Original Article

Evaluating the efficacy of desensitizing

Department of
Endodontics, National
dentifrices on dentinal hypersensitivity
Dental College
and Hospital, Dera management: A scanning electron
microscopic analysis
Bassi, 1Department
of Pediatric and
Preventive Dentistry,
National Dental Vasu Midha, Vishu Midha1, Anuraj Singh Kochhar2, Gulsheen Kaur Kochhar1,
College and Hospital, Ritasha Bhasin3, Himanshu Dadlani4
Dera Bassi, Punjab,
2
Former Orthodontist,
Department of Dentistry,
Max Hospital Gurgaon, Abstract:
Haryana, 3Faculty of Introduction: Dentin hypersensitivity (DH) adversely affects quality of life by impairing the ability to eat and
Dentistry, University drink certain foods, therefore, should be addressed promptly with a contingency plan that includes initial
of Toronto, Toronto, treatment with a noninvasive prophylactic home care approach, followed by in‑office treatment if desired result
is not achieved. Aim: The purpose of this study was to evaluate the effectiveness of four different pastes
Canada, 4Department of
containing 5% NovaMin (Sensodyne Repair and Protect®), Propolis (Phytoshield Propolis®), 5% potassium
Periodontology, Kalka nitrate (Sensodyne®), and 8% arginine (Colgate Sensitive Pro Relief®) based toothpastes in the treatment of
Dental College and DH. Materials and Methods: One hundred dentin slices were cut from the crown section of molars. Etching
Hospital, Meerut, with 37% orthophosphoric acid was done to open the tubules. Scanning electron microscope (SEM) study was
Uttar Pradesh, India done to ensure that the tubules are opened. The dentin specimens were divided into four groups: Group 1 –5%
NovaMin, Group 2 – Propolis, Group 3 – 5% potassium nitrate, and Group 4 – 8% arginine. Samples were
The work belongs to brushed for 2 min twice daily with a soft toothbrush for 15 days and were stored in distilled water. The samples
were rinsed under running water to remove the toothpaste. The SEM was performed to check the obliteration
the Department of
of tubules. Results: 5% NovaMin group showed more completely occluded dentinal tubules when compared to
Endodontics, National other groups. The differences among all the groups were statistically significant (P ≤ 0.05). Conclusion: In the
Dental College and present study, all materials, NovaMin, Propolis, potassium nitrate, and arginine, were effective in occluding dentinal
Hospital, Dera Bassi, tubules but NovaMin appeared most proficient in occluding tubules, followed by arginine, potassium nitrate, and
Punjab, India Propolis. Topical NovaMin is an upcoming agent demonstrating desensitization and remineralization properties.
Keywords:
Dentin hypersensitivity, scanning electron microscope, toothpaste
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DOI:
INTRODUCTION agents are removed by the daily challenge of
10.4103/jisp.jisp_247_20 diet.[4]
Quick Response Code:
D entin hypersensitivity (DH) accounts for
a widespread issue and is a mystery in
diagnosis. The uneasiness that arises as a result
Although there are numerous treatment
modalities such as LASER, regenerative
of DH is said to enormously influence the quality procedures (guided tissue regeneration), and
of life (QoL) of the patients. Review of literature 8% nano‑carbonated hydroxyapatite collagen/
reveals the prevalence of DH anywhere from poly (lactic‑co‑glycolic acid)., [1] toothpastes
4.8% to 62.3%.[1] The terms dentin sensitivity (DS) are still the most widely used dentifrices for
and DH have been used interchangeably to
describe the same clinical condition. Compared This is an open access journal, and articles are
distributed under the terms of the Creative Commons
with the typical sharp pain of short duration Attribution‑NonCommercial‑ShareAlike 4.0 License, which
Address for
correspondence:
seen in DH, true hypersensitivity due to pulpal allows others to remix, tweak, and build upon the work
Dr. Gulsheen Kaur inflammation presents with severe lingering non‑commercially, as long as appropriate credit is given and
the new creations are licensed under the identical terms.
Kochhar, pain, the features of irreversible pulpitis. [2]
National Dental Exposure of dentin due to erosion of the enamel For reprints contact: WKHLRPMedknow_reprints@
College and Hospital, by abrasion, erosion, attrition, and abfraction wolterskluwer.com
Derabassi, Punjab, India. or cementum at the root surface from gingival
E‑mail: gulsheenuppal@ recession are the two most common pathways How to cite this article: Midha V, Midha V,
gmail.com Kochhar AS, Kochhar GK, Bhasin R, Dadlani H.
that lead to dentin exposure and DH.[3]
Evaluating the efficacy of desensitizing dentifrices
Submitted: 07‑Apr‑2020 on dentinal hypersensitivity management:
Revised: 24‑Sep‑2020 Several products have been developed for DH
A scanning electron microscopic analysis. J Indian
Accepted: 04‑Oct‑2020 treatment, but the effects are often temporary,
Soc Periodontol 2021;25:283-7.
Published: 01-Jul-2021 and DH relapses as soon as the desensitizing
© 2021 Indian Society of Periodontology | Published by Wolters Kluwer - Medknow 283
 Midha, et al.: An update on contemporary trends in dentin hypersensitivity

