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Effect of photobiomodulation with low-level laser therapy combined with potassium nitrate on controlling post-bleaching tooth sensitivity: clinical, randomized, controlled, double-blind, and split-mouth study

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Abstract

Objectives

To evaluate the effect of photobiomodulation with low-level laser therapy (PBM-LLLT) combined with 5% potassium nitrate (KNO3) on controlling tooth sensitivity (TS) after in-office tooth bleaching.

Materials and methods

Fifty volunteers were selected based on the inclusion and exclusion criteria and were randomly allocated into four groups: G1 (control): placebo gel application, 35% hydrogen peroxide bleaching (HP35) and mock PBM-LLLT without light emission; G2: placebo gel application, bleaching with HP35 and PBM-LLLT; G3: application of KNO3, bleaching with HP35 and mock PBM-LLLT; and G4: application of KNO3, bleaching with HP35 and PBM-LLLT. A pain assessment questionnaire was used to evaluate TS during the 21 days of treatment. The Friedman test was used for intragroup analysis, and the Wilcoxon and Mann-Whitney tests were used for intergroup comparisons.

Results

The intragroup evaluation showed significant differences among the evaluation times in all groups (p ≤ 0.05). The highest pain sensitivity levels were recorded on the 1st, 8th, and 15th days. In G1, TS manifested for up to 3 days after each bleaching session, while G2, G3, and G4 presented TS only on the days of the bleaching sessions. Intergroup analysis showed that TS manifestation differed significantly between G1 and the other groups (p ≤ 0.05) but did not differ significantly among G2, G3, and G4 (p ≥ 0.05).

Conclusion

PBM-LLLT and KNO3 are effective at reducing pain sensitivity after tooth bleaching, but no synergistic effect between these treatments was observed for the different evaluation periods.

Clinical relevance

The effect of PBM-LLLT combined with KNO3 on post-bleaching tooth sensitivity is similar to their individual use alone.

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References

  1. Roberson TM, Heymann HO, Swift EJ (2002) Sturdevants art and science of operative dentistry, 4th edn. Elsevier, Missouri, pp 605–612

    Google Scholar 

  2. Tin-Oo MM, Saddki N, Hassan N (2011) Factors influencing patient satisfaction with dental appearance and treatments they desire to improve aesthetics. BMC Oral Health 23:11–16. https://doi.org/10.1186/1472-6831-11-6

    Article  Google Scholar 

  3. Kwon SR, Wertz PW (2015) Review of the mechanism of tooth whitening. J Esthet Restor Dent 27:240–257. https://doi.org/10.1111/jerd.12152

    Article  PubMed  Google Scholar 

  4. Kawamoto K, Tsujimoto Y (2004) Effects of the hydroxyl radical and hydrogen peroxide on tooth bleaching. J Endod 30:45–50. https://doi.org/10.1097/00004770-200401000-00010

    Article  PubMed  Google Scholar 

  5. Patri G, Agnihotri Y, Rao SR et al (2013) An in-vitro spectrophotometric analysis of the penetration of bleaching agent into the pulp chamber of intact and restored teeth. J Clin Diagn Res 7:3057–3059. https://doi.org/10.7860/JCDR/2013/7589.3852

    Article  PubMed  PubMed Central  Google Scholar 

  6. Benetti F, Gomes-Filho JE, Ferreira LL, Ervolino E, Briso ALF, Sivieri-Araújo G, Dezan-Júnior E, Cintra LTA (2017) Hydrogen peroxide induces cell proliferation and apoptosis in pulp of rats after dental bleaching in vivo. Arch Oral Biol 81:103–109. https://doi.org/10.1016/j.archoralbio.2017.04.013

    Article  PubMed  Google Scholar 

  7. Cintra LT, Benetti F, Facundo ACS et al (2013) The number of bleaching sessions influences pulp tissue damage in rat teeth. J Endod 39:1576–1580. https://doi.org/10.1016/j.joen.2013.08.007

    Article  PubMed  Google Scholar 

  8. Cintra LT, Benetti F, Ferreira LL et al (2016) Penetration capacity color alteration and biological response of two in office bleaching protocols. Braz Dent J 27:169–175. https://doi.org/10.1590/0103-6440201600329

    Article  PubMed  Google Scholar 

  9. Soares DG, Basso FG, Hebling J, de Souza Costa CA (2015) Immediate and late analysis of dental pulp stem cells viability after indirect exposition to alternative in office bleaching strategies. Clin Oral Investig 19:1013–1020. https://doi.org/10.1007/s00784-014-1321-3

