Preventive Use of a Resin-based Desensitizer Containing Glutaraldehyde on Tooth Sensitivity Caused by In-office Bleaching: A Randomized, Single-blind Clinical Trial

Dentinal Tubule Occlusion and Dentin Permeability Efficacy of Silver Diamine Fluoride Solutions

AIM

This in vitro study compared the effect of two commercially available silver diamine fluoride (SDF) products on dentinal tubule (DT) occlusion and dentin permeability.

METHODS

Sixty-six dentin discs (1.0 mm thick) were divided equally into six groups: acid-etched with no treatment (negative control-NC), etched and sealed with nail varnish (positive control-PC), non-etched and treated with Advantage Arrest (AA), non-etched and treated with Topamine (TP), etched and treated with AA, and etched and treated with TP. Eight specimens from each group were tested for permeability using the dye percolation method. The remaining three samples from each group were assessed for dentinal tubule occlusion, depth of SDF penetration, and elemental analysis using a scanning electron microscope coupled with an energy-dispersive X-ray (SEM/EDX) system. One-way ANOVA and Tukey's post hoc test were used to analyze the results.

RESULTS

TP exhibited lower (p < 0.05) dye percolation compared to AA. While both SDF materials showed a statistically similar (p > 0.05) penetration depth in the DT, none of them had the ability to completely occlude all the DTs. AA exhibited more silver and fluoride ion deposition on etched dentin than TP, and both materials showed a similar increase in the deposition of Ca and P compared to NC.

CONCLUSIONS

Whereas the effectiveness of dentin tubule (DT) occlusion varies based on the material used, both tested SDF products exhibit the capability to seal dentinal tubules, decrease dentin permeability, and promote dentin remineralization. These findings suggest their potential advantage in managing dentin hypersensitivity.

Effect of Glutaraldehyde-Based Desensitizer on Control of Tooth Sensitivity and Tooth Color Post-bleaching: A Randomized Clinical Trial

OBJECTIVES

 This randomized, controlled, single-blind, split-mouth clinical study evaluated the effect of the application of a glutaraldehyde-based desensitizer on the prevention of tooth sensitivity (TS) and the changes in the color of the teeth after bleaching.

MATERIALS AND METHODS

 Twenty-five patients were selected for participation in the study according to the inclusion and exclusion criteria. The patients' right and left hemiarches were randomized into two groups: the placebo group, which received distilled water application and whitening treatment, and the Gluma group, which received Gluma application, followed by whitening treatment. The patients were examined after three bleaching sessions with 35% hydrogen peroxide. TS was measured using a numerical rating scale for 21 days from the beginning of bleaching. The tooth color was monitored using a spectrophotometer at times T0 (baseline) and T1 (after 21 days). The color analysis results were recorded using the CieLab system; the CIEDE2000 formula was applied to obtain the ΔE00 and ΔL values.

STATISTICAL ANALYSIS

 For statistical analysis, the Friedman analysis of variance test was used for intragroup evaluation, and the Wilcoxon test was used for a between-group comparison of the TS results. Student's t-test paired the ΔE00 and ΔL values of the groups. A 5% significance level was adopted.

RESULTS

 Intragroup analysis of the sensitivity results showed a statistically significant difference between the pain levels evaluated through days 1 to 21 (p < 0.001), and the highest median values were observed on the days when the whitening sessions were performed (days 1, 8, and 15) and right after the sessions (days 2, 9, and 16). However, in the intergroup analysis, no statistical difference in sensitivity was found between the placebo and Gluma. No statistical difference was found between the influences of the placebo and Gluma treatments on the color obtained after tooth whitening using parameters ᐃE00 and ᐃL (p > 0.05).

CONCLUSION

 The use of Gluma prior to bleaching does not prevent TS and does not interfere with the color results obtained by tooth bleaching.

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.

Effect of bioactive glass paste on efficacy and post-operative sensitivity associated with at-home bleaching using 20% carbamide peroxide: a randomized controlled clinical trial

Background

The aim of this study was to evaluate the effect of bioactive glass (BAG) 45S5 paste on colour change and tooth sensitivity (TS) when used in combination with 20% carbamide peroxide (CP) during at-home vital tooth bleaching.

Methods

Twenty-four patients were selected and assigned into two experimental groups (n = 12) in a double-blind study design. Each patient received 20% CP followed by the application of either BAG paste or non-active placebo paste. The shade evaluation was performed using a digital spectrophotometer based on the CIE L*a*b* colour space system at different time points and the overall colour changes ΔE were calculated. TS was evaluated using visual analogue scale (VAS). The values of ΔE and TS were statistically analysed using paired t-test. The level of statistical significance was established at p = 0.05.

