Knowledge, Attitude and Practice for Management of Dentine Hypersensitivity Among Egyptian and Nigerian Dentists: A Cross-Sectional Comparative Study
Conditions: Dentin Sensitivity
Sponsor: Muhammad Modu

KNOWLEDGE, ATTITUDE AND PRACTICE FOR 
MANAGEMENT OF DENTINE HYPERSENSITIVITY 
AMONG EGYPTIAN AND NIGERIAN DENTISTS: A CROSS-
SECTIONAL COMPARATIVE STUDY 
 
 
Protocol submitted to 
Faculty of Dentistry, Cairo University for partial fulfilment of the requirements 
for Masters Degree in Restorative and Aesthetic Dentistry 
 
By 
Muhammad Adam Modu  
BDS (University of Maiduguri, Borno State Nigeria 2012) 
 
2024 
 
CONS 1-3-5 Evaluate and compare different preventive approaches in 
managing dental non-carious lesions. 
 
Supervisors Signature 
 
 
Head of Department’s Signature 
 
1- Prof. Dr. Iman ElSayad 
 
 
2- Dr. Alaa Fathi Abdelsalam 
 
 
 
Submitted:  29th June, 2024 
 
 
 
Approved: 4th July, 2024 
 
 

Protocol Checklist 
Section & Topic 
No. 
Checklist item 
Page 
Comments 
 
1 
Title 
1 
 
I. 
2 
Protocol Registration 
1 
 
Administrative  
3 
Protocol Version 
1 
 
Information 
4 
Funding 
1 
 
 
5 
Roles and 
Responsibilities 
1 
 
 
 
II. Introduction 
 
 
 
 
 
6a 
Scientific Background 
3 
 
 
6b 
Review of Literature 
3 
 
 
6c 
Specific Objectives 
4 
 
 
 
III. Methods 
 
A. Study Design 
and Setting 
7 
Study Design 
5 
 
8 
Setting 
5 
 
B. Participants 
9a 
Eligibility Criteria 
5 
 
9b 
Method of Selection of 
Case / Control 
Ascertainment 
NA 
 
9c 
Methods of follow up for 
Cohort Studies and 
Rationale for choosing 
Cases and Controls for 
Case Control Studies 
NA 
 
10 
Matched Cohort Study – 
Matching Criteria and 
Allocation Ratio 
(Exposed vs Non-
Exposed) 
 
Matched Case Control 
Study – Matching 
Criteria and Allocation 
Ratio (Case vs Control) 
NA 
 
C. Variables 
11 
Clearly define all 
variables including 
outcomes and exposures 
5 
 

12 
For each variable of 
interest, give data 
sources/measurement 
6 
 
13 
Address Potential sources 
of bias 
6 
 
D. Study Size 
14 
Study Size 
6 
 
E. Quantitative 
Variables 
15 
Handling of quantitative 
variables in the analysis 
6 
 
F. Statistical 
Methods 
16a Statistical method used to 
control for confounders 
NA 
 
16b Subgroup analysis 
7 
 
16c Management of missing 
data 
NA 
 
16d Analytical methods for 
different sampling 
strategies; if applicable. 
NA 
 
16e Sensitivity Analysis 
NA 
 
 
 
 
 
IV. 
Ethics and 
Dissemination 
 
17a Research Ethics Approval 
8 
 
17b Protocol Amendments 
8 
 
17c Informed Consent 
8 
 
17d Confidentiality 
8 
 
17e Declaration of Interest 
8 
 
17f Access to Data 
8 
 
17g Dissemination Policy 
8 
 
  
 
V. Budget 
18 
Estimated Research 
Budget 
9 
 
 
 
VI. Appendices 
19 
Informed Consent  
10 
 
 
 
 
VII. References 
20 
References  
11 
 
 
 
 
 
 
*NA = Not Applicable in The Study 

 
 
 
Scientific Committee 
 
Primary Reviewer 
Signature 
Date 
 
 
 
 
 
Secondary Reviewer 
Signature 
Date 
1. 
Prof. Elham Fawzi 
 
 
 
