Effect of topical application of ibuprofen/arginine on the in-office bleaching-induced tooth sensitivity: A randomized, triple-blind controlled trial.

OBJECTIVE: The application of anti-inflammatories as topical desensitizers before dental bleaching is an approach to reduce bleaching-induced tooth sensitivity (TS). This randomized controlled trial compared the risk and intensity of TS and the color change resulting from in-office dental bleaching after using an experimental desensitizing gel containing ibuprofen and arginine. METHODS: Sixty-two participants with upper canine shades A2 or darker were randomly assigned to either the ibuprofen-arginine desensitizing group or the placebo group. The desensitizing gel was applied for 15 min before in-office bleaching with 35 % hydrogen peroxide gel for 50 min (2 sessions). To assess the absolute risk and intensity of TS, visual (0-10) and numeric rating (0-5) scales were used, and group comparisons were made using the McNemar test, Wilcoxon test, and paired Student t-test (α = 0.05). Color change was evaluated using Vita Classical, Vita Bleachedguide (ΔSGU), and Vita EasyShade (ΔEab, ΔE00, and ΔWID) before and one month after the bleaching procedure. Group comparisons for color change were done using a paired t-test (α = 0.05). RESULTS: The odds ratio for TS was 0.14 [95 % CI 0.02 to 0.6], meaning lower odds of TS for the desensitizing gel. A lower intensity of TS was also observed for the experimental group (p < 0.005) up to 48 h after bleaching. All color evaluation tools demonstrated effective and similar whitening for both groups (p > 0.05). CONCLUSIONS: Using the experimental desensitizing gel containing ibuprofen and arginine effectively reduced the risk and intensity of TS without compromising the bleaching efficacy. CLINICAL RELEVANCE: The topical application of ibuprofen/arginine on the in-office bleaching reduced risk and intensity of bleaching-induced tooth sensitivity.

Clinical evidence for silver diamine fluoride to reduce dentine hypersensitivity: A systematic review.

OBJECTIVE: To assess the clinical evidence for silver diamine fluoride (SDF) to reduce dentine hypersensitivity in adults. METHODS: Two independent researchers searched the English literature in five databases (Scopus, PubMed, Web of Science, EMBASE and the Cochrane Library) up to 15th July 2023 for clinical trials investigating the desensitising effect of professionally applied SDF to manage dentine hypersensitivity in adults aged 18 or above at any follow-up period. The primary outcome was the change in dentine hypersensitivity between baseline and follow-up visits after SDF application regarding any validated pain outcome measures. The Cochrane guidelines were used for the risk of bias assessment. RESULTS: Three hundred and thirty-one studies were identified, and four of them were finally included. Three of the included studies were rated as having a 'low risk' of bias. The SDF solution reduced dentine hypersensitivity in adults. The percentage reduction in dentine hypersensitivity ranged from 23 % to 56 % after a single application of SDF solution. Moreover, the SDF solution was more effective than potassium nitrate, potassium oxalate and glutaraldehyde plus hydroxyethyl methacrylate in reducing dentine hypersensitivity. Meta-analysis indicated a more significant reduction in visual analogue scales (1-10) by 1.35 (95 % CI:0.9-1.8; p<0.00001) after receiving the SDF application than controls. CONCLUSION: The included clinical trials showed that SDF solution reduced dentine hypersensitivity in adults. However, clinical trials are few, and their protocol varied from one another. Further well-designed clinical trials should be conducted to provide more evidence on its use to manage dentine hypersensitivity. CLINICAL SIGNIFICANCE: SDF is cleared as desensitizing agents by the US Food and Drug Administration to manage dentine hypersensitivity, which induces pain, limits food choice, and impacts the quality of life. Evidence from this systematic review informs clinicians and provides researchers insight for future research on SDF use for dentine hypersensitivity. THE INTERNATIONAL PROSPECTIVE REGISTER OF SYSTEMATIC REVIEWS (PROSPERO) REGISTRATION NUMBER: CRD42023462613.

