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Neutral bleaching gel results in similar whitening effect and postoperative tooth sensitivity as acid bleaching gel
JADA+ CONTENT
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
NEUTRAL BLEACHING GEL RESULTS IN SIMILAR WHITENING EFFECT AND POSTOPERATIVE TOOTH SENSITIVITY AS ACID BLEACHING GEL
Loguercio AD, Servat F, Stanislawczuk R, et al. Effect of acidity of in-office bleaching gels on tooth sensitivity and whitening: a two-center double-blind randomized clinical trial [published online ahead of print March 17, 2017]. Clin Oral Investig. http://dx.doi. org/10.1007/s00784-017-2083-5. Key words. General dentistry; acidic gel; in-office bleaching; neutral gel; tooth sensitivity; whitening effectiveness; randomized clinical trial. Clinical relevance. Patients often request tooth bleaching treatments. Although in-office bleaching offers advantages that at-home bleaching does not, the higher concentration of the hydrogen peroxide used in in-office bleaching may increase the risk of developing and the intensity of postoperative tooth sensitivity (TS). Manufacturers have developed new bleaching gels to reduce these side effects, but the gels have to be tested before manufacturers can make such claims. Study summary. The researchers conducted a randomized clinical trial (RCT) to compare the effect of 2 bleaching gels on tooth whitening and sensitivity. They enrolled 54 participants* and divided the participants’ teeth into hemiarches. One hemiarch underwent 2 sessions of bleaching with an acid gel hydrogen peroxide (AGHP),y and the other underwent bleaching with neutral gel hydrogen peroxide (NGHP).z The risk of developing TS was 50% after applying AGHP and 28% after applying NGHP.§ The intensity of the TS was statistically higher after AGHP application than after
NGHP application during and up to 1 hour after application.{ From 1 to 48 hours after treatment, there were no statistical differences in TS intensity between the treatments. The color change was not statistically different when researchers compared the bleaching gels. Strengths and limitations. This RCT had a low risk of bias. The researchers assigned the hemiarches to receive AGHP or NGHP following adequate standards. This and the split-mouth nature of the study, in which participants were their own controls, minimized the risk of bias owing to imbalances of prognostic factors that may have affected the outcome. The data collectors and participants were blinded to the intervention, minimizing potential bias in the outcome assessment. In addition, data collectors and outcome assessors were calibrated, and there were no losses to follow-up. The results showed that the risk of developing TS is statistically lower when using NGHP than when using ACHP. However, although there were statistical differences between the gels up to 1 hour after treatment, the pain intensity was low on average in both groups. Therefore, the clinical importance of the pain reduction when using NGHP was questionable, and this RCT alone does not provide evidence of the benefit of using NGHP instead of ACHP. n http://dx.doi.org/10.1016/j.adaj.2017.04.004 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * Mean age, z 24 years; 37% female. y Acid gel 35% hydrogen peroxide, Pola Office (SDI). z Neutral gel 37.5% hydrogen peroxide, Pola Officeþ (SDI). § Risk ratio, 0.57; 95% confidence interval, 0.33 to 0.92. { Mean (standard deviation) tooth sensitivity intensity after acid gel hydrogen peroxide bleaching, 1.9 (2.1); mean (standard deviation) tooth sensitivity intensity after neutral gel hydrogen peroxide bleaching, 0.9 (1.6). Pain was reported by the participants using a visual analog scale ranging from 0 through 10, in which 0 represents no pain and 10 represents the highest pain intensity.
JADA 148(6) http://jada.ada.org
June 2017 e79
This review does not in any way substitute for professional advice and should not be regarded as clinical guidance. As always, any evidence should be carefully considered by clinician and patient to ensure that in their views, all potentially desirable consequences outweigh all potentially undesirable consequences.
JADA+ CLINICAL SCANS
Romina Brignardello-Petersen, DDS, MSc, PhD
NEUTRAL BLEACHING GEL RESULTS IN SIMILAR WHITENING EFFECT AND POSTOPERATIVE TOOTH SENSITIVITY AS ACID BLEACHING GEL
Loguercio AD, Servat F, Stanislawczuk R, et al. Effect of acidity of in-office bleaching gels on tooth sensitivity and whitening: a two-center double-blind randomized clinical trial [published online ahead of print March 17, 2017]. Clin Oral Investig. http://dx.doi. org/10.1007/s00784-017-2083-5. Key words. General dentistry; acidic gel; in-office bleaching; neutral gel; tooth sensitivity; whitening effectiveness; randomized clinical trial. Clinical relevance. Patients often request tooth bleaching treatments. Although in-office bleaching offers advantages that at-home bleaching does not, the higher concentration of the hydrogen peroxide used in in-office bleaching may increase the risk of developing and the intensity of postoperative tooth sensitivity (TS). Manufacturers have developed new bleaching gels to reduce these side effects, but the gels have to be tested before manufacturers can make such claims. Study summary. The researchers conducted a randomized clinical trial (RCT) to compare the effect of 2 bleaching gels on tooth whitening and sensitivity. They enrolled 54 participants* and divided the participants’ teeth into hemiarches. One hemiarch underwent 2 sessions of bleaching with an acid gel hydrogen peroxide (AGHP),y and the other underwent bleaching with neutral gel hydrogen peroxide (NGHP).z The risk of developing TS was 50% after applying AGHP and 28% after applying NGHP.§ The intensity of the TS was statistically higher after AGHP application than after
NGHP application during and up to 1 hour after application.{ From 1 to 48 hours after treatment, there were no statistical differences in TS intensity between the treatments. The color change was not statistically different when researchers compared the bleaching gels. Strengths and limitations. This RCT had a low risk of bias. The researchers assigned the hemiarches to receive AGHP or NGHP following adequate standards. This and the split-mouth nature of the study, in which participants were their own controls, minimized the risk of bias owing to imbalances of prognostic factors that may have affected the outcome. The data collectors and participants were blinded to the intervention, minimizing potential bias in the outcome assessment. In addition, data collectors and outcome assessors were calibrated, and there were no losses to follow-up. The results showed that the risk of developing TS is statistically lower when using NGHP than when using ACHP. However, although there were statistical differences between the gels up to 1 hour after treatment, the pain intensity was low on average in both groups. Therefore, the clinical importance of the pain reduction when using NGHP was questionable, and this RCT alone does not provide evidence of the benefit of using NGHP instead of ACHP. n http://dx.doi.org/10.1016/j.adaj.2017.04.004 Copyright ª 2017 American Dental Association. All rights reserved.
Address correspondence to Dr. Brignardello-Petersen at e-mail [email protected]. Disclosure. Dr. Brignardello-Petersen did not report any disclosures. * Mean age, z 24 years; 37% female. y Acid gel 35% hydrogen peroxide, Pola Office (SDI). z Neutral gel 37.5% hydrogen peroxide, Pola Officeþ (SDI). § Risk ratio, 0.57; 95% confidence interval, 0.33 to 0.92. { Mean (standard deviation) tooth sensitivity intensity after acid gel hydrogen peroxide bleaching, 1.9 (2.1); mean (standard deviation) tooth sensitivity intensity after neutral gel hydrogen peroxide bleaching, 0.9 (1.6). Pain was reported by the participants using a visual analog scale ranging from 0 through 10, in which 0 represents no pain and 10 represents the highest pain intensity.
JADA 148(6) http://jada.ada.org
June 2017 e79