Tooth color change and tolerability evaluation of a hydrogen peroxide whitening strip compared to a strip, paste, and rinse regimen containing plant-based oils and Dead Sea salt.

PURPOSE: To assess tooth color changes and tolerability with use of a hydrogen peroxide whitening strip compared to a regimen of a strip, rinse and paste for tooth whitening. METHODS: This was a single-center, parallel-group, double-blind, randomized controlled clinical trial. Qualified generally healthy adult participants were assigned to one of two treatment groups. The test group included peroxide-free strips, a fluoride-free whitening toothpaste, and a whitening mouthwash (all Lumineux Oral Essentials); all test products contain plant-based oils (coconut, sage, and lemon peel) and Dead Sea salt. The control group included hydrogen peroxide whitening strips (Crest 3DWhitestrips Classic White) and a sodium fluoride non-whitening toothpaste (Crest). Both groups used a soft manual toothbrush (Oral-B). Strips (for both groups) and rinse (for test group) were used once daily. Changes in tooth color were assessed objectively and quantitatively by digital image analysis after 7, 10 and 14 treatments. RESULTS: 50 participants were enrolled and randomized to treatment and 48 completed the trial. Participants had an average age of 40.8 years (range 18 to 62 years) and 64% were female. At the end of treatment, the test group did not provide statistically significant changes in yellowness (b*) or lightness (L*) from baseline (P≥ 0.411), whereas the control group demonstrated a statistically significant mean yellowness reduction (SD) of 1.55 (0.703) and a mean lightness improvement (SD) of 1.57 (1.141) compared to baseline (P< 0.001 for both). The control group also provided statistically significantly greater mean yellowness reductions and mean lightness improvements compared to the test group at all time points (P< 0.002). Products in both groups were well tolerated, with minor oral irritation and tooth sensitivity representing the most common findings during treatment. CLINICAL SIGNIFICANCE: The Crest Whitestrips control whitening strip provided significant tooth whitening efficacy, whereas the Lumineux Oral Essentials test regimen containing plant-based oils and Dead Sea salt did not. This evidence is important for dental professionals to consider when making recommendations for patients seeking at-home whitening treatments.

An in vitro evaluation of radicular penetration of hydrogen peroxide from bleaching agents during intra-coronal tooth bleaching with an insight of biologic response.

OBJECTIVES: External root resorption is the complication of intra-coronal bleaching done with 30% H2O2 alone or mixed with sodium perborate but not with sodium perborate mixed with water. The study was done to comparatively evaluate the H2O2 leakage from three H2O2 liberating bleaching agents. STUDY DESIGN: Fifty one single rooted human teeth were used. After root canal therapy gutta percha was removed below cemento-enamel junction. Three bleaching agents: sodium perborate mixed with water, sodium perborate mixed with 30% H2O2 and 30% H2O2 alone were used. Teeth without defect, with cervical root defect and with mid root defect constituted group A, group B and group C. According to various bleaching agents groups were subdivided into subgroup 1, 2 and 3. H2O2 leakage was measured with the help of spectrophotometer RESULTS: Almost all teeth showed H2O2 leakage. It was maximum in B1 followed by C1, B2, A1, A2, C2, B3, A3 and C3. CONCLUSION: Sodium perborate mixed with water was found to be the best bleaching agent.

Bleaching and bonding for the older patient.

UNLABELLED: Older people who remain reasonably well may wish to maintain or enhance their dental and oral appearance, preferably at minimal biologic and financial costs. Bleaching and bonding represents a very good treatment option and a sensible strategy for this group. Bleaching addresses the discoloration, while direct composite bonding can improve the shape of worn, or otherwise unaesthetic, teeth without damaging the structure or health of the residual tooth tissue. This pragmatic treatment is well tolerated by older patients. The visual and functional improvements are greatly appreciated by this group, partly because of the non-destructive and affordable nature of the benefits. CLINICAL RELEVANCE: Bleaching and bonding represents a proven, sensible, pragmatic, affordable and practical approach to managing the aesthetic problems of older patients, and the benefits are achievable without destroying their residual sound tooth tissue.

Multidisciplinary approach for a patient with dentinogenesis imperfecta and anterior trauma.

