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Comparative evaluation of a dentifrice containing calcium

sodium phosphosilicate to a dentifrice containing

potassium nitrate for dentinal hypersensitivity:

A clinical study Satyapal T, Mali R, Mali A, Patil V

J Indian Soc Periodontol 2014;18:581-5.

CHECKED BY: PREPARED BY:DR.NEHA MAHAJAN DR. VIRSHALI GUPTA

PG 1ST YEAR

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INTRODUCTION

Dentinal hypersensitivity - common oral complaint that affects

the teeth of many individuals.

International workshop on dentinal hypersensitivity (1983)

defined dentinal hypersensitivity as “short and sharp pain of a

rapid onset that arises in response to a stimulus from exposed

dentin and cannot be ascribed to any other dental defect or

pathology.”

Modification by the Canadian Advisory Board on Dentine

Hypersensitivity (2003), was suggested that “disease” should

be substituted for “pathology”.

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Recently, a new material, calcium sodium phosphosilicate,

was introduced for the treatment of dentinal hypersensitivity.

Acts by chemically reacting with the hydroxyapatite of the

teeth and promotes the formation of a hydroxycarbonate

apatite layer.

Useful in treating demineralized tooth structure or in

preventing further demineralization.

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AIM

Evaluation of the efficacy of calcium sodium phosphosilicate

in the treatment of dentinal hypersensitivity and comparing its

efficacy with potassium nitrate.

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MATERIALS AND METHOD

60 subjects with the complaint of hypersensitivity were recorded.

Clinical examination was carried out in dental chair under

standard conditions of light.

Dentinal hypersensitivity was scored using VAS (the visual

analogue scale) on air stimulus and cold water stimulus.

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A VAS scale is a line of 10 cm in length.

This line represents the limit of pain a patient might

experience from any external stimulus.

No pain is represented at one end of the line (marked 0) and

severe pain at the other end (marked 10).

Subjects were asked to place a mark on the 10-cm line,

indicating the intensity of their current level of dentin

hypersensitivity.

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COLD AIR BLAST TEST

The cold air was directed at the exposed surface of the

selected tooth that was isolated from the adjacent teeth using

cotton rolls.

A constant distance (3 mm) was kept between the tooth

surface and the tip of the air syringe for the assessment of

hypersensitivity.

The subjects were asked to rate their response to the stimulus

on the VAS scale.

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COLD WATER TEST

Cold water was taken in a syringe and applied to the exposed

dentin surface while the neighbouring teeth were isolated

during testing using the operator’s fingers and cotton rolls.

The subjects were asked to rate their response to the stimulus

on the VAS scale.

A period of at least 5 min was allowed between the two

stimuli on each tooth.

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After the sensitivity scores were recorded at baseline, scaling

and root planing was also carried out.

Subjects were then divided into two groups randomly:

Group I subjects were given dentifrice containing 5% calcium

sodium phosphosilicate .

Group II subjects were given dentifrice containing 5%

potassium nitrate.

Subjects were advised to use the toothpaste with a soft bristle

toothbrush twice a day.

Subjects were also directed to refrain from any other dentifrice

or mouth rinse during the trial, but were allowed to continue

their normal oral hygiene practice.

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RECALL

Subjects were recalled after 3 weeks.

Hypersensitivity scores were again recorded on cold air

stimulus and cold water stimulus.

Subjects were then asked to discontinue the respective

desensitizing dentifrices.

They were recalled after 3 weeks and the hypersensitivity

scores were again taken, i.e. 6 weeks from baseline.

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RESULTS

Statistically significant reduction of dentinal hypersenstivity

between baseline and 3rd week and between baseline and 6th

week in group I and group II.

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INTER-GROUP ANALYSIS

1) AT BASELINE:

There was no significant difference between group I and group

II.

2) AFTER 3 WEEKS:

Significant difference between group I and group II.

The VAS score of group I was significantly lower than group II.

3) AFTER 6 WEEKS:

Statistically significant difference between group I and II.

The VAS score of group I was significantly lower than group II.

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DISCUSSION

Burwell et al concluded in their study that calcium sodium

phosphosilicate adheres to an exposed dentin surface and reacts

with it to form a mineralised layer and provide continual

occlusion of the dentinal tubules.

5% calcium sodium phosphosilicate has a prolonged effect in

managing dentinal hypersensitivity, even after discontinuation,

compared to 5% potassium nitrate.

The results of the study showed that, calcium sodium

phosphosilicate resulted in better reduction in VAS scores after

3 weeks.

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Observed that the hypersensitivity scores increased over a

period of 3 weeks after cessation of use of toothpaste.

But the hypersensitivity scores still remained below the

baseline scores at the end of the study.

The increase in hypersensitivity score with 5% calcium sodium

phosphosilicate was significantly less compared to 5%

potassium nitrate after 3 weeks of cessation, i.e. 6 weeks from

baseline.

Therefore, at the end of the study, better results were obtained

with 5% calcium sodium phosphosilicate compared to 5%

potassium nitrate.

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CONCLUSION

Calcium sodium phosphosilicate showed greater reduction in

dentinal hypersensitivity compared to highly efficacious 5%

potassium nitrate and also tends to maintain it even after

discontinuation, it may provide a new direction for the

treatment of dentinal hypersensitivity.

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CROSS REFRENCE: Comparison of Clinical Efficacy of a

Dentifrice Containing Calcium Sodium Phosphosilicate to a

Dentifrice Containing Potassium Nitrate and to a Placebo on

Dentinal Hypersensitivity: A Randomized Clinical TrialAR Pradeep and Anuj Sharma

A total of 110 subjects were entered into the study. The

volunteers selected at baseline had a history of dentin

hypersensitivity caused by gingival recession.

Patients were required to have at least two teeth with a visual

analog scale score of ≥4 to be included in the study.

After sensitivity scores for controlled air stimulus and cold water

stimulus at baseline were recorded, subjects were given

toothpastes randomly, and sensitivity scores were measured

again at 2 and 6-week follow-ups.

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All three groups showed reduction in sensitivity scores at 2

weeks and 6 weeks for air stimulus and cold water. The

calcium sodium phosphosilicate group, however, was found to

be significantly better in reducing the visual analog scale score

compared to the potassium nitrate group and the placebo

group at anytime point for both measures of sensitivity.

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