delivering over‑the‑counter desensitizing agents. There is a vast The mean total number of tubules before application of 5%
array of agents available for desensitization containing fluoride, NovaMin (Group 1) was 48.40 ± 3.96, and after the application,
calcium hydroxide, strontium chloride, potassium and sodium the mean number of occluded tubules was 46.40 ± 1.76; hence,
nitrate, glutaraldehyde, etc., A product consisting of calcium it was statistically nonsignificant. The mean value of percentage
sodium phosphosilicate (NovaMin, Sensodyne Repair and of occluded tubules was 95.8 ± 2.20 [Figure 3].
Protect®) has been introduced recently. It claims to reduce the
sensitivity by blocking open tubules and by supplying calcium The mean total number of tubules before application of
and phosphorus ions when the environment is optimum.[5,6] Propolis (Group 4) was 37 ± 5.63, and after the application, the
mean number of occluded tubules was 12.60 ± 3.00. The mean
The present in vitro study was conducted to evaluate value of the percentage of occluded tubules was 33.84 ± 11.76,
the effectiveness of four different pastes containing 5% which was highly significant (P = 0.02) [Figure 4].
NovaMin (Sensodyne Repair and Protect®), Propolis (Phytoshield
Propolis ®), 5% potassium nitrate (Sensodyne ®), and 8% The mean total number of tubules before application of
arginine (Colgate Sensitive Pro Relief®), based toothpastes in 5% potassium nitrate (Group 6) was 39.80 ± 5.63, and
the treatment of DH. after the application, the mean number of occluded
tubules was 20.20 ± 3.00. The mean value of percentage
MATERIALS AND METHODS of occluded tubules was 51.12 ± 11.76 which was highly
significant (P = 0.02) [Figure 5].
After the ethical clearance from the institutional review
board, 100 extracted premolar and molar teeth were collected. The mean total number of tubules before application of 8%
The extractions were indicated either for orthodontic or arginine (Group 4) was 39.80 ± 7.19, and after the application,
periodontal conditions. Included teeth were caries free and the number of mean occluded tubules was 29.40 ± 3.84. The
without any erosion or abrasion. Endodontically treated teeth mean value of percentage of occluded tubules was 73.70 ± 13.35
were excluded. Following cleaning of the teeth from debris and was highly significant (P = 0.023) [Figure 6].
and tissue, the teeth were sectioned to 1 mm thickness from
the region below the crown and above the root canal and DISCUSSION
were stored in 10% formalin. The dentin discs were etched
with 37% phosphoric acid for 20 s and rinsed with distilled Pain being a persistent presenting feature of DH adversely
water. The teeth were randomly divided in four groups: affects the QoL.[7] Several theories have been proposed to
Group 1 (25 teeth) – application of NovaMin containing paste, explain the mechanism of DH, but the hydrodynamic theory
Group 2 (25 teeth) – application of Propolis containing paste, has been widely accepted.[8] This theory states that pain can be
Group 3 (25 teeth) – application of potassium nitrate containing perceived by the patient due to fluid movement in the dentinal
paste, and Group 4 (25 teeth) – application of Arginine tubules, which causes nerve ending deformation at the pulp
containing paste. The discs were subjected to a pretreatment dentin junction.[9] It is a well‑known fact that the agents effective
scanning electron microscope (SEM) analysis [Figure 1]. in the treatment of DH have affinity for dentin and occlude the
tubules and are effective for tooth sensitivity.
Examination (scanning electron microscope)
All the specimens of the respective groups were kept in 10% The width of the dentinal tubule is significant, as the rate of
formalin solution for 48 h to fix the samples. These specimens fluid flow is dependent on the fourth power of the radius. With
were dehydrated in ascending concentrations of aqueous the tubule diameter being doubled, a 16‑fold increase in fluid
alcohol solutions which were 70%, 80%, 90%, and 100% alcohol flow results. Sensitive teeth have many more tubules (about
for 10 min each. Following the dehydration process, specimens 8 times) and almost double the width at the buccal cervical area
were first air dried and then kept in a desiccator jar overnight. compared with nonsensitive teeth. The episodic condition of
Dried samples were mounted on SEM stubs. Specimens were DS is resultant of the tubule patency, which is altered by smear
then sputter coated with gold in a fine coat (JEOL 10 Nsputter layer formation and elimination.[10]
JFC 1100) by a sputtering device. The mounted specimens were
evaluated using model JEOL 6100 (SEM). There is a direct correlation between DH and thickness of the
tubules.[11‑13] In in vitro study, dentin surface area, thickness,
Samples were brushed for 2 min twice daily with a soft and surface characteristics can be controlled. Hydraulic
toothbrush with respective toothpaste for 15 days and were conductance causing DH is higher in coronal dentin when
stored in distilled water. The samples were rinsed under compared with radicular dentin. A positive correlation exists
running water to remove the toothpaste. The SEM study between tubule density and diameter and the measured
was performed. The micrographs were taken at appropriate hydraulic conductance.[14]
magnification and were evaluated for patent dentinal tubules.
The obtained data were tabulated and statistically analyzed Keeping these findings in view, this in vitro study was carried
used pair and unpaired t‑test. out to evaluate the tubular occlusion formed by four different
desensitizing dentifrices containing 5% NovaMin, Propolis,
RESULTS 5% potassium nitrate, and 8% arginine.

