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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 11  |  Issue : 3  |  Page : 121-124

Evaluation of different desensitizing agents on dentinal tubule occlusion: A scanning electron microscope study


Department of Periodontics, Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh, India

Date of Web Publication3-Jul-2019

Correspondence Address:
Saleeta Mushtaq
Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_36_19

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  Abstract 


Background: Dentinal hypersensitivity occurs on exposed dentin and depends on the patency of dentinal tubules. The purpose of this study was to evaluate different desensitizing agents on dentinal tubule occlusion by scanning electron microscopy. Materials and Methods: Thirty teeth were collected from extracted sound maxillary premolars. Samples were sectioned mesiodistally to obtain 30 buccal and 30 lingual surfaces, and enamel was removed in order to simulate hypersensitive dentin. Specimens were randomly divided into four groups. Group 1: 10 samples were coated with Gluma desensitizer, Group 2: 10 samples were coated with VivaSens, Group 3: 10 samples were coated with MS Coat, Group 4: 10 samples each of the contralateral parts of samples were coated with Gluma desensitizer, VivaSens, and MS Coat on which no desensitizing agent was applied, which acted as the controls. All the specimens were examined under SEM, and photomicrographs were evaluated to assess the opening of dentinal tubules in the controls and occlusion of dentinal tubules in their contralateral parts coated with the desensitizing agents. Results: Statistically significant amount of tubules got occluded after the application of MS Coat desensitizer as compared to tubules that got occluded after the application of VivaSens desensitizer and Gluma desensitizer. Conclusion: MS Coat showed better results in the closure of the dentinal tubules, followed by VivaSens and then Gluma desensitizer.

Keywords: Dentin hypersensitivity, desensitizers, Gluma desensitizer, MS Coat, VivaSens


How to cite this article:
Mushtaq S, Gupta R, Dahiya P, Kumar M, Bansal V, Melwani SR. Evaluation of different desensitizing agents on dentinal tubule occlusion: A scanning electron microscope study. Indian J Dent Sci 2019;11:121-4

How to cite this URL:
Mushtaq S, Gupta R, Dahiya P, Kumar M, Bansal V, Melwani SR. Evaluation of different desensitizing agents on dentinal tubule occlusion: A scanning electron microscope study. Indian J Dent Sci [serial online] 2019 [cited 2019 Oct 17];11:121-4. Available from: http://www.ijds.in/text.asp?2019/11/3/121/261950




  Introduction Top


Dentin hypersensitivity is characterized by short sharp pain arising from the exposed dentin in response to thermal, evaporative, tactile, osmotic, or chemical stimuli which may not be ascribed to any other form of dental defect or pathology.[1] The discomfort of dentin hypersensitivity experienced by the patients is highly subjective and can vary substantially between the individuals. For some patients, the discomfort is felt as a low-grade pain, of slight concern, but for others, the discomfort may present as a disturbing severe pain which can affect their quality of life.[2] Gingival recession is the most common clinical cause of exposed dentinal tubules. Brushing habits, diet, chewing tobacco, and some diseases including gastroesophageal reflux can also cause dentinal hypersensitivity.

The discomfort associated with dentinal hypersensitivity makes it difficult for patients to maintain proper oral hygiene and perform plaque control measures. The failure to perform satisfactory plaque control has deep-rooted consequences on gingival, periodontal, and oral health.[3] Various approaches exist to exterminate hypersensitivity, and these approaches fall into two classes: those that physically occlude the tubules, which comprise the majority of treatment modalities, and those that block neural transmission in pulpal tissues, chemically depolarizing the nerve synapse with potassium-based therapy hypersensitivity.[4]

The desensitizing agents that fall in “at-home” category include toothpastes, mouthwashes, or chewing gums and they act by either occluding the dentinal tubules or blocking the neural transmission. Many in-office treatment modalities are available to treat dentinal hypersensitivity and these include various desensitizing agents such as fluorides, oxalates, adhesive resins, Bioglass, Portland cement, laser, and casein phosphopeptide-amorphous calcium phosphate.[5] Some of the available agents are Admira Protect, VivaSens, Gluma desensitizer, seal and protect varnish, MS Coat, Clearfil SE Bond, Cervitec plus, and G Bond. Most of these are HEMA and glutaraldehyde based. The present study has been designed to comparatively evaluate and compare the effects of Gluma desensitizer (aqueous solution of 5% glutaraldehyde and 35% HEMA), VivaSens (protein precipitate desensitizer), and MS Coat commercially available as MS Coat ONE (methacrylate-co-p-styrene sulfonic acid called as MS polymer and 1% oxalic acid) on dentinal tubule occlusion under scanning electron microscope (SEM) after their application on dentin for the treatment of dentinal hypersensitivity.


