Longevity, effectiveness, safety, and impact on quality of life of low-concentration hydrogen peroxides in-office bleaching: a randomized clinical trial.

OBJECTIVE: The study evaluated the longevity, effectiveness, safety, and impact on the oral health-related quality of life of in-office dental bleaching using low-concentration hydrogen peroxides. MATERIALS AND METHODS: Randomized, parallel, and double-blinded clinical trial was performed with 54 participants using 6% or 15% hydrogen peroxide (HP) in-office bleaching activated via hybrid LED/laser light. Tooth color was evaluated at baseline (T1), 1 week of bleaching (T2), 2 weeks of bleaching (T3) and 1 week (T4) and 6 months (T5) after finishing the bleaching using the Classical Vita™ scale and spectrophotometer. Tooth sensitivity and gingival irritation were measured with Visual Numeric Scale and Modified Gingival Index. The impact on quality of life was evaluated using the Oral Impact on Daily Performance. The data were analyzed using the Friedman, Mann-Whitney, and McNemar tests (p < 0.05). RESULTS: The group HP15% presented significant color change (ΔE) from T1 to T4 (p = 0.002) and T1 to T5 (p < 0.001). Parameters L, a*, and b* differed significantly at T3, T4, and T5 compared T1 for both groups. At 6-month follow-up, 57.1% of HP6 and 43.7% of HP15% participants migrated from B1 to a darker color. No significant differences were observed between the groups in tooth sensitivity, gingival irritation, or impact on quality of life. CONCLUSIONS: Both agents showed bleaching effectiveness, but HP15% presented greater color stability than HP6%, at 6-month follow-up. The agents showed low levels of tooth sensitivity, gingival irritation, and did not affect the oral health-related quality of life of the participants. CLINICAL RELEVANCE: Despite the greater presence of sensitivity during treatment compared with 6% hydrogen peroxide, 15% hydrogen peroxide demonstrated better bleaching effectiveness, and greater color stability at the end of bleaching and at 6-month follow-up. The use of 15% hydrogen peroxide presents more suitable results.

Viability of Bovine Teeth as a Substrate in Bond Strength Tests: A Systematic Review and Meta-analysis.

PURPOSE: To assess whether bovine teeth can be used as viable alternatives for human teeth in tensile and shear bond strength testing. MATERIALS AND METHODS: Articles were selected from Web of Science, PubMed, Scopus, LILACS-Bireme, and BBO electronic databases using keywords obtained from Medical Subject Headings (MeSH). Of 1540 potentially eligible studies, 157 were selected for full text analysis. Five independent reviewers (Kappa = 0.89) selected the studies, abstracted information, and assessed quality based on standardized scales. After the analysis, 78 studies comparing bovine teeth to human teeth were found. Only 18 studies comparing bovine and human substrates in bond strength tests were included in the systematic review and 13 in the meta-analysis. Two authors independently selected the studies, extracted the data and assessed the risk of bias. Mean differences were obtained by comparing tensile and shear bond strengths between human and bovine teeth (permanent and deciduous) and considering enamel and dentin separately (subgroup analysis). Statistical analysis was performed using RevMan5.1, with a random-effect model, at a 5% significance level. RESULTS: No significant difference was found between human and bovine teeth in tensile tests (p = 0.41) for dentin (p = 0.86), but there was a difference for enamel (p = 0.01). Regarding shear bond strength, no significant difference was found between human and bovine teeth (p = 0.16) either for enamel (p = 0.07) or dentin (p = 0.68). Regarding shear bond strength on deciduous teeth, no significant difference was found between human and bovine substrates (p = 0.54), either for enamel (p = 0.42) or dentin (p = 0.05). Most studies were at high (low or unclear) risk of bias. CONCLUSIONS: In shear bond strength testing, bovine teeth can be a suitable alternative for permanent and deciduous human teeth, for both enamel and dentin substrates. However, they may not be suitable for enamel tensile bond strength testing. The findings are based on low quality studies (considerable heterogeneity) and should be interpreted with caution.

