Original Article

A comparative evaluation of propolis

and 5.0% potassium nitrate as a
dentine desensitizer: A clinical study
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Aamir Rashid Purra, Mubashir Mushtaq, Shashi Rashmi Acharya,1 Vidya Saraswati1
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 06/08/2023

Department of Abstract:
Conservative Dentistry Aim: The purpose of this clinical study was to evaluate the efficacy of saturated ethanolic solution of Propolis
and Endodontics, for the treatment of dentin hypersensitivity. Materials and Methods: Ten patients aged 20‑40 years with 156
Government Dental hypersensitive teeth were selected for a 3‑month study. Each patient was subjected to treatment with saturated
College and Hospital ethanolic solution of Propolis, 5% potassium nitrate and distilled water. The patients were recalled at seventh day,
Srinagar, Kashmir, 2 weeks and 4 weeks for the application of the agent and re‑evaluation. The final re‑evaluation of the patients
was done after 3 months from the first application. The responses of the patients to the test temperatures were
1
Manipal College of
converted to a ranking and data was statistically analyzed. A statistical analysis was done using ANOVA and
Dental Sciences, Bonferroni test and Tukey HSD test for multicomparison. Results: The results between the Propolis group and
Manipal, India the potassium nitrate group showed no significant difference in the immediate post‑treatment period; however, the
results were significant at the end of first week and second week. At 4 weeks and 3 months period, a comparison
between the groups again showed no significant difference. Conclusion: It was concluded that Propolis was more
effective than 5% potassium nitrate in relieving dentinal hypersensitivity and had an immediate and sustained effect.
Key words:
Cold graded water test, distilled water, potassium nitrate, propolis

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INTRODUCTION Potassium nitrate was introduced as a
Website: desensitizing agent by Hodosh.[2] It has been one

D
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entin hypersensitivity is one of the
DOI: most painful and least successfully
10.4103/0972-124X.138695
treated chronic problems of the teeth. It
Quick Response Code: is one of the common complaints and has
been reported that as many as one in every
seven patients undergoing dental treatment
experiences this painful condition.[1] A wide
array of treatment modalities is available for
the management of dentin hypersensitivity.
These modalities involve the application of
various chemicals (desensitizing agents) such
as potassium or ferric oxalates, potassium
nitrate, stannous fluoride, sodium fluoride,
sodium monofluorophosphate (MFP), strontium
chloride, copal varnishes, calcium hydroxide,
fluoride treatments, dentin bonding agents,
or iontophoresis. The desensitizing agents are
Address for applied either by the dentist (in office treatment)
correspondence: or used by the patient as home application.
Dr. Aamir Rashid Purra, Home applications are mainly in the form of
Department of Conservative dentifrices and also as mouthwashes. The effects
Dentistry and Endodontics, of home‑applied agents are manifested after a
Government Dental period of time and would require a considerable
College and Hospital degree of patient compliance. In office treatment,
Srinagar, Kashmir, India.
modalities provide instantaneous relief to the
E‑mail: mubashirendo@
rocketmail.com patient, but the effects are often temporary.
Thus, none of the treatment modalities has been
Submission: 15‑09‑2013 able to provide a permanent relief from dentin
Accepted: 25‑12‑2013 hypersensitivity.
of the widely prescribed desensitizing agents. It
has been used in concentrations of 1%, 2%, 5%,
10%, and 15% or as a saturated solution. 5% is
said to be most effective and is also incorporated
into dentifrices.[3] Potassium nitrate is supposed
to reduce hypersensitivity by inducing a
sustained depolarization of nerve membrane
as put forward by Pashlay.[4] It has also been
postulated that blockage of dentinal tubules by
potassium nitrate reduces sensitivity.[5]
Propolis is a resinous yellow brown to dark
brown substance collected by honey bees from
sprouts, exudates of trees and other parts
of plants and modified in the beehives by
addition of salivated secretions and wax. It is
used by bees for protection, to repair openings
and damages in hives, to construct aseptic
places for queen egging and to embalm killed
invaders. Chemically, Propolis of different
parts of the world is constituted by 50‑60% of
resins, 30‑40% of waxes, 5‑10% of essential oils,
5% pollen, besides microelements like aluminum
and calcium.[6] So far, more than 300 organic
compounds of different groups mainly phenolic,
such as: Flavonoids, stilbenes, phenolic acids and
its esters have been identified from Propolis.
Many biological activities have been reported
for Propolis, such as antimicrobial, antiparasitic,

