Gingival Sensitivity Research Articles

Tooth Sensitivity After Dental Bleaching With a Desensitizer-containing and a Desensitizer-free Bleaching Gel: A Systematic Review and Meta-analysis.

A systematic review and meta-analysis were performed to evaluate the risk and intensity of tooth sensitivity (TS) after dental bleaching with a desensitizer-containing and a desensitizer-free bleaching gel in adult patients. Color change and risk of gingival sensitivity was also evaluated. A comprehensive search was performed MEDLINE via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO), EMBASE and Cochrane Library, and System for Information on Grey Literature in Europe (SIGLE) without restrictions to identify randomized clinical trials. Abstracts from the annual conference of the International Association for Dental Research (1990-2016), unpublished and ongoing trials registries, dissertations, and theses were also searched. The quality of the evidence was rated using the Grading of Recommendations: Assessment, Development and Evaluation (GRADE) approach. After duplicates were removed, 1352 articles were identified. After title and abstract screening, only 47 studies remained for qualitative evaluation. Most of the studies had unclear risk of bias. No difference between groups were observed for the risk ratio of TS (risk ratio = 0.99; 95% confidence interval [CI] = 0.74-1.33); intensity of TS (standardized difference in means [SMD] = 0.04; 95% CI = 0.79-0.70); color change in shade guide units (SMD - 0.04; 95% CI = 0.50-0.42); color change in ΔE* (SMD = 0.41 (95% CI = 0.07-0.89); and risk ratio of gingival irritation (SMD = 1.05; 95% CI = 0.81-1.36). Except for the risk of TS, graded as moderate quality of evidence, all other outcomes were rated as low and very low quality. Incorporating desensitizers in the bleaching gel did not reduce the risk of TS, and the quality of this evidence was considered moderate. On the other hand, the intensity of TS, color change, and risk of gingival irritation was similar between groups, but the quality of the evidence for these outcomes was graded as low or very low, thus reducing the level of confidence in these outcomes.

Influence of Isolation Method of the Operative Field on Gingival Damage, Patients' Preference, and Restoration Retention in Noncarious Cervical Lesions.

To evaluate the retention rates, gingival damage, and patients' preferences for adhesive restorations in noncarious cervical lesions (NCCL) associated with the use of rubber dam vs cotton rolls/retraction cord isolation. Thirty patients having one pair of similar NCCL on opposing sides of the same arch were enrolled in this study. A total of 60 restorations were placed. In each patient one restoration was placed under rubber dam isolation (RD) using dental retainers, and the other one was placed using cotton rolls/retraction cord (CR/RC) isolation. Dental residents with more than 10 years of clinical experience restored all NCCL using the same adhesive (GO!, SDI Limited, Bayswater, Australia) and composite resin (Ice, SDI). The patients' preferences were recorded. The gingival condition (bleeding, gingival laceration, and gingival insertion level) was evaluated immediately after the restorative procedure and after one week. Gingival sensitivity was also assessed one week after the end of the restorative procedures. The clinical time required to perform each restoration was recorded. The performance of the restorations was assessed using the FDI criteria at baseline and six, 12, and 18 months after clinical service. All criteria evaluated were submitted to appropriate statistical analysis (α=0.05). The retention rates of the restorations at each recall time were not affected by the isolation method (p>0.05). No significant difference between isolation methods was found in regard to patients' preferences (p=0.86), gingival bleeding (p=0.57), laceration (p=0.64), insertion (p>0.52), gingival sensitivity (p=0.52), or chairside time (p=0.77). The use of CR/RC was shown to be similar to the use of RD in terms of retention rates, patient's preference, gingival damage, and chairside time for adhesive restorations in NCCL.

Differential changes in gingival somatosensory sensitivity after painful electrical tooth stimulation.

