Coffee-stained tooth enamel color restoration and surface abrasion with whitening and regular toothpaste.

PURPOSE: To evaluate the effectiveness of whitening toothpaste in restoring tooth color after coffee staining and its potential impact on enamel surfaces compared with regular toothpaste. METHODS: Bovine tooth enamel specimens were prepared and stained with coffee solutions before undergoing brushing simulation with different toothpaste slurries (whitening, regular, reference). For precise evaluation, spectrophotometric measurements were taken at intervals to assess color changes using the CIELAB (Commission Internationale de l'Éclairage Lab*) color space. Additionally, profilometric measurements were taken to determine the impact of toothpaste type on the roughness and abraded depth of the enamel surface. To understand the effects of toothpaste and brushing on color change, surface roughness, and abraded depth, while also considering correlations between these factors, the findings were analyzed using mixed-effects models. RESULTS: The whitening toothpaste group demonstrated the highest recovery rate (71%) after 10,000 brushstrokes, followed by the regular toothpaste group (48%) and the reference slurry group (43%). The mixed-effects model analysis revealed that the reference group had a smaller change in lightness (ΔL) than those in the regular toothpaste group. The whitening toothpaste group showed a greater change in lightness on average than those in the regular toothpaste group, with an increase in lightness as the number of brushstrokes increased. According to the roughness and abraded depth data, the whitening toothpaste group was least affected by brushing, while the reference and regular toothpaste groups showed higher levels of roughness and abraded depth at all intervals. CLINICAL SIGNIFICANCE: Gaining a thorough understanding of the effectiveness of whitening toothpaste and its impact on the enamel surface plays a crucial role in refining toothpaste formulations and advancing tooth whitening techniques in dental care.

Evaluation of Stain Removal Efficacy and Color Stability of Three Different Dentifrices on Artificially Stained Enamel Surface-An In Vitro Study.

AIM: The aim of the present study was to assess the stain removal ability and color stability of three distinct dentifrices on artificially stained enamel surface. MATERIALS AND METHODS: This study included 75 intact, healthy premolars free of dental caries that were extracted during orthodontic therapy. The samples were allowed to dry for 6 hours after being submerged in the prepared tea solution for roughly 18 hours every day. Then this procedure was repeated for seven successive days. All samples were randomly divided into three experimental groups with 25 samples in each group. Group I: control dentifrice, group II: dentifrice containing hydrogen peroxide, group III: dentifrice containing papain and bromelain. A specially designed toothbrushing simulator was used to brush every sample in the relevant group. Using a spectrophotometer and a measurement program, color measurement was evaluated after staining process after 4 weeks and 8 weeks of teeth cleaning. Using a profilometer, the surface roughness values (Ra) were assessed. RESULTS: After 8 weeks of brushing of stained samples, the color stability was better in dentifrice containing hydrogen peroxide (1.14 ± 0.11) followed by dentifrice containing papain and bromelain (1.22 ± 0.08) and control group (1.30 ± 0.09). And after 8 weeks of brushing of stained samples, the surface roughness was more in dentifrice containing hydrogen peroxide (0.237 ± 0.02) followed by dentifrice containing papain and bromelain (0.229 ± 0.13) and control group (0.207 ± 0.05). CONCLUSION: The present study concluded that the dentifrice containing hydrogen peroxide showed a superior whitening effect on the stained enamel surface than dentifrice containing papain and bromelain and control dentifrice. CLINICAL SIGNIFICANCE: The development of various dentifrice products has been greatly aided by the increased demand for an improved esthetic appearance. Teeth's natural color and any external stains that could accumulate on the tooth surface combine to determine a tooth's color. Additionally, the use of whitening dental pastes to remove external stains has grown in favor. With the development of these whitening toothpastes, dentifrices' ability to lessen or eliminate extrinsic dental stains has increased. How to cite this article: Mishra D, Kamath DG, Alagla M, et al. Evaluation of Stain Removal Efficacy and Color Stability of Three Different Dentifrices on Artificially Stained Enamel Surface-An In Vitro Study. J Contemp Dent Pract 2024;25(1):68-71.

At-home bleaching versus whitening toothpastes for treatment of tooth discoloration: a cost-effectiveness analysis.