Results

The overall colour changes (ΔE) between baseline and each time point showed no significant differences between BAG and placebo groups (p > 0.05). The use of BAG paste significantly decreased TS reported by the participants.

Conclusions

The association of BAG paste with at-home bleaching treatment presents a promising method as it decreased TS and did not deteriorate bleaching efficacy.

Trial registration This study was approved and registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under Registration number: ACTRN12621001334897.

Post-Operative Sensitivity and Color Change Due to In-Office Bleaching With the Prior Use of Different Desensitizing Agents: A Systematic Review

Bleaching agents can cause certain surface alterations on the enamel, such as depressions, surface porosity, and surface irregularities; this makes the dentin more susceptible to post-operative tooth sensitivity (PoS). In addition, the presence of flawed or leaky restorations, gingival recession, or defects in the cementoenamel junction can also cause severe tooth sensitivity post tooth bleaching.Hence, the current study aimed to perform a systematic review to determine the efficacy of various desensitizing agents (DA) in managing post-operative tooth sensitivity and color alteration when applied before in-office bleaching procedures. Randomized clinical trials were searched to conduct an SR where the post-operative tooth sensitivity was evaluated after in-office bleaching with various desensitizing agents used before the procedure. Post-operative pain assessment was measured using the Visual Analogue Scale (VAS). Outcomes were evaluated up to an hour and 24 hours post the procedure. Out of 163 articles, only 13 titles were selected that met the eligibility criteria. Eight hundred and forty-one adult patients with vital pulp status were included. The participants receiving prior desensitizing agent applications reported significantly lower pain scores in the VAS reports. The most significant reduction of post-operative sensitivity was observed in the immediate (up to an hour) and 24 hours after the in-office bleaching. The popular desensitizing agent that could manage post-operative tooth sensitivity (TS) is 5% potassium nitrate and 2% sodium fluoride used before the in-office bleaching procedure. 

Is the use of a potassium nitrate dentifrice effective in reducing tooth sensitivity related to in-office bleaching? A randomized triple-blind clinical trial

OBJECTIVE

The aims of this study were to evaluate whether the use of a dentifrice containing 5% potassium nitrate (KNO₃ ) prior to and during in-office dental bleaching reduces bleaching-induced tooth sensitivity and affects bleaching efficiency.

MATERIALS AND METHODS

Thirty-eight individuals were randomly distributed into two groups (n = 19). The experimental group performed toothbrushing using a dentifrice containing 5% KNO₃ , one week before treatment and before the first and second bleaching sessions. In the control group, a placebo dentifrice without KNO₃ was applied as described for the first group. Tooth sensitivity was recorded on visual analog scales (VAS) and numeric rating scales (NRS) immediately and up to 48 h after bleaching sessions. Color change at different time intervals, was evaluated with shade guide units (∆SGU) and a digital spectrophotometer (∆E CIELab 1976 and CIEDE2000) at baseline and 7, 15, and 30 days post-bleaching. Mann-Whitney test and t-test were used to evaluate TS intensity for NRS and VAS scales, respectively, and T-test was used for color difference evaluation.

RESULTS

No significant difference in tooth sensitivity's absolute risk and intensity were observed between tested groups in any evaluated treatment time for NRS (p = 0.91) or VAS scales (p = 0.48). T-test showed no significant difference in both ∆E and ∆SGU tooth color among the experimental and control groups during the different evaluation times (p = 0.27).

CONCLUSION

The use of a dentifrice containing 5% KNO₃ does not prevent post-operatory tooth sensitivity but allows the same whitening efficiency as a regular dentifrice.

CLINICAL SIGNIFICANCE

The use of a dentifrice-containing KNO₃ did not prevent bleaching-induced tooth sensitivity when high-concentrated hydrogen peroxide was used for in-office bleaching.

