feb;29(2):115-21.

An evaluation of the occluding effects of Er;Cr:YSGG, Nd:YAG, CO and diodelasers on dentinal tubules: a scanning electron microscope in vitro study.
Gholami GA, Fekrazad R, Esmaiel-Nejad A, Kalhori KA.

Source
Dental Faculty of Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract
OBJECTIVE AND BACKGROUND: Dentin hypersensitivity (DH) is one of the most frequent problems causing patients' complaints following stimulation of cervically exposed dentin. Studies have shown that different lasers have various occluding effects on dentinal tubules. This study is aimed at evaluating the occluding effects of Er;Cr:YSGG (P:0.25W,F:20Hz,Pd:140S), Nd:YAG (P:1W,F:20Hz), CO(2) (P:1W, Pd:50s), and 810-nm diode (P:2 W, Pd:30ms) laserson dentinal tubules. METHODS: Fifteen human third molars were collected and ground-sectioned vertically on the buccal and lingual surfaces to yield two dentin disks of 2-mm thickness. Then, four sites for laser irradiation and one control site were marked in the cervical areas of the dentin disks. Before laser application, specimens were exposed to a 14% EDTA solution to expose dentinal tubules and were then evaluated by scanning electron microscopy (SEM). The tubules' entrance diameters were determined by "scale-bar" software (Phillips Scale-Bar, Phillips, Amsterdam, The Netherlands), which is specifically designed for SEM. The mean diameters for the tubules were then estimated for each site and analyzed statistically. RESULTS: The mean dentinal tubule entrance diameters for Er;Cr:YSGG, 810-nm diode, CO(2), and Nd:YAG, were 1.73, 3.27, 2.10, and 1.64 microns, respectively, compared with 3.52 microns before laser irradiation. Overall, the furthest reduction in mean tubule diameter resulted from the Nd: YAG laser (53%). However, tubular diameter reduction in all laser groups (p<0.05) was found to be statistically significant. In all laser groups, melting of the peritubular dentin was the dominant observed phenomenon. CONCLUSION: Our results indicate that Nd: YAG, Er; Cr: YSGG, and CO(2) lasers, through their ability to melt peritubular dentin, can occlude dentinal tubules partially or totally, and therefore reduce patients' hypersensitivity symptoms. The 810-nm diode laser sealed tubules to a far lesser degree, with negligible effects on desensitization.

2. J Dent. 2011 Mar;39(3):249-54. Epub 2011 Jan 14.

Clinical evaluation of Er,Cr:YSGG and GaAlAs laser therapy for treating dentinehypersensitivity: A randomized controlled clinical trial.
Yilmaz HG, Kurtulmus-Yilmaz S, Cengiz E, Bayindir H, Aykac Y.

Source
Department of Periodontology, Faculty of Dentistry, Near East University, Mersin 10, Turkey. dr.hguneyyilmaz@gmail.com

Abstract

OBJECTIVE: The advent of dental lasers has raised another possible treatment option for dentine hypersensitivity (DH) and has become a research interest in the last decades. The aim of this randomized, controlled, double-blind, split mouth, clinical study was to evaluate and compare the desensitizing effects of erbium, chromium-doped:yttrium, scandium, gallium and garnet (Er,Cr:YSGG) to galium-aluminium-arsenide (GaAlAs) laser on DH. METHODS: Fifty-one patients participated in this study for a total of 174 teeth. DH was assessed for all groups with a visual analog scale. For each patient, the teeth were randomized to three groups. In the diode laser group, sensitive teeth were irradiated with the GaAlAs laser at 8.5J/cm(2) energy density. In the Er,Cr:YSGG laser group, sensitive teeth were irradiated with Er,Cr:YSGG laser in the hard tissue mode using a none-contact probe at an energy level of 0.25W and repetition rate of 20Hz, 0% water and 10% air. In the control group no treatment was performed. Treatment time was 60s for GaAlAs laser and 30s for Er,Cr:YSGG laser. RESULTS: When compared with the control group and baseline data, in both laser groups, laser irradiation provided a desensitizing effect immediately after treatment and this effect was maintained throughout the study (p<0.05). No significant differences between Er,Cr:YSGG and GaAlAs laser groups were found at any follow-up examination (p>0.05). CONCLUSION: Based on these findings, it may be concluded that both Er,Cr:YSGG and GaAlAs lasers were effective in the treatment of DH following a single application. 3. Lasers Med Sci. 2007 Mar;22(1):21-4. Epub 2006 Nov 18.

