|Year : 2014 | Volume
| Issue : 1 | Page : 7-12
The reduction efficacy of dentinal hypersensitivity by two commercially available desensitizing toothpastes: Vantej and Colgate Pro- Argin
Aditya Rao1, Dipika Mitra1, Ashok Kodangala Prabhakar1, Sweta Soni1, Sameer Ahmed1, Sugandha Arya2
1 Department of Periodontics and Oral Implantology, Vyas Dental College and Hospital, Kudi Haud Near NH 65, Pali Road, Jodhpur, Rajasthan, India
2 Department of Oral Medicine and Radiology, Vyas Dental College and Hospital, Kudi Haud Near NH 65, Pali Road, Jodhpur, Rajasthan, India
|Date of Web Publication||28-Feb-2014|
Department of Periodontics and Oral Implantology, Vyas Dental College and Hospital, Kudi Haud Near NH 65, Pali Road, Jodhpur, Rajasthan
Source of Support: Independent source (from the college institution, Conflict of Interest: The present study has been performed
independently and has not been sponsored by any of the test
desensitizing toothpastes. All the results of the study are authentic and
Background : Dentin hypersensitivity is a commonly experienced problem that is triggered by an external stimulus, such as hot and cold temperature changes, pressure from tooth brushing and osmotic changes caused due to sweet or sour food and beverages. Various treatment modalities are tried and tested, amongst them desensitizing pastes have been used extensively in the past decades. Objective: The objective of these 15 days, single center, randomized clinical pilot study was to evaluate the dentin hypersensitivity reducing efficacy of two commercially available desensitizing toothpastes: One with Pro-Argin technology and the other with Novamin. Materials and Methods: Eighty subjects of dentin hypersensitivity were sampled in the present pilot study. Subjects were randomly selected and the pastes were prescribed for both the groups. Subjects were advised to brush twice daily for 2 min with the desensitizing paste and also were advised for topical application of the desensitizing paste on sensitive teeth and were asked not to rinse until morning. The evaluation was done by Air blast technique using sensitivity visual analog scale consisting of mild, moderate, and severe parameters rated on a scale of 0-10. Efficacy was compared on baseline, after 1 min of application and after 15 days. Statistical Analysis: t-test was performed and P value ≤ 0.05 was considered as statistically significant. Results: There was no statistically significant difference between the two groups after 1 min of examination, but there was a statistically significant difference in reduction of dentin hypersensitivity after 15 days interval favoring Vantej group (P ≤ 0.02). Conclusion: Desensitizing paste containing 5% NovaMin crystals provided a statistically significant reduction at 15 days interval when compared with the one containing Pro-Arginine.
Keywords: Dentin hypersensitivity, desensitizing toothpaste, Novamin, Pro-Arginine, visual analog scale
|How to cite this article:|
Rao A, Mitra D, Prabhakar AK, Soni S, Ahmed S, Arya S. The reduction efficacy of dentinal hypersensitivity by two commercially available desensitizing toothpastes: Vantej and Colgate Pro- Argin. Saudi Endod J 2014;4:7-12
|How to cite this URL:|
Rao A, Mitra D, Prabhakar AK, Soni S, Ahmed S, Arya S. The reduction efficacy of dentinal hypersensitivity by two commercially available desensitizing toothpastes: Vantej and Colgate Pro- Argin. Saudi Endod J [serial online] 2014 [cited 2019 Nov 13];4:7-12. Available from: http://www.saudiendodj.com/text.asp?2014/4/1/7/127980
| Introduction|| |
Dentin hypersensitivity has been one of the most common complains of dentistry, referred to as "common cold of dentistry."  Dentin hypersensitivity is defined as short, sharp pain arising from exposed dentin in response to stimuli, typically thermal, evaporative, tactile, osmotic or chemical that cannot be ascribed to any other forms of dental defect or pathology.  Studies have reported that dentine hypersensitivity affects upto 57% dental patients of different lifestyles and cultures and appear to peak between the ages of 20 and 40 years. ,,, Gingival recession, caused by overly enthusiastic oral hygiene can be a reason for dentin hypersensitivity. Acid wear may be becoming more prevalent in all ages due to the modern acid containing diet.  Both of these conditions lead to exposed dentin, which under the right circumstances, leads to the initiation of dentin hypersensitivity-their sole and common symptom. Also as the availability of both preventive and interventional medicine flourishes, alongside improved living standards, evidence suggests an increase in longevity of the human life span. This improvement in general health is manifested in healthy functional tooth retention, alongside patient expectation of maintenance of a functional aesthetic dentition. As a result of individuals retaining their teeth longer, the incidence of exposed dentin from tooth wear, gingival recession and attachment loss from periodontal diseases can be expected to rise which can present with dentine hypersensitivity. Various modalities have been tried in the past. Tooth pastes containing potassium nitrate have been used since 1980. 