The effect of photobiomodulation therapy associated with casein phosphopeptide-amorphous calcium phosphate fluoride paste on the treatment of posthome whitening tooth sensitivity and color change: A randomized clinical trial.

OBJECTIVE: This study assessed whether combining photobiomodulation therapy (PBMT) with casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) paste can effectively reduce post-home whitening tooth sensitivity (TS) without compromising shade change. METHODS: Fifty participants were selected and assigned to one of four groups: (1) PLACEBO group-received a placebo paste and PBMT simulation; (2) PBMT group-received a placebo paste + PBMT; (3) CPP-ACPF group-received CPP-ACPF paste and PBMT simulation; (4) CPP-ACPF + PBMT group-received both CPP-ACPF paste and PBMT. The participants used whitening trays containing 22% carbamide peroxide for 2 h a day for 21 days. TS was measured daily using a visual analog scale, while shade change was assessed using a spectrophotometer: before bleaching treatment (T0), after the first (T1), second (T2), and third (T3) weeks of treatment, and 30 days (T4) after completing the whitening treatment. RESULTS: Intragroup analysis revealed that the PLACEBO group had the highest increase in sensitivity during the whitening treatment. The CPP-ACPF and PBMT groups showed no significant difference tooth whitening (TW) between weeks regarding aesthetic change. The CPP-ACPF and PBMT group exhibited a significant reduction in TS between the first and third and between the second and third weeks TW, but not between the first and second. Conversely, the PLACEBO group showed a higher sensitivity than the other groups (p < .05). The CPP-ACPF and PBMT groups did not differ from each other. Furthermore, the CPP-ACPF and PBMT group showed a greater decrease in sensitivity than the PLACEBO group at T1, T2, and T3 (p < .01), and was significantly differed from CPP-ACPF and PBMT groups only at T2 and T3. All groups confirmed TW effectiveness. Student's and paired t-test did not reveal any significant difference between groups (p > .05). CONCLUSION: Therefore, PBMT associated with CPP-ACPF paste can reduce TS without compromising the efficacy of TW.

Preemptive use of ibuprofen and desensitizer decreases immediate tooth sensitivity after in-office bleaching: A triple-blind, randomized, placebo-controlled clinical trial.

BACKGROUND: The authors evaluated the synergistic analgesic effect of preemptive administration of 400 mg of ibuprofen (IBU) and potassium fluoride 2% (KF2), both in isolation or combination, on the painful perception of tooth sensitivity after tooth bleaching. METHODS: Fifteen patients participated in this triple-blind, randomized, placebo-controlled clinical trial. The study used a crossover design for drug administration and a split-mouth design for desensitizer agent. Four paired groups were formed: IBU plus KF2 (IBU + KF2); IBU (IBU + placebo KF); KF2 (placebo IBU + KF2), and placebo (placebo IBU + placebo KF). The outcome measure was the perception of tooth sensitivity, assessed using a visual analog scale. Data were collected at 4 different times: immediately after tooth bleaching (baseline) and after 6, 30, and 54 hours. Statistical analysis was performed using the Friedman test and relative risk. RESULTS: IBU plus KF2 was found to be more effective in reducing tooth sensitivity immediately after bleaching (baseline) compared with the placebo group (P < .05). The risk of experiencing moderate or severe tooth sensitivity was approximately 4 times higher in the placebo group than in the IBU plus KF2 group (relative risk, 4.00; 95% CI, 1.01 to 15.81; P = .025). CONCLUSIONS: The combined use of 400 mg of IBU and KF2 appears to be beneficial in managing postbleaching tooth sensitivity. It provides a superior analgesic effect compared with placebo. PRACTICAL IMPLICATIONS: The preemptive administration of IBU plus KF2 reduces tooth sensitivity after tooth whitening when compared with placebo. This clinical trial was registered in the Brazilian Clinical Trials Registry Platform. The registration number is U1111-1249-8191.