Longevidade, efetividade, segurança e impacto na qualidade de vida relacionada à saúde bucal das técnicas de clareamento dentário caseiro e de consultório com peróxidos de baixa concentração: ensaio clínico randomizado / Longevity, effectiveness, safety and impact on oral health-related quality of life of at-home and in-office dental bleaching with low concentration peroxides: a randomized clinical trial

O objetivo desse estudo foi avaliar a longevidade, efetividade, segurança e o impacto na qualidade de vida relacionada à saúde bucal das técnicas de clareamento dentário utilizando baixas concentrações de peróxidos. Realizou-se um ensaio clínico randomizado, paralelo e simples cego. Os 81 participantes foram separados em três grupos (n=27): CP10%= Caseiro / peróxido de carbamida 10%(2 horas por dia durante 21 dias); HP6%= Consultório / peróxido de hidrogênio 6% (30 min/ sessão, 3 sessões, ativação luz LED/Laser); HP15%= Consultório / peróxido de hidrogênio 15% (30 min/ sessão, 3 sessões, ativação luz LED/Laser). A cor dos dentes foi avaliada em 5 momentos distintos: T1 (Baseline) = Antes do tratamento; T2 = 1 semana após o início do tratamento; T3 = 2 semanas após o início do tratamento; T4 = 1 semana após o final do tratamento e T5 = 6 meses após o final do tratamento, utilizando a escala de cor Vita Clássica e espectrofotômetro Vita Easy Shade Advance. A sensibilidade dentária foi avaliada utilizando a Escala Visual Numérica e a irritação gengival por meio do Índice Gengival Modificado - IGM. Para avaliação do impacto do clareamento na qualidade de vida utilizou-se o Oral Impact on Daily Performance (OIDP). Os dados foram analisados pelos testes de Friedman, Mann-Whitney, Qui-quadrado de Pearson e McNemar (p<0,05). Os resultados foram distribuídos em 2 artigos, de acordo com as comparações dos grupos CP10% e HP6% no primeiro artigo, e HP6% e HP15% no segundo artigo. No primeiro artigo, houve diferença estatisticamente significativa na mudança de cor (ΔE) de T1 para T4 em CP10% (p<0,001) e HP6% (p<0,001). Observou-se uma diferença significativa de ΔE em T4 entre CP10% (9,28) e HP6% (4,47) (p=0,042). A sensibilidade dentária foi significativamente maior (p=0,008) em CP10% (mediana=1,5) do que em HP6% (mediana=0,0), em T2. A irritação gengival diferiu significativamente (p=0,002) entre CP10% (mediana=0,2) e HP6% (mediana = 0,0), em T2. No segundo artigo não foram observadas diferenças significativas em relação aos parâmetros L*, a* ou b*, entre HP6% e HP15% de T1 a T5. Não foram observadas diferenças significativas entre os grupos HP6% e HP15% na sensibilidade dentária ou irritação gengival. Todos os protocolos utilizados apresentaram efetividade de clareamento. A técnica de consultório com HP6% e HP15% ocasionou baixa frequência de efeitos negativos como sensibilidade e irritação gengival. Nos dois artigos não houveram diferenças dos grupos quanto ao impacto na qualidade de vida relacionada à saúde bucal. No artigo um, a maior presença de efeitos negativos na técnica caseira não impactou significativamente a qualidade de vida relacionada à saúde bucal.(AU)

