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Dentinal tubule occluding effect of a herbal tooth paste – An invitro scanning electron microscopy analysis

Aim: To evaluate the effects of an herbal desensitizing dentifrice on dentinal tubule occlusion by scanning electron microscopy (SEM). Materials and Methods: 10 dentine blocks were prepared from the cervical region measuring 2mm×1.5 ×1.5 mm, was etched with 6% citric acid for 2 minutes, rinsed in distilled water and were dessicated. Results: All the groups excluding control showed complete occlusion of dentinal tubule on the 30th and 45thday. Conclusion: As the Herbal toothpaste used in this study occluded the dentinal tubules seen through scanning electron microscopy, it is found to be useful for the treatment of dentine hypersensitivity. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC license (https://creativecommons.org/licenses/by-nc/4.0/)


Introduction
Dentine hypersensitivity is an important issue that needs addressing both from a diagnostic and management perspective. It is described clinically as issue that needs a management an exaggerated response to anon noxious sensory stimulus. 1,2 It is viewed as originating from the underlying exposed dentin after the enamel or cementum has been eroded away (Joshi, 2013). 3 It is characterized by short, sharp pain arising from exposed dentin in response to external stimuli, typically thermal, evaporative, tactile, osmotic or chemical, and which cannot be ascribed to any other form of dental defect or disease (Pillai, 2013). 4 Treatment of dentin hypersensitivity is challenging for both the patient and the health care provider. Hypersensitivity can resolve without treatment or may require several weeks of desensitizing agents before improvement is seen. [5][6][7] There are two principal treatment options:-plug the dentinal tubules preventing fluid flow, or desensitize the nerve, making it less responsive to stimulation (Jacobsen, 2001). 2 Agents which occlude the dentinal tubules includes ions or salts which are hypothesized to precipitate within the tubule like stannous ion in stannous fluoride, Oxalate ions which react with the calcium in the tooth to form in soluble calcium oxalate crystals that occlude the tubules, Strontium ions also have the property of precipitating together forming a mass that occludes the tubules, precipitates like glutaraldehyde, resins like dentin sealers, methyl methacrylate etc (Jacobsen, 2001). 2 Recently herbal products like tooth pastes claim to reduce sensitivity with both desensitizing and occluding action. This tooth paste contains Spinach (Palakya), Rhubharb, Arnica and Licorice.
Palakya (spinach), rhubarb and mint contain natural oxalate compounds, which help in occluding the dentinal tubules.

Materials and Methods
The present study was conducted in the Department of Conservative Dentistry and Endodontics, Indraprastha College of Dental Sciences, Ghaziabad. Specimens divided into single group of 10 specimens. 10 dentinal blocks of thickness 2mm are prepared, etched with 6% citric acid for 2 minutes, rinsed in distilled water and specimens brushed for 2 minutes twice daily for 45 days with herbal antisensitivity toothpaste using a powered toothbrush.

Selection of teeth Inclusion criteria
10 extracted premolars were collected, cleaned of gross debris and sectioned labio-lingually. The specimens were placed in deionized water till dentine blocks were prepared. Each surface were wet ground to remove enamel and to expose a flat underlying dentine surface in the cervical region. Dentine blocks were prepared from the cervical region measuring 2mm ×1.5 ×1.5 mm. One block is obtained from each flat cervical dentine surface. The blocks were ultra sonicated in distilled water for 30 s to remove the particulate matter resulting from cutting. Blocks were mounted in acrylic resin to stabilize while brushing. Smear layer was removed by etching the blocks in 6% citric acid for 2 minutes and rinsed in distilled water. The blocks were stored in distilled water during the experimental period. The blocks were brushed using a power brush for 2 minutes twice daily.
Specimens were washed with distilled water, dried in desiccator for 2 days, sputter coated with thin gold layer and subjected for SEM analysis and was scored in accordance with the tubule occlusion classification scoring system (Pathan, 2016). 8 The 10 specimens were brushed for 2 minutes twice daily for 45 days with herbal toothpaste.
Teeth sections were assessed at baseline, 15 days, 30 days & 45 days for the occlusion of dentinal tubules due to the effect of the herbal antisensitivity paste via SEM imaging.
45th day all the tubular occlusion was found to be complete.
About 80% of occlusion is achieved by 15 to 30 days.

Discussion
The herbal toothpaste showed tubule occlusion when day 15 analysis was done in comparison to the day 0 SEM microscopy. The occluding effect of this tooth paste is attributed to the presence of Palakya (Spinicia Oleracea). It consisted of 1% Spinacia oleracea per gram of dentifrice. It has been found that soluble oxalates and oxalic acid in phytocomplexes present in Spinacia oleracea (spinach leaves) form calcium oxalate crystals by reacting with dentinal calcium (Sauro et al., 2006). 9 The ratios of calcium and oxalate/calcium determine the effect of phytocomplexes on dentinal tubule occlusion. Low amounts of calcium and excess oxalate (oxalate/calcium ratio >1) induce binding of oxalate to calcium, producing calcium oxalate directly inside dentinal tubules (Pashley, 1988). 10 Oxalate crystals are small enough to reach within the tubules and occlude tubular orifices. A study has shown that treatment with oxalate-containing phytocomplexes induce microcrystal deposition on dentine and inside dentinal tubules and thus reduce the tubular diameters by forming crystals or crystal like structures (Sauro, 2006). 9 In this formulation Spinacia oleracea, is the possible mechanism of having a synergistic effect along with licorice, arnica and rhubharb in reducing DH by its dentinal tubule obliterating property.

Conclusion
Recently there has been a growing interest in natural products. Herbal based toothpastes have been found as effective as the conventionally formulated dentifrice in the control of plaque and gingivitis. Herbal formulations have also been found to be effective in the prevention of dental caries. From the results of this study, it can be concluded that herbal formulations are also effective in the treatment of dentine hypersensitivity and this novel herbal dentifrice can be recommended for treatment of DH.

Source of Funding
Purexa Global Pvt Ltd.

Conflict of Interest
None.