2. 
Prof. Asmaa Yasin 
 
 
 
 

1 
 
I. ADMINISTRATIVE INFORMATION 
1. Title: 
Knowledge, attitude and practice for management of dentine hypersensitivity among 
Egyptian and Nigerian dentist: a cross-sectional comparative study 
 
2. Protocol Registration: 
Yet to be registered 
 
3. Protocol Version 
Version 1 
 
4. Funding 
The research will be self-funded. 
 
5. Roles and Responsibilities: 
A. Muhammad Adam Modu 
Affiliations:   
BDS (University of Maiduguri, Borno State, Nigeria. 2012) 
Dental Officer, Borno State Dental Hospital, Maiduguri Borno 
State. Nigeria 
 
Role:  
 
Principal Researcher / Master’s Degree Candidate 
 
Responsibilities: 
-     Propose potential research topics to supervisors 
- 
Conduct Literature review 
- 
Develop PICO for the study 
- 
Develop Research Protocol 
- 
Conduct research (Data collection) 
- 
Present collected data to statistician for analysis 
- 
Present completed work to supervisors 
- 
Submit completed work to Faculty Scientific Committee 
- 
Submit completed and approved work for publication in 
academic journal 
 
B. Prof. Dr. Iman ElSayad 
Affiliations:  
Professor of Conservative Dentistry, Faculty of Dentistry 
Cairo University 
 
Role:  
 
Main Supervisor 
 
Responsibilities: 
-     Guiding the candidate throughout the thesis 
- 
Mentoring 

2 
 
- 
Critiquing work 
- 
Identifying best practices and options for the research 
 
 
C. Dr. Alaa Fathi Abdelsalam 
Affiliations:  
Lecturer of Conservative Dentistry, Faculty of Dentistry 
Cairo University 
 
Role:  
 
Co Supervisor 
 
Responsibilities: 
-     Guiding the candidate throughout the thesis 
- 
Mentoring 
- 
Critiquing work 
- 
Identifying best practices and options for the research 
 
D. Scientific Committee 
Affiliations:  
Conservative Dentistry Department, Faculty of Dentistry 
 
 
 
Cairo University 
Role:  
 
Steering Committee 
Responsibilities:  
-    Ensures that the research idea follows the research plan of 
the department. 
- 
Review and Approve PICO 
- 
Review and Approve Protocol 
- 
Review completed thesis 
 
E. Medical Biostatistics Unit (MBU) 
Affiliations:  
Conservative Dentistry Department, Faculty of Dentistry 
 
 
 
Cairo University 
Role:  
 
Steering Committee 
Responsibilities:  
-       Sample Size Calculation 
 
F. Research Ethics Committee (REC) 
Affiliations:  
Conservative Dentistry Department, Faculty of Dentistry 
 
 
 
Cairo University 
Role:  
 
Steering Committee 
Responsibilities: 
-    Ensures the study/trial meets ethical requirements prior start 
- 
Approves secondary protocol 
 
G. Department Council Board 
Affiliations:  
Conservative Dentistry Department, Faculty of Dentistry 
 
 
 
Cairo University 
Role:  
 
Steering Committee 
Responsibilities: 
-     Approves secondary protocol prior to start of study/trial 
- 
Approves completed thesis after review by Scientific 
Committee 

3 
 
 
 
II. INTRODUCTION 
6a. Scientific Background 
Dentine Hypersensitivity (DH) was described as an “enigma” in 1980 because it is 
readily observed yet quite puzzling to understand (Johnson, Zulqar‐Nain et al. 1982). Pashley 
defined Dentine Hypersensitivity as “a sharp, transient, well-localized pain in response to 
tactile, thermal, evaporative, or osmotic stimuli, which does not occur spontaneously and does 
not persist after removal of the stimuli” (Pashley 1994). This definition was modified at a 
conference of The Canadian advisory on Dentine Hypersensitivity to “a distinctive short sharp 
pain arising from exposed dentine characteristically in response to an array of stimuli including 
thermal, tactile, evaporative, osmotic or chemical which cannot be attributed to any other form 
of dental defect or disease”(Gillam 2013). Diagnosis of DH is usually reached through 
exclusion of conditions that present with similar symptoms(Davari, Ataei et al. 2013). 
 
