26
J Gandhara Med Dent Sci
April - June 2025
ORIGINAL ARTICLE
:
:
COMPARING THE EFFECT OF STANNOUS FLUORIDE TOOTHPASTE WITH PLACEBO IN
TREATING DENTINAL HYPERSENSITIVITY
Huma Abid
1
,
Naila Noreen
2
,
Nousheen Daud
3
,
Saadia Sultana
4
ABSTRACT
OBJECTIVES
This study aimed to compare the efficacy of stannous fluoride toothpaste
versus placebo in treating dentinal hypersensitivity.
METHODOLOGY
This quasi
-
experimental study was conducted at the Department of
Periodon
tology, Rehman Medical Institute (RMI), Peshawar from July 25,
2023, to January 25, 2024. The study included 176 patients aged 18
-
70 years
with at least two hypersensitive teeth. Participants were randomly divided
into two groups: the test group (stannous
fluoride toothpaste) and the control
group (placebo). Sensitivity was measured at baseline, 3 minutes after
application, and 15 days post
-
application using the Schiff Cold Air Sensitivity
Scale (SCASS). Oral hygiene measures, clinical attachment loss, and
gingival
recession were also recorded. Data were analyzed using independent t
-
tests
and Chi
-
square tests.
RESULTS
The test group showed significant improvement in SCASS scores compared to
the control group (93.2% vs. 12.5%, p<0.001). Participants who used
toothbrushes had significantly better outcomes than those using miswak or
never engaging in oral hygiene. Participants who brushed more frequently
experienced improved sensitivity relief, as effective brushing helps distribute
the active fluorides uniform
ly across the teeth.
CONCLUSION
Stannous fluoride toothpaste significantly reduces dentinal hypersensitivity
compared to placebo, supporting its use as an effective treatment for DH.
KEYWORDS:
Toothpaste, Hypersensitivity, Placebo, Fluoride
How to cite this article
Abid H, Noreen N, Daud N, Sultana S.
Comparing the Effect of Stannous
Fluoride Toothpaste with Placebo in
Treating Dentinal Hypersensitivity
.
J
Gandhara Med
Dent Sci. 2025;12(2):26-
29. http://doi.org/10.37762/jgmds.12-2.
647
Date of Submission:
25
-
11
-
2
024
Date Revised:
23
-
02
-
2025
Date
Acceptance:
22
-
03
-
2025
2
Final
Y
ear
R
esident, Department of
Periodontology and Implantology,
Rehman College of Dentistry, Peshawar
3
Senior Registrar, Department of
Periodontology and Implantology,
Rehman College of Dentistry, Peshawar
4
Final
Y
ear
R
esident, Department of
Periodontology and Implantology,
Rehman College of Dentistry, Peshawar
Correspondence
1
Huma Abid,
Final
Y
ear
R
esident,
Department of Periodontology and
Implantology, Rehman
College of
Dentistry, Peshawar
+92
-
301
-
1814989
humaabid120@gmail.com
INTRODUCTION
Dentin hypersensitivity (DH), an oral health condition
that is not considered life
-
threatening but has a notable
impact, has been found to have a significant effect on
the quality of life experienced by numerous individuals.
It manifests
as a sudden, fleeting pain resulting from the
exposure of dentin to different stimuli. This condition
can significantly hinder individuals from fully savoring
a diverse array of culinary experiences, thereby causing
discomfort and emotional distress.
1
The
prevalence of
DH has been reported to range from 10% to 30% in the
general population, with peak incidence observed in
individuals aged 20
–
50 years.
2
It is most associated
with gingival recession, enamel erosion, and aggressive
toothbrushing practices.
3
T
he management of DH poses
significant challenges due to its multifactorial etiology
and individual variability in pain perception.
4
Broadly,
treatment strategies can be categorized into two
mechanisms: occlusion of dentinal tubules to prevent
fluid flow or
desensitization of interdental nerves to
block pain transmission.
