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
PubMed ID Author / Year Patient Group Study type (level of evidence) 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. 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). 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.
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	(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	Shannon Roberts, DDS
Faculty mentor 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?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available