6b. Review of Literature 
Several recent studies report that dentists around the world are unsure about the 
etiology, diagnosis, and management of dentine hypersensitivity(DH)(Pereira, Gillam et al. 
2018, Exarchou, Betsani et al. 2019). DH is associated with dentine exposure, as open 
dentinal tubules expose the pulp to external stimuli(Absi, Addy et al. 1987). The specifics of 
pathogenesis especially pain transduction has not been clearly elucidated. Although the 
hydrodynamic theory, which states that fluids within the exposed dentinal tubules move in 
response to stimuli to activate a baroreceptor, proposed by Branslohm(Brännström 1964) has 
been the most widely accepted, other theories include The Odontoblast Transduction Theory 
(Frank, 1968) and The Neural Theory (Frank & Steuer, 1988). These theories have recently been 
challenged by novel evidence suggesting the involvement of odontoblasts in mechanism of 
pain transduction(Sole-Magdalena, Martinez-Alonso et al. 2018). 
The DH has a prevalence of 3 – 98% with a global distribution. It is mostly found 
among young people and female gender (Dam et al., 2022). However, Doubts have been 
reported in the actual prevalence of dentine hypersensitivity with method of investigation, 
sample selection, location and clinical environment observed as potential factors that have an 
influence.(Pereira, Gillam et al. 2018) 
The management of DH is equally shrouded in complexities due to various Over-The -
Counter (OTC) and In-Office products and procedures claiming effectiveness. Published 
guidelines suggests 3 major strategies for the management of DH, patient education and 
behaviour modification; non-invasive treatments for occluding dentin tubules and relieving 
pain associated with DH; and restorative or surgical treatments for the management of DH 
along with restoration of associated tooth structure and soft tissue loss (Liu et al., 2020) 

4 
 
Despite published guidelines for DH management, dentists around the world are 
reported to use varying methods, occasionally combining different methods in the management 
of DH (Gillam 2017). A Senegalese publication reported the use of desensitizing toothpaste, 
In-Office fluoride application and endodontic treatment (Benoist et al., 2014). In India, Pereira 
el al reported the use of desensitizing toothpaste, patient education and dental restorations 
(Pereira, Gillam et al. 2018) while in USA, desensitizing toothpaste, fluoride varnish 
application and patient education (Kopycka-Kedzierawski, Meyerowitz et al. 2017) and in 
Greece, dentists favoured patient education, desensitizing toothpaste, in-office fluoride 
application and dental restoration (Exarchou, Betsani et al. 2019) 
 
6c. Specific Objectives 
Aims of the Study: 
The study aims to assess and compare the knowledge, attitudes, and practices of 
Egyptian and Nigerian dentists on etiology, diagnosis, and management of DH. Also to identify 
if the level of education, culture and environment have influences on the diagnosis and 
management of DH. 
 
Rationale 
Diagnosis of dentin hypersensitivity is a challenge faced by dentists with different 
educational levels and the condition might be overlooked and not properly managed leading to 
persistent pain and poor quality of life for patients. Till now, the literature lacks rigorous 
guidelines for systematic diagnosis, prevention, categorization of severity and management of 
dentin hypersensitivity. This study intends to spot the light on the current approaches adopted 
by dentists in Egypt and Nigeria towards diagnosis and management of Dentine 
Hypersensitivity. It also intends to compare the findings and identify the influence of 
geographic location, different educational levels, and degree of dental education in the 
management of Dentine Hypersensitivity. 
 
 
 
 
 
 
 
 

5 
 
 
III. METHODS 
A. Study Design and Setting 
7. Study Design: 
Comparative Cross Sectional study 
 
8. Setting: 
An electronic Self-administered questionnaire using Google forms to be administered over a 
period of 3 months with the 2024/2025 academic year. 
B. Participants 
9. Eligibility Criteria and Selection Method 
Dentists (at various levels of education and years of practice) practicing in Egypt and Nigeria 
who will choose to participate in the study. 
 
