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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 191-199

Comparison of two different forms of varnishes in the treatment of dentine hypersensitivity: A subject-blind clinical study in Lagos State university teaching hospital


1 Department of Restorative Dentistry, Lagos State University Teaching Hospital, Ikeja, Nigeria
2 Department of Preventive Dentistry, Lagos State University Teaching Hospital, Ikeja, Nigeria
3 Faculty of Family Dentistry, NPMCN, Ijanikin, Lagos, Nigeria

Date of Web Publication15-Dec-2017

Correspondence Address:
Afolabi Oyapero
Department of Preventive Dentistry, Faculty of Dentistry, Lagos State University College of Medicine, P. O. Box: 21266, Ikeja, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_47_17

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  Abstract 

Background: Dentine hypersensitivity is a significant clinical problem affecting several age groups within a population. Aim: This subject-blind randomized clinical study was designed to determine the clinical outcomes of two different varnishes in the management of dentine hypersensitivity. Materials and Methods: Self-reporting, consenting patients (n = 56) referred to the restorative unit of the dental center, Lagos State University Teaching Hospital (LASUTH), were examined for dentine hypersensitivity using the air jet and tactile probe methods. Enlisted patients were randomly assigned into Duraphat or Cervitec Plus varnish groups in a split-mouth study design. The teeth were assessed for sensitivity, and this procedure was repeated on week(s) 1, 2, and 4 following the initial visit. The data collected were analyzed using SPSS version 20, and statistical significance was done using the Student's t-test. P ≤ 0.05 was considered statistically significant. Results: The most affected teeth were the first molars (27.8%) followed by the second premolars (17.6%). There was a significant reduction in sensitivity following application of both control and experimental varnishes on day 1 and much further reduction by week 4. At week 4, P value using the tactile method was 0.090 while that of the air jet was 0.101. However, there was no statistically significant difference in the efficacy of the control and experimental varnishes. Conclusion: Duraphat exhibited better efficacy in the reduction of dentinal hypersensitivity, though the difference was not statistically significant. The Duraphat and Cervitec Plus varnishes can be substituted one for the other, though the Duraphat varnish is more readily available in our environment and costs less than Cervitec Plus varnish.

Keywords: Chlorhexidine-based varnish, dentine hypersensitivity, fluoride varnish, visual analog scale


How to cite this article:
Owoturo OE, Loto AO, Awotile AO, Oyapero A, Ebigwei SO. Comparison of two different forms of varnishes in the treatment of dentine hypersensitivity: A subject-blind clinical study in Lagos State university teaching hospital. Arch Med Health Sci 2017;5:191-9

How to cite this URL:
Owoturo OE, Loto AO, Awotile AO, Oyapero A, Ebigwei SO. Comparison of two different forms of varnishes in the treatment of dentine hypersensitivity: A subject-blind clinical study in Lagos State university teaching hospital. Arch Med Health Sci [serial online] 2017 [cited 2018 May 25];5:191-9. Available from: http://www.amhsjournal.org/text.asp?2017/5/2/191/220826




  Introduction Top


Dentine hypersensitivity is a frequently encountered clinical condition, which has not yet been clearly understood by dental practitioners, despite being extensively studied.[1],[2] It is an exaggerated painful response to the stimulation of vital dentine exposed to the oral environment, resulting in extreme discomfort to the patient. It is characterized by short-term, acute pain of variable intensity, which occurs in response to thermal, tactile, osmotic, or chemical stimuli that cannot be attributed to any other type of defect or dental pathology.[1] A huge variation, in the reported prevalence of dentine hypersensitivity, ranging from 1.1% to 98% has been ascribed to various methodologies adopted by different studies.[3],[4] However, according to general scientific consensus, between 10% and 30% of the global population are affected by this condition.[1],[5],[6] Nigeria has a relatively high prevalence of dentine hypersensitivity which ranges between 5% and 50% and varies across different age and occupational groups, geographic areas, and cultures.[7]