466 Journal of Indian Society of Periodontology - Vol 18, Issue 4, Jul-Aug 2014
 Purra, et al.: Comparative evaluation of propolis and potassium nitrate
antiviral, anti‑inflammatory, antitumor, antioxidant, anesthetic
and free radical scavenging action.[7] A pioneering pilot
study was under taken on the effect of Propolis on dentinal
hypersensitivity in vivo for a study period of 4 weeks.[8] It was
concluded that Propolis had a positive effect in control of dentin
hypersensitivity.
Thus, the primary objective of this 3‑month study was to
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evaluate the clinical efficacy of topical Propolis preparation and
to compare it with a topical 5% potassium nitrate preparation
in the treatment of dentin hypersensitivity using distilled
water as a control.
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MATERIALS AND METHODS
The subjects included in this study were selected from
outpatients attending the Department of Conservative
Dentistry and Endodontics. The study was designed following
consideration of the 1997 guidelines on clinical trials of
dentine sensitivity.[9,10] The study was a 3‑month, randomized,
double blind study. The subjects fulfilling certain qualifying
criteria were taken up for the study. (Subjects included in the
study were dentally mature individuals in the age group of
20‑40 years, having sensitive teeth with a clinical diagnosis
satisfying the definition of dentine hypersensitivity; subjects
willing to participate in the study for 3 months; subjects with
more than three hypersensitive teeth and the subjects capable of
giving a written informed consent. Subjects excluded from the
study included the patients who were on current desensitizing
therapy, patients with medical (including psychiatric) and
pharmacotherapeutic histories that may compromise the
protocol‑including the use of anti‑inflammatory, analgesic
and mind‑altering drugs; patient who were pregnant
or breast feeding; patients with allergies, idiosyncratic
reactions or with eating disorders; patients with systemic
conditions that are etiologic or predisposing to dentine
hypersensitivity (e.g., chronic acid regurgitation); patients
with excessive dietary or environmental exposure to acids;
patients with the history of Periodontal surgery in the
preceding 3 months (unless it is the effect of the agent on
post‑surgical sensitivity that is under study); patients with
orthodontic appliance treatment with in previous 3 months;
patients with painful pathology or defects in teeth or their
supporting structures; patients who had their teeth restored
in the preceding 3 months; patients with fixed or removable
prostheses or extensively restored teeth with restorations
extending into the test area.
Ten patients in the age group of 20‑40 years with
156 hypersensitive teeth fulfilling the above‑mentioned criteria
were included in the study. The teeth selected for the study
included canine, premolars and molars. Relevant information
related to history, precipitating causes, and past treatment
received for the condition was collected from each patient.
Thorough oral prophylaxis was done for all the patients.
Following this, the patients were allocated to treatment.
The agents were assigned as 5% potassium nitrate solution,
alcoholic solution of Propolis (Hi‑Tech Natural Products,
India Ltd) and distilled water. Propolis extract was made by
dissolving the Propolis into 70% ethanol and straining out the
