Incidence of Tooth Sensitivity After Home Whitening Treatment

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Incidence of tooth sensitivity after home whitening treatment

MICHAEL G. JORGENSEN and WILLIAM B.CARROLL

J Am Dent Assoc 2002;133;1076-1082

The following resources related to this article are available online atjada.ada.org ( this information is current as of November 16, 2009 !

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C O S M E T I C & RE ST OR A T I VE

C A R E A B S T R A C T

Background. A potential sideefect odentist-dispensed hometooth-

whitening systems is toothsensitivity. The authors

Incidence of tooth

sensitivity afterhome whiteningtreatment

MICHAEL G. JORGENSEN, D.D.S.;WILLIAM B.CARROLL, D.D.S.

uring the past several years, patientshave become increasingly interested inthe esthetic benets available romdental treatment. In periodontics, estheticoutcomes can be enhanced with crownlengthening, edentulous

ridge augmentation or root coverage by means o a

conducted a randomied

prospective double-blind

study to determine the

incidence o tooth sensi-

tivity ater home

whitening

treatment.C

Me!od". !ity adult sub"ects used a

gel containing #$ percent carbamide

pero%ide and &.## percent 'uoride ion(

an additional $& adult sub"ects used a

placebo gel daily or our wee)s. *ach

sub"ect+s plaue inde% score, gingival

recession status, caries status, current

dentirice and smo)ing history were

recorded at baseline. The researchers

evaluated sensitivity wee)ly by

interview or our wee)s.

Re"u#". !ity-our percent o sub"ects

in both test and control groups reported

mild sensitivity( #& percent o test

sub"ects and percent o control sub"ects reported moderate

variety o surgicaltechniues.#,

estorativeprocedures

sensitivity( / percent o test sub"ects and no

that modiy the shape, position or shade oteeth are

control sub"ects reported severe sensitivity.

used widely to accomplish estheticgoals.

0,/ 1hen

a2ensitivity decreased with time( by the

change in tooth position is desired, orthodontictreat-

ment may be preerable toinvasive

second wee), no severe sensitivity

was reported, and by the ourth

wee), no mod-

$a%en"con"%der%ng

restorative procedures.3onrestorativeprocedures such as enamelmicroabra-

erate sensitivity was reported. The

authors ound a statistically signicant

positive corre-sion

$ and toothbleaching4 arepopular lation between reported sensitivity and gin-!o&e

'!%en%

ng

rea&en

"!ou#d (e

ad)%"ed

!a &%#d

oo!

"en"%%)%*

%" a

co&&on

"%dee+ec

and !a

"e)ereoo!

alternatives to restorative treatmentwhen the goal is to achieve a lightershade o enamel. Internal bleachingo endodontically treated teeth isdone to reverse the dar)ening thatreuently occurs in con"unction withpulpal necrosis. 5leaching o vitalteeth has been perormed on alimited basis in the dental o6ce ormany years.7-8

ecently, whitening systemsused by patients at home havebecome increas-

gival recession. They ound no

statistically signicant correlations

between sensitivity and any o the other

recorded parameters. Conc#u"%on".

9ild tooth sensitivity can be e%pected

in appro%imately one-hal o patients who

undergo home whitening treatment

using the gel studied. Appro%imately #&

percent o patients may e%perience

moderate sensitivity, and / percent o

patients may e%perience severe

sensitivity or one to two wee)s. :atients

with gingival recession

D


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"en")%*

popular. ,tooth- appear more e y to e%per ence toot sens -

whitening procedures may adverselyocca"%ona##*

occur".

afect bothhard

#/-#4 and sot#7-

&

tissues

tivity during home whitening treatment.C#%n%ca# I&,#%ca%on". :atients consid-

in the oral cavity, as well as thedental

ering home whitening treatment should be

pulp,#-0 although when they areper-

advised that mild tooth sensitivity is a

ormed properly, their efects generally are mildandtransient. 9ucosal irritation oten is related to traydesign or improper application o bleaching

agents. Ad"ustment o the tray or modication othe techniue used to apply the agent generallyeliminates the irritation.

common side efect and that severe

tooth sensitivity occasionally occurs. I

gingival recession is present, the

probability o tooth sensitivity

increases, and tooth sensitivity tends todecrease as treatment progresses.

-/0 ol. #00, August&& Copyright 2002 American Dental Association. All rights reserved.


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C O S M E T I C &

ol. #00, August &&

#&77

?ne commonly reported potential sideefect o home-use whitening systems istooth sensitivity, which usually is mild andtransient, but occasionally may causesignicant discomort. To date, only

anecdotal reports and retrospective studieshave addressed tooth sensitivity aterwhitening treatment.#0,#@,&,# 1e conducted arandomied prospective double-blind studyto determine the incidence o toothsensitivity ater home whitening treatment.1e hoped that data obtained as a result othis investigation could enhance dentalpractitioners+ ability to more )nowledgeablydiscuss the ris)s and benets o homebleaching with their patients.