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.

In silico affinity between analgesic/anti-inflammatory drugs and the transient receptor potential A1 to predict potential pharmacological managing approaches for bleaching sensitivity.

Reducing in-office tooth bleaching sensitivity represents a challenge for professionals. Researchers have associated the block of the pain receptor TRPA1 with reducing bleaching sensitivity. However, the chemical affinity of analgesic/anti-inflammatory drugs to the TRPA1 needs to be verified. To perform a virtual screening of multiple drugs (analgesic and anti-inflammatory drugs) to verify chemical affinity for the TRPA1 receptor. The crystal structure of the TRPA1 receptor proteins was retrieved from the Protein Data Bank. The SMILES codes of the ligands were extracted from PubChem. The binding energy of the complex was obtained in ∆G - kcal/mol by AutoDock Vina© and replicated in the webservers SwissDock©, Dockthor©, and CbDock©. LigPlus© confirmed the binding sites. Codeine and dexamethasone showed regularity among all servers, even showing binding energy values of -7.9 kcal/mol for codeine and -8.1 kcal/mol for dexamethasone. Codeine and dexamethasone may be potential drugs to manage tooth bleaching sensitivity if they reach the dental pulp TRPA1 receptor.

Root coverage surgery for dentin hypersensitivity reduction: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the effectiveness of root coverage surgery in reducing dentin hypersensitivity (DH) through a systematic review and meta-analysis. DATA SOURCES: Unrestricted search of four indexed databases up to September 2022 was performed to identify randomized controlled trials (RCTs) evaluating the effect of root coverage surgery on DH frequency and/or intensity presurgically (baseline) and at least 3 months postsurgically. Two authors independently conducted study screening and data extraction. Subgroup meta-analyses were performed separately for stimulated and unstimulated DH frequency and intensity at different timepoints. The risk of bias and quality of the available evidence were assessed. RESULTS: Nineteen RCTs presenting data from 7 days to 30 months after root coverage surgery with various treatment modalities were included from the 662 identified studies. A total of 486 patients contributed 784 recession defects. Results from the subgroup meta-analyses showed that, overall, root coverage surgery reduced the risk for DH by 67% (RR, 0.33; 95% CI, 0.21 to 0.53) and 53% (RR, 0.47; 95% CI, 0.38 to 0.58) upon unstimulated and stimulated DH assessment, respectively. The DH intensity was also significantly reduced (mean visual analog score difference, 2.37; 95% CI, 2.02 to 2.71) upon stimulated DH assessment. No significant changes in DH intensity were observed upon unstimulated DH assessment. The included studies did not have high risk of bias and the quality of evidence was low to high. CONCLUSION: Existing evidence suggests that root coverage surgery may effectively reduce the DH frequency and intensity.

Effect of an experimental desensitizing gel on bleaching-induced tooth sensitivity after in-office bleaching-a double-blind, randomized controlled trial.

OBJECTIVES: To evaluate the risk and intensity of tooth sensitivity (TS), and the efficacy of in-office bleaching after applying an experimental desensitizing gel composed of 10% calcium gluconate, 0.1% dexamethasone acetate, 10% potassium nitrate, and 5% glutaraldehyde. MATERIAL AND METHODS: In a split-mouth, double-blind, placebo-controlled study, 50 participants had their upper hemiarches randomized into experimental and placebo groups. Desensitizing and placebo gels were applied for 10 min before in-office bleaching (35% hydrogen peroxide, 1 × 50 min; two bleaching sessions; 1-week interval). TS was recorded immediately after bleaching, 1, 24, and 48 h after each session, with a 0-10 visual analogue scale (VAS) and a five-point numerical rating scale (NRS). The color was recorded in all groups at baseline, 1 week after each session, and 1 month after the end of bleaching using shade guide units (ΔSGUs) and a spectrophotometer (ΔEab, ΔE00, and ΔWID). RESULTS: Most participants (96%) felt some discomfort during treatment regardless of the study group. The odds ratio for pain was 0.65 (95% CI 0.1 to 4.1; p = 1.0). The intensity of TS did not differ between groups (p > 0.31), and it was only 0.34 VAS units lower in the experimental group. A significant color change occurred in both groups regardless of the group. CONCLUSIONS: The desensitizing experimental gel applied before in-office bleaching did not reduce the risk and the intensity of TS and did not affect color change. CLINICAL RELEVANCE: Although the experimental desensitizing agent with varying mechanisms of action did not jeopardize the color change, it did not reduce the risk or intensity of in-office bleaching. CLINICAL TRIAL REGISTRATION NUMBER: RBR-7T7D4D.

