Effect of experimental propolis-based toothpastes on dentin hypersensitivity: a randomized clinical trial

doi:10.21203/rs.3.rs-2366899/v1

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Effect of experimental propolis-based toothpastes on dentin hypersensitivity: a randomized clinical trial

https://doi.org/10.21203/rs.3.rs-2366899/v1

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Background: Propolis is a natural product produced by bees, which has garnered attention due to its harmlessness and numerous beneficial biological properties. This randomized, double-blinded, placebo-controlled clinical trial aimed to assess the effect of toothpastes containing different concentrations of propolis (10% and 15%) on the control of dentin hypersensitivity (DH).

Methods: Sixty-six teeth with DH were randomly divided into three treatment groups (n= 22): placebo (toothpaste without active ingredient), 10% propolis (toothpaste with 10% propolis), and 15% propolis (toothpaste with 15% propolis). DH was assessed at three distinct time points (baseline, 15 and 30 days after treatment) by tactile and evaporative stimuli, using the visual analog scale (VAS). Data were analyzed using Friedman and Kruskal-Wallis tests. A significance level of 5% was used in all analyses.

Results: All the groups showed reduction in DH during the study period (p < 0.05). The experimental groups (10% and 15% propolis) showed significantly greater reduction in DH compared to the placebo group (p < 0.05) after 30 days of treatment; however, the findings of experimental groups were similar to each other (p > 0.05).

Conclusion: Toothpastes containing propolis at concentrations of 10% and 15% were equally effective in controlling DH, regardless of their concentration.

Trial registration: Registered on NCT05083052. Date of Registration: 19/10/2021

Dentin Sensitivity

Dentin Desensitizing Agents

Propolis

Toothpastes

Clinical Trial.

Dentin hypersensitivity (DH) is characterized by acute, short-lasting pain in response to thermal, evaporative, tactile, osmotic, or chemical stimuli, and cannot be attributed to dental defects or pathologies [1–4]. According to the hydrodynamic theory, fluid flow in the dentinal tubules results in neural discharge, which is transmitted as painful sensations [1, 5]. Treatment of DH is based on control or elimination of etiological factors via occlusal adjustment, dietary counseling, modification of brushing technique, and use of desensitizing agents [3, 4, 6]. Desensitizing agents may result in physical occlusion of the tubules and/or block neural transmission in the pulp tissues, and chemically depolarize the nerve synapse [7–9].

These agents can be used by the dental practitioners in the office or by the patients at home [3, 9]. Several toothpastes are commercially available for the treatment of DH and offer the advantage of home use, with routine application two to three times every day [8–11]. These toothpastes rely on incorporation of active ingredients such as sodium calcium phosphosilicate, nano-hydroxyapatite, arginine, or fluoride [9–11]. However, no desensitizing agent or management strategy is considered ideal for all patients in reducing or eliminating DH [1, 6, 9], which justifies the search for new desensitizing agents.

A recent systematic review suggested propolis as a promising, effective, safe, and low-cost alternative for reducing DH [12]. Propolis is a natural product produced by bees, which has garnered attention due to its harmlessness and numerous beneficial biological properties [12–16]. Its composition may vary depending on its geographic origin, however, it usually comprises a mixture of resin, balsams, essential and aromatic oils, wax mixed with bee glue (salivary secretions of bees), amino acids, minerals, ethanol, vitamins, pollen, and a high content of bioflavonoids [14, 16]. Bioflavonoids are well-known plant compounds with antibacterial, antifungal, antiviral, antioxidant, and anti-inflammatory properties [12, 14, 16, 17].

In dentistry, propolis has been used for plaque control, in the treatment of periodontal diseases [18, 19], severe oral mucositis [20], as an intracanal medication [21, 22] and for temporary retention of avulsed permanent teeth [23]. Although propolis has shown promising results in combating DH [12], data regarding it is relatively scarce. Moreover, no studies have been conducted on reduction of DH, using propolis in toothpastes. Therefore, the aim of this study was to test the efficacy of toothpastes containing propolis (10% and 15%) as a desensitizing agent, and its impact on the quality of life of the study participants. The null hypothesis tested was that there were no differences in the manifestations of DH between the groups treated with 10% and 15% propolis and placebo.

Ethical Considerations

This clinical, randomized, parallel, three-arm, double-blinded, single-center study was conducted after obtaining approval from the Human Research Ethics Committee of the Institute of Health Sciences of the Federal University of Pará (Belém, PA, Brazil) (protocol 23945219.0.0000.0018). The ClinicalTrials.gov identification number is NCT05083052. The study was conducted in the dental clinics of the Federal University of Pará (Belém, PA, Brazil) between August and December 2021. Informed consent was obtained from all the participants prior to the commencement of the study.