Comparative evaluation of the effects of Nd:YAG and Er:YAG laser in dentinhypersensitivity treatment.
Birang R, Poursamimi J, Gutknecht N, Lampert F, Mir M.

Source
Periodontology Department, Dental Faculty, Isfahan University of Medical Sciences, Esfahan, Iran.

Abstract
Dentin hypersensitivity (DH) is one of the most common complications that affect patients after periodontal therapy. So far, many investigators have successfully used different types of laser on DH treatment. The aim of this study was to evaluate the comparative effect of Nd:YAG laser and Er:YAG laser on human teeth desensitization. A group of nine patients with a total of 63 chronic hypersensitive teeth were selected. Each one of them should at least have three hypersensitive teeth. These teeth were randomly allocated into three groups. Group 1, Nd:YAG laser (1 W, 15 Hz, 60 s, two times); group 2, Er:YAG laser (100 mJ, 3 Hz, 60 s, two times); and group 3 serves as control group without any treatment. Assessment of pain was performed by a visual analysing scale (VAS) after stimulation of sensitive tooth by using the sharp tip of an explorer. This test was performed before treatment, immediately after that and at 1-, 3- and 6-month intervals after treatment by one blinded examiner. Analysis of VAS score between the three groups at the time of treatment did not show any significant difference (p = 0.506). However, by using repeated-measurement analysis of variance test, significant differences were seen in the three groups between before-treatment VAS score and after treatment (p < 0.0005). This statistically significant difference in the control group demonstrated a placebo effect. However, the effect of using Nd:YAG and Er:YAG lasers was stronger than this placebo effect, so that after removing the effect of the placebo, differences immediately after, 1, 3 and 6 months post treatment between all three groups still were statistically highly significant (p < 0.0005). Compared to the

Er:YAG laser group, using Nd:YAG laser resulted in a significant reduction of VAS score at each followup examination (p < 0.0005). Although using Nd:YAG and Er:YAG laser in desensitization of hypersensitive teeth showed a placebo effect limited to a short time, results of this study demonstrated that both of these lasers have an acceptable therapeutic effect. The observed effects seemed to last for at least 6 months. It was concluded that Nd:YAG laser is more effective than Er:YAG laser in reduction of patients' pain.

4a. Photomed Laser Surg. 2009 Oct;27(5):807-12.

Clinical evaluation of a 3% potassium oxalate gel and a GaAlAs laser for the treatment of dentinal hypersensitivity.
Vieira AH, Passos VF, de Assis JS, Mendona JS, Santiago SL.

Source
Department of Restorative Dentistry, Federal University of Cear, Fortaleza, Cear, Brazil.

Abstract
OBJECTIVES: This study evaluated the immediate and 3 month clinical effects of a low-level gallium-aluminum-arsenide (GaAlAs) laser and a 3% potassium oxalate gel for the treatment of dentinal hypersensitivity. MATERIALS AND METHODS: A total of 164 teeth from 30 patients with clinical diagnoses of dentinal hypersensitivity were selected for this randomized, placebo-controlled, double-blind clinical study. The teeth were randomized to three groups: GaAlAs laser, oxalate gel, and placebo gel. The treatment sessions were performed at 7 d intervals for four consecutive weeks. The degree of sensitivity in response to an air blast and tactile stimuli was assessed according to a visual analogue scale at baseline, immediately after the fourth application, and then 3 months after the fourth application. The reductions in dentinal hypersensitivity from baseline at the two follow-up assessments were evaluated as the main outcome. RESULTS: In both the active and control groups, there were statistically significant reductions in dentinal hypersensitivityimmediately after and 3 months after the treatments, when compared with the hypersensitivity at baseline. No significant differences among the three groups could be detected in their efficacy at either the immediate or 3 month evaluations irrespective of the stimulus. CONCLUSIONS: The treatments under study were effective for reducing dentinal hypersensitivity, and longer observational periods could enhance the ability of studies to detect differences between active and placebo groups.

