Efficacy of gluma desensitizertm and duraphattm in relieving dentinal hypersensitivity in non-carious cervical lesions.
The objective of this study was to compare the efficacy of Gluma DesensitizerTM and DuraphatTM in relieving dentinal hypersensitivity in non-carious cervical lesions by a randomized control trial. 196 patients having hypersensitive non-carious cervical lesions were divided into two groups. Gluma DesensitizerTM was applied to patients in Group A and DuraphatTM to patients in group B. Patient's pain response to compressed air was recorded on the visual analogue scale at baseline, 5 minutes, 7 days and 30 days after treatment. Data were analyzed using SPSS version 12. Comparison of sensitivity between the two treatment groups on application of compressed air showed a statistically significant difference. The results of this study showed that Gluma DesensitizerTM showed better results in relieving dentinal hypersensitivity than DuraphatTM in non-carious cervical lesions.
Key words: Non-carious cervical lesions, Hypersensitive teeth, desensitizing agents, GlumaTM, DuraphatTM
Etiology and treatment of dentine hypersensitivity or hyperalgesia, have been reported in the literature for over 100 years. It is a universal problem affecting people all over the world.1
Dentine hypersensitivity is described by short, sharp pain arising from exposed dentine due to ther- mal, evaporative or tactile stimuli, which cannot be explained, by any other dental defect or pathology.2,3,4
It has been reported that 15-17% of the population between the ages of eighteen and sixty-five years suffer from dentine hypersensitivity.5
Gluma is a dentine-bonding agent containing glut- araldehyde. Glutaraldehyde coagulates the serum al- bumin present in the dentinal fluid resulting in block- age of tubules.6,7 This reaction of glutaraldehyde with serum albumin is said to induce polymerization of hydroxyl ethyl methacrylate (HEMA) which is a hydro- philic monomer component of dentine bonding agents with the ability to infiltrate into acid etched and moist dental hard tissues.8
Duraphat is a varnish with high fluoride content. It creates a barrier by precipitating calcium fluoride thus
blocking patent dentinal tubules and reducing hyper- sensitivity.3,7 The resinous base of this material is an alcoholic suspension which evaporates when applied to the tooth surface leaving a layer of fluoride rich varnish attached to the tooth surface.9
The study aims to compare the effectiveness of Gluma and Duraphat in relieving dentine hypersensi- tivity.
This study was carried out in the Department of Operative Dentistry, Armed forces Institute of Den- tistry. Patients presenting with the complaint of hyper- sensitivity in at least two teeth having non-carious lesions resulting in exposed dentine on the facial surface assessed by the application of compressed air for two seconds and a cold stimulus (ethyl chloride soaked cotton) were included in the study.
Patients taking analgesics, anti-inflammatory or tri-cyclic anti-depressants, receiving orthodontic treat- ment, pregnant and lactating mothers and those who had received desensitizing treatment during the previous three months prior to the study were not included.
A final sample of 196 patients, both men and women, was selected by purposive sampling. Lots were drawn in order to divide the sample into two equal sized, random groups. The person drawing the lots was blinded to the participants' list.
Gluma Comfort Bond Plus Desensitizer (Heraeus Kulzer, Hanau, Germany) was applied to the patients in Group A. Each sensitive tooth was cleaned with a polishing paste, rinsed with water and air dried. The tooth was then conditioned with Gluma Etch 20 Gel for 20 seconds. Then it was rinsed, air dried and the tooth surface was moistened by pellets damped with distilled water. Gluma Comfort Bond Plus Desensitizer was applied using a disposable brush applicator. An addi- tional coat of the Desensitizer was applied and light cured for 15 seconds.
Duraphat (Colgate Oral Pharmaceuticals, New York) was applied to the patients in Group B. Each sensitive tooth was cleaned with a polishing paste, rinsed with water and air dried. Duraphat was applied using a disposable brush applicator. An additional coat was applied after 5 minutes.
Each patient's pain response was recorded at baseline, 5 minutes, 7 days and 30 days after treatment using a visual analogue scale by applying compressed air for two seconds.