precipitate. The study was carried out in a double‑blinded
Journal of Indian Society of Periodontology - Vol 18, Issue 4, Jul-Aug 2014
design, i.e., the patient, and the people analyzing the data were
unaware of the agent. One experienced operator was involved
in the application and other in the evaluation of the agent.
Freshly prepared potassium nitrate was used at each
appointment. Based on the treatment received, the
hypersensitive sites were divided into three groups:
• Group 1(Propolis)
• Group 2 (5% potassium nitrate)
• Group 3 (distilled water).
Fifty‑two hypersensitive teeth were allocated in each group.
Each patient received all the three treatments. The area to be
treated was isolated with rubber dam and was dried using air
spray. Propolis was applied with a brush and left undisturbed
at the site for 5 minutes. Potassium nitrate and water was
applied with saturated cotton pellets for 5 minutes. Patients
were instructed not to rinse or to take anything for half an
hour so that the desensitizing agent takes sufficient time to act
without getting washed away. The patients were advised to
use a soft toothbrush and a non‑fluoridated tooth paste while
brushing. Dietary counseling was also done in order to avoid
intake of excessive dietary acids during the study period.
Pre‑ and post‑treatment assessment was done at the baseline,
7th day, 14th day, 30th day, 3 months and measurements were
recorded by the same investigator.
Evaluation of hypersensitivity
The subject’s sensitivity to stimuli was assessed by using a cold
graded thermal test. The clinical evaluation of the sensitivity
was done before and after the application of the agents at 1st, 7th,
14th, 30th day and at 3 months recall. A thermal testing technique
developed by Brough et al. was used to quantify the patient’s
baseline response to a cold stimulus.[11] Each tooth included in
the study was isolated with a rubber dam without a clamp,
using finger adaptation only. The water temperatures used in
this study were 20°C, 10°C and 0°C with a variance of +l°C for
each temperature interval. Water temperature was maintained
throughout the procedure by the use of thermal‑insulated
containers. The required water temperature was adjusted in
each container by the addition of ice or hot water until the
desired temperature was obtained. The water temperature
was monitored by the use of a thermometer. The application
of water was done using a disposable syringe. The syringe
was changed after every patient. The syringes were kept in the
water containers and remained there until used to transport and
apply water to the exposure site. Each syringe was immediately
returned to the container following use. Using the syringe
and starting at 20°C the investigator flowed the water over
the isolated exposed tooth surface until a sensitive response
occurred or for a maximum of 3 s, if no response occurred.
The investigator waited for 2 minutes and then retested the
tooth with water at 10°C. Delaying reapplication of water for
2 minutes between each application was attempted to allow
the tooth to return to body temperature. The water temperature
was finally decreased by 10°C intervals until a sensitive
response was obtained or until the testing system’s limit (0°C)
was reached. As the thermal stimulus was applied, the thermal
stimulus either will or will not elicit a sensitive response
(yes/no). Following baseline data collection, the appropriate
467
 Purra, et al.: Comparative evaluation of propolis and potassium nitrate

