ARGININE-AN INSTANT RELIEF FOR DENTINAL HYPERSENSITIVITY.
The aim of this study was to assess the instant relief of dentinal sensitivity by application of toothpaste containing 8% Arginine CaCO3 compound in patients visiting the Department of Periodontology, Hamdard University Dental Hospital. One hundred patients (38 males and 62 females) with age range from 23 to 65 years having history of dentine hypersensitivity were included in this study by random sampling technique. The consent was taken from the patients and dentinal hypersensitivity was evaluated according to the Visual Analog Scale (VAS) index. DH was evaluated by air-blast stimulus. The response of the patient was recorded immediately at the time of air blast. The DH was measured with the help of Visual Analogue Scale (VAS).Then Arginine - CaCO3 was applied with finger on teeth where DH was reported.
After one minute DH was measured by using VAS and readings were calculated. After getting data from all selected patients, results were obtained by using SPSS version 16. Out of hundred patients, 25 patients (25%) were reported to had mild sensitivity and out of 25 patients 12(48%) had instant relief from sensitivity. Thirty five (35%) patients had moderate sensitivity and out of 35 patients, 05(14.28%) observed instant relief from DH whereas 40(40%) patients had severe sensitivity and out of 40 patients only 01(2.5%) had instant relief from DH. The results were statistically analyzed, and it was found that Arginine-CaCO3 application markedly decreases the dentinal sensitivity in majority of patients. It is concluded that patients who were having mild DH had more effect in reduction of DH followed moderate and least effect is observed in the patients with severe DH.
Key Words: Arginine, hypersensitivity, desensitizing agent, periodontal treatment, scaling and root planning.
Dentinal hypersensitivity is characterized as a sharp pain of short duration which is arising from exposed dentin surfaces in response to stimuli, typically thermal, evaporative, tactile, osmotic, chemical or electrical; and which cannot be attributed as any other dental disease.1,2 Dentinal tubules can be exposed either by enamel or cementum loss.3
Dentinal hypersensitivity is one of the common clinical dental condition with prevalence rate of 57% around the world.4 The dentinal hypersensitivity caused by routine tooth brushing will eventually interfere with regular tooth brushing thus causing more accumulation of food particles, plaque and calculus formation.5 There are several etiologic and predisposing factors related to DH including acute and chronic periodontal diseases, fractured tooth, trauma from occlusion, attrition, abrasion, erosion, faulty tooth brushing, para functional habits, diet containing more acidic components and periodontal therapy.6
Mechanical debridement is the important component of periodontal treatment. The most common non surgical periodontal treatment is scaling and root planning (SRP). Its aim is to remove plaque, calculus and necrotic cementum from the root surface.
Dentin hypersensitivity is most common in the cervical part of the roots, where the cementum is very thin. Thin layer of cementum is removed after scaling and root planning induces dentinal hypersensitivity. The ratio of sensitivity will be higher post scaling and root planning as compared to pre treatment.7
Several theories demonstrated the mechanism of DH. Hydrodynamic theory is proven by a number of scientific evidences. This theory is based on the movement of fluid inside the tubules when thermal and osmotic stimuli are applied. The fluid movement activates the nerve endings at the end of dentinal tubules.8 This mechanism is also supported by the patient's experience of hypersensitivity immediately after instrumentation or for a short period post treatment ,while it does not make clear why the symptoms increase over time and why the pain condition may affect certain patients and certain teeth.9,10
Common procedures used to decrease dentinal hypersensitivity are the use of desensitizing agent that occlude or desensitize tubules. To treat dentinal hypersensitivity there are numerous methods and materials are available for both in office and home use.
Dentinal hypersensitivity can be reduced either by using home care products such as toothpaste and mouthwashes containing agents like sodium fluoride, stannous fluoride, potassium nitrate, strontium chloride, or fluoride compounds, calcium compounds, cavity varnishes, restorative resins at office.11
Previously, fluoride toothpaste and fluoride solutions were very effective in treating dentinal hypersensitivity of exposed root surfaces. In one of the oldest study demonstrated that desensitizing effect of fluoride is related, to precipitate fluoride compounds thus mechanically blocking dentinal tubules and create a barrier on the tooth surface which reduces hypersensitivity.12,13 Arginine is an essential amino acid and has been investigated as Arginine bicarbonate when used with calcium carbonate compound enhances its ability to occlude dentinal tubules and reduce pain from Dentinal Hypersensitivity.14 Thus, Argininecalcium carbonates preventing the fluid movement in the dentinal tubules.
Different scales are used to evaluate pain in human beings; in this article pain measuring scale used by Haefeli et al15 was used to evaluate pain. The rationale of this study is to evaluate the instant decrease in dentinal hypersensitivity by using dentifrice containing 8% Arginine-CaCO3 following scaling and root planning.
The clinical study was a single-center, randomized design. Consent was obtained from all the patients and potential efficacy of Arginine-CaCO3 containing toothpaste was explained. Scaling, root planning and sensitivity test was performed by the same operator.
Inclusion criteria: Systemically healthy individuals with dentinal hypersensitivity to air stimulus from 10 mm distance in at least one vital tooth from two quadrants following periodontal therapy.
Exclusion criteria: Teeth with caries, prosthetic restoration, any dental pathology, restored less than three months.
One hundred randomly selected patients were included in this study after the treatment of scaling and root planning. The non surgical periodontal therapy including supra and sub-gingival scaling, root planning (SRP) were performed. Hypersensitive teeth were identified by the patient and verified by the air blast.
Sixty two females and thirty eight males were enrolled in this study. In this study, a blast of air was given onto the affected area for a second from triple syringe at 60 pound/inch 2 pressures from a distance of 10 mm.
