Pain meds don't reduce sensitivity from teeth bleaching

Anti-inflammatory and analgesic drugs may not prevent tooth sensitivity caused by in-office dental bleaching, according to a new systematic review published in the Journal of the American Dental Association.

Patients who took the drugs before having their teeth bleached experienced similar levels of sensitivity as those who did not take them, the authors reported.

"Despite the differences in drugs and protocols, the meta-analysis of the clinical trials evaluating the possible effect of anti-inflammatory and analgesic drugs for the prevention of bleaching-induced tooth sensitivity showed, with a high level of evidence, that these drugs did not prevent nor reduce tooth sensitivity," wrote the authors, led by Márcia Luciana Carregosa Santana, DDS, a graduate student at the Federal University of Sergipe in Aracaju, Brazil (JADA, October 2019, Vol. 150:10, pp. 818-829.e4).

In-office dental bleaching continues to remain a popular procedure despite increasing patients' risk of developing tooth sensitivity due to the inflammatory process of pulpal tissue. Up to 90% of patients experience hypersensitivity, often with the first 12 hours of undergoing procedures. Administering anti-inflammatory and analgesic drugs to eliminate the adverse effects of teeth bleaching have become a common practice for clinicians.

For this review, the authors examined 11 randomized clinical trials comparing anti-inflammatory and analgesic drugs with placebos and evaluating tooth sensitivity after in-office bleaching.

The review found that all the included studies used hydrogen peroxide concentrations of 35% to 38%, which are considered high levels. Different drugs, including ibuprofen, dexamethasone, acetaminophen, codeine, etoricoxib, and naproxen, were given at different intervals before and after whitening procedures. After reviewing the findings, the authors identified similar levels of sensitivity evaluated up to one hour after procedures and 24 hours after procedures despite the type of drug used.

The authors noted some limitations to their review, including that the findings may not be generalizable to middle-aged and older adults, as all the studies assessed viewed the effect of preventive and preemptive drugs used in patients with a mean age of about 24. Nevertheless, they stated that tooth sensitivity was observed in young patients and that outcomes would likely be the same in older patients.

With the review showing that oral anti-inflammatory and analgesic drugs fail to prevent tooth sensitivity, the authors concluded that future studies should focus on other solutions.

"Attempts to deliver anti-inflammatory and analgesic drugs via topical application on enamel should be the focus of future investigations," they wrote.