4b. Photomed Laser Surg. 2009 Feb;27(1):85-91.

Clinical evaluation of lasers and sodium fluoride gel in the treatment of dentinehypersensitivity.
Ipci SD, Cakar G, Kuru B, Yilmaz S.

Source
Department of Periodontology, Yeditepe University Dental Faculty, Istanbul, Turkey. sebnemdirikan@hotmail.com

Abstract
OBJECTIVE: The aim of the present study was to evaluate and compare the efficacy of CO(2) and Er:YAG lasers alone and in combination with topical sodium fluoride (NaF) in the management of dentine hypersensitivity. MATERIALS AND METHODS: A group of 50 patients presenting with a total of 420 hypersensitive teeth were randomly allocated into five groups. Group 1 was treated with 2% NaF, groups 2 and 3 were lased by a CO(2) (1 W, continuous wave mode, for 10 sec) or Er:YAG (30 Hz, 60 mJ for 10 sec, without water/air spray) laser, and groups 4 and 5 received NaF plus the CO(2) and the Er:YAG laser, respectively. The scanning speed of the laser was 0.8 mm/sec. The degree of thermal sensitivity was determined with an evaporative stimulus consisting of a 1-sec air blast at a distance of 2 mm from each site tested. Quantification of the degree of discomfort was determined according to a four-point pain scale before treatment and 1 wk, 1 mo, and 6 mo after treatment. RESULTS: All treatment forms resulted in significant improvement of discomfort. At 1 wk, 1 mo, and 6 mo, cold air blast scores were significantly reduced compared to baseline scores, except for the NaF group. In the NaF group, there was a statistically significant increase in mean degree of discomfort at 6 mo compared with 1 wk (p +/- 0.01) and 1 mo (p +/- 0.001). Comparison of the other treatment regimens revealed that cold air blast scores were significantly lower for the other four treatments than for NaF gel alone (p +/0.001). No superiority was found for desensitization among the CO(2), Er:YAG, CO(2) + NaF, and Er:YAG + NaF groups. CONCLUSIONS: We concluded that both the CO(2) and Er:YAG lasers have promising potential for the treatment of dentinehypersensitivity. Lasers in combination with NaF gel appear to show better efficacy compared to either treatment modality alone.

4c. J Periodontol. 2005 Jul;76(7):1140-7.

Short-term assessment of the Nd:YAG laser with and without sodium fluoride varnish in the treatment of dentin hypersensitivity--a clinical and scanning electron microscopy study.
Kumar NG, Mehta DS.

Source
Department of Periodontology and Implantology, Bapuji Dental College and Hospital, Davangere-577004, Karnataka State, India.

Abstract
BACKGROUND: The aim of the present study was to evaluate clinically and under scanning electron microscopy (SEM) the efficacy of Nd:YAG laser irradiation alone and in combination with 5% sodium fluoride varnish in the management of dentinhypersensitivity. Methods: The study was conducted on 40 patients divided into four groups who had at least one tooth of Grade III mobility with clinically elicitable dentin hypersensitivity. Following the pretreatment assessment of hypersensitivityusing the visual analog scale (VAS) and cold air blast test, the selected tooth in all the groups received 1% citric acid treatment for 1 minute. Group 1 patients received no further treatment; group 2, 3, and 4 patients received additional treatment with 5%

sodium fluoride varnish, Nd:YAG laser for 2 minutes, and a combination of 5% sodium fluoride varnish and Nd:YAGlaser, respectively. Two hours following treatment, hypersensitivity was again assessed, and the teeth were extracted, sectioned, and scanned using scanning electron microscopy (SEM). RESULTS: The mean VAS score in group 1 showed a 27% increase from baseline, but groups 2, 3, and 4 showed a decrease of 33%, 44%, and 62%, respectively. The mean cold air blast score showed a 22% increase in group 1, but values decreased by 43%, 50%, and 83% in groups 2, 3, and 4, respectively. The number of patent tubules also progressively decreased from group 1 through group 4. CONCLUSIONS: The combination of Nd:YAG laser and 5% sodium fluoride varnish seems to show an impressive efficacy, when compared to either treatment alone, in treating dentin hypersensitivity. The SEM findings seem to relate to the clinical findings in that reduction in number/patency of tubules was associated with improvement in treatment efficacy.