solutions, according to the treatment group assignment of each Table 1: Response of teeth at various temperatures and
tooth, were applied by the examiner. different time intervals in propolis group (Group 1)
Group 1
The facial surface was dried with gauze before the application Time Total
of the treatment solutions. The investigator used a brush
Baseline Immediate 7th 2 4 3
saturated with the treatment solution for Propolis and gauzes day weeks weeks months
saturated with treatment solution for potassium nitrate and
TEETH
water and carefully placed them without burnishing on the
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20 deg
exposed tooth surface for 2 minutes. The investigator again Count 20 9 6 6 8 7 56
dried the tooth with gauze and immediately applied similarly % 38.5 17.3 11.5 11.5 15.4 13.5 17.9
the second coat of solution for an additional 3 minutes. After the 10 deg
tooth had been treated, the investigator determined the patient’s Count 32 20 11 5 10 9 87
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immediate response to water temperatures using the identical % 61.5 38.5 21.2 9.6 19.2 17.3 27.9
0 deg
procedure that was performed at baseline. Each tooth was treated Count 0 13 9 13 9 9 53
and evaluated individually before proceeding to the next one. % 0.0 25.0 17.3 25.0 17.3 17.3 17.0
After all the teeth had been tested, the patient was instructed to NR
use normal daily oral hygiene regimen and to avoid using any Count 0 10 26 28 25 27 116
desensitizing dentifrices or any agents that contained fluoride. % 0.0 19.2 50.0 53.8 48.1 51.9 37.2
The teeth were again treated with agents at 7th day, 14th day and Total
Count 52 52 52 52 52 52 312
28th day. Additional post‑treatment measurements at 7th day,
% 100.0 100.0 100.0 100.0 100.0 100.0 100.0
14th day, 28th day and 3 months after initial treatment were made
a χ2=96.613 P=0.001 vhs, NR: No response
using the identical thermal testing technique used to establishing
baseline and immediate response data.
Table 2: Response of teeth at various temperatures and
different time intervals in potassium nitrate group (Group 2)
RESULTS
Group 2
Ten subjects with 156 hypersensitive teeth completed the Time
3‑month clinical study. Baseline Immediate 7th 2 4 3 Total
day weeks weeks months
For purpose of data analysis the responses of the patients to the Teeth
test temperatures were converted to a ranking as suggested by 20 deg
Brough et al.[11] The ranking were assigned as follows: Count 23 14 8 10 10 12 77
% 44.2 26.9 15.4 19.2 19.2 23.1 24.7
• 3 = 20°C 10 deg
• 2 = 10°C Count 29 24 17 14 11 12 107
• 1 = 0°C % 55.8 46.2 32.7 26.9 21.2 23.1 34.3
• 0 = No response. 0 deg
Count 0 10 16 13 12 13 64
The effectiveness of Propolis in reducing dentine hypersensitivity % 0.0 19.2 30.8 25.0 23.1 25.0 20.5
NR
was compared with 5% potassium nitrate and placebo treatment
Count 0 4 11 15 19 15 64
at baseline, 7th day, 2 weeks, 4 weeks and 3 month. % 0.0 7.7 21.2 28.8 36.5 28.8 20.5
Total
In Group 1, out of 52 teeth, 20 teeth reacted at 20°C, 32 teeth Count 52 52 52 52 52 52 312
at 10°C before treatment as shown in Table 1. In Group 1, % 100.0 100.0 100.0 100.0 100.0 100.0 100.0
application of Propolis resulted in significant reduction in a χ2=65.237 P=0.001 vhs, NR: No response
the temperature to which the patient responded immediately
after treatment, at 1 week, 2 weeks, 4 weeks and 3 month after to which the patient responded after treatment was seen but it
treatment. At the end of 3 months only 7 teeth reacted at 20°C, was not statistically significant at 1 week, 2 weeks and 4 weeks
9 teeth reacted at 10°C, 9 teeth react at 0°C and 27 teeth showed after the treatment. At the end of 3 months a significant response
no response i.e., 51.9% teeth were completely free of sensitivity. was seen. 17 teeth were reacting at 20°C, 20 teeth were reacting at
10°C, 7 teeth were reacting at 0°C, and 8 teeth showed no response.
In Group 2 out of 52 teeth, 23 reacted at 20°C and 29 reacted
at 10° before treatment as shown in Table 2. In Group 2, To obtain intra‑group and inter‑group comparisons, mean
application of 5% potassium nitrate resulted in a significant values with standard deviations for different time periods in
reduction in the temperature to which the patient responded at Groups 1, 2 and 3 were statistically analyzed. P value was set
1 week, 2 weeks, 4 weeks and 3 month after treatment. At the at 0.05 as shown in Table 4 and following results were obtained.
end of 3 months only 12 teeth reacted at 20°C, 12 teeth reacted
at 10°C, 13 teeth reacted at 0°C and 15 teeth showed no response A statistical analysis was done using ANOVA and multicomparison
i.e., 28.8% teeth were completely free of sensitivity. was done using the Bonferroni test and Tukey HSD test.

