Hydroxyapatite-Based Home Treatment for Dentin Sensitivity in Celiac Patients

The primary outcome is the variation in dentin hypersensitivity scores measured using the Schiff Air Index at baseline (T0), 1 week (T1), 1 month (T2), 3 months (T3), and 6 months (T4). The Schiff Air Index is a validated clinical scale ranging from 0 to 3, where higher scores indicate greater sensitivity. The primary analysis will compare the change in scores over time between the experimental group (toothpaste + mousse) and the control group (toothpaste only).

Plaque accumulation will be assessed using the Plaque Index (PI) at each time point. The index evaluates four surfaces per tooth and assigns a score from 0 to 3, where 0 indicates no plaque, 1 denotes plaque detectable only with a disclosing agent, 2 represents plaque visible to the naked eye, and 3 corresponds to abundant plaque covering the tooth surface. The average PI score per patient will be calculated and compared between the two groups over time (T0 to T4) to evaluate the impact of the interventions on daily oral hygiene and biofilm control.

Gingival bleeding will be evaluated using the Bleeding on Probing (BoP) index, where gentle probing is performed and bleeding is recorded as either absent (score 0) or present (score 1). The percentage of bleeding sites per participant will be calculated, and reductions in this percentage will indicate improvements in periodontal health.

Dentin hypersensitivity will be self-assessed by participants using a Visual Analogue Scale (VAS), consisting of a 10 cm line anchored at 0 (no pain) and 10 (worst imaginable pain). The score, measured in millimeters from the 0 mark, provides a quantitative measure of pain intensity. Changes in VAS scores over time will be analyzed between groups.

The DMFT index records the total number of Decayed, Missing, and Filled permanent Teeth per individual. Scores range from 0 (no caries experience) up to 28 or 32, depending on the number of teeth present. A reduction or stabilization of DMFT scores over time will indicate an improvement or prevention of caries progression.

The DMFS index expands the DMFT to include all tooth surfaces, providing a more sensitive measure of caries experience. Each surface is assessed individually, and scores range from 0 (no affected surfaces) to a maximum depending on the total number of tooth surfaces. Higher values indicate more extensive caries. Scores will be compared across time points between groups.

The extent of enamel demineralization will be assessed using near-infrared light transillumination with the DIAGNOcam device. The captured images will be processed using ImageJ software to quantify the surface area of enamel lesions in square millimeters. Each lesion will be manually outlined and analyzed by a calibrated examiner. The score assigned will represent the total area (in mm²) of demineralized enamel per tooth. Higher values indicate greater lesion extension. A progressive reduction in lesion surface area over time will be interpreted as a sign of remineralization. Intergroup comparisons will assess the impact of the hydroxyapatite-based intervention on enamel integrity.

Enamel demineralization will be measured using the DIAGNOdent pen, which emits a low-power laser and detects fluorescence from porous enamel. Each site will receive a numerical score ranging from 0 to 99, where 0-10 indicates sound enamel, 11-20 indicates initial demineralization, 21-30 suggests moderate demineralization, and scores above 30 reflect advanced mineral loss. For each lesion, the highest DIAGNOdent value will be recorded, and the average value per participant will be calculated. A reduction in fluorescence values across time points will indicate enamel remineralization and clinical improvement.