Calculation of sample size

A statistical power of 80% and an α-error probability of 5% were used to define the sample size. Data obtained in a pilot study were entered into the G Power® program (Heinrich-Heine-Universität, Düsseldorf, Germany). Considering a difference of three units on the visual analog scale (VAS), and estimating that the sample loss by the end of the study would be 20%, it was calculated that the required number of samples would be 22 teeth per group.

Patient Recruitment

Adults aged 18–40 years who complained of tooth sensitivity were assessed at the Federal University of Pará (UFPA), Brazil. Individuals who met the following inclusion criteria were recruited: two to four sensitive posterior teeth with a response ≥ 4 on the 10-cm VAS (0 - no pain and 10 - unbearable pain) after tactile and evaporative stimuli, presence of non-carious lesion with depth up to 2 mm [24] and/or class I gingival recession according to Miller’s classification [25]. The exclusion criteria were: restorations on sensitive teeth; dental caries and/or periodontal pockets; pulpitis; enamel cracks or fractures in sensitive teeth; pregnancy or lactation; systemic diseases; use of fixed orthodontic appliances and occlusal instability. Individuals on continuous treatment with anti-inflammatory and/or analgesic medications; or those who received desensitizing treatment three months prior to the study recruitment date were also not included in the study.

Study design

After randomization, participants were assigned to one of the three treatment groups: Placebo, Propolis 10% and Propolis 15% (Table 1). All treatments with toothpastes followed the same protocol, and were performed for 30 days. Assessment of DH by tactile and evaporative stimuli was performed at three distinct time points: baseline (immediately before the start of treatment), and 15 and 30 days after treatment. The toothpastes were prepared by F&A Laboratório Farmacêutico LTDA, São Paulo, Brazil. The toothpastes were formulated with the same composition, with the difference that propolis was included in some toothpastes (at concentrations of 10% and 15%), while it was not included in others.

Propolis used in the formulation of toothpastes was obtained from the company Florien (Piracicaba, São Paulo, Brazil), which acquired it from Apis mellifera L. (common name: bee, from the family Apoidea). Toothpastes with propolis had the following chemical composition (according to the manufacturer): 50% vegetable resins and balsams; 30% beeswax; 10% essential oils and 5% pollen grains. In addition, flavonoids, vitamins, enzymes, and minerals (aluminum, calcium, strontium, iron, magnesium, silicon, titanium, bromine, and zinc) were also added.

Table 1

Division of the groups by desensitizing treatments and toothpaste formulations.
Groups	Desensitizing Treatment	Composition
Placebo	Toothpaste without active ingredient (F&A Laboratório Farmacêutico LTDA, São Paulo, Brazil)	Calcium carbonate: 40.0%, Glycerin: 20.0%, Sodium Lauryl Sulfate: 1.2%, Carboxymethyl Cellulose: 2.0%, Xanthan Gum: 1.0%, Methylparaben (nipagin): 0.15%, EDTA: 0.5%, Saccharin: 0.1%, Flavoring agent: 0.75%, Deionized Water q.s.q − 100mL
Propolis 10%.	Toothpaste with 10% propolis concentration (F&A Laboratório Farmacêutico LTDA, São Paulo, Brazil)	Calcium carbonate: 40.0%, Glycerin: 20.0%, Sodium Lauryl Sulfate: 1.2%, Carboxymethyl Cellulose: 2.0%, Xanthan Gum: 1.0%, Methylparaben (nipagin): 0.15%, EDTA: 0.5%, Saccharin: 0.1%, Flavoring agent: 0.75%, Propolis 10%, Deionized Water q.s.q − 100mL
Propolis 15%.	Toothpaste with 15% propolis concentration (F&A Laboratório Farmacêutico LTDA, São Paulo, Brazil)	Calcium carbonate: 40.0%, Glycerin: 20.0%, Sodium Lauryl Sulfate: 1.2%, Carboxymethyl Cellulose: 2.0%, Xanthan Gum: 1.0%, Methylparaben (nipagin): 0.15%, EDTA: 0.5%, Saccharin: 0.1%, Flavoring agent: 0.75%, Propolis: 15%, Deionized Water q.s.q − 100mL

Randomization and blinding

A researcher not involved in the clinical intervention phases of this study was responsible for block stratified randomization of the sample. Randomization was performed by simple numerical drawing among participants by age group, with an interval of 18–29 years and 30–40 years. This was done to homogeneously assign each participant to one of the three groups, stratified by age. The block size was 3 per age group. Draw was made using numbered slips of paper which were coded and kept in opaque envelopes. The study participants were unaware of the codes of each group to maintain the confidentiality of assignment throughout the composition of sample.

