Over-the-counter products in tooth bleaching: A scoping review.

OBJECTIVE: To map and summarize the current scientific evidence concerning the active ingredients, effectiveness, and adverse effects of over-the-counter (OTC) bleaching products. DATA AND SOURCE: This study was conducted according to the PRISMA-ScR guidelines for scoping reviews and registered on the Open Science Framework platform. STUDY SELECTION: Database searches were conducted in PubMed/MEDLINE, Embase, and Scopus up to January 2024. All in vitro, in situ, and clinical studies evaluating the effectiveness and adverse effects of OTC bleaching products were included. A descriptive analysis of the included studies was performed. RESULTS: A total of 88 studies were included. Most of them were in vitro studies (n = 49), followed by randomized clinical trials (n = 28). The main OTC bleaching products identified were whitening or stain-removing toothpastes (n = 42), followed by whitening strips (n = 39). Most clinical studies indicate that whitening strips are effective in improving tooth color and providing whitening benefits. In contrast, the bleaching effectiveness of toothpastes, mouth rinses and whitening trays was mainly supported by in vitro studies. The main adverse effects associated with OTC bleaching agents were tooth sensitivity and gingival irritation. CONCLUSION: A wide variety of OTC bleaching products is available for consumer self-administered use. Clinical studies have mainly confirmed the bleaching effectiveness of whitening strips, while the validation for toothpastes, mouth rinses and whitening trays has mainly relied on in vitro studies. Nevertheless, the use of OTC bleaching products may result in adverse effects, including tooth sensitivity, gingival irritation, and enamel surface changes. CLINICAL SIGNIFICANCE: Some over-the-counter bleaching products may have whitening properties supported by clinical studies, particularly those containing hydrogen or carbamide peroxide. Nonetheless, clinicians must be aware of the potential risks associated with excessive self-administration of these products, which may result in adverse effects.

The Efficacy of At-home, In-office, and Combined Bleaching Regimens: A Randomized Controlled Clinical Trial.

OBJECTIVE: The aim of this study was to compare the clinical efficacy of at-home, in-office, and combined bleaching regimens. METHODS: Forty-eight participants were recruited and randomly divided into four groups based on the bleaching regimen (n=12) as follows: 1) at-home bleaching using 10% carbamide peroxide (Opalescence PF 10%, Ultradent) for 14 days (HB); 2) two sessions of in-office bleaching using 40% hydrogen peroxide (Opalescence BOOST PF 40%, Ultradent) with a one-week interval (OB); 3) one session of in-office bleaching followed by at-home bleaching for seven days (OHB); and 4) at-home bleaching for seven days followed by one session of in-office bleaching (HOB). Tooth color was measured using a spectrophotometer (Easyshade, Vita ZahnFabrik) at baseline (T0), day 8 (T1), day 15 (T2), and day 43 (T3, four weeks after the end of the bleaching treatment). The color data were calculated using the CIEDE2000 (ΔE00) and whiteness index for dentistry (WID) formulas. Tooth sensitivity (TS) was recorded using a visual analogue scale (VAS) for 16 days. Data were analyzed by one-way analysis of variance (ANOVA) and the Wilcoxon signed-rank test (α=0.05). RESULTS: All bleaching regimens resulted in a significant increase in WID values (all p<0.05), while no significant differences in WID and ΔWID values were found among the different groups at each time point (all p>0.05). Significant differences in ΔE00 values were observed between T1 and T3 for all groups (all p<0.05), while no significant differences in ΔE00 values were found among the different groups at any time point (all p>0.05). Significantly lower TS values were observed in the HB group than in the OB and HOB groups (p=0.006 and p=0.001, respectively). CONCLUSIONS: All bleaching regimens resulted in great color improvement, and different regimens led to similar color changes at any of the evaluation time points. The sequence of treatments applying in-office bleaching or at-home bleaching did not affect the bleaching efficacy. The in-office bleaching and combined bleaching regimens yielded a higher intensity of TS than did at-home bleaching.

Various Aspects Involved in the Study of Tooth Bleaching Procedure: A Questionnaire-Based Study.