OBJECTIVES: This study aimed to analyze the cost-effectiveness of whitening toothpastes and at-home bleaching for the treatment of tooth discoloration. METHODOLOGY: A cost-effectiveness economic analysis was conducted, and eight randomized clinical trials were selected based on the whitening agent product used: blue covarine dentifrices (BCD), hydrogen peroxide dentifrices (HPD), dentifrices without bleaching agents (CD, negative control), and 10% carbamide peroxide (CP10, positive control) for at-home bleaching. The consumer/patient perspective was adopted, macro-costing techniques were used and a decision tree model was performed considering the costs in the American and Brazilian markets. The color change evaluation (ΔE*ab) was used to calculate the effectiveness of tooth bleaching. A probabilistic analysis was performed using a Monte Carlo simulation and incremental cost-effectiveness ratios were obtained. RESULTS: CP10 resulted in the highest cost-effectiveness compared to the use of dentifrices in both markets. In Brazil, HPD was more cost-effective than BCD and CD. In the US, the increased costs of HPD and BCD did not generate any whitening benefit compared to CD. CONCLUSIONS: CP10 was more cost-effective than BCD and HPD for tooth bleaching from the perspectives of the Brazilian and American markets. Decision-making should consider the use of CP10 for treating tooth discoloration.

Inhibition of Silver Diamine Fluoride-induced Tooth Discoloration by Using Natural Antioxidant: In Vitro Study.

AIM: Silver diamine fluoride (SDF) is a well-known caries preventive aid capable of arresting carious lesions and preventing secondary caries formation. Despite having the caries prevention potential, the clinical use of SDF is limited due to the tooth discoloration caused by SDF. The objective of this study was to evaluate the efficiency of natural antioxidants to inhibit SDF-induced tooth discoloration. MATERIALS AND METHODS: A total of 32 bovine teeth were polished to create a 6 mm circular window on the middle 1/3 (for enamel) or on the cervical 1/3 (for dentin) of the labial surface. Specimens were treated either with SDF alone or SDF followed by ascorbic acid (AA)/alpha lipoic acid (ALA)/7th generation bonding materials. The color parameters Lightness (L*), Chroma (C*), and Hue (H*) of the tooth window were measured at pretreatment, 1-hour, 1-week, and 1-month posttreatment using a digital color chromometer. RESULTS: Repeated measure ANOVA showed a significant tooth color alteration at 1-hour posttreatment. The L* and H* values dropped and C* value elevated significantly in 1-hour posttreatment measurement. All experimental groups showed significant tooth color alteration after treatment (p < 0.05) and were unable to reverse the discoloration even after 1-month period except the ALA group which did not show any significant (p > 0.05) color alteration compared with the pretreatment value. CONCLUSIONS: Within the limitation of the in vitro model and according to the results of this study, it can be concluded that ALA has the potential to prevent SDF-induced tooth discoloration; however, AA was unable to prevent the discoloration. CLINICAL SIGNIFICANCE: SDF induces discoloration of enamel and dentin can be reversed by applying Alpha lipoic acid immediacy after SDF application.

Evaluation of the efficacy of a charcoal-based tooth whitening dentifrice on coffee stains: an in vitro study.

Background: Charcoal-based preparations have recently gained popularity, particularly in oral hygiene products such as tooth whitening dentifrices, owing to their abrasive and adsorptive properties. The present in vitro study evaluates the efficacy of a charcoal-based tooth whitening dentifrice compared with a non-charcoal-based whitening dentifrice in removing coffee stains on tooth surfaces. Methods: Thirty-three human extracted tooth specimens were randomly assigned to 1 of 3 study groups: Group 1 (charcoal-based whitening dentifrice [CBWD]), Group 2 (non-charcoal-based whitening dentifrice [NCBWD]), and Group 3 (distilled water [DW]). All tooth specimens were immersed in a prepared coffee extract for 4 weeks to facilitate staining and then mounted on blocks where they were brushed with an electric toothbrush daily for 8 seconds with 1 of the 2 allocated dentifrices or with DW for 4 weeks following staining. Spectrophotometric analysis was conducted using the CIELAB system to measure the L*, a*, and b* values at 3 time points: before staining, after staining, and following the brushing protocol. These values were used to calculate the colour change (ΔE) between time points. Results: Following the coffee staining, the tooth samples' whiteness (ΔL) decreased with the overall colour change (ΔE). Next, there was a significant improvement in the degree of tooth whiteness (ΔL) values following the brushing protocol in all 3 groups (p = 0.003), with the greatest improvement occurring in the CBWD group. However, the overall colour change (ΔE) was not significantly different between the groups. Conclusion: CBWD, NCBWD, and DW were effective in removing coffee stains from the tooth surface. However, the amount of colour change (ΔE) produced by CBWD was not significantly different from NCBWD or DW.