Effect of silver diamine fluoride, potassium nitrate, and glutaraldehyde in reducing the post vital tooth preparation hypersensitivity: A randomized controlled trial.

Aim: Hypersensitivity is the most common clinical problem which is encountered by most of dental patients undergoing a vital tooth preparation for a fixed crown prosthesis. The aim of this study is to evaluate the effect of silver diamine fluoride, potassium nitrate, and glutaraldehyde in reducing dentinal hypersensitivity following vital tooth preparation. Settings and Design: This study is a randomized control trial performed on 119 teeth of 68 patients who are in need of fixed prosthesis treatment. Materials and Methods: After a thorough clinical examination, patients were allocated into any of the randomly assigned four groups (Control, silver diamine fluoride, potassium nitrate, and glutaraldehyde) and the level of hypersensitivity was measured by blasting air on the surface of tooth at five different intervals (before preparation, after preparation, after application of desensitizers, before cementation and after a follow up period of about 30 days) and is graded using Schiff 's cumulative hypersensitivity index. Statistical Analysis Used: Kruskal wallis test is used to compare the rate of sensitivity between the 4 groups. Friedman and Wilcoxon test is used to compare the rate of sensitivity at 5 different intervals. Results: All the desensitizers used in this study reduced the level of hypersensitivity. Among which, silver diamine fluoride was found to be more effective after application, before cementation, and after a follow up period of about 30 days followed by GLUMA and potassium nitrate. Conclusion: The results of this study suggest that silver diamine fluoride was found to be more effective after application, before cementation of the definitive prosthesis and after a follow up period of 30 days.

Ocorrência e severidade da hipomineralização molar-incisivo em crianças e adolescentes: um estudo de painéis seriados / Occurrence and severity of molar-incisor hypomineralization in children and adolescents: a serial panel study

Introdução: A Hipomineralização Molar-Incisivo (HMI) é um defeito de desenvolvimento do esmalte, de origem sistêmica, que afeta pelo menos um primeiro molar permanente, podendo estar associado aos incisivos permanentes. Clinicamente é caracterizada como opacidades demarcadas de esmalte que podem variar de coloração (branco-creme ou amarelo-marrom). Objetivo: Estimar a ocorrência e a severidade da HMI em crianças e adolescentes e identificar os possíveis fatores associados à ocorrência da HMI. Metodologia: Foi realizado um estudo transversal em painéis seriados (2002 a 2011) e (2012 a 2021) que utilizou 230 prontuários de pacientes na faixa etária entre 06 e 12 anos, submetidos ao tratamento ortodôntico na Associação Brasileira de Odontologia entre os anos de 2002 e 2021. Os critérios diagnósticos utilizados foram a presença ou a ausência de opacidades demarcadas, restaurações atípicas, fraturas pós-irruptivas e extração de molar devido à HMI. Os dados coletados digitados e processados no programa SPSS, tratados estatisticamente através do teste do Qui-Quadrado para um nível de confiança de 95%. Resultados: A ocorrência de HMI em todo o período estudado foi de 26 casos dentre os 230 prontuários avaliados (o que representa 11,3% com IC de 95% de 7,21 a 15,39%). Desses, 03 casos são severos, o que equivale a 11,5% (com IC 95% de 5,00 a 18,00%). Foi observada uma associação da ocorrência da HMI com as variáveis gênero (masculino), idade (06 a 10 anos) e ano em que a documentação foi realizada (2012 a 2021). Conclusão: Esse trabalho evidencia que embora a ocorrência de HMI seja baixa em crianças e adolescentes de 06 a 12 anos, ela vem aumentando nos últimos anos. O percentual de indivíduos do gênero masculino e mais jovens com HMI é maior, apontando uma tendência de aumento da ocorrência de HMI nos próximos anos. Além disso, a maioria dos casos são leves, com um envolvimento maior de dentes molares em relação aos incisivos e de molares e incisivos maxilares em relação aos mandibulares. Esses achados são importantes para ajudar a formular estratégias para prevenir ou reduzir as consequências da HMI (AU).

