Comparative Study of Anti-COVID Mouthwash and Remineralization Agents on Dentinal Tubular Occlusion: An In Vitro Study.

Abstract

Aim: Tooth sensitivity caused by exposed dentin tubules is a common clinical problem requiring correct treatment methods. Owing to the spread of the COVID-19 virus, it has become common to use different mouthwashes, including 1.5% hydrogen peroxide (HP), before dental procedures. Therefore, this study investigated the effect of 1.5% HP, tooth mousse casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and nano-hydroxyapatite (n-HAP) toothpaste on dentinal tubular occlusion.

Materials and methods: In this laboratory interventional study, eighty dentin disks with a thickness of 15 mm were prepared from permanent human molar teeth. Five dentin disks were randomly placed in the untreated group (Group 1). The remaining dentin disks were immersed in 5 mL of 17% Ethylendiaminetetraacetic. Fifteen disks were randomly isolated from the resulting slices, constituting Group 2. The remnants of the disks were submerged in 15 mL of 1.5% HP. Then, they were randomly divided into four groups: not affected by any substance (Group 3), immersed in the artificial saliva (Group 4), tooth mousse CPP-ACP (Group 5), and n-HAP toothpaste (Group 6). A scanning electron microscope (SEM) evaluated the dentinal tubular occlusion in each group, according to the following scoring criteria: Score 1: no occlusion; Score 2: less than 50%; Score 3: more than 50%; Score 4: almost all dentin tubules. Two observers ranked the micrographs separately. The Kruskal-Wallis and Mann-Whitney U tests analyzed the findings (P < 0.05).

Results: There was a significant difference in the degree of dentin tubule occlusion among the six groups (P < 0.001). The HP group significantly differed with CPP-ACP, n-HAP, and artificial saliva (P < 0.001). Among the interfering experimental materials, the n-HAP demonstrated the highest rate of tubular obstruction (P < 0.05), with the first observer reporting that 66.7% scored 3 and 26.7% scored 4 and the second observer reporting that 73.3% scored 3 and 13.3% scored 4.

Conclusion: The study's findings suggest that the anti-COVID mouthwash did not amend dentin tubule obstruction, whereas the n-HAP toothpaste showed the best blockage. This implies that in patients with tooth sensitivity who use preprocedural anti-COVID mouthwash, the n-HAP toothpaste could be a beneficial choice to enhance dentinal tubule blockage.