Flávia Pardo Salata Nahsan

Effect of the Polishing Procedures on Color Stability and Surface Roughness of Composite Resins

Objectives. To evaluate the polishing procedures effect on color stability and surface roughness of composite resins. Methods. Specimens were distributed into 6 groups: G1: Filtek Supreme XT + PoGo; G2: Filtek Supreme XT + Sof-Lex; G3: Filtek Supreme XT + no polishing; G4: Amelogen + PoGo; G5: Amelogen + Sof-Lex.; G6: Amelogen + no polishing. Initial color values were evaluated using the CIELab scale. After polishing, surface roughness was evaluated and the specimens were stored in coffee solution at 37°C for 7 days. The final color measurement and roughness were determined. Results. Sof-Lex resulted in lower staining. Amelogen showed the highest roughness values than Filtek Supreme on baseline and final evaluations regardless of the polishing technique. Filtek Supreme polished with PoGo showed the lowest roughness values. All groups presented discoloration after storage in coffee solution, regardless of the polishing technique. Conclusion. Multiple-step polishing technique provided lower degree of discoloration for both composite resins. The final surface texture is material and technique dependent.

Effect of preventive use of nonsteroidal anti-inflammatory drugs on sensitivity after dental bleaching: A systematic review and meta-analysis

BACKGROUND Tooth sensitivity associated with bleaching remains a challenge for clinicians. Inflammatory mediators released by the penetration of bleaching agents into dental tissues can sensitize nociceptors, leading to tooth sensitivity. TYPE OF STUDIES REVIEWED In this systematic review, the authors included randomized clinical trials in which the investigators compared the preventive use of nonsteroidal anti-inflammatory drugs (NSAIDs) with a placebo for sensitivity after dental bleaching. The authors included only studies in which the investigators evaluated in-office tooth bleaching with high-concentration hydrogen peroxide and reported the risk or the level of tooth sensitivity after bleaching. RESULTS The authors included 3 studies and evaluated the levels of sensitivity reported at up to 1 hour after the procedure and from 1 to 24 hours after bleaching. The authors also calculated the pooled relative risk for the effect of preventive use of NSAIDs on sensitivity after dental bleaching. Preventive analgesia with NSAIDs did not have a significant effect on the risk of sensitivity after dental bleaching or on the levels of sensitivity reported by patients. PRACTICAL IMPLICATIONS There is insufficient evidence about the use of NSAIDs to prevent tooth sensitivity caused by in-office bleaching procedures.

Randomized Controlled Trial of Sealed In-Office Bleaching Effectiveness

Regardless of the high success rate, patients commonly report the occurrence of tooth sensitivity during the in-office bleaching procedures. Recently, it has been demonstrated that using a customized tray (called sealed in-office bleaching technique) reduces peroxide penetration. The aim of this randomized clinical study was to evaluate tooth sensitivity and bleaching efficacy of sealed bleaching, in comparison with a conventional in-office technique. Twenty patients were randomized allocated in two groups in which 35% hydrogen peroxide gel was used in a single 45-min application. For the sealed technique, a customized bleaching tray was fabricated and carefully positioned over the bleaching agent during the session. The color was recorded at a baseline, 7 and 28 days after the bleaching session, using Vita Easy Shade spectrophotometer. Tooth sensitivity was recorded during (20 and 40 min) and immediately after the treatment using a visual analogue scale. The bleaching efficacy was evaluated by repeated-measures ANOVA, while the absolute risk of tooth sensitivity and its intensity were evaluated by Fishers exact and Mann-Whitney tests, respectively (α=0.05). No significant difference on bleaching efficacy was observed between the conventional (7.4 and 8.1 ΔE) and sealed techniques (7.8 and 8.3 ΔE) at both evaluation periods. No significant difference was observed regarding the absolute risk of tooth sensitivity (p=0.15). Sealed technique showed a significant decrease of sensitivity intensity after 40 min (p=0.03). Sealed bleaching technique was able to reduce the sensitivity intensity during the bleaching procedure, without jeopardizing the bleaching efficacy.