5
Considering the significant
influence of dentin hypersensitivity (DH), there has
been a growing emphasis within the dental field on the
advancement of toothpaste compositions that
incorpor
ate diverse bioactive components, aiming to
effectively tackle this condition.
6
Over
-
the
-
counter
desensitizing toothpaste represents first
-
line
intervention due to their ease of use, affordability, and
accessibility. Active ingredients such as potassium
ni
trate, stannous fluoride, and arginine
-
calcium
carbonate have been extensively studied for their
efficacy in managing DH.
7
One notable development in
the field of oral hygiene is the emergence of toothpaste
infused with stannous fluoride. The ascent of DH
treatments in the field of therapeutic breakthroughs has
garnered significant interest, positioning them as a
prominent solution in the pursuit of effective
treatments. Stannous fluoride is widely recognized for
its notable dual
-
action effectiveness, encom
passing the
ability to facilitate the remineralization process of tooth
structures and safeguard the vulnerable dentinal tubules
against various external stimuli.
8
Stannous fluoride
(SnF2) forms an insoluble layer over exposed dentinal
tubules, effectively
reducing their permeability and
subsequent fluid movement.
9
Additionally, SnF2
exhibits antimicrobial properties that may contribute to
improved oral health by reducing plaque and
Comparing the Effect of Stannous Fluoride Toothpaste
27
J Gandhara Med Dent Sci
April - June 2025
gingivitis.
10
This characteristic renders it a compelling
choice in the rea
lm of DH management, as it provides
both prompt alleviation of symptoms and enduring
advantages for dental well
-
being. Management
strategies for DH are classified into two categories:
occluding dentinal tubules to reduce fluid movement or
desensitizing ner
ve endings to mitigate pain perception.
Among the commonly used agents, stannous fluoride
(SnF2) is particularly effective because it can occlude
tubules by forming stannous oxides and hydroxides.
These compounds precipitate on the dentinal surface,
sealin
g exposed tubules and reducing fluid flow.
11
Studies using scanning electron microscopy (SEM)
have demonstrated that SnF2 forms a durable barrier
over dentin, suggesting long
-
lasting effects compared to
alternatives like potassium nitrate or sodium fluorid
e.
12
Recent clinical investigations emphasize the dual action
of SnF2: occlusion of dentinal tubules and antimicrobial
activity, which contributes to its anti
-
inflammatory
properties. Stannous fluoride has also been shown to
significantly outperform other
desensitizing agents,
including arginine
-
based compounds and potassium
nitrate, regarding onset and duration of relief.
13
Furthermore, formulations combining SnF2 with other
active agents, such as sodium fluoride or calcium
phosphates, have synergistic eff
ects in promoting dentin
remineralization and tubule occlusion.
14
Despite its
efficacy, the widespread adoption of stannous fluoride
has been limited by potential side effects, such as
surface staining, and a lack of long
-
term comparative
studies. Placebo
-
controlled trials are essential to isolate
the specific impact of SnF2 from the placebo effect, as
psychological factors often influence self
-
reported pain
relief in DH studies. This research aims to evaluate the
efficacy of SnF2 toothpaste compared to pla
cebo in
reducing DH, employing rigorous clinical
methodologies to address these challenges.
METHODOLOGY
This quasi
-
experimental study evaluated the efficacy of
stannous fluoride toothpaste in treating dentinal
hypersensitivity compared to a placebo. Cond
ucted in
the Department of Periodontology at Rehman College
of Dentistry between July 25, 2023, and January 25,
2024, the study targeted patients reporting dentinal
hypersensitivity. Using the World Health Organization's
sample size calculator, 176 partici
pants were
determined as the required sample size, ensuring 80%
power and a 5% significance level. This calculation was
based on a 27.8% hypersensitivity relief rate in
stannous fluoride users and 42% in placebo users,
drawn from prior research. Participan
ts were selected
through non
-
probability consecutive sampling.