Journal of Applied Oral Science

Print version ISSN 1678-7757

J. Appl. Oral Sci. vol.12 no.4 Bauru Oct./Dec. 2004

http://dx.doi.org/10.1590/S1678-77572004000400003

ORIGINAL ARTICLES

Clinical evaluation of dentin hypersensitivity treatment with the low intensity Gallium-Aluminum-Arsenide laser AsGaAl

Avaliao clnica do tratamento da hiperestesia dentinria com laser de baixa potncia de Arseniato de Glio-Alumnio AsGaAl

Luciana Chucre GentileI; Sebastio Luiz Aguiar GreghiII

I

DDS, MSc in Periodontics DDS, MSc, PhD, Assistant Professor, Department of Prosthodontics, Discipline of Periodontology, Bauru Dental School - Univesity of So Paulo
II

Correspondence

ABSTRACT The dentin hypersensitivity is a painful condition rather prevalent in the general population. There are several ways of treatment for such condition, including the low intensity lasers. The proposal of this study was to verify the effectiveness of the Gallium-Aluminum-Arsenide diode laser in the treatment of this painful condition, using a placebo as control. MATERIALS AND METHODS: Thirty-two patients were selected, 22 females and 10 males, with ages ranging from 20 to 52 years old. The 32 patients were randomly distributed into two groups, treated and control; the sample consisted of 68 teeth, 35 in the treated group

and 33 in the control group. The treated group was exposed to six laser applications with intervals from 48 to 72 hours, and the control group received, as placebo, applications of a curing light. RESULTS: A significant reduction was observed in the pain condition between the initial phase and after six laser applications; however, such reduction could also be observed for the control group exposed to the placebo. CONCLUSION: Therapy with the low intensity Gallium-Aluminum-Arsenide laser AsGaAl induces a statistically significant reduction in the painful condition after each application and between the beginning and end of treatment, although there was no statistically significant difference between the treated group (laser) and the control group (placebo) at the end of treatment and after the mediate evaluation results (after 6 weeks), this way impairing the real measurement of laser effectiveness and placebo effect. Uniterms: Dentinal hypersensitivity; Tooth, hyperesthesia; Laser treatment.

RESUMO A hiperestesia dentinria trata-se de uma condio dolorosa bastante prevalente nas populaes mundiais. Vrias so as modalidades de tratamento para tal condio, entre elas, os lasers de baixa potncia. A proposta deste estudo foi a de verificar a efetividade do laser de diodo de Arseniato de Glio-Alumnio no tratamento desta condio dolorosa, utilizando-se um placebo como controle. MATERIAIS E MTODOS: Foram selecionados 32 pacientes, 22 do sexo feminino e 10 do sexo masculino, com idades entre 20-52 anos. Os 32 pacientes foram distribudos de maneira aleatria em dois grupos, um tratado e outro controle, um total de 68 dentes comps a amostra, sendo que 35 compuseram o grupo tratado, e 33 o grupo controle. O grupo tratado foi submetido a seis sesses sucessivas de irradiaes em intervalos de 48 a 72 horas, o grupo controle recebeu como placebo aplicaes de luz do fotopolimerizador. RESULTADOS: observou-se reduo significativa na sensao dolorosa entre a fase inicial e aps as seis sesses de tratamento com laser, porm tal reduo, tambm pode ser observada para o grupo controle, submetido ao placebo. CONCLUSO: a terapia com laser de baixa potncia de AsGaAl induz reduo estatisticamente significante da sensao dolorosa, aps cada uma das aplicaes, e entre o incio e o final do tratamento, embora no tenha havido, diferena estaticamente significante, ao final do tratamento e aps a avaliao mediata dos resultados (aps 6 semanas) entre o grupo tratado (laser) e o grupo controle (placebo); dificultando a mensurao real da efetividade do laser e do efeito placebo. Unitermos: Hipersensibilidade dentinria; Hiperestesia dentinria; Laser, tratamento.