    Article  PubMed  Google Scholar 

  10. Costa CA, Riehl H, Kina JF et al (2010) Human pulp responses to in-office tooth bleaching. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109:59–64. https://doi.org/10.1016/j.tripleo.2009.12.002

    Article  Google Scholar 

  11. Roderjan DA, Stanislawczuk R, Hebling J et al (2014) Histopathological features of dental pulp tissue from bleached mandibular incisors. Mater Sci Eng B 4:178–185. https://doi.org/10.17265/2161-6221/2014.06.006

    Article  Google Scholar 

  12. Roderjan DA, Stanislawczuk R, Hebling J, Costa CAS, Reis A, Loguercio AD (2015) Response of human pulps to different in-office bleaching techniques: preliminary findings. Braz Dent J 26:242–248 https://doi.org/10.1590/0103-6440201302282

    Article  PubMed  Google Scholar 

  13. Bonafé E, Bacovis CL, Lesen S et al (2013) Tooth sensitivity and efficacy of in-office bleaching in restored teeth. J Dent 41:363–369. https://doi.org/10.1016/j.jdent.2013.01.007

    Article  PubMed  Google Scholar 

  14. Soares DG, Ribeiro AP, Vargas FS et al (2013) Efficacy and cytotoxicity of a bleaching gel after short application times on dental enamel. Clin Oral Investig 17:1901–1910. https://doi.org/10.1007/s00784-012-0883-1

    Article  PubMed  Google Scholar 

  15. Sato C, Rodrigues FA, Garcia D et al (2013) Tooth bleaching increases dentinal protease activity. J Dent Res 92:187–192. https://doi.org/10.1177/0022034512470831

    Article  PubMed  Google Scholar 

  16. Trindade FZ, Ribeiro AP, Sacono NT et al (2009) Trans-enamel and trans-dentinal cytotoxic effects of a 35% H2O2 bleaching gel on cultured odontoblast cell lines after consecutive applications. Int Endod J 42:516–524. https://doi.org/10.1111/j.1365-2591.2009.01544.x

    Article  PubMed  Google Scholar 

  17. Cook SP, McCleskey EW (2002) Cell damage excites nociceptors through release of cytosolic ATP. Pain 95:41–47. https://doi.org/10.1016/S0304-3959(01)00372-4

    Article  PubMed  Google Scholar 

  18. Bowles WR, Withrow JC, Lepinski AM et al (2003) Tissue levels of immunoreactive substance P are increased in patients with irreversible pulpitis. J Endod 29:265–267. https://doi.org/10.1097/00004770-200304000-00009

    Article  PubMed  Google Scholar 

  19. Huynh MP, Yagiela JA (2003) Current concepts in acute pain management. J Calif Dent Assoc 31:419–427

    PubMed  Google Scholar 

  20. Cecarini V, Gee J, Fioretti E, Amici M, Angeletti M, Eleuteri AM, Keller JN (2007) Protein oxidation and cellular homeostasis: emphasis on metabolism. Biochim Biophys Acta 1773:93–104. https://doi.org/10.1016/j.bbamcr.2006.08.039

    Article  PubMed  Google Scholar 

  21. Kossatz S, Martins G, Loguercio AD, Reis A (2012) Tooth sensitivity and bleaching effectiveness associated with use of a calcium-containing in-office bleaching gel. J Am Dent Assoc 143:81–87. https://doi.org/10.14219/jada.archive.2012.0075

    Article  Google Scholar 

  22. Tang B, Millar BJ (2010) Effect of chewing gum on tooth sensitivity following whitening. Br Dent J 208:571–577. https://doi.org/10.1038/sj.bdj.2010.500

    Article  PubMed  Google Scholar 

  23. Basting RT, Amaral FL, França FM, Flório FM (2012) Clinical comparative study of the effectiveness of and tooth sensitivity to 10% and 20% carbamide peroxide home-use and 35% and 38% hydrogen peroxide in-office bleaching materials containing desensitizing agents. Oper Dent 37:464–473. https://doi.org/10.2341/11-337-C

    Article  PubMed  Google Scholar 

  24. Palé M, Mayoral JR, Llopis J, Vallès M, Basilio J, Roig M (2014) Evaluation of the effectiveness of an in-office bleaching system and the effect of potassium nitrate as a desensitizing agent. Odontology 102:203–210. https://doi.org/10.1007/s10266-013-0132-3

    Article  PubMed  Google Scholar 

  25. Markowitz K, Pashley DH (2008) Discovering new treatments for sensitive teeth: the long path from biology to therapy. J Oral Rehabil 35:300–315. https://doi.org/10.1111/j.1365-2842.2007.01798.x