Eligibility criteria included adults aged 18
-
70 with at
least two hypersensitive teeth anterior to molars, whose
hypersensitivity arose from attrition, abrasion, erosion,
or gingival recession,
provided they were otherwise
healthy and had no known allergies to the test products.
Exclusion criteria eliminated individuals with advanced
periodontal disease, carious lesions, or mobility greater
than 1, as well as those who had used desensitizing
too
thpaste in the last three months or were on certain
medications such as anticonvulsants, sedatives, or anti
-
inflammatory drugs. Ethical approval was obtained
from the Institutional Ethics Review Committee, and all
participants provided written informed con
sent. Patients
were divided into two groups: one received stannous
fluoride toothpaste (test group), while the other
received a placebo without active ingredients (control
group). Dentinal sensitivity was assessed using the
Schiff Cold Air Sensitivity Scal
e, with readings taken at
baseline, three minutes after application, and fifteen
days later to evaluate sustained relief. Participants were
given detailed usage instructions for their assigned
toothpaste and were monitored during follow
-
ups. Data
were anal
yzed using SPSS Version 26, where
continuous variables like age and clinical attachment
loss were expressed as means and standard deviations,
while categorical variables such as gender and brushing
frequency were summarized as percentages.
Relationships be
tween categorical variables were
evaluated using the chi
-
square
test, and stratification
accounted for modifiers like age and brushing habits. A
p
-
value ≤ 0.05 was considered statistically significant
for all analyses.
RESULTS
Table 1: Descriptive Statistics of Study (n=176)
Variable
Group
Mean
Std.
Deviation
P
-
Value
Age
(Years)
Test Group
43.88
15.925
0.949
Control Group
44.02
14.702
SCASS
Score
Test Group
0.13
0.543
0.000
Control Group
1.68
0.989
Clinical
Attachme
nt Loss
(mm)
Test Group
2.734
1.2506
0.806
Control Group
2.781
1.2865
Table 2:
Frequencies and Percentages for Recession
, Oral
Control Group
Hygiene and Tooth
rushing in
B
T
est and
Variable
Test
Group
(n=88)
Control
Group
(n=88)
P
-
Value
Recession
Yes
49 (55.7%)
47 (53.4%)
0.762
No
39 (44.3%)
41 (46.6%)
Oral
Hygiene
Measures
Miswak
16 (18.2%)
20 (22.7%)
0.037
Toothbrush
16 (18.2%)
23 (26.1%)
Others
28 (31.8%)
12 (13.6%)
Never
28 (31.8%)
33 (37.5%)
Tooth
Brushing
Frequency
Twice Daily
12 (13.6%)
10 (11.4%)
0.815
Once Daily
15 (17.0%)
12 (13.6%)
Occasionally
19
(21.6%)
18 (20.5%)
Never
42 (47.7%)
48 (54.5%)
Comparing the Effect of Stannous Fluoride Toothpaste
28
J Gandhara Med Dent Sci
April - June 2025
Comparing the Effect of Stannous Fluoride Toothpaste
Table 3: Comparison of Efficacy
in both Groups
Efficacy of
P
-
Value
Yes n (%)
No n (%)
Group
Test
Group
82 (93.2)
06 (6.8)
< 0.001
Control
Group
11 (12.5)
77 (87.5)
Table 4:
Stratification of Efficacy
of stannous fluoride
with Oral
Hygiene Measures and Tooth Brushing Frequency
.