Introduction: Molar-Incisor Hypomineralization (MIH) is an enamel development defect of systemic origin that affects at least one permanent first molar and may be associated with permanent incisors. Clinically, it is characterized as demarcated enamel opacities that can vary in color (white-cream or yellow-brown). Objective: To estimate the occurrence and severity of MIH in children and adolescents and identify possible factors associated with the occurrence of MIH. Methodology: A crosssectional study was carried out in serial panels (2002 to 2011) and (2012 to 2021) using 230 medical records of patients aged between 6 and 12 years, undergoing orthodontic treatment at the Brazilian Dental Association between 2002 and 2021. The diagnostic criteria used were the presence or absence of demarcated opacities, atypical restorations, post-rupturing fractures and molar extraction due to HMI. The collected data were typed and processed in the SPSS program, statistically treated using the chi-square test at a confidence level of 95%. Results: The occurrence of MIH throughout the study period was 26 cases among the 230 medical records evaluated (which represents 11.3% with a 95% CI of 7.21 to 15.39%). Of these, 03 cases are severe, which is equivalent to 11.5% (with CI 95% from 5.00 to 18.00%). An association was observed between the occurrence of MIH with the variables gender (male), age (06 to 10 years old) and year in which the documentation was carried out (2012 to 2021). Conclusion: This work shows that although the occurrence of MIH is low in children and adolescents from 6 to 12 years old, it has been increasing in recent years. The percentage of male and younger individuals with HMI is higher, indicating an increasing trend in the occurrence of HMI in the coming years. In addition, most cases are mild, with greater involvement of molar teeth compared to incisors and maxillary molars and incisors compared to mandibular ones. These findings are important to help formulate strategies to prevent or reduce the consequences of HMI (AU).

Influence of diet and red wine exposure on the velocity of at home bleaching: A randomized controlled clinical trial.

PURPOSE: To evaluate the influence of diet and exposure to red wine on the treatment velocity, clinical results, postoperative tooth sensitivity, and patient satisfaction after tooth bleaching. METHODS: 45 subjects undergoing home bleaching with 16% carbamide peroxide (CP) were randomly separated into three groups, depending on the restriction of colored food and the use of a red wine mouthwash. Shades of teeth 11 and 21 were assessed using a digital spectrophotometer (VITA Easy Shade) at T0 (before treatment), T7 (7 days after treatment), T15 (15 days after treatment), and T30 (30 days after treatment). The assessments were verified using the CIELab system (values of L*, a*, and b*) and the change in shade was calculated (ΔE, ΔL, Δa, and Δb). RESULTS: No statistically significant differences in ΔE, ΔL, Δa, and Δb were found between the groups. However, at T7, the group restricted from colored foods without red wine mouthwash had meaningful variations in L*, a*, and b*. Statistically, there was no difference in tooth sensitivity between the groups in the 7- and 15-day periods. Patients in the restricted colored foods without red wine mouthwash group were more satisfied after the end of treatment. CLINICAL SIGNIFICANCE: Tooth bleaching with 16% carbamide peroxide may be performed in subjects with colorant-rich diets without influencing the clinical outcome.

