JOURNAL OF ENDODONTICS

Copyright 2002 by The American Association of Endodontists

Printed in U.S.A.
VOL. 28, NO. 1, JANUARY 2002

CLINICAL ARTICLES
Effectiveness of Desensitizing Agents
Anand Kishore, MDS, Kamlesh Kumar Mehrotra, MDS, and Charanjit Singh Saimbi, MDS

Therefore the present study was designed to compare the efficacy of several desensitizing agents in the treatment of dentin
hypersensitivity.

This study was conducted to evaluate the efficacy

of desensitizing agents for the treatment of dentin
hypersensitivity. Seventy-five hypersensitive teeth
in 10 patients were studied. These were divided
into five groups of 15 hypersensitive teeth: group I,
control (triple distilled water); group II, 10% strontium chloride; group III, 5% potassium nitrate;
group IV, 2% sodium fluoride; and group V, 40%
formalin. The stimulus used to test thermal sensitivity was cold water at 15C, 10C, 5C, and 0C
applied on every alternate day for 10 days. Results
showed that 10% strontium chloride solution, 2%
sodium fluoride solution, and 40% formalin solution significantly reduced dentin hypersensitivity,
whereas a 5% solution of potassium nitrate did
not.

MATERIALS AND METHODS

Ten patients visiting the Department of Periodontics, Faculty of
the Dental Sciences, King Georges Medical College, Lucknow,
India, were selected. They had a total of 75 sensitive teeth. They
were further divided into five groups of 15 sensitive teeth.
Subjects with a history of treatment for dentin hypersensitivity,
poor periodontal condition, systemic debilitating diseases, caries or
restoration in the area of hypersensitivity, allergy to a chemical or
drug, a condition requiring analgesics, and with orthodontic appliances were excluded from the study. Patients reporting pain from
hot, cold, sweet, or sour or during brushing were included as
having dentinal sensitivity.
After proper consent from the patient the area of hypersensitivity was identified, and the details of each patient were recorded on
a specially prepared record sheet.
The desensitizing agents studied were grouped as follows: group
I, controltriple distilled water; group II, 10% strontium chloride;
group III, 5% potassium nitrate; group IV, 2% sodium fluoride;
and group V, 40% formalin.
The stimulus used to test thermal sensitivity was cold water at
different temperatures.
The pain scoring system used was a verbal rating based on a
4-point scale that graded pain as slight, moderate, severe, or
agonizing. This simple descriptive scale was modified as described
and was used in the present study.

Hypersensitivity of the teeth is a pathological condition in which

the teeth are sensitive to thermal, chemical, and physical stimuli.
The patient with dentin hypersensitivity experiences pain from
hot/cold and sweet/sour solutions. The pain may also be experienced when hot/cold air touches the teeth. It varies in degrees from
mild to sharp and excruciating pain.
Dentin hypersensitivity occurs due to exposure of dentinal tubules as a result of attrition, abrasion, erosion, fracture of tooth,
chipping of the tooth, or a faulty restoration. Dentin hypersensitivity can also occur after periodontal therapy, gingival recession,
shrinkage of the swollen gingiva after curettage, and elimination of
tissue by gingivectomy.
Lasers are being investigated for the treatment of hypersensitivity to avoid frequent visits of patients to the dental offices for a
local application, and desensitizing agents are incorporated in
toothpaste for regular use by patients.
A number of studies have tested iontophoresis and fluoride as
desensitizing agents (Lutkins et al.) (1). A reduction in sensitivity
with iontophoresis and fluoride has been reported.
Many medicinal plants have also been tried for relief from
sensitivity, including Kattha, pan leaves, Haldi rhizomes, and Tulsi
leaves. However there is no single universally accepted treatment
available.