    Article  PubMed  Google Scholar 

  26. Ladalardo TC, Pinheiro A, Campos RA et al (2004) Laser therapy in the treatment of dentine hypersensitivity. Braz Dent J 15:144–150. https://doi.org/10.1590/S0103-64402004000200011

    Article  PubMed  Google Scholar 

  27. Wakabayashi H, Hamba M, Matsumoto K, Tachibana H (1993) Effect of irradiation by semiconductor laser on responses evoked in trigeminal caudal neurons by tooth pulp stimulation. Lasers Surg Med 13:605–610. https://doi.org/10.1002/lsm.1900130603

    Article  PubMed  Google Scholar 

  28. Favaro–Pipi E, Ribeiro DA, Ribeiro JU et al (2011) Low level laser therapy induces differential expression of osteogenic genes during bone repair in rats. Photomed Laser Surg 29:311–317. https://doi.org/10.1089/pho.2010.2841

    Article  PubMed  Google Scholar 

  29. Silveira PC, Silva LA, Freitas TP et al (2011) Effects of low-power laser irradiation (LPLI) at different wavelengths and doses on oxidative stress and fibrogenesis parameters in an animal model of wound healing. Lasers Med Sci 26:125–131. https://doi.org/10.1007/s10103-010-0839-0

    Article  PubMed  Google Scholar 

  30. Kimura Y, Wilder-Smith P, Yonaga K, Matsumoto K (2000) Treatment of dentine hypersensitivity by lasers: a review. J Clin Periodontol 27(10):715–721. https://doi.org/10.1034/j.1600-051x.2000.027010715.x

    Article  PubMed  Google Scholar 

  31. Tay LY, Kose C, Loguercio AD, Reis A (2009) Assessing the effect of a desensitizing agent used before in-office tooth bleaching. J Am Dent Assoc 140:1245–1251. https://doi.org/10.14219/jada.archive.2009.0047

    Article  PubMed  Google Scholar 

  32. Thiesen CH, Filho R, Prates LH et al (2013) The influence of desensitizing dentifrices on pain induced by in-office bleaching. Braz Oral Res 27:517–523. https://doi.org/10.1590/S1806-83242013000600012

    Article  PubMed  Google Scholar 

  33. Wang Y, Gao J, Jiang T, Liang S, Zhou Y, Matis BA (2015) Evaluation of the efficacy of potassium nitrate and sodium fluoride as desensitizing agents during tooth bleaching treatment – a systematic review and meta-analysis. J Dent 43:913–923. https://doi.org/10.1016/j.jdent.2015.03.015

    Article  PubMed  Google Scholar 

  34. Nanjundassetty J, Ashrafulla M (2016) Efficacy of desensitizing agents on postoperative sensitivity following an in-office vital tooth bleaching: a randomized controlled clinical trial. J Conserv Dent 19:207–211 http://www.jcd.org.in/text.asp?2016/19/3/207/181927

    Article  Google Scholar 

  35. Schulz KF, Altman DG, Moher D (2010) Consort 2010 statement: updated guidelines for reporting parallel group randomized trials. BMJ 340:698–702. https://doi.org/10.1136/bmj.c332

    Article  Google Scholar 

  36. World Medical Association (2013) World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA 27:2191–2194. https://doi.org/10.1001/jama.2013.281053

    Article  Google Scholar 

  37. Abrams AP, Thompson LA (2014) Physiology of aging of older adults: systemic and oral health considerations. Dent Clin N Am 58:729–738. https://doi.org/10.1016/j.cden.2014.06.002

    Article  PubMed  Google Scholar 

  38. Farac RV, Morgental RD, De Pontes Lima RK et al (2012) Pulp sensibility test in elderly patients. Gerodontology 29:135–139. https://doi.org/10.1111/j.1741-2358.2012.00623.x

    Article  PubMed  Google Scholar 

  39. Moosavi H, Arjmand N, Ahrari F, Zakeri M, Maleknejad F (2016) Effect of low-level laser therapy on tooth sensitivity induced by in-office bleaching. Lasers Med Sci 31:713–719. https://doi.org/10.1007/s10103-016-1913-z

    Article  PubMed  Google Scholar 

  40. Pintado-Palomino K, Tirapelli C (2015) The effect of home-use and in-office bleaching treatments combined with experimental desensitizing agents on enamel and dentin. Eur J Dent 9:66–73. https://doi.org/10.4103/1305-7456.149645

    Article  PubMed  PubMed Central  Google Scholar 

  41. Eimar H, Siciliano R, Abdallah M et al (2012) Hydrogen peroxide whitens teeth by oxidizing the organic structure. J Dent 40:25–33. https://doi.org/10.1016/j.jdent.2012.08.008

