Pulpal penetration of peroxide, dehydration, and tray-related tooth movements have been implicated in bleach-induced tooth sensitivity. This sensitivity is transient and generally dissipates within a short time.
Strategies
- Decreasing the contact intervals may be a start, using 1-hour instead of 2-hour contact times or even every other day.
- Decreasing the concentration of the product chosen, 10% or less carbamide peroxide rather than higher levels, is a second choice.
- It has been reported that not pre-brushing the teeth decreases sensitivity without undue impairment in bleaching result. Dentifrices contain detergents (e.g., sodium lauryl sulfate) that may readily denature proteins on contact, which allows greater penetration of peroxide into the tooth and increases transient irritation.
- A prescription-strength fluoride dentifrice, such as Prevident 5000 Plus (Colgate) can be used to resolve persistent cases.
- Soft tissue irritation can occur with in-office methods unless proper isolation is used.
- Home bleaching trays must be well adapted and properly contoured to prevent prolonged soft tissue contact.
- Patients should be instructed not to overfill their trays to avoid swallowing excessive bleach material on insertion.
Source: Dental Secrets, Elsevier, 2015
I tell my patients with sensitive teeth to whiten every other day using the folowing instructions. They pretreat their teeth with M.I. Paste in the trays for up to 30 min, then use the whitening gel (usually a reduced-strength gel)and if sensitivity persists to follow with Sensodyne in the tray for 30 min. So far I have not had any patient who was unable to whiten, if they are willing to follow this somewhat labour-intensive protocol.
Excellent article