A beautiful smile is an important feature when it comes to a pleasant appearance of the face, and one of the most common situations that drive patients to book a dental appointment is tooth discoloration. Tooth bleaching is the treatment of choice for extrinsic tooth discoloration, as it is a cheap, fast, and minimally invasive procedure. This study aimed to provide comparative information on the perceptions of both patients and dentists regarding different whitening methods and on the factors involved in people's willingness to recommend and use a bleaching procedure. In addition to this, this study evaluated the degree of satisfaction in relation to the bleaching methods and materials used; it also evaluated the following: negative side effects, economic characteristics and the patients' perceptions of the aesthetic appearance of their dental arches, especially tooth color. The subjects that participated in the present study were selected based on their background and were then divided into two categories. The first group consisted of 120 patients who had received tooth-bleaching treatments in dental clinics during the study and the second group consisted of 127 dentists. A conventional sampling method was used. The study aimed to define a relationship between multiple aspects of the tooth-bleaching procedure, including the patients' desires and their general knowledge of this procedure. Tooth color and the way it changes is a very important factor that motivates patients to come to the dentist for whitening procedures. Patients showed the highest levels of satisfaction with the results of in-office bleaching procedures. In the group consisting of dentists, satisfaction levels were higher for the procedure of home bleaching supervised by a dentist. Factors influencing the choice of bleaching materials are appreciated differently by dentists and patients. Furthermore, the rate of patients using OTC (over the counter) products was found to be high. Further research is needed to find more effective and safer alternatives to home tooth-bleaching procedures.

Estabilidad del color en el blanqueamiento intracoronal / Color stability in intracoronal whitening

RESUMEN Introducción: El blanqueamiento intracoronal es una alternativa mínimamente invasiva que permite devolver el color a dientes no vitales tincionados. La estabilidad del color logrado es fundamental para evaluar la predictibilidad de este tipo de tratamiento. Objetivo: Evaluar la estabilidad del color 3 años después del blanqueamiento intracameral con peróxido de hidrógeno y carbamida a diferentes concentraciones. Métodos: Se utilizaron 44 premolares extraídos por indicación ortodóncica, los cuales fueron tratados endodónticamente y pigmentados artificialmente con cromógenos sanguíneos. Las muestras fueron divididas aleatoriamente en 4 grupos de estudio (n = 11) siendo: grupo A: peróxido de carbamida 37 por ciento, grupo B: peróxido de hidrógeno 35 por ciento, grupo C: peróxido de carbamida 100 por ciento y grupo D: control; para luego realizar 4 aplicaciones de agente blanqueador con un intervalo de 4 días entre cada aplicación. El registro del color se realizó mediante espectrofotometría, lo que permitió obtener los valores CIE L*a*b* para calcular la variación total de color entre los parámetros iniciales y finales del tratamiento, así como el control a los 3 años. Resultados: Los resultados fueron analizados mediante las pruebas de Shapiro-Wilks, ANOVA y Mann-Whitney, sin registrar diferencias significativas en la variación total de color al control de los 3 años (p > 0,05). Conclusión: Los resultados del blanqueamiento intracoronal, independiente del tipo y concentración del agente utilizado en este estudio son estables en el tiempo y cualquier variación regresiva de color debe ser atribuida a factores extrínsecos(AU)

ABSTRACT Introduction: Intracoronal whitening is a minimally invasive procedure to restore natural color to stained non-vital teeth. The color stability achieved is fundamental to evaluate the predictability of this type of treatment. Objective: Evaluate color stability 3 years after intracameral whitening with carbamide and hydrogen peroxide at various concentrations. Methods: A total 44 premolars were used which had been extracted by orthodontic indication. The premolars were treated endodontically and artificially pigmented with blood chromogenes. The samples were randomly divided into 4 study groups (n = 11): Group A: 37 percent carbamide peroxide, Group B: 35 percent hydrogen peroxide, Group C: 100 percent carbamide peroxide and Group D: control. Four applications were then made of the whitening agent with a 4-days' separation between them. Color was recorded by spectrophotometry, obtaining the values CIE L*a*b* to estimate total color variation between the initial and final parameters of the treatment, as well as control at 3 years. Results: The results were analyzed with Shapiro-Wilk, ANOVA and Mann-Whitney tests, not finding any significant differences in total color variation with respect to the 3 years' control (p > 0.05). Conclusion: The results of the intracoronal whitening studied are stable throughout time, regardless of the type and concentration of the agent used, and any regressive color variation should be attributed to extrinsic factors(AU)

Effectiveness of a combination of salicylic acid-based products for the treatment of mild comedonal-papular acne: a multicenter prospective observational study.

