Neurosensory analysis of tooth sensitivity during at-home dental bleaching: a randomized clinical trial

Abstract Objective The objective of this study was to evaluate dental sensitivity using visual analogue scale, a Computerized Visual Analogue Scale (CoVAS) and a neurosensory analyzer (TSA II) during at-home bleaching with 10% carbamide peroxide, with and without potassium oxalate. Materials and Methods Power Bleaching 10% containing potassium oxalate was used on one maxillary hemi-arch of the 25 volunteers, and Opalescence 10% was used on the opposite hemi-arch. Bleaching agents were used daily for 3 weeks. Analysis was performed before treatment, 24 hours later, 7, 14, and 21 days after the start of the treatment, and 7 days after its conclusion. The spontaneous tooth sensitivity was evaluated using the visual analogue scale and the sensitivity caused by a continuous 0°C stimulus was analyzed using CoVAS. The cold sensation threshold was also analyzed using the TSA II. The temperatures obtained were statistically analyzed using ANOVA and Tukey's test (α=5%). Results The data obtained with the other methods were also analyzed. 24 hours, 7 and 14 days before the beginning of the treatment, over 20% of the teeth presented spontaneous sensitivity, the normal condition was restored after the end of the treatment. Regarding the cold sensation temperatures, both products sensitized the teeth (p<0.05) and no differences were detected between the products in each period (p>0.05). In addition, when they were compared using CoVAS, Power Bleaching caused the highest levels of sensitivity in all study periods, with the exception of the 14th day of treatment. Conclusion We concluded that the bleaching treatment sensitized the teeth and the product with potassium oxalate was not able to modulate tooth sensitivity.

At-Home Bleaching: Color Alteration, Hydrogen Peroxide Diffusion and Cytotoxicity

This study evaluated the color change, cytotoxicity and hydrogen peroxide (HP) diffusion caused by different home bleaching protocols: 10% carbamide peroxide (CP) for 3 or 1.5 h, 6% hydrogen peroxide for 1.5 h or 45 min. To quantify the peroxide penetration, disks of bovine teeth were placed in artificial pulp chambers (APCs) containing acetate buffer, which was collected for evaluation in a spectrophotometer. For analysis of cytotoxicity, specimens were adapted in APCs containing culture medium, which subsequently was applied on MDPC-23 odontoblast-like cells for 1 h. Cellular metabolism was evaluated by methyl tetrazolium (MTT) assay and the color change of the specimens was analyzed using the CIE L * a * b * system. The data were submitted to ANOVA and Fisher test (α=5%). The treatment with 10% CP for 3 h was the most effective, and 6% HP for 45 min produced the lowest color change. The groups 10% CP for 1.5 h and 6% HP for 45 min had the lowest trans-enamel dentinal HP penetration, and the 6% HP for 1.5 h had the highest. None of the protocols affected cellular metabolism and morphology. In conclusion, reduced peroxide exposure time reduced the bleaching result; higher HP diffusion did not mean higher effectiveness.

Este estudo avaliou a alteração de cor, a citotoxicidade e a difusão de peroxido de hidrogênio ocorridos em diferentes protocolos clareadores caseiros: peróxido de carbamida (PC) 10% por 3 ou 1,5 h; peróxido de hidrogênio (PH) 6% por 1,5 h ou 45 min. Para a quantificação da penetração do peróxido, discos de dentes bovinos foram posicionados em câmaras pulpares artificiais (CPAs) contendo solução tampão de acetato, que foi coletada para avaliação em espectrofotômetro. Para análise da citotoxicidade, os espécimes foram adaptados nas CPAs contendo meio de cultura, que posteriormente foi aplicado sobre células odontoblastóides MDPC-23 por 1 h. O metabolismo celular foi avaliado pelo teste MTT e a alteração de cor dos espécimes foi analisada pelo sistema CIE L*a*b*. Os dados foram submetidos a ANOVA e teste de Fisher (α=5). O tratamento com PC10% por 3 horas foi o mais efetivo, enquanto que o tratamento com PH 6% por 45 min produziu a menor alteração cromática. Os grupos PC 10% por 1,5 h e PH 6% por 45 min causaram a menor penetração trans-amelodentinária do peróxido, e PH 6% por 1,5 h, a maior difusão. Nenhum tratamento alterou o metabolismo celular. A redução do tempo de exposição aos peróxidos comprometeu o resultado clareador; maior penetração de peroxido não significa maior efetividade clareadora.