Dentine hypersensitivity has a multifactorial etiology. The most common factors that are responsible for dentine hypersensitivity are abrasion, mainly caused by inappropriate tooth brushing technique; abfraction, caused by tooth flexion with ill-directed occlusal forces, parafunctional habits, or occlusal disequilibrium; erosion, as an effect of acids in the oral cavity; anatomic predisposition due to structural deficiency in the enamel-cementum junction; cavity preparations in teeth with vital pulp that expose the dentine; as well as improperly controlled dentinal acid conditioning.[8],[9] The varied presentations of this condition, ranging from minor inconvenience to the patient to a near incapacitating quality-of-life disturbance, and the wide range of treatment strategies certainly pose a challenge to the clinician. Exposed vital dentine responds to a varied assortment of stimuli, for example, dietary factors such as an iced or cold beverage to environmental influences such as exposure to atmospheric air on a cold breeze. The pain associated with dentinal hypersensitivity may be localized or generalized, affecting one or more tooth surfaces concomitantly, and ceases immediately after removal of the painful stimulus.[10] It may be associated with exposure of the root dentine following loss of cementum and overlying periodontal tissues. It can also occur as a result of exposure of cervical dentine due to loss of enamel.[11]

Exposure of dentine is not sufficient to cause hypersensitivity, but the corresponding dentinal tubules must be open to allow for fluid diffusion. These fluid movements stimulate nerve fibers to elicit painful nerve sensations in the pulp by activating mechanoreceptors of nerves situated at the inner ends of the tubules or in the outer layers of the pulp. It has been shown that sensitive teeth have much greater numbers of open tubules per unit area of exposed dentine as well as about double the average tubules' diameter compared to nonsensitive teeth. Therefore, it is postulated that the fluid diffusion in sensitive teeth is about a hundred times greater compared to nonsensitive teeth.[9]

Treatments for dentine hypersensitivity are numerous and depend on the presentation of the condition. It includes materials that act by nerve desensitization,[12] those that precipitate protein,[1] plug dentinal tubules,[13] and also dentine adhesive sealers [12] such as fluoride varnishes. These varnishes consist of natural resin-based vehicles for fluoride and are highly adhesive to tooth structure, easy to apply, and relatively inexpensive.[14] Fluoride varnishes were introduced to increase the efficacy and substantivity of fluoride when in contact with the tooth surface, in order to allow for a slow and continuous release of fluoride.[15] Chlorhexidine-containing varnish is also a more recent regimen for desensitization, with antimicrobial properties for caries resistance and control of periodontal infection, but very little data are available on its effectiveness for dentinal hypersensitivity in developing countries. The aim of this study is thus to compare the efficacy a fluoride-based varnish (Duraphat 5% F) and a chlorhexidine-based varnish, -Cervitec Plus (Ivoclar Vivadent) in the management/treatment of dentine hypersensitivity in a subject-blind, randomized clinical study.


  Materials And Methods Top


Study design

This was a subject-blind, experimental clinical study comparing efficacy a fluoride-based varnish (Duraphat 5% F) and a chlorhexidine-based varnish, -Cervitec Plus (Ivoclar Vivadent) in the management of dentine hypersensitivity using the split-mouth design.[16]

Description of study area

The dental center is the clinical unit of the Faculty of Dentistry of the Lagos State University College of Medicine located in the Lagos State University Teaching Hospital (LASUTH) on Oba Akinjobi Road GRA Ikeja, Lagos State, Nigeria. LASUTH is one of the tertiary health institutions located within Lagos State; hence, it is a referral center that meets the health needs of most residents within Lagos and its environs. The Conservative Dentistry unit has eight operatories, each equipped with fully functional dental chair and its accessories. There is a central room that has three autoclaves for sterilizing instruments, two rooms where radiographs are taken and processed and patients' waiting area and restrooms. There are 6 dental nurses, on hand to assist the dentists. The dental center is connected to the main hospital stand-by generator to render dental service with minimum interruption.

Study population

Study population was made up of the patients referred to the Conservative/Restorative Unit from Oral Diagnosis Unit of the dental center LASUTH for the management/treatment of dentine hypersensitivity over a period of 12 months from January to December 2015. Males and females between the ages of 18–70 years were included in the study once they met the selection criteria.