Introduction: Les préparations à base de charbon ont récemment gagné en popularité, en particulier dans les produits d'hygiène buccale comme les dentifrices blanchissants, en raison de leurs propriétés d'abrasion et d'adsorption. La présente étude in vitro évalue l'efficacité d'un dentifrice blanchissant à base de charbon par rapport à un dentifrice blanchissant sans charbon pour éliminer les taches de café sur la surface des dents. Méthodes: Trente-trois spécimens de dents humaines extraites ont été répartis aléatoirement dans 3 groupes d'étude : groupe 1 (dentifrice blanchissant à base de charbon [DBBC]), groupe 2 (dentifrice blanchissant sans charbon [DSC]) et groupe 3 (eau distillée [ED]). Tous les spécimens de dents ont été immergés dans une préparation de café pendant 4 semaines pour permettre la coloration, puis montés sur des blocs où ils ont été brossés quotidiennement à la brosse à dents électrique pendant 8 secondes avec l'un des deux dentifrices testés ou avec de l'eau distillée pour une période de 4 semaines après la coloration. Une analyse spectrophotométrique a été effectuée à l'aide du système CIELAB pour mesurer les valeurs L*, a* et b* à 3 moments précis : avant la coloration, après la coloration et après le protocole de brossage. Ces valeurs ont été utilisées pour calculer le changement de couleur (ΔE) entre les moments précis. Résultats: Après la coloration du café, la blancheur des échantillons de dents (ΔL) a diminué en raison du changement global de couleur (ΔE). Ensuite, il y a eu une amélioration significative du degré de blancheur des dents (ΔL) suivant le protocole de brossage dans les 3 groupes (p = 0,003), la plus grande amélioration ayant eu lieu dans le groupe DBBC. Toutefois, le changement global de couleur (ΔE) n'était pas significativement différent d'un groupe à l'autre. Conclusion: Les DBBC, DSC et l'ED se sont montrés efficaces pour éliminer les taches de café sur la surface des dents. Toutefois, le changement de couleur (ΔE) produit par le DBBC n'était pas significativement différent de celui produit par le DSC ou l'ED.

The Effect of Calcium Silicate-Based Materials on Tooth Discoloration and Evaluation of Color Change After Bleaching Treatment: A Spectrophotometric Study.

PURPOSE: To evaluate tooth discoloration after the use of calcium silicate-based materials and to examine the effect of internal bleaching on tooth discoloration. MATERIALS AND METHODS: The specimens were randomly divided into two experimental groups (n = 45) and a control group (n = 6). Cavities were filled with ProRoot MTA (Dentsply) in Group 1 and Biodentine (Septodont) in Group 2. Color measurements were taken with a spectrophotometer before and after the application of materials at 1 week and then at 13, and 6 months. After 6 months, Groups 1 and 2 were divided into three subgroups according to internal bleaching techniques. All color change ratios and lightness differences were calculated using the CIE L*a*b* system. Data were analyzed using repeated ANOVA and the Kruskal-Wallis test (P = .05). RESULTS: There were statistically significant differences between Groups 1 and 2 at all time intervals (P < .05). Group 1 showed more discoloration than Group 2 (P < .05). There were no significant differences between the bleaching agents (P > .05). Additionally, specimens in both groups became lighter than their initial color (P < .05). CONCLUSION: Teeth treated with ProRoot MTA exhibited darkening at 1 week that increased over time, whereas those treated with Biodentine maintained the lightness for 6 months.

Evaluation of oral and perioral irritation and sensitization potential of a whitening gel and a whitening toothpaste containing potassium monopersulfate.

