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ORIGINAL RESEARCH  
Year : 2013  |  Volume : 24  |  Issue : 5  |  Page : 571-574
An insight into dentin desensitizing agents - In vivo study


Dr. Dnyandeo Yashwantrao Patil Dental College and Hospital, Nerul, Navi Mumbai, Maharashtra, India

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Date of Submission15-Jan-2013
Date of Decision25-Feb-2013
Date of Acceptance22-Apr-2013
Date of Web Publication21-Dec-2013
 

   Abstract 

Aims: It is widely accepted that dentin hypersensitivity is an uncomfortable condition, which affects the function and quality of life. This study determines the difference in efficacy of four desensitizing agents.
Subjects and Methods: An in vivo study was conducted to compare four dentin desensitizing agents on 40 patients. Age, sex, and place of the patient were recorded. Hydroxyapatite containing agent, potassium nitrate containing, sodium fluoride containing, and natural resin containing agents were used for the study. The baseline measurement for pain perceived due to hypersensitivity was recorded by visual analog scale (VAS). Then after application of the respective desensitizing agent, the last score was taken after 7 days.
Statistical Analysis Used: The agents were compared in terms of mean differences in their VAS scale readings. Kruskall-Wallis test and Mann-Whitney tests were used to compare the efficacies of the four agents.
Results: The four desensitizing agents which contain different active agents were effective in relieving dentin hypersensitivity. Not much significant difference was found among the four. However, propolis (natural resin-containing agent) showed better clinical response in patients among the four, followed by sodium fluoride-containing agent.
Conclusions: Propolis proves to be a good natural and nontoxic option for treatment of dentin sensitivity.

Keywords: Dentin hypersensitivity, efficacy, propolis

How to cite this article:
Mehta P, Vimala N, Mandke L. An insight into dentin desensitizing agents - In vivo study. Indian J Dent Res 2013;24:571-4

How to cite this URL:
Mehta P, Vimala N, Mandke L. An insight into dentin desensitizing agents - In vivo study. Indian J Dent Res [serial online] 2013 [cited 2019 Nov 20];24:571-4. Available from: http://www.ijdr.in/text.asp?2013/24/5/571/123369
Dentin hypersensitivity is a common problem affecting adult population between 8% and 57% (Addy,1990), [1] (Irwin and McCusker, 1997). [2] This condition generally is characterized by pain of short duration and sharp nature, in response to stimuli such as tactile, thermal, evaporative, osmotic, or chemical and which cannot be ascribed to any other form of dental defect or pathology (Add,1990) [1] , (Kimura et al., 2000). [3] The most widely accepted Brannstroms' hydrodynamic theory of dentin hypersensitivity states that when stimuli is applied it displaces the dentinal fluid inwardly or outwardly (Ozen et al., 2009), [4] (Miglani et al., 2010). [5] This fluid then promotes mechanical deformation of nerve endings at the pulp-dentin complex which is interpreted as a painful sensation. Therefore, it seems appropriate to assume that any substance or technique that reduces dentinal fluid movement or dentin permeability should decrease sensitivity (Pashley 1990). [6]

Several agents and therapies have been proposed for the treatment of hypersensitivity, but none of them have proven completely effective and the development of newer desensitizing agents is needed. Propolis is a natural resin, which has been found to have promising results in treatment of hypersensitivity. Propolis is a natural, nontoxic resin produced by honey bees. Only a few studies have assessed the efficiency of desensitizing agents in vivo. The aim of this study was to evaluate the clinical efficiency of propolis and three others commonly used desensitizing agents in treating dentin hypersensitivity. The word propolis is derived from the greek word ''pro'' before and ''polis'' city or the defender of the city. [7] It has been shown to have antimicrobial, antitumor, anesthetic, anti-inflammatory, antiviral, and healing properties. [8]