Variable
Group
Efficacy
P
-
Value
Yes
n (%)
No
n (%)
Oral
Hygiene
Measures
Miswak
Test
Group
15
(93.8)
0
1
(6.3)
<
0.001
Control
Group
0
1
(5.0)
19
(95.0)
Toothbrush
Test
Group
16
(100.0)
0 (0.0)
<
0.001
Control
Group
0
6
(26.1)
17
(73.9)
Others
Test
Group
27
(96.4)
0
1
(3.6)
<
0.001
Control
Group
0
2
(16.7)
10
(83.3)
Never
Test
Group
24
(85.7)
0
4
(14.3)
<
0.001
Control
Group
0
2
(6.1)
31
(93.9)
Tooth
Brushing
Frequency
Twice Daily
Test
Group
12
(100.0)
0 (0.0)
<
0.001
Control
Group
0
1
(10.0)
0
9
(90.0)
Once Daily
Test
Group
15
(100.0)
0 (0.0)
<
0.001
Control
Group
0 (0.0)
12
(100.0)
Occasionally
Test
Group
19
(100.0)
0 (0.0)
<
0.001
Control
Group
0
1
(5.6)
17
(94.4)
Never
Test
Group
36
(85.7)
0
6
(14.3)
<
0.001
Control
Group
0
9
(18.8)
39
(81.3)
DISCUSSION
The results of this study provide compelling evidence
for the efficacy of stannous fluoride (SnF2) toothpaste
in treating dentinal hypersensitivity (DH) compared to a
placebo. The demographic data reveal no significant
differences in age between the test (
43.88 ± 15.93) and
control (44.02 ± 14.70) groups (p = 0.949). This
homogeneity indicates that age
-
related differences did
not influence treatment outcomes. Similarly, clinical
attachment loss (CAL) was comparable in the test (2.73
± 1.25 mm) and control (
2.78 ± 1.29 mm) groups (p =
0.806), indicating that periodontal health was consistent
across groups. This alignment with baseline
characteristics is crucial for minimizing confounding
variables, as
a study
noted that periodontal health can
influence pain p
erception in DH studies.
15
However, the
Schiff Cold Air Sensitivity Scale (SCASS) scores
differed significantly (p < 0.
001) between groups. The
test group (mean SCASS = 0.13 ± 0.54) showed a
substantial reduction compared to the control group
(mean SCASS = 1.68 ± 0.98), indicating the ability of
SnF2 to reduce dentinal hypersensitivity. Similar
decrease
s in SCASS scores ha
ve been reported in other
studies evaluating SnF2, noting that stannous fluoride
offers rapid occlusion of dentinal tubules and is more
effective than placebo
-
based interventions.
8
The
efficacy of stannous fluoride toothpaste was
significantly higher than that of
placebo
. In the test
group, 82 participants (93.2%) reported relief from DH,
while only 11 participants (12.5%) in the con
trol group
reported relief (p < 0.001). This result is consistent with
previous
researchers
who found that SnF2 significantly
reduces hypersensitivity within a short period, owing to
its rapid occlusion of exposed dentinal tubules.
16
The
dual action of SnF2
,
occlusion of tubules
,
and
antibacterial properties
provide
a strong basis for its
superiority over placebo
-
based treatments. These
findings also mirror those reported si
milar levels of
efficacy in a clinical trial of SnF2 for DH.
13
The
stratification of efficacy by oral hygiene measures
revealed that participants wh
o used toothbrushes (100%
efficacy) and "others" (96.4%) had significantly better
outcomes compared to those using miswak (93.8%) or
never engaging in oral hygiene (85.7%). This is a
critical finding, as it suggests that proper oral hygiene
practices enhan
ce the effectiveness of stannous
fluoride. Previous
research
highlighted that
12,17
The
control group had notably lower efficacy
across all oral
hygiene measures, with miswak users showing only 5%
efficacy and toothbrush users achieving 26.1%. The
discrepancy is likely due to the absence of the active
agent (S
nF2) in the placebo toothpaste.
Tooth brushing
frequency was another var
iable that significantly
influenced treatment efficacy. This observation
underscores the role of regular brushing in enhancing
the effect of stannous fluoride. Regular brushing may
facilitate more effective and even distribution of SnF2
across dentin surfa
ces, thereby increasing tubule
occlusion. T
he
frequency of oral hygiene practices
could influence the efficacy of desensitizing
toothpaste.
18
Participants who brushed more frequently
experienced improved sensitivity relief compared to
irre
gular brushers, as effective brushing helps distribute
the active fluoride ions uniformly across the teeth.
19
The enhanced action of SnF2 can be attributed to its
unique ability to form a consistent protective layer of
stannous complexes over dentinal tubules.
