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Interventions for bleaching-induced tooth sensitivity: an umbrella review
Madina A Kurmanalina1, Zhanar G Tankibayeva2, Togzhan B Sagimbayeva2
1School of Dentistry, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.
Objective:
This umbrella review aimed to synthesize and critically evaluate evidence from systematic reviews on interventions for the prevention and management of bleaching-induced tooth sensitivity, with emphasis on methodological quality, risk of bias, certainty of evidence, clinical relevance, and overlap of primary studies.
Methods:
An umbrella review was conducted following PRISMA 2020 guidance. PubMed, Scopus, Web of Science, the Cochrane Database of Systematic Reviews, Embase and LILACS Plus Collection were searched up to August 10, 2026. Methodological quality, risk of bias, certainty of evidence, clinical relevance, and overlap were assessed using AMSTAR-2, ROBIS, reported GRADE ratings, and the corrected covered area method.
Results:
Eighteen systematic reviews were included. Systemic analgesic and anti-inflammatory drugs consistently showed no clinically meaningful preventive effect. Potassium-nitrate-based interventions showed small reductions in sensitivity intensity, whereas effects on incidence were inconsistent. Evidence for fluoride was largely derived from combination formulations, limiting assessment of its independent effect. Calcium-based agents showed limited and low-certainty benefits. Photobiomodulation therapy (PBMT), historically referred to as low-level laser therapy (LLLT), appeared promising for reducing sensitivity intensity, but substantial protocol heterogeneity and variable risk of bias limited confidence in the findings. Overall, most interventions reduced sensitivity intensity rather than incidence.
Conclusion:
Bleaching-induced tooth sensitivity is common but usually transient. Systemic non-steroidal anti-inflammatory drugs appear ineffective. Potassium-nitrate-based interventions may provide modest relief in selected settings, whereas the independent benefit of fluoride remains uncertain because it was frequently evaluated as part of combination formulations. PBMT may also reduce sensitivity intensity, although protocol heterogeneity limits clinical recommendations. Standardized, high-quality randomized trials are needed.
Systematic Review Registration:
https://osf.io/9s8h7/.