   Subjects and Methods Top


Patients who visited the outpatient clinic of dental college and hospital and had dental pathology similar to dental hypersensitivity complaints were assessed. The exclusion criteria were as follows: Teeth with caries, orthodontic appliances, restorations, patients who received any previous treatment with desensitizing agents in a span of previous 6 months. Inclusion criteria were a minimum of two teeth showing hypersensitivity, teeth which demonstrated erosion/abrasion/recession of gingiva <4 mm as shown in [Figure 1]. The patients were included for further study only after they had read and signed the informed consent form for the current study. The informed consent form was prepared and obtained according to Helsinki Declaration.
Figure 1: Intraoral cervical abrasion in mandibular canine

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In this in vivo study, a total of four desensitizing agents were used as shown in [Figure 2]. Forty patients were equally divided into four groups in this study. Group I: Hydroxyapatite, xylitol containing (Remin Pro, VOCO); group II: Potassium nitrate containing topical desensitizing agent (Ultra EZ, Ultradent products); group III: Sodium fluoride (Fluoritop; ICPA), and group IV: Propolis (natural resin; alcohol-free health products USA). For each group, the following method was followed: Patients were first advised dental prophylaxis. Sensitivity assessment was done by means of evaporative stimuli. To produce air evaporative stimuli, a blast of air was applied using dental unit triple syringe at a distance of 0.5 cm away from the tooth surface. The stimulus was applied on the cervical region of the affected teeth and the adjacent teeth were isolated with cotton rolls or gloved fingers. The patients were then given a visual analog scale (VAS) upon which they were asked to place a pencil/pen mark at a point on the linear scale marked from 0 to 10 denoting the degree of pain perceived. This is determined as a baseline VAS score for each patient. Manufactures instructions were followed during application of each one of the four desensitizing agent as shown in [Figure 3]. The desensitizing agent was applied with an applicator tip and rubbed on to the tooth surface. It was left undisturbed for 60 s. The second VAS score was recorded after application of each agent for patients of all four groups. The patients were instructed to use commercially available nondesensitizing, nonfluoridated dentifrice, and brush twice daily for 7 days. After 7 days, patients were recalled and they were assessed for their responses to sensitive teeth in all four groups at 7 days and after application of the desensitizing agent on the 7 th day.
Figure 2: All four desensitizing agents

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Figure 3: Intraoral picture showing application of the desensitizing agent

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Statistical analysis

The analysis of variance test was used to compare the differences between the groups. Mann-Whitney Test analysis was used to find out significant differences among the four groups. Kruskal-Wallis test was done to find out the differences in VAS scores for the 1 st day and 7 th day for all the four groups.


   Results Top


The mean VAS scores for all the four groups before application of desensitizing agent, after application of desensitizing agent on 1 st day and after application of desensitizing agent on 7 th day were tabulated as shown in [Table 1]. Intergroup comparison of the efficacy of desensitizing agents in relieving pain was shown in Graph 1. The efficacy of the agents was determined using the mean difference using the VAS score after application on 1 st day and after application on 7 th day as shown in [Table 2]. From [Graph 1] [Additional file 1] and [Table 2], group IV showed maximum pain relief followed by group III.
Table 1: Mean VAS table of different groups


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Table 2: Mean VAS scores after application, on days 1 and 7


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Results in Kruskal-Wallis test, [Table 3] showed that there was significant difference in the VAS scores obtained before application and after application of desensitizing agent on 1 st day and on 7 th day, respectively. The P value for 1 st day was 0.006 and for 7 th day was 0.021, respectively. Since these values were less than 0.05, it was concluded that there was significant difference in the VAS scores. Mann-Whitney test analysis was done to find out significant differences among the four groups [Table 4] and [Table 5]. Interpretations of [Table 4] and [Table 5] were as follows:
Table 3: Test statistics


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Table 4: Mann-Whitney U test for day one


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Table 5: Mann-Whitney U test for 7th day


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  • Difference between Remin Pro and propolis is P = 0.008 < 0.05
  • Difference between Ultra EZ and propolis is P = 0.001 < 0.05
  • Difference between Remin Pro and fluoritop is P = 0.04 < 0.05


The interpretation of these tests showed group IV (propolis) and groupIII (fluoritop) showed better efficacy in pain reduction as compared to the other two groups.