Sample size determination

Using the sample size formula [13] as shown,



where

n = Number of subjects in each treatment (or sample size)

α = Type 1 error (from the normal table) = 0.05 (precision value)

β = Type 11 error (0.20)

Confidence interval of 95%

δ = Projected improvement or allowed error or effect size.[17]

therefore,



n = 25.52 patients

However, sample size was increased to 30 patients per group making a total of 60 teeth to be treated with both varnishes. This was to accommodate for patient defaulting at follow-up periods.

Sampling technique/randomization

Study sample comprised patients with at least two sensitive teeth in different sides of the mouth that presented at the Conservative unit of Restorative Department of LASUTH. Affected teeth were any incisor, canine, premolar, or molar with sound-exposed cervical dentine on the labial surface that was at least moderately sensitive to timed application of tactile and air stimuli. The teeth/sides to be used for the experiment were randomly allocated by simple ballot to Duraphat varnish (the control) and Cervitec Plus (experimental varnish). One ballot box contained rolled enclosed envelopes on which was written “varnish D” or “varnish C”.” Varnish D” was Duraphat gel (Colgate Oral Pharmaceuticals, New York City) and 'Varnish C” was Cervitec Plus. Another box contained enclosed envelopes in which the teeth/sides of the mouth to be used for the study had been written. One envelope was picked from one box, while another envelope was picked from the other box. Both envelopes were opened in the presence of the research assistant. The randomly selected varnish was then used on the teeth/side selected.

Inclusion criteria

The selection of patient and teeth was based on the following criteria:

  • Patients with teeth hypersensitive to air stimulus and good oral hygiene
  • Presence of noncarious cervical lesions
  • Oral conditions that pointed to possible diagnosis of dentine hypersensitivity, that is, teeth that had gingival recession, attrition, abrasions, abfractions, and erosion
  • Absence of severe systemic and/or psychological diseases such as bulimia.


Exclusion criteria

  • Teeth restored within the preceding 3 months
  • Teeth with extensive restorations as well as defective restorations
  • Abutment teeth for removable or fixed prostheses
  • Cracked teeth and chipped teeth
  • Crowned teeth
  • History of current/recent desensitizing therapy
  • Deep periodontal pocket and periodontal therapy/surgery in the last 6 months
  • Any chronic systemic disease
  • Also excluded were pregnant and lactating women.


Ethical clearance and permission to conduct the study

Ethical clearance for the study was obtained from the Ethics and Research Committee of the LASUTH. The title of the study was registered by the same committee. In addition, written consent of each patient was obtained before being included in the study. Patients who agreed to participate in the study were assured of their confidentiality and that there was no undesirable consequence for those that declined.

Instruments of measurement

Questionnaire

This was a self-administered questionnaire comprising three segments which are sociodemography, pain history, and clinical examination through which the following data were collected – subject's sex, age, nature of pain/sensitivity, frequency of episode, initiating stimuli, type of toothbrush used, medical history, tooth-type affected, and surfaces affected.

Visual analog scale

The degree of hypersensitivity was determined, using the visual analog scale (VAS). The VAS is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured, such as pain. When responding to a VAS item, in this case sensitivity of affected teeth, respondents specify their level of agreement to a statement by indicating a position between 0 and 10 on a 10 cm line, where 0 is no pain and 10 is the worst possible excruciating pain.[18]

Desensitizing agents

Desensitizing agents applied on affected teeth of selected patients were as follows:

  1. Duraphat 5%F (Colgate Oral Pharmaceutical, New York City)® contains ethanol 96%, white wax (E901), shellac DAB (E904), Colophony, Mastic, Saccharin (E954), and raspberry essence.


  2. This was the varnish used as the control.

  3. Cervitec Plus (Ivoclar Vivadent)® contains ethanol, water, Acrylate copolymer, Vinyl acetate copolymer, Chlorhexidine diacetate (1%), and Thymol (1%).