PURPOSE: Two clinical trials were conducted to investigate the oral and perioral irritation and sensitization potential of a tooth whitening leave-on-gel alone and in combination with a whitening toothpaste, each containing 1.0% of the active ingredient potassium monopersulfate (MPS). METHODS: Both clinical trials were Institutional Review Board (IRB) approved, double-blind, randomized, and parallel group designed studies. For the MPS leave-on gel study, 200 qualifying and consented subjects were randomly assigned to two groups: (1) 0.1% hydrogen peroxide (H2O2) gel pen (34 subjects); and (2) 0.1% H2O2 + 1.0% MPS gel pen (166 subjects). Subjects used the assigned products according to instructions provided and returned on Days 22 and 36 for oral and perioral tissue examination (pre-challenge). At the Day 36 visit, the subject applied the assigned gel on site (challenge) and received oral and perioral tissue examinations 1 and 24 hours following the application to detect any post-challenge tissue reactions. For the MPS toothpaste/MPS gel pen study, 200 qualifying and consented subjects were randomly assigned to three groups: (1) Placebo toothpaste + placebo gel pen (66 subjects); (2) 1.0% MPS toothpaste + 1.0% MPS gel pen (67 subjects); and (3) 1.0% MPS toothpaste + placebo gel pen (67 subjects). The study design and procedures were the same as those for the MPS gel pen study described above. RESULTS: For the MPS gel pen study, 192 subjects completed the study. None of the eight dropouts was related to the product use. The demographic data were comparable between the two groups. No evidence of tissue irritation and sensitization was detected in any subjects at any visit, and the findings were comparable between the groups. The detected and self-reported tissue issues were minimal and minor, and they were comparable between the two groups. For the MPS toothpaste/MPS gel pen study, 200 subjects were enrolled with 12 dropped from the study, resulting in an overall dropout rate of 6%. Of the 12 that did not complete the study, none were due to product-related use. The demographic data were comparable among the three groups. The detected and self-reported tissue issues were minimal and minor, and they were comparable among the three groups. CLINICAL SIGNIFICANCE: Potassium monopersulfate (MPS) at the active concentration of 1.0% in the tooth whitening leave-on-gel and the toothpaste plus the gel did not cause oral/perioral irritation nor sensitization.

One-year clinical observation of the effect of internal bleaching on pulpless discolored teeth.

OBJECTIVES: This study aimed to observe the color rebound and rebound rates of non-pulp discolored teeth within 1 year after routine internal bleaching to guide clinical practice and prompt prognosis. METHODS: In this work, the efficacy of bleaching was observed in 20 patients. The color of discolored teeth was measured by using a computerized colorimeter before bleaching; immediately after bleaching; and at the 1st, 3rd, 6th, 9th, and 12th months after bleaching. The L*, a*, and b* values of the color of cervical, mesial, and incisal parts of the teeth were obtained, and the color change amounts ΔE*, ΔL*, Δa*, and Δb* were calculated. The overall rebound rate (P*) and the color rebound velocity (V*) were also analyzed over time. RESULTS: In 20 patients following treatment, the average ΔE* of tooth color change was 14.99. After bleaching, the neck and middle of the teeth ΔE* and ΔL* decreased in the 1st, 3rd, 6th, 9th, and 12th months, and the differences were statistically significant. Meanwhile, from the 9th month after bleaching, the rebound speed was lower than that in the 1st month, and the difference was statistically significant. The incisal end of the tooth ΔE* and ΔL* decreased in the 6th, 9th, and 12th months after bleaching, and the differences were statistically significant. No significant difference was found in the rebound speed between time points. However, this rate settled after the 9th month, with an average color rebound rate of 30.11% in 20 patients. CONCLUSIONS: The results indicated that internal bleaching could cause a noticeable color change on pulpless teeth. The color rebound after bleaching was mainly caused by lightness (L*), which gradually decreased with time, and it was slightly related to a* and b*. The color of the teeth after internal bleaching rebounded to a certain extent with time, but the color rebound speed became stable from the 9th month. Clinically, secondary internal bleaching can be considered at this time according to whether the colors of the affected tooth and the adjacent tooth are coordinated and depending on the patient's needs.

