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Posted by: The Probe 11th May 2018
When done properly, tooth whitening is one of the safest, most effective ways of achieving a pearly-white smile. Indeed, it is the most popular cosmetic dental treatment available.[i]However, some patients will experience tooth sensitivity after a whitening procedure. This can lead to discomfort when consuming hot or cold foods and drinks, and the level of sensitivity that patients experience can vary from mild to extreme pain, with differing effects between patients. Nevertheless, there are steps that practitioners must advise patients to take, in order to minimise tooth sensitivity if it becomes an issue before, during or after treatment.
As you already know, tooth sensitivity is caused by the hydrogen or carbamide peroxide based bleaching agents found in whitening solutions. Bleaching molecules penetrate into the enamel of the tooth, increasing blood flow and pressure in the tooth pulp, which causes varying degrees of pulpitis. For better or worse, all whitening products must strip off the protective protein layer found on the surface of the teeth in order to dissolve chromophore molecules that cause staining – the pores of the dentine are exposed and vulnerable in this instance, and the increased pressure irritates the nerves, making the tooth more sensitive to stimuli in general. Some patients may not be aware of these tooth whitening effects, so it is important that practitioners take the time to educate them in this regard.
Tooth sensitivity during whitening is the most often reported adverse reaction. As a matter of fact, in clinical studies, tooth sensitivity during treatment has been reported in up to 78% of patients, following the use of either at-home tray delivery or in-practice procedures.[ii][iii][iv]One study, for example, showed that 55% of patients treated with 10% carbamide peroxide reported tooth sensitivity, and 20% of those who experienced side effects terminated treatment due to discomfort.[v]Each patient can experience different results using the same product, depending on factors such as the overall condition of their teeth, and the oral hygiene habits they employ.
Mild pulpitis can last for as long as two weeks after tooth whitening, so maintaining the protein pellicle on the surface of the tooth is important in keeping the dentine pores closed off from the oral environment.[vi]Patients should be discouraged from brushing their teeth immediately after whitening or, at the very least, use a soft bristle toothbrush, otherwise they risk increasing exposure of the dentine pores, potentially leading to greater sensitivity. Brushing can also damage the enamel as some bleaching agents are slightly acidic, so teeth should be left to recover for a time – it may be worth recommending that patients avoid particularly hot or cold foods and drinks for the first 24 to 48 hours following treatment.
Tooth sensitivity is particularly common with higher concentrations and prolonged exposure of hydrogen peroxide in professional whitening gels supplied by practitioners – these are applied to trays that are then used to continue treatment at home. In the same way you would ward off a headache, non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen can help manage tooth sensitivity prior to and during this procedure. The effect of these drugs do not last more than a couple of hours so to ensure they work as they should, patients should be advised to take 600mg of Ibuprofen preoperatively in order to decrease tooth sensitivity following in-practice whitening.[vii]Most over-the-counter products do not have as high a concentration of peroxide as practitioner-supplied solutions, so NSAIDs may not be necessary to use in this instance.
The potential for experiencing tooth sensitivity will directly correlate with the strength of the whitener a patient is using. A solution may be to switch to a gel that has a lower concentration of hydrogen peroxide or carbamide peroxide, or reduce the frequency of tooth whitening application.[viii]For the most relief, patients suffering from tooth sensitivity should be advised to apply a desensitising gel to their teeth before whitening, using the same custom-fitted trays supplied by you – ideally, the gel should contain both 5% potassium nitrate and fluoride. Using desensitising toothpaste and pH-balanced mouthwash with the same concentration of these chemicals will coat the teeth, plugging up any open pores and reducing sensitivity. Additionally, the re-mineralising effects of these products will help to improve whitening for an even more effective outcome.v
To achieve the desired effects of tooth whitening, patients must ultimately use the best products on the market. The Enlighten Whitening system, for example, employs a combination of both in-practice whitening and at-home procedures to guarantee a Vita shade B1 for every patient, with minimal sensitivity. Following treatment, Enlighten Whitening’s tooth serum paste can be used as a daily desensitise and enamel repair solution, to help patient’s maintain their teeth at home.
It is crucial that patients are educated on the value of qualified guidance from licensed practitioners. Dentists, after all, will offer their expertise on the most reliable tooth whitening methods, and what products will deliver optimum results, without suffering the pain of sensitivity and discomfort.
For more information, visit www.enlightensmiles.com, email at firstname.lastname@example.org call the team on 0207 424 3270
[i]Consumer Guide To Dentistry. (2018) Popular Cosmetic Dentistry Treatments. Link: https://www.yourdentistryguide.com/ss-cosmetic-dentistry/. [Last accessed: 04.01.18].
M., Littlejohn, S., Fabyanski, J. and Smith, S. (2005) Brushing with a potassium
nitrate dentifrice to reduce bleaching sensitivity. J Clin Dent. 16:17-22.
issues. Br Dent J. 200:371-6.
[v]Leonard, R.H. Jr., Haywood, V.B. and Phillips, C. (1997) Risk factors for developing tooth sensitivity and gingival irritation associated with nightguard vital bleaching. Quintessence International. 28(8):527-534.
[vi]Frey, S. (Unknown) How to Soothe Sensitive Teeth After Whitening. Link: http://www.freysmiles.com/blog/view/how-to-soothe-sensitive-teeth-after-whitening. [Last accessed: 04.01.18].
[vii]Charakorn, P., Cabanilla, L.L., Wagner, W.C., Foong, W.C., Shaheen, J., Pregitzer, R. and Schneider, D. (2009) The Effect of Preoperative Ibuprofen on Tooth Sensitivity Caused by In-Office Bleaching. Operative Dentistry. 34(2):131-135.
[viii]Animated-Teeth.com. (2017) Teeth-whitening side effects. Link: https://www.animated-teeth.com/teeth_whitening/t5a-whitening-side-effects.htm. [Last accessed: 04.01.18].
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