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THESIS – SYNOPSIS
DR. SOUPARNA MADHAVAN
POST GRADUATE STUDENT
DEPARTMENT OF CONSERVATIVE
AND
ENDODONTICS
K.V.G DENTAL COLLEGE & HOSPITAL
KURUNJIBAGH SULLIA-574327
DAKSHINA KANNADA
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE-KARNATAKA
ANNEXURE- II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 NAME OF THE CANDIDATE AND
ADDRESS
2 NAME OF THE INSTITUTION
3 COURSE OF STUDY AND SUBJECT
4 DATE OF ADMISSION TO COURSE
5 TITLE OF THE TOPIC
DR. SOUPARNA MADHAVAN
POST GRADUATE STUDENT
DEPT. OF CONSERVATIVE AND
ENDODONTICS
K.V.G. DENTAL COLLEGE &
HOSPITAL,KURUNJIBHAG,
SULLIA-574327
K.V.G. DENTAL COLLEGE &
HOSPITAL,KURUNJIBHAG,
SULLIA-574327
MASTER OF DENTAL SURGERY,
CONSERVATIVE DENTISTRY AND
ENDODONTICS
31-5-2006
A COMPARATIVE CLINICAL
EVALUATION OF CPP-ACP F, ACP ,
SODIUM FLUORIDE, POTASSIUM
NITRATE ,AND PROPOILIS IN TREATING
DENTINAL HYPERSENSITIVITY.
BRIEF RESUME OF INTENDED WORK:
6.1 NEED FOR STUDY:
Dentinal hypersensitivity is a significant clinical problem and has been reported to affect as
many as one in seven of patients attending for dental treatment1 .About 10-30% population
in general have dentinal hypersensitivity affecting canines and premolars followed by molars
and mostly occurs in patients of age group between 20-40 years2 .
Dentinal hypersensitivity is more a symptom complex than a true disease and severity of pain
or the patient interpretation appear to determine the treatment.
A complete knowledge and understanding of the mechanisms underlying dentine sensitivity
are not yet at hand. It would appear; therefore that whatever mechanisms are finally
understood to cause dentine hypersensitivity, the mechanical blocking of the tubules by
precipitation of compounds or by surface coating is an essential prerequisite to satisfy the
basic requirements of a desensitizing agent.1
Most of published information relates to prevalence of hypersensitivity, however currently
there does not appear to be globally agreed Gold standard procedure for comparative
purposes in clinical trial setting for evaluation of new desensitizing agents3.
The purpose of the study is to clinically evaluate efficiency of CPP-ACP F, ACP, by Sodium
fluoride , potassium nitrate and Propoilis in treating cervical dentinal hypersensitivity.
REVIEW OF LITERATURE:
In comparative evaluations of the effectiveness of sodium fluoride treatment with and
without iontophoresis, it was found that iontophoresis with sodium fluoride provided
immediate relief after one application and was preferable to treatment with a 33% sodium
fluoride paste. Using 2% sodium fluoride solution with and without iontophoresis, found that
overall both treatments were equally effective. The reduction in sensitivity with iontophoresis
was ascribed to the electrical stimulation of secondary dentine formation. However, the
positive effect observed after only one application would appear to be too short a period for
the induction of secondary dentine formation. Thus, the improvement has been attributed to
fluoride treatment giving rise to an increase in the resistance of the dentine to acid
decalcification and/or to precipitations in the exposed dentinal tubules.1
Effect of fluoride solutions on dentinal hypersensitivity and the effects over time of a
solution containing 1.09% sodium fluoride,0 .40% stannous fluoride, and 0.14% hydrogen
fluoride (0.717% fluoride solution was evaluated. Dentin Bloc) on pain associated with
dentinal hypersensitivity. After baseline data were collected for all subjects, one group was
instructed to apply the 0.717% fluoride solution twice a day. A second group was instructed
to apply a gel containing 0.04% stannous fluoride (Gel-Kam) twice a day. A third group was