BACKGROUND: The most common therapeutic approach to acne is a combined treatment of retinoid and benzoyl peroxide, with oral antibiotics recommended for moderate-to-severe cases. These kinds of therapies often lead to adverse reactions, leading to the request for new therapeutic options. Recently, the combined use of three salicylic acid-based products for the topical treatment of acne has been related to a significant improvement in acne lesions. METHODS: A multicenter prospective observational study was carried out on patients with a diagnosis of mild comedonal-papular facial acne to provide new evidence on the clinical effectiveness, tolerability and acceptability of three salicylic acid-based products for the topical treatment of acne in the daily clinical practice. Clinical effectiveness on lesions improvement, the evaluation of personal discomfort related to acne and the assessment of overall clinical outcome were the primary endpoints. Treatment acceptability and tolerability were also evaluated. RESULTS: The treatment with the three salicylic acid-based products has been related to a significant improvement on acne lesions over 8 weeks of treatment, along with a reduction of personal discomfort related to acne and an improvement on lesions appearance. The products have also shown good acceptability and tolerability. CONCLUSIONS: The results of this observational study support the effective and well-tolerated use of a combined treatment with three salicylic acid-based products for the topical treatment of acne.

Regresión de la luminosidad del color posblanqueamiento dental casero en pacientes fumadores y no fumadores / Color luminosity regression after home tooth whitening in smoking and nonsmoking patients

Introducción: Existen muchos estudios de efectividad del blanqueamiento dental; sin embargo, son muy pocos los que hablan de regresión de color (fenómeno que se produce posterior a un blanqueamiento dental), lo mismo ocurre en relación a pacientes fumadores. Objetivo Determinar la regresión de la luminosidad del color en pacientes sometidos a blanqueamiento dental casero con peróxido de carbamida al 10 por ciento, en pacientes fumadores y no fumadores. Métodos: Estudio descriptivo, transversal, en 43 pacientes de un grupo de 60 previamente tratados de forma casera durante 3 semanas con peróxido de carbamida al 10 por ciento. Fueron divididos en un grupo experimental (pacientes fumadores GE) y grupo control (no fumadores GC). Se midió la variación del color con el espectrofotómetro Vita Easyshade® a la semana, mes, 6 meses y 9 meses posblanqueamiento. Los datos obtenidos mediante la medición con el espectrofotómetro fueron analizados por el test de Shapiro Wilk y Kolmogorov-Smirnov para evaluar normalidad de la distribución y, posteriormente, sometidos al test Mann-Whitney U y Wilcoxon W (#945; = 0,05). Resultados: El delta L* fue: 2,3 (GE) y 3,66 (GC); deltas calculados con datos de los 9 meses vs. semana posblanqueamiento. No hubo diferencias estadísticamente significativas entre ambos grupos. Conclusiones: No existen diferencias estadísticamente significativas en la regresión del color posteriores al blanqueamiento casero con peróxido de carbamida al 10 por ciento en pacientes fumadores y no fumadores(AU)

Introduction: Many studies have been conducted about the effectiveness of tooth whitening, but few refer to color regression (a phenomenon occurring after tooth whitening) or to smoking patients. Objective: Determine color luminosity regression in smoking and nonsmoking patients undergoing home tooth whitening with 10 percent carbamide peroxide. Methods: A descriptive cross-sectional study was conducted of 43 patients from a group of 60 previously undergoing home treatment with 10 percent carbamide peroxide for 3 weeks. The patients were divided into an experimental group (EG, smoking patients) and a control group (CG, nonsmoking patients). A Vita Easyshade® spectrophotometer was used to measure color variation one week, one month, 6 months and 9 months after whitening. The data obtained by spectrophotometry were analyzed with the Shapiro-Wilk and the Kolmogorov-Smirnov tests to evaluate the normality of the distribution, and then they were subjected to the Mann-Whitney-Wilcoxon U test (α = 0,05). Results: Delta L* was 2,3 (EG) and 3,66 (CG); delta values were estimated from data obtained 9 months vs. one week after whitening. No statistically significant differences were found between the groups. Conclusions: No statistically significant color regression differences are found in either smoking or nonsmoking patients after home whitening with 10 percent carbamide peroxide(AU)

Novel in-office peroxide-free tooth-whitening gels: bleaching effectiveness, enamel surface alterations, and cell viability.