    Article  Google Scholar 

  42. Caviedes-Bucheli J, Ariza-Garcia G, Restrepo-Mendez S et al (2008) The effect of tooth bleaching on substance P expression in human dental pulp. J Endod 34:1462–1465. https://doi.org/10.1016/j.joen.2008.09.013

    Article  PubMed  Google Scholar 

  43. Vaz MM, Lopes LG, Cardoso PC, Souza JB, Batista AC, Costa NL, Torres ÉM, Estrela C (2016) Inflammatory response of human detal pulp to at-home and in-office tooth bleaching. J Appl Oral Sci 24:509–517. https://doi.org/10.1590/1678-775720160137

    Article  PubMed  PubMed Central  Google Scholar 

  44. Karu TI (2003) Cellular mechanism of low power laser therapy. Lasers Med Dent 3:79–100. https://doi.org/10.1117/12.518686

    Article  Google Scholar 

  45. Umana M, Heysselaer D, Tielemans M et al (2013) Dentinal tubules sealing by means of diode lasers (810 and 980 nm): a preliminary in vitro study. Photomed Laser Surg 31:307–314. https://doi.org/10.1089/pho.2012.3443

    Article  PubMed  Google Scholar 

  46. Pihlstrom BL, Barnett ML (2016) Design, operation, and interpretation of clinical trials. J Dent Res 89:759–772. https://doi.org/10.1177/0022034510374737

    Article  Google Scholar 

  47. Yilmaz HG, Kurtulmus-Yilmaz S, Cengiz E, Bayindir H et al (2011) Clinical evaluation of Er, Cr: YSGG and GaAlAs a randomized controlled clinical trial of a laser therapy for treating dentine hypersensitivity: a randomized controlled clinical trial. J Dent 39:249–254

    Article  PubMed  Google Scholar 

  48. Pandis N, Walsh T, Polychronopoulou A, Katsaros C, Eliades T (2013) Split-mouth designs in orthodontics: an overview with applications to orthodontic clinical trials. Eur J Orthod 35:783–789

    Article  PubMed  Google Scholar 

  49. Kara HB, Cakan U, Yilmaz B et al (2016) Efficacy of diode laser and Gluma on post-preparation sensitivity: a randomized split-mouth clinical study. J Esthet Restor Dent 28:405–411

    Article  PubMed  Google Scholar 

  50. Femiano F, Femiano R, Lanza A et al (2013) Efficacy of diode laser in association to sodium fluoride vs Gluma desensitizer on treatment of cervical dentin hypersensitivity. A double blind controlled trial. Am J Dent 26:214–218

    PubMed  Google Scholar 

  51. Dohi S, Jain S, Hegde R (2014) Effect of low-level laser therapy in reducing dentinal hypersensitivity and pain following periodontal flap surgery. Photomed Laser Surg 32:700–706

    Article  Google Scholar 

  52. García-Delaney C, Abad-Sánchez D, Arnabat-Domínguez J et al (2017) Evaluation of the effectiveness of the photobiomodulation in the treatment of dentin hypersensitivity after basic therapy. A randomized clinical trial. J Clin Exp Dent 9:e694–e702

    PubMed  PubMed Central  Google Scholar 

  53. Dilsiz A, Canakci V, Ozdemir A, Kaya Y (2009) Clinical evaluation of Nd: YAG and 685-nm diode laser therapy for desensitization of teeth with gingival recession. Photomed Laser Surg 27:843–848

    Article  PubMed  PubMed Central  Google Scholar 

  54. Farias RD, Closs LQ, Miguens SA Jr (2016) Evaluation of the use of low-level laser therapy in pain control in orthodontic patients: a randomized split-mouth clinical trial. Angle Orthod 86:193–198

    Article  PubMed  Google Scholar 

  55. Doshi-Mehta G, Bhad-Patil WA (2012) Efficacy of low-intensity laser therapy in reducing treatment time and orthodontic pain: a clinical investigation. Am J Orthod Dentofac Orthop 141:289–297

    Article  Google Scholar 

  56. Haywood VB, Cordero R, Wright K et al (2005) Brushing with a potassium nitrate dentifrice to reduce bleaching sensitivity. J Clin Dent 16:17–22

    PubMed  Google Scholar 

  57. Low SB, Allen EP, Kontogiorgos ED (2015) Reduction in dental hypersensitivity with Nano-hydroxyapatite, potassium nitrate, sodium monoflurophosphate and antioxidants. Open Dent J 9:92–97. https://doi.org/10.2174/1874364101509010092

