Review

Authors: Clifton M Carey

UNLABELLED

Current research about tooth whitening shows that it is safe and effective when manufacturer's protocol is followed, yet there are risks of which the profession and users should be aware. This update provides a summary of current research and assessment of the safety and efficacy of tooth whitening regimens.

BACKGROUND

Tooth whitening has become one of the most frequently requested dental procedures by the public. The public has come to demand whiter, more perfect smiles and in response many choices for tooth whitening have been made available. These include home-based products such as toothpastes, gels, and films, as well as in-office based systems where products containing highly concentrated bleaching agents are applied under professional supervision. The profession and public have been aware of certain risks related to tooth whitening such as increased tooth sensitivity and gingival irritation. New research has shown that there are other risks such as tooth surface roughening and softening, increased potential for demineralization, degradation of dental restorations, and unacceptable color change of dental restorations. The new research is also focused on optimizing whitening procedures to reduce tooth sensitivity and to increase the persistence of the whitening.

METHODS

Current reports in the literature are reviewed that are related to the use of peroxide based whitening methods. These reports include in vitro studies for method optimization and mechanism as well as clinical studies on effects of various whitening regimens.

CONCLUSIONS

When manufacturer's instructions are followed, hydrogen peroxide and carbamide peroxide based tooth whitening is safe and effective. Patients should be informed of the risks associated with tooth whitening and instructed on identification of adverse occurrences so that they may seek professional help as needed.

Topics: Dentin Sensitivity; Gingiva; Humans; Risk Factors; Tooth Bleaching; Tooth Bleaching Agents; Tooth Demineralization

PubMed: 24929591
DOI: 10.1016/j.jebdp.2014.02.006

Authors: Athaluri Mounika, Jyothi Mandava, B Roopesh...

BACKGROUND

Among the number of vital bleaching techniques currently available to the clinicians, home bleaching and in-office bleaching are widely used in dental practice.

AIM AND OBJECTIVES

The aim of this in vivo study was to compare the clinical performance, durability, and related tooth sensitivity with two vital bleaching procedures (in-office and at-home bleaching), in a split-mouth design.

PATIENTS AND METHODS

Thirty adult participants having teeth shade mean of A2 or darker were selected for the study. One-half of the maxillary arch of each patient received in-office bleaching with 35% hydrogen peroxide gel, and the other half received 16% carbamide peroxide night guard bleaching. Shade evaluation was done with shade guide and spectrophotometer at 1, 2, 3, and 4 week intervals during bleaching and postoperatively at 3 and 6 month intervals. Tooth sensitivity was recorded using the visual analog scale during the experimental period.

STATISTICAL ANALYSIS

Collected data of color and sensitivity readings were subjected to statistical analysis using SPSS/PC version 20 software. Intergroup comparison through unpaired t-test and within the groups using paired t-test was done.

RESULTS

At-home and in-office bleaching procedures are equally effective in producing tooth whitening. Color evaluation after 3 and 6 months showed more color decline for in-office bleaching procedure. For sensitivity parameter also, in-office procedure recorded higher sensitivity compared to home bleaching (P < 0.05).

CONCLUSION

Both the bleaching procedures are equally effective in producing tooth whitening. In-office bleaching recorded higher levels of tooth sensitivity and greater color rebound than home bleaching.

Topics: Adolescent; Adult; Aged; Carbamide Peroxide; Color; Dentin Sensitivity; Female; Humans; Hydrogen Peroxide; Male; Middle Aged; Spectrophotometry; Time Factors; Tooth; Tooth Bleaching; Tooth Bleaching Agents; Visual Analog Scale; Young Adult

PubMed: 30127190
DOI: 10.4103/ijdr.IJDR_688_16

Review

Authors: Rosmaliza Ramli, Nurhafizah Ghani, Haslina Taib...