In this double-blinded study, participants were not aware of the desensitizing treatment they received, since all the toothpaste formulations were identical in appearance, texture, color, and odor. Moreover, all the formulations were placed in identical containers to maintain anonymity. The single clinical evaluator of pain sensitivity was also not aware of the group the participant belonged to.

Clinical Protocol

Firstly, the participants received prophylaxis with a rubber cup (Microdont, São Paulo, SP, Brazil), pumice paste and water. Then, tactile and evaporative stimuli were applied to assess DH. An oral hygiene kit was then given to the patient, which contained a soft toothbrush (Curaprox 5460 Ultra Soft- CURADEN International AG, Kriens, Switzerland) and toothpaste, corresponding to the group to which the participant was assigned. All participants received oral hygiene instructions on techniques and frequency of brushing.

In addition, the following instructions were given: Rub toothpaste over the hypersensitive areas with a finger for 10 seconds, and then brush the teeth according to the given oral hygiene instructions. The participants were instructed to brush three times daily for 30 days and refrain from eating or drinking anything for 30 minutes after brushing. They were also instructed to not use any other oral hygiene products or methods, besides the toothpaste and toothbrush provided [26]. In addition, they were also advised to avoid acidic foods and beverages during the study period [27].

Assessment of Dentin Hypersensitivity

DH was assessed by asking participants to indicate a number between 0 and 10 which corresponded to their perception of pain on the VAS after tactile stimulation, and then by evaporative stimulation. These assessments were made at three distinct time points: baseline (immediately before the start of treatment), 15 days and 30 days after treatment.

Mechanical tactile assessment test was performed using explorer number 5 (Fava, Ribeirão Preto, Brazil), which was moved in a crosswise manner (from apical to incisal and from mesial to distal) through the hypersensitive area of each tooth, perpendicular to the long axis of the tooth, with a specific amount of pressure [26, 28]. The test was performed three times before recording the score corresponding to the stimulus [26].

After a 5-minute interval, an evaporative stimulus was applied. The evaporation test was performed using the air jet of the triple syringe of the dental chair, at a pressure of 40 psi for 3 seconds. The air jet was applied approximately 5 mm perpendicular to the long axis of the tooth in the area of each tooth to be assessed, and the adjacent teeth were isolated with cotton rolls [26, 28].

Data analysis and statistical tests

The values obtained were tabulated in an Excel spreadsheet (Microsoft Windows, 2019) and analyzed using the Jamovi program (version 1.8, Sydney, Australia). DH data for stimulus with the explorer probe and the air jet were analyzed separately. The baseline score (T0) was subtracted from the final score (T2-T0) and 15-day assessment (T1-T0) for analysis between the study groups. Shapiro-Wilk test was performed and non-normality of data distribution was checked (p < 0.05).

Friedman test was used to compare the different time points in the same group (T0xT1xT2) and post-hoc Durbin-Conover test was used for the analyses of pairwise comparisons. Kruskal-Wallis test was used for comparisons between the study groups (placebo x propolis 10% x propolis 15%), and the analyses of pairwise comparisons was done using post-hoc Dwass-Steel-Critchlow-Fligner test. A significance level of 5% was used in all the analyses.

Study Participants

A total of 63 participants were assessed, of which 19 formed the study population and were randomized, treated, and followed up according to Fig. 1. All the 19 participants completed all the phases of the study, and a total of 66 teeth were analyzed. No adverse reactions were reported during the study period.

Demographic characteristics

The demographic characteristics of the 19 study participants are described in Table 2. A higher proportion of female participants were present in the final sample (N = 11; 57.9%). The mean age of the participants was 33.7 years (range, 21–40 years). Majority of the teeth assessed and treated were the premolars (n = 54; 81.8%).

