Managing Bleaching Sensitivity

Last week the blog post on Thursday looked at the cause of tooth sensitivity during tooth bleaching procedures. Many of my patients are interested in bleaching and worried about sensitivity or have attempted it int he past and experienced it, so are reticent to try again. There are several techniques we can employ to minimize sensitivity and allow patients to bleach. We looked at the tooth forms of sensitivity caused by irritation of the pulp and fluid movement in the dentinal tubules. With this in mind it makes sense that our management strategies are to occlude the dentinal tubules or calm the pulpal tissue.

In the arena of preventing fluid movement within the dentinal tubules, the approach is to block those tubules as rapidly as possible before and after bleaching. Topical fluoride application does create a plug in the tubules, the challenge is that it takes extended time to occur and requires continuous exposure. Having patients brush with a high concentration fluoride toothpaste for several weeks prior to, during and following bleaching is an effective adjunct to minimize sensitivity. The most effective product we have available to block dentinal tubules is HEMA. Application HEMA ( available in GLUMA from Heraeus) is an effective way to rapidly replug the dentinal tubules and prevent fluid movement.  The HEMA will not have any negative effect on the bleaching process itself.

Potassium Nitrate is a common ingredient in toothpaste for sensitive teeth. The mechanism of action as best we can tell is that it creates neuronal suppression, or numbs the pulp of the tooth. As with fluoride it is a topical application, requires time to be effective and the effect disappears when use is discontinued. as with fluoride application of a desensitizing toothpaste or gel containing potassium nitrate before, during and after bleaching can be helpful. In addition having the patient pre-medicate with a NSAID prior to in office bleaching services is extremely helpful. You want the NSAID int he system suppressing the production of the neurotransmitter that regulates pain prior to the trauma.

Lastly, different bleaching products will cause differing amounts of sensitivity depending on the pH of the product, how aqueous it is and how much of the active ingredient is present. If patients are willing to be patient bleaching with a lower amount of active ingredient will eventually achieve the same tooth color, with less sensitivity.