MATERIALS AND METHODS

This clinical investigation was approved bythe scientic review committee and by thecommittee or the protection o humansub"ects at the 3aval 9edical enter, 2an=iego. 2ub"ects were recruited rom amongpatients receiving care at the dentaldepartment at the 3aval 9edical enter.Ater a pilot study in which three o #&sub"ects engaged in home whiteningtreatment e%perienced moderate sensitivity,we determined the appropriate sample sieusing power analysis B C .&$D. ?ne hundredadult dental patients par- ticipated in the

study. As recommended by the manuacturer,pregnant patients were not enrolled assub"ects.

Ater obtaining written inormed consentrom each sub"ect, the principal investigatorB1..D perormed the clinical e%amination,abricated a custom bleaching tray withreservoirs and instructed the sub"ect on useo the system and on the data collectionmethod. 2ub"ects were instructed to applyonly enough gel to ll the buccal reservoirspace in the tray and to wear the tray or one

three- to our-hour period daily.

/

:arametersrecorded at baseline included the sub"ect+sage, se%, plaue inde% score,$ gingivalrecession status, caries status, dentiricebeing used and history o tobacco use.2ub"ects were instructed to continue theircustomary oral hygiene regimen and tocontinue using their current dentirice. Theassociate investigator B9.


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C O S M E T I C &

#&7@ ol. #00, August &&

Copyright 2002 American Dental Association. All rights reserved.

tion program Bd5ase randomiationprogram, manuactured at the time othe study by 5orland 2otware orp.,2cotts >alley, ali., now manu- acturedby d5ase Inc., >estal, 3.J.D, we ran-domly determined the contents o the)its. 1e evaluated sensitivity byinterviewing each sub"ect on a wee)lybasis or our wee)s and recorded itusing the ollowing scaleKdno changes noted(d# C mild sensitivityFslight changenoted, nointererence with unction,well-tolerated(d C moderate sensitivityFdenitechangenoted, some intererence withunction, necessity o avoiding certainoods(d0 C severe sensitivityFsub"ectconsidered dis-continuing treatment,ma"or intererence with unction,necessity o avoiding many oods.

The principal investigator conductedall wee)ly evaluations( neither thesub"ect nor the principal investigatorwas aware o the nature o the gel beingused. Ater data collection wascompleted, the code was bro)en, andthe principal investigator issuedbleaching gel to sub"ects who had useda placebo, so that they mightaccomplish tooth whitening.

RES1LTS

Demographic and baseline data.2ub"ect

demographics and baseline data aresummaried in the table. !ity-seven womenand /0 men ranging rom #8 to $$ years oage too) part in the study.

Plaque index scores.:laue inde% scoresvaried rom to /& percent. ?ne sub"ect inthe carbamide pero%ide group had a plaueinde% score o /& percent, and anothersub"ect in that group had a plaue inde%score o 0& percent( all other sub"ects hadplaue inde% scores o less than or eual to& percent, and the average plaue inde%score or all sub"ects was 8.$ percent.

Gingival recession status.Twenty-eight sub-

"ects had no gingival recession( $ sub"ectshad at least one tooth with # millimeter ogingival recession( #4 sub"ects had at least

one tooth with mm o gingival recession(our sub"ects had at least one tooth with 0mm o gingival recession. 1e saw norecession greater than 0 mm. The magnitudeB&-0 mmD and distribution o recession wassimilar or the carbamide pero%ide andplacebo groups.

Dental caries status.1e detected no dental

caries in any sub"ect.Dentifrices used.!iteen diferent dentirices


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TOOTH SENSITI5IT6

-78 Car(a&%de $ero9%de $#ace(o Ge#

TABLE

;AAT*I2TI2 ?! 25SCORES

GINGI5AL

RECESSION?

SMO@ING

HISTOR6:N


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At the conclusion o the study, ater ourwee)s o treatment B!igure /D, our B@ percentDsub"ects using the carbamide pero%ide gel and

three B4 percentD sub"ects using the placebogel reported


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F. M%##%&eer" o G%ng%)a# Rece""%on

whitening should be inormed oits potential ris)s and benets.=entist- supervised home-usewhitening systems have beenshown to be sae and efective,

resulting in only mild, transientchanges in gingival and pulpaltissues. An agent commonly

0

-

3

4

used or home whitening is car-bamide pero%ide inconcentrations o #& to &percent. Adverse efects o this

irritation and tooth sensitivity.gival irritation can be minimied

3 reducing contact o the bleachingwith gingival tissue. This is bestaccomplished by adding a thin

o acrylic to the acial suraces o- 3 4 2 teeth on the plaster cast beore

adapting the tray material,WEE@S O

Incidence of Tooth Sensitivity After Home Whitening Treatment

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