We aimed to evaluate the effect of painful tooth stimulation on gingival somatosensory sensitivity of healthy volunteers in a randomized, controlled design. Thirteen healthy volunteers (six women, seven men; 28.4 ± 5.0 years) were included for two experimental sessions of electrical tooth stimulation: painful tooth stimulation and tooth stimulation below the sensory threshold (control). Eight of the human subjects participated in a third session without tooth stimulation. In all sessions, the somatosensory sensitivity of the gingiva adjacent to the stimulated tooth was evaluated with a standardized battery of quantitative sensory tests (QST) before, immediately after and 30 min after tooth stimulation. Painful tooth stimulation evoked significant decreases in warmth and heat pain thresholds (P < 0.001) as well as pressure pain thresholds (increased sensitivity) (P = 0.024) and increases in mechanical detection thresholds (decreased sensitivity) (P < 0.050). Similar thermal threshold changes (P < 0.019) but no mechanical changes were found after tooth stimulation below the sensory threshold (P > 0.086). No QST changes were detected in the session without tooth stimulation (P > 0.060). In conclusion, modest increased gingival sensitivity to warmth, painful heat and pressure stimuli as well as desensitization to non-painful mechanical stimulation were demonstrated after tooth stimulation. This suggests involvement of competing heterotopic facilitatory and inhibitory mechanisms. Furthermore, stimulation below the sensory threshold induced similar thermal sensitization suggesting the possibility of activation of axon-reflex-like mechanisms even at intensities below the perception threshold. These findings may have implications for interpretation of somatosensory results in patients with chronic intraoral pain.

Clinical comparison between two bleaching techniques: a 180-day follow-up study.

The aim of this clinical study was to compare tooth shade, color rebound, and tooth sensitivity after using either a combined bleaching technique (CBT) or a deep bleaching technique (DBT) to lighten stained teeth. CBT is a two-stage bleaching process consisting of an initial in-office bleaching treatment session using 35% hydrogen peroxide (HP) followed by a 7-day at-home bleaching session with 6% HP. DBT involves a 7-day at-home bleaching session with 6% HP prior to the initiation of a two-stage CBT process. Thirty-six volunteers were recruited in this split-mouth design randomized clinical trial. Tooth shade was objectively evaluated by using a spectrophotom-eter and shade guide tabs. Tooth and gingival tissue sensitivity were self-evaluated by recording any tooth or gingival sensitivity on a daily basis. Both CBT and DBT presented satisfactory whitening effects. Although DBT resulted in a better shade change, the two bleaching techniques had a similar rebound effect. CBT was associated with a lower frequency of tooth sensitivity, but both bleaching techniques can be considered safe from a clinical standpoint. The results indicate that CBT might potentially be preferred to whiten teeth, thus promoting the shade change, and avoiding gingival and tooth sensitivity.

A Clinical Study of the Effectiveness of a Light Emitting Diode System on Tooth Bleaching

The purpose of this study was to evaluate the efficacy of a Light Emitting Diode (LED) System (BriteWhite) on tooth bleaching. Method: eeth 11 and 21 of twenty one subjects were treated in the chair with a LED light and 44% carbamide peroxide gel, followed by an at-home treatment period of 14 days with 35% carbamide peroxide. The color of the teeth was measured with a spectrophotometer (L*; a*; b*) before treatment (control) and after the above mentioned two stages. The subjects were also instructed to note tooth and gingival sensitivity. Results: For the L* component a statistically significant difference (p<0.05) between base-line and directly after the LED treatment stage (whiter) was found and a complete relapse was found after the 14 day at-home treatment period. The b* component showed statistically significant differences (p<0.05) between base-line and the LED stage (less yellow more blue), with a further significant color improvement after the 14 day treatment period. For the a* component (green to red) no statistically significant change was (p>0.05) found throughout the study (Wilcox on Signed Rank Sum Test). A major color change of 1.8 units (ΔEab) was found after the LED treatment stage with only a further small 0.2 unit improvement after the 14 day at-home treatment stage. Tooth and gingival sensitivity scores were low (below mild) throughout the treatment stages. Conclusion: A major tooth color increase was found after the in-office LED/gel treatment stage and only an insignificant further improvement was noted after the additional 14 day at-home treatment period. Only low tooth and gingival sensitivity scores were found. A slight increase in both the sensitivity and gingival scores after the LED/gel activated stage could be observed. Overall the total color increase was low.