In Group 3 out of 52 teeth, 24 reacted at 20°C and 28 reacted at Intragroup comparison

10°C before treatment as shown in Table 3. In Group 3, who were When the results were compared in intra group at baseline,
treated with placebo treatment, slight reduction in the temperature immediately after treatment, 1 week, 2 weeks, 4 weeks and

468 Journal of Indian Society of Periodontology - Vol 18, Issue 4, Jul-Aug 2014
 Purra, et al.: Comparative evaluation of propolis and potassium nitrate

3 months using the Bonferroni test, there was a significant
difference. In Group 1, on comparison between baseline and
immediately after treatment, 1 week, 2 weeks, 4 weeks and
3 months, the results were very highly significant (P = 0.001).
On comparison between immediately after treatment and
1 week, the result was significant. A comparison between
results immediately after treatment and 2 weeks was highly
significant, with 4 weeks was not significant but was significant
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significant as shown. On comparison between immediately
after treatment and 1 week results were not significant, with
2 weeks results were significant, with 4 weeks results were
highly significant but not significant with 3 months. Rest of
the comparisons were not significant. In Group 3, comparisons
of results between different time periods were not significant
except between baseline and 3 months.

with 3 months. Rest of the comparisons were not significant.
In Group 2, a comparison between baseline and immediately
after treatment, 1 week, 2 weeks and 3 months were very highly
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Intergroup comparison
When baseline score of all the groups were compared with
each other using the Tukey HSD test, there was no significant
difference found (P > 0.05) as shown in Table 5.

Table 3: Response of teeth at various temperatures

and different time intervals in the distilled water Immediately after the treatment, the results between the
group (Group 3) groups showed that there was no significant difference
Group 3
between Group 1 and Group 2 and Group 2 and Group 3 but
between Group 1 and Group 3 results were highly significant.
Time
A comparison at first week between groups showed that there
Baseline Immediate 7th 2 4 3 Total was a significant difference between Group 1 and Group 2
day weeks weeks months
and very highly significant difference between Group 1 and
TEETH Group 3. Group 2 and Group 3 showed highly significant
20 deg
Count 24 19 19 19 19 17 117
difference. At 2 weeks a comparison between groups showed
% 46.2 36.5 36.5 36.5 36.5 32.7 37.5 same results as at first week. At 4 weeks a comparison between
10 deg groups showed that there was no significant difference between
Count 28 24 23 22 22 20 139 Group 1 and Group 2 but there was very highly significant
% 53.8 46.2 44.2 42.3 42.3 38.5 44.6 difference between Group 1 and Group 3 and also between
0 deg Group 2 and Group 3. At 3 months a comparison between
Count 0 4 5 5 5 7 26
Group 1 and Group 3 was very highly significant but a
% 0.0 7.7 9.6 9.6 9.6 13.5 8.3
NR comparison between Group 1 and Group 2 as well as Group 2
Count 0 5 5 6 6 8 30 and Group 3 was insignificant.
% 0.0 9.6 9.6 11.5 11.5 15.3 9.6
Total DISCUSSION
Count 52 52 52 52 52 52 312
% 100.0 100.0 100.0 100.0 100.0 100.0 100.0
It has been reported that 15% of global population suffers from
a χ2=16.508 P=0.349 ns, NR: No response
dentine hypersensitivity.[12] Till now no completely reliable
treatment has been found; an agent can be of benefit in one
Table 4: Mean values with standard deviations of scores case but fail in another. Search for an ideal agent still continues.
of the cold graded thermal test for different Groups at
different time periods in Groups 1, 2 and 3 Natural products have been used for thousands of years in
Time N Mean Std. deviation F P folk medicine for several purposes. Among them, Propolis a
Baseline
Group 1 52 2.3846 0.49125 Table 5: Intergroup comparison between different
Group 2 52 2.4423 0.50151 groups at different time intervals
Group 3 52 2.4615 0.50338 0.335 0.716
Immediate Time (I) Group (J) Group Mean P
Group 1 52 1.5385 0.99925 difference (I‑J)
Group 2 52 1.9231 0.88220 Baseline Group 1 Group 2 −0.0577 1.000
Group 3 52 2.0962 0.91308 4.869 0.009 hs Group 3 −0.0769 1.000
7th day Group 2 Group 3 −0.0192 1.000
Group 1 52 0.9423 1.09210 Immediate Group 1 Group 2 −0.3846 0.111
Group 2 52 1.4231 0.99698 Group 3 −0.5577 0.008 hs
Group 3 52 2.0769 0.92559 16.625 0.001 vhs Group 2 Group 3 −0.1731 1.000
2 weeks 7th day Group 1 Group 2 −0.4808 0.048 sig
Group 1 52 0.7885 1.03538 Group 3 −1.134 0.001 vhs
Group 2 52 1.3654 1.10309 Group 2 Group 3 −0.6538 0.003 hs
Group 3 52 2.0385 0.96936 18.912 0.001 vhs 2 weeks Group 1 Group 2 −0.5769 0.016 sig
4 weeks Group 3 −1.2500 0.001 vhs
Group 1 52 1.0192 1.14601 Group 2 Group 3 −0.6731 0.004 hs
Group 2 52 1.2308 1.14815 4 weeks Group 1 Group 2 −0.2115 0.973
Group 3 52 2.0385 0.96936 12.638 0.001 vhs Group 3 −1.0192 0.001 vhs
3 months Group 2 Group 3 −0.8077 0.001 vhs
Group 1 52 0.9231 1.11753 3 months Group 1 Group 2 −0.4808 0.082
Group 2 52 1.4038 1.14206 Group 3 −0.9615 0.001 vhs
Group 3 52 1.8846 1.04138 9.912 0.001 vhs Group 2 Group 3 −0.4808 0.082
vhs: Very highly significant, hs: Highly significant vhs: Very highly significant, hs: Highly significant