The prevalence of dentin hypersensitivity (DH) is increasing around the world. At least one in 10 individuals in the general population has been diagnosed with DH. It is a diagnosis that has significant negative effects on a person's oral health-related quality of life. This condition, which is characterized by sharp, short tooth pain in response to thermal, chemical, tactile, and evaporative stimuli, is more commonly seen in adults. DH has a tremendous impact on the social and financial aspects of patients and society at large. It is essential to recognize the factors that can contribute to a successful treatment outcome to guarantee the overall well-being of DH patients. The aim of this narrative review was to highlight strategies that can lead to successful DH treatment outcomes, along with current updates on DH mechanisms, treatment options, and the latest management approaches. A positive treatment outcome for DH requires a concerted effort from both the patient and the dental practitioner. Highly motivated patients and dental practitioners with sound knowledge of DH diagnosis and available treatment options will ensure successful long-term improvement of DH symptoms.

Topics: Adult; Dentin Sensitivity; Dentists; Humans; Professional Role; Quality of Life; Treatment Outcome

PubMed: 36206495
DOI: 10.17219/dmp/143354

Review

Authors: Xiu-Xin Liu, Howard C Tenenbaum, Rebecca S Wilder...

Though dentin hypersensitivity (DHS) is one of the most common complaints from patients in dental clinics, there are no universally accepted guidelines for differential diagnosis as well as selection of reliable treatment modalities for this condition. The neurosensory mechanisms underlying DHS remain unclear, but fluid movements within exposed dentinal tubules, i.e., the hydrodynamic theory, has been a widely accepted explanation for DHS pain. As several dental conditions have symptoms that mimic DHS at different stages of their progression, diagnosis and treatment of DHS are often confusing, especially for inexperienced dental practitioners. In this paper we provide an up-to-date review on risk factors that play a role in the development and chronicity of DHS and summarize the current principles and strategies for differential diagnosis and management of DHS in dental practices. We will outline the etiology, predisposing factors and the underlying putative mechanisms of DHS, and provide principles and indications for its diagnosis and management. Though desensitization remains to be the first choice for DHS for many dental practitioners and most of desensitizing agents reduce the symptoms of DHS by occluding patent dentinal tubules, the long-term outcome of such treatment is uncertain. With improved understanding of the underlying nociceptive mechanisms of DHS, it is expected that promising novel therapies will emerge and provide more effective relief for patients with DHS.

Topics: Dentin; Dentin Sensitivity; Dentists; Humans; Professional Role; Risk Factors

PubMed: 32762733
DOI: 10.1186/s12903-020-01199-z

Meta-Analysis Review

Authors: Luciana Antonio Pion, Laís Lopes Machado De Matos, Thaís Gimenez...

BACKGROUND

Laser protocols for the treatment of dentin hypersensitivity (DH) have not yet been studied systematically.

OBJECTIVES

The present study aimed to review clinical trials on the treatment of DH with laser therapy through a systematic review and meta-analysis.

MATERIAL AND METHODS

The search of electronic databases resulted in 562 publications up to April 2020. The inclusion criteria were studies carried out on humans and reporting on the treatment of DH with laser therapy. Case reports, literature reviews and systematic reviews were excluded. Selected by abstract, potentially eligible papers were read in full (n = 160). Independent examiners performed data extraction and the assessment of the risk of bias.

RESULTS

A total of 34 studies were included in the analysis, and 11 in the quantitative analysis. It was observed that most studies followed up patients for a maximum of 6 months (55%). Through the meta-analysis, we observed statistically significant differences between the average pain before and after 3 months of treatment with highand low-power lasers. However, through indirect comparisons, it was observed that the high-power laser showed a greater tendency to reduce the pain levels after 3 months of treatment as compared to the low-power laser, but without a statistically significant difference.

CONCLUSIONS

It was possible to conclude that regardless of the type of laser used in the treatment of DH, this treatment is an effective option for the control of pain symptoms. However, it was not possible to establish a defined treatment protocol, since the evaluation methods are very different from each other. Text for Rewiew and clinical cases.

