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Table of Contents   
ORIGINAL RESEARCH  
Year : 2015  |  Volume : 26  |  Issue : 1  |  Page : 38-42
Evaluation of three different agents for in-office treatment of dentinal hypersensitivity: A controlled clinical study


Department of Operative Dentistry, SDM Dental College, Dharwad, Karnataka, India

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Date of Submission16-Oct-2014
Date of Decision19-Nov-2014
Date of Acceptance31-Jan-2015
Date of Web Publication11-May-2015
 

   Abstract 

Context: Dentin desensitizers are used for in-office treatment of dentinal hypersensitivity. They block the open tubules and bring about a reduction in hypersensitivity.
Aim: The aim was to evaluate and compare the clinical effectiveness of a dentin desensitizer, a combination of a dentin desensitizer + adhesive and one-bottle self-etching adhesive for in-office treatment of dentin hypersensitivity.
Settings and Design: Institutional, prospective double-blind parallel clinical design.
Subjects and Methods: A total of 54 teeth in 20 patients were randomly allocated to one of the three study groups, with 18 teeth in each group as follows: Group A-Gluma Desensitizer (GD), Group B-Gluma Comfort Bond + Desensitizer (GCBD), Group C-Single Bond Universal (SBU). The patients' dentinal hypersensitivity scores for tactile (hand-held scratch device), thermal (cold), and evaporative (dental unit air syringe) stimuli were recorded on a visual analog scale. The parameters were recorded at baseline, immediately after application of the agent, 3- and 6-week posttreatment.
Statistical Analysis Used: The data were analyzed with Friedman's test, Wilcoxon signed ranks test, Kruskal-Wallis test, and Mann-Whitney-U-test (P < 0.05).
Results: All three groups showed a significant reduction in dentinal hypersensitivity (P < 0.05) compared to baseline at all time intervals. Statistically, significant differences were noted between GD and SBU; between GCBD and SBU in all testing parameters. Between GD and GCBD no significant difference was noted.
Conclusions: GD and GCBD showed a greater reduction in dentin hypersensitivity than SBU

Keywords: Dental adhesives, dentin desensitizers, Dentinal hypersensitivity, Gluma Comfort Bond + Desensitizer, Gluma Desensitizer, Single Bond Universal, visual analog scale

How to cite this article:
Patil SA, Naik BD, Suma R. Evaluation of three different agents for in-office treatment of dentinal hypersensitivity: A controlled clinical study. Indian J Dent Res 2015;26:38-42

How to cite this URL:
Patil SA, Naik BD, Suma R. Evaluation of three different agents for in-office treatment of dentinal hypersensitivity: A controlled clinical study. Indian J Dent Res [serial online] 2015 [cited 2019 Nov 17];26:38-42. Available from: http://www.ijdr.in/text.asp?2015/26/1/38/156796
Dentinal hypersensitivity is defined as "short, sharp pain arising from exposed dentin in response to stimuli typically thermal, evaporative, tactile, osmotic or chemical and which cannot be ascribed to any other form of dental defect or disease." [1] It has been reported that the most affected patients are in the age group of 20-50 years of age with slightly higher predilection in females. The most common stimulus causing hypersensitivity is cold, followed by heat, sweet, and tactile stimuli. [2]

The traditional approaches for management of dentinal hypersensitivity are based on hydrodynamic mechanism. [1],[3] The desensitizing materials are applied to the exposed dentinal tubules so as to occlude them or depress the activity of dentinal sensory nerves thereby preventing the pain signal from being transmitted to the central nervous system. [3],[4],[5]

Tubule occlusion may be achieved either by in-office topical application of the desensitizing agents or by self-application of the prescribed agents by the patient at home. Brännström et al. described the application of resin to reduce dentin hypersensitivity. [3] A study by Yoshiyama et al. showed that the desensitization brought about by resin application is due to the presence of resin tags or by the formation of hybrid layer in the tubules. [6]