This was the test or experimental varnish.

Validation of the study instrument

The instrument of measurement was pretested on 10 patients' teeth and a tooth only from each patient who presented at the oral diagnosis unit.

Data collection

Materials

  1. Diagnostic set: dental mirror, dental probe, and college tweezers
  2. Others: cotton rolls, cotton pellets, gauze packs, sterile water, periodontal scalers, and VAS
  3. Dental unit, slow speed handpiece, and disposable applicator brush
  4. Duraphat 5%F (Colgate Oral Pharmaceutical, New York City)® contains ethanol 96%, white wax (E901), shellac DAB (E904), Colophony, Mastic, Saccharin (E954), and raspberry essence.


  5. Used as the control.

  6. Cervitec Plus (Ivoclar Vivadent)® contains ethanol, water, Acrylate copolymer, Vinyl acetate copolymer, Chlorhexidine diacetate (1%), and Thymol (1%).


Used as the experimental varnish.

Methods

The participants were consecutively selected as they reported in the dental clinic. Each of the selected patients had at least two sensitive teeth, with each tooth being on either side of the mouth forming two experimental units – the left side of the mouth being a unit and the right side being another, and the units were randomly assigned to either of the treatment varnishes by ballot. The Duraphat varnish was applied on one side/tooth/unit and served as the control varnish while the Cervitec Plus was applied to the other unit, and served as the experimental varnish.

Baseline data collection

A detailed history was taken from each case who satisfied the selection criteria which included hospital number, address, age, sex, and occupation. The presenting complaint and history of presenting complaint were documented. The past dental history taken from each case included past dental treatments such as extractions, periodontal surgery and treatment, endodontic procedures, and any history of use of topical agents to relieve any form of dental pain. Past medical history was taken to ascertain any underlying systemic conditions such as diabetes mellitus, allergies, pregnancy, and use of medication that may contraindicate the involvement of the subject in the study. A thorough clinical examination was done followed by a radiographic investigation. Extraoral examination determined facial asymmetry, mouth opening, and temperomandibular joints. Intraorally, the oral mucosa, gingiva, and tongue were examined for swelling and ulcerations. All standing teeth were examined; their number, position, mobility, and occlusal relations were noted. Also, any evidences of caries, wear facets, fractures, chipping, and dentine hypersensitivity were recorded. Clinical examination was performed using a uniform light source, provided by a conventional operating light system, a mouth mirror, and a probe. With the aid of a film holder using parallel technique, periapical radiographs of teeth likely to be included in the study were taken for diagnostic purposes.

To commence with each subject, a self-administered questionnaire was filled and treatment result sheets opened for each subject to be included in the study. The subjects had dental prophylaxis, and the initial hypersensitive pattern (baseline score) was recorded. Each tooth received two stimuli, which were scratching with the dental probe (tactile stimulus) and air blast using the air jet. The tactile (or probe) stimulus was performed under slight manual pressure in the mesiodistal direction on the cervical area of the tooth using the dental probe until the patient reported pain similar to the one that had prompted him to seek medical attention. After about 5 min, the air blast stimulus was also applied on the lesion at a distance of 0.5–1 cm to the tooth surface for 2 s through the compressed air jet from the dental unit to avoid desiccating the dentin surface.

After each stimulus, the degree of hypersensitivity was determined by the patients using the VAS from 0 to 10 placed on a 10 cm line, which corresponded to:

  • 0 cm = no pain
  • 2 cm = mild pain
  • 4 cm = discomforting pain
  • 6 cm = distressing pain
  • 8 cm = horrible pain
  • 10 cm = excruciating pain.


The VAS was provided on a sheet of paper on which the patients identified points that corresponded to the degree of pain experienced following each stimulus and each of these values recorded.