The mean number of occluded tubules was maximum for Sensodyne Repair and Protect ® contains NovaMin key
NovaMin, followed by arginine, potassium nitrate, and constituent, which is an over‑the‑counter DH dentifrice. It
Propolis [Figure 2]. is technically described as an inorganic amorphous   calcium

284 Journal of Indian Society of Periodontology - Volume 25, Issue 4, July-August 2021
 Midha, et al.: An update on contemporary trends in dentin hypersensitivity

Figure 1: Scanning electron microscope image of dentin disc presenting open

dentinal tubules Figure 2: Intergroup comparison of different groups

Figure 4: Scanning electron microscope image of dentin disc following the

Figure 3: Scanning electron microscope image of dentin disc following the application of Propolis (Group 2)
application of 5% NovaMin sample (Group 1)

Figure 6: Scanning electron microscope image of dentin disc following the

application of 8% arginine (Group 4)
Figure 5: Scanning electron microscope image of dentin disc following the
application of 5% potassium nitrate (Group 3)
causes the formation of an apatite layer which further leads
sodium phosphosilicate (CSP) material that was designed to the occlusion of dentinal tubules.[3] Topical NovaMin
based on a class of materials known as bioactive glasses.[15] application has significant remineralization potential along
Silicate acts as foci for precipitation of calcium and phosphate. with desensitization action which is a win‑win situation for
SEM analysis has shown that the application of bioglass the patients.[16]

Journal of Indian Society of Periodontology - Volume 25, Issue 4, July-August 2021 285
 Midha, et al.: An update on contemporary trends in dentin hypersensitivity