Grade
Grade
Grade
Grade

0 No pain
1Mild pain
2Moderate pain
3Severe pain.

The sensitive area was isolated and dried with cotton rolls.
Small cotton pellets dipped in desensitizing agents were left on the
area of sensitivity for 5 min. After removal of the cotton pellet the
tooth was tested for sensitivity. Patients were recalled every alternate day, and the same procedure was repeated for 10 days spread
over five appointments.
The thermal stimulation test was done on each follow-up visit at
the temperature previously recorded for pain to see the effect of the
34

Vol. 28, No. 1, January 2002

test solution. If there was no pain at the previous recorded temperature, the next lower water temperature was tested on the
hypersensitive tooth surface until the patient reported pain. The
grading of pain was recorded, and a fresh test sample was applied.
The patient was recalled on every alternate day for the next
follow-up visits.
The results were analyzed by comparing the postoperative finding (after every sitting) with the preoperative recordings of severity
of pain. Data obtained were subjected to statistical analysis by
students t test.
RESULTS
Ten percent strontium chloride solution, 2% sodium fluoride
solution, and 40% formalin solution significantly reduced dentin
hypersensitivity, whereas a 5% solution of potassium nitrate did
not.
It was noted that in comparing 10% strontium chloride (group
II), 5% potassium nitrate solution (group III), 2% sodium fluoride
(group IV), and 40% formalin (group V), the 2% solution of
sodium fluoride was significantly superior. When a 10% strontium
chloride solution was compared with a 5% potassium nitrate and
40% formalin solution, it was found that a 10% solution of strontium chloride was significantly superior. Forty percent formalin
was significantly superior to 5% potassium nitrate.
DISCUSSION
Hypersensitive dentin implies an abnormal sensitivity when
exposed to heat, cold, sweet, and sour articles. Graf and Galasse (2)
reported that 1 of 7 dental patients suffer a hypersensitive reaction
to thermal, chemical, and mechanical stimuli. Brannstrom et al. (3)
reported that dentin hypersensitivity results when a stimulus applied to dentin causes movement of fluid in the dentinal tubules,
which stimulates nerve processes in the pulpal area of the dentin
and produces pain impulse transmission.

Effectiveness of Desensitizing Agents

35

Ross (4) treated 86 patients with 10% strontium chloride who

had thermal or nonthermal hypersensitivity and found that 93.6%
of patients showed improvement after a 1-month period.
Kim (5) suggested that the active moiety may be potassium
nitrate ions. Presumably the mechanism of action depends on the
ability of potassium ion to penetrate through the dentinal tubules to
the nerve endings at the dentin pulpal junction. These ions modify
the usual exchange of sodium and potassium in the nerve.
Minkov et al. (6) conducted a double-blind study evaluating 2%
sodium fluoride at 4 wk. At compilation of their 8-month study
they found no significant difference between the two treatments.
Fitzgerald (7) reported excellent results with a paste containing
1.4% formalin. Abel (8) found excellent symptomatic relief in the
treatment of hypersensitivity with 1.4% formalin containing
toothpaste.
Dr. Kishore is a resident, Dr. Mehrotra is professor and head, and Dr.
Saimbi is professor, Department of Periodontics, Faculty of Dental Sciences,
King Georges Medical College, Lucknow (U.P.), India. Address requests for
reprints to Dr. Charanjit Singh Saimbi, Department of Periodontics, Faculty of
Dental Sciences, King Georges Medical College, Lucknow (U.P.), India.

References
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2. Graf H, Galasse R. Morbidity, prevalence, and intraoral distribution of
hypersensitive teeth. J Dent Res 1973;56(Suppl. A):162.
3. Brannstrom M, Linden LA, Astrom A. The hydrodynamics of dentin and
pulp fluid. Caries Res 1967;1:310 7.
4. Ross MR. Hypersensitive teeth. Effect of strontium chloride in a compatible dentifrice. J Periodontol 1961;32:49.
5. Kim S. Hypersensitive teeth desensitization of pulpal sensory nerves. J
Endodon 1986;12:4825.
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sodium fluoride treatment with or without iontophoresis on the reduction of
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