Table 2

Demographic characteristics of the research participants
Groups	Placebo	Propolis 10%.	Propolis 15%.	Total
	(N = 6/n = 22)	(N = 6/n = 22)	(N = 7/n = 22)	Total
Sex N (%)
Female	4 (66.7)	3 (50)	4 (57.2)	11 (57.9)
Male	2 (33.3)	3 (50)	3 (42.8)	8 (42.1)
Age, years
Average	35.5	33.3	32.7	33.7
Interval	29–40	21–39	21–39	21–40
Type of teeth n (%)
Premolars	16 (72.8)	18 (81.8)	20 (91)	54 (81.8) 12 (18.2)
Molars	6 (27.2)	4 (18.2)	2 (9)	54 (81.8) 12 (18.2)

Tactile stimulus

Friedman test showed a significant difference in DH assessed by VAS scores in response to tactile stimulus at different assessment time points (p < 0.001). Analyses of pairwise comparisons showed a statistically significant difference between the three assessment time points (p < 0.001) for the 15% propolis group. On the other hand, no significant differences were noted between time points T1 and T2 (p = 0.741 and p = 0.288, respectively) for 10% propolis and placebo groups. All three groups showed reduction in pain scores, and significant differences were found between the initial median scores and scores obtained after 30 days of treatment (p < 0.05).

Median scores and interquartile deviation (IQD) of the groups assessed using tactile stimulus at different assessment time points are described in Table 3. Intergroup assessment showed similar initial median of all analyzed treatment groups (p = 0.87). Reduction in DH (T1-T0) was not significantly different between the groups (p > 0,.05) after 15 days of treatment (T1). After 30 days of treatment (T2-T0), 15% propolis group showed significantly greater reduction in DH compared to the placebo group (p = 0.03). However, the findings of 10% propolis group were not significantly different from the placebo (p = 0.09) and 15% propolis groups (p = 0.98).

Table 3

Median and interquartile range (IQR) of dentin hypersensitivity (DH) in different assessment periods; median of baseline score (T0) subtracted from the final score (T2-T0); and 15-day assessment (T1-T0) of analysis between the study groups using tactile stimulus.
Groups (n = 66)	Baseline (T0)	15 days (T1)	30 days (T2)
Groups (n = 66)	Median (IQR) / [Median of the intragroup DH subtraction]
Placebo (n = 22)	6.0 (2.0) _Aa [ - ]	4.0 (3.75) _Ba [-3.0]	4.5 (1.75) _Ba [-1.5]
10% Propolis (n = 22)	6.0 (3.5) _Aa [ - ]	3.0 (6.75) _Ba [-2.0]	2.0 (3.0) _Bab [-4.0]
15% Propolis (n = 22)	5.0 (4.5) _Aa [ - ]	2.5 (4.5) _Ba [-2.0]	1.5 (1.75) ^Cb [-3.5]
*Different capital letters represent statistically significant intragroup difference (p ≤ 0.05);
**Different lower case letters represent statistically significant intergroup difference (p ≤ 0.05);

†P p-values calculated according to Friedman and Kruskal-Wallis test.

Evaporative stimulus

When DH was assessed by VAS scores using evaporative stimulation, intragroup analysis showed significant difference between the assessed time points (p < 0.001). Pairwise comparison analyses showed significant difference between the three assessment time points (p < 0.05) for placebo and 15% propolis groups. Contrarily, no significant difference was observed between T1 and T2 time points (p = 0.14) for the 10% propolis group. All three groups showed reduction in pain scores over the study period, and significant differences were found between the initial median scores and the scores obtained after 30 days of treatment (p < 0.05).

Median and QDI results of the groups assessed by evaporative stimulation at different assessment time points are described in Table 4. Intergroup assessment showed similar initial median of all analyzed treatment groups (p = 0.12). It was observed that after 15 days of treatment (T1), reduction of DH (T1-T0) was significantly higher in 15% and 10% propolis groups compared to the placebo group (p = 0.03 and p = 0.002, respectively); while that of 15% and 10% propolis groups were similar to each other (p = 0.48). Similar results were obtained after 30 days of treatment (T0-T2). Reduction of DH was significantly higher in 15% and 10% propolis groups than in the placebo group (p < 0.01 and p = 0.001, respectively), and that of 15% and 10% propolis groups were similar to each other (p = 0.54).

Table 4

Median and interquartile range (IQR) of dentin hypersensitivity (DH) in different assessment periods; median of baseline score (T0) subtracted from the final score (T2-T0); and 15-day assessment (T1-T0) of analysis between the study groups using evaporative stimulus.
Groups (n = 66)	Baseline (T0)	15 days (T1)	30 days (T2)
Groups (n = 66)	Median (IQR) / [Median of the intragroup DH subtraction]
Placebo (n = 22)	7.0 (3.0) _Aa [ - ]	7.0 (2.0) _Aa [-0.5]	5 (3.0) _Ba [-1.0]
10% Propolis (n = 22)	8.0 (3.0) _Aa [ - ]	3.0 (2.0) _Bb [-3.5]	2.5 (3.0) _Bb [-5.0]
15% Propolis (n = 22)	5.0 (3.75) _Aa [ - ]	3.0 (5.0) _Bb [-2.5]	1.0 (2.75) ^Cb [-4.5]
*Different capital letters represent statistically significant intragroup difference (p ≤ 0.05);
**Different lower case letters represent statistically significant intergroup difference (p ≤ 0.05);

†P p-values calculated according to Friedman and Kruskal-Wallis test.

