Use of clinical bleaching with 35% hydrogen peroxide in esthetic improvement of fluorotic human incisors in vivo.

AIM: The aim of the study was to evaluate esthetic improvement with the use of 35% hydrogen peroxide clinical bleaching as related to the different grades of enamel fluorosis in vivo and to study adverse effect of clinical bleaching with 35% hydrogen peroxide on teeth and gingiva. MATERIALS AND METHODS: A total of 60 children of different grades of fluorosis were included in the study. With 35% hydrogen peroxide-based dual activated bleaching system, in-office vital teeth bleaching was carried out for each subject. Clinical evaluation for improvement in esthetics, effect on teeth and gingiva were performed for each child during preoperative, immediate postoperative and later 6 months postoperative period. For evaluation and comparison, all the collected data were subjected to statistical analysis. RESULTS: Although in all the subjects, partial shade relapse was seen over a period of time, good homogeneous and esthetic results were seen in very mild and mild cases. A total of 35% hydrogen peroxide in-office bleaching has no adverse effect on teeth and gingiva. CONCLUSION: Comparing all the three groups who participated in the study, 35% hydrogen peroxide in-office bleaching seems to be very effective in very mild and mild forms of fluorosis. CLINICAL SIGNIFICANCE: In very mild and mild forms of fluorosis, in-office vital tooth bleaching with 35% hydrogen peroxide is the most conservative and effective approach in esthetic improvement.

Safety of individual medication of Ma Qian Zi (semen strychni) based upon assessment of therapeutic effects of Guo's therapy against moderate fluorosis of bone.

OBJECTIVE: To assess the safety of individual medication of Guo's Ma Qian Decoction on the basis of effective treatment of fluorosis of bone with Guo's therapy. METHODS: One hundred and fourteen cases of moderate fluorosis of bone were randomly divided into a treatment group (n = 60) and a control group (n = 54) between December 2007 and August 2009 by using the block randomized method and a central random system. At the same time of basic treatment, the patients in the treatment group were orally administrated with Guo's Ma Qian Decoction. The initial dose of Ma Qian Zi (Semen Strychni) was 0.4 g and increased by 0.05 g every two days, with the doses of other drugs unchanged, until the patient had "nux vomica response". For the patients with no "nux vomica response", the dosage was continued to increase and the maximum dosage was not more than 1.2 g/day. The control group was treated with decoction placebo. The changes of strychnine and brucine contents before and after processing and after decoction of Ma Qian Zi (Semen Strychni) were determined with reversed-phase high-performance liquid chromatography, which were controlled within ranges stipulated in the Pharmacopeia; Adverse events were analyzed; Blood strychnine and brucine contents in 10 cases who had taken the drugs were determined. RESULTS: 1) Strychnine (2.125%) and brucine (1.425%) contents before processing of Ma Qian Zi and 1.88% and 1.31% after processing all conformed with the standards of strychnine (1.2-2.2%) and brucine (no less than 0.8%) stipulated in the Pharmacopeia. When the maximum dosage of Ma Qian Zi was 1.2 g/day, strychnine in the decoction was 11.17 mg and brucine was 7.44 mg, which all conformed with the maximum limited amount (strychnine 13.32 and brucine no less than 4.8 mg) stipulated in the Pharmacopeia. 2) Eight cases had "nux vomica response" in the treatment group and one case in the control group, with a significant difference between the two groups (P < 0.05). 3) Altogether 18 cases had adverse events, with an incidence rate of 15.38% (8 cases) in the treatment group and 18.52% (10 cases) in the control group, with no difference between the two groups (P > 0.05); Among them, 10 cases (8.77%) with the adverse event were not related with therapeutic drugs, with an incidence rate of 6.67% (4 cases) in the treatment and 11.11% (6 cases) in the control group, with no significant difference between the two groups (P > 0.05). Seven cases had suspicious relative adverse events, the risk in the treatment group was 0.658 times of the control group, with no significant difference (P > 0.05), and one case had the toxic reaction of nux-vomica seed. 4) Strychnine and brucine were unable to be detected in the blood in all points of time in the 10 cases who had taken the drugs, indicating that plasma strychnine and brucine contents were lower than the minimum detectable amount (10 ng), and accumulation of strychnine and brucine were not found in blood of the patient during and after administration for 8 weeks. CONCLUSION: The individual medication of Ma Qian Zi (Semen Strychni) in the Guo's therapy has a better safety.