  Materials and Methods Top


Gluma desensitizer ® (Kulzer), VivaSens ® (Ivoclar Vivadent), and MS Coat ® (Sun Medical) were used in this study. Thirty teeth were collected from extracted sound maxillary premolars stored in normal saline. The root surfaces of all the teeth were scaled with an ultrasonic scaler and thoroughly planed with #5–6 Gracey curette (GDC). The coronal portion of the root and the apical third of the root were removed. The middle third portion of samples was grounded by a straight bur to remove the cementum layer and expose the dentinal tubules, so that it simulates the hypersensitive teeth. Samples were sectioned mesiodistally with a diamond wheel disc bur to obtain 30 buccal and 30 lingual surfaces.

Chemical treatment of the dentinal blocks

All the samples were kept in 17% ethylenediaminetetraacetic acid for 40 min in order to completely open the dentinal tubules. These blocks were ultrasonicated in distilled water for 12 min to remove the residual smear layer.

Preparation of samples for scanning electron microscopic study

Following the chemical treatment, all samples were dehydrated in a graded series of ethanol (10%–90%) for 30 min each and finally in 100% acetone for 30 more minutes. The samples were randomly divided into four groups.

  • Group 1 – 10 samples were coated with Gluma desensitizer
  • Group 2 – 10 samples were coated with VivaSens
  • Group 3 – 10 samples were coated with MS Coat
  • Group 4 – 10 contained 10 samples each of the contralateral parts of samples coated with Gluma desensitizer, Vivasens and MS Coat on which no desensitizing agent was applied. which acted as controls.


The samples were dried and mounted on metal stubs, and inserted in SC7640 sputter coating machine, the samples were sputter coated with 25 nm of gold for 10 min. All the specimens were examined in a POLARON-SEM at a magnification of ×3000, and photomicrographs were evaluated to assess the opening of dentinal tubules in the controls and occlusion of dentinal tubules in their contralateral parts coated with the desensitizing agents, as shown in [Figure 1], [Figure 2], [Figure 3], [Figure 4]. The mean score of tubule occlusion by the three blinded reviewers was taken and used for statistical analysis. The results obtained were statistically analyzed by nonparametric (NPar) test.
Figure 1: Gluma test

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Figure 2: VivaSens test

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Figure 3: MS Coat test

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Figure 4: Control group

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Scanning electron microscope scoring

After observing the SEM images at a magnification of ×3000, the images were assessed independently by three well-trained blinded reviewers to score the level of tubule occlusion (on a categorical scale of 1–5), in accordance with the tubule occlusion classification scoring system:[6]

  1. Occluded (100% of tubules occluded)
  2. Mostly occluded (50–<100% of tubules occluded)
  3. Partially occluded (25–<50% of tubules occluded)
  4. Mostly unoccluded (<25% of tubules occluded)
  5. Unoccluded (0%, no tubule occlusion).


The mean score of tubule occlusion by the three blinded reviewers was taken and used for analysis.


  Results Top


All test groups showed significantly more tubule occlusion as compared to their respective control groups upon intragroup comparison, as given in [Table 1], [Table 2], [Table 3]. [Table 4] depicts the intergroup comparison of level of tubule occlusion in all the three test groups. This table indicates that statistically significant amount of tubules got occluded after the application of MS Coat desensitizer as compared to tubules that got occluded after the application of VivaSens desensitizer and Gluma desensitizer.
Table 1: Intragroup comparison of Gluma test group With Gluma control group

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Table 2: Intragroup comparison of VivaSens test group and VivaSens control group

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Table 3: Intragroup comparison of MS Coat test group with MS Coat control group

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Table 4: Inter group comparison of Gluma test group, VivaSens test group, and MS Coat test group

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  Discussion Top


Dentin is a porous, fluid-filled, mineralized tissue which comprises of dentinal tubules that contribute to penetrability. Attrition, erosion, abfraction, and gingival recession contribute to loss of enamel and cementum so that dentinal tubules are exposed to the oral environment, causing hypersensitivity.[7] Management of painful dental problems such as dental hypersensitivity has been very difficult for many years, and this has created a major problem.[8] Successful treatment regimens which can provide rapid, long-lasting tubule occlusion and resistance to the challenges in the oral environment are needed. Occlusion of dentinal tubules is a very effective approach currently used in the treatment of dentin hypersensitivity.

In this study, an effort has been made to evaluate the dentinal tubule occluding ability of three desensitizers: Gluma desensitizer, MS Coat, and VivaSens and to compare their occluding abilities. Thirty samples were collected from extracted sound maxillary premolars and stored in normal saline. The premolars were selected because the most frequently affected teeth with sensitivity are premolars (68.8), followed by molars, canines, and incisors.[9] Only vital teeth were included in the study. The teeth which had caries, fractured, having periapical infection or nonvital teeth, with any developmental malformation, with wasting disease were excluded from the study. The root surfaces of all the teeth were scaled with an ultrasonic scaler and thoroughly planed with #5–6 Gracey curette.

The study design was similar to the study carried out by Pathan et al.[10] All the specimens were examined in a POLARON-SEM at a magnification of ×3000, and photomicrographs were evaluated to assess the opening of dentinal tubules in the controls and occlusion of dentinal tubules in their contralateral parts coated with the desensitizing agents. The evaluation of SEM images was done by three blind scorers in order to reduce bias, in accordance with the tubule occlusion classification scoring system as reported by West et al.[11] The same index was used by Chen et al. The mean score of tubule occlusion by the three blinded reviewers was taken and used for statistical analysis. The results obtained were statistically analyzed by NPar test.