    Article  Google Scholar 

  58. Peacock JM, Orchardson R (1995) Effects of potassium ions on action potential conduction in A- and C-fibers of rat spinal nerves. J Dent Res 74:634–641. https://doi.org/10.1177/00220345950740020301

    Article  PubMed  Google Scholar 

  59. Diamanti I, Koletsi-Kounari H, Mamai-Homata E, Vougiouklakis G (2010) Effect of fluoride and of calcium sodium phosphosilicate toothpastes on pre-softened dentin demineralization and remineralization in vitro. J Dent 38:671–677. https://doi.org/10.1016/j.jdent.2010.05.010

    Article  PubMed  Google Scholar 

  60. Pinto SCS, Bandéca MC, Pinheiro MC, Cavassim R (2014) Preventive effect of a high fluoride toothpaste and arginine-carbonate toothpaste on dentinal tubules exposure followed by acid challenge: a dentine permeability evaluation. BMC Res Notes 7:385. https://doi.org/10.1186/1756-0500-7-385

    Article  PubMed  PubMed Central  Google Scholar 

  61. Alencar CM, Silva RC, Araújo JLN et al (2017) A clinical, randomized, double-blind study on the use of toothpastes immediately after at-home tooth bleaching. Am J Dent 30:267–271

    Google Scholar 

  62. Alexandrino LD, Alencar CM, da Silveira ADS et al (2017) Randomized clinical trial of the effect of novamin and CPP-ACPF in combination with dental bleaching. J Appl Oral Sci 25:335–340. https://doi.org/10.1590/1678-7757-2016-0408

    Article  PubMed  PubMed Central  Google Scholar 

  63. Brannstrom M, Linden LA, Johnson G (1968) Movement of dentinal and pupal fluid caused by clinical procedures. J Dent Res 47:679–682. https://doi.org/10.1177/00220345680470050201

    Article  PubMed  Google Scholar 

  64. Stead WJ, Orchardson R, Warren PB (1996) A mathematical model of potassium ion diffusion in dentinal tubules. Arch Oral Biol 41:679–687. https://doi.org/10.1016/S0003-9969(96)00073-8

    Article  PubMed  Google Scholar 

  65. Markowitz K, kim S (1985) The effects of various ionic solutions on pulpal nerve sensitivity. J Dent Res 64:309

    Google Scholar 

  66. Pirnat S (2007) Versatility of an 810 nm diode laser in dentistry: an overview. J Laser Health Acad 4:1–8

    Google Scholar 

  67. Borges A, Barcellos D, Gomes C (2012) Dentin hypersensitivity-etiology, treatment possibilities and other related factors: a literature review. World J Dent 3:60–67. https://doi.org/10.5005/jp-journals-10015-1129

    Article  Google Scholar 

  68. Melzack R (1975) The McGill pain questionnaire: major properties and scoring methods. Pain 1:277–299. https://doi.org/10.1016/0304-3959(75)90044-5

    Article  PubMed  Google Scholar 

  69. Addy M, West N, Barlow A et al (2007) Dentine hypersensitivity: is there both stimulus and placebo responses in clinical trials? Int J Dent Hyg 5:53–59. https://doi.org/10.1111/j.1601-5037.2007.00228.x

    Article  PubMed  Google Scholar 

  70. Porto IC, Andrade AK, Montes MA (2009) Diagnosis and treatment of dentinal hypersensitivity. J Oral Sci 51:323–332. https://doi.org/10.2334/josnusd.51.323

    Article  PubMed  Google Scholar 

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Funding

The work was supported by the National Council for Scientific and Technological Development, Ministry of Science and Technology, Brazil.

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Authors and Affiliations

  1. Graduate Program in Dentistry, Federal University of Pará, Belém, PA, Brazil

    Brennda de Paula, Cristiane Alencar, Mariángela Ortiz, Roberta Couto & Cecy Silva

  2. School of Dentistry, Federal University of Pará, Belém, PA, Brazil

    Jesuína Araújo

  3. Faculdade de Odontologia, Universidade Federal do Pará, Avenida Augusto Correa, no 1, Guamá, Belém, PA, 66075-110, Brazil

    Cecy Silva

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  1. Brennda de Paula
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de Paula, B., Alencar, C., Ortiz, M. et al. Effect of photobiomodulation with low-level laser therapy combined with potassium nitrate on controlling post-bleaching tooth sensitivity: clinical, randomized, controlled, double-blind, and split-mouth study. Clin Oral Invest 23, 2723–2732 (2019). https://doi.org/10.1007/s00784-018-2715-4

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