20
The results
of this study align with previous findings in the
literature regarding the efficacy of SnF2 in treating
dentinal hyp
ersensitivity. The findings
provide
a more
comprehensive understanding of how
oral hygiene
29
April - June 2025
J Gandhara Med Dent Sci
measures and tooth brushing frequency influence the
effectiveness of SnF2.
Additionally, the finding that
oral hygiene methods like brushing with a toothbrush
result
in greater efficacy compared to using miswak or
no hygiene practices has practical significance.
Although miswak is a traditional and culturally
significant oral hygiene tool in many regions, its use
may not
be as effective
as
stannous fluoride toothpaste
.
This finding calls for increased awareness regarding the
role of modern oral hygiene methods in enhancing the
action of advanced dentifrice formulations like SnF2
toothpaste.
LIMITATIONS
The limitations of the study are the subjectivity of self
reported
outcomes and the relatively short follow
-
up
period. The findings strongly support the use of
stannous fluoride as an effective treatment option.
Future research should explore long
-
term efficacy and
investigate the role of dietary factors and emerging
tre
atments, such as bioactive materials, to enhance DH
management and improve patient outcomes.
CONCLUSIONS
S
tannous fluoride toothpaste is significantly more
effective than placebo in reducing dentinal
hypersensitivity
influenced by oral hygiene measures
and
brushing frequency
. The ability of stannous
fluoride to occlude dentinal tubules and prevent fluid
movement, which is responsible for the pain in DH,
was evident in the marked reduction in SCASS scores
among the test group.
CONFLICT OF INTEREST:
None
FUNDING SOURCES:
None
REFERENCES
Comparing the Effect of Stannous Fluoride Toothpaste
1.
Bae JH, Kim YK, Myung SK. Desensitizing toothpaste versus
placebo for dentin hypersensitivity: a systematic review and
meta‐analysis. Journal of
clinical periodontology.
2015;42(2):131
-
41.
doi
:
10.1111/jcpe.12356
.
2.
Gillam D, Koyi B. Dentin hypersensitivity in clinical practice:
JP Medical Ltd; 2020.
3.
Moraschini V, da Costa LS, Dos S
antos GO. Effectiveness for
dentin hypersensitivity treatment of non
-
carious cervical
lesions: a meta
-
analysis. Clinical oral investigations.
2018;22:617
-
31.
doi
:
10.1007/s00784
-
017
-
2331
-
1
.
4.
Yadav BK, Jain A, Rai A, Jain M. Dentine hypersensitivity: a
review of its management strategies. Journal of International
Oral Health. 2015;7(10):137.
5.
Dam VV, Trinh HA, Dung DT, Hai TD. Advances in the
management of dentin hypersensitivity: An
updated review. The
Open Dentistry Journal. 2022;16(1).
doi
:
10.2174/187421062201130
.
6.
Hu M
-
L, Zheng G, Jiang R
-
D, Han J
-
M, Zhang Y
-
D, Lin H.
The evaluation of the desensitization effect
of a desensitizing
agent and desensitizing toothpastes in vitro. Dental Materials
Journal. 2020;39(5):855
-
61.
doi:
10.4012/dmj.2019
-
265
.
7.
Marto CM, Baptista Paula A, Nunes T, Pimenta M, Abra
ntes
AM, Pires AS, et al. Evaluation of the efficacy of dentin
hypersensitivity treatments
—
A systematic review and follow‐up
analysis. Journal of oral rehabilitation. 2019;46(10):952
-
90
.
doi:
10.
1111/joor.12839
.
8.
Hines D, Xu S, Stranick M, Lavender S, Pilch S, Zhang Y
-
P, et
al. Effect of a stannous fluoride toothpaste on dentinal
hypersensitivity: In vitro and clinical evaluation. The Journal of
the American Dental Association.
2019;150(4):S47
-
S59.
doi:
10.1016/j.adaj.2018.11.024
.
9.
