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Effectiveness of Desensitizing Agents
JOURNAL OF ENDODONTICS Copyright © 2002 by The American Association of Endodontists
Printed in U.S.A. VOL. 28, NO. 1, JANUARY 2002
CLINICAL ARTICLES Effectiveness of Desensitizing Agents Anand Kishore, MDS, Kamlesh Kumar Mehrotra, MDS, and Charanjit Singh Saimbi, MDS
Therefore the present study was designed to compare the efficacy of several desensitizing agents in the treatment of dentin hypersensitivity.
This study was conducted to evaluate the efficacy of desensitizing agents for the treatment of dentin hypersensitivity. Seventy-five hypersensitive teeth in 10 patients were studied. These were divided into five groups of 15 hypersensitive teeth: group I, control (triple distilled water); group II, 10% strontium chloride; group III, 5% potassium nitrate; group IV, 2% sodium fluoride; and group V, 40% formalin. The stimulus used to test thermal sensitivity was cold water at 15°C, 10°C, 5°C, and 0°C applied on every alternate day for 10 days. Results showed that 10% strontium chloride solution, 2% sodium fluoride solution, and 40% formalin solution significantly reduced dentin hypersensitivity, whereas a 5% solution of potassium nitrate did not.
MATERIALS AND METHODS Ten patients visiting the Department of Periodontics, Faculty of the Dental Sciences, King George’s Medical College, Lucknow, India, were selected. They had a total of 75 sensitive teeth. They were further divided into five groups of 15 sensitive teeth. Subjects with a history of treatment for dentin hypersensitivity, poor periodontal condition, systemic debilitating diseases, caries or restoration in the area of hypersensitivity, allergy to a chemical or drug, a condition requiring analgesics, and with orthodontic appliances were excluded from the study. Patients reporting pain from hot, cold, sweet, or sour or during brushing were included as having dentinal sensitivity. After proper consent from the patient the area of hypersensitivity was identified, and the details of each patient were recorded on a specially prepared record sheet. The desensitizing agents studied were grouped as follows: group I, control—triple distilled water; group II, 10% strontium chloride; group III, 5% potassium nitrate; group IV, 2% sodium fluoride; and group V, 40% formalin. The stimulus used to test thermal sensitivity was cold water at different temperatures. The pain scoring system used was a verbal rating based on a 4-point scale that graded pain as slight, moderate, severe, or agonizing. This simple descriptive scale was modified as described and was used in the present study.
Hypersensitivity of the teeth is a pathological condition in which the teeth are sensitive to thermal, chemical, and physical stimuli. The patient with dentin hypersensitivity experiences pain from hot/cold and sweet/sour solutions. The pain may also be experienced when hot/cold air touches the teeth. It varies in degrees from mild to sharp and excruciating pain. Dentin hypersensitivity occurs due to exposure of dentinal tubules as a result of attrition, abrasion, erosion, fracture of tooth, chipping of the tooth, or a faulty restoration. Dentin hypersensitivity can also occur after periodontal therapy, gingival recession, shrinkage of the swollen gingiva after curettage, and elimination of tissue by gingivectomy. Lasers are being investigated for the treatment of hypersensitivity to avoid frequent visits of patients to the dental offices for a local application, and desensitizing agents are incorporated in toothpaste for regular use by patients. A number of studies have tested iontophoresis and fluoride as desensitizing agents (Lutkins et al.) (1). A reduction in sensitivity with iontophoresis and fluoride has been reported. Many medicinal plants have also been tried for relief from sensitivity, including Kattha, pan leaves, Haldi rhizomes, and Tulsi leaves. However there is no single universally accepted treatment available.
• • • •
Grade Grade Grade Grade
0 —No pain 1—Mild pain 2—Moderate pain 3—Severe pain.
