pyri ORIGINALCo ARTICLEgh Not for Publicationt b y Q u Comparison of Two Different Forms of Varnishes in the N i n o t t r f e o Treatment of Dentine Hypersensitivity: A Subject-Blindssence Randomised Clinical Study* Gulnar Dara Sethnaa/M.L.V. Prabhujib/B.V. Karthikeyanc Purpose: Dentine hypersensitivity is one of the most frequently recorded complaints of dental discomfort. Current evi- dence implicates patent dentinal tubules in hypersensitive dentine, and it follows that one effective way to reduce den- tine sensitivity is to occlude the dentinal tubules. The purpose of this study was to compare the efficacy of two different desensitising agents, Cervitec varnish and Gluma varnish. Materials and Methods: Two hundred fifty patients self-reporting dentine hypersensitivity completed the paired split mouth randomised, subject-blind study. Each participant had a minimum of two sensitive teeth in at least two different quadrants and displaying a response of ≥3 cm to an evaporative stimulus. The hypersensitivity levels were measured with a tactile stimulus (scratchometer), thermal stimulus (cold water test), and an evaporative stimulus (air blast test) using a visual analogue scale. The teeth were evaluated immediately after treatment, and at 4 and 12 weeks after ap- plication of the chlorhexidine-containing varnish Cervitec and the glutaraldehyde-containing varnish, Gluma Desensitizer. Results: Statistical analysis indicated that both the desensitising varnishes were effective in alleviating dentine hyper- sensitivity at all time intervals compared to baseline. There was a highly statistically significantly greater reduction in dentine hypersensitivity to evaporative stimulus, cold stimulus, and tactile stimulus after application of Cervitec than after Gluma Desensitizer (P < 0.001). Conclusion: Both the varnishes have a therapeutic potential to alleviate dentine hypersensitivity at all time intervals compared to baseline. However, Cervitec varnish is more efficacious in reducing dentine hypersensitivity than Gluma varnish at both 4 weeks and 12 weeks post-treatment. Key words: dentine hypersensitivity, Cervitec varnish, Gluma varnish, visual analogue scale, scratchometer, thermal test Oral Health Prev Dent 2011; 9: 143-150 Submitted for publication: 13.05.10; accepted for publication: 29.07.10. he term dentine hypersensitivity has been used ology’ (Banoczy, 2002). In 1982, Johnson and co- Tfor decades and has been defined as ‘short workers stated that ‘dentine hypersensitivity is an sharp pain arising from exposed dentine in re- enigma being frequently encountered yet ill under- sponse to stimuli typically thermal, evaporative, stood’ (Addy, 2000). tactile, osmotic or chemical and which cannot be Besides causing discomfort, this condition may ascribed to any other form of dental defect or path- deter a patient from establishing or maintaining adequate oral hygiene procedures, which may ad- * This study was conducted as part of an MDS dissertation at the versely affect gingival and periodontal health. Krishnadevaraya College of Dental Sciences under the guidance of Thus, the vicious cycle of sensitive teeth leading Drs Prabhuji and Karthikeyan. to reduced plaque control, more periodontal dis- a Private Practice, Mumbai, India. ease and more recession may be established b Head, Department of Periodontics, Krishnadevaraya College of (Dowell, 1985). One of the factors which play an Dental Sciences, Bangalore, Karnataka, India. (Dr Sethna’s MDS supervisor) important role in the etiology of dentine hypersen- c Reader, Department of Periodontics, Krishnadevaraya College of sitivity may be plaque accumulation (Kakaboura Dental Sciences, Bangalore, Karnataka, India. and Rahiotis, 2005). Plaque and plaque products Correspondence: Dr G. Sethna, Chicago Center of Advanced Den- which invade the dentinal tubules bring about de- tistry, METROPOLIS, Firuz Ara,160 Backbay Reclamation, Madam calcification of peritubular dentine. This eventually Cama Road, Near Mantralaya 23, Mumbai 400 021, India. Tel: +91-22-2283-6440-441-442, Fax: +91-080-284-677-083. enlarges the tubules and leads to dentine hyper- Email: [email protected] sensitivity. Vol 9, No 2, 2011 143 pyri Sethna et al Co gh Not for Publicationt b y Although several hypotheses have been advocat- The literature bears evidence ofQ the potential u ed to explain how external stimuli may influence the role of chlorhexidine (CHX) and glutaraldehyde de-N i nerve fibers, the most widely accepted is the hydro- sensitiser as effective desensitisingn agents (Ar-o t t r f e o dynamic theory, where the movement of fluid within rais, 2004; Kakaboura and Rahiotis, 2005).ssen How-ce the dentine transduces surface stimuli by deforma- ever, to the best of our knowledge, there are no