JICDRO is a UGC approved journal (Journal no. 63927)

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ORIGINAL RESEARCH
Year : 2021  |  Volume : 13  |  Issue : 1  |  Page : 42-47

Comparative evaluation of the effectiveness of the two herbal desensitizing toothpastes in the relief of dentinal hypersensitivity


Department of Dentistry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India

Date of Submission19-Aug-2020
Date of Acceptance19-Feb-2021
Date of Web Publication26-Jun-2021

Correspondence Address:
Dr. Disha Bansal
Department of Dentistry, Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jicdro.jicdro_55_20

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   Abstract 


Background: Dentinal hypersensitivity is a sharp pricking pain occurring on exposure of the dentinal surface to the external stimuli such as hot, cold, air, tactile, and chemical. This study was conducted to compare the effectiveness of two herbal desensitizing pastes in the relief of dentinal hypersensitivity at different time intervals. Materials and Methods: Forty subjects (with two teeth per patient) were considered for this study and randomly divided into two groups: Group 1: Hiora K, herbal desensitizing toothpaste and Group 2: Dant Kanti medicated desensitizing toothpaste. Using tactile stimulus and air stimulus, the sensitivity scores were recorded on visual analog scale immediately, then at 2 weeks, and then at the end of 4 weeks and compared. Results: There was no significant difference in the distribution of tactile sensitivity score and air blast sensitivity score at baseline, immediately after application, after 2 weeks, and after 4 weeks between Groups 1 and 2. Statistical Analysis: Chi-square test was used for statistical analysis. Conclusion: Desensitizing pastes can be used as a safe, economical, and effective option in the management of dentinal hypersensitivity.

Keywords: Air blast, dentinal hypersensitivity, external stimulus, herbal desensitizing tooth paste, tactile sensitivity


How to cite this article:
Bansal D, Mahajan M. Comparative evaluation of the effectiveness of the two herbal desensitizing toothpastes in the relief of dentinal hypersensitivity. J Int Clin Dent Res Organ 2021;13:42-7

How to cite this URL:
Bansal D, Mahajan M. Comparative evaluation of the effectiveness of the two herbal desensitizing toothpastes in the relief of dentinal hypersensitivity. J Int Clin Dent Res Organ [serial online] 2021 [cited 2021 Sep 24];13:42-7. Available from: https://www.jicdro.org/text.asp?2021/13/1/42/319528




   Introduction Top


Dentinal hypersensitivity is a very commonly encountered condition in the field of dentistry. The diagnosis is often challenging and should always be differentially diagnosed from other diseases causing similar symptoms. Patients with dentinal hypersensitivity presents with discomfort when exposed to external stimuli such as air movement and physical pressure.[1] This discomfort varies from minor inconvenience to major disturbance.[2] Routinely, these patients face difficulty in maintaining oral hygiene; consequently, there is an increase in the plaque accumulation, and hence, caries and periodontal disease flourish.[3] The most accepted theory for dentinal hypersensitivity is the hydrodynamic theory by Brännström.[4] Simplest clinical method of diagnosing dentinal hypersensitivity includes evaporative or air blast method or an exploratory probe on the exposed dentinal surface in the mesiodistal direction, for all the teeth in the area of pain.[5]


   Materials and Methods Top


The duration of this study was 4 weeks; the sensitivity scores were recorded at baseline, at 2 weeks, and at 4 weeks. A total of 40 subjects were selected from the outpatient section of the department of dentistry.

Inclusion criteria

Healthy patients from age range of 20-40 years.

Before starting the treatment, the baseline sensitivity values were recorded by using the tactile method and the air blast stimuli.

Exclusion criteria

  • Subjects with gross underlying pathologies
  • Subjects with existing systemic medical condition
  • Pregnant and lactating females.