Journal of Indian Society of Periodontology - Vol 18, Issue 4, Jul-Aug 2014 469
 Purra, et al.: Comparative evaluation of propolis and potassium nitrate
bee product has attracted increased interest due to its harmless
nature and innumerable biological activities. Certain clinical
studies have shown Propolis to be a promising dentine
desensitizer in the treatment of dentinal hypersensitivity.[8]
The authors explained the effect due to blockade of dentinal
tubules in light of their SEM observation.[9] Literature review
indicates that there has been no study comparing Propolis with
a known desensitizing agent and a negative control.
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The aim of this study was to evaluate the clinical efficacy of
Propolis in a controlled study and compare it with a positive
and a negative control. Potassium nitrate was used as a positive
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control as it is currently the most frequently used agents for
control of hypersensitivity.[13] A purified saturated ethanolic
extract of Propolis was used in the study.
One of the inherent problems of desensitizing studies is in the
development of a technique and stimulus that will quantify
reliably a patient’s response to pain Only in few studies
were fairly sophisticated thermoelectric measuring devices
used.[14] These devices give a precise reading but are extremely
expensive. In the present study, the Brough technique of
using cold graded water enabled the investigator to confine
the stimulus to the tooth being tested, was reproducible,
inexpensive and could stimulate the irritation of a cold stimulus
within a realistic temperature range.[11] As the thermal stimulus
was applied, the temperature at which sensitivity was elicited
was noted using the pain scoring system of Brough et al.[11]
According to the system the thermal stimulus either will or will
not elicit a sensitive response (Yes/No). They found that by
asking the participant simply to report that the tooth was or was
not painful eliminated the requirement that the patient classify
the pain response e.g., mild, moderate, severe or very severe.
This enabled the examiner to collect quantitative data and
allowed for statistical analysis. This technique determines the
degree of hypersensitivity through the use of a range of water
temperatures applied directly to the exposed root surface.
Application of Propolis in Group 1 resulted in a significant
reduction in the temperature to which the patient responded
immediately after treatment in 19% of teeth and 25% teeth
responded only at 0°C 5 minutes after treatment. This was
followed by an increase in the efficacy of agent over a period of
time with maximum relief from hypersensitivity by end of the
study period i.e., 3 months. At 3 months after the application of
the agent, 51% teeth very completely free of sensitivity and those
that reacted only at 0°C decreased to 17.3%. Propolis thus had an
immediate as well as increased sustained effect. The immediate
relief could be due to its tubular sealing effect which prevents the
flow of the dentinal fluid in the tubules, thereby preventing any
alteration in the arrangement of the odontoblastic process and
nerve endings. The long lasting of effect of Propolis probably
could be due to stable nature of the deposits so formed. The
retention and stability of the Propolis deposits in hostile oral
environment needs further investigation and is not within the
scope of this study. Over 3 months time response gradually
reduced to only 28.8% teeth free from hypersensitivity and
25% teeth reacting at 0°C. Propolis is a power house of chemicals
