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Abstract
A 1-week study was conducted to compare the tooth whitening efficacy of two carbamide peroxide-based products (one containing 5% carbamide peroxide and one containing 10% carbamide peroxide). In addition, the perception of transient tooth hypersensitivity associated with the use of these products was subjectively evaluated. Sixty participants took part in a double-blind, randomized, parallel clinical study. Change in tooth color was measured by chroma meter and Vita shade guide at the initiation of the study and after 7 days of product use. Color change (delta E) was calculated using the color-difference equation established by the Commission Internationale de L'Eclairage. Data concerning dental hypersensitivity was assessed by subjective panelist questionnaires administered after the day 7 recall examination. Results of the whitening data showed that there was no significant difference between the two products. After 1 week, the mean delta E for the product containing 5% carbamide peroxide was 4.43 +/- 1.89 and the mean delta E for the product containing 10% carbamide peroxide was 4.05 +/- 1.84. However, the subjective data collected on tooth hypersensitivity showed that the product containing 5% carbamide peroxide was associated with less discomfort. Of the group using the 5% carbamide peroxide product, 20% reported transient sensitivity of their teeth after product use for 1 week compared with 53% of the group using the product with 10% carbamide peroxide. Statistical analysis using a 2-tailed t test showed significant differences between the two groups (P < .05). The data suggest that these products are clinically equivalent for tooth whitening; however, the product containing 5% carbamide peroxide was associated with less tooth hypersensitivity after 1 week of application.
... Patients perform home bleaching (HB) at home, usually with a customized tray filled with bleaching gel; it is typically administered after dinner or overnight for a week or two. The bleaching gel employed is typically carbamide peroxide (CP) with a concentration of 5-35% (2)(3)(4)(5). In-office bleaching is clinically performed by dentists and does not involve wearing of bleaching trays. Treatment time is much shorter than HB, and in-office bleaching is completed in a single clinical visit. ...
... Bleaching efficacy is primarily determined by the degree of tooth color change and is often measured against a standardized dental shade guide arranged according to values i.e., number of shades lighter (2,6,10). This approach of assessing bleaching efficacy is somewhat subjective and not quantifiable. ...
... In this study, color changes noted in canines after bleaching were greater than those in incisors. The ΔE* values obtained corroborated those reported by Costa et al. and Nathoo et al., who reported a mean ΔE* of approximately 5.2 and 4.05 for products containing 10% CP at 1 week after bleaching (2,9). Tooth color after bleaching remained relatively stable and did not change much at 3 months. ...
This in vivo study aimed to evaluate the efficacy of in-office and home teeth bleaching in Asian patients. Moreover, the correlation between tooth color change and patient’s outcome satisfaction was investigated. Overall, 40 Chinese patients were randomly divided into two groups and prescribed in-office (OB) or take-home bleaching (HB). The color of the maxillary central incisor and canine were recorded at baseline, immediately after first treatment, 1 week, and 3 months after treatment by using a spectrophotometer. Bleaching sensitivity and outcome satisfaction were assessed using Likert and visual analogue scale (VAS), and the results were analyzed using independent t-test and Pearson correlation (P < 0.05). ΔL*, Δa*, Δb*, and ΔE* values of HB were greater than those of OB. Color changes observed in canines were generally greater than those in incisors. Moreover, HB was generally associated with less tooth sensitivity than OB. Patients were satisfied with both treatments, but VAS scores were greater for HB. Furthermore, the correlation between ΔE* and VAS was significant for canines immediately after the first treatment and 1 week after HB. In conclusion, HB was more effective in lightening teeth and reducing chromacity in Chinese patients. The correlation between tooth color change and outcome satisfaction was generally insignificant and weak.
... h λεύκανση στο σπίτι πραγματοποιείται με τη βοήθεια ατομικών ναρθήκων, που τοποθετεί ο ασθενής για κάποιες ώρες ημερησίως, για χρονικό διάστημα περίπου 1-2 εβδομάδων [21][22][23] . Οι λευκαντικοί παράγοντες που χρησιμοποιούνται για τη λεύκανση στο σπίτι είναι ήπιοι με συγκεντρώσεις 3-9,5% υπεροξείδιο του υδρογόνου ή 10-16% υπεροξείδιο του καρβαμιδίου. ...
... Αυτή η κατάσταση αναφέρεται ως οδοντινική υπερευαισθησία 19 και είναι η πιο κοινή ανεπιθύμητη ενέργεια που αναφέρεται κατά τη διάρκεια ή μετά το πέρας της διαδικασίας της λεύκανσης. [21][22][23] Σύμφωνα με τη βιβλιογραφία, η υπερευαισθησία που προκαλείται αμέσως μετά τη λεύκανση των δοντιών, διαρκεί συνήθως 2-3 ημέρες 22 και υποχωρεί εντός της εβδομάδας. 36,41,42,46,47 Σε αντικρουόμενα συμπεράσματα καταλήγουν οι κλινικές μελέτες ως προς τη συσχέτιση της υπερευαισθησίας και της χρήσης των φωτεινών πηγών. ...
The number of people who want to improve their smile has been increased in recent years. Tooth bleaching is a conservative and well-documented procedure for the treatment of tooth discoloration. It remains unclear, however, whether light-assisted
bleaching is advantageous over conventional methods. The purpose of this study was to investigate the risk-benefit profile of the vital teeth bleaching assisted by light sources. The first objective was to discuss whether bleaching using a light source increases, decreases or not affect tooth sensitivity. The second objective was to discuss the effectiveness of light-assisted bleaching. Although the use of light sources may accelerate the bleaching process, it does not necessarily lead to optimum
aesthetic outcomes. Evidence supported that the effectiveness was not significantly improved with light-activated protocols. The use of a light source during whitening was safe and did not increase the risk of dentinal hypersensitivity. Dentinal hypersensitivity
was more common when higher concentrations of hydrogen peroxide were used, regardless of the use of a light source. Therefore, light-assisted bleaching is not considered necessary and should be recommended in specific clinical cases.
... This free movement is due to the relatively low molecular weight of the peroxide molecule [3,4,11] . Its prevalence has been reported to lie between 11% and 93% [12,13,14,15,16] . In a study conducted by Basting, a higher prevalence of tooth sensitivity was observed in 71.4% of the volunteers who used a 20% carbamide peroxide home-use bleaching agent, which may be ascribed to the peroxide concentration and/or the time/length the agent was in contact with the dental structures [16] . ...