The data analysis was carried out using SPSS (version 12). Descriptive statistics were calculated. Mean and standard deviation for numerical data for age and VAS score was calculated. Frequency and percent- ages for gender and intensity of pain were calculated. Chi-square test was used to compare pain intensity at baseline and after treatments. Chi-square test was also used to compare pain intensity with both materials 5 minutes, 7 days and 30 days after treatment. The arbitrary p value of less than 0.05 was considered to be statistically significant.
The study included 196 patients requiring treat- ment for hypersensitivity in non-carious cervical le- sions. Each treatment arm had 98 patients. All 196 patients were treated according to the laid out treat- ment protocol by a single operator. All patients were evaluated at baseline, five minutes and seven days after treatment. Fourteen patients (7.1%) failed to report at the 30 days evaluation.
Comparison of the two treatment groups was made for baseline characteristics to assess for effectiveness of randomization and assessment of bias. The mean age for Group A was 43.52 + 7.17 years and 42.88 + 7.27 years for Group B. There were 59 (60.2%) men and 39 (39.8%) women in group A while 56 (57.1%) men and 42 (42.9%) women in group B. Independent sample t test was used to assess any difference between the treat- ment groups with respect to age and gender. The two groups were found to be balanced with respect to age (p = 0.534) and gender (p = 0.663) (Figure 1).
The mean VAS for pain was 7.46 + 1.09 for group A and 7.41 + 1.00 for group B at the baseline. After five minutes, sensitivity for group A was 4.13 + 1.07 and 5.11 + 0.97 for group B. After seven days, it was 2.85 + 1.31 for group A and 4.41 + 1.26 for group B. After 30 days, it was 2.15 + 1.39 and 3.86 + 1.27 for group A and B respectively (Table 1).
Comparison of pain before treatment revealed that 53.1% of patients of Group A (Gluma Desensitizer) and 50% in Group B (Duraphat) had severe pain on applica- tion of compressed air for two seconds. About 46.9% patients of the group A and 50% patients of the group B had moderate pain. There was no significant difference between groups A and B in sensitivity with compressed air application at baseline (p value = 0.668) (Fig 2).
Five minutes after treatment with dentine bonding agent, in group A, 68.4% patients had moderate and 31.6% patients had mild pain while none had severe pain. In group B, 95.9% of patients had moderate pain while 4.1% of the patients had mild pain. There was a significant difference between the two treatment groups five minutes after application (p value less than 0.05).
Seven days after the application of the Desensitizer in the patients within group A, 30.6% had moderate pain, 66.3% had mild pain while in 3.1% of the patients, the pain had completely subsided. In group B, 75.5% patients had moderate while 24.5% patients had mild pain. Both treatment groups revealed a significant difference in sensitivity 7 days after the application of the Desensitizer, with the patients in group A demon- strating more relief from the sensitivity (p value less than 0.05).
Thirty days after treatment in group A, 19.6% patients had moderate pain, 65.2% had mild pain, while 15.2% patients had no pain at all. In group B, 61.1% patients had moderate while 38.9% patients had mild pain. At 30 days, a significant difference was seen in sensitivity between the two groups, with 14 patients in group A being completely painless, whereas there was no patient in group B completely free of pain (p value less than 0.05). (Fig 5).
After 5 minutes A###4.13###1.07
After 7 days###A###2.85###1.31
After 30 days###A###2.15###1.39
In the present study, a comparison of short term effectiveness of two commonly used tubule occluding agents - a dentine bonding agent with glutaraldehyde and a fluoride varnish was done.
The mean age in the study was 43.46 + 7.11 for group A and 42.85 + 7.20 for group B. Dentinal hyper- sensitivity affects women more often than men, though the sex difference is rarely significant and same is the case in this study.
Previously, only a few clinical studies have mea- sured the efficacy of Gluma Desensitizer or Duraphat or both in class V cavities and the results have been mixed.