The Impact of a Customized Tray on In-Office Bleaching Tooth Sensitivity: A Randomized Clinical Trial

OBJECTIVE It was recently demonstrated that using a tray over a bleaching agent reduces its pulpal chamber penetration, which can reduce tooth sensitivity. This study evaluated the effect of the sealed technique on the presence and level of sensitivity reported by patients during and after the bleaching procedure performed in office. METHODS Forty-six patients underwent a bleaching procedure with 35% hydrogen peroxide used in a single application of 45 minutes for two sessions with an interval of seven days. A customized tray was maintained over the bleaching agent during the entire procedure in half of the patients. The sensitivity level was evaluated during and immediately after the bleaching using verbal and visual analogue scales. The shade alteration was evaluated with a bleach guide scale. The peak sensitivity after 24 hours and the presence/level at 24 hours were also evaluated using a verbal rating scale. Relative risks were calculated for all time assessments. Data on the sensitivity level for both scales were subjected to Friedman and Mann-Whitney tests (α=0.05). Data on the shades were analyzed by two-way repeated-measures analysis of variance and Tukeys test (α=0.05). RESULTS The use of a customized tray increased the relative risks to the tooth measured 24 hours after each bleaching session. The sealed technique also increased the level of tooth sensitivity only at 24 hours after the first session. No difference was observed between the bleaching techniques regarding the shade evaluation. CONCLUSION Using a tray over the bleaching agent can increase the level and risk of tooth sensitivity for the first 24 hours after in-office bleaching.

Use of scientific evidence by dentists in Brazil: Room for improving the evidence-based practice

This study investigated the use of scientific evidence and the practice of evidence-based dentistry (EBD) among dentists working in Brazil. An online questionnaire was emailed to dentists registered with Brazilian state dental councils. The questionnaire assessed the demographic, educational, and work characteristics of the sample, along with habits in reading scientific articles and other updating resources. Data were analyzed descriptively and by using Bonferroni, Kruskal-Wallis, ANOVA, and T-test statistical methods (α = 0.05). A total of 795 responses were received between June, 2015 and January, 2016. The response rate was not calculated because it was not possible to determine precisely how many dentists received these e-mails. Over 77% of the responding dentists completed postgraduate training. They referred mainly to books, scientific or clinical journals, conferences, and short-term courses for updating their knowledge. Dentists who reported having a habit of reading scientific journals (60.9%) showed a preference for reading case reports, clinical research articles, and literature reviews. Most dentists (77.5%) reported changing their clinical behaviors or procedures based on information gleaned from journal articles. The types of articles that led them to change their clinical practices were primarily clinical research articles and case reports. Working in the public sector was also associated with a lower prevalence of a habit of reading scientific journals and practicing EBD (i.e., self-reported practice). The results suggest that dentists are interested in reading journal articles, especially those addressing clinical outcomes, and that there is room for improving the practice of EBD, particularly in the public sector.

Preemptive use of etodolac on tooth sensitivity after in-office bleaching: a randomized clinical trial

Abstract Purpose This study determined the effectiveness of the preemptive administration of etodolac on risk and intensity of tooth sensitivity and the bleaching effect caused by in-office bleaching using 35% hydrogen peroxide. Material and methods Fifty patients were selected for this tripleblind, randomized, crossover, and placebo-controlled clinical trial. Etodolac (400 mg) or placebo was administrated in a single-dose 1 hour prior to the bleaching procedure. The whitening treatment with 35% hydrogen peroxide was carried out in two sessions with a 7-day interval. Tooth sensitivity was assessed before, during, and 24 hours after the procedure using the analog visual scale and the verbal rating scale. Color alteration was assessed by a bleach guide scale, 7 days after each session. Relative risk of sensitivity was calculated and adjusted by session, while overall risk was compared by the McNemars test. Data on the sensitivity level of both scales and color shade were subjected to Friedman, Wilcoxon, and Mann-Whitney tests, respectively (α=0.05). Results The preemptive administration of etodolac did not affect the risk of tooth sensitivity and the level of sensitivity reported, regardless of the time of evaluation and scale used. The sequence of treatment allocation did not affect bleaching effectiveness, while the second session resulted in additional color modification. The preemptive administration of etodolac in a single dose 1 hour prior to in-office tooth bleaching did not alter tooth color, and the risk and intensity of tooth sensitivity reported by patients. Conclusion A single-dose preemptive administration of 400 mg of etodolac did not affect either risk of tooth sensitivity or level of sensitivity reported by patients, during or after the in-office tooth bleaching procedure.