To evaluate the bleaching ability, the effect on enamel surface and cytotoxicity of novel tooth-whitening formulations containing papain, ficin, or bromelain. Forty bovine dental discs (6 cm ×4 cm) were pigmentated and randomly allocated into the following groups (n = 10): Group 1, 20 wt% carbamide peroxide (control); group 2, 1% papain-based whitening; group 3, 1% ficin-based whitening; and group 4, 1% bromelain-based whitening. The whitening gels were prepared and applied on the enamel three times per day once a week, for 4 weeks. Color measurement was obtained by CIEDE2000. Enamel Knoop microhardness and roughness were evaluated. The WST-1 assay was used to evaluate the cell viability of mouse fibroblast cells (L929). Data were statistically analyzed by one-way analysis of variance (ANOVA) and Student Newman Keuls's post hoc test at α = 0.05 significance level. Bromelain, ficin-based, and carbamide peroxide bleaching gels showed a similar color change (p < 0.001). Higher enamel hardness decrease and higher enamel roughness were caused by the carbamide peroxide (p < 0.05). The experimental whitening gels did not affect cell viability. Tooth bleaching gels containing bromelain, papain, or ficin have substantial clinical potential to be used in the development of peroxide-free tooth whitening gels.

Efficacy of natural, peroxide-free tooth-bleaching agents: A systematic review, meta-analysis, and technological prospecting.

The aim of this study is to analyze the efficacy of natural bleaching agents and the current technological development in this research field. Two reviewers performed a literature search up to July 2019 in 15 databases. Five laboratory studies and 25 patents were included. Data regarding natural bleaching agent used, application protocol, and the main findings of studies were analyzed. Laboratory studies that evaluated natural bleaching agents' peroxide-free or associated to peroxides and patents related to natural bleaching agents were included. The studies evaluated papain, bromelain, chlorine dioxide, sodium chloride plus vinegar and sodium bicarbonate as peroxide-free agents; and sweet potato extract, lactoperoxidase, and peroxidase associated to peroxide used were included. Twenty-five patents were included; among the most cited are the papain and the chlorine. The addition of non-peroxide agents into peroxide showed improvement in bleaching effect with the incorporation of these non-peroxide agents (p < .05). On the other hand, peroxide-free agents did not show an improvement in bleaching effect (p < .05). The evidence in literature suggested that natural bleaching agents incorporated to peroxide may improve the bleaching. Therefore, the current literature does not support the use of natural agents as dental bleaching.

Clinical analysis of color change and tooth sensitivity to violet LED during bleaching treatment: A case series with split-mouth design.

BACKGROUND: The aim of this study was to analyze bleaching treatment performed with different products, with or without the use of Violet LED. METHODS: The color and dental sensitivity of six patients were evaluated as follows: (1)at-home bleaching with 10% Carbamide Peroxide (CP); (2)in-office bleaching with 17.5% Hydrogen Peroxide (HP), and (3)treatment with a placebo gel. All patients, including patients receiving at-home bleaching, received irradiation with violet LED in the office. The right hemiarch was protect with silicone. The color was evaluated using Vita Easyshade digital spectrophotometer and the Vita scale on teeth 13-23. Visual analog scale sensitivity analysis was performed per hemiarch, while the thermal sensation threshold was performed on teeth 11, 13, 21 and 23. RESULTS: Regarding the color change (ΔE) it can be observed that treatment 1, in which 10%CP was used, presented the highest values, followed by treatment 2, in which 17.5%HP was used. Regarding sensitivity, only patients who received 17.5%HP showed moderate sensitivity, and there was no difference between the arches. The analysis of dental thermal sensation threshold showed that there was more dental sensitization between 7 and 14 days and that the use of violet LED made the teeth more sensitive. CONCLUSIONS: It was concluded that violet LED enhanced the bleaching effect when used with 10%PC gels, and a discreet effect was seen when used either in conjunction with 17.5%PH or alone. Violet LED had no effect on pain sensation, but increased the detection threshold of thermal changes in the teeth that were irradiated.

Color Regression and Maintenance Effect of Intracoronal Whitening on the Quality of Life: RCT-A One-year Follow-up Study.