Tactile sensitivity record

Tactile sensitivity was recorded under slight manual pressure using a blunt probe over the hypersensitive areas of the tooth.[6]

Air blast sensitivity record

The evaporative stimuli using the controlled air pressure from the standard dental airway syringe at 40–65 psi at room temperature, directed perpendicular to the hypersensitive area from a distance of around 3 mm, with adjacent teeth protected with the gloved fingers to prevent false results.[7]

The record of hypersensitivity was based on the visual analog scale; the scores were recorded on the 10 cm scale, with stipulated ratings ranging from 0 to 1 with no pain, from 2 to 3 with slight pain, from 4 to 6 with moderate pain, and from 7 to 10 with severe pain. Subjects who had baseline scores more than or equal to 4 were taken up for the study.[6]

The individuals who qualified the tactile as well as the air blast sensitivity assessment were selected [Figure 1] and randomly were assigned within the two study groups; 20 patients in each group with two teeth per patient [Figure 2] to be considered in the study:
Figure 1: hypersensitive teeth

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Figure 2: rubber dam application

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  • Group 1: Desensitizing herbal tooth paste (n = 40 teeth) (Hiora K, Himalaya Herbal Healthcare) [Figure 3]
  • Group 2: Desensitizing herbal toothpaste (n = 40 teeth) (Dant Kanti, medicated, Patanjali) [Figure 3].
Figure 3: materials used

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Using a disposable applicator tip [Figure 4], an assigned amount (pea sized) of tooth paste was applied over the isolated hypersensitive area of the tooth [Figure 2] for 10 s, and rotary polishing cup was used to polish the paste over this surface for 1 min. Patients were prescribed to use the respective toothpaste twice daily at home.
Figure 4: desensitizing toothpaste application using disposable applicator tip

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Postapplication immediately, after 2 weeks, and 4 weeks scores were recorded by the same examiner using the same methodology of tactile stimuli and evaporative stimuli.

Ethics

The procedures followed were in accordance with the Ethical Standards of the Institutional Ethical Committee on Human Experimentation (Registration No. ECR/710/Inst/UK/2015/RR-18).


   Results Top


The distribution of tactile sensitivity scores at baseline, immediately after application, after 2 weeks, and after 4 weeks was compared between Groups 1 and 2 using the Chi-square test. There was no significant difference in the distribution of tactile sensitivity scores at baseline, immediately after application, after 2 weeks, and after 4 weeks between Groups 1 and 2 [Table 1].
Table 1: Comparison of tactile sensitivity scores between Groups 1 and 2

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The distribution of tactile sensitivity scores was compared between baseline, immediately after application, after 2 weeks, and after 4 weeks using the Chi-square test. There was a significant difference in the distribution of tactile sensitivity scores between baseline, immediately after application, after 2 weeks, and after 4 weeks [Table 2].
Table 2: Comparison of tactile sensitivity scores within Group 1

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The interinterval comparison of tactile sensitivity scores was done using the Chi-square test. The distribution of tactile sensitivity scores changed significantly from baseline and immediately after application to after 2 weeks to after 4 weeks [Table 3].
Table 3: Interinterval comparison of tactile sensitivity scores within Group 1

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The distribution of tactile sensitivity scores was compared between baseline, immediately after application, after 2 weeks, and after 4 weeks using the Chi-square test. There was a significant difference in the distribution of tactile sensitivity scores between baseline, immediately after application, after 2 weeks, and after 4 weeks [Table 4].
Table 4: Comparison of tactile sensitivity scores within Group 2

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The interinterval comparison of tactile sensitivity scores was done using the Chi-square test. The distribution of tactile sensitivity scores changed significantly from baseline and immediately after application to after 2 weeks to after 4 weeks [Table 5].
Table 5: Interinterval comparison of tactile sensitivity scores within Group 2

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The distribution of air blast sensitivity scores at baseline, immediately after application, after 2 weeks, and after 4 weeks was compared between Groups 1 and 2 using the Chi-square test. There was no significant difference in the distribution of air blast sensitivity scores at baseline, immediately after application, after 2 weeks, and after 4 weeks between Groups 1 and 2 [Table 6].
Table 6: Comparison of air blast sensitivity scores between Groups 1 and 2

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The distribution of air blast sensitivity scores was compared between baseline, immediately after application, after 2 weeks, and after 4 weeks using the Chi-square test. There was a significant difference in the distribution of air blast sensitivity scores between baseline, immediately after application, after 2 weeks, and after 4 weeks [Table 7].
Table 7: Comparison of air blast sensitivity scores within Group 1

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The interinterval comparison of air blast sensitivity scores for group 1 was done using the Chi-square test. The distribution of air blast sensitivity scores changed significantly from baseline and immediately after application to after 2 weeks to after 4 weeks [Table 8].
Table 8: Interinterval comparison of air blast sensitivity scores within Group 1

