Does simultaneous versus individual-arch at-home dental bleaching regimen influence patient satisfaction? A randomized clinical trial

Clinical decision-making in tooth bleaching based on current evidence: A narrative review

OBJECTIVE

This review consolidates current knowledge on dentist-supervised tooth bleaching for vital teeth, drawing from systematic reviews, meta-analyses, and randomized clinical trials (RCTs) that followed CONSORT guidelines.

DATA RESOURCES

MeSH and free terms like "tooth bleaching," "tooth whitening," "randomized clinical trial," and "systematic review" were used in PubMed, Scopus, and Web of Science databases STUDY SELECTION: Out of 839 articles, 444 were selected for full-text review, excluding case reports, non-randomized trials, literature reviews and those not directly related to tooth bleaching or RCTs not following CONSORT 2010. The remaining 203 studies were used to compare the dentist-supervised at-home and in-office clinical protocols, assessing factors such as color change, tooth sensitivity, and gingival irritation. In vitro studies were cited to support and explain basic concepts of different clinical decisions CONCLUSIONS: Daily at-home bleaching with 10 % carbamide peroxide or lower-concentration hydrogen peroxide over three to four weeks is effective. In-office bleaching with high-concentration hydrogen peroxide exhibits variations in protocols based on the HP concentration and gel's pH. Emerging technologies like violet LEDs and photobiomodulation with infrared lasers show promise in enhancing efficacy and reducing sensitivity, respectively, though more research is needed. The review underscores the importance of ongoing research into desensitization strategies to manage sensitivity related to bleaching.

CLINICAL SIGNIFICANCE

Tooth bleaching is central to dental aesthetics, offering a range of options that can challenge clinicians. Adverse effects, particularly sensitivity, highlight the need for practice supported in protocols clinically tested and effective desensitization approaches.

Dental bleaching: patient perception and satisfaction

BACKGROUND

Teeth bleaching is a common practice performed by dental hygienists and dentists to correct aesthetic problems due to dental discoloration. Patients' opinions on this procedure may be different according to their personal experiences, expectations and individual sensitivities. The aim of this study is to assess the degree of satisfaction and related sensitivity of patients to professional and home bleaching treatment.

METHODS

A questionnaire consisting of 12 multiple-choice questions was submitted to 625 subjects among general population. These were related to: 1) patient's age and whether the patient is a smoker; 2) personal satisfaction; and 3) post-treatment tooth sensitivity. Descriptive analyses of all variables in the questionnaire were performed, and statistical analyses between variables were carried out by Chi-square test and Fisher's Exact test.

RESULTS

Of the people surveyed, 66% performed home bleaching, while the remaining performed the treatment in a dental office. Thirty-three percent of patients had previously undergone teeth bleaching and the 95.7% stated that they were satisfied with the treatment. Of these, only 36.4% reported experiencing postoperative hypersensitivity. Most patients (91.3%) received professional scaling before undergoing bleaching treatment.

CONCLUSIONS

Patient satisfaction with tooth whitening treatment can vary from patient to patient and represents a strong indicator of treatment efficacy and suitability. A proper communication, careful management and individualized patient assessment are key to maximizing satisfaction and ensuring a positive and fulfilling patient experience.

Effect of gingival barrier brands on operator perception, cervical adaptation, and patient comfort during in-office tooth bleaching: a randomized clinical trial

BACKGROUND

Light-cured resins are widely used as gingival barriers to protect the gums from highly concentrated peroxides used in tooth bleaching. The impact of barrier brand on clinical outcomes is typically considered negligible. However, there is limited evidence on the effects of different brands on operator experience, barrier adaptation, and patient comfort.

OBJECTIVE

This clinical trial assessed the impact of four commercial gingival barrier brands (Opaldam, Topdam, Lysadam, and Maxdam) on operator perception, adaptation quality, and patient comfort.

METHODS

Twenty-one undergraduate students placed gingival barriers in a randomized sequence using blinded syringes. Photographs of the barriers were taken from frontal and incisal perspectives. After bleaching procedures, operators rated handling features and safety using Likert scale forms. Two experienced evaluators independently assessed barrier adaptation quality on a scale from 1 (perfect) to 5 (unacceptable). The absolute risk of barrier-induced discomfort was recorded. Data were analyzed using Friedman and Chi-square tests (α = 0.05).

RESULTS

Opaldam and Topdam received the highest scores in most handling features, except for removal, which was similar among all brands. No significant difference was observed in barrier adaptation quality between the evaluated brands. Discomforts were mainly reported in the upper dental arch, with Maxdam having the highest absolute risk (35% for this arch and 24% overall).

CONCLUSIONS

This study suggests that gingival barrier brands can influence operator perception and patient comfort. Opaldam and Topdam were preferred by operators, but all brands demonstrated comparable adaptation quality.

CLINICAL TRIAL REGISTRATION

The study was nested in a randomized clinical trial registered in the Brazilian Clinical Trials Registry under identification number RBR-9gtr9sc.