Propolis, obtained from honey bees, is a nontoxic, resinous hydroxyapatite was effective for tactile and air stimuli with
substance composed of resins, wax, essential oils, and pollen moderate certainty of evidence. Among all active ingredients,
exhibiting anti‑inflammatory, antimicrobial, antiparasitic, calcium sodium phosphosilicate (CSP) was more effective for
antiviral, antioxidant, anesthetic, and free‑radical scavenger all three stimuli with high‑to‑moderate certainty. Furthermore,
properties.[17] The use of Propolis to study the occlusion of SnF2‑based formulations seem to be more effective than
dentinal tubules, as a treatment modality for DH, is scarce regular‑fluoride toothpastes to manage DH due to tactile
in the literature, making this study innovative, and the and air stimuli with high‑to‑moderate certainty.[31] Another
concept of a naturally derived product adds further to the systematic review of 74 articles suggested marked long‑term
innovation.[18] reduction in DH with agents such as potassium nitrate, arginine,
glutaraldehyde with hydroxyethyl methacrylate (HEMA),
Potassium possibly blocks the transmission of nerve endings hydroxyapatite, adhesive systems, glass ionomer cements, and
by its oxidizing effect or blocking of tubules by crystallization, LASER, whereas short‑term relief (1 week) was seen by the use
but the exact mechanism has not been proven.[19,20] potassium of glutaraldehyde with HEMA, glass ionomer cements, and laser,
salts (potassium nitrate, potassium chloride, or potassium and intermediate DH reduction (up to 1 month) was seen in
citrate) depolarize the nerve cells, causing them to become stannous fluoride, glutaraldehyde with HEMA, hydroxyapatite,
refractory to excitatory stimuli by diffusion along the dentinal. glass ionomer cements, and laser groups. Moreover, in‑office
The cumulative effect of potassium nitrate may take several treatments were more efficacious for immediate DH reduction
weeks for reducing DH.[20] and at‑home treatments are recommended for long‑time
effects.[32]
Arginine‑containing toothpastes (arginine bicarbonate and
calcium carbonate) mimic natural desensitizing processes of the With the advent of newer materials, many recent studies
saliva and can form a plug to physically block and seal the open have shown promising results. Li et al. have suggested
dentinal tubules so as to minimize DH.[21] Arginine suppresses that procyanidins, tannic acid, and naringin can effectively
protein interactions with other molecules or surfaces exhibiting seal dentinal tubules, which provided a basis for clinical
antiviral properties.[22] treatment of DH.[33] Polymers containing catechol groups
exhibited modification of demineralized dentin by promoting
Arantes et al. compared the clinical efficacy of Pro‑Arginine imitating the role of charged noncollagenous proteins.
and NovaMin toothpastes, in which they concluded that no The use of poly (catechols) may be encouraged for the
statistical difference was observed among the two toothpastes development of a therapeutic technique for DH.[34] Mir et al.
and both can be prescribed to treat DH in adults with equivalent compared the effectiveness of home‑use photobiomodulation
effectiveness up to 4 weeks.[23] toothbrush with fluoride varnish and combination of the
two and observed a significant reduction in dentin pain
A similar study by Bansal and Mahajan comparing 1:5% and hypersensitivity concluding photobiomodulation
NovaMin, 8% arginine, and herbal desensitizing toothpaste toothbrush a convenient, safe, and effective method for the
found that there was a significant change in the VAS scores in management of DH.[35] Mesoporous bioactive glass combined
NovaMin when compared to arginine and herbal toothpastes. with Graphene Oxide Quantum Dot is a promising treatment
NovaMin showed a better reduction in hypersensitivity which modality for DH which needs to be explored on a larger study
is in accordance with our results.[24] sample size.[36]

Results of Burwell et al. also were in accordance with our study, CONCLUSION
where he stated that a mechanically strong, mineralized layer,
resistant to acid challenge was formed when exposed dentin 1. DH adversely affects QoL by impairing the ability to eat
reacted with NovaMin. There was a sustained release of calcium and drink certain foods therefore should be addressed
over time which suggested to maintain the protective effects on promptly by clinicians with a contingency plan
dentin.[25] However, a study by Hoffman et al. and Khijmatgar 2. Therapy should be initiated with a prophylactic home
et al. advocated that NovaMin has nonsignificant effects care approach, followed by in‑office treatment with nerve
on remineralizing effects on white spot lesions. Our results desensitization, precipitating, or plugging agents if desired
indicate that a toothpaste containing,[26,27] whereas Haghgoo result is not achieved
et al. confirmed that topical NovaMin and nano‑hydroxyapatite 3. In the present study, all materials, NovaMin, Propolis,
were effective on surface remineralization.[28] potassium nitrate, and arginine, were effective in occluding
dentinal tubules but NovaMin appeared more promising
Askari and Yazdani proposed that Propolis extracts were in occluding tubules and formation of dentin matrix‑like
uniformly effective irrespective of their concentration and were surface layer completely after initial application followed by
equally efficacious to the application of single bond universal arginine, potassium nitrate. Propolis was least efficacious
in relieving DH.[29] Kripal et al. also implied propolis varnish as 4. Topical NovaMin is an upcoming agent demonstrating
a natural treatment modality for DH. It also has antimicrobial, desensitization and remineralization properties.
anti‑inflammatory, healing. and cariostatic properties along
with stimulation of reparative dentin formation.[30] Financial support and sponsorship
Nil.
Martins et al. concluded that strontium and potassium showed
moderate effectiveness for tactile stimulus and arginine for Conflicts of interest
air stimulus. The combination of potassium with SnF2 or There are no conflicts of interest.

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 Midha, et al.: An update on contemporary trends in dentin hypersensitivity

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