... Their choice was influenced by the fact that in-office bleaching would give fast results and would be under the control and supervision of the dentist. Most scientific articles have reported similar whitening effects and duration of results for both techniques [9,14,15,16] . The dentist should provide patients with data about these two techniques, but the final decision should be left with the patients. ...
... Indeed, colorimeters have found widespread use in dental research for measuring the colour of teeth, restorative materials and soft tissues [2,4,99,[102][103][104]. The change in tooth colour following tooth whitening treatments has been described in both in vitro [105,106] and in vivo studies [77,107]. For longitudinal tooth whitening clinical studies, the use of custom-made mouthguards with apertures aligned to the anterior teeth are frequently used to ensure accurate realignment of the colorimeter measuring head onto the tooth surface before and after treatment [77,107]. ...
... The change in tooth colour following tooth whitening treatments has been described in both in vitro [105,106] and in vivo studies [77,107]. For longitudinal tooth whitening clinical studies, the use of custom-made mouthguards with apertures aligned to the anterior teeth are frequently used to ensure accurate realignment of the colorimeter measuring head onto the tooth surface before and after treatment [77,107]. ...
Objectives:
To review current knowledge concerning the application of colour science on tooth colour and whiteness description, measurement, distribution and its psychological impact.
Data sources:
"Scopus" databases were searched electronically with the principal keywords tooth, teeth, colour, white, whiteness. Language was restricted to English and original studies and reviews were included. Conference papers and abstracts were excluded.
Conclusions:
The appearance and colour of teeth is a common concern for patients across many populations and is associated with an increased desire for treatments that improve dental aesthetics, including tooth whitening. The application of colour science in dentistry has allowed the precise description of tooth colour and whiteness. Coupled with the advances in instrumental tooth colour measurement, such as spectrophotometers, colorimeters, spectroradiometers and digital imaging systems, these parameters are quantifiable in a reproducible and robust manner. These principles have been applied to the tooth colour distribution in many study populations, indicating, in general, differences in tooth colour for subject age and gender, but not for ethnicity. Psychophysical studies on tooth colour and whiteness via third party assessment of images indicate that whitened teeth lead to judgements that are more positive on personality traits such as social competence and appeal, intellectual ability and relationship satisfaction.
... También Nathoo y cols. en otro trabajo desarrollado con pacientes a doble ciego y tras una semana de tratamiento con peróxido de carbamida al 5% y al 10%, respectivamente, encontraron igual de eficaces a ambos agentes en cuanto a su capacidad para la modificación del color dental (20). De la misma forma, Leonard y cols. ...
... No obstante, tanto Nathoo y cols. (20) como Leonard y cols. (21) y Kihn y cols. ...
Tray bleaching of vital teeth performed at home by the patient under the dentist's supervision, whether alone or in combina- tion with any of the in-office techniques, provides an interesting alternative to other methods employed in this type of dental treatment. This bleaching procedure applies low-concentration peroxides to the enamel by means of a custom-made mouth tray specifically designed for this purpose. The aim of this study is to examine and compare two commercially-available bleaching products, at equivalent concentrations, for use in this technique: VivaStyle (Vivadent) and FKD (Kin); the former is a 10% carbamide peroxide and the latter a 3.5% hydrogen peroxide formulation. It examines the parameters that must be monitored during the application of this type of procedure and presents 6 cases (3 treated with one of the above-mentioned products and the other 3 with the other), establishing the bleaching power of the products and the appearance and intensity of post-operatory hypersensitivity. The results obtained show that both products are effective for the purpose for which they were designed. In general, dental hypersensitivity was minimal.
... The modification of the traditional night guard vital bleaching technique to incorporate the use of bleaching agents at increased concentrations has lead to reports of increased tooth sensitivity (13)(14)17). In order to minimize tooth sensitivity, tooth whitening protocols should consider prescribing shorter application times when using bleaching agents of higher concentrations (18). ...
... The presence of a greater concentration of active hydrogen peroxide from the 9%HP versus the resultant 7.2% hydrogen peroxide from the 20%CP formulation during the active bleaching sessions should have been expected to further favor an increased tooth whitening efficacy of Colgate Visible White (9%HP) over Opalescence (20%CP). The results support the findings of in vitro (13,22) and in vivo (16)(17)(18) studies regarding the efficiency in tooth whitening with increased tooth whitening agent concentrations. All of the cited studies also concluded that, given greater length of time (greater number of active bleaching sessions) for product use, the lower concentration products will achieve the same results as higher concentrations. ...
The purpose of this 14-day parallel, double blind clinical trial was to evaluate the tooth whitening efficacy of a 9% hydrogen peroxide gel (Colgate Visible White) relative to a 20% carbamide peroxide gel (Opalescence) positive control.
Forty-six consenting adults were randomly assigned to use one of the two products. All participants had 6 unrestored maxillary anterior teeth averaging a shade ranking score of 9 (A3) in the Vitapan Classical Shade Guide scale of 1 through 16 (lightest to darkest). Tooth whitening consisted of at-home 30-minute daily self-applications of the assigned product after brushing with a non-bleaching dentifrice. One of two calibrated examiners performed the baseline, 5-day, 7-day, and 14-day tooth shade evaluations for a given participant, utilizing the same Vita guide under unmodified color-corrected lighting conditions. Thirty-seven participants made all visits. Bleaching efficacy was measured with respect to mean shift (reduction from baseline) in rank scores of the maxillary anterior teeth, in which baseline rank scores functioned as covariables.
Both treatment groups exhibited statistically significant mean shade rank score improvements from baseline after 5, 7, and 14 days at 3.14, 3.70 and 4.68 for Colgate Visible White and 1.60, 2.52 and 3.85 for Opalescence.
Between-group comparison shows that while Colgate Visible White (9% hydrogen peroxide) provides a statistically significant tooth whitening improvement over Opalescence (20% carbamide peroxide) after 5 days of self-application, both products have a similar whitening effect after 7 and 14 days.
... The results of both methods were found to be consistent. (37,38) In the present study, the difference in color between the WSL and the sound adjacent enamel in group I after the application of Icon has decreased near to baseline value. The efficacy of resin infiltration in treating WSLs has already been demonstrated in many studies.(39) ...