The null hypothesis was rejected based on the study findings, which showed that the toothpaste formulation containing 15% propolis significantly reduced DH (measured by VAS in response to tactile and evaporative stimuli), in comparison to the placebo toothpaste after 30 days; while 10% propolis group was statistically different from the placebo group only in terms of evaporative stimulus. Reduction in DH achieved by the experimental toothpastes was progressive and similar over the 30-day treatment period. These findings suggest that this toothpaste formulation with propolis can potentially reduce DH. Despite the significant differences between the experimental and placebo groups, improvements in DH scores were also observed in the placebo group. The overall reduction in DH could be attributed to placebo effect, oral hygiene and dietary guidelines given to the participants [29–32].

The promising results observed for propolis therapy in the present study can be accredited to bioflavonoids. These polyphenols reduce DH by interacting with dentin and form crystals that occlude the dentinal tubules [33–35]. Research has shown that propolis can stimulate the formation of reparative dentin, which could reduce dentin permeability and improve DH [13, 33]. Another possible factor associated with occlusion of dentinal tubules is the presence of natural resinous substances in propolis, which may have a binding mechanism similar to dental adhesive materials such as composite resin or varnish [36, 37]. Although most studies have demonstrated the ability of propolis to reduce DH, variation in results among studies may be due to different botanical origins, extractions, preparations, and delivery methods [38].

The concentration of propolis has not been standardized till date. Clinical studies have used concentrations ranging between 10%-40%, and there are few studies which have compared the effect of different concentrations of propolis on DH [12, 13, 34, 37–39]. Studies reported that varying the concentration of propolis did not increase the effectiveness of treatment [34, 39], indicating that different concentrations may be efficacious in reducing DH. In the present study, both the concentrations used resulted in reduced DH, and the difference in use of toothpaste containing 10% and 15% propolis was not significant. This implies that the effectiveness of propolis in reducing DH is not dose dependent. However, it has been noted that higher concentrations of propolis provides greater relief, and this finding warrants further study in the future [39].

Control of DH with desensitizing toothpastes has been proposed as one of the first alternatives, especially in cases with limited or invisible loss of dental hard tissue [32]. In general, desensitizing treatments with toothpastes are non-invasive, reversible, easily available (in pharmacies and supermarkets), and have a good cost-benefit ratio, especially compared to products of professional use [27, 32]. In addition, toothbrushing is a common habit and does not impose any additional obligation on the patient [32]. Direct comparison of results obtained in this clinical trial with other studies was not possible since this was the first clinical study to investigate the effect of this compound in the form of a toothpaste for treatment of DH. However, ointments containing propolis are commercially available for the treatment of numerous oral conditions [36, 40]. In the previous studies, propolis was used as a topical solution (alcohol- or water-based), and applied to hypersensitive teeth using a micro brush or a truncated needle [13, 39, 41–43].

Mahmoud et al [44] conducted a pioneering in vivo study exploring the effect of propolis on DH. In this study, propolis was applied twice daily to hypersensitive teeth, and it was concluded that propolis had a positive effect in controlling DH [44]. Recent studies also confirm the effectiveness of propolis in reducing DH, even in comparison to products already established for the treatment of DH, such as 5% potassium nitrate [13], amorphous phosphopeptide calcium phosphate casein (CPP-ACP) [42], and dentin adhesives [39, 41]. Propolis shows an immediate effect on the painful symptomatology of DH, which appears to last over a prolonged period of time [41]. It is likely that the immediate relief is due to the tubular sealing effect, and the long-lasting effects are due to the stable nature of deposits formed [33–35, 41].

Pain is a subjective experience and is dependent on several factors, such as psychological profile, previous experiences of pain, and anxiety levels [32]. It is recommended that DH be measured by using more than one clinical stimulus (since different forms of stimulation are associated with different outcomes) and that appropriate scales are used, such as the VAS [30]. In the present study, effectiveness of treatment on DH symptomatology was initially assessed using the less severe tactile stimulus; and after an interval, the evaporative stimulus was applied [45]. Differences in pain scores on VAS with tactile stimulus may be attributed to the difficulty in standardizing the passage of explorer probe over hypersensitive dentin [7]. Furthermore, not all the exposed dentin surface includes areas of DH, and the location of this area may change between assessments [29].

