Dental pain induced by an ambient thermal differential: pathophysiological hypothesis

Can all highly concentrated in-office bleaching gels be used as a single-application?

OBJECTIVE

This in vitro study aims to evaluate of hydrogen peroxide (HP) diffusion into the pulp chamber, bleaching efficacy (BE), and pH stability (pH) of single-application high concentrated in-office bleaching gels.

MATERIALS AND METHODS

Eighty-eight healthy premolars were randomly into eleven groups (n = 8) according to the in-office dental bleaching: DSP White Clinic 35% calcium (DW), Nano White 35% (NW), Opalescence XTra Boost 40% (OB), Pola Office + 37.5% (PO), Potenza Bianco Pro SS 38% (PB), Total Blanc 35% (TB), Total Blanc One-Step 35% (TO), Whiteness Automixx 35% (WA), Whiteness Automixx Plus 35% (WP), and Whiteness HP Blue 35% (WB). A group not exposed to bleaching agents was the control group (CG). All bleaching agents were applied in one session with a single application. After the bleaching procedure, the concentration of HP diffusion (μg/mL) into the pulp chamber was assessed using UV-Vis spectrophotometry. The BE (ΔEab and ΔE00) was evaluated before and 1 week after the bleaching procedure using a digital spectrophotometer. The pH of each bleaching gel was evaluated by digital pHmeter. The one-way ANOVA and Tukey's was used for a statistical analysis (α = 0.05).

RESULTS

The concentration of HP diffusion into the pulp chamber was higher in all in-office bleaching gels when compared to CG (p < 0.0000001). However, there are a significant difference between them (p = 0.0001). A significant BE was observed in all in-office bleaching gels (p < 0.0001 for ΔEab and ΔE00), with a significant difference between them (p < 0.0001). PO, OB, TB, WP, and WB showed a higher BE when compared to DW, PB, and WA (p < 0.0001). Most bleaching gels were slightly acidic or alkaline during the total application time, while DW, PB, TB, and WA showed a high acidic behavior after 30 min of application.

CONCLUSIONS

A single application was able to produce a bleaching efficacy. However, usually, gels with slightly acidic or alkaline pH during the application time reduces the HP diffusion into the pulp chamber.

CLINICAL RELEVANCE

The single-application of bleaching gels with slightly acidic or alkaline and stable pH decreased the penetration of hydrogen peroxide into the pulp chamber in in-office bleaching and maintained the bleaching efficacy.

Assessment of Patients’ Experience and Perception Toward Dentinal Hypersensitivity for Its Diagnosis and Management: A Cross-Sectional Study

Background Dentinal hypersensitivity (DH) is a common clinical finding that varies greatly in prevalence. An appropriate impulse that detonates noxious stimuli in the pulp/dentin boundary causes the typical DH pain, which is sudden, short, sharp, and of rapid onset. The objective of this research was to ascertain the incidence of DH in Keralites and evaluate some contributory factors, along with other initiating stimuli. Methodology Over three months, from June 2022 to August 2022, a cluster sampling technique was employed to conduct the study in 14 districts of Kerala. Patients from five clinics from each district who reported having DH and were aged 25 to 65 years were chosen at random. Using Google Survey forms, a 20-question, closed-ended survey was mailed to patients. The data were collected, evaluated, and analyzed using SPSS Version 23.0 (IBM Corp., Armonk, NY, USA). The statistical difference in the distribution of DH and the patient's age was determined using analysis of variance (ANOVA). A chi-square test was carried out to test the association between dentinal hypersensitivity, gender, and other parameters; P < 0.05 was considered to be statistically significant. Results Among the 2,520 persons to whom questionnaires were mailed, 2,321 responded, with an unresponsive rate of 7.89%. The study revealed a sensitivity predilection among females (54%), although statistically insignificant. Respondents aged 25 to 35 years (41.01%) were commonly reported to have DH, the age distribution of which was found to be highly significant statistically (P < 0.01). Teeth whitening resulted in 82.98% of the sensitivity, whereas 47.99% accepted poor oral hygiene as an additional contributory factor. DH was reported in 52.01% of the patients with gastritis and 63.03% of the patients with gingival recession. Further, blame for poor dental treatment (88.88%) and climate change (82.92%) were also found relevant. The quality of life was claimed to be afflicted in 90.99% of the patients. Desensitizing agents were used by 68.97% of the patients, with which 68.03% reported satisfaction. Of the subjects who underwent professional treatment, 87.03% reported being satisfied. Oral prophylaxis-induced sensitivity was reported in 57.99%, indicating enhanced oral health awareness among Kerala residents. There was a statistically highly significant difference in the patient distribution based on the exposure to DH, and their perception of the causes and factors affecting DH (P < 0.01). Conclusions DH is a frequently and widely prevalent dental malady. Respondents demonstrated that they were conversant with DH. The quality of life and enjoyment of daily activities are both impacted by dentin hypersensitivity, and many patients are unaware that it is a treatable illness. Various desensitizing substances are also available and can be applied quickly to sensitive areas. Patients prefer this procedure as it is simpler to apply these agents and the effects are pleasant and beneficial.