One-year clinical observation of the effect of internal bleaching on pulpless discolored teeth / 华西口腔医学杂志

OBJECTIVES@#This study aimed to observe the color rebound and rebound rates of non-pulp discolored teeth within 1 year after routine internal bleaching to guide clinical practice and prompt prognosis.@*METHODS@#In this work, the efficacy of bleaching was observed in 20 patients. The color of discolored teeth was measured by using a computerized colorimeter before bleaching; immediately after bleaching; and at the 1st, 3rd, 6th, 9th, and 12th months after bleaching. The L*, a*, and b* values of the color of cervical, mesial, and incisal parts of the teeth were obtained, and the color change amounts ΔE*, ΔL*, Δa*, and Δb* were calculated. The overall rebound rate (P*) and the color rebound velocity (V*) were also analyzed over time.@*RESULTS@#In 20 patients following treatment, the average ΔE* of tooth color change was 14.99. After bleaching, the neck and middle of the teeth ΔE* and ΔL* decreased in the 1st, 3rd, 6th, 9th, and 12th months, and the differences were statistically significant. Meanwhile, from the 9th month after bleaching, the rebound speed was lower than that in the 1st month, and the difference was statistically significant. The incisal end of the tooth ΔE* and ΔL* decreased in the 6th, 9th, and 12th months after bleaching, and the differences were statistically significant. No significant difference was found in the rebound speed between time points. However, this rate settled after the 9th month, with an average color rebound rate of 30.11% in 20 patients.@*CONCLUSIONS@#The results indicated that internal bleaching could cause a noticeable color change on pulpless teeth. The color rebound after bleaching was mainly caused by lightness (L*), which gradually decreased with time, and it was slightly related to a* and b*. The color of the teeth after internal bleaching rebounded to a certain extent with time, but the color rebound speed became stable from the 9th month. Clinically, secondary internal bleaching can be considered at this time according to whether the colors of the affected tooth and the adjacent tooth are coordinated and depending on the patient's needs.

Incorporation of Green Capping Agents to Reduce Silver-Mediated Dentine Staining.

Silver diammine fluoride (SDF) is known as a noninvasive, cost-effective, safe, and simple method of dental caries treatment. However, staining and discoloration seem inseparable with SDF and continue as a cosmetic concern. Research is ongoing to overcome these issues, for example, by using glutathione (G) or potassium iodide among others. Therefore, the study aimed to investigate the effects of incorporating different concentrations of capping agents on SDF chemistry and SDF-mediated tooth staining at different time points. Tannic acid (TA), gallic acid (GA), carboxymethyl chitosan (CM), and G at different concentrations (5, 10, and 15% w/v) were incorporated in 30% SDF. FTIR and UV-Vis spectroscopies of the prepared solutions was performed to evaluate chemical changes. Time-dependent color changes (ΔE) in bovine dentine specimens (6 × 6 × 1 ± 0.25 mm3) were measured spectrophotometrically at application/washup, 1 and 3 h, after 1, 2, 4, 7, and 14 days. Results showed suppression of FTIR peaks at 3,358 cm-1 and 1,215 cm-1 in capping agent-modified SDF indicative of a successful capping effect of the silver ions, which was corroborated by UV-Vis blueshift of ∼∆32 nm. The capping effect on SDF increased proportionally with the concentrations of TA, GA, CM, and G used. A more pronounced tooth staining reduction however was shown more in TA- and G- rather than in GA- and CM-modified SDF. At day 14, SDF showed the highest mean ΔE(50.14 ± 2.14), while 15% TA showed the lowest ΔE(30.14 ± 0.81). In conclusion, capping agent incorporation significantly reduced SDF-mediated tooth staining. This reduction in staining is more dependent on the respective capping agent functional groups than concentrations per se. The potential of capping agents to minimize tooth staining of SDF was TA>G>CM>GA.

Simultaneous Photodynamic Eradication of Tooth Biofilm and Tooth Whitening with an Aggregation-Induced Emission Luminogen.

Dental caries is among the most prevalent dental diseases globally, which arises from the formation of microbial biofilm on teeth. Besides, tooth whitening represents one of the fastest-growing areas of cosmetic dentistry. It will thus be great if tooth biofilm eradication can be combined with tooth whitening. Herein, a highly efficient photodynamic dental therapy strategy is reported for tooth biofilm eradication and tooth discoloration by employing a photosensitizer (DTTPB) with aggregation-induced emission characteristics. DTTPB can efficiently inactivate S. mutans, and inhibit biofilm formation by suppressing the expression of genes associated with extracellular polymeric substance synthesis, bacterial adhesion, and superoxide reduction. Its inhibition performance can be further enhanced through combined treatment with chlorhexidine. Besides, DTTPB exhibits an excellent tooth-discoloration effect on both colored saliva-coated hydroxyapatite and clinical teeth, with short treatment time (less than 1 h), better tooth-whitening performance than 30% hydrogen peroxide, and almost no damage to the teeth. DTTPB also demonstrates excellent biocompatibility with neglectable hemolysis effect on mouse red blood cells and almost no killing effect on mammalian cells, which enables its potential applications for simultaneous tooth biofilm eradication and tooth whitening in clinical dentistry.