instructed to apply distilled water. Each subject was assessed at second, fourth and sixteenth
weeks utilizing the "method of limits" with a standardized, repeatable cold thermal stimulus. .
It was concluded that the fully active 0.717% fluoride solution was an effective agent in the
control of dentinal hypersensitivity after two one-minute application.4
Clinical evaluation of a potassium nitrate dentifrice for the treatment of dentinal
hypersensitivity was assessed in a double-blind study in thirty six Japanese subjects who
complained of cold and/or tactile hypersensitivity. The subjects were divided into two groups,
with eighteen being given a 5% potassium nitrate dentifrice and the other eighteen a vehicle
paste. Both groups were instructed to brush their teeth two times a day. The hypersensitivity
levels of the affected teeth were assessed by two stimuli, one tactile and the other cold air,
and by the perception of pain. The results of all three -assessment methods indicated that the
potassium nitrate dentifrice significantly decreased the level of hypersensitivity at fourth,
eight, and fourteenth weeks.5
The reproducibility of commonly used measurement protocols for dentine
hypersensitivity on single or multiple teeth was investigated. In addition, newly-developed
controlled air and cold fluid stimuli were investigated, standardized pain stimulation
techniques were used in two investigations with sixty three and forty two subjects,
respectively. The reproducibility of perceived hypersensitivity before and following
stimulation was recorded over time periods of fourteenth and second day respectively, using
visual analogue scales and threshold techniques. Analysis using several measures of
reproducibility indicated that subject-based reproducibility was limited, even when the
stimuli were standardized.6
The clinical effect of amorphous calcium phosphate on root surface hypersensitivity
was assessed. Thirty adult patients exhibiting dentinal hypersensitivity participated in the
study. ACP solution (calcium chloride and tripotassium phosphate) applied successfully over
exposed root surface. Placebo solution containing potassium chloride and distilled water were
also applied over root surface and after rubbing the solution the solution stayed undisturbed
on the tooth surface for sixty seconds. The treatment was repeated at seventh and twenty
eighth day recalls. There was a rapid decrease in air sensitivity over time and the amorphous
calcium phosphate more rapidly and effectively reduced dentine hypersensitivity.7
6.3 OBJECTIVES OF STUDY:
1. To compare and evaluate the clinical efficiency of ACP-CPP F, ACP, Potassium
nitrate, Sodium fluoride and Propoilis in treating dentinal hypersensitivity.
2. To evaluate the rapidity of action of above desensitizing agents over a time period.
7. MATERIALS AND METHODS
7.1 Source of data:
One hundred and eighty patients with age group between 20-40 years reporting to the
department of conservative and endodontics, K.V.G Dental College and Hospital, Sullia
and diagnosed as having dentinal hypersensitivity in relation to either canine, premolar
and molars requiring treatment will be selected.
7.2 Method of collection of data: [including sampling procedures if any]
One hundred and eighty patients with age group between 20-40 years reporting with a
complaint of dentinal hypersensitivity with respect to either canine, premolars and
molars, diagnosed according to visual analogue scale with the aid of air jet stimulator and
periodontal probe as hypersensitive will be selected. Written informed consent will be taken
prior to the treatment.
Inclusion criteria:
Hypersensitive teeth with cavitated lesion less than 1mm in depth in middle to
cervical third of buccal and lingual/palatal surface of canines, premolars, and
molars.