Protections against toxicity in the brains of rat with chronic fluorosis and primary neurons exposed to fluoride by resveratrol involves nicotinic acetylcholine receptors.

Protection of Resveratrol (RSV) against the neurotoxicity induced by high level of fluoride was investigated. Sprague-Dawley (SD) rats and their offspring, as well as cultures of primary neurons were divided randomly into four groups: untreated (control); treated with 50 mg RSV/kg/ (once daily by gavage) or (20 M in the cultured medium); exposed to 50 ppm F- in drinking water or 4 mmol/l in the cultured medium; and exposed to fluoride then RSV as above. The adult rats were treated for 7 months and the offspring sacrificed at 28 days of age; the cultured neurons for 48 h. For general characterization, dental fluorosis was assessed and the fluoride content of the urine measured (by fluoride-electrode) in the rates and the survival of cultured neurons monitored with the CCK-8 test. The spatial learning and memory of rats were assessed with the Morris water maze test. The levels of α7 and α4 nicotinic acetylcholine receptors (nAChRs) were quantified by Western blotting; and the activities of superoxide dismutase (SOD) and catalase (CAT), and the levels of malondialdehyde (MDA) and H2O2 assayed biochemically. The results showed that chronic fluorosis resulted in the impaired learning and memory in rats and their offspring, and more oxidative stress in both rat brains and cultured neurons, which may be associated the lower levels of α7 and α4 nAChR subunits. Interestingly, RSV attenuated all of these toxic effects by fluorosis, indicating that protection against the neurotoxicity of fluoride by RSV might be in mechanism involved enhancing the expressions of these nAChRs.

A case of distal renal tubular acidosis, Southeast Asian ovalocytosis and possible fluorosis.

A 39-year old man had periodic paralysis due to hypokalaemia. Investigations led to the diagnosis of distal renal tubular acidosis (dRTA) and Southeast Asian ovalocytosis (SAO). Both can originate in mutations of the anion-exchanger 1 gene (AE1), which codes for band 3, the bicarbonate/chloride exchanger in both the red cell membrane and the basolateral membrane of the collecting tubule alpha-intercalated cell. The finding of diffuse osteosclerosis led to the suspicion of coexisting fluorosis.

Effect of phosphoric acid concentration used for etching on the microtensile bond strength to fluorotic teeth.

To evaluate the effects of different etching concentrations of phosphoric acid on the microtensile bond strength of Adper Single Bond 2 to fluorotic teeth.Deidentified extracted teeth were collected, including 30 sound teeth, 30 teeth with mild fluorosis, 30 teeth with moderate fluorosis, and 30 teeth with severe fluorosis. The teeth in each group were randomly divided into 3 subgroups (n = 10) that were subjected to acid etching using 35%, 40%, or 45% phosphoric acid. Adper Single Bond 2 (3M, Saint Paul, MN) was used as the adhesive for bonding Z250 universal resin (3M) to the etched dental enamel. Microtensile testing was used to determine the bond strength. After the microtensile test, the fractured specimens were examined under scanning electron microscopy (SEM).Both dental fluorosis and concentrations of phosphoric acid significantly affected the microshear bond strength of Adper Single Bond 2 to dental enamel. The maximum bond strength was achieved by using 40% phosphoric acid. Failure analysis showed that most failures occurred at the bonding interface. The rates of failures at the bonding interface decreased as the degree of fluorosis increased and as the concentration of phosphoric acid increased from 35% to 45%.The bond strength of fluorosis tooth was lower than that of healthy tooth, the bond strength increased with the increasing concentration of phosphoric acid, but an excessively high acid concentration can conversely lead to an apparent decline in bond strength.

Dental Fluorosis Treatment Can Improve the Individuals' OHRQoL? Results from a Randomized Clinical Trial.

This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

[Impact of antioxidative therapy on the activity of salivary glutathione-dependent enzymes in patients with fluorosis].

Fluorosis caused by long-term intake of high fluoride levels is characterized by clinical bone and tooth manifestations. The adverse impact of high fluoride intake was also observed in soft tissues. Although fluorosis is irreversible it could be prevented by appropriate and timely interventions through the understanding of the process at biochemical and molecular levels. Increased production of reactive oxygen forms and lipid peroxidation are considered to play an important role in the pathogenesis of chronic fluoride toxicity. Saliva is a biological fluid of the human organism may be a reflection of the metabolic state. Salivary indices are clinical diagnostic indicators. The purpose of this investigation was to comparatively study the salivary antioxidative defense system, including glutathione, glutathione reductase, glutathione-S-transferase, and glucose-6-phosphate dehydrogenase in adult patients with fluorosis before and after complex antioxidative therapy. Analysis indicated that there was a negative correlation between the level of glutathione and the clinical characteristics of the disease in patients with fluorosis. There was a direct relationship between the activity of glutathione-S-transferase and the clinical manifestations in the patients. These results reflected dose-dependent fluoride intoxication and metabolic imbalance. The imbalanced salivary antioxidative defense system was in part corrected by complex antioxidative therapy.