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.

Comparison of the effectiveness of professionally delivered and OTC whitening toothpastes. An in vitro study.

PURPOSE: To evaluate the effectiveness of five whitening toothpastes applied three times a day for 4 weeks. METHODS: 25 human extracted teeth were selected. Two peroxide-based dental bleaching pastes (professionally delivered): Enawhite 2.0 (En), Whitekin (Wk); and three over the counter whitening toothpastes: Opalescence whitening toothpaste (Op), Colgate max White expert White (Cg) Premium activated charcoal (Cr) were used. Teeth were brushed for 4 weeks, three times a day. Color was measured with a spectrophotometer according to the CIELab system. ΔEab, W* and ΔE00 values were calculated at baseline, at the end of the treatment, and 1 week after the end of treatment. Data analysis was performed using a generalized estimating equations model, evaluating the effect of treatment, time and interaction (P< 0.05). RESULTS: ΔEab values ranged from 5.01 for En to 3.22 for Wk after the 4-week treatment period. One week after the end of treatment, ΔEab ranged from 5.91 for Cr to 3.62 for Op (P> 0.05 between groups). The closest to pure white (W* differences between baseline and after 1 week from the end of treatment) was for En and Wk. ΔE00 values after 4 weeks of treatment ranged from 3.23 for En to 1.79 for Wk. One week after the end of treatment, the ΔE00 ranges were between 3.31 for Cr to 2.03 for Op (P> 0.05 between groups). CLINICAL SIGNIFICANCE: All the evaluated whitening toothpastes improved dental color values higher than those perceptible and acceptable at the 50:50 threshold.

Present status and future directions - Managing discoloured teeth.

Managing tooth discolouration involves a range of different protocols for clinicians and patients in order to achieve an aesthetic result. There is an increasing public awareness in the appearance of their teeth and management of tooth discolouration may be inter-disciplinary and involve both vital and nonvital teeth. Vital teeth can be easily treated with low concentration hydrogen peroxide products safely and effectively using an external approach and trays. For endodontically treated teeth, the walking bleach technique with hydrogen releasing peroxide products is popular. However, there is an association with external cervical root resorption with higher concentrations of hydrogen peroxide of 30%-35%. There are also regulatory considerations for the use of hydrogen peroxide in certain jurisdictions internationally. Prosthodontic treatments are more invasive and involve loss of tooth structure as well as a life cycle of further treatment in the future. This narrative review is based on searches on PubMed and the Cochrane library. Bleaching endodontically treated teeth can be considered a safe and effective protocol in the management of discoloured teeth. However, the association between bleaching and resorption remains unclear although there is likely to be a relation to prior trauma. It is prudent to avoid thermocatalytic approaches and to use a base/sealer to cover the root filling. An awareness expectations of patients and multidisciplinary treatment considerations is important in achieving the aesthetic result for the patient. It is likely that there will be an increasing demand for aesthetic whitening treatments. Bleaching of teeth has also become increasingly regulated although there are international differences in the use and concentration of bleaching agents.

Comparison of the Bleaching Efficacy of Different Agents Used for Internal Bleaching: A Systematic Review and Meta-Analysis.