The objective of this study was to evaluate the longevity, effectiveness, safety and impact on oral health related quality of life of teeth whitening techniques using low concentrations of peroxides. A randomized, parallel and single blind trial was conducted. The 81 participants were separated into three groups (n = 27): CP10% = Homemade / 10% carbamide peroxide (2 hours per day for 21 days); HP6% = Office / Hydrogen peroxide 6% (30 min / session, 3 sessions, LED / Laser light activation); HP15% = Office / 15% hydrogen peroxide (30 min / session, 3 sessions, LED / Laser light activation). The color of the teeth was evaluated in 5 different moments: T1 (Baseline) = Before treatment; T2 = 1 week after initiation of treatment; T3 = 2 weeks after initiation of treatment; T4 = 1 week after the end of the treatment and T5 = 6 months after the end of treatment, using the Vita Classical color scale and Vita Easy Shade Advance spectrophotometer. Dental sensitivity was assessed using the Numerical Visual Scale and gingival irritation using the Modified Gingival Index - IGM. Oral Impact on Daily Performance (OIDP) was used to assess the impact of bleaching on quality of life. Data were analyzed by the Friedman, Mann-Whitney, Pearson's and McNemar's Chi-square tests (p <0.05). The results were distributed in 2 articles, according to the comparisons of groups CP10% and HP6% in the first article, and HP6% and HP15% in the second article. In the first article, there was a statistically significant difference in color change (ΔE) from T1 to T4 in CP10% (p <0.001) and HP6% (p <0.001). A significant difference of ΔE in T4 was observed between CP10% (9.28) and HP6% (4.47) (p = 0.042). Dental sensitivity was significantly higher (p = 0.008) in CP10% (median = 1.5) than in HP6% (median = 0.0), in T2. Gingival irritation differed significantly (p = 0.002) between CP10% (median = 0.2) and HP6% (median = 0.0) in T2. In the second article no significant differences were observed in relation to the L *, a * or b * parameters, between HP6% and HP15% of T1 to T5. No significant differences were observed between HP6% and HP15% groups in tooth sensitivity or gingival irritation. All the protocols used showed bleaching effectiveness. The office technique with HP6% and HP15% caused low frequency of negative effects such as sensitivity and gingival irritation. In both articles there were no differences of the groups regarding the impact on quality of life related to oral health. In article one, the greater presence of negative effects in the homemade technique did not significantly affect the quality of life related to oral health.(AU)

Mechanical control of biofilm in children with cerebral palsy: a randomized clinical trial.

BACKGROUND: Dental biofilm removal is difficult and can be ineffective in individuals with cerebral palsy. OBJECTIVE: Determine the effectiveness of brushing with an electric toothbrush on and off in comparison with manual brushing for the removal of biofilm in children aged four to 16 years with cerebral palsy. METHODS: A crossover, randomized, simple-blind, clinical trial was conducted. The examiner was blinded to the brushing method (G1: manual; G2: electric toothbrush on; and G3: electric toothbrush off). The order was determined randomly. The participants (n = 40) were examined before and after brushing performed by caregivers using the Turesky-Quigley-Hein biofilm index. Statistical analysis involved the paired t-test, Wilcoxon, Kruskal-Wallis, and anova tests. RESULTS: Biofilm was significantly reduced with the three brushing methods (P < 0.001) (mean reductions: 47.6% in G1; 47.4% in G2; 44.5% in G3). Significant differences were found between G1 and G3 (P < 0.001) and between G2 and G3 (P = 0.007). No significant difference was found between G1 and G2 (P = 0.06). CONCLUSION: All methods reduced biofilm. Effectiveness was similar between manual brushing and with the electric toothbrush on, whereas both these methods achieved better results in comparison with the electric toothbrush switched off.

Biological Restoration of a Fractured Anterior Tooth with the Use of Dentine Pin (Biopins).

This case study describes the esthetic and functional reconstruction of a fractured maxillary central incisor. Due to the requirement for additional retention, treatment was performed using the homogenous technique of biological restoration associated with cementation of posts made from human dentin (biopins). This type of treatment is a new alternative to conventional techniques and favors the dental esthetic and function, as well as biocompatibility, and is an inexpensive procedure.

Clinical consequences of untreated dental caries and toothache in preschool children.