   Discussion Top


Dentin hypersensitivity is a chronic dental problem, characterized by a short duration of pain initiated by many types of stimuli such as tactile, thermal, osmotic, or chemical. There is need to develop new treatment or products which permit the relief of symptoms. The two principal mechanisms of action of desensitizing agents are occlusion of dentinal tubule openings and thus blocking the movement of dentinal fluid and blocking nerve stimulation by altering the excitability of nerve endings and thus depolarizing the nerve. [4] The aim of this study was to compare the clinical efficiency of propolis and three commonly used desensitizing agents in treating dentin hypersensitivity.

The effectiveness of the agents was evaluated with VAS score; the most common unidimensional pain measurement system. It is extensively used in clinical studies to assess the intensity of pain. It is based on a 0-10 scale, the extreme left indicated zero pain and the extreme right maximal pain. [9]

Comparison between the groups proved, propolis to be more effective as a desensitizing agent. Propolis (liquid extract, 2000 mg/2 mL) is a sticky filler substance with the aroma of poplar honey and vanilla that is collected by bees from the buds and barks of trees and plants such as horse chest, nuts, poplar, and fir. Bees use this resin to fill cracks, strengthen comb attachments, and smoothen interiors of the nest. It is composed of resins (55%), essential oils, and wax (30%) mixed with glue ''the salivary secretion of bees'' and pollen (5%) and other constituents (10%) which are amino acids minerals, ethanol (alcohol), vitamins A, B complex, and E, and the highly active biochemical substance known as bioflavonoid. It is a prime source of histamine and serotonin being substances needed to help the body cope with allergies. [5]

Propolis has many therapeutic uses like antibacterial, antiviral, antifungal, antioxidant, anti-inflammatory agent, and in dentistry it has been used for treating dentin hypersensitivity, improving wound healing, as a storage media for avulsed tooth and pulp capping agent. Mahmoud et al., [7] studied the effect of propolis as a desensitizing agent and demonstrated that 85% of subjects were found highly satisfied during the study period. In the current study also, it was observed that propolis (group IV) is more effective followed by sodium fluoride (group III). Propolis has an anti-inflammatory action; it stimulates reparative dentin formation which would be able to reduce dentin permeability. Geiger et al., [10] have postulated that propolis precipitates and obstructs dentinal tubules and decrease dentin permeability by 85% or more.

The bioflavonoids in propolis may interact with the dentine, thus forming crystals that reduce fluid movement within dentinal tubules and, consequently reduce dentine sensitivity. This theory was based on the study by Sabir et al., [11] in which direct pulp capping was performed with propolis-derived flavinoids and mild and moderate inflammation was seen in the pulp chamber at weeks 2 and 4, partial dentin bridge formation was detected beneath the pulp capping material at 4 th week. [11]

The other products used in the study, that is, hydroxyapatite, potassium nitrate, and sodium fluoride also caused a significant reduction in hypersensitivity for short duration of 1 week. These findings were supported by results of other studies. Yaun et al., [12] showed incorporation of hydroxyapatite in dentrifices helped in reducing sensitivity of teeth after 7 days of brushing. Scanning electron microscope (SEM) images in the study have shown dentine tubule occlusion within 7 days, thus causing reduced sensitivity of teeth. In this study; group I also showed reduction in hypersensitivity, but in comparison to other three groups, it was not significant. Ritter et al., [13] showed that sodium fluoride was effective in reducing hypersensitivity of teeth at 8 and 24 weeks of treatment. However, in this study, the use of sodium fluoride was evaluated for a week and it has shown reduction of hypersensitivity.

Ozen et al., [4] compared potassium nitrate with other desensitizing agents and found that it was effective as a desensitizing agent.

Since the nature of propolis used is a liquid, the penetration into dentinal tubules is higher in comparison to a gel form. This study was the first one which used higher concentration of propolis other than 10% and 30%. [14] It was found that increasing the concentration leads to decrease in sensitivity over a shorter duration of time. Thus, considering the advantages of propolis in comparison to the other desensitizing agents used in the study, propolis proved to be a efficient and effective desensitizing agent. Hence, it may be possible to apply the results of this study over clinical trials with larger sample size for longer evaluation time.


