Assessment of efficacy and post-bleaching sensitivity of home bleaching using 10% carbamide peroxide in extended and non-extended bleaching trays.

AIM: This study aimed to compare the effect of extended margin and conventional bleaching trays on tooth bleaching and tooth sensitivity. METHOD AND METHODS: Twenty subjects (18-56 years) were investigated in a split arch design clinical study that was conducted in a general dental practice. Each subject received a custom made bleaching tray and 10% carbamide peroxide gel. The bleaching trays had the borders extended 5 mm beyond the gingival margins on the right side and finished just at the gingival margin on the left side. Shade change and tooth sensitivity were the primary outcomes studied and analysed in this study. The shade of the six upper and lower anterior teeth was assessed using a value-ordered shade guide before, one week and two weeks after treatment. Sensitivity was self-assessed using a visual analogue scale (VAS) at the end of the first and second weeks of the study. RESULTS: At the end of week two, the mean shade change was 5.01 (± 3.37) and 5.10 (± 3.36) for teeth covered by extended and non-extended tray design, respectively. The mean VAS sensitivity scores for teeth covered by extended and non-extended tray design were 0.96 (± 1.39) and 0.66 (± 0.96), respectively. There was no significant statistical difference between the two designs at any assessment point with regard to shade change and sensitivity (p >0.05). CONCLUSIONS: It can be concluded that an extended tray design confers no superior effect in terms of the whitening outcome achieved or in reducing levels of sensitivity. Thus, both tray designs can be used depending on a dentist's personal preference.

Nanoscratch testing for the assessment of enamel demineralization under conditions simulating wine erosion.

BACKGROUND: Erosive tooth wear and dentinal hypersensitivity are common problems affecting professional wine tasters. By using nanoscratch testing, the aim of this in vitro study was to assess enamel softening under conditions simulating 10 one-minute episodes of wine erosion. METHODS: Ten enamel specimens were bathed in artificial saliva for 2 hours before being eroded for 10 episodes, with each episode comprising one minute of wine erosion followed by one minute of remineralization in artificial saliva. Nanoscratches were placed with a spherical tip (20 µm radius) in a nanoindenter under a load of 100 mN at baseline (stage 1), after a one-erosion episode (stage 2) and after 10-erosion episodes (stage 3). RESULTS: There were significant effects of erosion stages on both scratch depth (p<0.001) and surface roughness (p<0.001). Post hoc tests showed significant differences in both scratch depths and surface roughness between stages 1 and 3 (p<0.001), and between stages 2 and 3 (p<0.01). CONCLUSIONS: Enamel softening occurs at an early stage of wine tasting, emphasizing the need to implement early preventive strategies in professional wine tasters. Further research elucidating the fundamental mechanisms involved in early stages of erosion has the potential to lead to development of more effective preventive strategies.

A decision tree for the management of exposed cervical dentin (ECD) and dentin hypersensitivity (DHS).

INTRODUCTION: Dentin hypersensitivity (DHS) is a problematic clinical entity that may become an increasing clinical problem for dentists to treat as a consequence of patients retaining their teeth throughout life and improved oral hygiene practices. OBJECTIVES: The aim of this review was to develop a decision tree for the management of exposed cervical dentin (ECD) and DHS. MATERIAL AND METHODS: A brief PUBMED literature search was performed on dentin hypersensitivity using "MeSH" terms, "review", and "management". In addition, some websites and local guidelines were screened. RESULTS: From this review, it became clear that all dentate patients should routinely be screened for ECD and DHS. In this respect, underdiagnosis of the condition will be avoided and the preventive management can be initiated early. CONCLUSION: A decision tree process and a flowchart for daily practice were designed which should be started up as soon as a patient present with ECD or suffers from DHS. This approach takes into account the possible improved quality of life of the patient and is further based on a hierarchy of treatment options. In this respect, active management of DHS will usually involve a combination of at-home and in-office therapies. Starting with the use of desensitizing toothpastes is strongly recommended.

Vanderbilt Head and Neck Symptom Survey version 2.0: report of the development and initial testing of a subscale for assessment of oral health.

BACKGROUND: The prevalence, severity, and functional implications of adverse oral health outcomes attributed to head and neck cancer therapy are largely undefined. We report development of an oral health outcome subscale for the Vanderbilt Head and Neck Symptom Survey (VHNSS). METHODS: Oral health outcome questions were formulated through literature review and consultation with an expert panel. Questions were incorporated into the VHNSS resulting in a 50-item survey, scored 0 (none) to 10 (severe). The tool was administered to 70 subjects who completed radiation to assess for feasibility. RESULTS: Patient acceptance was high with a completion time <10 minutes. A full range of scores was noted for 46 of 50 questions. Oral health symptom burden was high early and late posttreatment. CONCLUSIONS: The VHNSS version 2.0 was feasible and could be completed in a timely manner. Validation studies are ongoing. The high prevalence of adverse oral health outcomes warrants further study.