INTRODUCTION

Dentistry, as other health sectors, often faces a great trouble, which is pain, defined as "an unpleasant experience, sensory and emotional, associated to real or potential tissue damage"2 . Most orofacial pains are related to teeth and, among the odontalgias, dentin hypersensitivity is a painful condition highly prevalent in the general adult population 3,9. Dentine hypersensitivity is clinically described as a short and acute pain, originated from exposed dentine, as an answer to typical thermal, evaporable, tactile, osmotic or chemical stimulation, and that cannot be attributed to any other defect or dental pathology 8,13,22. This way, usual habits such as feeding, drinking and brushing teeth, which at normal dental conditions would not bring discomfort to a person, can become a chronic source of irritation3,5. According to Dowell; Addy7 in 1983, dentin hypersensitivity is associated to exposure of the root surface to stimuli external to the oral cavity. Dentin exposure to the oral external environment is a result of enamel loss or gingival recession in combination with cement loss, with or without non-carious cervical lesions as abrasion and erosion3,5. Some theories were proposed to explain the breaking out of such painful sensitivity, being the "Hydrodynamic Theory" the most accepted, which proposes that peripheral stimuli are transmitted to the pulp surface through fluid movement inside the dentin ducts, causing pain. There are several options for treatment of this painful condition, including the low intensity lasers, whose performance is based on the increase of the excitability threshold of the free nervous terminations, causing an analgesic effect, besides stimulation of the pulp mesenchymal cells to differ in odontoblasts, with the purpose to produce reparative dentin10,21. The proposal of this study was to verify the effectiveness of the Gallium-Aluminum-Arsenide diode laser in the treatment of this painful condition, evaluating the patients' immediate responses before and after each of the consecutive laser applications, using a placebo as control, and also comparing the achieved results with the initial condition, for both groups and between them.

MATERIALS AND METHODS

Based at the pertinent literature13,15,20, patients and teeth selection was made in accordance with the recommended inclusion criteria: A) Patients selection: - Complaint of sensitivity at the cervical part of the anterior and/or posterior teeth to current stimulus such as air, touch, sweet foods or brushing, with or without non-carious cervical lesions and with gingival recession, independent of their length or wideness;

- Good levels of oral hygiene, with an oral health condition that would allow precise diagnosis of dentin hypersensitivity; - Absence of serious systemic and psychological diseases; - Those using any analgesic or anti-inflammatory medicines were oriented to not make use of it 6 hours before hypersensitivity treatment. B) Teeth selection: - Exclusion of teeth presenting decays, cracks or fissures, large and unsatisfactory restorations, class V restorations, prosthetic elements and abutments of partial prosthesis under abnormal occlusion forces; - Without periodontal cysts and increased mobility; in cases submitted to periodontal surgery, a minimum period of at least three months was respected before treatment of dentin hypersensitivity; - Absence of occlusal trauma; - Teeth should not have been submitted to dentin hypersensitivity treatment in the last six months. Thirty-two patients were selected, being 22 females and 10 males, with ages ranging from 20 to 52 years old. The thirty-two patients were randomly distributed into two groups, treated and control; the sample consisted of 68 teeth, being 35 in the treated group and 33 in the control group. All patients participating in the study signed an Informed Consent Term, based on the Guidelines of the Ethics Committee of Bauru Dental School 6, 1998. All patients were submitted to an accurate anamnesis, in order to detect any systemic alteration, use of any medication, or psychological disturbances that could have been omitted at the initial report and that could be relevant for maintenance of the patient in the study. A second approach comprised questioning the patients about their current food habits, oral hygiene and about any periodontal treatments that could act as coadjutant factors triggering dentin hypersensitivity. However, no alteration regarding food habits was introduced, only concerning hygiene methods when the technique was considered traumatic. C) Determination of dentin hypersensitivity patterns: Each selected tooth of each patient received two stimuli, namely a tactile with a #5 dental probe and an air jet, considered as a thermal-evaporative stimulus. The first stimulus consisted in investigating all lesion extension with the probe tip, which can lead to compression of the dentin, thus favoring motion of the dentin fluid, which activates the mechanoreceptors causing the painful sensation23. The second stimulus, the air-jet, was applied to the exposed dentin with an air syringe for one second, at room temperature and at a distance of 1cm from the dentin surface17,20,23. This stimulus can be considered a combination of thermal and evaporative stimuli, and this way two mechanisms operate to cause pain, namely the decrease in temperature at the dentin surface and fluid evaporation from some opened dentinal tubules, activating the hydrodynamic forces at the dentinal tubules and stimulating the painful sensation17.