Resin primers alone or primer-adhesive bonding systems have been used to treat dentin hypersensitivity with promising results. [7] The one-bottle self-etching adhesives have been suggested for use to treat hypersensitive dentin since they produce an acid-resistant hybrid layer. [8],[9]

Dentin desensitizers are one class of products that have now been recommended for treatment of hypersensitive dentine. These products contain a combination of glutaraldehyde and hydroxyl ethyl methacrylate (HEMA) primer, which have shown to block the dentinal tubules and bring about a reduction in dentinal hypersensitivity. This in vivo study was thus designed to evaluate and compare the clinical effectiveness of a dentin desensitizer, a combination of a dentin desensitizer + adhesive and one-bottle self-etching adhesive for in-office treatment of dentin hypersensitivity.


   Subjects and methods Top


This double-blind, randomized, parallel, prospective study was undertaken in the Department of Operative Dentistry and Endodontics after approval from the institutional ethical review board. A total of 54 teeth in 20 patients in the age range of 18-35 years (12 females, 8 males) were recruited for the study.

Inclusion criteria

The patients with the chief complaint of dentinal hypersensitivity and seeking treatment for the same with a maximum of 3 teeth requiring treatment, good general health, ready to sign informed written consent and complete the study period.

Exclusion criteria

Patients not agreeable and compliant with the terms of the study, pregnant women, and lactating mothers, systemically compromised individuals, patients on medications including analgesics, antihistamines, anti-depressants or anti-inflammatory drugs, patients with a history of allergy to any of the components of the study materials, conditions of teeth which might have caused pain similar to that of dentin hypersensitivity (tooth sensitivity due to improper restorations, dental caries, tooth fractures, tooth cracks and abfraction, active cervical caries or deep abrasions requiring Class V restorations, clinical or radiographic evidence of pulpal disease), patients who have used tooth desensitizing agents within the past 6 weeks, patients who have undergone surgical or nonsurgical periodontal therapy within the previous 3 months.

Assessment of hypersensitivity

The hypersensitive teeth were subjected to tactile (hand-held scratch device), thermal (cold) and evaporative (dental unit air syringe) stimuli at baseline, immediately after application of the agent, 3- and 6-week post treatment. The patients' responses to the stimuli were recorded on a visual analog scale (VAS).

Method of study

The hypersensitive teeth were randomly allocated to one of the three study groups with each group having 18 teeth (n = 18). The teeth were grouped into: Group A-Gluma Desensitizer (GD), Group B-Gluma Comfort Bond + Desensitizer (GCBD), Group C-Single Bond Universal (SBU).

The baseline sensitivity levels were assessed before treatment using VAS. Patients were given a VAS and asked to place pen mark at a point on a linear scale marked from 0 to 10 to describe the pain experienced, where 0 indicated no pain and 10 as the maximum. All stimuli were applied on the cervical region of the hypersensitive teeth with the adjacent teeth being isolated by means of cotton rolls and a suction device.

Tactile method

Mechanical stimulation was using a hand-held scratch device (Correx gram dial, Wagner Instruments Greenwich, CT) [Figure 1], which recorded the forces required to elicit a painful response over a range of 0-250 cN. The device was maintained at a 90° contact angle [Figure 2] to avoid any angular variation. An increasing force was used until the patient responded by raising a hand at which the pain was elicited. The same was repeated thrice and the average of load at which the patient experienced pain was recorded as the threshold value in cN, a total of 3 readings were taken and the average value was recorded.
Figure 1: Hand-held scratch device

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Figure 2: Application tactile stimuli with hand-held scratch device

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Evaporative stimuli: Air blast stimulation

A blast of air from a dental three-way syringe at a pressure between 45 and 60 psi was placed perpendicularly to the tooth at a distance [Figure 3] of 0.5 cm for 3 s and the pain was caused by the stimulus was recorded.
Figure 3: Application of evaporative stimuli using a three-way syringe