The efficacy of propolis toothpastes in treatment of DH needs further investigation. Longer follow-up period of participants is important to clarify long-term effectiveness. In addition, future studies should compare propolis toothpastes with toothpastes containing traditional ingredients of DH treatment (inclusion of a positive control). Further studies are needed to assess other concentrations of propolis in toothpastes, and to investigate safety issues and dose-benefit ratio, with focus on the therapeutic dose needed to treat DH with minimum potential side effects. Although propolis is considered harmless, there are reports of some individuals who have experienced adverse effects from propolis; however, these effects have not been studied adequately [46].

Within the limitations of this randomized clinical trial, it can be concluded that toothpastes containing 10% and 15% propolis were equally effective in reducing DH.

Ethics approval and consent to participate

All procedures performed in this study, were carried out in accordance with relevant ethical guidelines and regulations of Helsinki Declaration. Institutional approval for this study was acquired from the ethical committee of Institute of Health Sciences of the Federal University of Pará (Belém, PA, Brazil) (protocol 23945219.0.0000.0018). Written informed consent was obtained from all participants.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

No funding was obtained for this study.

Authors’ contributions

Alexandra Melo Pingarilho Carneiro: conceptualization, methodology; Elma Vieira Takeuchi: investigation, formal analysis, data curation, writing- original draft preparation; Brennda Lucy de Paula: methodology, investigation; Roberta Pimentel de Oliveira: conceptualization, methodology; Antônia Patricia Oliveira Barros: visualization, writing- original draft preparation; Cecy Martins Silva: writing - review & editing, supervision.

Acknowledgements

Not applicable.