Effective and long-lasting treatment of dentine hypersensitivity is thus of paramount interest to both patient and clinician, and a number of toothpastes are available on the market claiming to reduce dentine hypersensitivity. A recent review by Cummins D (2010) provides an overview of various approaches to tubule occlusion.  There are two routes of tubule occlusion:
- deposition of layer of fine particles
- induction of natural mineral formation in situ.
The present study is about the comparison of two commercially available desensitizing toothpastes Vantej containing Novamin and Colgate Pro-Argin with Pro-Arginine technology, both of which are proposed rapid relief tooth pastes, causing mechanical occlusion of dentinal tubules by induction of mineral formation in situ. Pro-Argin formula and Novamin crystals are comparatively newer technologies; hence the present study is about the comparison of both of them in reducing dentine hypersensitivity.
The aim of the present study was to compare the clinical efficacy of two desensitizing toothpastes: Vantej desensitizing toothpaste containing Novamin with Colgate Pro-Argin desensitizing paste containing Pro-Arginine Formula.
The objective was to evaluate the dentin hypersensitivity reduction efficacy of Novamin containing desensitizing toothpaste with Pro-Arginine containing desensitizing toothpaste by visual analog scale after 1 min and after 15 days follow up period.
| Materials and Methods|| |
The present study is single centerd, randomized clinical control study done at Vyas Dental College and hospital, Jodhpur. Prior to the initiation of the study, the protocol and the letter of informed consent were approved by the Institutional Review committee of Vyas dental college, Jodhpur. Eighty subjects having the chief complaint of dentine hypersensitivity were included as a part of pilot study for which this much sample size was sufficient. Among the 80 subjects, 39 were females and 41 males. Subjects were required to be available for the study duration and to sign an informed consent form. The subjects were advised to fill a special questionnaire, which included questions like age, sex, chief complaint, cause, whether pain experienced on having either cold or hot food stuffs or sweets, duration of pain, tooth/teeth involved, prior treatments received (if any) on the tooth/teeth of interest, etc., To be eligible for participating in the study, each subject had to have minimum of two dentine hypersensitive teeth and a minimum of score 3 on Schiff cold air sensitivity scale.
The inclusion criteria for the present study included age group between 18-70 years, minimum of two hypersensitive teeth, with a minimum air blast stimulus score of 3 on Schiff cold air sensitivity scale, patients willing for follow up visits.
The exclusion criteria for the present study were current use of anti-depressants, sedatives or analgesics, history of allergy to any of the test product, patient who had any kind of treatment for dentinal hypersensitivity on that particular tooth, use of any desensitizing paste within the last 3 months, extensive or defective restorations/suspected pulpitis/cracked enamel with the tooth of interest.
Prior to the baseline examination of the teeth of interest were isolated. Instructions such as refraining of oral hygiene procedures and avoiding analgesics were given to the patient prior to the baseline examination. Baseline examination was carried out using Air-blast technique  and the scores were given on a 10 cm sensitivity visual analog scale, which had ratings from 0-1 No Pain, 2-3 for mild pain, 4-6 for moderate and 7-10 for severe pain.