Sonic Activation of a Desensitizing Gel Prior to In-Office Bleaching

This double-blind, randomized, and controlled clinical trial evaluated the effect of sonic activation during the application of a desensitizing agent (DA) containing 5% potassium nitrate and 2% sodium fluoride on the occurrence of tooth sensitivity (TS) associated with in-office dental bleaching. Treatment with or without sonic activation of the DA was randomly assigned to one-half of the maxillary teeth of 34 patients in a split-mouth design. On the side without sonic activation (noSA), the DA was applied and maintained in contact with the teeth for 10 minutes. On the sonic activation side (SA), the DA was activated 30 seconds per tooth. The DA application was followed by application of 35% hydrogen peroxide in two bleaching sessions separated by a one-week interval. The primary outcome was the absolute risk of TS, recorded using a numeric rating scale and a visual analog scale. Color was evaluated with a digital spectrophotometer and a value-oriented shade guide. No significant difference between treatments was observed in the absolute risk of TS, which occurred in 93% (p=1.00) of both noSA and SA groups. The TS intensity was higher in the 24-hour interval after sessions, for both treatments, without differences between them. There was no difference in the color change for the treatments, with the average change in number of shade guide units of the Vita Classical scale of 6.35 for both (p=0.87). Sonic activation of DA containing 5% potassium nitrate and 2% sodium fluoride did not reduce the absolute risk and intensity of TS associated with in-office bleaching.

Combination of strontium chloride and photobiomodulation in the control of tooth sensitivity post-bleaching: A split-mouth randomized clinical trial

Objective

This split-mouth randomized controlled clinical trial assessed the effect of 10% strontium chloride in combination with photobiomodulation (PBM) for the control of tooth sensitivity (TS) post-bleaching.

Methods

The upper/lower, right and left quadrants of fifty volunteers were randomized and allocated to four groups (n = 25): PLACEBO—placebo gel + simulation of PBM; Placebo + PBM; STRONTIUM—10% strontium chloride + simulation of PBM; and PBM + STRONTIUM—10% strontium chloride + PBM. All groups received tooth bleaching treatment with 35% hydrogen peroxide. For the PBM treatment, the laser tip was positioned in the apical and cervical regions of the teeth bleached in the respective hemi-arch. The laser system was operated in continuous mode, using 1.7 J of energy. A dose of 60 J/cm² was applied to each point for 16 seconds under 808 nm near-infrared light (100mW of power), with a point area of 0.028 cm². TS was assessed during a 21-day follow-up, using the modified visual analogue scale.

Results

In the intragroup assessment, the Friedman test indicated that PBM + STRONTIUM promoted the greatest reduction in TS after the second week of treatment (p ≤ 0.05). The Wilcoxon-Mann-Whitney test indicated that the groups Placebo + PBM, STRONTIUM, and STRONTIUM + PBM did not differ statistically (p ≥ 0.05) in the first and third weeks of treatment The group PLACEBO exhibited the greatest TS in the first three days after each bleaching session.

Conclusion

The combination of 10% strontium chloride with PBM was effective in reducing post-bleaching TS; however, the combination of 10% strontium chloride with PBM was effective in reducing post-bleaching TS; however, it did not differ from the individual use of Placebo + PBM or STRONTIUM groups assessed after 21 days of follow-up.

Effect of desensitizing agents on dentin hypersensitivity after non-surgical periodontal therapy: A systematic review and meta-analysis

OBJECTIVE

To investigate the effectiveness of desensitizing agents (DA) on dentin hypersensitivity (DH) after non-surgical periodontal treatment (NSPT) through a systematic review and meta-analysis.

DATA

The PICO strategy was used to include randomized clinical trials in human subjects with DH (P) after NSPT treated with DA (I) compared to those treated with placebo or control (C) to identify DH relief (O). The Cochrane guidelines and GRADE was used to classify the risk of bias and the quality of the evidence, respectively.

SOURCES

PubMed, Web of Science, Scopus, Lilacs, Cochrane Library databases, and OpenGrey were searched on the 20^th of May 2020.

STUDY SELECTION

Nine studies were included in the quantitative synthesis. Five meta-analyses were performed. Three meta-analyzes assessed the effectiveness of DA compared to a placebo or control in relation to pain assessment stimuli and two meta-analyzes assessed the mechanism of action of DA. For the mechanical stimulus in overall analysis, the control group presented a higher mean of pain reduction (SMD 1.03 [0.73, 1.32], p < 0.001) with very low certainty of evidence. For water (SMD -0.78 [-1.22, -0.35], p = 0.0009) and evaporative in overall analysis (SMD -1.21 [-1.79, -0.64], p < 0.001) stimuli, the DA decreased DH pain with very low and low certainty of evidence, respectively.

CONCLUSION

Due to the limited quality of evidence, there is no definitive conclusion on the effectiveness of DA on DH after NSPT. Thus, further clinical studies with a low risk of bias and high-quality evidence are encouraged to reinforce the certainty of evidence on that issue.

CLINICAL SIGNIFICANCE

The use of desensitizing agents show promise for relief of dentin hypersensitivity after non-surgical periodontal therapy.