OBJECTIVE:: This randomized clinical study evaluated two parameters: 1) the clinical color rebound of whitening patients' tooth discoloration using the walking bleaching technique and 2) the impact on psychological and aesthetic self-perception at the one-year follow-up of patients who underwent bleaching of nonvital teeth. METHODS AND MATERIALS:: Fifty study participants with nonvital tooth discoloration were recruited. Teeth were assigned randomly into one of two groups: 1) 35% hydrogen peroxide (n=25) and 2) 37% carbamide peroxide (n=25). Intracoronal bleaching was carried out over the course of four sessions using the walking bleach technique. Tooth color was evaluated after each session in order to measure the total color variation (ΔE). The guide was arranged from highest (B1) to lowest values (C4) for evaluating color, and color changes using Vita Classical Shade (ΔSGUs) units were calculated. Subjective and objective assessments were compared with the counterpart of the tooth. Aesthetic perception and psychosocial factors were evaluated before and after treatment by the Oral Health Impact Profile (OHIP) and Psychological Impact of Dental Impact Questionnaire (PIDAQ) surveys. RESULTS:: Color changes (ΔE) were 15.48 ± 5.17 and 14.02 ± 4.85 for carbamide and hydrogen peroxide groups, respectively. There were no significant differences ( p>0.05) between these two groups at the one-year follow-up. There was a decrease in the PIDAQ scores after treatment compared to baseline values ( p<0.05). The majority of OHIP values regressed to baseline values. CONCLUSION:: The technique of walking bleaching was highly effective and showed minimal color rebound in nonvital teeth and had a positive effect on patients' psychological impact at the one-year follow-up.

Home-based chemically-induced whitening (bleaching) of teeth in adults.

BACKGROUND: With the increased demand for whiter teeth, home-based bleaching products, either dentist-prescribed or over-the-counter products have been exponentially increasing in the past few decades. This is an update of a Cochrane Review first published in 2006. OBJECTIVES: To evaluate the effects of home-based tooth whitening products with chemical bleaching action, dispensed by a dentist or over-the-counter. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 12 June 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library (searched 12 June 2018), MEDLINE Ovid (1946 to 12 June 2018), and Embase Ovid (1980 to 12 June 2018). The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (12 June 2018) and the World Health Organization International Clinical Trials Registry Platform (12 June 2018) were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included in our review randomised controlled trials (RCTs) which involved adults who were 18 years and above, and compared dentist-dispensed or over-the-counter tooth whitening (bleaching) products with placebo or other comparable products.Quasi-randomised trials, combination of in-office and home-based treatments, and home-based products having physical removal of stains were excluded. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials. Two pairs of review authors independently extracted data and assessed risk of bias. We estimated risk ratios (RRs) for dichotomous data, and mean differences (MDs) or standardised mean difference (SMD) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included 71 trials in the review with 26 studies (1398 participants) comparing a bleaching agent to placebo and 51 studies (2382 participants) comparing a bleaching agent to another bleaching agent. Two studies were at low overall risk of bias; two at high overall risk of bias; and the remaining 67 at unclear overall risk of bias.The bleaching agents (carbamide peroxide (CP) gel in tray, hydrogen peroxide (HP) gel in tray, HP strips, CP paint-on gel, HP paint-on gel, sodium hexametaphosphate (SHMP) chewing gum, sodium tripolyphosphate (STPP) chewing gum, and HP mouthwash) at different concentrations with varying application times whitened teeth compared to placebo over a short time period (from 2 weeks to 6 months), however the certainty of the evidence is low to very low.In trials comparing one bleaching agent to another, concentrations, application method and application times, and duration of use varied widely. Most of the comparisons were reported in single trials with small sample sizes and event rates and certainty of the evidence was assessed as low to very low. Therefore the evidence currently available is insufficient to draw reliable conclusions regarding the superiority of home-based bleaching compositions or any particular method of application or concentration or application time or duration of use.Tooth sensitivity and oral irritation were the most common side effects which were more prevalent with higher concentrations of active agents though the effects were mild and transient. Tooth whitening did not have any effect on oral health-related quality of life. AUTHORS' CONCLUSIONS: We found low to very low-certainty evidence over short time periods to support the effectiveness of home-based chemically-induced bleaching methods compared to placebo for all the outcomes tested.We were unable to draw any conclusions regarding the superiority of home-based bleaching compositions or any particular method of application or concentration or application time or duration of use, as the overall evidence generated was of very low certainty. Well-planned RCTs need to be conducted by standardising methods of application, concentrations, application times, and duration of treatment.