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The interinterval comparison of air blast sensitivity scores for group 2 was done using the Chi-square test. The distribution of air blast sensitivity scores changed significantly from baseline and immediately after application to after 2 weeks to after 4 weeks [Table 9] and [Table 10].
Table 9: Comparison of air blast sensitivity scores within Group 2

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Table 10: Interinterval comparison of air blast sensitivity scores within group 2

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   Discussion Top


Dentin is a fluid-filled, porous, mineralized tissue including tubules that contribute to penetrability. Noncarious cervical lesions as attrition, erosion, abfraction, and gingival recession contribute to loss of enamel and cementum, hence exposed dentinal tubules to the oral environment, causing hypersensitivity.[8]

The increase in oral health awareness has brought great benefits in identifying the oral diseases.[9] Management of painful dental problems such as dental hypersensitivity has been very difficult for many years, and this has been a major problem till now.[10]

Pain that occurs due to dentinal hypersensitivity is mainly subjective in nature, so it requires thorough patient assessment and regular reviews. The requirements of the materials used for the treatment of dentinal hypersensitivity are nonirritant to the pulp, easy to apply, not painful on application, rapidly acting, consistent.[11]

Desensitizing toothpastes are easy, economic, and readily available options for the management of dentinal hypersensitivity.[12]

This study included the usage of only the herbal toothpastes because of the increasing public interest in the usage of the natural or herbal healthcare products. According to the World Health Organization, in the developing countries, up to 80% of the population uses plants and its products as the traditional medicine for primary healthcare. However, in the developed countries, 25% of the medical drugs are based on herbs and their derivatives.[13]

Low cost, least side effects, and ease of availability compared to conventional chemical toothpastes make the herbal preparations important for all available therapies, especially in rural areas.[14]

The available scientific data show that herbal preparations are as effective as conventional preparations, but there is a lack of scientific literature showing comparative efficacy of one herbal preparation over the other; therefore, only herbal preparations of toothpastes have been selected for this study.[15],[16]

The paste Hiora K (Himalaya Herbal Healthcare) contains naturally derived potassium nitrate (Suryakshara) which seems to help in desensitization of the dental nerves and other natural ingredients spinach (Palakya) contains natural oxalates which help in the formation of phytocomplexes and occlude the exposed dentinal tubules, and also the presence of clove (Lavanga) controls pain due to the obtundant action of eugenol.

Dant Kanti medicated (Patanjali) is a unique fluorinated blue gel that is infused with the powerful herbal extracts of Sphatika Bhasma and Kalmishora. Each 10 g contain extracts of Akarkara Anacyclus pyrethrum, Azadirachta indica (Neem), Acacia Arabica (Babool), Zanthoxylum alatum, Mentha spicata (Pudina), Syzygium aromaticum (Laung), Piper sylvaticum (Pippli), Barleria prionitis (Vajradanti), Mimusops elengi (Bakul), Embelia ribes (Vidang), Curcuma longa (Haldi), Salvadora persica (Pilu), and Quercus infectoria (Majuphal).

One of the most common remedies used for toothache is the use of Lavanga oil, applied directly onto the cavity in a decayed tooth, which lessens pain and acts as disinfectant.[17]

The purpose of this study was to investigate which paste among these two was able to alleviate the symptoms of the patient immediately or in shorter duration.

In this study, the stimuli used were both tactile and the evaporative as it was recommended by Holland et al.[18] that it is always better that more than one stimulus should be used because different stimuli stimulates different pain sensations of different intensities.

Various costly options such as iontophoresis and laser therapy exist, but they have disadvantages such as cost, complex apparatus, and long-term ineffectiveness.[19],[20]


   Conclusion Top


Desensitizing pastes can be used as a safe, economical, and effective option in the management of dentinal hypersensitivity.



