Original Article

EFFECT OF TOOTHPASTE IN REDUCING DENTINE HYPERSENSITIVITY

MUHAMMAD NASIR SHAH
ABSTRACT
The present study was conducted at Khyber College of Dentistry during the year 2014 with the
aim to investigate dentine hypersensitivity (DH), one of an unpleasant condition experienced by young
to middle age people which restricts the daily drinking/eating habits of patients. For this purpose
fifty patients (25 male, 25 female) were randomly selected and examined for sensitivity. The patients
were divided in to 2 groups i.e. treatment (Sensodyne Rapid action tooth paste) and control (Colgate
total care tooth paste). The patients were given blast of air for 10 seconds and tooth sensitivity was
evaluated by Visual analogue scale. Statistical analysis of the data revealed that all of the subject
patients had DH due to periodontal problem/attachment loss. Results indicated that regular use of
desensitizing tooth paste drastically reduced dentine hypersensitivity when compared to the daily use
tooth paste (control).
Key Words: Dentine hypersensitivity (DH), Attachment loss, Toothpaste. Visual analogue scale (VAS).

INTRODUCTION Dental literature suggests that dentin hypersensitivity

Dentin hypersensitivity (DH) is a brief and acute
pain produced when dentin is subjected to chemical,
osmotic, thermal, tactile or evaporative stimuli.1 It has
been reported that the acute pain is actually a normal
pulpal response to the uncovered dentine and patients
with periodontal diseases are particularly at high risk
(70%) of experiencing DH.2,3,4,5 The exact mechanism of
dentin hypersensitivity is still unknown, however, it is
reported that the main cause of DH is due to change
in the flow of fluid in dentinal tubules that can trigger
pain receptors available on nerve endings in the pulpal
part.6 The hydrodynamic flow is usually increased due
to fluctuations of humidity, temperature, osmotic and
air pressure, or forces acting on the tooth exterior.
Cold or hot foods, drinks and physical pressure usually
trigger people with dentin hypersensitivity. It has been
estimated that about 30% of adults of the 40 million
people in the US at one time of their life are encoun-
tered with dentine hypersensitivity.7 A large difference
in the reported prevalence of dentine hypersensitivity
ranging from 1.1% to 98% has been related to different
methods adopted by various studies.8,9 According to
scientific consensus, from 10% to 30% of the universal
population are affected with this condition.10,11
DH can affect a person of any age, however, most
likely susceptible people are in the age group of 20-49
years with peak hypersensitivity between 30-39 years.12
Muhammad Nasir Shah, Assistant Professor & Head of Depart-
ment of Periodontology, Khyber College of Dentistry, University
Campus, Peshawar Email: mnshah85@hotmail.com
Received for Publication: April 28, 2015
Revised: May 21, 2015
Approved: May 25, 2015
usually occurs among people of 30 to 40 years.13 Similar
to any other clinical condition, an accurate diagnosis
is crucial before managing DH.
Currently various options exist for the treatment
of DH including professional and at home remedies.
Professional treatment is usually invasive and includes
the use of lasers for reducing DH in modern dental
practice14, mucogingival surgery/grafting procedure
and different topical agents applied in clinic such as
resins and bonding agents.15 The home remedy includes
use of desensitizing tooth paste.16 An easy clinical
method of diagnosing DH includes a blast of air and
using investigative probe on the uncovered dentin in
mesiodistal direction, examining all teeth in the area
where the patient experiences pain.17 The severity or
degree of pain can be quantified either according to
categorical scale (i.e., slight, moderate or severe pain)
or using a visual analogue scale.18
METHODOLOGY
The present study was carried out at the Depart-
ment of Periodontology, Khyber College of Dentistry,
Peshawar, KPK, Pakistan. Approval was obtained from
the Ethical committee of Khyber College of Dentistry,
Peshawar. Before treatment each participant was ex-
plained the purpose and procedures of the study and
an informed consent was obtained. Inclusion criterion
included patients having 4 mm attachment loss while
exclusion criteria was patients who had received
non-surgical periodontal therapy within the last three
months, received medicine for any medical problem
during the last three months, having a carious tooth
or defective restoration and Para functional habits.