After the baseline evaluation, the teeth of interest were again isolated and wiped using cotton rolls. Each subject topically self-applied a pea sized amount (approximately 0.3 mg) of their assigned toothpaste directly onto each of his/her hypersensitive teeth using a fingertip by massaging each tooth for 60 s before expectoration. This technique was in accordance to a study done by Yiming Li and Sean Lee in 2011.  Then the evaluation was carried out in the same manner as it was for baseline examination. Subjects were divided in two groups based on the desensitizing paste they were prescribed. The two desensitizing pastes which were prescribed in the present study included: Vantej desensitizing toothpaste containing Novamin (Dr. Reddy's company, India) and Colgate Pro-Argin desensitizing paste (Colgate Palmolive company, New Jersey, USA). Instructions for the home application of desensitizing paste were given to the patient, which included twice brushing with the desensitizing paste for duration of 2 min and at night, topical application of desensitizing paste which was to be left un-rinsed till morning for longer period of action.
Patients were asked to follow all the instructions and to report after 15 days. Fifteen days follow-up examination was carried out in the same manner as of the previous ones by Air blast technique. The patients were asked about any kind of discomfort or burning sensation or any other side effect which they experienced after using the test tooth paste.
There were no drop outs in the present study and every participant completed the study. Non parametric Chi-square test was carried out between the two groups at all the evaluation periods. Null hypothesis was stated saying there is no difference among the two groups (H 0 ).
H,= There is no difference between vantej and Colgate pro pain (Vas Score)
H 3 = There is difference between vantej and Colgate pro pain (Vas Score)
| Results|| |
All the 80 subjects completed the parallel study in 15 days. Throughout the study there were no adverse events on the hard and soft tissue. There was no statistically significant difference (P = 0.091) in the baseline scores of both the samples, thus nullifying the inter-sampling discrepancy [Table 1] and [Table 2], Chart 1]. No statistically significant scores (P = 0.077) were obtained between the groups when difference between baseline scores and after 1 min scores was taken into consideration [Table 3] and [Table 4], Chart 2]. However in both the groups, we observed statistically significant differences when their baseline scores were compared with their after 1 min evaluation scores.
|Table 1: Indicates the basic VAS scores for both the groups prior to the study |
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|Table 2: Indicates that there was no significant difference among the two groups at the baseline (P = 0.091) |
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|Table 3: Indicates the Visual Analog Scores for pain after 1 minute of application of Vantej And Colgate pro-argin |
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|Table 4: Indicates there was no statistically significant difference for both the groups after 1 min of application |
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There was highly significant difference observed in both groups after 15 days of evaluation. (P = 0.000) revealing that Vantej group showing better results [Table 5] and [Table 6], Chart 3]. Also after the completion of study no patient was in moderate pain category for Vantej group when compared to Colgate pro-relief where in still 31 patients remained in moderate pain group.
|Table 5: Indicates the VAS pain scores for both groups after 15 days period |
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|Table 6: Indicates there was a highly significant statistical difference (P = 0.000) between the two groups |
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| Discussion|| |
Dentine hypersensitivity has been a concern for both the patients as well as for the clinician. The etiology for dentin hypersensitivity when assessed in the present study were gingival recession, generalized attrition, cervical abrasion as most of the subjects in the study were older people with a mean age of 48 years. Various researches in this field have brought light on different treatment options to treat the same. The principle of occluding dentin tubules to block the hydrodynamic mechanism of pain stimulation is a seemingly straightforward one. Yet, there are multiple and complex ways in which different agents and products could potentially act to partially or completely occlude tubules. In simple theoretical terms, these ways might include  :
- Creation of a "natural" smear layer - mechanical forces, such as professional burnishing of sensitive dentin surfaces, have been hypothesized to encourage natural oral constituents to interact with the dentin surface and loosely occlude the tubules;
- Deposition of a thin film coating - professionally- applied polymer-based materials, such as restorative resins or dentin bonding agents, have been suggested to create an "artificial smear layer" on the exposed dentin surface and over the open tubules;
- Deposition of a layer of fine particles - materials delivered directly from a dentifrice, such as fine abrasive particles, or formed as a precipitate in situ, such as strontium, stannous, and calcium phosphate particles, have been proposed to form a physical barrier on the exposed dentin surface and in the openings of the tubules; and
- Induction of natural mineral formation in situ - new technologies, such as the Pro-Argin technology and NovaMin bioactive glass, are believed to bind to the exposed dentin surface and within the openings of the dentin tubules to mediate the formation of biological mineral.