Topics: Humans; Dentin Sensitivity; Laser Therapy; Low-Level Light Therapy; Treatment Outcome; Lasers

PubMed: 37023343
DOI: 10.17219/dmp/151482

Meta-Analysis

Authors: Livia Favaro Zeola, Paulo Vinícius Soares, Joana Cunha-Cruz...

OBJECTIVES

The purpose of this study was to estimate the prevalence of dentin hypersensitivity in various populations.

SOURCES

Four electronic databases (Medline via PubMed, Cochrane Library, Wiley Online Library and Web of Science) were searched until June 2018.

STUDY SELECTION

Cross-sectional studies on the prevalence of dentin hypersensitivity were included. Meta-analysis were conducted and meta-regression models were used to explain the variation of the prevalence measures. Data were extracted, and the studies were assessed for quality.

DATA

A total of 65 papers (reporting on 77 studies) met the inclusion criteria and were included in the meta-analysis. The prevalence range was observed to be as low as 1.3% and as high as 92.1%. Effect modifiers for dentin hypersensitivity prevalences were the type of participants included in the study, age range, recruitment strategy and number of study sites. Higher prevalences were observed in studies involving specialty practice patients, younger adults, convenience sample and those characterized as single-site.

CONCLUSION

The best estimate of dentin hypersensitivity was 11.5% (95%CI:11.3%-11.7%) and the average from all studies was 33.5% (95%CI: 30.2%-36.7%). The extremely high degree of heterogeneity among studies can only be partially explained by characteristics of the studies.

CLINICAL SIGNIFICANCE

Dentin hypersensitivity is a persistent clinical problem that poses significant challenge for clinicians and affects patients' quality of life. Better understanding of the dentin hypersensitivity burden and its associated factors can assist on resource planning for reducing/preventing any discomfort arising from this condition and will aid in the decision-making process.

Topics: Cross-Sectional Studies; Databases, Factual; Dentin Sensitivity; Humans; Prevalence; Quality of Life

PubMed: 30639724
DOI: 10.1016/j.jdent.2018.12.015

Review

Authors: N X West, A Lussi, J Seong...

OBJECTIVES

The paper's aim is to review dentin hypersensitivity (DHS), discussing pain mechanisms and aetiology.

MATERIALS AND METHODS

Literature was reviewed using search engines with MESH terms, DH pain mechanisms and aetiology (including abrasion, erosion and periodontal disease).

RESULTS

The many hypotheses proposed for DHS attest to our lack of knowledge in understanding neurophysiologic mechanisms, the most widely accepted being the hydrodynamic theory. Dentin tubules must be patent from the oral environment to the pulp. Dentin exposure, usually at the cervical margin, is due to a variety of processes involving gingival recession or loss of enamel, predisposing factors being periodontal disease and treatment, limited alveolar bone, thin biotype, erosion and abrasion.

CONCLUSIONS

The current pain mechanism of DHS is thought to be the hydrodynamic theory. The initiation and progression of DHS are influenced by characteristics of the teeth and periodontium as well as the oral environment and external influences. Risk factors are numerous often acting synergistically and always influenced by individual susceptibility.

CLINICAL RELEVANCE

Whilst the pain mechanism of DHS is not well understood, clinicians need to be mindful of the aetiology and risk factors in order to manage patients' pain and expectations and prevent further dentin exposure with subsequent sensitivity.

Topics: Dentin; Dentin Sensitivity; Disease Susceptibility; Humans; Hydrodynamics; Pain; Periodontal Diseases; Risk Factors; Tooth Cervix; Tooth Wear

PubMed: 23224116
DOI: 10.1007/s00784-012-0887-x

Review

Authors: W K Seow

Abnormalities of enamel and dentine are caused by a variety of interacting factors ranging from genetic defects to environmental insults. The genetic changes associated with some types of enamel and dentine defects have been mapped, and many environmental influences, including medical illnesses that can damage enamel and dentine have been identified. Developmental enamel defects may present as enamel hypoplasia or hypomineralization while dentine defects frequently demonstrate aberrant calcifications and abnormalities of the dentine-pulp complex. Clinically, developmental enamel defects often present with problems of discolouration and aesthetics, tooth sensitivity, and susceptibility to caries, wear and erosion. In contrast, dentine defects are a risk for endodontic complications resulting from dentine hypomineralization and pulpal abnormalities. The main goals of managing developmental abnormalities of enamel and dentine are early diagnosis and improvement of appearance and function by preserving the dentition and preventing complications. However, despite major advances in scientific knowledge regarding the causes of enamel and dentine defects, further research is required in order to translate the knowledge gained in the basic sciences research to accurate clinical diagnosis and successful treatment of the defects.