   Conclusion Top


Thus, the following conclusions were drawn from the study:

  • All the four groups reduced dentin hypersensitivity significantly, but they differed in their efficacy for a period of 7 days
  • Group IV (propolis) showed rapid decrease of dentin hypersensitivity as compared with all the other three groups
  • Group I (Remin Pro) was least effective of the other three in reducing hypersensitivity.


With the market flooded with a variety of desensitizing agents, propolis has great potential for treatment of dentin hypersensitivity. Propolis being a natural product can be easily procured. The study has highlighted the beneficial effects of increased concentration of propolis; without any allergic side effects and with desirable outcome in treatment of tooth sensitivity.

 
   References Top

1.Addy M. Etiology and clinical implications of dentine hypersensitivity. Dent Clin North Am 1990;34:503-14.  Back to cited text no. 1
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2.Irwin CR, McCusker P. Prevalence of dentine hypersensitivity in a general dental population. J Ir Dent Assoc 1997;43:7-9.  Back to cited text no. 2
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3.Kimura Y, Wilder-Smith P, Yonaga K, Matsumoto K. Treatment of dentine hypersensitivity by lasers: a review. J Clin Periodontol 2000;27:715-21.  Back to cited text no. 3
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4.Ozen T, Orhan K, Avsever H, Tunca YM, Ulker AE, Akyol M. Dentin hypersensitivity: A randomized clinical comparision of three different agents in a short-term treatment period. Oper Dent 2009;34:392-8.  Back to cited text no. 4
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5.Miglani S, Aggarwal V, Ahuja B. Dentin hypersensitivity: Recent trends in management. J Conserv Dent 2010;13:218-24.  Back to cited text no. 5
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6.Pashley DH. Mechanisms of dentin sensitivity. Dent Clin North Am 1990;34:449-73.  Back to cited text no. 6
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7.Mahmoud AS, Almas K, Dahlan AA. The effect of propolis on dentinal hypersensitivity and level of satisfaction among patients from a University Hospital Riyadh, Saudi Arabia. Indian J Dent Res 1999;10:130-7.  Back to cited text no. 7
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8.Almas K, Mahmoud A, Dahlan A. A comparative study of porpolis and saline application on human dentin: A SEM study. Indian J Dent Res 2001;12:21-7.  Back to cited text no. 8
    
9.Ide M, Wilson RF, Ashley FP. The reproducibility of methods of assessment for cervical dentine hypersensitivity. J Clin Periodontol 2001;28:16-22.  Back to cited text no. 9
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10.Geiger S, Matalon S, Blasbalg J, Tung M, Eichmiller FC. The clinical effect of amorphous calcium phosphate (ACP) on root surface hypersensitivity. Oper Dent 2003;28:496-500.  Back to cited text no. 10
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11.Sabir A, Tabbu CR, Agustiono P, Sosroseno W. Histological analysis of rat dental pulp tissue capped with propolis. J Oral Sci 2005;47:135-8.  Back to cited text no. 11
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12.Yuan P, Shen X, Liu J, Hou Y, Zhu M, Huang J, et al. Effects of dentifrice containing hydroxyapatite on dentinal tubule occlusion and aqueous hexavalent chromium cations sorption: A preliminary study. PLoS One 2012;7:e45283.  Back to cited text no. 12
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13.Ritter AV, de L Dias W, Miguez P, Caplan DJ, Swift EJ Jr. Treating cervical dentin hypersensitivity with fluoride varnish: A randomized clinical study. J Am Dent Assoc 2006;137:1013-20.  Back to cited text no. 13
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14.Sales-Peres SH, Carvalho FN, Marsicano JA, Mattos MC, Pereira JC, Forim MR, et al. Effect of propolis gel on in vitro reduction of dentin permeability. J Appl Oral Sci 2011;19:318-23.  Back to cited text no. 14
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Correspondence Address:
Purvi Mehta
Dr. Dnyandeo Yashwantrao Patil Dental College and Hospital, Nerul, Navi Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.123369

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    Figures

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    Tables

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