Coppla F M, Rezende M, de Paula E, Farago P V, Loguercio A D, Kossatz S, Reis A
Oper Dent. 2018 Mar/Apr;43(2):E53-E63. doi: 10.2341/17-092-C.
Bleaching-induced tooth sensitivity (TS) is highly prevalent.
This study aimed to determine if the combination of opioids and nonopioids analgesics (Tylex) may provide a better analgesic effect.
A triple-blind, parallel, randomized two-center clinical trial was conducted with 105 healthy patients who received either a placebo or a combination of acetaminophen/codeine. The first dose of Tylex 30 mg (acetaminophen 500 mg/codeine 30 mg) or placebo was administered one hour before the in-office bleaching (35% hydrogen peroxide), and extra doses were administered every six hours for 48 hours. The TS was recorded using a visual analog scale of 0 to 10 and a numeric rating scale of 0 to 4 in different periods: during bleaching, one hour up to 24 hours, and 24 hours up to 48 hours postbleaching. The color was measured before and one month after dental bleaching with a visual shade guide (Vita Classical), Vita Bleachedguide 3D-MASTER, and the spectrophotometer Vita Easyshade. The absolute risk of TS was evaluated using the Fisher exact test. Data of TS intensity with numeric rating scale of the two groups were compared with the Mann-Whitney U-test and the Friedman test, while data from the visual analog scale were evaluated by two-way repeated measures analysis of variance and the Tukey test for pairwise comparison. The color changes between groups were compared using the Student t-test (α=0.05).
No significant differences between the groups were observed in the risk and intensity of TS. The overall absolute risk of TS was approximately 96%. No significant differences between groups were observed in terms of color change ( p>0.05) for any scale.
The use of an acetaminophen/codeine combination prior to in-office bleaching does not reduce the risk and intensity of bleaching-induced TS.
漂白引起的牙齿敏感（TS）非常普遍。
本研究旨在确定阿片类药物与非阿片类镇痛药（泰勒克斯）联合使用是否能提供更好的镇痛效果。
对105名健康患者进行了一项三盲、平行、随机双中心临床试验，这些患者接受了安慰剂或对乙酰氨基酚/可待因组合。在诊室漂白（35%过氧化氢）前一小时给予第一剂30毫克泰勒克斯（对乙酰氨基酚500毫克/可待因30毫克）或安慰剂，之后每六小时额外给药一次，持续48小时。在不同时间段使用0至10的视觉模拟量表和0至4的数字评定量表记录牙齿敏感情况：漂白期间、漂白后1小时至24小时以及漂白后24小时至48小时。在牙齿漂白前和漂白后一个月，使用视觉比色板（维他经典）、维他漂白比色板3D-MASTER和分光光度计维他易美进行颜色测量。使用Fisher精确检验评估牙齿敏感的绝对风险。两组数字评定量表的牙齿敏感强度数据采用Mann-Whitney U检验和Friedman检验进行比较，而视觉模拟量表的数据则通过双向重复测量方差分析和Tukey检验进行两两比较。使用Student t检验（α=0.05）比较组间颜色变化。
在牙齿敏感的风险和强度方面，两组之间未观察到显著差异。牙齿敏感的总体绝对风险约为96%。在任何量表上，组间在颜色变化方面均未观察到显著差异（p>0.05）。
在诊室漂白前使用对乙酰氨基酚/可待因组合并不能降低漂白引起的牙齿敏感的风险和强度。