West NX, Lussi A, Seong J, et al. Dentin hypersensitivity: pain mechanisms and etiology of exposed cervical dentin. Clin Oral Investig. 2013;17(1):9–19. doi:10.1007/s00784-012-0887-x.
Machuca C, Vettore MV, Krasuska M, et al. Using classification and regression tree modelling to investigate response shift patterns in dentine hypersensitivity. BMC Med Res Methodol. 2017;17(1):120. doi:10.1186/s12874-017-0396-3.
Gillam DG. A new perspective on dentine hypersensitivity: guidelines for general dental practice. Dent Update. 2017;44(1):33–6. 10.12968/denu.2017.44.1.33. 9–42.
Shiau HJ. Dentin hypersensitivity. J Evid Based Dent Pract. 2012 Sep;12(3 Suppl):220–8. doi: 10.1016/S1532-3382(12)70043-X.
Brännström M. The hydrodynamics of the dental tubule and pulp fluid: its significance in relation to dentinal sensitivity. Annu Meet Am Inst Oral Biol. 1966;23:219.
Zeola LF, Teixeira DNR, Galvão ADM, et al. Brazilian dentists' perception of dentin hypersensitivity management. Braz Oral Res. 2020; 10;33:e115. doi: 10.1590/1807- 3107bor-2019.vol33.0115.
Guanipa Ortiz MI, Alencar CM, Freitas De Paula BL, et al. Effect of the casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) and photobiomodulation (PBM) on dental hypersensitivity: A randomized controlled clinical trial. PLoS ONE. 2019;2(12):e0225501. doi:10.1371/journal.pone.0225501. 14 ) .
de Melo Alencar C, de Paula BLF, Guanipa Ortiz MI, et al. Clinical efficacy of nanohydroxyapatite in dentin hypersensitivity: A systematic review and meta-analysis. J Dent. 2019;82:11–21. doi:10.1016/j.jdent.2018.12.014.
Martins CC, Firmino RT, Riva JJ, et al. Desensitizing Toothpastes for Dentin Hypersensitivity: A Network Meta-analysis. J Dent Res. 2020;99(5):514–22. doi:10.1177/0022034520903036.
Arshad S, Zaidi SJA, Farooqui WA. Comparative efficacy of BioMin-F, Colgate Sensitive Pro-relief and Sensodyne Rapid Action in relieving dentin hypersensitivity: a randomized controlled trial. BMC Oral Health. 2021; 6;21(1):498. doi: 10.1186/s12903-021-01864-x.
Hu ML, Zheng G, Zhang YD, et al. Effect of desensitizing toothpastes on dentine hypersensitivity: A systematic review and meta-analysis. J Dent. 2018;75:12–21. doi:10.1016/j.jdent.2018.05.012.
Tavares JAO, da Silva FA, Santos TML, et al. The effectiveness of propolis extract in reducing dentin hypersensitivity: A systematic review. Arch Oral Biol. 2021;131:105248. doi:10.1016/j.archoralbio.2021.105248.
Purra AR, Mushtaq M, Acharya SR, et al. A comparative evaluation of propolis and 5.0% potassium nitrate as a dentine desensitizer: A clinical study. J Indian Soc Periodontol. 2014;18:466–71. doi:10.4103/0972-124X.138695.
Marcucci MC. Propolis: chemical composition, biological properties and therapeutics activity. Apidologie. 1995;26:83–99. doi:10.1051/apido:19950202.
Santiago KB, Piana GM, Conti BJ, et al. Microbiological control and antibacterial action of a propolis-containing mouthwash and control of dental plaque in humans. Nat Prod Res. 2018;32(12):1441–5. doi:10.1080/14786419.2017.1344664.
Zulhendri F, Felitti R, Fearnley J, et al. The use of propolis in dentistry, oral health, and medicine: A review. J Oral Biosci. 2021;63(1):23–34. doi:10.1016/j.job.2021.01.001.
Abbasi AJ, Mohammadi F, Bayat M, et al. Applications of Propolis in Dentistry: A review. Ethiop J Health Sci. 2018;28(4):505–12.
Halboub E, Al-Maweri SA, Al-Wesabi M, et al. Efficacy of propolis-based mouthwashes on dental plaque and gingival inflammation: a systematic review. BMC Oral Health. 2020;10(1):198. doi:10.1186/s12903-020-01185-5. 20 ) .
Saeed MA, Khabeer A, Faridi MA, et al. Effectiveness of propolis in maintaining oral health: a scoping review. Can J Dent Hyg. 2021; 1;55(3):167–176.
Kuo CC, Wang RH, Wang HH, et al. Meta-analysis of randomized controlled trials of the efficacy of propolis mouthwash in cancer therapy-induced oral mucositis. Support Care Cancer. 2018;26(12):4001–9. doi:10.1007/s00520-018-4344-5.
Tamhankar K, Dhaded NS, Kore P, et al. Comparative Evaluation of Efficacy of Calcium Hydroxide, Propolis, and Glycyrrhiza glabra as Intracanal Medicaments in Root Canal Treatment. J Contemp Dent Pract. 2021; 1;22(6):707–712.
Shabbir J, Qazi F, Farooqui W, et al. Effect of Chinese Propolis as an Intracanal Medicament on Post-Operative Endodontic Pain: A Double-Blind Randomized Controlled Trial. Int J Environ Res Public Health. 2020; 9;17(2):445. doi: 10.3390/ijerph17020445.
De Brier N, Borra OD, Singletary V. EM, et al. Storage of an avulsed tooth prior to replantation: A systematic review and meta-analysis. Dent Traumatol. 2020;36(5):453–76. doi:10.1111/edt.12564.
Smith BG, Knight JK. An index for measuring the wear of teeth. Br Dent J. 1984; 23;156(12):435-8. doi: 10.1038/sj.bdj.4805394.
Miller PD Jr. A classification of marginal tissue recession. Int J Periodontics Restorative Dent. 1985;5(2):8–13.
Vano M, Derchi G, Barone A, et al. Reducing dentine hypersensitivity with nanohydroxyapatite toothpaste: a double-blind randomized controlled trial. Clin Oral Investig. 2018;22(1):313–20. doi:10.1007/s00784-017-2113-3.