[Influence of correcting therapy course on salivary components of patients with fluorosis].

Fluorosis, caused by long-term intake of high levels of fluoride, is characterized by clinical manifestations in bones and teeth. However, detrimental effects of high fluoride intake are also observed in soft tissues. Saliva, as a biological liquid of the human organism, may be a reflection of the metabolic state. The concentration of calcium (Ca2+), phosphate (PO(3)(4)-), chloride-ions (CL-) and activity of alkaline phosphatase were determined in saliva of 46 patients with fluorosis before and after antioxidant therapy. An imbalance of salivary components of the patients with fluorosis has been corrected by the therapy course partially.

Effect of fluoride exposure on mRNA expression of cav1.2 and calcium signal pathway apoptosis regulators in PC12 cells.

This study investigated the effects of fluoride exposure on the mRNA expression of Cav1.2 calcium signaling pathway and apoptosis regulatory molecules in PC12 cells. The viability of PC12 cell receiving high fluoride (5.0mM) and low fluoride (0.5mM) alone or fluoride combined with L-type calcium channel (LTCC) agonist/inhibitor (5umol/L FPL6417/2umol/L nifedipine) was detected using cell counting kit-8 at different time points (2, 4, 6, 8, 12, 10, and 24h). Changes in the cell configuration were observed after exposing the cells to fluoride for 24h. The expression levels of molecules related to the LTCC were examined, particularly, Cav1.2, c-fos, CAMK II, Bax, and Bcl-2. Fluoride poisoning induced severe cell injuries, such as decreased PC12 cell activity, enhanced cell apoptosis, high c-fos, CAMKII, and Bax mRNA expression levels. Bcl-2 expression level was also reduced. Meanwhile, high fluoride, high fluoride with FPL64176, and low fluoride with FPL64176 enhanced the Cav1.2 expression level. In contrast, low fluoride, high fluoride with nifedipine, and low fluoride with nifedipine reduced the Cav1.2 expression level. Thus, Cav1.2 may be an important molecular target for the fluorosis treatment, and the LTCC inhibitor nifedipine may be an effective drug for fluorosis.

Abordaje clínico mínimamente invasivo de fluorosis dental en estadios de TF1 a TF5. Revisión sistemática / Minimally invasive clinical approach of dental fluorosis in stages of TF1 to TF5. Systematic review

Introducción: El manejo clínico de las lesiones dentales ocasionadas por fluorosis dental se realiza mediante diversas técnicas que resultan ser muy agresivas y con pobres resultados estéticos, por estas razones se plantea como objetivo determinar el tratamiento mínimamente invasivo y estético para fluorosis dental en los estadios de 1 a 5 según el índice de Thylstrup and Fejerskov, descritos en la literatura. Metodología: Revisión sistemática de 2.299 artículos, procedentes de cuatro bases de datos: PubMed, Embase, Science Direct y EBSCO; la búsqueda se realizó con ocho términos MeSH y tres conectores booleanos para una selección final de 22 artículos en inglés, español y portugués, publicados entre enero de 2009 y diciembre de 2018. Resultados: El tratamiento más efectivo para lesiones en estadios TF1 y TF2 fue aclaramiento dental con peróxido de carbamida a 15% o peróxido de hidrógeno a 35% durante tres sesiones de 15 minutos cada una, reforzado con peróxido de carbamida a 10%. Para estadios TF3 y TF4 fue microabrasión con ácido clorhídrico al 6% y carburo de silicio y/o con aclaramiento dental. Para lesioneTF5 fue la técnica combinada de macro y microabrasión con ácido fosfórico a 37% o ácido clorhídrico a 6%, 15% y 18%, aclaramiento y aplicación de resina infiltrante. Conclusión: Existen bases científicas que indican que el tratamiento de la Fluorosis es directamente proporcional al estadio de la lesión. (AU)