Assessment of tooth sensitivity using a desensitizer before light-activated bleaching.

UNLABELLED: CLINICAL OBJECTIVE: This clinical study evaluated whether the use of a desensitizing agent (5% potassium nitrate/2% sodium fluoride) before in-office light-activated bleaching decreased this sensitivity. METHODS: Before in-office bleaching with 35% hydrogen peroxide gel (three applications, 15 minutes each) associated with an LED/laser unit, clinicians applied a placebo gel or the desensitizing agent on the buccal surfaces of all participants. They repeated this protocol one week later. Patients recorded their tooth sensitivity on a 0-to-4 scale. The authors used one-way repeated measures ANOVA to compare the tooth color changes and non-parametric statistics to compare the different percentages of patients with tooth sensitivity and the levels of tooth sensitivity in the different periods of time between groups (α=0.05). RESULTS: The use of a desensitizing gel did not affect the bleaching efficacy. Eighty percent and 100% of the participants from the experimental and placebo groups, respectively, experienced tooth sensitivity (p>0.05). The intensity of sensitivity was similar immediately after bleaching for both groups (p>0.05). After 24 hours, lower sensitivity was reported in the experimental group, while most of the participants from the placebo group experienced tooth sensitivity (p<0.05).

A multidisciplinary approach to the functional and esthetic rehabilitation of amelogenesis imperfecta and open bite deformity: a case report.

UNLABELLED: The treatment of amelogenesis imperfecta (AI) with an anterior open bite (AOB) is a challenge for the clinician and often requires a multidisciplinary team of specialists. Most often, patients suffering from these conditions are young and a good functional and esthetic long-term result must be aspired. This clinical report illustrates the orthodontic, maxillofacial, restorative, and prosthodontic rehabilitation of a 20-year-old woman with a hypoplastic form of AI and an AOB malocclusion, having received treatment for the last 6 years. It included adhesive resin composite restorations, orthodontical and maxillofacial surgery with a one-piece Le Fort I osteotomy, and a genioplasty. Subsequent prosthodontic therapy consisted of 28 all-ceramic crowns whereby a solid interdigitation, a canine guidance, and consistent and regular contacts between tooth crowns could be achieved to assure a good functional and esthetic oral situation. The tooth preparation techniques guaranteed minimally invasive treatment. The patient was affected very positively. CLINICAL SIGNIFICANCE: This article describes an interdisciplinary approach to the successful treatment of a patient with a hypoplastic form of amelogenesis imperfecta over a period of 6 years. It starts with a discussion of the conservative steps taken during adolescence and concludes with the final prosthetic rehabilitation with all-ceramic crowns after reaching adulthood.

Patients' experiences of the impact of periodontal disease.

AIM: To examine critically patients' experiences of the impact of periodontal disease on their daily lives. MATERIAL AND METHODS: Semi-structured interviews of a purposive sample of patients with periodontal conditions were conducted using a flexible evolving topic guide. Data collection and analysis were an inductive, iterative process that occurred concurrently. The data were organized in a framework and recurrent themes identified. Interviews occurred until it was felt that no new themes or ideas were being expressed by respondents (n=14). RESULTS: Effects of periodontal disease on patients' daily lives included impairment, functional limitation, discomfort and disability (including physical, psychosocial and social disability). A large number of the emergent themes from the analysis were relevant to the domains of Locker's conceptual model of oral health. The domain within Locker's model that had no data relevant to it in the context of periodontal disease was death. Two additional themes emerged that appeared unrelated to Locker's model, these were stigma and retrospective regret. CONCLUSION: Periodontal disease reportedly affects patients' lives in a negative manner in a variety of ways. This is of relevance in the management of patients with periodontitis.

Clinical assessment of postoperative sensitivity in posterior composite restorations.

This incidence of postoperative sensitivity was evaluated in resin-based posterior restorations. Two hundred and ninety-two direct restorations were evaluated in premolars and molars. A total of 143 Class I and 149 Class II restorations (MO/OD and MOD) were placed in patients ranging in age from 30 to 50 years. After the cavity preparations were completed, a rubber dam was placed, and the preparations were restored using a total-etch system (Prime & Bond NT) and a resin-based restorative material (TPH Spectrum). The patients were contacted after 24 hours and 7, 30 and 90 days postoperatively and questioned regarding the presence of sensitivity and the stimuli that triggered that sensitivity. The Chi-square and Fisher's Exact Test were used for statistical analysis. Evaluation at 24 hours after restorative treatment revealed statistically significant differences among the types of cavity preparations restored and the occurrence of postoperative sensitivity (p = 0.0003), with a higher frequency of sensitivity in Class II MOD restorations (26%), followed by Class II MO/DO (15%) and Class I restorations (5%). At 7, 30 and 90 days after restorative treatment, there was a decrease in the occurrence of sensitivity for all groups. The percentage of sensitivity among the groups was not significantly different. This study shows that the occurrence of sensitivity is correlated with the complexity of the restoration.