The sensitive area was isolated and dried with cotton rolls. Small cotton pellets dipped in desensitizing agents were left on the area of sensitivity for 5 min. After removal of the cotton pellet the tooth was tested for sensitivity. Patients were recalled every alternate day, and the same procedure was repeated for 10 days spread over five appointments. The thermal stimulation test was done on each follow-up visit at the temperature previously recorded for pain to see the effect of the 34
Vol. 28, No. 1, January 2002
test solution. If there was no pain at the previous recorded temperature, the next lower water temperature was tested on the hypersensitive tooth surface until the patient reported pain. The grading of pain was recorded, and a fresh test sample was applied. The patient was recalled on every alternate day for the next follow-up visits. The results were analyzed by comparing the postoperative finding (after every sitting) with the preoperative recordings of severity of pain. Data obtained were subjected to statistical analysis by student’s t test. RESULTS Ten percent strontium chloride solution, 2% sodium fluoride solution, and 40% formalin solution significantly reduced dentin hypersensitivity, whereas a 5% solution of potassium nitrate did not. It was noted that in comparing 10% strontium chloride (group II), 5% potassium nitrate solution (group III), 2% sodium fluoride (group IV), and 40% formalin (group V), the 2% solution of sodium fluoride was significantly superior. When a 10% strontium chloride solution was compared with a 5% potassium nitrate and 40% formalin solution, it was found that a 10% solution of strontium chloride was significantly superior. Forty percent formalin was significantly superior to 5% potassium nitrate. DISCUSSION Hypersensitive dentin implies an abnormal sensitivity when exposed to heat, cold, sweet, and sour articles. Graf and Galasse (2) reported that 1 of 7 dental patients suffer a hypersensitive reaction to thermal, chemical, and mechanical stimuli. Brannstrom et al. (3) reported that dentin hypersensitivity results when a stimulus applied to dentin causes movement of fluid in the dentinal tubules, which stimulates nerve processes in the pulpal area of the dentin and produces pain impulse transmission.
Effectiveness of Desensitizing Agents
35
Ross (4) treated 86 patients with 10% strontium chloride who had thermal or nonthermal hypersensitivity and found that 93.6% of patients showed improvement after a 1-month period. Kim (5) suggested that the active moiety may be potassium nitrate ions. Presumably the mechanism of action depends on the ability of potassium ion to penetrate through the dentinal tubules to the nerve endings at the dentin pulpal junction. These ions modify the usual exchange of sodium and potassium in the nerve. Minkov et al. (6) conducted a double-blind study evaluating 2% sodium fluoride at 4 wk. At compilation of their 8-month study they found no significant difference between the two treatments. Fitzgerald (7) reported excellent results with a paste containing 1.4% formalin. Abel (8) found excellent symptomatic relief in the treatment of hypersensitivity with 1.4% formalin containing toothpaste. Dr. Kishore is a resident, Dr. Mehrotra is professor and head, and Dr. Saimbi is professor, Department of Periodontics, Faculty of Dental Sciences, King George’s Medical College, Lucknow (U.P.), India. Address requests for reprints to Dr. Charanjit Singh Saimbi, Department of Periodontics, Faculty of Dental Sciences, King George’s Medical College, Lucknow (U.P.), India.
References 1. Lutins ND, Greco GW, McFall WT Jr. Effectiveness of sodium fluoride on tooth hypersensitivity with and without iontophoresis. J Periodontol 1984; 55:285– 8. 2. Graf H, Galasse R. Morbidity, prevalence, and intraoral distribution of hypersensitive teeth. J Dent Res 1973;56(Suppl. A):162. 3. Brannstrom M, Linden LA, Astrom A. The hydrodynamics of dentin and pulp fluid. Caries Res 1967;1:310 –7. 4. Ross MR. Hypersensitive teeth. Effect of strontium chloride in a compatible dentifrice. J Periodontol 1961;32:49. 5. Kim S. Hypersensitive teeth desensitization of pulpal sensory nerves. J Endodon 1986;12:482–5. 6. Minkov B, Marmari I, Gedalia I, Garfunkel A. The effectiveness of sodium fluoride treatment with or without iontophoresis on the reduction of hypersensitive dentin. J Periodontol 1975;45:246 –9. 7. Fitzgerald G. A clinical evaluation of new agent for the relied of hypersensitive dentin. Dent Dig 1956;62:494. 8. Abel I. Study of hypersensitive teeth and a new therapeutic aid. Oral Surg Oral Med Oral Pathol 1958;11:491.
