Employment of Reservoirs in At-Home Whitening Trays: Efficacy and Efficiency in Tooth Whitening.

AIM: This study aimed to determine the efficacy of trays made with and without reservoirs, in conjunction with time and cost evaluations, by measuring color change with home whitening procedures. MATERIALS AND METHODS: Extracted human maxillary teeth (central incisors n = 20; canines n = 20; molars n = 20) and 60 artificial teeth (lateral n = 20; premolar n = 40) were mounted into ten typodonts. Tray fabrication was completed such that a block-out resin reservoir was placed on half of the buccal surface of the tray, while the other half remained without a reservoir. Whitening with custom fabricated trays was performed based on two different whitening regimens, where each regimen was assigned to five typodonts: Night-time: Opalescence PF 10% carbamide peroxide for 8 hours daily and Day-time: Philips DayWhite 9.5% hydrogen peroxide for 30 minutes, twice daily. Both systems were applied for 1 week. To evaluate tooth shade, the VITA Easyshade® Advance 4.0 spectrophotometer was used. Color measurements were obtained at baseline (T1), 1-day post-whitening (T2), and 1 month post-whitening (T3). One-way ANOVA, followed by post-hoc Tukey's HSD test, was used to detect significant difference in the overall color change (ΔE*) among the four groups at T2 and T3. Additionally, paired-sample t-test was used to assess difference in ΔE* between T2 and T3 treatment within each of four techniques of tray fabrication. RESULTS: No significant difference in ΔE* was found among the four groups at T2 and T3 (p > 0.05 in each instance). There were significant differences in mean ΔE* between T2 and T3 treatment for the day white treatment groups without reservoir (6.96 vs 10.19 respectively; p = 0.0026) and with reservoirs (6.23 vs 9.79 respectively; p = 0.0031). CONCLUSION: The use of reservoirs does not have a significant effect on whitening efficacy, regardless of type of whitening material and regimen. CLINICAL SIGNIFICANCE: The use of custom fabricated trays with or without reservoirs were equally effective in whitening teeth.

Bleaching and bonding for the older patient.

UNLABELLED: Older people who remain reasonably well may wish to maintain or enhance their dental and oral appearance, preferably at minimal biologic and financial costs. Bleaching and bonding represents a very good treatment option and a sensible strategy for this group. Bleaching addresses the discoloration, while direct composite bonding can improve the shape of worn, or otherwise unaesthetic, teeth without damaging the structure or health of the residual tooth tissue. This pragmatic treatment is well tolerated by older patients. The visual and functional improvements are greatly appreciated by this group, partly because of the non-destructive and affordable nature of the benefits. CLINICAL RELEVANCE: Bleaching and bonding represents a proven, sensible, pragmatic, affordable and practical approach to managing the aesthetic problems of older patients, and the benefits are achievable without destroying their residual sound tooth tissue.

The influence of tooth colour on the perceptions of personal characteristics among female dental patients: comparisons of unmodified, decayed and 'whitened' teeth.

OBJECTIVE: Physical appearance plays a key role in human social interaction and the smile and teeth are important features in determining the attractiveness of a face. Furthermore, the mouth is thought to be important in social interactions. The purpose of this study was to determine the relationship between tooth colour and social perceptions. METHODS: Cross-sectional survey. One hundred and eighty female participants viewed one of six images, either a male or a female digitally altered to display one of three possible dental statuses (unmodified, decayed, or whitened). The images were rated on four personality traits: social competence (SC), intellectual ability (IA), psychological adjustment (PA), and relationship satisfaction (RS). RESULTS: Decayed dental appearance led to more negative judgements over the four personality categories. Whitened teeth led to more positive appraisals. The gender of the image and the demographic background of the participant did not have a significant effect on appraisals. CONCLUSION: Tooth colour exerts an influence on social perceptions. The results may be explained by negative beliefs about dental decay, such as its link with poor oral hygiene.

Evidence-based decision making in action: Part 2--evaluating and applying the clinical evidence.

This is the second of a two-part series addressing the use of evidence-based decision making (EBDM) in the use of home bleaching. In Part 1, a case scenario demonstrated the skills involved in (1) structuring a clinical question and (2) conducting an online search using PubMed.1 Part 2 demonstrates the third and fourth steps in the EBDM process, i.e., (3) critical appraisal to assess the validity of a study and (4) applying that information to clinical decision making. This 4-step approach to EBDM recognizes that clinicians can never be completely current with all conditions, medications, materials, and products. Thus, EBDM provides a mechanism for addressing these gaps in knowledge in order to provide the best care possible.

Current status of nightguard vital bleaching.

Indications for using a 10% carbamide peroxide material in a custom-fitted tray to whiten teeth include teeth discolored from aging, chromogenic foods and drinks, and smoking, and also brown fluorosis-stained teeth, single dark teeth, and tetracycline-stained teeth. Tetracycline-stains may require 2 to 6 months of nightly treatment, whereas after discolorations generally resolve in 2 to 6 weeks. After an initial relapse in the first 2 weeks after the end of treatment, color tends to be stable for 1 to 3 years, with some treatments being permanent. The ADA has approved only six 10% carbamide peroxide materials, which have extensive research and publications on safety and efficacy. Considering the average cost of $196 per arch, and the noninvasive nature of this treatment, nightguard vital bleaching is probably the safest, most cost-effective, patient-pleasing method to improve the appearance of a smile. However, it should be supervised by a dentist for the proper examination, diagnosis of the cause of discoloration, treatment options, and fabrication and fitting of the carrier. Sensitivity during whitening may be treated with fluoride and potassium nitrate.