Background: Resin infiltration and bleaching have been used as minimally invasive methods for the treatment of white spot lesions (WSLs) following orthodontic treatment.
Objective: To compare the color uniformity of the tooth with WSL treated with either resin infiltration or bleaching.
Material and Methods: WSLs were created in the right middle buccal half of the enamel surface of 40 sound extracted human premolars. The teeth were randomly assigned to 2 groups (n = 20) treated with: (I) resin infiltration, (II) chemically activated office-bleaching. Color parameter of the lesion and the adjacent enamel were measured by spectrophotometer at 3 time points: baseline (T0), after WSL formation (T1), after treatment (T2) and color difference ΔE* was calculated. Each tooth was visually scored for color homogeneity.
Results: ΔE* was significantly smaller after treatment in group I compared to group II [mean difference = 5.03 ± 1.11, P <0.0001]. Group II showed a statistically significant difference after treatment compared to baseline (P < 0.0001), whereas group I did not (P = 1.00). The visual score showed that the tooth color in group I had two-fold chance to be uniform in color compared to group II [Odds ratio = 2.00, P < 0.01]
Conclusions: Treatment of WSLs with resin infiltration result in a more uniform tooth color was achieved compared to bleaching.
... The use of 10% carbamide peroxide has been found to Teeth Bleaching: A Closer View cause mild, reversible histological changes in some patients [26]. To minimize tooth sensitivity, lowering the concentration of peroxide in the paste has been recommended [43]. Some strategies have been used to reduce tooth sensitivity caused by peroxide bleaching [44,45]. ...
Effect of light activating devices Tooth whitening nowadays is one of the most frequently requested cosmetic dental procedures by patients who want a "perfect white smile" [1]. Usually, vital tooth bleaching can be categorized generally as in-office (professionally administered), at-home (professionally dispensed) or over-the-counter (self-administered). Advantages of in-office dental bleaching over at home or over-the-counter bleaching techniques include professional control, avoidance of soft tissue exposure and material ingestion, reduced total treatment time, and the possibility of immediate results [2,3]. Most bleaching solutions contain hydrogen peroxide or carbamide peroxide as the active ingredient delivered through various carrier designs [4] that are applied with or without light activation. Proponents of light-activated bleaching claim that this procedure reduces total in-office bleaching time by energizing hydrogen peroxide through the use of various light sources [1,2,5]. The theoretical advantage is the ability of the light source to heat the hydrogen peroxide, thereby increasing the rate of decomposition of oxygen and accelerating the release of free radicals with higher kinetic energy, thus enhancing the rupture of stain-containing molecules Abstract Background: Tooth bleaching is a popular cosmetic procedure that can give someone a brighter smile and the appearance of youth
... Accurate determination of tooth color is essential on procedures performed on aesthetic, restorative, and prosthetic dentistry. Tooth color is currently either subjectively evaluated by visual shade matching with standardized shade guides [1][2][3][4][5][6][7][8][9][10] or objectively assessed 11,12 by colorimetric [13][14][15][16][17][18][19][20][21] , spectrophotometric 12,14,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] , photographic 31,[40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] , fluorescence 57 and other types of spectroscopic methods used to investigate biological tissues. However, visual assessment is highly subjective on the professional's experience and factors influencing the perception of color (e.g. ...
... Vital Diş Beyazlatma Sırasında ve Sonrasında Diş Hassasiyeti: Sistematik Bir Derleme ma ajanına farklı oranlarda potasyum nitrat (KNO 3 ), [25][26][27][28][29] sodyum florid (NaF) 30 veya amorf kalsiyum fosfat 31 ilave edilmektedir. Risk faktörleri değerlendirilirken hastanın dişlerine yönelik tedavi öncesi bulgular (mevcut hassasiyet, gingival iritasyon, kavitasyonlar veya diğer defektler), yaş, cinsiyet ve diyet alışkanları göz önüne alınmalıdır. ...
Beyazlatma hassasiyeti, karbamid peroksit, hidrojen peroksit, risk faktörleri/prediktörler, terapötik yaklaşımlar, diş hassasiyeti, vital diş beyazlatma. Özet Amaç: Vital diş beyazlatma sırasında ve sonrasında meydana gelen diş hassasiyetine yönelik güncel literatürün taranması, hassasiyetin görülme sıklığının, şiddetinin ve süresi-nin değerlendirilmesi ve beyazlatma sonrası hassasiyete yönelik olası etkenler ve risk faktörlerinin araştırılması. Tarama stratejisi: Cochrane Central Register of Controlled Trials , Ebsco, Embase, PubMed ve Scopus veritabanları Şubat 1991 ve Şubat 2015 tarihleri arasında yayınlanmış İngilizce ve Almanca makalelerin belirlenmesi amacıyla tarandı. Se-çim kriterleri: Başlangıç katılımcı sayısının en az 30 kişi olduğu, beyazlatma sonrası hassa-siyetin tedavi edildiği ve sonuçların istatistiksel olarak değerlendirildiği, plasebo veya kontrol grupları içeren randomize kontrollü klinik araştırmalar derlemeye dâhil edildi. Veri toplanması ve analiz: Makale başlıkları ve özet kısımları incelendi, veri özütleme (data extraction) uygulandı, tam metin makaleler kalite açısından değerlendirildi. Bulgular: Be-lirlenen 136 makalenin 18'i seçim kriterlerine uygundu ve analiz amacıyla kullanılabilecek veri sağlamaktaydı. Araştırmalarda beyazlatma sonrası hassasiyetin oluşumu, şiddeti ve süresine yönelik bilgi sağlanmakla birlikte, makalelerin büyük bir kısmı sadece bu konu üzerine odaklanmamaktaydı. Araştırmaların çoğu taraf tutma riski (risk of bias) oluştura-cak şekilde kurgulanmıştı. Beyazlatma sonrası hassasiyetin şiddeti ve süresi farklı yön-temlerle değerlendirilmiş ve farklı bulgulara ulaşılmıştı. Bu istenmeyen yan etkiye yönelik kanıta dayalı bilimsel bir açıklama belirlenemedi. Sonuç: Beyazlatma sonrası meydana gelen hassasiyet çözülememiş bir olgu olarak kalmayı sürdürmektedir. Tablonun daha net şekilde anlaşılabilmesi amacıyla yüksek kaliteli ve CONSORT rehberliğine uygun kurgu-lanmış araştırmalara ihtiyaç vardır. (Quintessence Int. 2015;46:881-897) Son yıllarda toplumda 'daha beyaz dişlere' sahip olma talebinin artması ile birlikte, bireylerin estetik diş he-kimliği uygulamalarına olan ilgisi artmıştır. 1 Bu neden-le vital diş beyazlatma tedavileri diş hekimliğinde en sık uygulanan kozmetik tedavilerden biri haline gelmiş-tir. Peroksitlerin beyazlatma potansiyellerinin keşfiyle birlikte, renklenmiş dişlerin tedavisi amacıyla vital be-yazlatma işlemleri daha sık uygulanmaya başlamıştır. 2
... The use of 10% carbamide peroxide has been found to cause mild, reversible histological changes in some patients [9]. To minimize tooth sensitivity, lowering the concentration of peroxide in the paste has been recommended [10]. Some strategies have been used to reduce tooth sensitivity caused by peroxide bleaching [5,11,12]. ...
