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Color change in number of shade guide units (Vita Classical and Vita Bleachedguide 3D-MASTER) and color differences between baseline and 1 month after bleaching.
Source publication
Background:
In this randomized study, split-mouth, triple-blind clinical trial, the authors evaluated the efficacy of a desensitizing gel that contained 5% potassium nitrate and 5% glutaraldehyde applied before in-office bleaching with 35% hydrogen peroxide (HP).
Methods:
Treatment with the desensitizing or placebo control gels was randomly assi...
Contexts in source publication
Context 1
... whitening was observed in both study groups under the subjective and objective eval- uation methods (P < .005). At the end of the bleaching protocol, a whitening of 4.7 to 6.0 SGU (for both scales) was detected for both groups, and the DE varied by 5.6 to 5.9 units (Table 4). The results of the subjective (Vita Classical: P ¼ .77; ...
Citations
... This sensitivity occurs because hydrogen peroxide, which has low molecular weight, penetrates dental tissues and reaches the pulp chamber approximately 15 min after application [13,14]. Its presence in pulp tissues can trigger inflammatory processes [15] and active pain-specific receptors [16], leading to an uncomfortable Clinical Trial Registration Number: RBR-9v2xz6 experience for patients and causing some to discontinue their bleaching treatment [7,17]. ...
... Another alternative way to accelerate the absorption of desensitizing agents, allowing their fast mechanism, is their topical application to the dental surfaces, as demonstrated in previous studies [17,40,41]. We hypothesize that topical application of ibuprofen and arginine may reduce TS. ...
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.
... The etiology of hypersensitivity is complex and may be related to the amount of hydrogen peroxide that reaches the pulp [16,17,20,21]. Fluoride occludes dentinal tubules [22] with precipitation of calcium fluoride crystals on the dentin tubules, reducing their diameter and thus reducing the movement of pulpal fluid [23]. ...
... 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 6 . Existe uma grande variação no risco de desenvolver sensibilidade dentária, no entanto, o maior risco é geralmente observado no clareamento dental em consultório, sendo relatado sensibilidade entre 60% e 98% dos casos 7 . ...
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.
... De acordo com pesquisas realizadas por Parreiras et al. (2018) o processo de dessensibilização antes do clareamento com um gel dessensibilizante que contém glutaraldeído e 5% de nitrato de potássio, em uma única formulação, por 10 minutos reduziu consideravelmente a ST induzida pelo clareamento em comparação com um tratamento placebo. Conforme relatado acima, os benefícios de um produto de glutaraldeído para redução da ST induzida por clareamento foram relatados em 2 estudos clínicos que realizaram clareamento em consultório com 38% a 40% de peróxido de hidrogênio. ...
O crescente apelo estético nos dias atuais é determinado pela demanda por dentes mais brancos nos consultórios odontológicos. É comum os pacientes aderirem ao processo de clareamento dental, sejam eles de consultório, caseiro ou associando as duas técnicas. No entanto, faz parte do cotidiano dos cirurgiões-dentistas que alguns pacientes relatem sensibilidade aos géis clareadores e suas composições durante ou após o processo de clareamento. O objetivo deste trabalho foi discutir em uma revisão de literatura os fatores causadores da hipersensibilidade dentária após o clareamento, abordando o diagnóstico e tratamento baseado no clareamento dental (caseiro supervisionado e de consultório). Portanto, é determinante que o profissional realize uma anamnese completa acerca da etiologia da hipersensibilidade e, sabendo identificar, realize o tratamento a fim de amenizar todo o desconforto causado pela hipersensibilidade dentária.
... Another desensitizer tested, glutaraldehyde (15.4%), was present in the studies by Diniz et al. [24] and Parreiras et al. [25]. This substance causes a cross-linking with the enamel matrix proteins and with the proteins present in the dentin tubular fluid, thus reducing the passage of peroxides [25]. ...
... Another desensitizer tested, glutaraldehyde (15.4%), was present in the studies by Diniz et al. [24] and Parreiras et al. [25]. This substance causes a cross-linking with the enamel matrix proteins and with the proteins present in the dentin tubular fluid, thus reducing the passage of peroxides [25]. The action of gluteraldehyde can also be explained by the reaction produced by the contact of enamel proteins with the desensitizer, hindering the penetration of peroxides through the enamel [19]. ...
... The application of gluteraldehyde on dentin for at least 1 minute reduces the intensity of sensitivity [19,25]. Also, its association with potassium nitrate 5% aids in reducing sensitivity after bleaching [25]. ...