Preemptive Use of Naproxen on Tooth Sensitivity Caused by In-Office Bleaching: A Triple-Blind, Crossover, Randomized Clinical Trial

OBJECTIVES A triple-blind, randomized, crossover clinical trial evaluated prior use of nonsteroidal anti-inflammatory naproxen on sensitivity reported by patients undergoing in-office tooth bleaching. METHODS AND MATERIALS Fifty patients were subjected to two sessions of in-office tooth bleaching with 35% hydrogen peroxide in a single application of 40 minutes for two sessions, with an interval of seven days between applications. One hour prior to the procedure, each patient randomly received a single dose of naproxen (500 mg) or placebo. The patients sensitivity level was evaluated during and immediately after the bleaching using two scales (verbal and visual analog); the verbal scale only was repeated after 24 hours. The effectiveness of the bleaching procedures was evaluated with the Bleachedguide scale. Relative risk to sensitivity was calculated and adjusted by session, while comparison of overall risk was performed by the McNemar test. Data on the sensitivity level for both scales and shade were subjected to the Friedman, Wilcoxon, and Mann-Whitney tests (α=0.05). RESULTS The use of naproxen only decreased the absolute risk and intensity of tooth sensitivity reported immediately after the second session. On the other hand, no measurable effect was observed during or 24 hours after either session. The sequence of drug administration did not affect the bleaching effectiveness. CONCLUSIONS Preemptive use of naproxen only reduced tooth sensitivity reported by patients immediately after the second session of bleaching.

Original ContributionsAnti-Inflammatory AgentsEffect of preventive use of nonsteroidal anti-inflammatory drugs on sensitivity after dental bleaching: A systematic review and meta-analysis

BACKGROUND Tooth sensitivity associated with bleaching remains a challenge for clinicians. Inflammatory mediators released by the penetration of bleaching agents into dental tissues can sensitize nociceptors, leading to tooth sensitivity. TYPE OF STUDIES REVIEWED In this systematic review, the authors included randomized clinical trials in which the investigators compared the preventive use of nonsteroidal anti-inflammatory drugs (NSAIDs) with a placebo for sensitivity after dental bleaching. The authors included only studies in which the investigators evaluated in-office tooth bleaching with high-concentration hydrogen peroxide and reported the risk or the level of tooth sensitivity after bleaching. RESULTS The authors included 3 studies and evaluated the levels of sensitivity reported at up to 1 hour after the procedure and from 1 to 24 hours after bleaching. The authors also calculated the pooled relative risk for the effect of preventive use of NSAIDs on sensitivity after dental bleaching. Preventive analgesia with NSAIDs did not have a significant effect on the risk of sensitivity after dental bleaching or on the levels of sensitivity reported by patients. PRACTICAL IMPLICATIONS There is insufficient evidence about the use of NSAIDs to prevent tooth sensitivity caused by in-office bleaching procedures.

Effect of preventive use of nonsteroidal anti-inflammatory drugs on sensitivity after dental bleaching

BACKGROUND Tooth sensitivity associated with bleaching remains a challenge for clinicians. Inflammatory mediators released by the penetration of bleaching agents into dental tissues can sensitize nociceptors, leading to tooth sensitivity. TYPE OF STUDIES REVIEWED In this systematic review, the authors included randomized clinical trials in which the investigators compared the preventive use of nonsteroidal anti-inflammatory drugs (NSAIDs) with a placebo for sensitivity after dental bleaching. The authors included only studies in which the investigators evaluated in-office tooth bleaching with high-concentration hydrogen peroxide and reported the risk or the level of tooth sensitivity after bleaching. RESULTS The authors included 3 studies and evaluated the levels of sensitivity reported at up to 1 hour after the procedure and from 1 to 24 hours after bleaching. The authors also calculated the pooled relative risk for the effect of preventive use of NSAIDs on sensitivity after dental bleaching. Preventive analgesia with NSAIDs did not have a significant effect on the risk of sensitivity after dental bleaching or on the levels of sensitivity reported by patients. PRACTICAL IMPLICATIONS There is insufficient evidence about the use of NSAIDs to prevent tooth sensitivity caused by in-office bleaching procedures.