The subject's mouth was rinsed first and then followed by dental prophylaxis using the periodontal scalers to remove gross plaque accumulation. The control or experimental agents were applied to the selected teeth/side by simple ballot. The selected teeth for test were isolated from adjacent ones using cotton rolls and the dentine dried with the air jet. The subjects did not know what materials (varnishes) were being applied to their (sensitive) teeth. The application of the varnishes was done following manufacturer's instruction. Any excess was removed using cotton pellets. For both Duraphat and Cervitec Plus, a disposable applicator brush was used to apply a single-layered coating on the dried tooth surface and left to dry. After 10 min, these teeth were assessed for sensitivity using first the tactile (probe) stimulus then the air jet after a 5 min interval and the values were recorded.

Data collection at 1, 2, and 4 week(s)

The pain assessment was done once they presented for follow-up visit on week 1 before application of the varnishes, and the values were recorded. The teeth were dried with the air jet, then isolated with cotton rolls and the same test varnishes selected at the first visit (day 1) were applied on the corresponding teeth/side selected by the ballot at that maiden visit. The teeth were left to dry for about 10 min and the values were read and recorded. This process was repeated on week 2 and week 4. Application of varnishes and the measurement using the VAS was done by the same operator throughout this study.

Postoperative instruction

In all, 56 patients were each allocated the two agents for treatment and clinical responses assessed over a 4-week period. The patients were instructed to avoid using any other in-office desensitizing agent and/or dentifrices containing desensitizing agents during the study. They were also given dietary advice as an adjunct to the management of the condition.

Data analysis

The data collected during the period revealed the subjective response of each subject using the VAS for the analysis of effectiveness of the two desensitizing agents where 0 is the most effective (no pain) and 10 the least effective (excruciating pain). These results were analyzed using Statistical Package for Social Science (SPSS) for Windows version 20.0. Analysis included frequency, cross tabulation, and calculation of mean values. Differences of mean values were tested using the Students t-test. The categorical variables were analyzed using the Chi-square test. All tests were carried out at 5% level of significance.

Limitations

Evaluation of clinical performance of desensitizing agents requires long-term follow-up to ascertain the clinical performance over time. People also have different threshold for pain and subjective responses may not be the best for determining the degree of pain, with a view to giving effective management.


  Results Top


Sociodemographic distribution

Fifty-six respondents consisting of 26 (46.4%) males and 30 (53.6%) females completed this study. The majority (38, 67.9%) of respondents were over 40 years of age and business men/artisans constituted 21 (37.5%) while 19 (33.9%) were professionals. During the study, there were no reported adverse events such as allergic reactions or pulpitis. Recall rate was 93.3% as 4 respondents were not available for the follow-up periods [Table 1].
Table 1: Sociodemographic characteristics of participants

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Characteristics of pain, predisposing factors, and triggers of dentine hypersensitivity

The majority (45, 80.3%) of respondents presented with hypersensitivity as severe pain that was nonradiating (46, 82.1%). Pain frequency was occasionally in 32 (57.1%) respondents and majority (54, 96.4%) had no history of vomiting. Most of the respondents felt pain while drinking (83.6%), on exposure to cold (96.4%) and sour stimuli (50%) [Table 2]. The mean duration of tooth sensitivity before presentation for females was 1.8 ± 1.94 years compared to males (2.78 ± 1.05 years) although this was not statistically significant [Table 3].
Table 2: Distribution of factors contributing to hypersensitivity

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Table 3: Tolerance to tooth sensitivity prior to presentation (years) (n=56)

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Tooth surfaces most commonly affected were occlusal (36.17%) and cervical (34.04%) which were both evidenced by loss of enamel tissue. Over 8.5% of respondents presented with a combination of occlusal and cervical tooth surface loss. Only 6.38% of respondents presented with sensitivity on the labial and buccal surfaces without obvious tooth tissue loss. The differences were however not significant [Figure 1].
Figure 1: Pie chart showing the tooth surfaces involved in male and female subjects. Enamel tissue loss is commonly seen on the occlusal surface followed by the cervical surface

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In all 205 teeth examined, 60% (123 teeth) showed signs of attrition and was abrasion seen in 56.1% (115 teeth). The tooth-wear type least observed was abfraction (3.4%, 7 teeth). Gingival recession was seen in 128 (62.4%) of all hypersensitive teeth examined [Table 4].
Table 4: Frequency of predisposing factors implicated in toothwear