The hydrodynamic theory, the most accepted one, suggests the pain sensation is caused by activation of mechanoreceptors in intratubular nerves or in superficial pulp due to the changes in the fluid flow and or volume of fluid within dentinal tubules. Dentine fluid flow rate is proportional to the fourth power of the tubule radius, so the difference in the tubule diameter between sensitive and non sensitive teeth is, almost certainly, of clinical relevance to the treatment of dentine hypersensitivity.  Tubule occlusion concept in the treatment of dentin hypersensitivity has been known since quiet few years. Desensitizing pastes have been used widely in the past for treating dentine hypersensitivity because of their low cost and ease for the use for home application. The vast majority of desensitizing toothpastes, representing approximately 10% of the global toothpaste market, contain a potassium salt to "numb" the pain of dentin hypersensitivity. 
Both the test desensitizing toothpastes have rapid relief action and are known to cause tubule occlusion by mineral formation. Pro-Argin technology is a newer technology mimicking natural mineral formation.  Novamin chemically termed as calcium sodium phophosilicate (CSSP) represents a method of tubule occlusion consisting of oxides of calcium, sodium, phosphorus ions and help in the formation of hydroxycarbonate apatite (HCA), which is similar in composition to minerals of teeth and bone. 
New technologies such as Pro-Argin and Novamin have been proposed to physically adhere to the exposed dentin surface and the dentinal tubules to mediate formation of calcium- and phosphate rich mineral.  According to literature, very few studies have been done to compare the reduction efficacy clinically between the Pro-Argin and Novamin technology. Hence, the interest of the present study was to compare among the two commercially formulated desensitizing toothpastes one containing Novamin crystals and the other with Pro-Argin formula, respectively.
Results revealed that the baseline scores obtained for both the group subjects when compared showed no statistically difference nullifying inter- sampling discrepancy.
Both the test desensitizing pastes are proven rapid relief toothpastes; hence comparison was done between the baseline scores and after 1 min examination scores for both the groups. Statistically significant results were seen, when their baseline scores were compared with their after 1 min evaluation scores. However, among the groups when difference between baseline and after 1 min scores were tested for significance, no such statistically significant difference was seen indicating that both were equally effective in their rapid relief action. The reason could be due to their same mechanism of action causing dentinal tubule occlusion.
Results revealed that Novamin crystals gave statistically significant reduction efficacy after 15 days follow up period when compared with Pro-Argin formula. These results match the findings from a study done by West et al., (2011) who found that Novamin was superior at occluding patent dentinal tubules when compared with 8% Arginine under acid challenges.  Thus, Novamin proved to be more effective on a longer duration period.
Thus, both the technologies have convincing supporting evidence for efficacy and, most importantly, for sustainable surface occlusion, even following an acidic challenge. 
Dentin hypersensitivity pain is often confused with a sharp endodontic pain arising from dental pulp, thus its very essential to differentiate the kind of pain.
| Conclusion|| |
With dentin hypersensitivity presenting with such a high frequency, a fast acting, durable, effective treatment modality is needed to reduce or alleviate the episodes of pain. With Vantej showing better results than Colgate Pro-Argin technology on a long term basis it could be considered as an effective treatment modality.
| Acknowledgement|| |
I would like to thank Bhavana Pandit for helping me out with the statistical analysis.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]