Manejo da sensibilidade dental advinda do clareamento em consultório e do protocolo de clareamento caseiro

Abstract

The objectives of this study were: 1) To evaluate the effect of the application of desensitizing gel based on potassium nitrate and sodium fluoride applied before vs before and after in office bleaching, on TS (tooth sensitivity) and on the effectiveness of bleaching, through a triple-blind randomized controlled trial (RCT), split mouth; 2) Answer the following PICO question through a systematic review: “Are the risk and intensity of tooth sensivity and bleaching efficacy different between adult patients undergoing at-home bleaching using trays with reservoirs and those using trays without reservoirs?” and 3) To evaluate, through a randomized, blinded, split mouth trial, whether the use of reservoirs in at-home bleaching trays is equivalent to trays without the presence of reservoirs in the color change, TS and gingival irritation. For study 1, 90 patients with canines of color A2 or darker were selected and randomly divided into two groups: application of desensitizing gel only before vs before and after in-office bleaching with HP (hydrogen peroxide) 35%, for 10 min. Dental sensitivity was assessed immediately and 1 h, 24 h and 48 h after bleaching and recorded by the patients themselves using a 5-point numerical scale (NRS) and visual analog (VAS 0-10). Color was assessed using visual scales and spectrophotometer initially, one week after each session and one month after the end of the procedure. For study 2, a comprehensive survey was conducted without restrictions, in databases and gray literature, where only RCTs were included and evaluated using the Cochrane Collaboration's Risk of Bias (RoB) tool. Due to the low quality of primary studies and high risk of bias, it was not possible to perform the meta-analysis and a well-designed RCT was suggested to answer this research question, which was carried out in study 3, where 46 patients with A2 or darker ones were selected to perform at-home bleaching with 10% CP (carbamide peroxide) gel, and in one half of the arch the trays had reservoirs and in the other half they did not. Tooth sensitivity during bleaching was assessed using VAS and NRS scales, a questionnaire on gingival irritation and the color was assessed using visual scales and a spectrophotometer. It was observed after one month, in both RCTs performed, significant and similar bleaching between groups (p> 0.45 for study 1 and p <0.01 for study 3) and in relation to TS, there was no statistically significant difference between the groups (with OR = 0.25; 95% CI 0.005 to 2.52; p = 0.37 for study 1 and OR = 0.8; 95% CI 0.2 to 3.0; p = 1.0 for study 3). It can be concluded that the application of desensitizing agent did not influence the efficacy of in-office bleaching, but it was not efficient in reducing TS, when applied before the bleaching, or before and after it. In addition, the at-home bleaching protocol with 10% CP with reservoirs is equivalent in color change, TS and gingival irritation to that of non-reservoir, as observed through the RCT. Therefore, there is no evidence to conclude about the effectiveness of the presence or absence of reservoirs in the bleaching trays.