especially bioactive flavonoids. Flavonoids have been shown
to have tissue regenerative activity. Propolis has been shown
to stimulate various enzymes, cell metabolism, circulation and
collagen formation, as well as improve healing.[15] Sabir et al.
470
found that direct pulp capping with Propolis flavonoids in rats
may delay dental pulp inflammation and stimulate reparative
dentin formation.[16] In our study no histologic sections were
taken to determine if Propolis formed reparative dentine, but
this is a possible explanation for the decrease in sensitively at
the 3‑month interval.
Potassium nitrate acts by reducing the excitability of the
interdental nerves in the pulp by depolarizing them.[17,18]
Potassium ions have to traverse the length of the dentinal
tubule in sufficient quantity to cause depolarization. The
results show that at the end of 5 minutes after treatment, the
concentration of potassium ions in the dentinal tubules was not
sufficient to make the nerves in excitable and it takes longer
time for the potassium ions to reach the nerves. The effect of
desensitization achieved by K ions decreased with time and
this could be attributed to a decrease in concentration of the
ions in dentinal tubules.
The placebo treatment which was used in Group 3 was effective
only to a certain extent. With 9.6% teeth free from sensitivity
and 7.7% reacting at 0°C only, 5 minutes after treatment and
increasing to 15.3% teeth free from sensitivity and 13.5% reacting
at 0°C at the end of the study. Placebo effect consists of a
complex mixture of physiologic and psychological interactions,
depending considerably on the doctor patient relationship with
both parties believing that the treatment is of value and the
desire to obtain relief from symptoms. Despite randomization
of subjects in the study, the enrolled subjects often try to please
clinicians. Furthermore, positive emotional and motivational
behavioral responses can activate the body’s central pain
inhibiting system, which can modulate painful stimuli from the
periphery through the release of endorphins centrally.
Yet another possible phenomenon which could occur is the
‘Hawthorne effect’.[19] This may influence the interpretation of the
results. The ‘Hawthorne effect’ is a response to non‑intervention
procedure such as frequent examinations, improved oral
hygiene or compliance with the treatment regimen. Patients
frequently appear to improve merely from the effect of being
placed on a trial. This reaction is thought to occur in many
clinical trials. In this study, patients were reinforced in each
visit about their oral hygiene and dietary acid consumption.
Further, most patients like to have clean mouths if they attend
the dental surgeon and will therefore by more vigilant about
brushing during a period of frequent examination. These factors
unintentionally alter behavior. Better oral hygiene may allow
greater saliva access to patent dentinal tubules. This in turn may
enhance tubules obliteration through deposition of salivary
calcium, phosphate and proteins. The influence of Hawthorne
effect may explain the change in the results from 5 minutes
after treatment to end of study at 3 months. Many investigators
have described patients obtaining relief without treatment due
to placebo effect.[19,20] This is thought to vary from 20% to 60%
in dentine sensitivity clinical trials.[21]
CONCLUSION
Observations from the present study are:
• Propolis was the most effective desensitizer providing both
immediate relief which gradually increased by the end of
3 months
Journal of Indian Society of Periodontology - Vol 18, Issue 4, Jul-Aug 2014
 Purra, et al.: Comparative evaluation of propolis and potassium nitrate