Dentinogenesis imperfecta is an inherited dentinal dysplasia involving several risks for orthodontic treatment. This case report describes the multidisciplinary treatment of a 17-year-old girl whose Class II Division 1 malocclusion was complicated by dentinogenesis imperfecta type II and maxillary anterior trauma.

Conservative esthetic management of severe dental fluorosis with in-office power bleaching.

Fluorosis is an endemic disease, prevailing in about 25 countries globally. Dental fluorosis is an acquired defect of enamel due to the exposure of an individual to excessive fluoride levels during tooth development. It could result in mild-to-severe discoloration of teeth, which might necessitate esthetic correction. Bleaching is one of the common treatment modalities used in the esthetic correction of such cases. In-office power bleaching is one of the techniques of tooth bleaching that involves clinical application and activation of the bleaching agent with light to accelerate the bleaching process. This case report describes the esthetic correction of severe dental fluorosis by power bleaching, without any need for invasive treatment. This report suggests that in-office power bleaching is an effective and conservative method for esthetic correction of tooth discoloration in severe dental fluorosis.

Résumé La fluorose est une maladie endémique, qui prévaut dans environ 25 pays dans le monde. La fluorose dentaire est un défaut acquis des l'émail dû à l'exposition d'un individu à des niveaux excessifs de fluor pendant de développement des dents. Cela pourrait aboutir à une décoloration légère à sévère des dents, qui nécessite une correction esthétique. Le blanchiment est l'une des modalités de traitement courantes utilisées dans la correction esthétique de ces cas. "In-office power" le blanchiment est l'une des techniques de blanchiment des dents qui implique l'application clinique et l'activation de l'agent de blanchiment avec de la lumière pour accélérer le processus de blanchiment. Ce rapport de cas décrit la correction esthétique de la fluorose dentaire sévère par blanchiment "power", sans aucun besoin pour d'un traitement invasif. Ce rapport suggère que le blanchiment "In-office power" est une méthode efficace et conservatrice pour la correction esthétique de la décoloration dentaire dans la fluorose dentaire sévère.

New developments in tooth whitening. The current status of external bleaching in orthodontics.

This article provides a contemporary view of external tooth whitening procedures currently available, with particular reference to bleaching. The various techniques and products are described, with their advantages, disadvantages, mode of action and the current legal stand-point discussed. The results of a British Orthodontic Society survey of Specialist and Practitioner Groups regarding current usage patterns of tooth whitening products are presented.

A review of the efficacy of tooth bleaching.

UNLABELLED: Current tooth lightening systems use hydrogen peroxide or carbamide peroxide which releases hydrogen peroxide as the bleaching agent. In vitro and in vivo studies, mostly comparing different bleaching systems, have demonstrated the efficacy of vital and non-vital tooth bleaching. Bleaching treatments are affected by a number of factors including the actual cause of tooth discoloration. All in-surgery bleaching agents are chemically activated and, whilst better results are possible with lights, these are not essential. Shade change can be evaluated subjectively and may be observed after only a few nights with Night Guard Vital Bleaching (NGVB). Objective methods of shade evaluation are used in most randomized controlled trials. There are a number of methods used to bleach teeth but NGVB using 10% carbamide peroxide in trays produces the optimal result with the least side-effects. The'inside/outside' bleaching technique using 10% carbamide peroxide is the most effective and safest method of bleaching non-vital teeth. Although more than 90% success has been reported, regression of the colour change is a common problem in vital and non-vital tooth bleaching and retreatment is necessary in many cases, usually after 1-3 years. The overwhelming evidence indicates that tooth bleaching is effective if supervised by a dentist. CLINICAL RELEVANCE: The clinician should be able to inform patients that both vital and non-vital tray bleaching using 10% carbamide peroxide can produce excellent results when supervised. However, shade regression is likely in 1-3 years.

Treatment planning in esthetic dentistry requires careful listening to the patient.

Creating an esthetic result that is pleasing to both the patient and the dentist requires careful consideration of patient concerns and treatment goals. This article presents a case involving a patient with many esthetic concerns. Following in-depth examination of the patient and consultations, an esthetic treatment plan involving the placement of laminate veneers was developed and executed. After the first set of laminate veneers was placed, some concerns led to an alteration in the proposed treatment plan. Each step of the treatment plan must be assessed before the next step is performed to guarantee a result that is both functional and esthetically pleasing.

