University of Otago, Faculty of Dentistry, 310 Great King Street, Dunedin 9016, New Zealand.
University of Otago, Biostatistics Unit, Division of Health Sciences, 310 Great King Street, Dunedin 9016, New Zealand.
J Dent. 2019 May;84:22-29. doi: 10.1016/j.jdent.2019.03.007. Epub 2019 Mar 20.
To carry out a systematic review and meta-analysis of studies that investigated changes in perceived quality of life following vital tooth bleaching.
Online searches (Medline, PubMed, the Cochrane database of systemic reviews and Google scholar), bibliographic, and manual searches were carried out. Two authors independently screened the 313 articles identified from the searches and two authors extracted data, including risk of bias using the Cochrane data collection form. Random effects meta-analysis was used to estimate the pooled standardized mean difference (with 95% CI) and the 95% prediction interval.
Only four studies met the inclusion criteria, two showing statistically significant improvement, one worsening, and one inconclusive. The pooled standardized estimate for change in quality of life after bleaching was 0.04 (95% CI -0.15, 0.24) with substantial heterogeneity (I-squared 82.1%). Within these studies, there was a pattern of improvement in aesthetic-related domains (e.g. smiling and psychological discomfort) and deterioration in function-related domains (e.g. hygiene and pain).
Vital bleaching was not associated with improvements in overall Oral Health Related Quality of Life (OHRQoL) in these heterogeneous populations. Vital bleaching appeared to impact some domains of OHRQoL positively and some negatively, indicating the need for clinicians to treat patients receiving bleaching treatment so as to obtain the best improvement in aesthetics with minimal side effects. Clinicians should be aware of the potential impact caused by tooth sensitivity and offer proper instruction to prevent it or treatment to reduce its impact.
Bleaching treatment produces positive changes in young participants' OHRQoL in aesthetic areas such as smiling, laughing, and showing teeth without embarrassment. Tooth sensitivity, the main side-effect of vital bleaching treatment, can affect quality of life, and so oral health professionals should offer evidence-based advice to prevent and manage sensitivity.
对研究活髓牙漂白后感知生活质量变化的研究进行系统评价和荟萃分析。
在线搜索（Medline、PubMed、Cochrane 系统评价数据库和 Google Scholar）、参考文献搜索和手动搜索。两位作者独立筛选从搜索中确定的 313 篇文章，并由两位作者提取数据，包括使用 Cochrane 数据采集表评估偏倚风险。使用随机效应荟萃分析来估计汇总标准化均数差（95%置信区间）和 95%预测区间。
只有四项研究符合纳入标准，其中两项显示统计学上显著改善，一项恶化，一项不确定。漂白后生活质量变化的汇总标准化估计值为 0.04（95%置信区间-0.15，0.24），具有显著异质性（I-平方 82.1%）。在这些研究中，审美相关领域（如微笑和心理不适）有改善的趋势，而功能相关领域（如卫生和疼痛）则有恶化的趋势。
在这些异质人群中，活髓牙漂白与整体口腔健康相关生活质量（OHRQoL）的改善无关。活髓牙漂白似乎对一些 OHRQoL 领域有积极影响，对一些领域有负面影响，这表明临床医生在为接受漂白治疗的患者提供治疗时，需要尽力获得美学上的最佳改善，同时尽量减少副作用。临床医生应该意识到牙齿敏感引起的潜在影响，并提供适当的指导，以防止或治疗来减轻其影响。
漂白治疗可使年轻参与者的 OHRQoL 在微笑、大笑、无尴尬地露出牙齿等美学方面产生积极变化。活髓牙漂白治疗的主要副作用——牙齿敏感，会影响生活质量，因此口腔健康专业人员应提供基于证据的建议，以预防和管理敏感性。