The objective of this study was to investigate if a prolonged bleaching effect of carbamide peroxide-loaded hollow calcium phosphate spheres (HCPS) can be achieved. HCPS was synthesized via a hydrothermal reaction method. Carbamide peroxide (CP) was-loaded into HCPS by mixing with distilled water as solvent. We developed two bleaching gels containing CP-loaded HCPS: one gel with low HP concentration as at-home bleaching gel, and one with high HP concentration as in-office gel. Their bleaching effects on stained human permanent posterior teeth were investigated by measuring the color difference before and after bleaching. The effect of gels on rhodamine B degradation was also studied. To investigate the potential effect of remineralization of using HCPS, bleached teeth were soaked in phosphate buffer solution (PBS) containing calcium and magnesium ions. Both bleaching gels had a prolonged whitening effect, and showed a strong ability to degrade rhodamine B. After soaking in PBS for 3 days, remineralization was observed at the sites where HCPS attached to the teeth surface. CP-loaded HCPS could prolong the HP release behavior and improve the bleaching effect. HCPS was effective in increasing the whitening effect of carbamide peroxide and improving remineralization after bleaching process.
... 5 The common side effect of vital tooth bleaching using high concentration of hydrogen peroxide is tooth sensitivity. 6,7 This side effect normally persists for up to 4 days after the cessation of bleaching treatment. 7 In vitro and in vivo experiments have shown that the peroxide had ability to penetrate enamel and dentinal tubule and therefore, enter the pulp chamber. ...
Background: In-office vital tooth bleaching is a treatment to remove tooth stains. Tooth sensitivity is one of side effect commonly complained by patients receiving this treatment. Purpose: The aim of this study was to examine histological inflammatory cells infiltration of dental pulp after application of 38% H2O2 as a vital tooth bleaching agent. Methods: Under informed consent, a total of 15 premolars from 8 healthy subjects scheduled for orthodontic extraction were used in this study. Thirty eight percent H2O2 was applied on the buccal surface of the treated group. The treated teeth were extracted after 1 hour, 5, 8, and 15 days. All specimens were embedded in paraffin wax, sectioned serially and stained with Hematoxyllin Eosin. Histological specimens were then observed under a light microscope. Results: All treated groups showed a slight disorganization of odontoblasts layer and slight inflammation in the pulp tissue adjacent to the 38% H2O2 application site. The number of polymorphonuclear leukocytes (PMN) had increased significantly 1 hour after application of 38% H2O2 (p<0.05), while macrophages had significantly increased 5 days after the application (p<0.05). The most intense PMN and macrophages infiltration was found 5 days after the application and gradually decreased 8 days after application of38% H2O2. Conclusion: Application of 38% H2O2 as a vital tooth bleaching agent induces acute inflammation in human dental pulp; however, the inflammation will decrease 8 days after the application.Latar belakang: Perawatan pemutihan gigi vital metode in-office merupakan tindakan untuk menghilangkan pewarnaan pada gigi. Salah satu efek samping yang sering dikeluhkan oleh pasien yang menjalani perawatan ini adalah sensitivitas gigi. Tujuan: Penelitian ini bertujuan untuk mengamati infiltrasi sel inflamasi pada pulpa gigi setelah aplikasi H2O2 38% sebagai bahan pemutih gigi. Metode: Sampel penelitian ini berupa 15 gigi premolar yang berasal dari 8 subjek sehat yang akan melakukan pencabutan gigi untuk perawatan ortodontik. Seluruh subjek telah menandatangani informed consent. Hidrogen peroksida 38% diaplikasikan pada permukaan bukal gigi kelompok perlakuan. Gigi kemudian dicabut 1 jam, 5, 8, dan 15 hari setelah aplikasi H2O2 38%. Seluruh spesimen kemudian ditanam dalam parafin, dipotong secara serial dan diwarnai dengan Hematoxillin Eosin. Pengamatan preparat histologis dilakukan dengan menggunakan mikroskop cahaya. Hasil: Hasil penelitian ini menunjukkan gangguan pada lapisan odontoblas dan peradangan pada jaringan pulpa di bawah daerah aplikasi H2O2. Jumlah PMN meningkat secara signifikan (p<0,05) 1 jam setelah aplikasi H2O2 38% sedangkan jumlah makrofag meningkat secara signifikan 5 hari setelah aplikasi hidrogen peroksida 38%. Infiltrasi PMN dan makrofag paling banyak ditemukan 5 hari setelah aplikasi dan menurun secara bertahap 5 dan 8 hari setelah aplikasi H2O2 38%. Kesimpulan: Aplikasi H2O2 38% sebagai bahan pemutih gigi vital dapat menginduksi inflamasi akut pada pulpa gigi manusia, namun, inflamasi akan mereda 8 hari setelah aplikasi.
... Questi prodotti vanno applicati uniformemente nelle mascherine sopra descritte, da calzare per tutta la notte, consecutivamente, per una o due settimane. Numerosi lavori hanno evidenziato come le metodiche domiciliari siano in grado di sbiancare i denti con successo e soddisfazione da parte dei pazienti [16][17][18][19][20][21] . Tuttavia, l'applicazione delle mascherine o delle matrici nelle metodiche domiciliari può risultare poco confortevole, dati i lunghi tempi necessari, ed addirittura sgradevole, dato che errori di applicazione del gel sbiancante nelle stesse possono causare scottature e piccole ulcerazioni a livello dei tessuti gengivali. ...
