|Year : 2018 | Volume
| Issue : 8 | Page : 1029-1033
Iontophoresis and topical application of 8% arginine-calcium carbonate to treat dentinal hypersensitivity
S Kumar1, BS Thomas2, K Gupta1, V Guddattu3, Mohan Alexander4
1 Department of Periodontology, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
2 Department of Periodontology, Faculty of Dentistry, MAHSA University, Selangor, Malaysia
3 Department of Statistics, Manipal Academy of Higher Education, Manipal, Karnataka, India
4 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, MAHSA University, Jenjarom, Kuala Langat, Selangor, Malaysia
|Date of Acceptance||07-Feb-2018|
|Date of Web Publication||02-Aug-2018|
Dr. B S Thomas
Department of Periodontology, Faculty of Dentistry, MAHSA University, Jalan Sp-2 Bandar Saujana Putra, 42610, Jenjarom Kula Langat, Selangor
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim and objectives: The aim and the objectives were. (1) to assess the efficacy of a desensitizing toothpaste containing 8.0% arginine-calcium carbonate (Colgate® Sensitive Pro-Relief™), (2) to assess the efficacy of a desensitizing toothpaste containing 8.0% arginine-calcium carbonate (Colgate® Sensitive Pro-Relief™) used in combination with iontophoresis, and (3) to compare the effectiveness of the above methods. Subjects and Methods: Two groups of 40 patients each having dentinal hypersensitivity were treated using 8% proarginine and iontophoresis. The patients were recalled after 1, 2, and 4 weeks. The scores were tabulated and the results were analyzed using SPSS statistical software. Results: Visual analog scale between the two groups showed a significant difference from the 1st week till the 4th week. ANOVA values showed the reduction in the dentinal hypersensitivity in Group 2 using the iontophoresis along with the 8.0% arginine-calcium carbonate toothpaste. The Cochran–Mantel–Haenszel correlation test of the Schiff's dentinal hypersensitivity cross-tabulation showed P < 0.001 which was statistically significant reduction after the 4th week following the application of 8.0% arginine-calcium carbonate along with iontophoresis. Conclusion: Iontophoresis, when used along with Colgate® Sensitive Pro-Relief™ toothpaste, can provide additional benefit as this provides a better sealing effect.
Keywords: Arginine, calcium carbonate, dentin hypersensitivity, iontophoresis
|How to cite this article:|
Kumar S, Thomas B S, Gupta K, Guddattu V, Alexander M. Iontophoresis and topical application of 8% arginine-calcium carbonate to treat dentinal hypersensitivity. Niger J Clin Pract 2018;21:1029-33
|How to cite this URL:|
Kumar S, Thomas B S, Gupta K, Guddattu V, Alexander M. Iontophoresis and topical application of 8% arginine-calcium carbonate to treat dentinal hypersensitivity. Niger J Clin Pract [serial online] 2018 [cited 2020 Feb 19];21:1029-33. Available from: http://www.njcponline.com/text.asp?2018/21/8/1029/238421
| Introduction|| |
Dentinal hypersensitivity is caused due to nonnoxious stimuli. Greater than 40 million people in the US annually have this symptom  and in India, it is about 20.06% which is seen more in females. Later in life, symptoms may reduce due to age related dentin and pulpal changes.
Based on the modified hydrodynamic and hydrodynamic theories  of the dentinal fluids, several agents such as potassium nitrate,, calcium compound containing agents,,, and photobiomodulation leading to the tubular occlusion  are used in practice today. Recently used 8.0% arginine calcium carbonate has shown to provide temporary relief from this symptom by partially plugging the dentinal tubules.,
Aim and objectives
The aim of the present study was to compare and evaluate the effectiveness of two methods used for the treatment of dentinal hypersensitivity. The objectives were to assess the efficacy of a desensitizing toothpaste containing 8.0% arginine-calcium carbonate (Colgate® Sensitive Pro-Relief™) used alone and used in combination with iontophoresis and also to compare the effectiveness of the above methods.
| Subjects and Methods|| |
A preliminary screening of 500 individuals was done at the Manipal Press, Manipal, Karnataka, for selection of patients. This study was a prospective single-centered, single-blind, randomized controlled trial that was conducted on two groups of 40 patients each. The study group comprised 35 males and 45 females between the age group of 21–68 years having dentinal hypersensitivity. The study protocol was reviewed and approved by the Institutional Ethical Committee IEC 193/2015. The patients were randomized using computer software. The control group was treated using 8.0% arginine-calcium carbonate toothpaste (Colgate® Sensitive Pro-Relief™ [Colgate-Palmolive (Eastern) Pte. Ltd., (350), Orchard Road, #18-08 Shaw House Singapore 238868]). The test group was treated using 8.0% arginine-calcium carbonate along with iontophoresis (Jonofluor Scientific, Medical S.R.L., Via Olivera, 42 31020 San Vendemiano [TV], Italy).
The criteria used for selection of the patients were a willingness to participate in this study for 4 weeks, no recent treatment for any hypersensitivity or any fluoride application, the absence of caries/restoration on the hypersensitive tooth, and a severe form of dentinal hypersensitivity elicited at the cervical area of the teeth. The exclusion criteria were patients having pacemakers, chronic severe periodontal disease, with gross pathologies or chronic illness, patients on analgesics and anti-inflammatory drugs, and pregnant women.
Dentinal hypersensitivity score assessment
The patients enrolled were assessed for the pain score by the following methods: A sharp explorer was used at the cervical area of the tooth where the patient complained of hypersensitivity or by a gentle air blast, visual analog scale (VAS, 1–10 rating scale) and Schiff dentinal hypersensitivity (SDH) scores were then recorded by the first examiner.