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Thermal stimulation

A cotton pellet sprayed with a refrigerant spray containing dichlorodifluoromethane (Endo-Frost, Roeko, Germany) was applied to the mid-facial area of the tooth crown [Figure 4] and the pain caused by the stimulus was recorded. A time gap of 10 min was given between the application of each stimulus to allow the test tooth to return to normal and adapt to temperature changes (Kleinberg and Kaufman, 1990). [10] The order of application of stimuli was tactile stimulus followed by thermal stimulus and air blast was applied last, since it is generally considered to be the most severe stimulus. [11],[12]
Figure 4: Application of thermal stimuli

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After recording the baseline scores, the subjects were randomly assigned to one of the treatment groups. The randomization of the teeth was done by drawing of lots prior to the application of the desensitizers by a co-investigator. The subjects and the principal investigator were blind to the agent being used. The co-investigator applied the test materials whereas the principal investigator assessed the sensitivity levels at all investigation times. The experimental agents were applied in compliance with the manufacturer's instructions [Table 1]. After the application of the test materials, all the subjects were given nonfluoridated toothpaste and soft bristle brush and were demonstrated and instructed to brush with a roll-on technique for the duration of the study.
Table 1: Materials used in the study are described with their application procedure


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Statistical analysis

The statistical analysis was done using SPSS 20.0® (IBM, USA) software package. The nature and distribution of variables indicated a nonparametric data. The differences between the treatment groups were analyzed by the Kruskal-Wallis test, Mann-Whitney U-test and Wilcoxon signed ranks test. In addition, Friedman's test was used to determine differences between the subject responses for each material at baseline, immediate and after 3 and 6 weeks. The significance level of this study was set atP< 0.05.


   Results Top


The results of the present study are presented in [Table 2] [Table 3] [Table 4]. The data showed that all three groups showed a reduction in dentin hypersensitivity to various stimuli at all time intervals (immediate, 3 and 6 weeks) compared to baseline. No adverse effects were observed in any of the subjects enrolled in the study. Kruskal-Wallis test showed a statistically significant difference at 3 rd week and 6 th week with respect to air blast (P < 0.05) as shown in [Table 3]; at 3 rd week and 6 th week with respect to cold test (P < 0.05) as shown in [Table 4]; and at 6 th week with respect to the hand-held scratch device (P < 0.05) as shown in [Table 2]. Mann-Whitney U-test showed that GD and GCBD exhibited a greater reduction in dentine hypersensitivity than SBU (P < 0.05) especially at 3 weeks and 6-week. However, nonsignificant difference was seen between GD and GCBD in all testing parameters (P > 0.05).
Table 2: Comparison of VAS scores recorded for tactile stimulus for all the three groups


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Table 3: Comparison of VAS scores recorded for evaporative stimulus for all the three groups


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Table 4: Comparison of VAS scores recorded for thermal stimulus for all the three groups


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   Discussion Top

"Dentine hypersensitivity is an enigma, being frequently encountered yet ill-understood." [13] The ultimate goal in the treatment of dentin hypersensitivity is the immediate and permanent alleviation of pain and sealing of the open dentinal tubules.

Resin-based materials have been reported to be successful in reduction of dentin hypersensitivity. The experimental rationale for the use of resins, dentin bonding agents or both to treat dentin hypersensitivity is to create resin plugs or resin tags that physically close the open dentin tubules and completely seal orifices. [14]

Gluma Desensitizer, containing HEMA and glutaraldehyde has been one of the most successful desensitizing agent. HEMA is a hydrophilic monomer compound with an ability to infiltrate into acid-etched and moist dental hard tissues and physically blocks the dentinal tubules. [15] Glutaraldehyde is an effective fixative or flocculating agent and forms a physiological seal by coagulating the plasma proteins within the dentinal tubules. [16] HEMA and glutaraldehyde together have shown to achieve dentine tubule occlusion to depths of 50-200 μm. [17],[18],[19]