The effects of at-home whitening on patients' oral health, psychology, and aesthetic perception.

BACKGROUND: The aesthetic self-perception and psychosocial impact of whitening is poorly explored in the literature; it is even less clear whether the effect of whitening may influence the psychology or social relations of patients. Therefore, the aim of this trial is to evaluate the impact of an at-home whitening procedure on patients' quality of life. Also, this study's secondary objective is the adaptation and validation of the Spanish version of the OES questionnaire (OES-SP). METHODS: Fifty eight patients underwent whitening with 10% carbamide peroxide (CP) gel for 1 h daily for 3 weeks. For these participants, the OHIP-Esthetics, PIDAQ, and OES surveys were applied before, one week after, and one month after the whitening procedure. Oral health-related quality of life was measured using the OHIP-Esthetics survey and the psychosocial impact using the PIDAQ survey. The orofacial aesthetics was measured by OES and validated for the Spanish Chilean context. The treatment efficacy (ΔE and ΔSGU) and data from the OHIP-Esthetics PIDAQ and OES surveys were compared using the Wilcoxon Signed-Rank test. RESULTS: The whitening procedure was effective (ΔE = 5.9 ± 1.8). The OHIP-Esthetics results were significant when comparing the initial baseline survey prior to the treatment and one week after whitening (p < 0.001) and when comparing the baseline and one-month results (p < 0.001). The overall score on the PIDAQ, after one week post-whitening, was separated into factors and all factors were statistically significant (p < 0.03); the factors for the one-month results were also all statistically significant (p < 0.001), except the social impact factor. The OES questionnaire had statistically significantly increased scores both one week and one month post-treatment (p < 0.0001). The reliability, validity, and responsiveness of the OES-SP were satisfactory. CONCLUSION: The at-home whitening procedure with carbamide peroxide 10% had a positive effect on patients' oral health-related quality of life, psychology, and aesthetic perception after one month post-whitening. The Chilean Spanish version of the OES showed satisfactory psychometric characteristics to evaluate dental whitening. TRIAL REGISTRATION: NCT02605239 . Date that the study was retrospectively registered: 11-11-2015.

Evaluation of in-office tooth whitening treatment with violet LED: protocol for a randomised controlled clinical trial.

INTRODUCTION: In-office tooth whitening treatment using violet light emited diode (LED) (405 nm) is a novel bleaching method that causes less sensitivity while offering the same effectiveness as the gold standard (35% hydrogen peroxide, H2O2). This study describes a protocol for the first randomised controlled clinical trial to compare the effects of the two methods. METHODS AND ANALYSIS: Eighty patients will be divided into four groups: G1 violet LED; G2 violet LED +35% carbamide peroxide; G3 35% H2O2 and G4 violet LED +gingivoplasty. Colour will be measured at baseline, immediately after the first session and at the 15 and 180 days follow-up using the Vita Classical and the digital Easyshade V spectrophotometer (Vita, Zahnfabrik, Germany). Sensitivity after whitening will be measured using the Visual Analogue Scale at baseline and at each session in all groups and in all follow-ups. The tissue removed during gingivoplasty (G4) will be submitted to immunohistochemical analysis for the determination of inflammatory changes caused by violet LED. The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) will be evaluated before, as well as at established time point controls. The results will be expressed as mean and SD values. After determining the normality of the data, a one-way repeated-measures analysis of variance will be used for the comparison of data with normal distribution and the Kruskal-Wallis test will be used for data with non-normal distribution. A p<0.05 will be considered indicative of statistical significance. After determining the normality of the data, the Kruskal-Wallis test will be used for non-parametric data. Multivariate analysis of variance (MANOVA) and the Wilcoxon test will be used for comparing data from the PIDAQ. ETHICS AND DISSEMINATION: This protocol has been approved by the Human Research Ethics Committee of UniversidadeNove de Julho (certificate: 2.034.518). The findings will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT03192852; Pre-results.

Violet LED with low concentration carbamide peroxide for dental bleaching: A case report.