... In the dental literature, there is a great variety of theses about etiology, risk factors/predictors, and treat-ment options of BS. Suggestions for treatment and prevention of BS range from strategies conducted prior to the whitening procedure 24 to treatment regimens trying to combine the respective bleaching treatment with products with varying concentrations of potassium nitrate (KNO 3 ), [25][26][27][28][29] sodium fluoride (NaF), 30 or others like amorphous calcium phosphate. 31 Risk factors under discussion are patients' tooth specific data (pre-existing sensitivity, GI, and teeth with cavitations or other defects) as well as sex, age, or dietary habits. ...
OBJECTIVE:
To review the current literature, and to evaluate the occurrence, severity, and duration of tooth sensitivity during and after vital tooth bleaching as well as to identify possible sources and risk factors of bleaching sensitivity (BS). The inclusive analysis should allow the clinician to get an overview about today's evidence based results concerning BS.
SEARCH STRATEGY:
The search included Cochrane Central Register of Controlled Trials, Ebsco, Embase, PubMed, and Scopus from February 1991 to February 2015. Studies published in English and German were considered.
SELECTION CRITERIA:
Randomized controlled trials including placebo or control groups, with statistical analysis of BS interventions, and with a study sample size of at least 30 participants at baseline were selected.
DATA COLLECTION AND ANALYSIS:
Screening of titles and abstracts, data extraction, and quality assessment of full texts were undertaken.
RESULTS:
A total of 136 articles were identified, with 18 papers meeting the inclusion criteria and presenting data that could be used in the analysis. Included trials provided some details on occurrence, severity, or duration of BS, but papers did not focus solely on BS. The majority of the studies were judged to be at a high risk of bias according to their study design. Investigation methods and outcomes concerning severity of BS and duration varied significantly. Evidence-based explanations for BS could not be found.
CONCLUSION:
BS still remains an unsolved phenomenon that needs further follow-up with high-quality studies following the well-accepted CONSORT guidelines.
... This technique is still the most common whitening procedure, and literature heavily supports the efficacy of this method. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Despite the great amount of research on at-home tray whitening with 10% CP, some patients do not desire to wear trays over a long period of time and still aspire to have whiter teeth faster. In order to achieve a faster whitening effect in a shorter period of time, dental product manufacturers have increased the peroxide concentration of the whitening products. ...
Purpose:
This study compared the whitening efficacy, side effects, and patients' preferences/perceptions of two whitening systems of similar peroxide concentration but different formulation and delivery methods.
Methods:
The tooth color change of 24 participants was measured using a shade guide (BSG) and a spectrophotometer (ES). Color difference was calculated: ΔE* = [(ΔL*)(2) + (Δa*)(2) + (Δb*)(2)](1/2). One whitening treatment was randomly applied to the right or left maxillary anterior teeth and the other was applied to the contralateral teeth, at-home with 35% carbamide peroxide in a tray (TW) or with 14% hydrogen peroxide in strips (WS). The tooth color was evaluated at baseline, 15 and 30 days (15 days postwhitening). Participants rated their tooth and soft tissue sensitivity (1-10 scale) and completed a questionnaire on their preferences. Results were analyzed by repeated measurement regression analysis/Tukey and Mann-Whitney (p<0.05).
Results:
At 15 days, the teeth treated with TW and WS presented ΔE* = 7 and 6, respectively (ΔBSG=3 for both), and at 30 days, they presented ΔE* = 7.5 and 6.5, respectively (ΔBSG=3 for both). There was no significant difference in tooth and soft tissue sensitivity between treatments. No participant reported tooth and gingival sensitivity at the postwhitening appointment. Of the participants, 83% preferred the TW over WS.
Conclusion:
Both ΔE* and ΔBSG showed no significant difference in tooth color change between TW and SW at either time point. By the end of the study no participants reported tooth and gingival sensitivity. Participants preferred TW over SW.
... Some studies, to evaluate the effectiveness of external tooth bleaching agents, have also used both spectrophotometer and visual evaluation of color change using the Vita Lumin shade guide. 29,30 In the same context, Guan et al. 27 have compared the use of spectrophotometer and nonlinear image analysis with visual evaluation using the Vita Lumin shade guide. Results from these studies using different methods of evaluation were consistent. ...
The aim was to evaluate the bleaching efficacy of sodium perborate/37% carbamide peroxide paste and traditional sodium perborate/distilled water for intracoronal bleaching.
Thirty patients with dark anterior teeth were divided into 2 groups (n = 15): group A: sodium perborate/distilled water; and group B: sodium perborate/37% carbamide peroxide paste. The bleaching treatment limited each patient to the maximum of 4 changes of the bleaching agent. Initial and final color shades were measured using the Vita Lumin shade guide.
Data was analyzed with Wilcoxon test for initial and final comparison according to the bleaching agent, demonstrating efficacy of the bleaching treatment with both agents. Mann-Whitney test was used for comparison of the efficacy of the bleaching agents, showing that there was no significant difference between them.
The sodium perborate/37% carbamide peroxide association for intracoronal bleaching has proven to be as effective as sodium perborate/distilled water.
... Therefore, Vachon et al. (1998) suggested that although their spectrophotometer readings may indicate a statistical difference, these differences could be clinically indistinguishable to the human eye. Some studies to evaluate the effectiveness of external tooth bleaching agents have also used both spectrophotometer and visual evaluation of colour change using the Vita Lumin shade guide (Nathoo et al. 2001, Li et al. 2003). Results from these studies using both methods of evaluation were consistent. ...
To evaluate the bleaching efficacy of 35% carbamide peroxide, 35% hydrogen peroxide and sodium perborate for intracoronal bleaching of root filled discoloured teeth.
Extracted premolars were artificially stained using whole blood then root canal treatment was performed. After obturation, a 2 mm intermediate base was placed 1 mm below the buccal amelo-cemental junction. Intracoronal bleaching was performed in 11 teeth per group, using either 35% carbamide peroxide gel (group CP), 35% hydrogen peroxide gel (group HP) or sodium perborate mixed with distilled water (group SP). The bleaching agents were replaced after 7 days. The shade of the teeth was evaluated at day 0, 7 and 14. The results were analysed using Kruskal-Wallis one-way analysis of variance and Mann-Whitney U-test.