Doğan Ç, Yıldırım HS, Gürsoy H, Kuru L. Occlusion of
dentinal tubules on periodontally involved teeth by dentifrice
containing st
annous fluoride and sodium fluoride. Journal of
Oral Science.2023;65(3):149-52. doi:10.2334/josnused.22-0517.
10.
Haraszthy VI, Raylae CC, Sreenivasan PK. Antimicrobial
effects of a stannou
s fluoride toothpaste in distinct oral
microenvironments. The Journal of the American Dental
Association. 2019;150(4):S14
-
S24.
doi
:
10.1016/j.adaj.2018.11.022
.
11.
Takamizawa T, Tsujimoto
A, Ishii R, Ujiie M, Kawazu M,
Hidari T, et al. Laboratory evaluation of dentin tubule occlusion
after use of dentifrices containing stannous fluoride. Journal of
oral science. 2019;61(2):276
-
83
.
doi:
10.2334/josnusd.18
-
0382
.
12.
Mahmoodi B. Protection, remineralisation and tubule occlusion
of dentine by desensitising toothpastes: University of
Southampton; 2020.
13.
Fiorillo L, Cervino G, Herford AS, Laino L, Cicciù M. Stannous
fluoride effects on enamel: A systematic review. Biomimetics.
2020;5(3):41.
doi:
10.3390/biomimetics5030041
.
14.
Prete B, Ba
rsoum F, Ouanounou A. Toothpaste in Dentistry: A
Review. Oral Health Group. 2022.
15.
Grover V, Kumar A, Jain A, Chatterjee A, Grover HS, Pandit N,
et al. ISP good clinical practice recommendations for the
management of dentin hypersensitivity. Journal of
Indian
Society of Periodontology. 2022;26(4):307
-
33.
doi:
10.4103/jisp.jisp_233_22
.
16.
Creeth J, Maclure R, Seong J, Gomez‐Pereira P, Budhawant C,
Sufi F, et al. Three randomized studies
of dentine
hypersensitivity reduction after short‐term SnF2 toothpaste use.
Journal of clinical periodontology. 2019;46(11):1105
-
15.
doi:
10.1111/jcpe.13195
.
17.
Mrinalini UB, Hegde MN, Bhat GS.
An update on dentinal
hypersensitivity
-
aetiology to management
–
a review. J Evol Med
Dent Sci. 2021;10(37):3289
-
93
.
doi: 10.14260/jemds/2021/667
18.
Arua SO, Fadare A, Adamu V. The etiology and management of
dentinal hypersensitivity. Orapuh
Journal. 2021;2(2).
doi:
10.5281/zenodo.5152606.
19.
Bagaria A, Garg V, Kumar K. Oral Hygiene The Pulse of the
Practice: DENTOMED PUBLICATION HOUSE; 2022.
20.
Frese C, Wohlrab T, Sheng L, Kieser M, Krisam J, Wolff D.
Clinical effect of stannous fluoride a
nd amine fluoride
containing oral hygiene products: A 4
-
year randomized
controlled pilot study. Scientific Reports. 2019;9(1):7681.
doi
:
10.1038/s41598
-
019
-
44056
-
5
CONTRIBUTORS
1.
Huma Abid
-
Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical Revision
2.
Naila Noreen
-
Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical Revision
3.
Nousheen Daud
-
Concept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical Revision
4
.
Saadia Sultana
-
C
oncept & Design; Data Acquisition; Data
Analysis/Interpretation; Drafting Manuscript; Critical Revision;
Critical Revision; Supervision; Final Approval
LICENSE:
JGMDS publishes its articles under a Creative Commons Attribution Non-Commercial Share-Alike license (
CC-BY-NC-SA 4.0
).
COPYRIGHTS:
Authors retain the rights without any restrictions to freely download, print, share and disseminate the article for any lawful purpose.
It includes scholarlynetworks such as Research Gate, Google Scholar, LinkedIn, Academia.edu, Twitter, and other academic or professional networking sites.