INTRODUCTION: The aim of this study was to analyze and compare the efficacy of different bleaching agents typically used for internal bleaching of endodontically treated discolored teeth. METHODS: Electronic databases (PubMed, Web of Science, and Cochrane Library) were searched by 2 reviewers for clinical trials in which the color of endodontically treated discolored teeth before and after internal bleaching was examined using shade guide units (ΔSGU) or a spectrophotometer/colorimeter (ΔE). The efficacies of the bleaching agents were compared using subgroup analyses. Statistical heterogeneity was assessed with the Cochran Q test and I2 statistic. Publication bias was evaluated using funnel plots. RESULTS: Eight studies were included in the systematic review, 6 of which could be included in the meta-analyses. Internal bleaching led to a significant change in tooth shade (ΔSGU: 6.27 [95% confidence interval, 5.36-7.17], ΔE: 12.83 [95% confidence interval, 9.46-16.20]). With regard to ΔSGU, the use of carbamide peroxide (35% or 37%), hydrogen peroxide (35%), and the combination of sodium perborate and hydrogen peroxide (3% or 30%) led to a better bleaching effect than sodium perborate (adjusted P value ≤ .026). Regarding ΔE, there were no significant differences between carbamide peroxide (37%), hydrogen peroxide (35%), and sodium perborate mixed with hydrogen peroxide (P = .051). The risk of bias of the included studies was classified as moderate to high. CONCLUSIONS: Carbamide peroxide, hydrogen peroxide, and sodium perborate have a significant bleaching effect on discolored, root canal-treated teeth. For a valid assessment of shade stability and a comparison of bleaching agents and their concentrations, further studies with long-term recalls are necessary.

Effectiveness and color stability of bleaching techniques on blood-stained teeth: An in vitro study.

OBJECTIVE: Evaluate the effectiveness and color stability of bleaching techniques on blood-stained teeth. MATERIAL AND METHODS: The teeth were stained by blood and allocated to groups: walking bleach, inside/outside, and in-office bleaching. L*, a*, b*, C*, h° color coordinates were measured using a clinical spectrophotometer at baseline, weekly (T1-T2-T3), and at 1-week (T4), 6-months (T5), and 1-year (T6) follow-up evaluations. ΔEab* , ΔE00 , and ΔWID were calculated between sequential evaluation timepoints and between baseline and each evaluation timepoint. Color coordinates and WID differences in each timepoint and technique were analyzed by Wilcoxon Signed Rank, Kruskal-Wallis and Mann-Whitney U test, respectively. ΔEab* , ΔE00 , and ΔWID were interpreted by color visual thresholds. RESULTS: The techniques presented a significant increase in L* and WID and, a significant decrease in a* and b* until the completion of treatments. Statistical differences between the techniques for a*, b* and WID were observed from T1 until T3. All techniques demonstrated excellent effectiveness for ΔEab* , ΔE00 , and ΔWID between baseline and each evaluation and follow-up timepoints. However, at T6, it was possible to identify a rebound effect for all techniques. CONCLUSIONS: All bleaching techniques presented excellent effectiveness. The stability of the whitening produced was maintained for 6 months. CLINICAL SIGNIFICANCE: Effective whitening of blood-stained teeth was achieved using walking bleach (sodium perborate), inside/outside (hydrogen peroxide - 7.5%) and in-office techniques (hydrogen peroxide - 35%). The bleaching techniques were effective after the completion of the treatments. A slight rebound was observed at 1 year follow-up.

Anti-discoloration system: a new chlorhexidine mouthwash.

Chlorhexidine is defined as biocompatible, which is why it is used as a mouthrinse for the patient before starting dental procedures (2). It has the ability to bind well to teeth and mucous membranes and is released for twelve hours, which is why it is used as a treatment for gingivitis and also in post-operative wound healing. The long-term side effects of chlorhexidine are pigmentations. To remedy this, various types of antidiscoloration have been tried out over time. Nowadays there are other types of anti-discoloration systems such as, for example, in our study we used a test group containing an anti-discoloration system called SPPD. A single-center, prospective, double-blind randomized clinical trial on 84 patients. The investigated treatments consisted of 4 mouthwashes (CHX 0.12% SPDD alcohol free; CHX 0.20% SPDD alcohol free; CHX 0.12% alcohol free with ADS; CHX 0.20% alcohol free with ADS). Despite the limitations of the study, all the mouthwashes tested showed good efficacy in reducing the amount of plaque. Comparing the two experimental concentrations (0.12% and 0.20%) tested here demonstrates that the 0.20% chlorhexidine concentration slightly surpasses its 0.12% equivalent with regard to the PI and BI parameters. The SPDD is an innovative anti-discoloration system and gives the mouthwash a great taste.

Efficacy of non-hydrogen peroxide mouthrinses on tooth whitening: An in vitro study.