tion of pulpal mechanoreceptors, which in turn studies reported in the literature comparing the causes pain and hypersensitivity (Addy and West, efficacy of CHX vs glutaraldehyde as desensitising 1994; Brannstrom and Astrom, 1964). Approaches agents for the treatment of dentine hypersensitivity. to preventing or treating dentine hypersensitivity in- In view of this fact, the present study was under- clude reaction of exposed surfaces with chemical taken with the objective of comparing the efficacy agents which might either occlude dentinal tubules of Cervitec varnish with Gluma varnish as desensi- or make smear layer covered surfaces resistant to tising agents. tubular exposure (Addy, 2000). A number of desensitising agents have been used to alleviate the pain caused by dentine sensi- MATERIALS AND METHODS tivity. These include neural stimulus blockers (Or- chardson, 2006), protein precipitants, tubule oc- Three hundred patients (140 males and 160 fe- cluding agents and tubule sealants (Jacobsen and males; age range 20 to 55 years) who attended the Bruce, 2001), fluoride iontophoresis (Kern und Mc- outpatient section, Department of Periodontics, Quade), and lasers (Schwarz and Arweiler, 2002). Krishnadevaraya College of Dental Sciences, However, none of them have shown to be consist- Bangalore, were randomly selected for the clinical ently effective (Panduric and Sutalo, 2001). study conducted from March 2008 to Dec 2009. Chlorhexidine has been widely accepted as an Recruitment of the patients was stopped in Sep- anti-plaque and antimicrobial agent. It is adsorbed tember 2009; of the total 300 patients recruited in to enamel and dentine surfaces and prevents ad- the study, 50 were excluded (attrition rate of 16.8 sorption of bacteria, thereby exerting an anti-plaque %). and anti-bacterial activity. It is thought to be one of Those patients with self-complaint of tooth hy- the best chemicals to control plaque and prevent persensitivity in at least two teeth present in differ- plaque-related morphological changes dentinal tu- ent quadrants of the mouth, buccal gingival reces- bules (Kakaboura and Rahiotic, 2005). A commer- sion and/or exposed dentine greater than 2 mm cially available chlorhexidine containing varnish, from the cementoenamel junction (CEJ), and a re- Cervitec (1% thymol and 1% chlorhexidine, Ivoclar sponse of ≥ 3 cm on a 10-cm scale to an evapora- Vivadent; Schaan, Liechtenstein), decreases bacte- tive stimulus were selected for the split-mouth, rial colonisation on the teeth, disrupts the bacterial subject-blind randomised clinical study. Patients metabolism and reduces formation of lactic acid. with defective restorations, root caries, deep perio- This varnish creates a mechanical barrier after dry- dontal pockets, dentures or bridgework, orthodon- ing and effectively seals the dentinal tubules with tic appliances, history of use of dental desensitis- no known adverse effects. It may thus be valuable ing agents, or those who had received periodontal in the treatment of dentine hypersensitivity (Pan- therapy in the preceding six months were excluded duric and Sutalo, 2001). from the study. The protocol was clearly explained Glutaraldehyde (5%) and hydroxyethylmeth- to all the patients and written consent was obtained acrylate (HEMA, 35%) in a varnish (Gluma Desensi- from all the subjects. The study protocol was ap- tizer, Heraeus Kulzer; Hanau, Germany) are used in proved by the Ethics Committee, Krishnadevaraya the treatment of dentine hypersensitivity. Glutaral- College of Dental Sciences, Rajiv Gandhi University dehyde acts as a biological fixative and forms a of Health Sciences, Bangalore, India. physiological seal by coagulating the plasma pro- teins in the dentinal tubules (Arrais, 2004). Simi- larly, HEMA is also a hydrophilic monomer com- Screening and study protocol pound found in dentine bonding agents with an ability to infiltrate into acid-etched and moist dental The oral examination was conducted on all subjects hard tissues. It causes precipitation of serum pro- to ensure that they were in good general health ex- teins in the dentinal tubules, thus also alleviating cept for the symptoms of dentinal hypersensitivity. dentine hypersensitivity (Schupbach et al, 1997). Detailed clinical and radiographic investigations 144 Oral Health & Preventive Dentistry pyri SethnaCo et galh Not for Publicationt b y Q u 300 patients included in the study N i n o t t r f ess o e r 50 drop outs due to change of residence, ill health. enc r Patient undergoing root canal treatment/dental restorations in the same quadrant. 500 sites assessed in 250 patients To test 250 sites (Cervitec) To test 250 sites (Gluma Desensitizer) Follow-up Immediately after varnish application 4 weeks after baseline 12 weeks