Pakistan Oral & Dental Journal Vol 35, No. 2 (June 2015) 246

Patients who had undergone tooth whitening during
last three months were also excluded from the present
study. Fifty patients (25 male, 25 female) were random-
ly selected for the present study that had DH due to
attachment loss/periodontal problem. All participants
were in good general health, aged between 25-55 years
and at least two teeth per quadrant of their mouths
that were sensitive to air stimuli (total of 8 teeth in a
single patient).
Participants were examined for their sensitivity
with a controlled blast of air having pressure of 40
p.s.i for 10 seconds from a distance of 1 cm and tooth
sensitivity was evaluated by visual analog scale (VAS).
With VAS, a patient marks the pain intensity on a 10-cm
straight line (0 = no pain, 10 = extreme pain). Patients
with VAS 4 were included in the study. Patients were
divided in two groups (A and B). All patients received
full mouth scaling with root debridement and polish-
ing. Modified Stillman technique of brushing teeth
was demonstrated to all the patients to carry out at
home twice a day. Group A was advised Colgate total
care that contains Sodium Fluoride 0.24% (0.14% w/v
fluoride ion) Tricloson 0.30% marketed by Colgate
Palmolive Pakistan to use with brush. Group B was
advised test toothpaste which contains 8% strontium
Fig 1: Gender-wise distribution of DH over the period
of three weeks of Treatment
TABLE 1: EFFECT OF TOOTH PASTE ON VAS ALONG WITH SD AND SE (TOTAL NUMBER
OF PATIENTS = 50)
Treatment period Treatment groups
Day 1 Total care T/Paste
SensodynR /A T/paste
Week 1 control
Treatment
Week 2 control
Treatment
Week 3 control
Treatment
Pakistan Oral & Dental Journal Vol 35, No. 2 (June 2015)
Reducing dentine hypersensitivity
acetate and 1040 ppm fluoride as NaF in a silica base
currently marketed as Sensodyne Rapid action tooth
paste (Glaxo Smithkline Pakistan) to rub over all the
teeth with finger, wait for 3 minutes and then use soft
tooth brush to clean the teeth. Visual analog scale was
recorded at day 1 (baseline) and patients were recalled
for measuring DH after one, two and three weeks after
use of recommended tooth paste. Statistical analysis
was carried using SPSS version 16 to calculate stan-
dard deviation and standard error. For difference in
scores between two the groups, independent sample-t
test was used.
RESULTS
The data indicated that the overall reduction in
dentin hypersensitivity measured in terms of the
Visual Analog Scale (VAS) for all the patients in the
present study was statistically significant (Tables 1 and
2). Analysis of the data revealed that after the use of
desensitizing tooth paste, all the patients showed less
dentin sensitivity-related pain after 3-weeks follow-up
compared to the baseline. Data shown In Table 1 re-
vealed that different treatment group showed marked
differences in their scores for dentin sensitivity-related
pain when independent sample-t test was used.
The pain level for control group A was higher than
treatment group B even after 3 weeks of continuous
use of Colgate total care tooth paste. The mean values
of the data suggested that pain was high in treatment
group B on day 1 (5.20), however, data recorded after
one week of treatment revealed a reduction in the pain
level (3.77) and three weeks after treatment it was 1.21
when compared with control group (2.31) (Table 1).
The data shown in Table 2 revealed the effect of
duration on DH when measured by VAS. It is clear
from data shown in Table 2 that the VAS on day 1 for
group A was less (4.27) compared to group B (5.26) with
the difference of 0.54. After 3 weeks of treatment, the
VAS for group A reduced to 2.13 compared to group B
with marked reduction in VAS of 1.13. These results
Mean VAS Std. Deviation Std. Error
4.7200 0.94847 0.13413
5.2600 1.174 0.16613
4.0400 0.90824 0.12844
3.7700 1.05565 0.14929
3.3100 0.63800 .09023
2.6400 0.71457 .10106
2.3100 0.66922 .09464
1.2100 0.47477 .06714
247
 Reducing dentine hypersensitivity

TABLE 2: EFFECT OF DURATION ON DH Strontium acetate tooth paste by occluding the dentinal
MEASURED WITH VAS tubules and withstanding acid erosion. Mason et al.20
concluded that the efficiency of tooth paste containing
Duration Group A Group B Differ- 8% Strontium acetate was more, than tooth paste con-
(VAS) (VAS) ence taining Sodium fluoride when evaluated for six weeks,
Day 1 4.27 5.26 0.54 however, our study was carried out for 3rd weeks. The
Week 1 4.04 3.77 -0.27 present study could not be extended beyond 3rd week
due to non-availability of the subject patients. Gillam
Week 2 3.31 2.61 -0.67 and Orchardson21,22 also reported that increased concen-
Week 3 2.13 1.13 -1.1 tration of fluorides can reduce dentine hypersensitivity
probably through precipitation of calcium fluoride
TABLE 3: MEAN AGE OF MALES AND FEMALES
globules within the dentine tubules and that may be
Gender Mean Number of Std. reason of reduction of DH in group A because Colgate
patients Deviation total care contains Sodium Fluoride 0.24% (0.14% w/v
fluoride ion). The results also suggested that the mean
Male 40.2800 25 10.17972 age of all participants was 39.28 years. These results
Female 38.2800 25 7.89789 are also supported by different researchers who con-
Total 39.2800 50 9.07349 cluded that DH increased between the age of 30 to 40
and then decreased.23,24 This study also indicated that
demonstrated that the use of Strontium Acetate tooth males were having average age of 40.28 and females
paste for three weeks drastically reduced the VAS from 38.28. The data showed more DH for male compared
5.26 to 1.21 compared to Sodium fluoride tooth paste with females on day 1. However, treatment for three
for the same period of treatment (Table 2). weeks drastically reduced DH in males than female.
These results do not agree with Amarasena et al25,
The data indicated that the mean age of males was who concluded that females are more affected than
40.28 with standard deviation of 10.17 and females males, however, these differences are statistically non
were having 39.28 with standard deviation of 7.89 significant. Despite the fact that there is little evidence
years where as average age of all the participants were confirming the edge of one toothpaste over the other, yet,
39.28. The data shown in Fig 1 indicated that the VAS desensitizing tooth paste provides relief in overcoming
for male was 5.2 compared with females (4.32) on day the problem.26
1. The data further suggested that treatment up to
three week reduced VAS from 5.2 in males to 1.22 on CONCLUSION
week while the same period revealed reduction of VAS From the present study it can be concluded that
in females from 4.32 to 2.4. the use of desensitizing tooth paste at home is a simple
DISCUSSION remedy. Application of Sensodyne rapid action tooth
paste was more effective to control DH when compared
Presently people are trying to retain their teeth for with Colgate total care tooth for the same period of
longer due to better dental health facilities; therefore, time.
it is reasonable to expect that there seems to be higher
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