Preemptive use of etodolac on tooth sensitivity after in-office bleaching: a randomized clinical trial

Abstract Purpose: This study determined the effectiveness of the preemptive administration of etodolac on risk and intensity of tooth sensitivity and the bleaching effect caused by in-office bleaching using 35% hydrogen peroxide. Material and methods: Fifty patients were selected for this tripleblind, randomized, crossover, and placebo-controlled clinical trial. Etodolac (400 mg) or placebo was administrated in a single-dose 1 hour prior to the bleaching procedure. The whitening treatment with 35% hydrogen peroxide was carried out in two sessions with a 7-day interval. Tooth sensitivity was assessed before, during, and 24 hours after the procedure using the analog visual scale and the verbal rating scale. Color alteration was assessed by a bleach guide scale, 7 days after each session. Relative risk of sensitivity was calculated and adjusted by session, while overall risk was compared by the McNemar's test. Data on the sensitivity level of both scales and color shade were subjected to Friedman, Wilcoxon, and Mann-Whitney tests, respectively (α=0.05). Results: The preemptive administration of etodolac did not affect the risk of tooth sensitivity and the level of sensitivity reported, regardless of the time of evaluation and scale used. The sequence of treatment allocation did not affect bleaching effectiveness, while the second session resulted in additional color modification. The preemptive administration of etodolac in a single dose 1 hour prior to in-office tooth bleaching did not alter tooth color, and the risk and intensity of tooth sensitivity reported by patients. Conclusion: A single-dose preemptive administration of 400 mg of etodolac did not affect either risk of tooth sensitivity or level of sensitivity reported by patients, during or after the in-office tooth bleaching procedure.

Fluoride-Releasing Materials to Prevent White Spot Lesions around Orthodontic Brackets: A Systematic Review

Abstract The relation between orthodontic fixed appliances use and enamel demineralization is well established. Different preventive approaches have been suggested to this problem, but controversy remains about which is the best. The aim of this study was to perform a systematic review of clinical trials that investigated the effectiveness of materials containing fluorides to lute brackets or cover the bonding interface in order to inhibit the development and progression of white spot lesions. The null hypothesis was that fluoride materials do not affect the incidence of white spot lesions around brackets. A MEDLINE search was conducted for randomized clinical trials evaluating the development of white spot lesions in patients using fixed orthodontic appliances, followed by meta-analysis comparing the results for patients for whom dental materials containing fluorides were used (experimental group) to those for whom these materials were not used (control group). The pooled relative risk of developing white spot lesions for the experimental group was 0.42 (95% confidence interval: 0.25 to 0.72); hence, when fluoride-releasing materials are used, the patient has 58% less risk of white spot lesion development. Regarding white spot lesion extent, the pooled mean difference between the experimental and control groups was not statistically significant (-0.12; 95% confidence interval: -0.29 to 0.04). In conclusion, the results of the present systematic review suggest that fluoride-releasing materials can reduce the risk of white spot lesions around brackets. However, when white spot lesions had already occurred, there is no evidence that fluoride-releasing materials reduce the extent of these lesions.

Resumo A relação entre o uso de aparelhos ortodônticos fixos e desmineralização do esmalte é bem estabelecida. Diferentes abordagens preventivas têm sido sugeridas para este problema, mas ainda permanece controverso qual é o melhor. O objetivo deste estudo foi realizar uma revisão sistemática de ensaios clínicos que investigaram a efetividade de materiais contendo fluoretos para cimentação de bráquetes ou cobrindo a interface de união buscando inibir o desenvolvimento e progressão de lesões de mancha branca. A hipótese nula foi que materiais fluoretados não afetam a incidência de lesões de mancha branca em volta de bráquetes. Uma busca no MEDLINE foi conduzida para ensaios clínicos controlados avaliando o desenvolvimento de lesões de mancha branca em pacientes usando aparelhos ortodônticos fixos, seguido por meta-análise comparando os resultados de pacientes em que materiais usando fluoretos foram utilizados (grupo experimental) com aqueles em que tais materiais não foram usados. O risco relativo agrupado de desenvolvimento de lesões de mancha branca para o grupo experimental foi 0,42 (95% de intervalo de confiança: 0,25 a 0,72); enquanto que, quando materiais liberando fluoretos foram utilizados, o paciente teve 58% menos risco de desenvolver lesões de mancha branca. Em relação à extensão das lesões de mancha branca, a diferença média agrupada entre os grupos experimental e controle não foi estatisticamente significante (-0,12; 95% de intervalo de confiança: -0,29 a 0,04). Em conclusão, os resultados da presente revisão sistemática sugerem que materiais que liberam fluoretos podem reduzir o risco de lesões de mancha branca em volta de bráquetes. Entretanto, quando lesões de mancha branca já ocorreram, não há evidência que materiais que liberam fluoretos reduzem a extensão da lesão.