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The teeth that were most commonly affected in all four quadrants were the first molars followed by the premolars ( first and second premolars). Each side of the mouth had an almost equal distribution of teeth type [Table 5].
Table 5: Frequency of type of teeth according to treatment type

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Following application of Duraphat (the control varnish) and Cervitec Plus (the experimental varnish), the baseline scores of pain significantly dropped which was confirmed with the application of air jet and tactile stimuli [Table 6]. Similar significant reduction in pain scores was observed at subsequent stipulated intervals [Table 7], [Table 8], [Table 9].
Table 6: Mean comparison of pre- and post-treatment sensitivity assessment after using Cervitec Plus and Duraphat at baseline/day 1 (n=205)

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Table 7: Mean comparison of pre- and post-treatment sensitivity assessment after using Cervitec Plus and Duraphat at week 1 (n=205)

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Table 8: Mean comparison of pre- and post-treatment sensitivity assessment after using Cervitec Plus and Duraphat at 2 weeks (n=205)

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Table 9: Mean comparison of pre- and post-treatment sensitivity assessment after using Cervitec Plus and Duraphat at 4 weeks (n=205)

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  Discussion Top


In the present study, a comparison of the short-term effectiveness of two tubule occluding varnishes - a chlorhexidine-based varnish Cervitec Plus (the experimental varnish) and a fluoride varnish Duraphat (the control varnish) was done. More females than males were shown to have dentine hypersensitivity. Although not statistically significant, this corroborates previous studies [19],[20] which could be because women are more sensitive to pain than men [21],[22] while one study showed higher prevalence in males.[23] However, the reasons for difference between the two genders regarding the prevalence of dentine hypersensitivity are not yet clear.[24] It could be attributed to the fact that women have better overall healthcare and oral hygiene awareness, which would make them more prone to predisposing factors such abrasion due to tooth brushing.

Respondents over 40 years of age were in the majority, in line with an independent research study of 683 adults drawn from a nationally representative sample of Canadians which showed a 30% prevalence of sensitive teeth in adults ranging from 18 to 64 years of age.[2] Studies have shown that older people and younger individuals with poor oral hygiene will develop periodontal disease which may predispose to dentine hypersensitivity due to root exposure from gingival recession.[25],[26] One hundred and twenty-eight sensitive teeth in subjects above 40 years of age in the present study showed some gingival recession and one or more type of tooth wear which could be attributed to diet, physiologic changes, poor oral hygiene, and/or parafunctional habits such as bruxism.[27],[28] It is pertinent to note that some teeth had undergone periodontal changes, thereby confirming the report of Addy [27] that periodontal changes and disease condition that cause gingival recession acts as a precursor to developing sensitivity.

The majority of respondents (80.3%) in the present study had sensitivity presenting as severe pain of short duration. The tolerance to pain can vary considerably among individuals and within them, depending on the time and circumstance because the perception of pain depends on individual factors such as psychological factors, educational level, personality, and pain threshold among others.[22] These circumstances and individual factors may be the reason people try to manage the condition of dentine sensitivity on their own, in the way they know how before reporting in the dental clinic. This period of self-medicating/self-management which could be referred to as their tolerance level to dentine hypersensitivity and/or pain before reporting it in the dental clinic, was shorter in females (1.88 ± 1.94 years) when compared to males (2.78 ± 1.05 years), though there was no statistically significant difference between gender. In this type of situation, they usually try to avoid things that may trigger pain.[22]

On application of both varnishes after obtaining the baseline scores, there was instant relief of sensitivity manifesting either as marked reduction in sensitivity or pain as reported by the patients. This may be due to the fact that both Cervitec Plus and Duraphat function by occluding the tubules. While Duraphat forms a complex, the calcium-fluoride crystal that plugs the tubules, Cervitec Plus seals the dentinal tubules as well with acrylate copolymer and vinyl acetate, the vehicle that carries chlorhexidine and thymol. Previous studies have shown that the crystals formed are of a small size (0.05 μm), and a single application of varnish could be effective in occluding the dentinal tubules.[29]