Introduction: The clinical management of dental lesions caused by dental fluorosis is carried out through various techniques that are very aggressive and with poor aesthetic results. For these reasons, the aim is to determine the minimally invasive and aesthetic treatment for dental fluorosis in stages of 1 to 5 according to the Thylstrup and Fejerskov index, described in the literature. Methodology: Systematic review of 2,299 articles, from four databases: PubMed, Embase, Science Direct and EBSCO; the search was carried out with eight MeSHterms and three Boolean connectors for a final selection of 22 articles in English, Spanish and Portuguese, published between January 2009 and December2018. Results: The most effective treatment for lesions in stages TF1 and TF2 was dental clearance with carbamide peroxide at 15% or hydrogen peroxide at 35% for three sessions of 15 minutes each, reinforced with 10% carbamide peroxide. For stages TF3 and TF4 it was microabrasion with 6% hydrochloric acid and silicon carbide and / or with dental clearance. For lesioneTF5 was the combined technique of macro and microabrasion with phosphoric acid at 37% or hydrochloric acid at 6%, 15% and 18%, clearance and application of infiltrating resin. Conclusion: There are scientific bases that indicate that the treatment of Fluorosis is directly proportional to the stage of the lesion. (AU)

A clinical comparison of treatments for endemic dental fluorosis.

A case report is presented describing the treatment for endemic dental fluorosis. Six maxillary anterior teeth were treated, three with an acid-bleach combination technique and three with an acid technique. No clinical differences was noted in treatment time or esthetic results.

Effectiveness, side effects and long-term status of nightguard vital bleaching.

In this clinical trial of nightguard vital bleaching for six weeks, 92 percent of the patients experienced some lightening of treated teeth. About 97 percent of patients with teeth stained through aging, inherent discoloration, brown fluorosis or trauma experienced lightening, as did 75 percent with tetracycline-stained teeth. Sixty-six percent experienced side effects, which resolved in 24 to 48 hours. Earliest re-treatment was done after one year in less time. Minimal color change occurred for 74 percent after 1 1/2 years and 62 percent after three years.

Treatment of fluorosed and white-spot human enamel with calcium sucrose phosphate in vitro.

A number of treatments have been devised to improve the appearance of fluorosed enamel. However, many of these have been empirically based, and the success of the various treatment regimens have not been quantitated. In this study, the relative whiteness of normal, mildly fluorosed, moderately fluorosed, and carious white-spot lesions on extracted teeth was quantitated by light reflectance using a Minolta Chroma Meter. The color was again determined following a number of treatment regimens to assess the potential use of various agents in treating the enamel lesions. Treatment of the enamel with a 35% hydrogen peroxide gel resulted in a significantly increased whitening, which was not reduced by subsequent treatment (P < 0.05). Removal of the enamel surface with a dental bur, followed by treatment with 5.25% sodium hypochlorite and placement in an artificial saliva was successful for returning white-spot lesions to a normal enamel color. Treatment of enamel with 5.25% sodium hypochlorite followed by calcium sucrose phosphate paste and placement in artificial saliva was most successful in returning both white-spot and fluorosed lesions to a normal color. SEM imaging of the calcium sucrose phosphate treated enamel suggests that this treatment filled the porous enamel, resulting in a normal light reflectance from the enamel.

Reversal of clinical and dental fluorosis.

A large number of Indians are forced to consume fluoride contaminated water. Toxic effects of chronic fluoride ingestion are hitherto considered irreversible. In this study 20 children were selected from an area consuming water containing 4.5 ppm of fluoride (Group A) and a second sample of 20 children from another area consuming water containing 8.5 ppm of fluoride (Group B). All the children were in an age group of 3 to 12 years and weighed 12 to 25 kg. Both samples were graded for clinical, radiological and dental fluorosis. All grades of manifestations were observed. These children were given ascorbic acid (500 mg), calcium (250 mg) and vitamin D3 (800 IU) daily. Follow up revealed reversal of clinical and dental fluorosis after 44 days. Improvement in the Group B sample was slower than Group A. Dosage of ascorbic acid was increased to 750 mg per day, keeping the dosages of other drugs unchanged to Group B children. After 15 days of the revised therapy a marked improvement was noticed in clinical and dental fluorosis in this sample also.

In vitro evaluation of NaF and APF-gel application on surface microhardness of enamel in children of low, optimum and high fluoride areas.

