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| Title |
Hydrogen Peroxide Bleaching Systems With Nano-Hydroxyapatite Do Not Significantly Reduce Postoperative Sensitivity Following Tooth Whitening Procedures |
| Clinical Question |
In healthy adult patients with no prior history of tooth sensitivity, does the use of nano-hydroxyapatite in in-office bleaching systems reduce the amount of post-operative sensitivity experienced by patients? |
| Clinical Bottom Line |
Hydrogen peroxide bleaching systems with nano-hydroxyapatite and hydrogen peroxide bleaching systems without nano-hydroxyapatite appear to be comparable in terms of postoperative sensitivity experienced by healthy adult patients following tooth whitening procedures; however the current evidence available is weak (see comments below). |
| Best Evidence |
(you may view more info by clicking on the PubMed ID link) |
| PubMed ID |
Author / Year |
Patient Group |
Study type
(level of evidence) |
| #1) 25600272 | Vano/2015 | 60 subjects who satisfied the inclusion criteria requirements | Randomized Controlled Trial | | Key results | The patients were followed up for sensitivity for 14 days after having in-office bleaching treatment. Patients that were treated with 6% hydrogen peroxide with 2% nano-hydroxyapatite experienced significantly less sensitivity (P<0.05) than the placebo group of patients that used bleaching product without 2% nano-hydroxyapatite at 24 hours post-bleaching; there was no significant difference at 7 and 14 days. | | #2) 26313348 | Loguercio/2015 | 40 patients randomly divided into placebo and nano-calcium phosphate paste groups | Randomized Controlled Trial | | Key results | This study used two applications of an in-office bleaching treatment, 1 week apart. In the placebo group, 80% (95% CI, 58%-91%) experienced tooth sensitivity at least once during the bleaching treatment. In the nano-phosphate group the tooth sensitivity was 85% (95% CI, 63%-94%). There was no significant difference in the risk and intensity of tooth sensitivity observed in the two different groups (p=1.0 and p=0.53, respectively). | | #3) 22863133 | Browning/2012 | 42 participants randomly assigned to use either a n-HAP paste or a placebo (zero-HAP) paste to reduce bleaching-related tooth sensitivity | Randomized Controlled Trial | | Key results | This study was a 14-day at-home bleaching protocol in which n-HAP was applied as a paste after each 30-minute bleaching session. Significantly fewer days of sensitivity were reported by the n-HAP group (76 days) than the placebo group (36 days) (p=0.001). However, there was no significant difference on the basis of number of subjects reporting sensitivity: 51% of the zero-HAP group participants and 29% of the n-HAP group participants reported tooth sensitivity (p=0.06). Also there was no statistically significant difference between the groups for pain intensity measures on a VAS scale (p=0.16). The study indicates that paste containing nano-hydroxyapatite crystals can effectively reduce the duration of tooth sensitivity.
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| Evidence Search |
PubMed: "Tooth Bleaching Agents"[Mesh] AND "Tooth Bleaching"[Mesh] AND "Bleaching Agents"[Mesh] AND "Tooth Discoloration"[Mesh] AND "Peroxides"[Mesh] |
Comments on
The Evidence |
Compliance, completion rate, and follow-up were adequate for all the clinical trials. Both short term (<48hr) and long-term (9 months) effects were monitored. The treatment groups were similar at the start; however, the group sizes were relatively small (n=60, n=40, n=42) and the treatment techniques tested in each clinical trial differed in type, duration, and concentration of active ingredients used. Also it is not clear if these studies were conducted using a double-blinded method or if there were competing interests involved. Overall the current available evidence is weak. |
| Applicability |
This evidence applies to healthy adult patients treated with in-office hydrogen peroxide containing tooth bleaching systems as well as at-home bleaching systems. Patients should be made aware that all bleaching systems containing hydrogen peroxide may cause post-operative sensitivity but bleaching systems containing nano-hydroxyapatite may help to reduce this amount. These results may vary depending on the concentration of hydrogen peroxide and active ingredients, duration of treatment, and oral hygiene of the patient. |
| Specialty/Discipline |
(General Dentistry) (Restorative Dentistry) |
| Keywords |
Tooth whitening, bleaching, esthetics, sensitivity;
|
| ID# |
3167 |
| Date of submission: |
03/23/2017 |
| E-mail |
albrechtcb@livemail.uthscsa.edu |
| Author |
Colton Albrecht |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Shannon Roberts, DDS |
| Faculty mentor/Co-author e-mail |
Dobelbower@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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