 
   References Top

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Addy M. Dentine hypersensitivity: New perspectives on an old problem. Int Dent J 2002;52 Suppl 1:367-75.  Back to cited text no. 1
    
2.
Bissada NF. Symptomatology and clinical features of hypersensitive teeth. Arch Oral Biol 1994;39 Suppl:31S-2S.  Back to cited text no. 2
    
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Carranza FA. Clinical Periodontology. General Principles of Periodontal Surgery. 10th ed. St. Louis: Saunders; 2009. p. 87-901.  Back to cited text no. 3
    
4.
Brännström M. A hydrodynamic mechanism in the transmission of pain production stimuli through dentine. In: Anderson DJ, editor. Sensory Mechanisms in Dentine. Oxford: Pergamon Press; 1963. p. 73-9.  Back to cited text no. 4
    
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Gillam DG, Orchardson R. Advances in the treatment of root dentin sensitivity: Mechanisms and treatment principles. Endod Topics 2006;13:13-33.  Back to cited text no. 5
    
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Clark GE, Troullos ES. Designing hypersensitivity clinical studies. Dent Clin North Am 1990;34:531-44.  Back to cited text no. 6
    
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Pradeep AR, Agarwal E, Naik SB, Bajaj P, Kalra N. Comparison of efficacy of three commercially available dentifrices on dentinal hypersensitivity: A randomized clinical trial Aust Dent J 2012;57:429-34.  Back to cited text no. 7
    
8.
Dundar A, Yavuz T, Orucoglu H, Daneshmehr L, Yalcin M, Sengun A. Evaluation of the permeability of five desensitizing agents using computerized fluid filtration. Niger J Clin Pract 2015;18:601-6.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Ferrari M. The micromorphologic relationship between resin and dentin in Class V restorations: An in vivo and in vitro investigation. Quintessence Int 1994;25:621-5.  Back to cited text no. 9
    
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Oberg C, Pochapski MT, Farago PV, Granado CJ, Pilatti GL, Santos FA. Evaluation of desensitizing agents on dentin permeability and dentinal tubule occlusion: An in vitro study. Gen Dent 2009;57:496-501.  Back to cited text no. 10
    
11.
Dowell P, Addy M. Dentine hypersensitivity--a review. Aetiology, symptoms and theories of pain production. J Clin Periodontol 1983;10:341-50.  Back to cited text no. 11
    
12.
Docimo R, Montesani L, Maturo P, Costacurta M, Bartolino M, DeVizio W, et al. Comparing the efficacy in reducing dentin hypersensitivity of a new toothpaste containing 8.0% arginine, calcium carbonate, and 1450 ppm fluoride to a commercial sensitive toothpaste containing 2% potassium ion: An eight-week clinical study in Rome, Italy. J Clin Dent 2009;20:17-22.  Back to cited text no. 12
    
13.
Kumar G, Jalaluddin M, Rout P, Mohanty R, Dileep CL. Emerging trends of herbal care in dentistry. J Clin Diagn Res 2013;7:1827-9.  Back to cited text no. 13
    
14.
Singab AN, Youssef FS, Ashour ML. Medicinal plants with potential antidiabetic activity and their assessment. Med Aromat Plants 2014;3:1-12.  Back to cited text no. 14
    
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Al-Kholani AI. Comparison between the efficacy of herbal and conventional dentifrices on established gingivitis. Dent Res J (Isfahan) 2011;8:57-63.  Back to cited text no. 15
    
16.
Mohan Kumar KP, Priya NK, Madhushankari GS. Anti-cariogenic efficacy of herbal and conventional tooth pastes – A comparative in vitro study. J Int Oral Health 2013;5:8-13.  Back to cited text no. 16
    
17.
Kothawar SK, Mahesh, Madugula S, Surekha B. A comparative study of the clinical efficacy of natural-orebased Bhasmas and Lavang oil in the management of Krimidanta. Indian J Mednodent Alli Sci 2013;1:11-8.  Back to cited text no. 17
    
18.
Holland GR, Narhi MN, Addy M, Gangarosa L, Orchardson R. Guidelines for the design and conduct of clinical trials on dentine hypersensitivity. J Clin Periodontol 1997;24:808-13.  Back to cited text no. 18
    
19.
Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A. Lasers for the treatment of dentin hypersensitivity: A meta-analysis. J Dent Res 2013;92:492-9.  Back to cited text no. 19
    
20.
Bansal D, Mahajan M. Comparative evaluation of effectiveness of three desensitizing Tooth pastes for relief in the dentinal hypersensitivity. Contemp Clin Dent 2017;8:195-9.  Back to cited text no. 20
[PUBMED]  [Full text]  


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