Comparison of Casein Phosphopeptide with Potassium Nitrate and Sodium Monofluorophosphate Desensitizing Efficacy after In-Office Vital Bleaching—A Randomized Trial

Hafiz Muhammad Adil,Muhammad Adeel Ahmed,Sakeenabi Basha,Afsheen Maqsood,Anil Kumar Nagarajappa,Rizwan Jouhar,Mohammad Khursheed Alam,Maria Shakoor Abbasi,Naseer Ahmed

doi:10.3390/app11199291

Abstract

Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), potassium nitrate, and sodium monofluorophosphate are desensitizing agents that help in reducing teeth sensitivity. However, indecisive evidence exists regarding their efficacy. Therefore, this study was conducted to compare the desensitizing efficacy of casein phosphopeptide-amorphous calcium phosphate and potassium nitrate with sodium monofluorophosphate agents after in-office vital bleaching. A randomized controlled trial was conducted on 2011 patients. The patients were randomly and equally divided into the CPP-ACP group (group 1), potassium nitrate with sodium monofluorophosphate group (group 2), and placebo gel (group 3). The upper and lower anterior teeth including the first premolar were isolated with a rubber dam, then the bleaching agents were applied on the labial surface of all the teeth, followed by light activation for 15 min. The procedure was repeated 3 times with an interval of 5 min in-between. After carrying out the bleaching procedure, patients were given a desensitizing gel or placebo gel in unmarked syringes with an instruction to apply it every 12 h for up to 3 days. The intensity of pain was recorded using a discomfort interval scale (DIS). A decrease in pain was observed 24 h after the application of the desensitizing gel in groups 1 and 2. However, in group 3, the pain persisted, with 46 (69.69%) patients having moderate pain and 14 (21.21%) developing severe pain over time. A significant difference in discomfort level with time was noted in group 1 (p = 0.015) and group 2 (p = 0.036). However, no significant difference was found in group 3 (p = 0.085). It was concluded that both desensitizing agents performed exceptionally well in reducing teeth sensitivity.

Highlights

Vital tooth bleaching, including in-office bleaching and at-home bleaching, has been adopted as an effective and safe method for the esthetic treatment of stained teeth
A total of 201 patients participated in this double-blind randomized controlled trial; patients were randomly and divided into three groups of 67 patients in each
The results of the current study are in agreement with the findings reported by Nanjundasetty et al [10]

Summary

Introduction

Vital tooth bleaching, including in-office bleaching and at-home bleaching, has been adopted as an effective and safe method for the esthetic treatment of stained teeth. The most common side effect of in-office vital bleaching teeth is postoperative sensitivity [2]. Since bleaching occurs by the penetration of free radical ions into the enamel and dentin, it leaves behind micro-porosities that can lead to postoperative sensitivity; this is where desensitizing agents come into action. Several desensitizing agents are available with different mechanisms of action, for instance, some penetrate these micro-porosities and reduce the effects of sensitivity by occluding them, and others work by reducing the ability of nerve endings to block pain [3]. The amorphous calcium phosphate plays a significant role in repairing tooth structure and reducing dentin hypersensitivity [4]. The combination of CPP-ACP provides desensitizing action through protein binding followed by continuous deposition of calcium and phosphate on exposed dentinal tubules [5]. CPP-ACP is reported to be effective in reducing sensitivity after teeth bleaching [6]

Methods

Results

Discussion

Conclusion