Effectiveness of Analgesics in Dental Whitening Pain Management: A Systematic Review and Meta-Analysis

This study evaluated the impact of anti-inflammatory and analgesic agents on managing pain and sensitivity related to dental bleaching.
A PROSPERO-registered systematic review (CRD42024528788) searched PubMed, Scopus, Web of Science, LILACS, EBSCOhost, LIVIVO, Embase, and Grey literature (Google Scholar) up to March 2024. From 3,185 articles screened, 16 placebo-controlled RCTs involving 823 patients were included. NSAIDs were the most commonly used drugs, with some studies incorporating corticosteroids. Risk of Bias (RoB) was assessed using Rob-2, and a meta-analysis evaluated mean differences and relative risks across subgroups. GRADE-pro assessed evidence certainty.
Findings revealed no significant improvement in pain or sensitivity scores (VAS: p = 0.770; NRS: p = 0.980) or tooth sensitivity incidence (p = 0.750) compared to placebo. However, 1 hour post-bleaching, the intervention group showed a slight VAS score reduction (mean difference: −0.49, CI95% = -0.83 to −0.16; p = 0.004). Whitening results (ΔE: p = 0.140) and NSGU perception showed no differences, but the VITA scale slightly favored the placebo (p = 0.030). Ibuprofen or paracetamol-plus-codeine were the only that showed any clinical benefit.
Anti-inflammatory or analgesic agents provided minimal benefit for controlling post-bleaching pain/sensitivity reducing 0.49-VAS-scores (clinically insignificant). There is a need to optimize pain management in dental bleaching, especially focusing on COX-2 selective NSAIDs.

本研究评估了抗炎与镇痛药物在管理牙科漂白相关疼痛及敏感症状中的应用效果。
本研究为一项在PROSPERO平台注册的系统评价（注册号：CRD42024528788），检索了PubMed、Scopus、Web of Science、LILACS、EBSCOhost、LIVIVO、Embase及灰色文献（谷歌学术）数据库，检索截止至2024年3月。初筛获得3185篇文献后，最终纳入16项安慰剂对照随机对照试验（Randomized Controlled Trial, RCT），共涉及823名受试者。其中非甾体抗炎药（Non-Steroidal Anti-Inflammatory Drugs, NSAIDs）为最常用药物，部分研究纳入了糖皮质激素。采用Rob-2工具评估偏倚风险（Risk of Bias, RoB），通过Meta分析评估亚组间的均数差与相对风险，并采用GRADEpro工具评估证据确定性等级。
研究结果显示，与安慰剂组相比，干预组的疼痛或敏感评分[视觉模拟评分法（Visual Analogue Scale, VAS）：p=0.770；数字评定量表（Numerical Rating Scale, NRS）：p=0.980]以及牙齿敏感发生率（p=0.750）均无显著改善。但在漂白后1小时，干预组的VAS评分出现小幅降低（均数差：-0.49，95%置信区间：-0.83~-0.16；p=0.004）。美白效果（ΔE：p=0.140）以及NSGU感知评分无组间差异，但VITA量表结果显示安慰剂组略占优（p=0.030）。仅布洛芬或对乙酰氨基酚联合可待因展现出一定临床获益。
抗炎或镇痛药物在控制牙科漂白后疼痛/敏感方面仅能带来极小获益，仅可降低0.49分的VAS评分（临床意义可忽略）。目前仍需优化牙科漂白后的疼痛管理方案，尤其应聚焦于选择性环氧合酶-2（COX-2）非甾体抗炎药。