PURPOSE: The purpose of the present study was to assess the clinical consequences of untreated dental caries related to the occurrence of toothache among Brazilian preschool children. METHODS: A random sample of 540 two- to five-year-olds underwent a clinical oral examination for the assessment of early childhood caries (ECC) using the dmft (decayed, missing and filled primary teeth) index and pufa (carious lesions with pulpal involvement [p], ulceration of the mucosa due to root fragments [u], fistula [f], and abscess [a]) index to score consequences of dental caries in soft tissues. Parents/guardians were asked to answer a questionnaire addressing sociodemographic characteristics and toothache experience in the children. Descriptive analysis and hierarchically adjusted Poisson regression models were employed. RESULTS: The prevalence of ECC and pufa (≥1) was approximately 50 percent and 12 percent, respectively. A total of 25 percent of the children had toothache experience. Toothache was significantly associated with: an older age (prevalence ratio [PR]=3.70; 95% confidence interval [CI]=2.09-6.58); carious lesions with pulpal involvement (PR=3.93; 95% CI=3.09-5.01); ulceration of the mucosa due to root fragments (PR=2.73; 95% CI=1.52-4.89); fistula (PR=2.91; 95% CI=1.89-4.49); and abscess (PR=4.43; 95% CI=3.78-5.19). CONCLUSION: Toothache experience in preschool children was associated with untreated cavitated dentin lesions and their consequences.

Prevalência de cárie dentária em crianças de seis a 60 meses e fatores associados, Diamantina, Minas Gerais, Brasil / Prevalence of dental caries in children aged 6 to 60 months and associated factors in Diamantina, Minas Gerais, Brazil

Objetivo: Verificar a prevalência e os fatores associados à cárie dentária em crianças de seis a 60 meses de idade em Diamantina, Minas Gerais, Brasil. Método: Foi realizado um estudo transversal com amostra representativa (n=233) da população pré-escolar (06-60 meses) de Diamantina, Minas Gerais, Brasil. A cárie dentária (variável dependente) foi avaliada por meio de exame clínico bucal e as variáveis independentes (gênero, idade, nível socioeconômico, estado nutricional, higiene e alimentação da criança) foram obtidas pelo exame das medidas antropométricas (peso e altura) e entrevistas com os pais ou responsáveis. A análise estatística foi realizada por meio de análise descritiva, teste qui-quadrado e regressão logística múltipla. Resultados: A prevalência de cárie dentária foi 44,8% (n=104). As variáveis idade da criança, higiene bucal, tempo e frequência de uso de mamadeira foram significativamente associadas à cárie dentária. Os pacientes com idade superior a 36 meses (OR [95%CI]=10,4 [3,7-29,5]), frequência de consumo de mamadeira igual ou superior a três vezes por dia (OR [95%CI]=3,3 [1,1-10,0]), tempo de uso de mamadeira superior a cinco meses (OR [95%CI]=6,2 [1,8-21,2]) e higienização bucal insatisfatória (OR [95%CI]=3,7 [1,2-11,5]) apresentaram maior chance de desenvolver cárie dentária. Conclusão: A prevalência de cárie dentária entre crianças de seis a 60 meses de idade foi alta. Os principais fatores diretamente envolvidos no desenvolvimento de cárie dentária foram: a idade do paciente, a frequência de consumo e tempo de uso de mamadeira e a higienização bucal insatisfatória.

Objective: The aim of this study was to assess the prevalence of dental caries and associated factors among children aged 6 to 60 months in Diamantina, MG, Brazil. Methods: A cross-sectional study was performed with a representative sample (n = 233) of the preschool population (6 to 60 months) of Diamantina, MG, Brazil. Dental caries (dependent variable) was evaluated by clinical examination and the independent variables (gender, age, socioeconomic status, nutritional status, oral hygiene and diet) were assessed by the determination of anthropometric measurements (weight and height) and interviews with parents/caregivers. Statistical analysis was performed using descriptive analysis, chi-square test and univariate and multivariate logistic regression model. Results: The prevalence of dental caries was 44.8% (n = 104). Child's age, oral hygiene and duration and frequency of bottle feeding were significantly associated with dental caries. Patients older than 36 months (OR [95% CI] = 10.4 [3.7 to 29.5]), those bottle-fed three or more times a day (OR [95% CI] = 3.3 [1.1 to 10.0]), those bottle-fed for more than five months (OR [95% CI] = 6.2 [1.8 to 21.2]) and those with poor oral hygiene (OR [ 95% CI] = 3.7 [1.2 to 11.5]) had greater chances of developing dental caries. Conclusion: The prevalence of caries among children aged 6 to 60 months was high. The main factors directly involved in the development of dental caries were the patient's age, frequency and duration of bottle feeding, and poor oral hygiene.