Comparison of Two At-home Whitening Products of Similar Peroxide Concentration and Different Delivery Methods

This study compared the whitening efficacy, side effects, and patients' preferences/perceptions of two whitening systems of similar peroxide concentration but different formulation and delivery methods. The tooth color change of 24 participants was measured using a shade guide (BSG) and a spectrophotometer (ES). Color difference was calculated: ΔE* = [(ΔL*)(2) + (Δa*)(2) + (Δb*)(2)](1/2). One whitening treatment was randomly applied to the right or left maxillary anterior teeth and the other was applied to the contralateral teeth, at-home with 35% carbamide peroxide in a tray (TW) or with 14% hydrogen peroxide in strips (WS). The tooth color was evaluated at baseline, 15 and 30 days (15 days postwhitening). Participants rated their tooth and soft tissue sensitivity (1-10 scale) and completed a questionnaire on their preferences. Results were analyzed by repeated measurement regression analysis/Tukey and Mann-Whitney (p<0.05). At 15 days, the teeth treated with TW and WS presented ΔE* = 7 and 6, respectively (ΔBSG=3 for both), and at 30 days, they presented ΔE* = 7.5 and 6.5, respectively (ΔBSG=3 for both). There was no significant difference in tooth and soft tissue sensitivity between treatments. No participant reported tooth and gingival sensitivity at the postwhitening appointment. Of the participants, 83% preferred the TW over WS. Both ΔE* and ΔBSG showed no significant difference in tooth color change between TW and SW at either time point. By the end of the study no participants reported tooth and gingival sensitivity. Participants preferred TW over SW.

One‐Year Clinical Evaluation of the Efficacy of a New Daytime At‐Home Bleaching Technique

The aim of this study was to compare the clinical efficacy and side effects of a new daytime at-home bleaching technique (28% carbamide peroxide [CP] gel) with the overnight application of 10% CP and to determine the change of tooth color 1-year post-treatment. Twenty healthy volunteers were assigned to one of two sample groups of 10. All participants employed one of the two at-home bleaching systems: (1) the new daytime at-home bleaching system including 28% CP gel with a non-custom-fit tray (Meta Tray, Remedent, Deurle, Belgium) for 20 minutes, and (b) the conventional overnight at-home bleaching system with a 10% CP gel and a custom-fit tray (Opalescence PF, Ultradent, South Jordan, UT, USA) for 6 to 8 hours. Digital images and CIE (International Commission on Illumination) L*, a*, and b* spectrophotometric measurements were taken at baseline, after the bleaching treatment and 1-year post-treatment. Tooth and gingival sensitivity was measured with a specially designed 4-point scale. Significant differences were found in L*, a*, and b* values, between initial and post-treatment, for both bleaching systems (p < 0.05). However, no significant difference was detected between post-treatment and 1-year follow-up. The bleaching effectiveness of Opalescence PF was found to be superior to that of Meta Tray, considering the color parameter of DeltaE (p < 0.05). Meta Tray provoked less tooth sensitivity (p < 0.05), however gingival sensitivity appeared more in this group (p < 0.05). Within the limitations of this study, it can be concluded that the new daytime at-home bleaching system tested (Meta Tray) produced significant bleaching effects. However, the clinical efficacy of the overnight bleaching system was found to be superior to the daytime at-home bleaching system evaluated in this study. The whitening effect remained similar 1-year after the bleaching treatment for both at-home bleaching systems. CLINICAL SIGNIFICANCE Although the new daytime at-home bleaching system tested exhibited significant bleaching effects, overnight bleaching with a 10% CP gel resulted in a higher bleaching effectiveness than this new system. Although the participants using the new bleaching system exhibited less tooth sensitivity probably because of the reduced contact time of bleaching gel with tooth surfaces, the application of the bleaching agent with a non-customized tray provoked more gingival sensitivity in this group.