Introduction: Teeth whitening is the most sought after aesthetic conservative treatment by patients, however, one of the side effects is the sensitivity caused by the technique. To promote the reduction of post-bleaching sensitivity, different presented and systemic protocols were presented. However, it is clear that there is still no desensitizer that controls tooth sensitivity during and after bleaching. Objective: To summarize the available evidence on the efficacy of desensitizing agents on dentin sensitivity following tooth whitening. Sources: On September 04, 2021, a comprehensive search of MEDLINE via PubMed, EMBASE, LILACS (Latin American and Caribbean Health Sciences Literature), LIVIVO, SCOPUS, Web of Science, and the gray literature by Google Scholar was performed. Study Selection: After removal of duplicates, title, and abstract screening by two reviewers (performed in the Rayyan tool for systematic reviews), 13 articles were included, selected only blinded randomized clinical trials, which present patients with discolored teeth submitted to in-office and/or home tooth whitening and desensitizing agents used. The following data were collected: authors, year of publication, objectives or research questions, desensitizing agent, number of participants, number of groups, control group description, study group description, whitening approach, outcomes evaluated, main results, main conclusions, the scale used for outcome measurement, risk of tooth sensitivity (outcome), statistical test used, odds ratio/IC results, dentin sensitivity intensity analysis (intergroup statistical test), dentin sensitivity intensity analysis (intragroup statistical test), and maximum analysis time. After applying readability criteria, a total of 11 articles were deemed suitable for inclusion in the meta-analysis. The overall analysis demonstrated a statistically significant difference in the impact of desensitizing agent use, with lower dental sensitivity scores observed compared to placebo treatment (p = 0.036, 95% CI: -0.273; -0.009). Conclusion: Based on the findings of this study, it was possible to verify that the desensitizing agents acted significantly reducing tooth sensitivity and the odds-ratio of patients submitted to in-office tooth whitening.
... A significant reduction in the color assessment level was observed in the groups, showing the desensitizers' non-interference in the bleaching result. This corroborates the study by Parreiras et al. [28], which reports that desensitizing agents do not alter the diligence of tooth whitening with 35% hydrogen peroxide. Thus, sensitizing agents allow the diffusion of the bleaching agent through enamel and dentin without impairing its diligence. ...
Aims: This research aimed to evaluate the action of ozonized oil associated with an obliterating desensitizing agent in reducing post-dental bleaching sensitivity. Study Design: This was a randomized, prospective, double-blind, split-mouth study, in which the patient and evaluator were blinded to the distribution of the groups. Place and Duration of Study: The study was conducted at the Dentistry Clinics of the Local University from June to December 2021. Methodology: Forty patients were selected and divided into two groups according to the desensitizing agent used: control group (GC) - potassium nitrate and sodium fluoride and treatment group (GT) - sunflower oil ozonized and glutaraldehyde. In-office bleaching was performed with 35% hydrogen peroxide in a single clinical session. The following variables were evaluated: I – the intensity of sensitivity at different times in the same group; II – the intensity of sensitivity at different times in different groups; III- global sensitivity; IV - worse pain and V - color change, which was evaluated at the beginning of treatment and one week after the end of the treatment with the help of a VITA color scale. The risk analysis of tooth sensitivity of both groups was compared using McNemar's exact test. To analyze the intensity of tooth sensitivity, the Wilcoxon and Friedman tests were used, P < 0,05. Results: The study revealed that there were significant differences in the risk and degree of tooth sensitivity between the test and control groups. Out of the total participants, 14 did not experience sensitivity, while 66 did. The test group exhibited lower pain scores at 35 and 40 minutes compared to the control group. In the intragroup analysis, significant differences were found within both the test and control groups across multiple time intervals. The analysis of global sensitivity showed significant differences between the treatment approaches, with the group receiving the specific treatment demonstrating lower sensitivity values compared to the control group. However, there were no significant differences in the worst pain between the treatment approaches. Regarding bleaching effectiveness, there were no statistically significant differences between the test and control groups. The comparison did not show a significant variation in bleaching effectiveness. Conclusion: The protocol showed promising results as a less invasive and discomfort-free method. However, the study was limited to using only one bleaching agent, and further research with different bleaching agents could provide additional insights.
... Recent studies have indicated treatments intended to reduce these effects caused by TS [7,[10][11][12][13]. Likewise, laser therapy has recently been presented as a treatment method for reducing TS after DB [3]. ...