An interval was allowed between the stimuli application, which was enough to avoid interferences between them. The stimulus considered as most severe was used as a last option, in this case the thermal-evaporative stimulation, in agreement with the literature11,14. Measurement of sensitivity was performed after each stimulus by a Visual Analogue Scale, which consists of a 10-cm long line, where the ends represent the pain limits the patient can suffer through an external stimulus; one end represents absence of discomfort and the other represents a severe discomfort caused by certain stimuli. Each time the patient is submitted to a stimulus, he or she was requested to point, at the interval from 0 to 10, a number to correspond to the pain felt. The convenience of this type of scale is to allow demonstration of the pain intensity with absolute numbers or as a percentage of a maximum value11,20. The treated group, with 16 patients adding up to 35 teeth with dentin hypersensitivity, was submitted to treatment with the low intensity Gallium-Aluminum-Arsenide diode Laser (AsGaAl). The technical characteristics of the equipment used are: - Laser emitter: AsGaAl diode - Constant power: 15mW - Density of adjustable irradiated energy: from 0 to 15J/cm 2 - Wavelength: 670hm (visible in red) - Area irradiated with the intraoral tip: 4mm2 The teeth included in the treated group were submitted to the sequence of treatment established by Brugnera; Pinheiro4, in 1998: a) prophylaxis of the region with rubber cup, when possible; if prophylaxis was not possible due to sensitivity, a slightly wet cotton ball was used; b) drying with cotton rolls; c) punctual application of the laser, that is, application at 3 points (distal, central and mesial), and with the intraoral tip positioned perpendicular to the dentin surface. The laser dosage applied to each tooth was 4J/cm2 for a predetermined time of 2min, according to calibration of the laser device18. With regard to the control group, also composed of 16 patients adding up to 33 teeth with dentin hypersensitivity, a curing light was used as a placebo; each dentin surface was exposed to the curing light for 30 seconds. The teeth in the control group were also submitted to items a and b described above; a wood tongue depressor was placed over the sensitive area to avoid possible effects from heat produced by the curing light on the pulp tissue. It should be mentioned that patient from both treated and control groups was submitted to six sessions for treatment of hypersensitivity, with intervals from 48 to 72 hours. The

number of sessions and the intervals between the applications were performed as indicated by the manufacturer of the Low Intensity Laser device. The painful sensation was measured previously to each one of the six sessions and immediately after treatment, for each stimulus applied, for both groups. After the six applications, the patients were called back for reevaluation after six to eight weeks; this is the accepted time for evaluation of effectiveness, at short rate, of chemical desensitizers 11. The tactile and thermal-evaporative tests were made again at the teeth submitted to treatment with the AsGaAl Laser or in the control group in which the placebo was used, the results being recorded once more in a Visual Analogue Scale. All collected measurements, from the first until the reevaluation session, were converted in numbers for posterior statistical analysis. According to Kaufman; Kleinberg15, in 1994, non-parametric tests must be used when two groups are compared, to check if there are significant differences between the analyzed groups. Thus, Wilcoxon and Mann-Whitney non-parametric tests were used to verify if there was pain reduction after each application, from the beginning to the end of treatment, besides comparison between the mean painful sensation of the treated and control groups. The significance level adopted was 5% (p=0.05) for all tests.