• 5% potassium nitrate was effective in reducing dentin
hypersensitivity but to a lesser degree when compared to
Propolis
• The placebo group failed to show any statistically significant
difference than the other experimental agents and was not
effective in reducing dentin sensitivity.
REFERENCES
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of iontophoresis in reducing dentin hypersensitivity. J Am Dent
Assoc 1985;111:761‑5.
12. Fischer C, Fischer R G, Wennberg A. Prevalence and distribution
of cervical dentine hypersensitivity in a population in Rio de
Janeiro. Brazil J Dent 1992;20:272‑6.
13. Berman LH. Dentinal sensation and hypersensitivity. Review
of mechanisms and treatment alternatives. J Periodontol
1984;56:216‑21.

14. Thrash WJ, Dorman HL, Smith FD. A method to measure

1. Muzzi KB, Johnson R. Effect of potassium oxalate on dentin
hypersensitivity in vivo. J Periodontol 1989;60:67‑78.
2. Hodosh M. A superior desensitizer‑potassium nitrate. J Am Dent
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 06/08/2023
pain associated with hypersensitive dentin. J Periodontol
1983;54:160‑2.
15. Al‑Shaher A, Wallace J, Agarwal S, Bretz W, Baugh D. Effect of
Propolis on human fibroblasts from the pulp and periodontal

Assoc 1974;88:831‑2. ligament. J Endod 2004;30:359‑61.

3. Kanapka JA. Over the counter denitrifies in the treatment of tooth
hypersensitivity. Review of clinical studies. Dent Clin North Am
1990;34:545‑59.
4. Pashley DH. Dentin permeability, dentin sensitivity and treatment
through tubule occlusion. J Endod 1986;12:465‑74.
5. Kim S. Thermal stimuli in dentin hypersensitivity. Endod Dent
Traumatol 1986;2:138‑40.
6. Simões LMC, Gregório LE, da Silva Filho AA, de Souza ML,
Azzolini AE, Bastos JK, et al. Effect of Brazilian green Propolis
on the production of reactive oxygen species by stimulated
neutrophils. J Ethnopharmacol 2004;94:59‑65.
7. Al‑Shaher A, Wallace J, Agarwal S, Bretz W, Baugh D. Effect of
Propolis on human fibroblasts from the pulp and periodontal
ligament. J Endod 2004;30:359‑61.
8. 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;10:130‑7.
9. Mahmoud AS, Almas K, Dahlan AA. Comparative study of
Propolis and saline application on human dentin. A SEM study.
Indian J Dent Res 2001;12:21‑7.
10. Holland GR, Narhi MN, Addy M, Gangarosa L, Orchardson R.
Guidelines for the design and conduct of clinical trials on dentine
hypersensitivity. J Periodontol 1997;24:808‑13.
11. Brough KM, Anderson DM, Love J, Overman PR. The effectiveness
16. Sabir A, Tabbu CR, Agustiono P, Sosroseno W. Histological
analysis of rat dental pulp tissue capped with Propolis. J Oral Sci
2005;47:135‑8.
17. Markowitz K, Bilotto G, Kim S. Decreasing intra dental nerve
activity in the cat with potassium and divalent cations. Arch Oral
Biol 1991;36:1‑7.
18. Peacock JM, Orchardson R. Effects of potassium ions on action
potential conduction in A‑ and C‑fibers of rat spinal nerves. J Dent
Res 1995;74:634‑41.
19. West NX, Addy M, Jackson RJ, Ridge DB. Dentin hypersensitivity
and the placebo response. A comparison of the effect of strontium
acetate, potassium nitrate and fluoride toothpastes. J Clin
Periodontol 1997;24:209‑15.
20. Tarbet WJ, Silverman G, Stolman JM, Fratarcangelo PA. Clinical
evaluation of a new treatment for dentin hypersensitivity.
J Periodontol 1980;51:535‑9.
21. Kleinberg I, Kaufman HW. Methods of measuring hypersensitive
teeth. Dent Clin North Am 1990;34:515‑27.
How to cite this article: Purra AR, Mushtaq M, Acharya SR,
Saraswati V. 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.
Source of Support: Nill, Conflict of Interest: None declared.

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