Minimally invasive aesthetic treatment of white spots by dental fluorosis in children: case report

The presence of white spots due to dental fluorosis can cause aesthetic discomfort, being one of the factors for a search for dental treatment. Objective: Report a clinical case in which the aesthetic complaint was solved through the association of the dental bleaching to the microabrasion technique. Case report: Male patient, 13 years, attended to the Integrated Clinic of the School of Dentistry of the Federal University of Rio de Janeiro, with fluorosis, mainly in the antero-superior teeth and aesthetic complaint. Initially, it was made an immediate bleaching with hydrogen peroxide at 35%, in 3 sessions of 15 minutes each, to soften the disparity of shades between tooth-stain. The result was insufficient and the dental microabrasion technique was adopted. A pumice paste was applied together with gel of phosphoric acid at 37% under relative isolation, in a total of 8 applications (1 minute each). At the end of each application, it was made an abundant water washing, microengine mounted fine-grained disc polishing and topical application of neutral NaF2 in gel (4 minutes each application) to eliminate possible postoperative sensitivity. Conclusion: The dental bleaching and the microabrasion technique promoted satisfactory immediate clinical results that increased self-esteem of the patient in a minimally invasive way to dental structure.

Introdução: A presença de manchas brancas por fluorose dentária pode causar desconforto estético, sendo um dos fatores para busca de tratamento odontológico. Objetivo: Relatar um caso clínico em que a queixa estética foi resolvida através da associação do clareamento dentário à técnica de microabrasão. Relato do caso: Paciente do sexo masculino, 13 anos, compareceu a Clínica Integrada da Faculdade de Odontologia da UFRJ, com fluorose, principalmente nos dentes ântero-superiores e queixa estética. Inicialmente, realizou-se clareamento imediato com peróxido de hidrogênio a 35%, em 3 sessões de 15 minutos, para suavizar a disparidade de tons entre mancha-dente. O resultado obtido foi insuficiente e a técnica de microabrasão dentária foi adotada. Uma pasta de pedra pomes foi aplicada juntamente com gel de ácido fosfórico a 37% sob isolamento relativo, perfazendo um total de 8 aplicações (1 minuto cada). Ao final de cada aplicação, foi realizada lavagem abundante com água, polimento com disco de granulação fina montado em micromotor e aplicação tópica de NaF2 neutro em gel (4 minutos cada aplicação) para eliminar possível sensibilidade pós-operatória. Conclusão: O clareamento dentário e a técnica de microabrasão promoveram resultados clínicos imediatos satisfatórios que elevaram a autoestima do paciente, de maneira minimamente invasiva para estrutura dentária.

Effect of tooth enamel staining by coffee consumption during at-home tooth bleaching with carbamide peroxide / Efeito da coloração do esmalte dentário pelo consumo de café durante o clareamento dentário caseiro com peróxido de carbamida

Introduction: Obtaining the result expected during tooth bleaching requires a correct diagnosis of the type of staining presented. The causes of tooth staining differ depending on the etiological factor. Objective: To assess the color change caused by the immersion of bovine teeth in coffee solution during at-home tooth bleaching using a 16% carbamide peroxide gel. Material and method: Thirty-three sound bovine teeth were assigned to three groups of eleven teeth each: 1 - Teeth bleached (TB) four hours per day for 21 days; 2 - TB four hours per day for 21 days and immersed in coffee solution immediately after tooth bleaching; 3 - TB four hours per day for 21 days and immersed in coffee solution four hours after the end of tooth bleaching. Immersed in coffee was performed for 15 minutes and tooth color was assessed before the start of the bleaching procedure and after 21 days with an intraoral spectrophotometer. Test Shapiro-Wilk was used to assess homoscedasticity and data were submitted to one-factor Analysis of Variance (ANOVA) and Tukey's test (p <0.05). Result: The color change observed in group 1 (5.76 ± 2.74)A was not statistically different from group 2 (8.83 ±5.11)A, which was immersed in coffee solution immediately after tooth bleaching, and from group 3, which was immersed in coffee solution four hours after tooth bleaching (8.20 ±3.71)A. Conclusion: Coffee did not interfere with the tooth bleaching results, regardless of the time after the procedure. Hence, diet restrictions are not necessary during tooth bleaching.

Introdução: A obtenção do resultado esperado durante o clareamento dental exige um diagnóstico correto do tipo de coloração apresentado. As causas da coloração dos dentes diferem dependendo do fator etiológico. Objetivo: Avaliar a mudança de cor causada pela imersão dos dentes bovinos na solução de café durante o clareamento dentário caseiro, utilizando gel de peróxido de carbamida a 16%. Material e método: Trinta e três dentes bovinos hígidos foram distribuídos em três grupos de onze dentes cada: 1 - Dentes clareados quatro horas por dia durante 21 dias; 2 - Dentes clareados quatro horas por dia durante 21 dias e imerso em solução de café imediatamente após o clareamento dentário; 3 - Dentes clareados quatro horas por dia durante 21 dias e imerso em solução de café quatro horas após o término do clareamento dentário. Imersão em café foi realizada durante 15 minutos e a cor dos dentes foi avaliada antes do início do procedimento do clareamento e após 21 dias com um espectrofotômetro intraoral. O teste Shapiro-Wilk foi utilizado para avaliar a homocedasticidade e os dados foram submetidos à análise de variância de um fator (ANOVA) e ao teste de Tukey (p <0,05). Resultado: A mudança de cor observada no grupo 1 (5,76 ± 2,74)A não foi estatisticamente diferente do grupo 2 (8,83 ± 5,11)A, imerso em solução de café imediatamente após o clareamento dentário, e do grupo 3, imerso em café quatro horas após o clareamento dental (8,20 ± 3,71). Conclusão: O café não interferiu nos resultados do clareamento dental, independentemente do tempo após o procedimento. Portanto, restrições alimentares não são necessárias durante o clareamento dental.

Is the morphology and activity of the occlusal carious lesion related to the lesion progression stage?

OBJECTIVE: To investigate the relationship between degree of dentin demineralization with both lesion activity and morphology of the occlusal carious cavity. DESIGN: Occlusal sites (n=138) were identified by visual examination (Nyvad's scores 0-6) in 67 extracted teeth which were scanned in a high energy micro-CT. After 3D reconstruction, each stack was resliced in the mesio-distal direction and tooth mineral density (MD) was measured along a path from enamel to the deepest part of dentin in the slice showing the most severe carious involvement. Each site was classified in "open" or "closed" (if cavitated) depending on the morphology of the surrounding enamel walls as measured using micro-CT and as active or inactive in enamel or dentin by a clinical scoring system. RESULTS: Lesions showing dentin cavitation presented higher demineralization degree compared to non-cavitated, or enamel cavitated lesions. Inactive lesions presented lower demineralization degree compared to active lesions, although with a low effect size. According to the morphological aspect of the carious cavity, open enamel lesions showed lower dentin demineralization degree than closed lesion environments. CONCLUSION: Active lesions showed higher dentin demineralization degree than inactive ones, while lesions showing closed cavitation resulted in higher dentin demineralization degree only for enamel lesions. Including those parameters in treatment decisions may help to improve prognosis and increase effectiveness of the caries diagnostic systems in the clinical setting.