Healthy patients with no systemic disorders

Age group between 20-40 years

Hypersensitive teeth should be free of any restorations

Oral hygiene treatment must have been done with in last six months.

Hypersensitive in relation to exposed dentinal tubule with etiologic factor like
gingival recession, tooth wear, defective tooth brushing, gastric problems and Para
functional habits.
Exclusion criteria:

Carious lesions / periapical pathology.

Non vital teeth.

Prior use of any desensitizing agents.

Periodontally involved teeth.

Referred pain, sinusitis, and orofacial pain.

Use of regular medications in case of systemic diseases, use of analgesics, anti
inflammatory drugs.

Systemic illness.

Fracture and craze lines.
ARMAMENTARIUM AND MATERIALS

Rubber dam with cervical retraction clamp

Diagnostic instruments

Light curing unit

Visual Analogue Scale

Air jet stimulator

Periodontal probe

Cotton rolls

CPP-ACP F

ACP

Sodium fluoride 0.09%

Potassium nitrate 10%

Propoilis

Distilled water.
INVESTIGATION DESIGN:
180 patients will be included in the study
Charting of records- medical and dental history
Investigation for dentinal hypersensitivity
Prior to the treatment assessment of dentinal sensitivity with visual analogue scale with air jet
Stimulator and periodontal probe
The patients will be randomly divided in to 6 groups and 30 patients in each group
CPP-ACPF
Group1
Group6
Group2 Group3 Group4
ACP
Sodium
Fluoride
Group5
Potassium
Nitrate
Placebo
Propoilis
mm
Pre and post assessment of hypersensitivity using visual analogue scale will be done over a
period of time that is after 30 minutes of application on 1st day, 7th , 15th 28th , 2nd
month .On 90th day the final assessment of hypersensitivity will be done
Statistical analysis will be done using analysis of variance, chi- square test.
METHODOLOGY
DIAGNOSIS OF HYPERSENSTIVITY
Dentinal hypersensitivity will be diagnosed with aid of air jet stimulator and periodontal
probe.

An operator controlled 1-second air blast applied using an air syringe held
perpendicular to, and 2mm away from the tooth surface whilst shielding adjacent
teeth with the operator’s fingers.

Periodontal probe tip placed perpendicular to the tooth surface , and passed across, in
Successively apical sweeps until the subject responded or gingival margin is reached.
ISOLATION – All the groups will be isolated using rubber dam with cervical retainer
clamp
ASSESSMENT OF HYPERSENSITIVITY– All the groups will be assessed for
hypersensitivity using visual analogue scale
GROUPINGS
Group 1- The patients will be treated with ACP solution
Application -Cotton pellet saturated with the solution will be applied over the tooth surface
for five seconds and is undisturbed on the tooth surface for next sixty seconds.
Group 2. The patients will be treated with CPP-ACP F topical cream
Application - Tooth mousse plus will be applied over the tooth surface for one minute and
left undisturbed for 3minutes.
Group 3.
Patients will be treated with Potassium nitrate
Application -10% potassium nitrate gel will be applied over the tooth surface for one minute
and left undisturbed for 60 seconds.
Group 4. Patients will be treated with sodium fluoride.
Application – Sodium fluoride will be applied over the tooth surface for 30 seconds and left
undisturbed for a minute.
Group 5. Patients will be treated with Propoilis
Application- Propoilis will be applied using a cotton pellet over the tooth surface for 60
seconds and left undisturbed for one minute.
Group 6. Patients will be treated with Placebo
Application- Distilled water will be applied over the tooth surface left undisturbed for 60
seconds.
All the patients will be advised not to have anything for next thirty minutes after application
of desensitizing agents.
STASTISTICAL ANALYSIS
The results will be statistically evaluated using analysis of variance and chi-square tests.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS TO
BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO
PLEASE DESCRIBE BRIEFLY.
Yes .Clearance has been obtained from the ethical committee and the guide of the department
for the study. This study will be done under the supervision of our guide.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN
CASE OF 7.3?
Yes . The ethical committee clearance certificate from our institution has been enclosed.
LIST OF REFERENCES
1. Dowell.P, Addy.M. “Dentin hypersensitivity A review. J clin periodontol1983; 10:341350.
2. Bartold .PM. “Dentinal hypersensitivity: A review. Aust Dent J2006;51(3):212-18
3. Gillam. DG. “Advances in the treatment of
root dentine sensitivity
mechanisms and treatment principles”. Endod Topics 2006; 13:13–33
4. Thrash .WJ, Jones .DL, Dodds. WJ “Effect of a fluoride solution on
dentinal hypersensitivity” Am J Dent. 1992 Dec; 5(6):299-302.
5. Nagata.T, Ishida.H, Shinohara.H, Nlshikawa.S.
Kasahara.S , Wakano.Y et al ‘Clinical evaluation of a potassium nitrate dentifrice for
the treatment of dentinal hyper sensitivity’. J Clin Periodontol1994; 21: 217-221
6. Ide .M, Wilson.RF, Ashley.FP. The reproducibility of methods of assessment for
cervical dentine hypersensitivity’ J Clin Periodontol 2001; 28: 16–22
7. Geiger.S , Matalon.S , Blasbalg.J ‘The clinical effect of Amorphous calcium
phosphate on root surface Hypersensitivity’ Oper Dent 2003;28(5):496-500