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Is It Possible to Reduce Whitening-Related Tooth Sensitivity?

I often suggest to patients who experience mild sensitivity caused by at-home whitening treatment to reduce any excess solution in the tray by using a Q-tip to apply it directly to the teeth. For very sensitive patients, I also recommend putting less solution in the tray, shortening the time the tray is used, or decreasing the percentage of the solution. But my colleague informed me that the application of whitening solution with a Q-tip is not recommended. Is she correct?

QUESTION: I often suggest to patients who experience mild sensitivity caused by at-home whitening treatment to reduce any excess solution in the tray by using a Q-tip to apply it directly to the teeth. For very sensitive patients, I also recommend putting less solution in the tray, shortening the time the tray is used, or decreasing the percentage of the solution. But my colleague informed me that the application of whitening solution with a Q-tip is not recommended. Is she correct?

ANSWER: Tooth sensitivity and gingival sensitivity are two of the most challenging situations faced with bleaching. It sounds like you are providing effective suggestions to your patients to reduce their sensitivity. Without knowing what type and concentration of solution you are using, we can make the following suggestions:

  • Use a 10% carbamide peroxide solution, which is the lowest concentration available. This is equivalent to a 3.5% hydrogen peroxide solution.
  • The higher the concentration of material used, the more the tray needs to be trimmed to avoid gingival irritation, and the greater the risk of tooth sensitivity. With a 10% carbamide peroxide solution, however, a nonscalloped tray that allows tissue contact can be utilized. This is because carbamide peroxide is an oral antiseptic designed to be applied to the tissue.
  • It does not take much solution to whiten teeth, but the tray is key because it isolates the material from saliva. A small amount of solution should be applied to the inner wall of the tooth mold in the tray. Any excess solution should be wiped from the gingiva if a concentration higher than 10% carbamide peroxide is used.

If the solution is applied directly to the teeth with a Q-tip, then the tray should be immediately placed over the teeth, as the bleaching material loses its effectiveness without such protection. Trays can be worn overnight or for a minimum of 2 hours to 4 hours when using carbamide peroxide. Hydrogen peroxide is only active for 30 minutes to 60 minutes.

Sensitivity can be managed by reducing the frequency of application and duration of treatment. Patients can skip 1 night to 2 nights of treatment per week or limit wear time. In our experience, the best material for addressing tooth sensitivity is 5% potassium nitrate, which can be found in most desensitizing toothpastes. It should be administered via a whitening tray, which is then worn for 10 minutes to 30 minutes before beginning or following the bleaching treatment—whether an over-the-counter or professionally supplied product is used. Sometimes gingival irritation, especially in women, is related to the flavor of the bleaching material. Banana flavor has been cross-linked to latex allergies and mint flavor may cause a reaction. Some materials also may contain gluten, which can cause gingival irritation. Experimenting with flavors may help reduce sensitivity.

The Ask the Expert column features answers to your most pressing clinical questions provided by Dimensions of Dental Hygiene’s online panel of key opinion leaders, including: Jacqueline J. Freudenthal, RDH, MHE, on anesthesia; Nancy K. Mann, RDH, MSEd, on cultural competency; Claudia Turcotte, CDA, RDH, MSDH, MSOSH, on ergonomics; Van B. Haywood, DMD, and Erin S. Boyleston, RDH, MS, on esthetic dentistry; Michele Carr, RDH, MA, and Rachel Kearney, RDH, MS, on ethics and risk management; Durinda Mattana, RDH, MS, on fluoride use; Kandis V. Garland, RDH, MS, on infection control; Mary Kaye Scaramucci, RDH, MS, on instrument sharpening; Stacy A. Matsuda, RDH, BS, MS, on instrumentation; Karen Davis, RDH, BSDH, on insurance coding; Cynthia Stegeman, EdD, RDH, RD, LD, CDE, on nutrition; Olga A.C. Ibsen, RDH, MS, on oral pathology; Jessica Y. Lee, DDS, MPH, PhD, on pediatric dentistry; Bryan J. Frantz, DMD, MS, and Timothy J. Hempton, DDS, on periodontal therapy; Ann Eshenaur Spolarich, RDH, PhD, on pharmacology; and Caren M. Barnes, RDH, MS, on polishing. Log on to dimensionsofdentalhygiene.com/asktheexpert to submit your question.

 

From Dimensions of Dental Hygiene. June 2014;12(6):74.

 

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