Treating tetracycline staining in the adult dentition: a case report.

Tetracycline staining in the adult dentition has presented an esthetic challenge for many years. Many clinicians have treated the problem by utilizing invasive techniques that may involve crowns, veneers, and composite bonding. Some major disadvantages to these invasive techniques include the cost involved and the need to cut on sound tooth structures. This article showcases a protocol for treating tetracycline staining non-invasively.

A comparison of various minimally invasive techniques for the removal of dental fluorosis stains in children.

CONTEXT: Dental fluorosis is caused by successive exposure to high concentrations of fluoride during tooth development leading to enamel with lower mineral content and increased porosity. AIMS: The aim of the study was to evaluate and compare the effectiveness of minimally invasive techniques for the removal of dental fluorosis stains in children in vivo. DESIGN: Ninety children in the age group of 10-17 years were selected. MATERIALS AND METHODS: The study sample was equally and randomly divided into three groups; Group 1: In-office bleaching with 35% hydrogen peroxide (HP) activated by light-emitting diode (LED) bleaching unit (35% HP), Group 2: Enamel microabrasion (EM) followed by in-office bleaching with 44% carbamide peroxide gel (EM), Group 3: In-office bleaching with 5% sodium hypochlorite (5% NaOCl). Statistical analysis was done using one-way ANOVA test. RESULTS: Bleaching with 35% HP activated by LED bleaching unit and EM followed by bleaching with 44% carbamide peroxide were equally effective for the removal of dental fluorosis stains in children in vivo. However, bleaching with 5% NaOCl could not completely remove moderate to severe stains. It was effective in removing only mild stains. Bleaching and microabrasion procedures caused slight decrease in tooth sensitivity readings by electric pulp vitality tester which continued to increase over time. However, none of the patients reported sensitivity in their teeth at any point of time. Patients were highly satisfied with the treatment outcome postoperatively but reported slight relapse of color in the three groups. CONCLUSIONS: Bleaching and microabrasion techniques can consider as an interesting alternatives to conventional operative treatment options.

Esthetic restoration of discolored primary incisors.

Restoring primary teeth can be a strenuous task for many dentists who would like to have an esthetic, easy-to-use and relatively quick restoration for children. But, the restoration of carious, fractured or discolored primary incisors gives the dentist the satisfaction of knowing that he/she has restored the smile and self-confidence of a growing child. This article describes a technique which is relatively easy and produces a beautiful outcome in a relatively short time. The author has used the technique in hundreds of children for over twenty-five years. Modifications in the technique have been made as newer materials and techniques have evolved.

Laser tooth whitening.

Cosmetic and adhesive dentistry has not only increased patients' self-esteem and confidence, it has increased their awareness of the value of healthy teeth and gums. White teeth have always been a high priority with patients. Creating and maintaining white teeth, however, has not always been easily achieved. The recent development of laser-assisted tooth whitening procedures makes it easier, faster, non-invasive, and affordable for patients to have whiter teeth.

Efficacy of two dentifrices on removal of natural extrinsic stain.

PURPOSE: To evaluate the 6-week effect on natural extrinsic dental stain from the use of a dentifrice containing 10% aluminum oxide, 1500 ppm sodium monofluorophosphate in a precipitated calcium carbonate (PCC) base or a second dentifrice containing 0.5% calcium peroxide (CP), 1500 ppm sodium monofluorophosphate in a PCC base compared to a fluoride placebo dentifrice without stain removal ingredients. MATERIALS AND METHODS: A total of 94 subjects were entered in the study, and stratified into three balanced groups according to their baseline mean Lobene Stain Index scores. The three groups were randomly assigned to use one of the two test dentifrices or the placebo dentifrice. The three groups were well balanced with regard to their mean baseline stain index scores, gender and tobacco habits. Subjects were instructed to brush their teeth twice daily (morning and evening) for 1 minute with their assigned dentifrice and a commercially available soft bristled toothbrush. Extrinsic dental stain examinations, which included mean stain area and mean stain intensity, were conducted at baseline and 6 weeks. Examinations were conducted by the same dental examiner (F.A.) on the subjects at each examination. RESULTS: After 6 weeks' use of their assigned products, those subjects in the aluminum oxide/PCC dentifrice group and those subjects in the CP/PCC dentifrice group demonstrated statistically significant improvements, as compared to the fluoride placebo dentifrice group without stain removal ingredients.