The use of violet LED was recently introduced as a new alternative technique to perform tooth bleaching, associated or not with bleaching agents. This paper shows a tooth bleaching clinical case report performed in a 26-year-old woman, using a violet LED with 10% carbamide peroxide (CP). The tooth bleaching protocol was performed in 3 sessions. Fifteen irradiations using a violet light system (BMW, MMoptics, São Carlos, SP, Brazil) were done during 30 s (on) and 60 s (off) without bleaching gel, and more 5 irradiations associated to 10% CP. Upper and lower arches were irradiated separately. The total procedure time was 30 min. Subjective and objective color assessments were performed using Vitapan Classical shade guide and VITA Easyshade spectrophotometer, respectively. Dentin sensitivity was measured using a visual analogue scale. The use of violet LED associated to a low concentration carbamide peroxide successfully promoted tooth bleaching and no side effects i.e. dentin sensitivity during and post treatment was observed.

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.

Aclaramiento Dental con Enjuagues de Libre Venta que Contienen Peróxido de Hidrógeno / Toothbleaching with over the Counter Mouthwashes Containing Hydrogen Peroxide

RESUMEN: El objetivo de este estudio in vitro fue evaluar la eficacia en el aclaramiento dental de tres enjuagues orales que contienen peróxido de hidrógeno en diferentes períodos de inmersión en comparación con el peróxido de carbamida al 10 %. Cuarenta muestras de premolares humanos se dividieron aleatoriamente en cuatro grupos según el agente al que se expuso: G1: Colgate Plax®Whitening, G2: Listerine®Whitening Extreme y G3: Oral B® 3D White™ se sumergieron dos minutos al día durante 28 días y G4: Peróxido de carbamida al 10 %, ocho horas al día durante 14 días. La medición de color se realizó con un espectrofotómetro Vita Easyshade usando la escala CIELab inicialmente, a los 14, 28 y 35 días de evaluación. Las comparaciones entre los grupos se realizaron utilizando las pruebas Kruskal-Wallis y U Mann-Whitney, mientras que entre los tiempos las pruebas Friedman y Signo-Rango de Wilcoxon. Los resultados revelaron que a los 14 días, los cuatro grupos mostraron cambios de color, pero no se evidenció mayor eficacia de alguno sobre el otro (p>0,05). Sin embargo, a los 28 y 35 días se observó una clara eficacia del peróxido de carbamida sobre los enjuagues (p<0,05). Los enjuagatorios orales aclaran los dientes a partir de los 28 días, con los protocolos indicados; sin embargo no llegan a tener resultados similares a un aclaramiento profesional con gel de peróxido de carbamida al 10 %.

ABSTRACT: The objective of this in vitro study was to evaluate the efficacy in dental toothbleaching of three mouthwashes containing hydrogen peroxide in different periods of immersion compared to 10 % carbamide peroxide. Forty samples of human premolars were randomly divided into four groups according to the agent to which they were exposed: G1: Colgate Plax®Whitening, G2: Listerine®Whitening Extreme and G3: Oral B® 3D White ™ were immersed two minutes a day during 28 days and G4: 10 % carbamide peroxide, eight hours a day for 14 days. The color measurement was performed with a Vita Easyshade spectrophotometer using the CIELab scale initially, at 14, 28 and 35 days of evaluation. The comparisons between the groups were made using the Kruskal-Wallis and U Mann-Whitney tests. While between the times the tests Friedman and Sign-Range of Wilcoxon. The results revealed that at 14 days, the four groups showed color changes, but no greater effectiveness was shown of one over the other (p>0,05). However, at 28 and 35 days a clear efficacy of carbamide peroxide was observed on the rinses (p<0,05). Mouthwashes clear the teeth after 28 days, with the indicated protocols; however, they do not reach similar results to a professional clarification with 10 % carbamide peroxide gel.

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.