The response was evaluated at two time points: end of the periodontal therapy (baseline); immediately after applications of desensitizing agent. Pea sized toothpaste containing 8% arginine-CaCO3 was applied on the tooth by finger for one minute, the response was reevaluated. After that the teeth were washed with water and the test was repeated. One tooth was selected from two quadrants in the mouth to evaluate dentinal hypersensitivity.
Statistical analysis was performed using a Statistical Package for Social Sciences 16 software (SPSS). Differences between before and after VAS scores within each group were analyzed. There are a different ways to evaluate the degree of hypersensitivity. A verbal rating scale and short intermittent air blast is used in this study to quantify the subjective level of pain which is as follows:
The scale ranges from 0 to 10 where 0= no sensitivity and 10= severe sensitivity.
The aim of this study was to evaluate the instant decrease in dentinal hypersensitivity by using dentifrice containing 8% Arginine-CaCO3 following scaling and root planning. Several studies have shown that periodontal treatment frequently is associated with DH.16 Tammaro et al. found significant change in dentin hypersensitivity after periodontal treatment i.e; scaling and root planning using VAS.17 Von Troil et al. also observed that one-half of the patients after periodontal treatment experience dentinal hypersensitivity.18
In this study, dentinal hypersensitivity was measured by air stimulus and Visual Analogue Scale (VAS). The scale has also been used in different studies previously, as the scale is simple and is also easier on the patient's part to explain the intensity of pain.
Ozen et al. used VAS for evaluation of dentinal hypersensitivity by using desensitizing agents and a placebo. Results have shown that the mean pain scores of the placebo group were greater as compared to the desensitizing agents.19 DH is one of the most common outcomes of periodontal treatment. This study showed instant relief in dentinal hypersensitivity by single application of Arginine - CaCO3 containing toothpaste.
The mode of action of products containing Arginine-CaCO3 is to seal exposed dentinal tubules thus, blocking external stimuli and reducing intensity of pain instantly. A recent clinical trial showed that 8% Arginine along with calcium carbonate produces immediate and lasting relief in dentin hypersensitivity.
Cummins et al also used Arginine CaCo3 compound in their study for an instant relief in dentinal hypersensitivity. Clinical studies have shown that toothpaste with Pro-Argin technology containing Arginine and calcium carbonate with 1450 ppm fluoride, produces instant and lasting relief of dentin hypersensitivity.
Three 8-weeks clinical studies have shown that this new toothpaste with Pro-Argin technology provides statistically greater efficacy in reducing dentinal hypersensitivity as compared to the other desensitizing toothpastes containing 2% potassium ion.20
In another study, Lee Y et al did a comparative study to evaluate clinical efficacy of three toothpastes in reducing dentin hypersensitivity. 150 subjects complied with the protocol and data has been collected for the study. Arginine and 1450 ppm fluoride is one group while 1100 ppm fluoride as NaF in a silica base is the second one. The positive control toothpaste containing 8.0% Arginine and 1450 ppm fluoride as monoflourophosphate in a calcium carbonate base shown greater reduction in mean tactile and air blast dentin hypersensitivity scores compared to the negative control toothpaste containing 1100 ppm fluoride as NaF in a silica base (p < 0.05).21
Kakar A (-) individuals using Subjects who brushed with the new dentifrice containing 8.0% Arginine, calcium carbonate, and 1000 ppm MFP shown exhibited statistically significant reductions (p < 0.05) in dentin hypersensitivity in response to tactile (36.2%, 33.1%, and 29.7%) and air blast (16.4%, 31.1%, 58.8%) stimuli.22
Out of one hundred patients, 25 patients had mild sensitivity in which 11(44%) were males and 14 (56%) were females. After application of 8%arginineCaCO3 48% patients had mild to no sensitivity while 40% had minimum sensitivity(remain in same bracket of VAS scale but with minimum intensity) 12% patients had no effect in sensitivity.
35 patients had moderate sensitivity in which 12(34.28%) were males and 23 (65.7%) were females. After application of 8%arginineCaCO3 14.28% patients had moderate to no sensitivity while 74.28% had moderate to mild sensitivity while 11.42% patients had no effect in sensitivity. In the study of Hegde et al, DH relief was evaluated in patients from the Mangalore, India area using the Jay Probe, air blast and VAS methods. Dentin hypersensitivity was measured at initial visit and after 2, 4, and 8 weeks using either a dentifrice formulated with 8% Arginine, calcium carbonate and 1,000 ppm fluoride or a commercially available dentifrice containing 1,000 ppm fluoride as Monoflourophosphate (MFP) . At each visit, both groups shown reductions in DH from their corresponding baselines (P< 0.05).
Group using 8% Arginine, calcium carbonate and 1,000 ppm fluoride toothpaste demonstrated statistically significant reductions in responses to tactile stimuli, air blast, and VAS responses in comparison to those provided the toothpaste containing 1,000 ppm fluoride after 2, 4, and 8 weeks, respectively.23
40 patients had severe sensitivity in which 15(37.50%) were males and 25 (62.5%) were females. After application of 8%arginineCaCO3 2.5% patients had severe to no sensitivity while 40% had severe to moderate sensitivity 47.5% patients had severe to mild sensitivity and 10% patients had no effect in sensitivity.
In the present study periodontal treatment was one of the causative factors of DH. The results of this study have shown that single application of Arginine - CaCO3 agent reduces dentinal hypersensitivity instantly. The Arginine-CaCO3 might be an effective agent in the prevention of dentinal hypersensitivity caused by periodontal therapy such as scaling and root planning procedures.
A single fingertip topical application of the 8% Arginine-calcium carbonate toothpaste directly onto the hypersensitive surface of teeth provides instant improvement in the reduction of dentinal hypersensitivity.
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|Publication:||Pakistan Oral and Dental Journal|
|Date:||Mar 31, 2017|
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