Printed in U.S.A. VOL. 28, NO. 1, JANUARY 2002
CLINICAL ARTICLES Effectiveness of Desensitizing Agents Anand Kishore, MDS, Kamlesh Kumar Mehrotra, MDS, and Charanjit Singh Saimbi, MDS
Therefore the present study was designed to compare the efficacy of several desensitizing agents in the treatment of dentin hypersensitivity.
This study was conducted to evaluate the efficacy of desensitizing agents for the treatment of dentin hypersensitivity. Seventy-five hypersensitive teeth in 10 patients were studied. These were divided into five groups of 15 hypersensitive teeth: group I, control (triple distilled water); group II, 10% strontium chloride; group III, 5% potassium nitrate; group IV, 2% sodium fluoride; and group V, 40% formalin. The stimulus used to test thermal sensitivity was cold water at 15°C, 10°C, 5°C, and 0°C applied on every alternate day for 10 days. Results showed that 10% strontium chloride solution, 2% sodium fluoride solution, and 40% formalin solution significantly reduced dentin hypersensitivity, whereas a 5% solution of potassium nitrate did not.
MATERIALS AND METHODS Ten patients visiting the Department of Periodontics, Faculty of the Dental Sciences, King George’s Medical College, Lucknow, India, were selected. They had a total of 75 sensitive teeth. They were further divided into five groups of 15 sensitive teeth. Subjects with a history of treatment for dentin hypersensitivity, poor periodontal condition, systemic debilitating diseases, caries or restoration in the area of hypersensitivity, allergy to a chemical or drug, a condition requiring analgesics, and with orthodontic appliances were excluded from the study. Patients reporting pain from hot, cold, sweet, or sour or during brushing were included as having dentinal sensitivity. After proper consent from the patient the area of hypersensitivity was identified, and the details of each patient were recorded on a specially prepared record sheet. The desensitizing agents studied were grouped as follows: group I, control—triple distilled water; group II, 10% strontium chloride; group III, 5% potassium nitrate; group IV, 2% sodium fluoride; and group V, 40% formalin. The stimulus used to test thermal sensitivity was cold water at different temperatures. The pain scoring system used was a verbal rating based on a 4-point scale that graded pain as slight, moderate, severe, or agonizing. This simple descriptive scale was modified as described and was used in the present study.
Hypersensitivity of the teeth is a pathological condition in which the teeth are sensitive to thermal, chemical, and physical stimuli. The patient with dentin hypersensitivity experiences pain from hot/cold and sweet/sour solutions. The pain may also be experienced when hot/cold air touches the teeth. It varies in degrees from mild to sharp and excruciating pain. Dentin hypersensitivity occurs due to exposure of dentinal tubules as a result of attrition, abrasion, erosion, fracture of tooth, chipping of the tooth, or a faulty restoration. Dentin hypersensitivity can also occur after periodontal therapy, gingival recession, shrinkage of the swollen gingiva after curettage, and elimination of tissue by gingivectomy. Lasers are being investigated for the treatment of hypersensitivity to avoid frequent visits of patients to the dental offices for a local application, and desensitizing agents are incorporated in toothpaste for regular use by patients. A number of studies have tested iontophoresis and fluoride as desensitizing agents (Lutkins et al.) (1). A reduction in sensitivity with iontophoresis and fluoride has been reported. Many medicinal plants have also been tried for relief from sensitivity, including Kattha, pan leaves, Haldi rhizomes, and Tulsi leaves. However there is no single universally accepted treatment available.
• • • •
Grade Grade Grade Grade
0 —No pain 1—Mild pain 2—Moderate pain 3—Severe pain.