[Table 1] shows the intragroup comparison of level of tubule occlusion of Gluma test group and Gluma control group. A mean of 3.10 ± 0.61 was seen in Gluma test group as compared to mean of 4.60 ± 0.50 which was observed in Gluma control group. This indicates that statistically significant amount of tubules got occluded after the application of Gluma desensitizer. This may be due glutaraldehyde present in Gluma desensitizer which is a biological fixative which occludes the dentinal tubules as an effect of the reaction with plasma proteins from dentinal fluid.[12]

[Table 2] shows the intragroup comparison of level of tubule occlusion of VivaSens test group and VivaSens control group. A mean of 2.27 ± 0.58 was seen in VivaSens test group as compared to mean of 4.50 ± 0.51 which was observed in VivaSens control group. This indicates that a statistically significant amount of tubules got occluded after the application of VivaSens desensitizer on the samples. This may be due to the presence of polyethylene glycol dimethacrylate in VivaSens desensitizer which triggers the precipitation of plasma proteins in the dentinal tubules.[13]

[Table 3] shows the intragroup comparison of level of tubule occlusion of MS Coat test group and MS Coat control group. A mean of 1.57 ± 0.50 was seen in MS Coat test group as compared to mean of 4.77 ± 0.43 which was observed in MS Coat control group. This indicates that a statistically significant amount of tubules got occluded after the application of MS Coat desensitizer on the samples. This may occur due to the presence of methacrylate-co-p-styrene sulfonic acid and 1% oxalic acid in MS Coat desensitizer which chemically reacts with tooth structure to form a barrier that seals open tubules and blocks thermal, mechanical, and chemical stimulation of the odontoblastic process.[14]

[Table 4] shows the intergroup comparison of level of tubule occlusion in all the three test groups: Gluma test group, VivaSens test group, and MS Coat test group. A mean of 3.10 ± 0.61 was observed in Gluma test group, a mean of 2.27 ± 0.58 was observed in VivaSens test group, and a mean of 1.57 ± 0.50 was observed in MS Coat test group.


  Conclusion Top


Within the limits of this study, after comparing the three desensitizing agents and control group, it was concluded that all the three desensitizing agents were effective in the closure of dentinal tubules despite their different chemical compositions and application procedures.

On intergroup comparison between Gluma desensitizer, VivaSens, and MS Coat, it was found that MS Coat had shown better results in the closure of the dentinal tubules, followed by VivaSens and then Gluma desensitizer.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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. 1
    
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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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Carlo GT, Ciancio SG, Seyrek SK. An evaluation of iontophoretic application of fluoride for tooth desensitization. J Am Dent Assoc 1982;105:452-4.  Back to cited text no. 3
    
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Wara-Aswapati N, Krongnawakul D, Jiraviboon D, Adulyanon S, Karimbux N, Pitiphat W. The effect of a new toothpaste containing potassium nitrate and triclosan on gingival health, plaque formation and dentine hypersensitivity. J Clin Periodontol 2005;32:53-8.  Back to cited text no. 4
    
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Miglani S, Aggarwal V, Ahuja B. Dentin hypersensitivity: Recent trends in management. J Conserv Dent 2010;13(14): 218-24.  Back to cited text no. 5
    
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Chen CL, Parolia A, Pau A, Celerino de Moraes Porto IC. Comparative evaluation of the effectiveness of desensitizing agents in dentine tubule occlusion using scanning electron microscopy. Aust Dent J 2015;60:65-72.  Back to cited text no. 6
    
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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. 7
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8.
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. 8
    
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de Souza AM, Colares RC, Mendonça JS, Rodrigues LK, Santiago SL. Effect of oxalic acid pre-treatment in restorations of non-carious cervical lesions: A randomized clinical trial. J Conserv Dent 2014;17:427-31.  Back to cited text no. 9
    
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Pathan AB, Bolla N, Kavuri SR, Sunil CR, Damaraju B, Pattan SK. Ability of three desensitizing agents in dentinal tubule obliteration and durability: An in vitro study. J Conserv Dent 2016;19:31-6.  Back to cited text no. 10
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West NX, Macdonald EL, Jones SB, Claydon NC, Hughes N, Jeffery P. Randomized in situ clinical study comparing the ability of two new desensitizing toothpaste technologies to occlude patent dentin tubules. J Clin Dent 2011;22:82-9.  Back to cited text no. 11
    
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Gupta AK, Sharma N, Bramta M. Dentin tubular occlusion with bioactive glass containing dentrifice and gluma desensitizer – A comparative SEM evaluation. Dent J Adv Stud 2014;2:16-21.  Back to cited text no. 12
    
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Malkoç MA, Sevimay M. Evaluation of mineral content of dentin treated with desensitizing agents and neodymium yttrium-aluminium-garnet (Nd: YAG) laser. Lasers Med Sci 2012;27:743-8.  Back to cited text no. 13
    
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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