Liu XX, Tenenbaum HC, Wilder RS, et al. Pathogenesis, diagnosis and management of dentin hypersensitivity: an evidence-based overview for dental practitioners. BMC Oral Health. 2020;6(1):220. doi:10.1186/s12903-020-01199-z. 20 ) .
Wang L, Magalhães AC, Francisconi-Dos-Rios LF, et al. Treatment of dentin hypersensitivity using nano-hydroxyapatite pastes: A randomized three-month clinical trial. Oper Dent. 2016;41(4):E93–101. doi:10.2341/15-145-C.
Boiko OV, Baker SR, Gibson BJ, et al. Construction and validation of the quality of life measure for dentine hypersensitivity (DHEQ). J Clin Periodontol. 2010;37(11):973–80. doi:10.1111/j.1600-051X.2010.01618.x.
Douglas-De-Oliveira DW, Lages FS, Paiva SM, et al. Cross-cultural adaptation of the Brazilian version of the Dentine Hypersensitivity Experience Questionnaire (DHEQ-15). Braz Oral Res. 2018;32:e37. doi:10.1590/1807-3107bor-2018.vol32.0037.
Pandis N. Use of controls in clinical trials. Am J Orthod Dentofacial Orthop. 2012;141(2):250–1. doi:10.1016/j.ajodo.2011.10.018.
Rösing CK, Fiorini T, Liberman DN, et al. Dentine hypersensitivity: analysis of selfcare products. Braz Oral Res. 2009;23(Suppl 1):56–63. doi:10.1590/s1806- 83242009000500009.
Sabir A, Tabbu CR, Agustiono P, et al. Histological analysis of rat dental pulp tissue capped with propolis. J Oral Sci. 2005;47(3):135–8. doi:10.2334/josnusd.47.135.
Sales-Peres SH, Carvalho FN, Marsicano JA, et al. Effect of propolis gel on the in vitro reduction of dentin permeability. J Appl Oral Sci. 2011;19(4):318–23. doi:10.1590/s1678-77572011005000004.
Hongal S, Torwane NA, Goel P, et al. The effect of 30% ethanolic extract of Indian propolis on replica of human dentin compared against commercially available desensitizing agent: A methodological SEM study in vitro. Pharmacognosy Res. 2014;6(2):113–9. doi:10.4103/0974-8490.129026.
Skaba D, Morawiec T, Tanasiewicz M, et al. Influence of the toothpaste with brazilian ethanol extract propolis on the oral cavity health. Evid Based Complement Alternat Med. 2013;2013:215391. doi:10.1155/2013/215391.
Chen CL, Parolia A, Pau A, et al. Comparative evaluation of the effectiveness of desensitizing agentsin dentine tubule occlusion using scanning electron microscopy. Aust Dent J. 2015;60(1):65–72. doi:10.1111/adj.12275.
Riad HR, Mosallam OS, Salama AH, et al. Effect of experimental moringa and propolis toothpastes on surface microhardness of simulated hypersensitive dentin. Bull Natl Res Cent. 2021;45:224. doi:10.1186/s42269-021-00681-0.
Askari M, Yazdani R. Comparison of two desensitizing agents for decreasing dentin hypersensitivity following periodontal surgeries: a randomized clinical trial. Quintessence Int. 2019;50(4):320–9. doi:10.3290/j.qi.a42096.
Morawiec T, Dziedzic A, Niedzielska I, et al. The biological activity of propoliscontaining toothpaste on oral health environment in patients who underwent implantsupported prosthodontic rehabilitation. Evid Based Complement Alternat Med. 2013;2013:704947. doi:10.1155/2013/704947.
Maity S, Priyadharshini V, Basavaraju S. A comparative evaluation of propolis and light-cured ormocer-based desensitizer in reducing dentin hypersensitivity. J Indian Soc Periodontol. 2020;24(5):441–6. doi:10.4103/jisp.jisp_500_19.
Torwane NA, Hongal S, Goel P, et al. A clinical efficacy of 30% ethenolic extract of Indian propolis and Recaldent™ in management of dentinal hypersensitivity: A comparative randomized clinical trial. Eur J Dent. 2013;7(4):461–8. doi:10.4103/1305-7456.120675.
Torwane NA, Hongal S, Goel P, et al. Effect of Two Desensitizing Agents in Reducing Dentin Hypersensitivity: An in-vivo Comparative Clinical Trial. J Clin Diagn Res. 2013;7(9):2042–6. doi:10.7860/JCDR/2013/6005.3401.
Mahmoud AS, Almas K, Dahlan AA. The effect of propolis on dentinal hypersensitivity and level of satisfaction among patients from a university hospital Riyadh, Saudi Arabia. Indian J Dent Res. 1999 Oct-Dec;10(4):130–7.
Holland GR, Narhi MN, Addy M, et al. Guidelines for the design and conduct of clinical trials on dentine hypersensitivity. J Clin Periodontol. 1997;24(11):808–13. doi:10.1111/j.1600-051x.1997.tb01194.x.
de Groot AC. Propolis: a review of properties, applications, chemical composition, contact allergy, and other adverse effects. Dermatitis. 2013;24(6):263–82. doi:10.1097/DER.0000000000000011.

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Effect of experimental propolis-based toothpastes on dentin hypersensitivity: a randomized clinical trial

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Abstract

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Background

Methods

Ethical Considerations

Calculation of sample size

Patient Recruitment

Study design

Randomization and blinding

Clinical Protocol

Assessment of Dentin Hypersensitivity

Data analysis and statistical tests

Results

Study Participants

Demographic characteristics

Tactile stimulus

Evaporative stimulus

Discussion

Conclusion

Declarations

References

Additional Declarations

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