Olusile et al. in a single blind, split mouth study design evaluated four agents. The mean VAS for teeth treated with Gluma and Duraphat were 6.03 + 2.37 and 4.66 + 1.82 respectively, while it was 7.46 + 1.08 and 7.41 + 1.00 in the present study. In this study, VAS was higher because only NCCLs were included. After 7 days, the VAS mean was reduced to 0.10 + 0.44 and 1.0 + 1.89, whereas it was 2.87 + 1.32 and 4.40 + 1.25 in the peresnt study. A lesser reduction in pain was seen in this study can be assumed to be due to a greater num-ber of open tubules in NCCL than normal. All the agents signifi- cantly reduced the sensitivity but Gluma desensitizer reduced sensitivity more than Duraphat at all measure- ment intervals.
However, the evaluation period was quite less which does not give a long term picture of effectiveness of these desensitizing agents. Only 25 patients were included in the above mentioned study. Such a small sample size could have biased the results. However, this study in which 196 patients were treated had similar results as that of the study by Olusile et al.
There was no control group in either of the studies.3
A number of other treatment modalities and chemi- cal agents have been employed for the treatment of dentinal sensitivity with mixed results.
Jalalian E compared the efficacy of potassium nitrate with Gluma desensitizer and control in reducing hypersensitivity in full coverage crown patients and found potassium nitrate to be more effective in reduc- ing dentine hypersensitivity than Gluma or control. 10
Tasanee and Worawan compared the efficacy of 30mW gallium-aluminum-arsenide laser (GaAlAs) ap- plied for 1 minute with dentine bonding agent in 70 patients. The results revealed dentine bonding agents to be more effective in reducing hypersensitivity. 11
However, in a study conducted by Corona et al., no significant difference was found between the efficacy of GaAlAs and dentine bonding agent. 4
Assis et al carried out a double blind split mouth study on ten patients having at least two teeth with gingival recession and root exposure. Gluma treated teeth had a mean VAS value of 4.75 + 2.65 at baseline and 4.61 + 3.14 after four weeks. Control teeth had a mean VAS value of 4.08 + 2.91 at baseline and 4.76 + 3.26 after four weeks. This shows that Gluma desensi- tizer had no effect on hypersensitive teeth with gingi- val recession and root exposure for up to four weeks.12
Duran and Sengun compared the effectiveness of five desensitizer products, including Gluma desensitizer in a split mouth study design. 52 patients were included in the study with mean age of 36 + 7 years while in the present study, the mean age of group A was 43.46 + 7.11 and 42.85 + 7.20 for group B. The mean VAS value for hypersensitivity in patients in which Gluma Desensi- tizer was employed was 5.21 + 2.35 while it was 7.46 + 1.08 in the present study, at the baseline. After treat- ment, it was reduced to 2.33 + 2.32 in study conducted by Duran and Sengun and 4.14 + 1.06 for this study. The VAS scores at post-treatment evaluation points were significantly decreased compared with baseline data (p less than 0.05) but a placebo control was not used. 13
Dondi dall'Orologio et al. found Gluma desensitizer to be successful in a non-controlled trial. However, evidence from studies without controls should be considered with great caution.14
The efficacy of low viscosity glass ionomer (Fuji VII) was studied by Polderman and Frencken using the Discomfort Interval Scale (DIS) of 0-4. They found it to be superior (79%) in relieving dentine hypersensitivity after 6 months as compared to Gluma Desensitizer (40%) in a split mouth study design. 5
Ritter et al compared the effect of five percent sodium fluoride varnish (All Solutions fluoride varnish) with Duraphat (control) and found it to be effective in reducing dentine hypersensitivity. However, the effi- cacy was not significantly different from that of the control.15
Atassi and Baby compared another fluoride con- taining desensitizing agent Bifluorid with Duraphat and found that both are effective in occluding dentinal tubules when observed under electron microscope.16
Among the strength of the study are: use of a randomized control trial study (randomization done by lottery method), application of materials by a single operator the materials, use of a larger sample size and employing a split mouth study design. Limitations of the study include: single blind study where bias of the operator or assistant recording the readings cannot be
excluded, only subjects having NCCLs were included in the study whereas sensitivity can be present without these lesions, subjects may have found the use of it visual analogue scale difficult, nonuse of rubber dam for isolation (cotton rolls and high volume suction were used) and the control group was not used to rule out placebo effect.