Laser Doppler flowmetry for assessment of anterior mandibular teeth in conjunction with bone harvesting in the symphysis: a clinical pilot study.

PURPOSE: To evaluate the pulp sensitivity and vitality of mandibular incisors and canines before and after bone harvesting in the symphysis. MATERIALS AND METHODS: In 20 patients requiring bone grafts from the symphysis, pulp sensitivity (carbon dioxide [CO2]) and pulpal blood flow (laser Doppler flowmetry [LDF]) of mandibular incisors and canines were evaluated preoperatively, postoperatively, and 6 months after surgery. Teeth were allocated to 1 of 3 groups according to their initial and final reaction to CO2 (group A = teeth with a positive reaction throughout the study, group B = teeth that exhibited a sensitivity change from positive to negative, and group C = teeth with a negative reaction throughout the study). RESULTS: Preoperative flux measurements (LDF) did not differ between groups A, B, and C. Teeth with sensitivity changes (group B) showed the greatest decrease (a statistically significant decrease) of pulpal blood flow over time, whereas teeth in groups A and C demonstrated an insignificant reduction of flux over time. DISCUSSION AND CONCLUSIONS: LDF was purely used as an experimental tool in the present study. Pulpal blood flow measurements using LDF demonstrated a decrease of flux over time in anterior mandibular teeth following bone harvesting in the symphysis. A significant change of flux, however, was only observed for teeth that also demonstrated a loss of pulp sensitivity during the same study period. Loss of pulp sensitivity appeared to be correlated to a significant decrease of blood flow assessed by LDF.

Green Or preparation in dentin hypersensitivity treatment.

The effectiveness of Green Or preparation in the treatment of cervical dental hypersensitivity was evaluated. This problem is difficult for patients and for dentists because of dual and unknown methods of treatment. The preparation was used in 30 patients between the ages of 20 and 70 years on 240 teeth with exposed and hypersensitive necks. The obtained results are acceptable, as total elimination of hypersensitivity was attained in 85% of cases, partial reduction of hypersensitivity in 15% cases.

Assessment of chair side techniques for composite resin restoration--a survey.

The purpose of this survey was to assess the awareness of dental practitioners relating to chair side techniques in restoring teeth with light cure composite. The survey package consisted of a consent form, a leaflet stating the rationale and purpose of the survey and the questionnaire. Randomised sample of dental surgeons in practice was selected. The collected data was then analysed. A 52% response was obtained. Gross deficiencies in practice technique were observed, especially related to parameters like isolation, etching, bond and composite application and finishing of the restoration. Significantly individual assessment of problems by dental practitioners was found to be different from objective rationale. It is suggested that adequate and periodic re-evaluation of techniques must be made by the general dental practitioners, through continuing dental education or workshops so as to achiEve optimum quality.

Teaching nightguard bleaching and other tooth-whitening procedures in North American dental schools.

Tooth-whitening using carbamide peroxide delivered in a custom-fitted tray (nightguard bleaching) is a relatively new procedure, yet it is currently one of the most commonly used types of esthetic dental treatment in private practice. This study determined the extent that nightguard bleaching (NGB) has been included in dental school curricula. All sixty-five dental schools in North America were surveyed about curriculum content and treatment protocol for the use of nightguard and other bleaching procedures, generating an 82 percent response. The survey covered eighteen subject areas related to NGB ranging from clinical requirements and indications to products and recall intervals used. The most commonly taught tooth-whitening procedure was NGB, which was most often taught by operative and restorative faculty. Although no schools had clinical requirements for NGB, 92 percent taught it. The most common indications for NGB were esthetic shade change and pre-restorative lightening of teeth. Unrestored caries, defective restorations, and pre-existing sensitivity were common contraindications. Most schools do not use a specific NGB consent form, but most use written patient instructions. Most schools use at least two different NGB products, bleach for two to four weeks, and use reservoired and scalloped trays. An average of 25 percent of NGB patients were estimated to develop sensitivity, for which treatment recommendations include fluoride, desensitizing toothpaste, and reduced exposure time. Curriculum time and safety concerns were reasons for not teaching NGB (8 percent schools). Most schools indicated that the relative importance of NGB in the curriculum was increasing.

Dentine hypersensitivity: its prevalence, aetiology and clinical management.

Dentine hypersensitivity can be a frustrating condition to treat. The most common form of treatment is use of a desensitizing dentifrice, but for many patients this may provide only partial pain relief and recurrence is common. Recent research has provided several important findings which may serve as a basis for refining the approach to dentine hypersensitivity management, and for improving the success of treatment. This paper reviews the research and outlines a management system which transfers readily to clinical practice.