10. Matching Criteria and Allocation Ratio: 
Not applicable in Cross Sectional Study 
 
C. Variables 
11. Details about variables: 
POTS 
- 
Population (P): Dentists (at various levels of education and years of practice) 
practicing in Egypt and Nigeria 
- 
Outcomes (O): 
o Primary Outcome: Awareness of appropriate diagnosis and management of 
DH among practicing dentists in Egypt and Nigeria 
o Secondary Outcome: Comparison of Knowledge Attitudes and Practices of 
dentists in Egypt and Nigeria in the management of DH 
o Tertiary Outcome: In Each geographic location, comparison of Knowledge, 
Attitude and Practices among dentists of different educational levels. 
 
 

6 
 
 
Prioritization 
of Outcome 
Outcome 
Measurement 
Method 
Primary 
Outcome 
Awareness of appropriate diagnosis 
and management of DH among 
practicing dentists in Egypt and 
Nigeria 
Validated Questionnaire used in the 
study by (Gillam et al., 2019.) 
Secondary 
Outcome 
Comparison of Knowledge Attitudes 
and Practices of dentists in Egypt and 
Nigeria in the management of DH 
Statistical analysis using Chi Square 
or McNamara Test 
Tertiary 
Outcome 
Comparison of Knowledge, Attitude 
and Practices among dentists of 
different educational levels 
 
 
12. Data Source and Management: 
Data would be sourced from willing participants via and electronic self-administered 
questionnaire utilizing Google forms platform. This service is equipped with cloud storage and 
data security as only authorized persons have access to complied data. 
 
13. Address Potential Source of Bias: 
1. Selection Bias: 
Participants would be approached via specific platforms for practicing dentists in Egypt and 
Nigeria. 
2. Information Bias: 
The questionnaire utilises easily understood language and avoids the use or jargons or other 
complicated terms. 
 
D. Study Size 
14. Study Size 
To be determined after Primary Protocol Review 
 
E. Quantitative Variables 
15. Handling of Quantitative Variables in The Analysis: 

7 
 
1. Continuous Variables would be expressed in Mean and Standard Deviation (SD) 
2. Categorical Variables would be expressed in Percentages (%) 
 
F. Statistical Methods 
16. Statistical analysis of data would be carried out by Statistical Package for Social Sciences 
(SPSS) IBM. Categorical data would be compared between groups and subgroups using 
ChiSquare or McNemara tests. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

8 
 
 
IV. ETHICS AND DISSEMINATION 
17a. Research Ethics Approval: 
Protocol would be reviewed by the Research Ethics Committee of the department for approval 
prior to start of study. 
 
17b. Protocol Amendments: 
All modifications to the protocol in part or whole, which may have an impact on the conduct 
of the study, study design, sample sizes, study procedures, or significant administrative aspects 
will be agreed upon by the scientific committee prior to starting the study. 
 
17c. Informed Consent: 
Informed consent would be sought in the first page of the electronic questionnaire. Willing 
participants would proceed to the questionnaire while those who choose not to participate 
would exit the questionnaire. 
 
17d. Confidentiality: 
Information would be sought anonymously. However, email or IP address would be limited to 
one access to the questionnaire to limit multiple data entry. 
 
17e. Declaration of Interest: 
There is no conflict of interest in this study. 
 
17f. Access to Data: 
Only principal researcher, supervisors and statistician would have access to collected data 
unless otherwise advised or requested by Steering Committees. 
 
17g. Dissemination Policy: 
1. Results of the study will be available in the department database 
2. Copies of the thesis will be available at the department library and at the official site of 
The Egyptian Universities Libraries Consortium. 
3. Final report of the trial will be published in international journals. 

9 
 
 
 
V. BUDGET 
18. Estimated Research Budget: 
This research is estimated to cost EGP 10,000 – 15,000. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

10 
 
 
 
VI. APPENDICES 
19. Informed Consent: 
 

11 
 
 
 
VII. REFERENCES 
Absi, E., M. Addy and D. Adams (1987). "Dentine hypersensitivity: a study of the 
patency of dentinal tubules in sensitive and non‐sensitive cervical dentine." J of clin perio 
14(5): 280-284. 