Application of 8.0% arginine-calcium carbonate and iontophoresis
For the control group, Colgate® Sensitive Pro-Relief™ toothpaste was applied using cotton pledget  on the intended site [Figure 1], and iontophoresis was applied as a sham without passage of the electric current. In the test group, the procedure included an application of the toothpaste over the site using a cotton pledget. Following this, specially designed sponges having spaces to harbor teeth were moistened with distilled water. These were then placed on a plastic tray lined by conducting metal strip [Figure 2], which was connected to a black coil lead. The patient was given a metal manual electrode to hold which was attached to a red coil lead.
The intensity of the unit was adjusted by turning the knob in a clockwise direction until the green light glowed [Figure 3]. The current was maintained at 3–4 mA for 2–3 min. This was repeated three times during single appointment at an interval of 2 min between each application. The scores were recorded 5 min before and 5 min after treatment for both the groups. The treatment for both the groups was carried out by the second examiner.
Soft-bristled toothbrush and oral hygiene instructions were given to all the patients. Patients were advised to use regular toothpaste (Colgate Strong teeth TM, Colgate-Palmolive (India) Limited, Colgate Research Centre, Main Street, Hiranandani Gardens, Powai, Mumbai) without any desensitizing agent during the routine brushing. The patients were recalled after 1, 2, and 4 weeks. Application of the Colgate® Sensitive Pro-Relief™ toothpaste and iontophoresis was made during each visit. Oral hygiene instructions were given, and the patients were informed to use soft-bristled toothbrush. Patients were advised to use the regular toothpaste without any desensitizing agent during the routine brushing. Pain score based on VAS and SDH score was recorded immediately after the treatment and on 7th, 14th, and 28th day of the recall period.
| Results|| |
While comparing the VAS between the two groups, there was a significant difference from the 1st week till the 4th week. However, the significance was not seen immediately after treatment between the groups. The data were analyzed statistically of pretreatment and after 4 weeks of application of desensitizing agent with or without iontophoresis.
At baseline, the median values were 6 (4.25, 7) and 6 (4.25, 7) of the VAS scores [Table 1] of both the control group 1 and test group 2. After 4 weeks, the median values were measured using the repeated measures ANOVA, and it showed P < 0.001 which was statistically significant. The graphical representation [Table 2] of the ANOVA values showed clearly the reduction in the dentinal hypersensitivity in Group 2 using the iontophoresis along with the 8.0% arginine-calcium carbonate toothpaste. Most of the patients treated with toothpaste with iontophoresis showed a significant decrease in the VAS scores. The Cochran–Mantel–Haenszel correlation test [Table 3] of the SDH cross-tabulation showed P < 0.001 which was statistically significant reduction after the 4th week following the application of 8.0% arginine-calcium carbonate along with iontophoresis when compared to 8.0% arginine-calcium carbonate alone.
| Discussion|| |
In light of the hydrodynamic theory, many of the treatment modalities aim to reduce sensitivity by blocking the dentinal tubules. Iontophoresis uses a low amperage direct electrical current to introduce ions or ionized drugs into tissues. Pivati described the method of iontophoresis in 1747. Two eminent scientists Galvani and Volta in the 18th century combined the knowledge that electricity can move different metal ions and that movement of ions produce electricity. Leduc in 1900 mentioned the use of iontophoresis for administration of pharmacologic drugs. He also introduced the word iontotherapy and formulated the laws for this process. Normally ionized drugs will not penetrate the tissue rapidly enough to be of any therapeutic value. But by applying approximately charged direct electrical current, ionized drugs can be driven into the tissue. This is based on the principle – like charges repel and opposite charges attract.
To treat dentinal hypersensitivity, iontophoresis was first used in the early 1960s. Gangarosa and Hill  have provided extensive evidence that iontophoresis is useful in the treatment of aphthous ulcer, lichen planus, and herpes labialis., This procedure allows concentration of the drug in a desired localized area.
Desensitization by iontophoresis has been explained by several hypotheses. One of the mechanisms is the formation of reparative dentin. The application of the current can result in dead tract formation. The second mechanism proposed is that electrical current produces paresthesia by altering the sensory mechanism of pain conduction and the third mechanism describes that it causes microprecipitation of calcium fluoride around the tubules, thus blocking the hydrodynamically mediated stimuli that induce pain. Iontophoresis has been found to cause a significant improvement in 70%–80% of patients  and has been found to meet most criteria of an ideal desensitizing agent.
Colgate ® Sensitive Pro-Relief™ is clinically proven to provide rapid relief from tooth sensitivity. Most of the currently available toothpaste plug the tubules providing only temporary benefit. With regular use, it can build a long and lasting protective barrier that can act as a seal against sensitivity. This effect was enhanced when 8.0% arginine-calcium carbonate when used along with iontophoresis in this study. Colgate® Sensitive Pro-Relief™ contains calcium carbonate and arginine, an amino acid naturally found in the saliva. It can also be used before or after dental procedures, such as scaling and polishing. This provides an instant benefit that provides relief in minutes and lasts for 4 weeks.,
Carlo et al. found that patients with severe dentinal hypersensitivity required a second application, while those with mild-to-moderate sensitivity experienced highly significant relief and did not require any further therapy. The present study has shown 63% of the teeth with total abolition of pain in the group of toothpaste application and iontophoresis. Pain relief was seen in most of the patients in the group using Colgate® Sensitive Pro-Relief alone. However, the effect was not as good as with the combination with iontophoresis.
| Conclusion|| |
The data from our study suggest that iontophoresis may be a useful adjunct to topical application of Colgate ® Sensitive Pro-Relief™ as this can cause deeper penetration of the ions thus giving a better sealing effect. Hence, it can be used as the first line of treatment in severe dentinal hypersensitivity.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]