Intracoronal bleaching of nonvital teeth in children and adolescents: interim results.

This study was undertaken to investigate the outcomes in 20 children and adolescents who had undergone an intracoronal nonvital bleaching technique. Twenty-one discolored central incisor teeth were treated by the walking bleaching method and reviewed at intervals for 18 months following completion of bleaching. All teeth bleached lightened to varying degrees, and 62% of patients expressed satisfaction with the result. When a porcelain shade guide was used as a reference before bleaching, the percentage of teeth deemed off the shade guide, gray or reddish gray, was 97%. Immediately postbleaching, the percentage had been reduced to 57%, and relatively more teeth were at the lighter end of the scale for each color band. At 18 months, three teeth (17%) had been veneered, and 33% of the remainder were found to be off the shade guide, gray or red-gray. Radiographically, 81% of teeth were classified as healthy at 18 months, with no evidence of cervical or progressive apical resorption.

Effects of a Baking Soda Gum on extrinsic dental stain: results of a longitudinal 4-week assessment.

An evaluation of the effects of ARM & HAMMER DENTAL CARE The Baking Soda Gum (AHDC) on extrinsic dental stain was made in 48 subjects presenting with measurable extrinsic stain. The subjects were randomized to use either the baking soda gum or a non-baking soda placebo gum for 20 minutes twice daily after lunch and dinner while brushing once daily. The procedure of limited brushing was chosen to simulate the level of hygiene normally practiced by participants entering a clinical study. After 4 weeks, the reduction in measurable extrinsic stain in the baking soda gum group was statistically significant (P = .0044) relative to baseline. Statistical analysis of the placebo gum group revealed no significant change in extrinsic stain from baseline. The magnitude of the unadjusted longitudinal reduction in extrinsic stain in the baking soda gum group was 29.7% at 4 weeks.

Combined professional and home care nightguard bleaching of tetracycline-stained teeth.

The effectiveness of combining in-office and at-home nightguard vital bleaching on tetracycline-stained teeth was evaluated. Grade 1 and grade 2 tetracycline stains were eliminated completely in two months by this combination approach. Grade 3 stains, the most severe, were lightened significantly with a reduction in the banding effect. The most common side effect was an increase in tooth sensitivity, especially to cold, while actively in treatment. All patients reported disappearance of the sensitivity after termination of the treatment phase.

Frequently asked questions about bleaching.

Nightguard vital bleaching, or at-home bleaching using a 10% carbamide peroxide material in a custom-fitted tray, has become the standard for tooth whitening. This article answers many of the questions associated with this process, and compares the procedure with other whitening options.

Managing discoloured non-vital teeth: the inside/outside bleaching technique.

The discoloured, non-vital anterior tooth is a common aesthetic concern for many patients. It can have a profound effect on their self-esteem, interaction with others and employability. Discoloured non-vital teeth are frequently compromised owing to previous trauma, caries, endodontic therapy and failed restorations. Destructive invasive treatment options are likely to weaken the residual structure of the tooth. This can reduce the prognosis and challenge the long-term viability of the tooth, thereby initiating further prosthetic predicaments. This paper discusses modern approaches to the treatment of discoloured teeth. The importance of preventing and eliminating the potential for discoloration will be highlighted. The paper will include a detailed technical account on the application of the inside/outside bleaching technique, with several clinical examples.

[Treatment of dental fluorosis]. / Le traitement de la fluorose dentaire.

Fluorotic stains present a variety of clinical surface alteration with the modification of the enamel colour, we have a structural modification of hard tissues resulting in their hypo-mineralisation. A knowledge of the kind of surface, nature, and deepness of the discoloration is necessary in order to make the right diagnosis and so, to adapt the specific treatment which can varies from a simple general treatment based on VIT C drugs, to aesthetic veneers and includes micro-abrasion technique, and chemical bleaching methods.