Different light-activated in-office bleaching systems: a clinical evaluation

The aim of this clinical study was to evaluate the efficiency of in-office bleaching systems with different light sources for color change and possible side effects such as tooth sensitivity and gingival irritations. Forty healthy volunteers aged 18 years and older (average age 27.3 years), having all their natural healthy teeth in shade A3 or darker on the Vita shade guide, with no restorations on the buccal surfaces and no tooth sensitivity, participated in this study. Participants were randomly assigned to four groups of ten volunteers. Group 1 received bleaching without light activation (Opalescence Xtra Boost, Ultradent); group 2 received bleaching (Laser White 10, Biolase) with a diode laser (810 nm, 10 W/ Laser Smile, Biolase) activation; group 3 received bleaching treatment (Remewhite, Remedent) with a plasma arc lamp (400-490 nm, 2800 mV/cm(2), Remecure CL15), and group 4 received bleaching with a light emitting diode (LED) lamp (By White accelerator, Ensodent) according to the manufacturers' recommendations. The shade was assessed with a classical Vita shade guide (Vita Zahnfabrik) and a digital spectrophotometer (Vita Easy Shade, Vident). The color of teeth was scored at baseline and 1 week after bleaching. Any side effects on teeth or gingiva was recorded by visual analog scale. Results were analyzed statistically, by one-way analysis of variance (ANOVA), Kruskal-Wallis, and Mann-Whitney U tests with Bonferroni correction. All the bleaching techniques resulted in shade change. No significant differences were found in the color change among the four groups with shade guide assessment (P > 0.05), but spectrophotometer readings exhibited significant differences among the groups (P < 0.05). The overall shade change values expressed as DeltaL, Deltaa, Deltab, DeltaE for group 2 was significantly higher than those for the other groups (P < 0.05). Group 2 also showed lower tooth and gingival sensitivity scores than those of the other groups (P < 0.05). All techniques resulted in shade change. Although the shade guide evaluation did not exhibit any differences among the bleaching treatment groups, spectrophotometer readings showed different findings. The results obtained by the two methods of evaluation of shade change used in this study were different from each other. Bleaching with diode laser resulted in less tooth and gingival sensitivity than the other bleaching systems. in-office bleaching systems used with or without light, lead to a shade change. As bleaching with diode laser resulted in less tooth and gingival sensitivity, it might be preferred among in-office bleaching systems.

EFFECTIVITY OF TWO BLEACHING AGENT OF 10% CARBAMIDE PEROXIDE WITH AND WITHOUT POTASSIUM NITRATE-FLUORIDE (CLINICAL STUDY)

Tooth bleaching has become a popular treatment for esthetic improvement in dentistry. There are several 10% carbamide peroxide bleaching agents that are available in Indonesia which contained potassium nitrate-fluoride or without potassium nitrate-fluoride. However, there was no clinical report about these products in Indonesia. This study was conducted to compare the effectiveness of two bleaching and sensitivity of tooth and gingiva. Sixty-four participants were divided into 2 groups. The first group was treated with bleaching agent that contained potassium nitrate-fluoride (Opalescence PF, Ultradent). Bleaching treatment was done for 6-8 hours per night over a 2 week-period. Evaluations were performed at the baseline and at 3, 7, 14 day afterwards. Color change was measured using a value-ordered Vita classic shade guide; tooth and gingival sensitivity were examine using Electric Pulp Tester, Gingival Index and patient log. The results showed that there were no statistical differences in degree of color change between the two products. The mean color change after 2 weeks was 7-8 tabs lighter than baseline. Also there was no statistical difference in tooth and gingival sensitivity between the products. It can be concluded that 10% carbamide peroxide containing potassium nitrate-fluoride has the same effectiveness compared to other agent without potassium nitrate-fluoride for tooth color change and tooth and gingival sensitivity.

A CLINICAL EVALUATION OF CARBAMIDE PEROXIDE AND HYDROGEN PEROXIDE WHITENING AGENTS DURING DAYTIME USE

Vital tooth bleaching for esthetic reasons has gained in popularity during the last few years. However, few studies have investigated the efficacy of daytime bleaching products. The purpose of this double-blind in vivo study was to evaluate the efficacy of 20 percent carbamide peroxide, or CP, and 7.5 percent hydrogen peroxide, or HP, during daytime use. The degree of color change, any color relapse, and tooth or gingival sensitivity were evaluated. Twenty-four patients participated in this study. The bleaching gels were randomly applied to the right and left maxillary anterior teeth. Patients were shown how to place the two bleaching agents in a custom tray for one hour, twice a day for two weeks. Patients returned in one, two, three, six and 12 weeks for color evaluation with the colorimeter and shade guides as well as to have color slide photographs taken. The authors evaluated sensitivity by asking the patients to record daily for 21 days any tooth or gingival sensitivity they experienced. Use of the 20 percent CP resulted in significantly more lightness than the 7.5 percent HP during the first 14 days of the study, but at the end of the study, there was no significant difference between products with regard to tooth lightness. In addition, the authors found no statistically significant difference between products with regard to gingival or tooth sensitivity. Both CP and HP are effective at-home bleaching agents when daytime bleaching is preferred. Dentists who choose to use daytime bleaching can select either CP or HP.