Topics: Amelogenesis Imperfecta; Dental Caries; Dental Enamel; Dental Enamel Hypoplasia; Dental Research; Dentin; Dentin Sensitivity; Dentinogenesis Imperfecta; Humans; Tooth Demineralization

PubMed: 24164394
DOI: 10.1111/adj.12104

Authors: Thomas Linner, Yeganeh Khazaei, Katharina Bücher...

Tooth hypersensitivity is a common symptom in patients with molar-incisor hypomineralization (MIH). Therefore, this clinical study aimed to assess potential associations between patient- and tooth-related variables and the intensity of hypersensitivity in MIH-affected permanent teeth compared to healthy controls. Fifty-seven MIH patients and 20 healthy adolescents with a total of 350 MIH-affected and 193 healthy teeth were included in this study. The intensity of hypersensitivity was measured after cold air stimulation using the Schiff Cold Air Sensitivity Scale (SCASS) by the dentist and visual analogue scale (VAS) by the patient. Tooth hypersensitivity was low in non-MIH teeth (97.9% of the group had zero SCASS and VAS values). In contrast, MIH-affected teeth with demarcated opacities and atypical restorations had moderate SCASS and VAS values, whereas teeth with enamel breakdown were mostly linked to severe hypersensitivity. The logistic regression model confirmed a significantly lower level of hypersensitivity in MIH patients aged ≥ 8 years (OR 0.06, 95% CI 0.01-0.50, p = 0.009) and higher levels in molar teeth (OR 5.49, 95% CI 1.42-21.27, p = 0.014) and teeth with enamel disintegration (OR 4.61, 95% CI 1.68-12.63, p = 0.003). These results indicate that MIH-related tooth hypersensitivity seems to be present in disintegrated molars immediately after tooth eruption.

Topics: Child; Dental Enamel Hypoplasia; Dentin Sensitivity; Female; Humans; Male; Prevalence; Tooth Eruption

PubMed: 34504122
DOI: 10.1038/s41598-021-95875-x

Authors: Maria Aidos, Carlos Miguel Marto, Inês Amaro...

OBJECTIVES

The objective of this umbrella review is to evaluate the efficacy and adverse effects of different teeth whitening techniques in-office (IO) and at-home (AH), regarding chromatic changes and teeth sensitivity.

MATERIALS AND METHODS

The search was carried out from several databases. The included studies were all systematic reviews with or without meta-analysis of RCT or quasi-RCT. The participants were patients that underwent external dental bleaching in permanent vital teeth. The interventions were in-office (IO) bleaching techniques and at-home (AT) bleaching techniques with different bleaching agents and concentrations.

RESULTS

The search resulted in a total of 257 articles, and 28 SR were included in the qualitative analysis and nine in the quantitative analysis. There is no difference between in-office and at-home techniques in terms of color change ( = 0.95) and post-treatment sensitivity ( = 0.85). There is similarity risk and intensity of teeth sensitivity between AH and IO bleaching. IO bleaching with light-activated systems with low concentrations of bleaching agent showed similar results to IO bleaching techniques with high concentrated bleaching gels. With the application of the criteria of the AMSTAR 2 tool, the reviews were considered critically low to high.

CONCLUSIONS

There are no significant differences in terms of color change between the different bleaching techniques compared. Teeth sensitivity is always present regardless of the technique used. The use of light activation systems did not increase the intensity and risk of post-operative sensitivity.

PubMed: 38371984
DOI: 10.1016/j.heliyon.2024.e25833