12 
 
 
Benoist, F. L., F. G. Ndiaye, B. Faye, K. Bane, P. I. Ngom and P. M. K. Ndong (2014). 
"Knowledge of and management attitude regarding dentin hypersensitivity among 
dentists from a West African country." J of Cont Dent Pract 15(1): 86. 
 
Brännström, M. (1964). "[Dentin sensitivity]." Arsb Goteb Tandlak Sallsk: 15-35. 
 
Dam, V. V., Trinh, H. A., Dung, D. T., & Hai, T. D. (2022). Advances in the management 
of dentin hypersensitivity: An updated review. The Open Dentistry Journal, 16(1). 
 
Davari, A., E. Ataei and H. Assarzadeh (2013). "Dentin hypersensitivity: etiology, 
diagnosis and treatment; a literature review." J of Dent 14(3): 136. 
 
Exarchou, C., I. Betsani, D. Sakellari, D. Chatzopoulou and D. Gillam (2019). "A Survey 
of Dentists in the Management of Dentine Hypersensitivity: A Questionnaire-based 
Study." Eur J Dent 13(3): 383-390. 
 
Frank, R. M. (1968). Attachment sites between the odontoblast process and the 
intradentinal nerve fibre. Archives of oral biology, 13(7), 833-IN39. 
 
Frank, R. M., & Steuer, P. (1988). Transmission electron microscopy of the human 
odontoblast process in peripheral root dentine. Archives of oral biology, 33(2), 91-98. 
 
Gillam, D. G. (2013). "Current diagnosis of dentin hypersensitivity in the dental office: an 
overview." Clin Oral Investig 17 (Suppl 1): S21-29 
 
Gillam, D. G. (2017). "A new perspective on dentine hypersensitivity–guidelines for 
general dental practice." Dent update 44(1): 33-42. 
 
Gillam DG, N. Dashti and Chatzopoulou D. (2019) "A Survey of the Professional 
Opinions of Kuwaiti Dentists for the Treatment and Managementof Dentine 
Hypersensitivity: A Questionnaire-based Study". Jacobs J Dentistry Res  5(2): 046. 
 
Johnson, R., B. Zulqar‐Nain and J. Koval (1982). "The effectiveness of an electro‐
ionizing toothbrush in the control of dentinal hypersensitivity." J of perio 53(6): 353-359. 
 
Kopycka-Kedzierawski, D. T., C. Meyerowitz, M. S. Litaker, S. Chonowski, M. W. Heft, 
V. V. Gordan, R. L. Yardic, T. E. Madden, S. C. Reyes, G. H. Gilbert and P. C. G. National 
Dental (2017). "Management of Dentin Hypersensitivity by National Dental Practice-
Based Research Network practitioners: results from a questionnaire administered prior to 
initiation of a clinical study on this topic." BMC Oral Health 17(1): 41. 
 

13 
 
Liu, X. X., Tenenbaum, H. C., Wilder, R. S., Quock, R., Hewlett, E. R., & Ren, Y. F. 
(2020). Pathogenesis, diagnosis and management of dentin hypersensitivity: an evidence-
based overview for dental practitioners. BMC oral health, 20, 1-10. 
 
Pashley, D. H. (1994). "Theory of dentin sensitivity." The Journal of clinical dentistry 5: 
65-67. 
 
Pereira, R., D. Gillam, S. Bapatla and P. Satyamurthy (2018). "Awareness of Dentine 
Hypersensitivity among General Dental Practitioners in Mumbai, India." Journal of 
Odontology 
 
Sole-Magdalena, A., M. Martinez-Alonso, C. A. Coronado, L. M. Junquera, J. Cobo and 
J. A. Vega (2018). "Molecular basis of dental sensitivity: The odontoblasts are 
multisensory cells and express multifunctional ion channels." Ann Anat 215: 20-29.