It has been shown that multiple applications further improve the efficacy of the fluoride varnish.[29] This was confirmed by the results in the 1st week of application of both varnishes, with further reduction at subsequent visits, throughout the study. A study in line with the result of the present study conducted by Lan et al.[30] showed that the fluoride varnish (Duraphat) at a concentration of 2% was capable of reducing the dentin hypersensitivity scores after the first application. On a single application of 5% sodium chloride topically, most of the fluoride is released within 2 weeks with small amounts being released up to 21 weeks after as reported in a previous study.[31] This may be the reason for the almost immediate and sustained reduction in sensitivity following initial application of Duraphat seen in this study. Similar observations were made with Cervitec Plus. In a previous study, Sethna et al.[32] compared two varnishes one of which was Cervitec Plus varnish and followed up the respondents up to 12 weeks posttreatment. There was significant effectiveness of the Cervitec Plus varnish. On assessment, at the follow-up visit, there was a marginal increase in sensitivity of the teeth relative to previous visit, but generally the participants were satisfied with the progress made.

Comparing these mean values obtained for the two varnishes revealed minor differences, which was not statistically significant. In this study, there were noticeable reduced mean values of sensitivity following application of both varnishes compared to pre-assessment in both tactile and air jet baseline values. Likewise, at 1-, 2-, and 4-week periods following baseline assessment, all were found to be statistically significant. Based on this study, which is in agreement with some previous studies,[30],[32] repeated application of these varnishes over a specified time frame has a potentiating effect which desensitizes the tooth offering comfort and relief to the patient.

Except at baseline following application of the test varnishes, testing with the tactile method showed that Duraphat was more effective in reducing dentine sensitivity which could be due to the fact that calcium fluoride crystals formed, occluded the tubules, and there was an immediate and a sustained slow release of fluoride for that 1st week. By the 4th week of applying the varnish, Duraphat showed possibility of further reduction of sensitivity based on its mechanism of slow, sustained release of calcium fluoride crystals. Duraphat varnish sets in contact with intraoral moisture and thorough drying is not required before application of the varnish.[33] The varnish remains on the tooth surface for several hours. Microscopic evaluations of the enamel surface have shown that small blocks of varnish remain attached to enamel even after demineralization challenge and sonication in vitro.[34]

Cervitec Plus also reduces the hydraulic permeability of dentin, and from a chemical point of view, the varnish polymer and the solvent mixture of Cervitec Plus are hydrophilic, making it increased moisture tolerant during application. Furthermore, the adhesion of Cervitec Plus varnish may explain the longer duration of reduction in hypersensitivity. The efficacy of Cervitec Plus could still be observed 90 days after application because of better adhesion of the varnish.[35] In effect, Cervitec Plus gives rapid desensitization on application with sustained desensitization for up to 90 days (3 months) while Duraphat gives rapid and sustained desensitization for up to 24 weeks (6 months).[36]

The first line of treatment of dentine hypersensitivity should be removal/modification of causes and/or predisposing factors of dentine hypersensitivity coupled with daily use of desensitizing toothpastes.[1],[2] Oral hygiene instructions, including correct tooth brushing techniques as well as a regular dental follow-up, will play a significant role in the prevention of dentine hypersensitivity. Considering the frequency of presentation in our clinics, every dental clinic (private and public) should be equipped with at least one of these desensitizing agents. Further studies clinical with long-term assessment should be conducted to evaluate the efficacy of these desensitizing agents on the long run.


  Conclusion Top


Among the study group, more females than males presented with hypersensitivity of the teeth and the most common predisposing factor was attrition. Gingival recession was a significant contributing factor. Both Cervitec Plus and Duraphat exhibited high efficacy in reducing dentinal sensitivity. Duraphat had a better efficacy in reducing dentinal hypersensitivity, though the difference was not statistically significant. Choice of material to use will however depend on patients' clinical presentation, availability of the material, cost, and clinician's preference.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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