RESULTS
Figures 1 and 2 represent the means obtained from painful sensation to tactile and thermalevaporative stimuli, from the initial evaluation (Pre1) to the mediate evaluation (ME), effected 6 weeks after the last application (Post6) for both groups.

Application of Wilcoxon non-parametric test allowed comparison between the mean painful sensations triggered by the tactile and thermal-evaporative stimuli since the beginning of the study, when the sensations previous to the first application (Pre1) were recorded until the means obtained immediately after the last application (Post6), for both groups. A significant reduction was observed in the pain condition between the initial phase and after the six laser applications; however, such reduction was also observed for the control group, exposed to the placebo. The Mann-Whitney test was applied for evaluation of the difference between the value obtained immediately after the last application (Post6) and the initial value of the painful sensations (Pre1), for both stimuli used at the study, evidencing that there was no statistically significant difference in pain reduction between treated and control groups. The same was verified when comparing the results obtained at the mediate evaluation, which took place 6 weeks after last application, with the initial results (Pre1).

DISCUSSION
Utilization of low intensity lasers in the oral cavity has been of great applicability in cases of post-surgical pain, dentin hypersensitivity, angular cheilitis, aphthae and common herpes, besides promoting a faster dentin formation; however, the exact mechanism of its biostimulating action has not yet been completely determined in the literature 21,24.

Studies with the low intensity laser in Dentistry have presented stimulating results, mainly with the HeNe and AsGaAl lasers, but such studies are usually poorly controlled and reported in an incomplete way1. The present study tried to verify the effectiveness of the low intensity Gallium-AluminumArsenide laser irradiation for reduction or remission of dentin hypersensitivity.

Clinically the patients demonstrated, at each session, relief of painful sensation when exposed to the hydrodynamic stimuli, also describing relief at daily stimuli such as contact of the exposed dentin surface with icy water, acidic foods, sweet foods and even toothbrushing. Statistically, the means obtained during the applications for the group treated with the low intensity AsGaAl laser and for the control group where the placebo was used showed significant gradual reduction in pain condition, simultaneous to irradiation, for both hydrodynamic stimuli, one tactile and one thermal-evaporative. Statistical and clinical results revealed that pain reduction occurred for both stimuli, tactile and thermal-evaporative. The initial results, clinical and in absolute values, demonstrated more pronounced painful response to thermal-evaporative stimulus when compared to tactile stimulus, and that the pain reduction pattern during treatment, as well as at evaluation after the last session presented a more positive response to tactile stimulus than to thermal-evaporative stimulus in a general way. Such results differ from the findings of Gerschman; Ruben; Gebart-Eaglemont10, in 1994, that using the AsGaAl laser with wavelength of 830hm, applications of 1.8J/cm 2 at intervals of 1, 2 and 8 weeks verified a more accentuated reduction of pain using the thermalevaporative stimulus, instead of the tactile stimulus. Wakabayashi, Matsumoto26, in 1988, exposed 130 teeth with dentin hypersensitivity to airjet to a treatment with the AsGaAl laser (wavelength of 780hm, Cw, 30mW) when the hypersensitive dentine surfaces were irradiated for 30 to 180 seconds, and the results obtained showed 98% reduction at dentin hypersensitivity, while in the control group, not exposed to irradiation, the reduction was 19%. Manton, Renton-Haper, Midda19, in 1992, in a comparative study between the Nd:YAG and the low intensity GaAs lasers for dentine hypersensitivity treatment, verified reduction in the painful response to a thermal-evaporative stimulus, finding that the group treated with the Nd:YAG laser and reevaluated at 3 and 28 days after treatment took longer to respond to the stimulus with the air-jet than the group treated with the GaAs laser, whose result approached very much the one observed at the control group that did not receive any treatment. Groth12, in 1993, evaluated the dentin hypersensitivity reduction in 25 teeth irradiated with laser. The device employed was a low intensity AsGaAl laser with wavelength of 790hm and 30mW potency. The hypersensitive teeth were exposed to the thermal-evaporative stimulus with an air-jet for 5 seconds, being afterwards irradiated for 4 minutes; this procedure was repeated three times at 72-hour intervals. The variation in the degree of dentin hypersensitivity was evaluated for a period of 15 and 30 days after the first irradiation. The author observed, at the end of the reevaluations, a statistically significant reduction in painful sensation to the thermal-evaporative stimulus. Although the results obtained by the present study are in agreement with Wakabayashi, Matsumoto26, in 1988 and with Groth12, in 1993 concerning the painful sensation reduction, it is known that the precise mechanisms of the low intensity laser action for cases of dentin hypersensitivity cases are not well clarified. Wider-Smith28, in 1998, when evaluating the effectiveness of the low intensity HeNe laser at treatment of the dentin hypersensitivity obtained very poor results when comparing to