At the end of 7 days, both groups CP and HP lightened by 8 +/- 3 Vita tab positions, respectively, whereas group SP lightened by 5 +/- 3 tab positions (P < 0.05). At the end of the second bleaching period at day 14, group CP and HP lightened by a further 2 +/- 2 and 2 +/- 3 tab positions, respectively, whereas group SP lightened by a further 3 +/- 4 tab positions. There were no statistical differences between groups at day 14.
Thirty-five per cent carbamide peroxide and 35% hydrogen peroxide were equally effective for intracoronal bleaching, and significantly better than sodium perborate after 7 days. After 14 days, there were no significant differences between the groups. Thirty-five per cent carbamide peroxide can be recommended as an equally effective alternative to hydrogen peroxide for intracoronal bleaching.
... Another study compared a tooth whitener containing 5% and one containing 10% carbamide peroxide. Assessing the efficiency of bleaching over a period of 1 week the authors suggested that the whitening gels were clinically equivalent [21]. Using a value-oriented shade guide, there was no statistical difference between the outcome of a 10% and a 15% carbamide peroxide containing gel after 1 week's application [6]. ...
The aim of the present study was to assess the hypothesis that the efficiency of vital tooth bleaching depends on the concentration of carbamide peroxide agents.
The front teeth of 30 subjects were bleached at home with 10%, 17% or 0% (control) carbamide peroxide for 1 week in a double-blind study design. Tooth shades were determined in the LCH color space employing a visual shade matching system and a spectrophotometer. Differences in lightness (Deltal), chroma (Deltac) and hue (Deltah) were measured to assess the treatment process. After 2 weeks of no treatment, tooth shades were evaluated again to assess stability of the resultant shade.
First-time changes of shade values could be observed after 3 days in the 17% group and after 7 days in the 10% group. After 1 week, in both the 17% group (Deltal: 2.80, Deltac: -3.33, Deltah: 0.60) and the 10% group (Deltal: 2.61, Deltac: -2.54, Deltah: 0.09), values for lightness and chroma were significantly different from the control (Deltal: 0.13, Deltac: 0.14, Deltah: 0.21, p<0.05) with no difference between the test groups (p>0.05). Two weeks after treatment, a rebound of shade values could be observed in the test groups (p<0.05).
The study indicates that higher concentration bleaching agents might whiten teeth faster with major changes in lightness and chroma. However, by bleaching daily for 1 week, similar effects can be achieved with both a high and a low concentration agent. After treatment, a regression of the resultant shade has to be expected.
... [36][37][38] Additionally, the shade guide offers a measurement that is more meaningful to the consumer. 39 Human perception of tooth color is very complex and consists of both subjective and objective components. The subjective component of color is highly variable and dependent on factors such as ambient lighting, the color of the person's skin, and the appearance of adjacent teeth. ...
To evaluate the influence of a desensitizing agent (VivaSens) on efficacy of a paint-on bleaching agent (VivaStyle Paint On Plus).
Bleaching was performed for 7 days with VivaStyle Paint On Plus. The varnish was applied twice a day for 10 minutes each. 80 subjects were included in the study and randomly distributed in two groups (n = 40) according to exposed cervical dentin and perceived hypersensitivities. Group A used VivaStyle without VivaSens while Group B used VivaStyle Paint On Plus after a single application of VivaSens. Tooth color was assessed on facial surfaces of first upper incisors with Vita shade guide at baseline and 10 days after bleaching therapy. Sensitivity, with intensity graded from 0 (no sensitivity) to 10 (high sensitivity), was assessed chair-side using a blow of air at baseline, at the end of therapy (7 days) and 10 days after bleaching therapy. Statistical evaluation was performed with non parametric ANOVA.
Thirteen subjects dropped out of the study; six due to gingival burning sensation (A: 3; B: 3) related to the bleaching regimen and seven due to lack of compliance. Directly after completion of bleaching therapy, tooth color had changed significantly compared to baseline in both treatment groups without difference among the groups. Color changes (Delta) according to Vita shade guide were as follows (mean +/- standard deviation): Group A: Delta 2.7 +/- 1.0, Group B: Delta 2.8 +/- 0.9. After bleaching (7 days) the intensity of tooth hypersensitivity (mean +/- standard deviation) was increased significantly compared to baseline in both groups (P < 0.05): Group A: 1.58 +/- 1.91 (baseline: 0.4 +/- 0.5); Group B: 1.3 +/- 1.8 (baseline: 0.5 +/- 0.7). The number of subjects reporting tooth hypersensitivity increased in Group A by 5 (n = 13) and in Group B by 1 (n = 10) subject. Although degree of hypersensitivities and number of subjects with hypersensitivities were lower in Group B, there was no significant difference between the groups.
A transient sensitivity during tooth whitening is generally reported to occur in 30% of patients, and tooth sensitivity sometimes leads to discontinuation of treatment. To prevent tooth sensitivity, application of sodium fluoride prior to use of whitening agents is recommended. This study evaluated the influence of fluoride containing dentifrice on the whitening effect of the agents. Eight human teeth were selected and each tooth crown was sectioned into two halves in the mesial-distal direction. One half of the sectioned tooth was brushed with fluoride containing dentifrice (900 ppm) and the other half was used as a control. After brushing, these specimens were treated by the 10% carbamide peroxide whitening agents. Color change was measured using a spectro-photometer and evaluated by the CIE L*a*b*. Evaluations were performed at baseline and 7, 14, 21 and 28 days. The results were as follows: 1. While L* value increased, a* and b* values decreased during tooth whitening. 2. Color change during tooth whitening was not affected by the use of a fluoride containing dentifrice. 3. Enamel surface texture during tooth whitening was not affected by the use of a fluoride containing dentifrice.