Gluma Comfort Bond + Desensitizer has a combined sealing effect of protein precipitation and resin penetration on application to the etched dentin surface and produce a uniform seal on the dentine surface. The 4-Methacryloxyethyl trimalletic anhydride in GCBD is a wetting agent that has an ability to chemically adhere to calcium ions producing good bond with the tooth. The combined water and ethanol solvents achieve deeper penetration into the dentinal tubules. Ethanol being a water chaser and solvent for monomers ensures good infiltration of the adhesive as well as better sealing. [20] The etching of the surface prior to the application of the reagent may ensure a resistant hybridized layer and resin tags. The occluding protein precipitates are not permeable to monomers and bring about a reduction in sensitivity. Single Bond Universal utilizes phosphorylated monomers in an aqueous solution that provide acidity and allow the adhesive bond to dentin. The unique chemistry allows for rehydration of the collagen network and the formation of a distinct hybrid layer whether dentin is kept moist or dry. This provides a strong bond to seal the dentin if used in the self-etch or total-etch mode and protects the dentin from open tubules and potential sensitivity, or as a method for reducing sensitivity for patients that are already symptomatic. [21]

In the present study, no significant difference was noted between GD and GCBD. This can be attributed to the presence of glutaraldehyde and HEMA in both reagents responsible for the intrinsic blockage of dentinal tubules via inter-dental sealing as explained by Dijkman et al. [22] and Schupbach et al. [19] However, the one-bottle self-etching adhesive (SBU) tested in the current study did not perform better than GD and GCBD. This might be due to the fact that single-bottle self-etching adhesives contain mixtures of hydrophilic and less hydrophobic monomers and thus, are permeable to water after application to the dentinal surface and thus may not penetrate deeper into the dentinal tubules. [14]

The hand-held scratch device was used to determine the pain threshold of patients to tactile stimulus. The device permits quantitative and objective assessment of the hypersensitivity to tactile stimulus as the initial pain threshold is indicated just at the moment when the pain starts without any other subjective interpretation. [23] Camps et al. showed that the dentinal grooves made by a probe under clinically relevant forces were between 20 and 30 μm wide and scratching would stimulate about 1-2 mm 2 of dentine depending on the depth and length of the scratch. [23],[24] The VAS was used to assess the subjective perception of dentin hypersensitivity with thermal/evaporative stimuli for both pre-and post treatment measurement. The 0-10 numerical rating VAS has been shown to be an efficacious alternative to the continuous VAS while being simpler in application and patient comprehension. [25],[26] VAS has been considered to be the most commonly used method of quantitative scoring of pain and can complement the tactile testing method, however, its use while evaluating resin-containing materials has been not so certain. [25],[27]

The data from the study depict that all the three test materials brought about a reduction in dentinal hypersensitivity over a 6-week period. Though there are studies that have evaluated the study subjects from duration ranging from 24 h to 6 months, the subjects in the current study were evaluated over a period of 6-week. [25],[26],[27],[28] The 6-week duration was based on a study carried out on a similar population. [28] There was a significant amount of reduction in sensitivity scores from baseline to immediate post application and till the end of the study there was a continual improvement in the sensitivity for all the 3 groups. This suggests that the test materials used in the study hold promise in in-office management of patients with dentinal hypersensitivity.


   Conclusions Top


All three in-office agents GD, GCBD, and SBU effectively reduced dentin hypersensitivity after a single application for up to 6 weeks under clinical conditions. GD and GCBD showed a greater reduction in dentin hypersensitivity than SBU.

Clinical relevance

Dentin desensitizers, combination of a dentin desensitizer + adhesive and one-bottle self-etching adhesives can significantly reduce dentin hypersensitivity. However, the clinical effectiveness depends on the individual material used.

 
   References Top

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Correspondence Address:
Shruti A Patil
Department of Operative Dentistry, SDM Dental College, Dharwad, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.156796

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]

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