Análise de citotoxicidade, desmineralização e potencial clareador de géis clareadores experimentais, baseado em peróxido de carbamida 15% adicionados de nano-hidróxiapatita / Analysis of cytotoxicity, demineralization and bleaching potential of experimental bleaching gels, based on 15% carbamide peroxide added with nanohydroxyapatite

O clareamento dental é considerado um procedimento muito seguro, de efeito rápido e agradável, tornando-se um dos procedimentos mais realizados na odontologia. Contudo, o mesmo apresenta alguns efeitos colaterais, sendo o principal deles a sensibilidade dental, que pode ser causada pela citotoxidade, pela desmineralização, pela geração de espécies reativas do oxigênio na polpa dental e pela degradação da região interprismática facilitando o estimulo nos túbulos dentinários. Diante disso, a presente pesquisa avaliou a desmineralização, a citotoxidade e o potencial clareador de géis clareadores experimentais baseados em peróxido de carbamida (PC) 15%, adicionados de 5% e 10% de nano partículas de hidroxiapatita (n-Hap). Para a avaliação cromática foram utilizados 36 incisivos bovinos divididos em 3 grupos: Grupo1 PC 15%, Grupo 2 PC 15% adicionado 5% nHap e grupo 3 PC 15% com 10% n-Hap, mensurando a cor antes e depois do procedimento terapêutico clareador com auxilio de um espectrofotômetro. As coordenadas do CIELAB foram analisadas para verificação da diferença de cor (ΔE) obtida entre os grupos e dentro do próprio grupo (L*) e, após a analise estatística, foi verificado que todos os géis foram capazes de clarear e não houve diferenças entre os grupos. A citotoxidade foi verificada através da absorbância das células viáveis após o tratamento com o MTT e 1:800 das preparações de agente clareador e gel contendo 5% e 10% de n-Hap aplicadas sobre células L929. Nesse caso os grupos foram desiguais estatisticamente, apresentando o PC 15% como o mais tóxico, seguido do PC 15% adicionado de 10% de n-Hap e o melhor resultado foi obtido pelo gel acrecido de 5% de n-Hap. A análise do conteúdo mineral foi realizada pela fluorescência de raios X por dispersão de energia, onde foi necessário o uso de 15 dentes bovinos, que tiveram seus terços médios seccionados, embutidos em resina epóxi e planificados, e foram dividos em grupos de 5 CPs. Cada CP foi aferido em 8 pontos diferentes antes e depois, nos mesmos pontos da terapia clareadora. Foi então verificado que os géis experimentais apresentaram menor perda de Ca e P. No entanto, não houve diferenças estatísticas entre os grupos 2 e 3. Diante das limitações do presente estudo in vitro é possível concluir que os géis experimentais contendo n-Hap foram eficazes em reduzir a citotoxidade e desmineralização sem perder a eficácia da terapia clareadora

Dental whitening is considered a very safe, quick and pleasant procedure, making it one of the most accomplished procedures in dentistry. However, it has some side effects, the main one being sensibility, which can be caused by cytotoxicity, demineralization, oxygen arrival in the dental pulp and the degradation of the interprismatic region facilitating the stimulation in the dentin tubes. Therefore, the present study evaluated the demineralization, cytotoxicity and bleaching potential of 15% carbamide peroxide-based (PC) based bleaching gels added with 5% and 10% nano-hydroxyapatite (n-Hap) particles. For the chromatic evaluation, 36 bovine incisors were divided into 3 groups: Group 1 PC 15%, Group 2 PC 15% added 5% nHap and group 3 PC 15% with 10% n-Hap, measuring the color before and after the the CIELAB coordinates were analyzed to verify the color difference (Δe) obtained between the groups and within the group (L *). After the statistical analysis it was verified that all the gels were able to lighten and there were no differences between the groups. Cytotoxicity was verified by optical density of viable cells after treatment with MTT and 1: 800 of the bleach and gel preparations containing 5% and 10% nHap applied in L929 cells. In this case, the groups were statistically unequal, presenting 15% PC as the most toxic, followed by PC 15% added with 10% n-Hap and the best result was obtained by the 5% n-Hap increased gel. The mineral content analysis was performed by X-ray Fluorescence by energy dispersion, where it was necessary to use 15 bovine teeth, which had their middle sections sectioned, embedded in epoxy resin and planned, and were divided into groups of 5 CPs, each CP was measured at 8 different points before and after, at the same points of the bleaching therapy, then it was verified that the experimental gels presented a lower loss of Ca and P, however there were no statistical differences between groups 2 and 3. On the face of the limitations of the present in vitro study, it is possible to conclude that the experimental gels were effective in reducing the cytotoxicity and demineralization without losing the effectiveness of the bleaching therapy.