Photobiomodulation Reduces Pain-Related Symptoms Without Interfering in the Efficacy of In-Office Tooth Bleaching: A Systematic Review and Meta-Analysis of Placebo-Controlled Clinical Trials.

Objective: This systematic review aimed to determine whether the use of photobiomodulation (PBM) with low-level laser therapy prevents tooth sensitivity induced by in-office tooth bleaching with hydrogen. Methods: Placebo-controlled clinical trials were included to evaluate the efficacy of PBM with low-level laser therapy in the prevention of tooth sensitivity after in-office tooth bleaching. Searches were conducted on the Medline database via PubMed, Scopus, Web of Science, EBSCO, SciELO, LILACS, Cochrane, DOSS, and Google Scholar until July 2020, and fixed-effects meta-analysis was performed for tooth sensitivity [standardized mean differences (MDs)] and color changes (MDs). Results: Five studies were included in this systematic review and meta-analysis, with a total of 288 patients, 123 patients in the PBM group and 165 patients in the placebo group. In the meta-analysis, despite high heterogeneity, PBM significantly reduced the tooth sensitivity after the first [p < 0.001; Cohen's d = -0.32, 95% confidence interval (CI) = -0.46 to -0.18], second (p < 0.001; Cohen's d = -0.30, 95% CI = -0.46 to -0.15), and third (p < 0.001; Cohen's d = -0.82, 95% CI = -1.06 to -0.58) sessions of in-office tooth bleaching, without impairing the ΔE (p = 0.300). Conclusions: The results of this systematic review and meta-analysis suggest that PBM significantly prevents pain-related symptoms after the first three weekly sessions of in-office tooth bleaching with hydrogen.

Effectiveness of remineralization agents on the prevention of dental bleaching induced sensitivity: A randomized clinical trial.

OBJECTIVES: This study aims to compare the use of different remineralization agents before in-office bleaching for decreasing bleaching induced sensitivity. METHODS: A total of 64 volunteers were randomly divided into four groups. Before undergoing in-office bleaching with 38% hydrogen peroxide gel (three applications of 15 min each, one session), clinicians applied a placebo gel (control group), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), neutral sodium fluoride gel (NSF) or nano-hydroxyapatite solution (n-HAP) on all buccal surfaces of teeth. The gel was left undisturbed for 4 min. The efficacy of tooth whitening was assessed by determining the colour change using SGU. Patients recorded their tooth sensitivities on the VAS scale. Kruskal-Wallis test followed by Mann-Whitney U test was used to compare changes in tooth colour and intensity of tooth sensitivity between groups. RESULTS: Overall, there was no significant difference in shade change between the groups. Control and CPP-ACP groups showed significantly higher rates of hypersensitivity than NSF and the n-HAP group (p < 0.05). CONCLUSIONS: The use of a remineralization agent (n-HAP/NSF) before in-office bleaching did not affect the bleaching efficacy but did reduce tooth sensitivity. The before bleaching treatment use of an n-HAP solution can be suitable for reducing bleaching born sensitivity as well as commonly used NSF remineralizing gel before in-office tooth bleaching can reduce tooth sensitivity, the most common side effect associated with this 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.

In-office bleaching with complete cervical third protection protocol: A split-mouth, double-blind, randomized clinical trial.