Objectives
Perform a systematic review to evaluate the influence of smoking on the effectiveness of tooth whitening (TW) and to analyze whether tooth sensitivity is different between smokers and non-smokers.Materials and methodsA systematic review modeled according to the PRISMA guidelines was conducted. PubMed, Embase, Web of Science, Cochrane, Scopus, and OpenGrey databases were searched for related clinical trials. The population, exposure, comparison, outcomes (PECO) was individuals who had TW performed, smoking individuals, non-smoking individuals, and effectiveness of TW, respectively. Risk of bias was assessed with the ROBINS-I tool, and data from included studies were extracted by two researchers independently. The certainty of the evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach.ResultsFive studies were selected for qualitative analysis. The ROBINS-I tool classified 3 studies as having a moderate risk of bias, one study as having a serious risk of bias, and one with a critical risk. GRADE performed only for color change results and showed a low certainty of evidence. Limited evidence suggests that effectiveness of TW between smokers and non-smokers is similar. The tooth sensitivity also does not seem to be influenced by smoking. Due to the heterogeneity of the data, a meta-analysis could not be performed.Conclusions
Effectiveness of TW between smokers and non-smokers is comparable. The tooth sensitivity also does not seem to be influenced by smoking.Clinical relevanceThe effectiveness of bleaching among smokers and non-smokers appears to be similar. Tooth sensitivity during TW also appears not to be influenced by smoking.
... The preventive effect of analgesics and opioids [13,14], anti-inflammatories [15][16][17][18], antioxidants [19], and corticosteroids [20][21][22] has previously been investigated, and they could not mitigate bleaching-induced TS [23]. So far, the most successful approach to reducing TS has been the topical application of desensitizers, such as those containing glutaraldehyde [24,25], potassium nitrate [26,27], and calcium agents [28,29]. ...
... Potassium nitrate prevents the repolarization of nerve fibers blocking the transmission of painful stimuli [26,27,30]. Meanwhile, glutaraldehyde was reported to coagulate proteins from enamel and dentinal tubules, reducing the easy passage of HP to the pulp [25,31,32]. Calcium-containing agents can also reduce the risk and intensity of TS mainly through the saturation of components on the enamel surface [33]. ...
... The 16 shade guide tabs from the Vita Classical shade guide were arranged from the highest (B 1 ) to the lowest (C 4 ) value for the subjective examination. Although this scale is not linear in the truest sense, we treated the changes as representing a continuous and approximately linear ranking for analysis as already performed in published studies [21,25,27,44,45]. The Vita Bleachedguide 3D-MASTER contains lighter shade tabs and is organized from the highest (0M1) to the lowest (5M3) value. ...
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.
... The preventive effect of analgesics and opioids [12,13], anti-in ammatories [14][15][16], antioxidants [17], and corticosteroids [18][19][20] has previously been investigated, and they could not mitigate bleachinginduced TS [21]. So far, the most successful approach to reducing TS has been the topical application of desensitizers, such as those containing glutaraldehyde [22,23], potassium nitrate [24,25], and calcium agents [26,27]. ...
... Potassium nitrate prevents the repolarization of nerve bers blocking the transmission of painful stimuli [24,25,28]. Meanwhile, glutaraldehyde was reported to coagulate proteins from enamel and dentinal tubules, reducing the easy passage of HP to the pulp [23,29,30]. Calcium-containing agents can also reduce the risk and intensity of TS mainly through the saturation of components on the enamel surface [31]. ...
... The 16 shade guide tabs from the Vita Classical shade guide were arranged from the highest (B 1 ) to the lowest (C 4 ) value for the subjective examination. Although this scale is not linear in the truest sense, we treated the changes as representing a continuous and approximately linear ranking for analysis as already performed in published studies [20,23,25,41]. The Vita Bleachedguide 3D-MASTER contains lighter shade tabs and is organized from the highest (0M1) to the lowest (5M3) value. ...
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, 1x50 min; two bleaching sessions; one-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 at baseline, one week after each session, and one 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 all 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
... Despite the effectiveness of this technique in achieving the desired tooth whitening results, tooth sensitivity (TS) is the most common adverse adverse effect. [19][20][21][22][23][24] In total, 55% through 90% of patients have had TS pain diagnosed after this procedure. 25 The hypersensitivity appears to result from an inflammatory process in the dental pulp 26,27 owing to the action of free radicals from the hydrogen peroxide (HP) that spreads through the enamel and dentin, then permeating the pulp chamber. ...
... 31 In this case, the adverse effects that occur to the pulp from tooth whitening correlate directly with the effect of the HP particles that penetrate the pulp, which leads to pulpal damage on the release of inflammatory mediators. 16,20,35 These mediators are soluble and diffusible molecules that act locally in the inflammatory area. These mediators perform many functions, such as vasodilation, increased vascular permeability, phagocytosis, apoptosis, and pain sensation. ...
