Restor Dent Endod.  2020 May;45(2):e20. 10.5395/rde.2020.45.e20.

Influence of pain-relieving therapies on inflammation and the expression of proinflammatory neuropeptides after dental bleaching treatment

• Silva LMAVd
• Cintra LTA
• Gallinari MdO
• Benetti F
• Rahal V
• Ervolino E
• Alcântara Sd
• Briso ALF

• KMID: 2503515
• DOI: http://doi.org/10.5395/rde.2020.45.e20

Abstract

Objectives
To minimize the tooth sensitivity caused by in-office bleaching, many dentists use non-steroidal anti-inflammatory drugs and topical desensitizing gels containing potassium nitrate and sodium fluoride. This study aimed to evaluate the influence of these substances on inflammation and the expression of substance P and calcitonin gene-related peptide in pulp nerve fibers.
Materials and Methods
Seventy-two rats were divided into 6 groups as follows: GI, control; GII, only dental bleaching; GIII, only ibuprofen; GIV, ibuprofen administered 30 minutes before and after the bleaching treatment and every 12 hours until the analysis; GV, only topical application of a desensitizing agent; and GVI, topical application of a desensitizing agent before dental bleaching. Placebo gel was applied to the upper left jaw and the bleaching agent was applied to the upper right jaw in all groups. Subsequently, the groups were divided into 3 subgroups based on the time of analysis: 0, 24, and 48 hours after bleaching (n = 8). The rats were euthanized and the maxillae were processed and evaluated by histopathological and immunohistochemical analyses. The data were analyzed using the Kruskal-Wallis test, followed by the Dunn test (p < 0.05).
Results
In the bleaching groups, the inflammatory process and expression of neuropeptides decreased over time. The animals in which a desensitizing agent was applied showed better results within 24 hours.
Conclusions
The use of a desensitizing agent had positive effects on inflammation and pain-related neuropeptide expression, minimizing the painful effects of dental bleaching treatment.

Keyword

Tooth bleaching; Hydrogen peroxide; Ibuprofen; Laboratory research; Pain; Reactive oxygen species

Figure

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  Figure 1 Flowchart detailing the division of the rats according to the experimental groups and analysis times.Pla, placebo; HP, hydrogen peroxide; Ibu, ibuprofen; Des, desensitizing agent.

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  Figure 2 Longitudinal section of the coronary third of the pulp tissue of the study groups. The (A-D) correspond to photomicrographs immediately after bleaching: control group (A), 38% hydrogen peroxide without pain-relieving therapy (B), bleaching therapy associated with oral administration of ibuprofen (C), and bleaching therapy associated with topical application of Desensibilize KF 2% (D). The (E-H) correspond to photomicrographs at 24 hours after bleaching: control group (E), 38% hydrogen peroxide without pain-relieving therapy (F), bleaching therapy associated with oral administration of ibuprofen (G), and bleaching therapy associated with topical application of Desensibilize KF 2% (H). The (I-L) correspond to photomicrographs at 48 hours after bleaching: control group (I), 38% hydrogen peroxide without pain-relieving therapy (J), bleaching therapy associated with oral administration of ibuprofen (K), and bleaching therapy associated with topical application of Desensibilize KF 2%.

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  Figure 3 Histological sections showing immunostaining patterns for substance P. Photomicrographs showing the pattern of immunostaining for SP in the dental pulp in groups GI (A, E), GII (B, F), GIV (C, G) and GVI (D, H) after 24h (A–D) and 48h (E–H) local post treatment. It's possible observe the baseline level of SP expression in the control group and the significant increase in immunostaining for SP after bleaching therapy. Original magnification: ×1,000.

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  Figure 4 Histological sections showing the immunostaining pattern for calcitonin gene-related peptide. Photomicrographs showing the pattern of immunostaining for CGRP in the dental pulp in groups GI (A, E), GII (B, F), GIV (C, G) and GVI (D, H) after 24h (A–D) and 48h (E–H) after local treatment. It's possible observe the baseline level of CGRP expression in the control group and the significant increase in immunostaining for CGRP after bleaching therapy. Original magnification: ×1,000.

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