PURPOSE: To evaluate the bleaching sensitivity and the bleaching effectiveness of in-office bleaching, following a protocol of complete cervical third protection with gingival dam in comparison with a traditional manner of applying gingival dam (used only in the gingival sulcus area). METHODS: 35 participants were selected for this double-blind split-mouth randomized clinical trial. The control group received the gingival barrier in the traditional manner, and in the experimental group the barrier was extended by about 3 mm to include the cervical region. The bleaching agent was applied in two sessions. The risk and intensity of bleaching sensitivity were assessed using two scales. The bleaching effectiveness was evaluated with a digital spectrophotometer with the tip placed in the cervical area. The absolute risk of bleaching sensitivity was compared by the McNemar's test and bleaching effectiveness (ΔEab, ΔE00 and ΔWi) and intensity of bleaching sensitivity was evaluated by Wilcoxon-paired test (α= 0.05). RESULTS: No significant difference at risk (P= 1.0) and intensity of bleaching sensitivity (P> 0.45) was seen between groups. After 30 days, bleaching effectiveness had no statistical difference between the groups (P> 0.09). CLINICAL SIGNIFICANCE: Extending the barrier in the cervical region of teeth did not reduce the risk and intensity of bleaching sensitivity, nor jeopardize the bleaching effectiveness.

The effectiveness of propolis extract in reducing dentin hypersensitivity: A systematic review.

OBJECTIVE: This systematic review was performed to evaluate the effectiveness of propolis on dentin hypersensitivity reduction. DESIGN: The search was conducted in Pubmed, Scopus, Web of science, Latin American and Caribbean Health Sciences Literature data base (Lilacs), Brazilian Library in Dentistry (BBO), Embase, and Cochrane Library aiming to identify relevant randomized clinical trials that evaluated the effect of propolis on dentin hypersensitivity. The Cochrane Collaboration tool was used for assessing the risk of bias. RESULTS: From the total of 63 articles found in the search, six clinical trials were selected. All studies reported that propolis was more effective in reducing hypersensitivity than the placebo. No side effects were observed. CONCLUSIONS: Overall, propolis extract can be considered an effective, safe and low-cost alternative to reduce the dentin hypersensitivity.

Clinical effects of the exposure to red wine during at-home bleaching.

OBJECTIVES: This clinical trial evaluated the effects of red wine exposure on the effectiveness of at-home bleaching with 10% carbamide peroxide, degree of tooth sensitivity, and levels of periodontal inflammatory markers. METHOD AND MATERIALS: Eighty participants were assigned to two groups, namely, those who drank red wine (experimental group), and those who did not drink red wine (control group). The experimental group participants rinsed their mouths with 25 mL of red wine four times a day during the bleaching period. Shade evaluation was assessed visually by using the Vita Classical and Vita Easyshade techniques. Tooth sensitivity was evaluated by the numeric and visual analog scales, and the salivary and gingival crevicular fluids were collected for assessment of nitric oxide (NO) levels, a marker of inflammation. Differences in color change were analyzed by one-way analysis of variance (ANOVA). The absolute risks of tooth sensitivity were compared by the Fisher exact test. Tooth sensitivity intensity data sets for both the visual analog scale and the numeric rating scale were compared using the Wilcoxon signed rank test (α = .05). Repeated measures and two-way ANOVA followed by the Bonferroni test were used to assess time-course and differences between groups in NO production. RESULTS: The bleaching technique was effective regardless of wine consumption (P > .05). Tooth sensitivity was classified as mild, with no differences between groups (P > .05). Red wine reduced both the gingival crevicular fluid and salivary levels of NO (P < .05). CONCLUSION: Red wine does not interfere with the effectiveness and sensitivity of at-home teeth bleaching with 10% carbamide peroxide and protects against bleaching-induced inflammation.