The sensitive area was isolated and dried with cotton rolls. Small cotton pellets dipped in desensitizing agents were left on the area of sensitivity for 5 min. After removal of the cotton pellet the tooth was tested for sensitivity. Patients were recalled every alternate day, and the same procedure was repeated for 10 days spread over five appointments. The thermal stimulation test was done on each follow-up visit at the temperature previously recorded for pain to see the effect of the 34
Vol. 28, No. 1, January 2002
test solution. If there was no pain at the previous recorded temperature, the next lower water temperature was tested on the hypersensitive tooth surface until the patient reported pain. The grading of pain was recorded, and a fresh test sample was applied. The patient was recalled on every alternate day for the next follow-up visits. The results were analyzed by comparing the postoperative finding (after every sitting) with the preoperative recordings of severity of pain. Data obtained were subjected to statistical analysis by student’s t test. RESULTS Ten percent strontium chloride solution, 2% sodium fluoride solution, and 40% formalin solution significantly reduced dentin hypersensitivity, whereas a 5% solution of potassium nitrate did not. It was noted that in comparing 10% strontium chloride (group II), 5% potassium nitrate solution (group III), 2% sodium fluoride (group IV), and 40% formalin (group V), the 2% solution of sodium fluoride was significantly superior. When a 10% strontium chloride solution was compared with a 5% potassium nitrate and 40% formalin solution, it was found that a 10% solution of strontium chloride was significantly superior. Forty percent formalin was significantly superior to 5% potassium nitrate. DISCUSSION Hypersensitive dentin implies an abnormal sensitivity when exposed to heat, cold, sweet, and sour articles. Graf and Galasse (2) reported that 1 of 7 dental patients suffer a hypersensitive reaction to thermal, chemical, and mechanical stimuli. Brannstrom et al. (3) reported that dentin hypersensitivity results when a stimulus applied to dentin causes movement of fluid in the dentinal tubules, which stimulates nerve processes in the pulpal area of the dentin and produces pain impulse transmission.
Effectiveness of Desensitizing Agents
35
Ross (4) treated 86 patients with 10% strontium chloride who had thermal or nonthermal hypersensitivity and found that 93.6% of patients showed improvement after a 1-month period. Kim (5) suggested that the active moiety may be potassium nitrate ions. Presumably the mechanism of action depends on the ability of potassium ion to penetrate through the dentinal tubules to the nerve endings at the dentin pulpal junction. These ions modify the usual exchange of sodium and potassium in the nerve. Minkov et al. (6) conducted a double-blind study evaluating 2% sodium fluoride at 4 wk. At compilation of their 8-month study they found no significant difference between the two treatments. Fitzgerald (7) reported excellent results with a paste containing 1.4% formalin. Abel (8) found excellent symptomatic relief in the treatment of hypersensitivity with 1.4% formalin containing toothpaste. Dr. Kishore is a resident, Dr. Mehrotra is professor and head, and Dr. Saimbi is professor, Department of Periodontics, Faculty of Dental Sciences, King George’s Medical College, Lucknow (U.P.), India. Address requests for reprints to Dr. Charanjit Singh Saimbi, Department of Periodontics, Faculty of Dental Sciences, King George’s Medical College, Lucknow (U.P.), India.
References 1. Lutins ND, Greco GW, McFall WT Jr. Effectiveness of sodium fluoride on tooth hypersensitivity with and without iontophoresis. J Periodontol 1984; 55:285– 8. 2. Graf H, Galasse R. Morbidity, prevalence, and intraoral distribution of hypersensitive teeth. J Dent Res 1973;56(Suppl. A):162. 3. Brannstrom M, Linden LA, Astrom A. The hydrodynamics of dentin and pulp fluid. Caries Res 1967;1:310 –7. 4. Ross MR. Hypersensitive teeth. Effect of strontium chloride in a compatible dentifrice. J Periodontol 1961;32:49. 5. Kim S. Hypersensitive teeth desensitization of pulpal sensory nerves. J Endodon 1986;12:482–5. 6. Minkov B, Marmari I, Gedalia I, Garfunkel A. The effectiveness of sodium fluoride treatment with or without iontophoresis on the reduction of hypersensitive dentin. J Periodontol 1975;45:246 –9. 7. Fitzgerald G. A clinical evaluation of new agent for the relied of hypersensitive dentin. Dent Dig 1956;62:494. 8. Abel I. Study of hypersensitive teeth and a new therapeutic aid. Oral Surg Oral Med Oral Pathol 1958;11:491.