Effect of an experimental desensitizing gel on bleaching-induced tooth sensitivity after in-office bleaching—a double-blind, randomized controlled trial

OBJECTIVES

To evaluate the risk and intensity of tooth sensitivity (TS), and the efficacy of in-office bleaching after applying an experimental desensitizing gel composed of 10% calcium gluconate, 0.1% dexamethasone acetate, 10% potassium nitrate, and 5% glutaraldehyde.

MATERIAL AND METHODS

In a split-mouth, double-blind, placebo-controlled study, 50 participants had their upper hemiarches randomized into experimental and placebo groups. Desensitizing and placebo gels were applied for 10 min before in-office bleaching (35% hydrogen peroxide, 1 × 50 min; two bleaching sessions; 1-week interval). TS was recorded immediately after bleaching, 1, 24, and 48 h after each session, with a 0-10 visual analogue scale (VAS) and a five-point numerical rating scale (NRS). The color was recorded in all groups at baseline, 1 week after each session, and 1 month after the end of bleaching using shade guide units (ΔSGUs) and a spectrophotometer (ΔE_ab, ΔE₀₀, and ΔWI_D).

RESULTS

Most participants (96%) felt some discomfort during treatment regardless of the study group. The odds ratio for pain was 0.65 (95% CI 0.1 to 4.1; p = 1.0). The intensity of TS did not differ between groups (p > 0.31), and it was only 0.34 VAS units lower in the experimental group. A significant color change occurred in both groups regardless of the group.

CONCLUSIONS

The desensitizing experimental gel applied before in-office bleaching did not reduce the risk and the intensity of TS and did not affect color change.

CLINICAL RELEVANCE

Although the experimental desensitizing agent with varying mechanisms of action did not jeopardize the color change, it did not reduce the risk or intensity of in-office bleaching.

CLINICAL TRIAL REGISTRATION NUMBER

RBR-7T7D4D.

Tusks, the extra-oral teeth

OBJECTIVE

The present review aims to: a) describe the features that support tusks in extra-oral position, and b) represent distinctive features of tusks, which provide insights into tusks adaptation to ambient conditions.

DESIGN

A comprehensive review of scientific literature relevant to tusks and comparable dental tissues was conducted.

RESULTS

The oral cavity provides a desirable condition which is conducive to tooth health. Therefore, it remains questionable how the bare (exposed) tusks resist the extra-oral conditions. The common features among tusked mammals indicate that the structural (e.g. the peculiar dentinal alignment), cellular (e.g. low or lack of cell populations in the tusk), hormonal (e.g. androgens), and behavioral traits have impact on a tusk's preservation and occurrence.

CONCLUSIONS

Understanding of bare mineralized structures, such as tusks and antlers, and their compatibility with different environments, can provide important insight into oral biology.