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The CURASEPT BIOSMALTO range: a valuable ally in the management of dentinal sensitivity and the cariological risk in periodontal patients

The presence of GINGIVAL RECESSION is a condition common to many patients affected by periodontal disease.
By gingival recession we mean the apical migration of the gum beyond the cementoenamel junction, exposing the dentine as a result. In the case of periodontal disease, this phenomenon is mainly caused by the degradation of the supporting tissues of the tooth due to bacterial and inflammatory insult.

GINGIVAL RECESSION can also be further intensified by some treatments against periodontal disease: on the one hand, due to the modification of the gingival architecture through certain resective surgical procedures; on the other hand, in response to non[1]surgical treatments that can increase the migration of tissues as a result of the resolution of inflammatory oedema.

Other factors may coexist together with these aetiological factors, such as trauma from brushing, acid erosion, specific underlying anatomy and/or trauma.

The presence of recession can cause considerable distress to the patient, both aesthetic and of algid nature, due to DENTINE SENSITIVITY.

Dentine sensitivity is defined as a painful, short and acute response to an external stimulus that impacts the exposed dentine. It is estimated that 20–40% of the population are affected, particularly females. Its incidence decreases with age as the exposed dentine undergoes sclerotic processes through the apposition of tertiary dentine, which makes it less receptive to stimuli.

Several theories have been hypothesised to justify the mechanism behind dentinal sensitivity: Brännström’s hydrodynamic theory appears to be the most credited.

This theory is based on the fact that, once the nociceptive stimulus reaches the exposed dentine tubules, this will cause a displacement of the dentinal fluid that directly stimulates the pulp nerve, causing the painful twinge.

The nociceptive stimulus can be triggered by several factors: research conducted by Amarasena et al. in 2011 on the Australian population shows that the stimulus with the most impact is that of COLD (80%), but it can also occur with heat, touch, sweet or acidic stimuli. The premolars are the teeth that are most affected by this disorder (38%), followed by incisors (26%), canines (25%) and molars (12%).

In the context of periodontal treatments, the majority of patients receiving non[1]surgical procedures using instruments report an increase in dentine sensitivity, with a prevalence of about 85%. This sensitivity often decreases over time (up to 4 weeks), although in some cases it may not resolve in the short term. Although modern treatment approaches are increasingly minimally invasive towards hard and soft tissues, often the use of instruments on the root surface, added to the natural contraction of the gums, can trigger or exacerbate dentinal sensitivity.

The mechanical control of biofilm at home is crucial to lead to stability of the periodontal tissues: alleviating any pain that may occur after treatments is essential in order not to hinder the patient in pursuing this goal. Moreover, this discomfort could lower the level of compliance, leading to the patient not attending recall and/or maintenance appointments.

Another problem linked to the presence of recessions in the periodontal patient is the cariological risk: exposed dentine tissue is much more vulnerable to the caries process. Moreover, the presence of recessions has a higher incidence in the older population, who may have a poor salivary flow and, therefore, reduced natural mechanisms of defence against caries.

Finally, a condition we frequently find in patients with advanced periodontal disease is exposure of the furcation area: an extremely delicate area that is not easy for the patient to manage in terms of hygiene and for which the occurrence of carious lesions is one of the most frequent complications.

Faced with the need to treat dentinal sensitivity while protecting tissues from caries, the CURASEPT BIOSMALTO range is also a valuable aid for patients affected by periodontal disease, with its dual desensitising and remineralising effect.

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Using CURASEPT BIOSMALTO Sensitive Teeth Impact Action Mousse Pro in the surgery first, immediately after the periodontal treatment session, then using at home helps avoid dentinal sensitivity and prevent root caries, due to the F-ACP complex it contains.

Amorphous calcium phosphate (ACP) is a highly reactive material that is able to convert into hydroxyapatite, the substance that enamel and dentine consist of. Thanks to the rapid release of active ions in contact with saliva, together with the small particle size, ACP can also achieve an obliterating effect on the exposed dentine tubules responsible for dentinal sensitivity, providing immediate relief for the patient. The formulation is free from water in order to avoid crystallisation. In this way, release is immediate once the F-ACP complex comes into contact with saliva.

The ACP complex is functionalised with FLUORIDE (F-ACP): present in free form within the formulation, it contributes to the formation of fluoroapatite, a mineral phase that is much more resistant to acid attack. Moreover, fluoride has antibacterial properties and inhibits the adhesion of pathogens on the surfaces.

CURASEPT BIOSMALTO Sensitive Teeth Impact Action Mousse Pro contains strontium salts: the incorporation of strontium into the new crystals in the dentine stabilises them, with a preventative effect on the phenomena of DENTINAL SENSITIVITY.

The F-ACP particles are covered by CITRATE, which functions to make the complex biomimetic and biomechanical. Also, citrate is able to neutralise the acids in bacterial plaque, laying the foundations to promote the remineralisation process.
The Mousse also contains CARBONATE, which acts to increase the solubility of the complex and thus the bioavailability of the ions that it is composed of.

For a prolonged action over time and to achieve a synergistic effect with CURASEPT BIOSMALTO Sensitive Teeth Impact Action Mousse Pro, for periodontal patients with recessions, exposure of furcations and at risk of the onset of root caries, there are toothpastes and mouthwashes in the Biosmalto range, composed of an innovative mixture of two hydroxyapatites for an additional remineralising and desensitising effect.

The first compound present is Bio-Active Complex: a hydroxyapatite partially replaced with magnesium, strontium and carbonate, and conjugated to chitosan.

Magnesium increases the rate of nucleation, or the formation of new hydroxyapatite crystals. Therefore, it accelerates both the enamel remineralisation process, and the repair of the exposed dentine.

Strontium has an additional effect on dentine sensitivity. Carbonate increases the solubility of hydroxyapatite and its ability to release calcium and phosphate ions with a remineralising effect.

Finally, chitosan enhances the bonding of the compound to the surfaces.

The second component is HAF complex: this is hydroxyapatite partially replaced by fluoride, for an even more enhanced remineralising effect, added to the protective and anti-bacterial effect of fluoride.

Managing dental sensitivity in the periodontal patient is one of the goals of the professional, in order to reduce discomfort, facilitate oral hygiene and encourage adherence to treatment and maintenance programmes. In addition, the presence of gingival recession, and the subsequent exposure of the dentine tissue or the area of the furcation, predisposes this type of patients to the onset of root caries. In this regard, it is also appropriate to implement preventive strategies that involve oral hygiene at home, lifestyle and the use of molecules that protect the surfaces and promote their remineralisation.

The CURASEPT BIOSMALTO Sensitive Teeth Impact Action Pro range provides professionals with high-performance molecules that are able to give dentine sensitivity relief to the patient while providing protection from caries.

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