Purpose: This study examined the color analysis of 3% hydrogen peroxide on organic and inorganic chromogen sources in bovine dentin. Materials and Methods: 21 bovine dentin samples with a thickness of 0.5mm were prepared. Samples were divided into 7 groups discolored by organic chromogen sources (Maillard reaction using a glucose; GL solution), inorganic chromogen sources (trace metal elements; Ni, Cu, Fe) and by mixture of both the Maillard reaction and trace metal elements. Spectrophotometric measurements were taken before the samples were subjected to 3% hydrogen peroxide and throughout the bleaching process at 10 seconds intervals (total 120 seconds). Color changes on dentin samples of 7 groups were analyzed for color difference ⊿E, L*, a* and b* values. Results: Samples discolored via the Maillard reaction responded best by increasing their ⊿E values while decreasing the b* values. In contrast, samples discolored by trace metal elements of Cu were not responsive, and samples discolored by Fe were darkened greatly. Ni indicated a slightly positive response. Conclusion: Hydrogen peroxide was effective in bleaching samples discolored by Glucose and Ni. However, the peroxide bleaching decreased the value of L*, and worsened the effect for samples discolored by Fe. This study suggests that the type of chromogen that discolors teeth has a great role in determining the efficacy in peroxide bleaching.
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.
We reviewed the literature to evaluate: a) The compliance of randomized clinical trials (RCTs) on bleaching with the CONSORT; and b) the risk of bias of these studies using the Cochrane Collaboration risk of bias tool (CCRT). We searched the Cochrane Library, PubMed and other electronic databases, to find RCTs focused on bleaching (or whitening). The articles were evaluated in compliance with CONSORT in a scale: 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the number of studies by journal, follow-up period, country and quality assessments were performed with CCRT for assessing risk of bias in RCTs. 185 RCTs were included for assessment. More than 30% of the studies received score 0 or 1. Protocol, flow chart, allocation concealment and sample size were more critical items, as 80% of the studies scored 0. The overall CONSORT score for the included studies was 16.7 ± 5.4 points, which represents 52.2% of the maximum CONSORT score. A significant difference among journal, country and period of time was observed (p < 0.02). Only 7.6% of the studies were judged at "low" risk; 62.1% were classified as "unclear"; and 30.3% as "high" risk of bias. The adherence of RCTs evaluating bleaching materials and techniques to the CONSORT is still low with unclear/high risk of bias.
El objetivo del estudio fue evaluar los efectos clínicos del blanqueamiento dental aplicando dos técnicas diferentes. Técnica aplicada en consultorio. Técnica aplicada en Hogar. Fueron seleccionados 10 pacientes divididos en 2 grupos de 5 pacientes para cada técnica. Los criterios de evaluación fueron: duración de color, sensibilidad post operatoria, estado de salud gingival. Los resultados de la evaluación clínica a los 08 meses presentan 100% de estabilidad del color en los casos tratados con ambas técnicas. No se presentan cuadros clínicos de sensibilidad dentinaria post operatoria en 80% de los casos tratados en consultorio, comparado con el 60% de los casos tratados en Hogar. No se presenta irritación gingival en 100% de casos tratados con ambos técnicas.
This chapter begins with an introduction to the structure of the dentition and its environment followed by a review of the optical properties of teeth. Tooth colour will be reviewed with particular emphasis on colour distribution and variation. Important factors that influence tooth colour and its perception will be discussed. With the current interest in tooth whitening, this chapter will then describe approaches to quantifying tooth whiteness and the measurement of tooth colour, in particular, visual assessment approaches and instrumental techniques. In addition, methods to improve tooth colour will be reviewed including whitening toothpastes, tooth bleaching and microabrasion.
Bleaching-related tooth sensitivity has been shown to be facilitated by the presence of enamel defects. A nano-hydroxyapatite (n-HAP) paste has been shown to repair these defects.
Using a randomized clinical trial, an n-HAP paste was investigated to determine its efficacy in reducing bleaching-related tooth sensitivity.
An n-HAP paste (Renamel AfterBleach, Sangi Co., Ltd., Tokyo, Japan) and a placebo (zero-HAP) were randomly assigned for use in 42 participants. A 7% hydrogen peroxide gel was used twice daily for 14 days, with use of assigned desensitizer for 5 minutes immediately following. A diary was completed daily for 4 weeks to note: use of the agents and sensitivity on a visual analog scale (VAS). Three aspects of tooth sensitivity were investigated: percentage of participants; number of days; and intensity level. Color change was assessed.
For Groups zero-HAP and n-HAP, respectively, 51 and 29% of participants reported tooth sensitivity (p = 0.06). Days of sensitivity were 76 and 36, respectively (p = 0.001). Change in VAS score from baseline trended higher for group zero-HAP (p = 0.16). Color change was equivalent.
The data trend indicated group n-HAP experienced less sensitivity over all three measures. Only the number of days of sensitivity was statistically significant.
Within the limits of the study it can be concluded that the use of the n-HAP paste was associated with a statistically significant reduction in the number of days of tooth sensitivity experienced during active bleaching.
For those using a tooth whitener without a desensitizing agent, this study indicates that a paste containing nano-hydroxyapatite crystal can effectively reduce the duration of tooth sensitivity.
To evaluate whether the use of a desensitizing agent before at-home vital bleaching decreased this sensitivity.
After informed consent, 60 subjects, 18-31 years of age, participated in the study and were divided into desensitizer and placebo groups. Before bleaching treatment with 16% carbamide peroxide (CP), a placebo or desensitizer gel (DG; 5% potassium nitrate and 2% sodium fluoride) was applied in the tray and used by patients for 10 minutes. Color was evaluated at the baseline, second and fourth week following the initial delivery of bleaching trays. Color change was measured using the Vita Classic Shade Guide arranged by value. The subjects recorded their perception of tooth sensitivity on a 0-4 scale. The bleaching treatment at each week recall was evaluated by repeated measures ANOVA. The percentage of patients with tooth sensitivity was evaluated by Chi-square test. The tooth intensity ratio (% of days with tooth sensitivity) as well as the tooth sensitivity intensity between groups were analyzed using chi-square and the Mann-Whitney tests, respectively (alpha = 0.05).
The use of DG did not affect the bleaching efficacy of the CP (P > 0.05). The prevalence and intensity of tooth sensitivity was similar for both groups (P > 0.05). However, participants from the placebo group had sensitivity in 33.6% of the bleaching days, which was significantly higher than the DG experimental group (20.1%) (P < 0.05).
