Topical application of a desensitizing agent containing potassium nitrate before dental bleaching: a systematic review and meta-analysis

• Published in: Clinical oral investigations 2021-07, Vol.25 (7), p.4311-4327
• Main Authors: Martini, E. C., Favoreto, M. W., Rezende, M., de Geus, J. L., Loguercio, A. D., Reis, A.
• Format: Article
• Language: English
• Subjects: Bleaching; Color; Dentin Sensitivity - drug therapy; Dentin Sensitivity - prevention & control; Dentistry; Humans; Hydrogen Peroxide; Medicine; Meta-analysis; Nitrates; Placebos; Potassium; Potassium Compounds; Potassium nitrate; Review; Systematic review; Tooth Bleaching; Tooth Bleaching Agents; Topical application
• ISSN: 1432-6981; 1436-3771
• DOI: 10.1007/s00784-021-03994-6

Objectives To conduct a systematic review and meta-analysis to evaluate the risk and intensity of tooth sensitivity (TS) after topical application of desensitizers containing potassium nitrate before dental bleaching. Methods We searched PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE. We also surveyed gray literature without restrictions. We meta-analyzed the data using the random-effects model to compare potassium nitrate and placebo in terms of risk and intensity of TS and color change (∆SGU or ∆E). The quality of the evidence was rated using the GRADE approach. The risk of bias (RoB) of the included studies was analyzed using the Cochrane RoB tool. Results After the database screening, 24 articles remained. A significant 12% lower risk for the groups where desensitizing agents were applied (p = 0.02), with a risk ratio of 0.88 (95% CI 0.78 to 0.98). About the intensity of TS, a significant average mean difference of − 0.77 units of VAS units (95%CI − 1.34 to − 0.19; p = 0.01) in favor of the desensitizer group. In the NRS scale, a significant average mean difference of − 0.36 (95% CI − 0.61 to − 0.12; p value = 0.004) in favor of the desensitizer group. No significant difference was observed in color change (p > 0.28) in ∆SGU and ∆E. Conclusions Although a significant reduction in the risk and intensity of TS was observed in groups treated with a potassium nitrate at some point during the bleaching, the clinical significance of this reduction is subtle and clinically questionable. Color change is not affected by the use of agents. Clinical relevance The reduction in the risk and intensity of TS with the topical application of potassium nitrate–based desensitizing agents in dental bleaching is subtle and maybe clinically questionable.