Uso do fluoreto de sódio como dessensibilizante no clareamento dental: uma revisão de literatura / Use of sodium fluoride as a desensibilizer in dental bleaching: a literature review

Objetivo: Verificar, por meio de uma revisão de literatura, a efetividade do uso do fluoreto de sódio como dessensibilizante para casos de sensibilidade induzida por clareamento dental. Resultados: O clareamento dentário tornou-se um dos procedimentos estéticos mais procurados na odontologia. Atualmente, existem duas técnicas supervisionadas por dentistas: o clareamento caseiro e o de consultório. Os materiais mais utilizados são o peróxido de carbamida e o de hidrogênio, respectivamente. O clareamento dental baseia-se na premissa de que o peróxido de hidrogênio penetra na estrutura dentária para interagir com os cromóforos orgânicos. Embora o protocolo de clareamento exija o uso de agentes oxidantes de baixa concentração, a sensibilidade dentária ainda está presente e pode ser considerado o principal efeito adverso da técnica de clareamento. Para minimizar este problema, a aplicação tópica de dessensibilizantes antes e após o clareamento dentário tem mostrado bons resultados na redução da intensidade de sensibilidade. Considerações finais: Mediante revisão apresentada, constatou-se que fluoreto de sódio quando utilizado após o protocolo clareador, como dessensibilizante, não elimina a sensibilidade, mas diminui a intensidade da dor. Quando utilizado antes do clareamento dental, não apresenta resultados positivos. Ademais, salienta-se que quando o fluoreto é incorporado no gel clareador, resulta em menor desmineralização do esmalte dentário.(AU)

Objective: To verify, through a literature review, the effectiveness of using sodium fluoride as a desensitizer for cases of sensitivity induced by tooth whitening. Literature review: Teeth whitening has become one of the most desired aesthetic procedures in dentistry. Currently, there are two techniques supervised by dentists: home whitening and office whitening. The most used materials are carbamide peroxide and hydrogen peroxide, respectively. Teeth whitening is based on the premise that hydrogen peroxide penetrates the tooth structure to interact with organic chromophores. Although the whitening protocol requires the use of low concentration oxidizing agents, tooth sensitivity is still present and can be considered the main adverse effect of the whitening technique. To minimize this problem, the topical application of desensitizers before and after tooth whitening has shown good results in reducing the intensity of sensitivity. Final considerations: Upon the review presented, it was found that sodium fluoride, when used after the whitening protocol, as a desensitizer, does not eliminate sensitivity, but reduces the intensity of pain. When used before tooth whitening, it has no positive results. Furthermore, it should be noted that when fluoride is incorporated into the whitening gel, less enamel demineralization is induced.(AU)

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.

Topical application of a desensitizing agent containing potassium nitrate before dental bleaching: a systematic review and meta-analysis.

OBJECTIVES: To conduct a systematic review and meta-analysis to evaluate the risk and intensity of tooth sensitivity (TS) after topical application of desensitizers containing potassium nitrate before dental bleaching. METHODS: We searched PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE. We also surveyed gray literature without restrictions. We meta-analyzed the data using the random-effects model to compare potassium nitrate and placebo in terms of risk and intensity of TS and color change (∆SGU or ∆E). The quality of the evidence was rated using the GRADE approach. The risk of bias (RoB) of the included studies was analyzed using the Cochrane RoB tool. RESULTS: After the database screening, 24 articles remained. A significant 12% lower risk for the groups where desensitizing agents were applied (p = 0.02), with a risk ratio of 0.88 (95% CI 0.78 to 0.98). About the intensity of TS, a significant average mean difference of - 0.77 units of VAS units (95%CI - 1.34 to - 0.19; p = 0.01) in favor of the desensitizer group. In the NRS scale, a significant average mean difference of - 0.36 (95% CI - 0.61 to - 0.12; p value = 0.004) in favor of the desensitizer group. No significant difference was observed in color change (p > 0.28) in ∆SGU and ∆E. CONCLUSIONS: Although a significant reduction in the risk and intensity of TS was observed in groups treated with a potassium nitrate at some point during the bleaching, the clinical significance of this reduction is subtle and clinically questionable. Color change is not affected by the use of agents. CLINICAL RELEVANCE: The reduction in the risk and intensity of TS with the topical application of potassium nitrate-based desensitizing agents in dental bleaching is subtle and maybe clinically questionable.