Pulpal
Sensitivity
The symptoms, causes and solutions for pulpal/dentin sensitivity
include:
Tooth
dehydration - Symptoms may come in the form of a dull toothache
or a headache. Using short-term modality (20 to 60 minute treatments)
should avoid this problem. By the end of the first hour, the
carbamide peroxide has been expended by approximately 70%.(1)
Wear beyond that point does less bleaching and continues to
keep the teeth coated with gel. Short-term modality allows rapid
saliva re-hydration to quickly counteract the hydrostatic imbalance
created by the H2O2
in the dentin tubules and enzyme systems in the pulp. One answer
for patient discomfort is taking a break for a day or two and/or
cutting back the treatment time.
Acute
Sensitivity - When the patient has a history of acute pulpal
sensitivity or is experiencing severe sensitivity, it is being
caused by direct access to the dentin from recessed gums, enamel
fractures, a chipped tooth, leaking margins, etc. The pain comes
in the form of a jolt or shock from a single tooth. In these
cases, a KNO3/Fluoride sensitivity toothpaste
is recommended for use two weeks prior to whitening and then
throughout the treatment. Toothpaste is the safest way to administer
KNO3, and it allows the KNO3
to adequately neutralize the nerve endings and the fluoride
to reduce dentin orifices. A common pain reliever such as aspirin
or ibuprofen is also a good strategy for acute sensitivity due
to exposed dentin.
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Tingling,
stinging gums, blanching, tenderness:
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- Overlapping
tray
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Overfilling tray
- Food,
floss, or toothbrush cuts & abrasions
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Trim
the tray off the soft tissue
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Instruct
patient to apply proper dosage - a drop in each tooth
indentation - total of just .25cc
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The
wounds need to heal before whitening
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A
dull toothache or headache:
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A
jolt or shock in a single tooth:
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Whether
the sensitivity is from soft tissue irritation or pulpal sensitivity,
have the patient take a break in the treatments for a day or
two to allow him/her to normalize. Then make the appropriate
diagnosis and adjustment and continue treatment. Those who experience
discomfort will most likely not have the prior magnitude of
discomfort.
Sensitivity is based on the patients' perception, which can
be positively affected by you. Helping the patients categorize
the sensations that are experienced during whitening treatments
can help them put what they feel into proper perspective.
Remind them it is safe. Tell them that bleaching gels whiten
much like cosmetologists color or lighten the hair of millions
of people. Cosmetologists use 10% to 40% H2O2
while dentists whiten teeth with at-nome strengths from 3.3%
to 10.5% H2O2.
Literally millions of people have had their teeth safely whitened
- a magnitude of safety rarely enjoyed by other cosmetic procedures.
Carbamide peroxide is prescribed to treat gums and combat gingivitis.
Under professional supervision, whitening is safe and effective.
Inform your patients what to expect. Keep in mind that 15%
to 20% of your patients will experience sensitivity wearing
the tray alone. Another 15% on top of that will experience
sensitivity with a placebo in the tray.(2)
Your awareness of these varied sensitivity ABC's will help your
patients get the best results with the least amount of discomfort.
1. Clinical Research Associates Newsletter, Tooth bleaching,
state-of-art '97, 21 :4, 1 :3
2. Haywood - See Footnote 1, Pg. 3
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