An in vitro study was conducted on 78 sound human pre-molars collected from low (0.24 ppmF), optimum (0.7 ppmF) and known endemic fluoride areas (> 1.5 ppmF), to study the effects of topical application of sodium fluoride and APF-gel on surface microhardness of enamel of these three areas using Vickers microhardness measurements before and after application of topical fluorides at time intervals of 1/2 an hour, 6 hours and 24 hours. It was found that both the topical fluorides increased the surface microhardness of enamel in the three areas; the maximum increase in surface microhardness was observed in fluorosed teeth. APF-gel was found to be more effective than sodium fluoride.

[Microelement-molybdenum and its use for the treatment of children's fluorine-stained teeth].

This paper is a study of the effects of molybdenum on the experimental fluorine poisoning in rats and on sodium molybdate treatment of the F-stain teeth in children. The experimental results show that the high-F and Mo feed animal, the excretion of urine-F was more than high-F, the F-content of teeth was reduced, the pathological change of skeletal tissue was relatively little, when sodium molybdate was used to treat children with fluorosis teeth for 3 months, the hair-F would reduce, whereas the hair-Mo increase the immune function would rise--the PHA skin test positive rate raised from effect 33.3% to 69.2%. It is suggested that Mo can interfere with the F-poisoning effect and that Mo may well be used as z worth medicine for the prevention and control of this illness.

Esthetic alternative for fluorosis blemishes with the usage of a dual bleaching system based on hydrogen peroxide at 35%.

Esthetic dental procedures in pediatric dentistry represent sources of satisfaction and realization, as much for the patient as for the professional. Lack of dental esthetics may develop psychological problems in infant as well as in adolescent patients. Blemishes produced by fluorosis appear as a challenge to the pediatric dentist and alternatives for treatment are desired. The scope of this present paper is to relate a clinical case with esthetic solution for blemishes in teeth enamel due to fluorosis. A dual system of bleaching was used (photo/chemically activated) based on hydrogen peroxide at 35% (Hi-Lite-Shofu) in a male eight-year-old patient with white fluorosis blemishes on teeth 11 and 21. The bleaching system used was efficient in bleaching teeth with white blemishes due to fluorosis, thus masking the blemishes and providing a more uniform appearance.

[The effect of calcium glycerophosphate and Remodent on the dental enamel permeability in dogs with fluorosis]. / Vliianie glitserofosfata kal'tsiia i remodenta na pronitsaemost' émali zubov sobak pri fliuoroze.

In 14 dogs aged 6 months with severe fluorosis, the authors studied the effects of intake of calcium glycerophosphate and local remodent application on 45Ca enamel incorporation and the depth of its penetration into the dental hard tissues. The treatment led to a substantial decrease in both enamel 45Ca accumulation and the depth of its penetration under severe fluorosis. Combined use of the drugs was more beneficial in terms of enamel 45Ca permeability.

Dental fluorosis treatment can improve the individuals' ohrqol? results from a randomized clinical trial

Abstract This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Resumo Este estudo teve como objetivo avaliar o efeito na qualidade de vida relacionada à saúde bucal (QVRSB) de dois protocolos de tratamento para fluorose dentária, em indivíduos incluídos em um ensaio clínico randomizado. Setenta voluntários, os quais viviam em uma área de fluorose endêmica no Brasil, e que possuíam pelo menos quatro dentes ântero-superiores com índice de Thylstrup e Fejerskov de 1 a 7, foram randomizados em dois grupos de tratamento (n= 35): GI- microabrasão de esmalte; ou GII- microabrasão associada com clareamento caseiro. A microabrasão foi realizada com ácido fosfórico 37% e pedra pomes e, o clareamento caseiro com peróxido de carbamida 10% e uso de moldeira. Os voluntários responderam um questionário antes e 1 mês após o tratamento, visando avaliar mudanças na QVRSB através do instrumento Oral Impact on Daily Performance (OIDP). Diferenças nos escores de impacto geral entre e nos mesmos grupos de tratamento foram analisadas através dos testes Wilcoxon (mesmo grupo) e Mann-Whitney (entre grupos), respectivamente. Alterações no escores dos domínios foram analisadas usando o teste Wilcoxon (a<0.05). Um mês após o tratamento, os indivíduos relataram melhora na QVRSB. Ambos os grupos apresentaram menores escores do OIDP (p<0,001), sem diferença entre eles. Os escores dos domínios comer, limpar os dentes, sorrir e estado emocioal diminuíram após o tratamento para toda a amostra. Concluiu-se que o tratamento com microabrasão melhorou a QVRSB de indivíduos vivendo em uma área de fluorose endêmica independentemente da associação com o clareamento caseiro.