The results of this study showed Gluma Desensi- tizerTM as a better agent in relieving dentinal hypersen- sitivity than DuraphatTM in non-carious cervical lesions.
Disclaimer: Authors declare that there was no con- flict of interest.
1 Dugmore CR, Rock WP. The prevalence of tooth erosion in 12- year-old children. Br Dent J. 2004 13;196:279-82;273.
2 Madhu PS, Setty S, Ravindra S. Dentinal hypersensitivity?- Can this agent be the solution? Indian J Dent Res. 2006 ;17:178-84.
3 Olusile AO, Bamise CT, Oginni AO, Dosumu OO. Short-term clinical evaluation of four desensitizing agents. J Contemp Dent Pract. 2008;9:22-29.
4 Corona SA, Nascimento TN, Catirse AB, Lizarelli RF, Dinelli W, Palma-Dibb RG. Clinical evaluation of low-level laser therapy and fluoride varnish for treating cervical dentinal hypersensitivity. J Oral Rehabil. 2003;30:1183-89.
5 Polderman RN, Frencken JE. Comparison between effective- ness of a low-viscosity glass ionomer and a resin-based glutaraldehyde containing primer in treating dentine hypersensitivity-a 25.2-month evaluation. J Dent. 2007;35:144-49.
6 de Assis Cde A, Antoniazzi RP, Zanatta FB, Rosing CK.
7. Efficacy of Gluma Desensitizer on dentine hypersensitivity in periodontally treated patients. Braz Oral Res. 2006;20:252-56.
8 Camps J, About I, Van Meerbeek B, Franquin JC. Efficiency and cytotoxicity of resin-based desensitizing agents. Am J Dent. 2002;15:300-04.
9 Vaikuntam J. Fluoride varnishes: should we be using them? Pediatr Dent. 2000;22:513-16.
10 Jalalian E, Meraji N, Mirzaei M. A comparison of the efficacy of potassium nitrate and Gluma desensitizer in the reduction of hypersensitivity in teeth with full-crown preparations. J Contemp Dent Pract. 2009;10:66-73.
11 Tengrungsun T, Sangkla W. Comparative study in desensitiz- ing efficacy using the GaAlAs laser and dentine bonding agent. J Dent. 2008;36:392-95.
12 Assis CA, Antoniazzi RP, Zanatta FB, Rosing CK. Efficacy of Gluma Desensitizer on dentin hypersensitivity in periodontally treated patients. Braz Oral Res. 2006;20:252-56.
13 Duran I, Sengun A. The long-term effectiveness of five current desensitizing products on cervical dentinee sensitivity. J Oral Rehabil. 2004;31:351-56
14 Dondi dall'Orologio G, Lorenzi R, Anselmi M, Opisso V. Dentine desensitizing effects of Gluma alternate, Health- Dent Desensitizer and Scotchbond Multi-purpose. Am J Dent. 1999;12:103-06.
15 Ritter AV, de L Dias W, Miguez P, Caplan DJ, Swift EJ Jr. Treating cervical dentine hypersensitivity with fluoride varnish: a randomized clinical study. J Am Dent Assoc. 2006;137:1013-20.
16 Atassi F, Baby N. Obturation of dentinal tubules in the treatment of root sensitivity. An invitro scanning electron microscopic study. Indian J Dent Res. 1997;8:47-51.
1,2,3,5 Residents AFID, Rawalpindi
4 Head, Department of Operative Dentistry, Armed Forces Institute of Dentistry, Rawalpindi
6 PhD student
Correspondence: Dr M Umer Javed, Department of Prosthodontics, AFID, Rawalpindi, Cell: 0333-5364189
|Printer friendly Cite/link Email Feedback|
|Author:||Mehmood, Zahid; Ali Shah, Jawad; Umer Javed, Muhammad; Ahmed Manzoor, Manzoor; Asghar, Imran; Hamza|
|Publication:||Pakistan Oral and Dental Journal|
|Date:||Jun 30, 2011|
|Previous Article:||Smear layer and sealing ability of three root canal sealers.|
|Next Article:||Comparative role of radiographs and electronic apex locator in working length determination.|