OBJECTIVES: To evaluate the tooth whitening efficacy of non-hydrogen peroxide containing mouthrinses. METHODS: Forty incisors were randomly assigned into four groups. Four whitening mouthrinses, Oral-B 3D White Luxe/Procter & Gamble (WL), Listerine Advanced White/Johnson & Johnson (AW), Colgate Max White/Colgate (MW), and iWhite Whitening Mouthwash/Sylphar (iW), were used over a four-week period. Color changes of L*, a*, b*, ΔE*ab , and ΔE00 , were recorded by a digital spectrophotometer (Spectroshade Micro/Mht), at baseline and intermediate week-intervals. Data were statistically analyzed using repeated measures ANOVA at α = 0.05. RESULTS: The first-week mean change of L* was 0.76 and significantly different from the baseline for all solutions, without any further changes. Correspondingly, a* decreased by -0.36, while b* increased by 0.48, contributing to a color change of 1.15 ΔE*ab or 0.91 ΔE00 . No differences were found among the solutions in respect to color-parameter changes (p > 0.05). Differences among time intervals were significant (p < 0.05) and mainly observed between the baseline and the following week-measurements. There was no statistically significant time-solution interaction (p > 0.05). CONCLUSIONS: Non-hydrogen peroxide whitening mouthrinses, slightly contribute to tooth whitening, by removing superficial staining, without any further tooth bleaching effect. CLINICAL SIGNIFICANCE: Non-hydrogen peroxide containing whitening mouthrinses, despite having a quick initial action, reach their ceiling relatively soon. Their effectiveness is barely perceptible and definitely inferior to other professional tooth bleaching methods. Thus, they can only be considered as a supplementary way of keeping teeth whiter, mainly by preventing recurrent tooth discoloration.

Tigecycline-Induced Tooth Discoloration in Children Younger than Eight Years.

Tetracycline may cause tooth discoloration when used in young children during tooth development. Whether tigecycline, a tetracycline derivative, has either a similar adverse event or not remains unclear. We assessed the discoloration of the permanent teeth of patients <8 years old after tigecycline exposure. These patients were identified through a retrospective chart review in a Chinese children's hospital. Those who had at least one erupted permanent tooth after tigecycline exposure were interviewed, examined, and photographed by an experienced pediatric dentist and independently assessed by another senior dentist to detect tetracycline-like tooth discoloration. We identified 101 patients who were exposed to tigecycline, 12 of whom were included. The mean daily dose of tigecycline was 2.3 mg/kg of body weight (standard deviation, 0.6), and the median duration was 12.5 days (interquartile range [IQR], 8.0 to 19.3). The median age of exposure was 5.2 years (IQR, 4.5 to 7.4), and the median age of dental examination was 9.1 years (IQR, 9.0 to 10.3). Two patients (16.7%) developed yellow discoloration: a girl having yellow discoloration with white-to-yellow opacities in the upper lateral incisors and lower incisors and a boy with a suspicious buccal yellow discoloration and enamel dysplasia in the second molars. The incidence and extent of tigecycline-associated dental adverse events remain unclear due to the small sample size and inadequate follow-up period.

Sonic Activation of a Desensitizing Gel Prior to In-Office Bleaching.

This double-blind, randomized, and controlled clinical trial evaluated the effect of sonic activation during the application of a desensitizing agent (DA) containing 5% potassium nitrate and 2% sodium fluoride on the occurrence of tooth sensitivity (TS) associated with in-office dental bleaching. Treatment with or without sonic activation of the DA was randomly assigned to one-half of the maxillary teeth of 34 patients in a split-mouth design. On the side without sonic activation (noSA), the DA was applied and maintained in contact with the teeth for 10 minutes. On the sonic activation side (SA), the DA was activated 30 seconds per tooth. The DA application was followed by application of 35% hydrogen peroxide in two bleaching sessions separated by a one-week interval. The primary outcome was the absolute risk of TS, recorded using a numeric rating scale and a visual analog scale. Color was evaluated with a digital spectrophotometer and a value-oriented shade guide. No significant difference between treatments was observed in the absolute risk of TS, which occurred in 93% (p=1.00) of both noSA and SA groups. The TS intensity was higher in the 24-hour interval after sessions, for both treatments, without differences between them. There was no difference in the color change for the treatments, with the average change in number of shade guide units of the Vita Classical scale of 6.35 for both (p=0.87). Sonic activation of DA containing 5% potassium nitrate and 2% sodium fluoride did not reduce the absolute risk and intensity of TS associated with in-office bleaching.