conventional therapies that promote physical obstruction of the dentinal tubules, obtaining remission of dentin hypersensitivity in only 4 of a total of 97 treated teeth. The referred author believes that lasers with wavelengths from 632.8 to 780hm are unable to produce any alteration on the tooth mineralized surface, or pulp alterations that accelerate the cellular differentiation process. In agreement with the above mentioned study, Kimura, Wilder-Smith, Matsumoto16, in 2000, evaluated the low intensity AsGaAl laser action with 3 wavelengths, 780, 830, 900hm, and stated that only after a wavelength of 830hm it is possible to transmit the laser energy through enamel and dentin, reaching the pulp tissue. Although the above mentioned studies do not present results that support conclusions concerning the ideal wavelength, it should be mentioned that the wavelength of the device used in this study was 670hm, and the obtained results showed a clinically relevant reduction in pain sensation, although it cannot be stated if it was completely due to the laser. However, there are no absolute scientific proofs of which would be the most adequate wavelength, as well as timing of application, quantity of joules to be applied, number of applications and the interval between them. The ideal standards for use of the low intensity lasers, both Hene and the AsGaAl, are difficult to establish, as important factors must be considered, such as severity of the pain sensation with the stimulus, exposure area of the root surface, degree of loss of root structure and the individual response of each patient to treatment. This last aspect is very critical because, as people react differently to the several types of dentin hypersensitivity treatments, one can also assume that, among all these multiple variants, there is a limit from which treatment can be stimulating. Therefore, defining patterns for laser utilization is still questionable, considering that the biological variability between patients can be great. An important aspect to be considered in the present results is that, although a clinical and statistically significant reduction was observed in dentin sensitivity for the treated group, a significant reduction was also observed for the control group that received application of curing light as a placebo, a condition attributed to the so-called "placebo effect". According to West, et al.27, in 1997, the placebo effect is commonly verified in dentin hypersensitivity studies, being characterized as an answer to the interventions and not to any particular mechanism of action. Such effect consists of a complex mixing of physiological and psychological interaction, depending considerably of a positive relation between professional and patient, with both parts believing in the treatment validity and wishing relief of the painful symptomatology. A positive relation between professional and patient can motivate the patient to obtain relief of the painful sensation; besides, this favorable emotional behavior can activate the system of pain inhibition of the organism, leading to release of endorphins by the central nervous system and this way controlling the painful stimulus at the periphery 16,25. Anyway, the achievement of reduction of dentin hypersensitivity in both treated and control groups, this way corroborating the results of several studies in the literature where a placebo was not used as a control, leaves some controversy regarding the effectiveness of use of the low intensity lasers for this therapeutics, opening space for new research works.

CONCLUSIONS
- There was statistically significant reduction of painful sensation after each laser application and between the beginning and the end of treatment, although there was no statistically significant difference between the treated group (laser) and the control group (placebo) at the end of treatment and after the mediate evaluation results (after 6 weeks), this way impairing the real measurement of laser effectiveness and placebo effect. - Caution is advised when evaluating the results obtained by the applied therapy, considering the placebo effect, as the results obtained for the control group are very similar to those obtained for the treated group. Such fact implies at the need of controls for longer periods of time after the end of applications, when maybe the placebo effect would dissipate and then it would be possible to verify the real laser effect more clearly.

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