This randomized clinical study assessed efficacy in terms of color change and production of sensitivity after home whitening alone and home whitening supplemented with in-office bleaching. Thirty-six subjects (aged 19 to 58 years) were randomly assigned to one of three different treatment groups: (A) home whitening for two weeks, with 16% carbamide peroxide in custom-made trays; (B) home whitening for two weeks, with 16% carbamide peroxide in custom-made trays supplemented with in-office bleaching with 9% hydrogen peroxide (in the same trays); or (C) home whitening for two weeks, with 16% carbamide peroxide in custom-made trays supplemented with in-office bleaching with 27% hydrogen peroxide (in the same trays). The efficacy of tooth whitening was assessed by determining the color change associated with the six upper anterior teeth using a value-ordered shade guide. Sensitivity was self-assessed with the use of a visual analog scale (VAS). Tooth shade and sensitivity were assessed at the following points: pretreatment; immediately after the home whitening phase; immediately after the in-office phase (groups B and C); and one week post active treatment. At the one week follow-up visit, subjects in group A had a mean (SD) color change of 5.9 (1.83) (teeth were lighter) immediately after cessation of treatment (p<0.01). Subjects in groups B and C experienced a greater change in mean (SD) shade immediately following their respective in-office treatments of 5.1 (1.53) and 5.4 (1.55). However, within one week, the shade of these teeth regressed to a similar degree to that achieved by subjects treated in group A. Overall, no significant difference in shade change or sensitivity was produced between the three groups. Investigators concluded that the in-office element of combined whitening produced no significant difference in tooth color or sensitivity when compared with home whitening alone.
This study evaluated the time necessary for at-home whitening (HW) to match the results of an in-office (OW) treatment, side effects and patients' preferences/perceptions.
The tooth color change of 20 subjects was measured using a shade guide (BSG) and spectrophotometer (ES). Color difference was calculated: delta E* = [(delta L*)2 + (delta a*ab)2 + (delta b*ab)2]1/2. The whitening treatments were randomly applied to the right or left maxillary anterior teeth, in-office, with 25% hydrogen peroxide or at-home, overnight, with 10% carbamide peroxide. The tooth color was evaluated at baseline, one day after OW, six days (five days after HW) and at 20 days (14 days after HW and 19 days OW). Subjects rated their tooth and soft tissue sensitivity (1-10 scale). The results were analyzed by two-way RM ANOVA/Tukey's and Mann-Whitney (p<0.05).
At six days, the teeth that were treated with HW and OW presented delta E* = 5.2 and 6.6, respectively, delta BSG = 3, and at 20 days, they presented delta E* = 6.2 and 6.6, respectively, delta BSG = 3. Less than 40% of the subjects experienced tooth sensitivity after OW and HW. No subjects experienced tooth and gingival sensitivity at 20 days. Seventy-four percent preferred HW over OW, 63% recommended OW and 100% recommended HW.
While there was a subtle difference in delta E* between HW and OW at six days, the measurement of delta E* and delta BSG agreed that five days of home whitening produced the same results as a single in-office treatment. The tissue and teeth sensitivity were mild and transient. Subjects preferred and would recommend HW over OW.
Vital bleaching procedures are a popular means of improving the appearance of discolored teeth. There is a wide array of whitening products for home and dental office use; all involves placing peroxide containing gels or solutions in contact with the teeth. In order to whiten teeth peroxide has to be able to penetrate tooth structure and oxidize colored compounds in the dentin. Unfortunately beauty comes with a price; many patients undergoing peroxide based whitening procedures complain of bleaching sensitivity (BS) arising in the treated teeth. In BS, pain can occur in healthy intact teeth without any provoking stimulus. Currently the mechanism of nociceptors activation in BS is unknown. A more common form of dental pain-dentin sensitivity (DS) occurs when stimuli such as cold or tactile stimulation contact areas of exposed dentin in otherwise healthy teeth. In DS, stimulation of the dentin results in fluid shifts in the dentinal tubules, these fluid shifts activate mechanosensitive nerve endings in the deep dentin and pulp. Since many aspects of BS and DS symptoms differ, it is hypothesized that that the mechanism of pain generation differs for these two conditions. Recently the functional properties of a chemosensitive ion channel-TRPA1 have been described. This channel is activated by a variety of oxidizer compounds including hydrogen peroxide. Pulpal sensory afferents express TRPA1. It is hypothesized that direct activation of intradental nerve activity via TRPA1 is the mechanism of BS pain. If this theory were correct, tooth sensitivity treatments that reduce the excitability of the intradental nerves such as potassium salts, would be the treatment of choice for BS.
Im Rahmen dieser Studie wurden drei Homebleaching-Produkte (Colgate Platinum (R), Dentsply NuproGold TM, Discus Dental Nite White Excel (R)) an drei Gruppen mit je 15 Probanden bezüglich Ihrer Bleichwirkung sowie Wirkungsdauer getestet. Es wurden individuell angefertigte Bleichschienen mit Reservoir verwendet. Eine signifikante Zahnaufhellung wurde bei allen drei Produkten nachgewiesen. Colgate Platinum (R) zeigte die besten Ergebnisse bei gleichzeitig stärkster Ausprägung von Nebenwirkung wie Hypersensibilität und Gingivairritationen. Die Bleichanwendung führte bei keinem Probanden zu nachgewiesen Schäden an Zahnhartsubstanz oder Gingiva. Sämtliche Nebenwirkungen sind reversibel. Zur Abschluß-Untersuchung, 24 Monate nach der Bleichanwendung, erschien der Bleicheffekt nur geringfügig reduziert. Neuere Produkte zeigen bei geringerem technischen und finanziellem Aufwand ähnlich gute Ergebnisse wie das Homebleaching dieser Untersuchung. Eine sorgfältige Indikationsstellung ist Voraussetzung für eine erfolgreiche Bleichbehandlung.
To evaluate the efficacy of 16% carbamide peroxide gel (CP16%), tetrahydrate sodium perborate (SP) and mixture (CP16% + SP), in walking bleaching of non-vital discolored teeth.
Sixty single-rooted human premolars with intact crowns were used and initial color was assessed using Vita shade guide and standardized photos. The teeth were stained using rabbit fresh blood for 18 days and photos of discolored teeth and color evaluation were performed. The teeth were divided into 4 groups (n= 15), according to bleaching agent used: G1) CP16% gel; G2) CP16% gel + SP; G3) SP + distilled water; G4: control. The bleaching agents were replaced twice at 7-day intervals for 21 days. All teeth were evaluated by two endodontists at days 0, 7, 14 and 21 and the color changes were assessed using Vita shade guide and standardized photos. The results were analyzed by Kruskal-Wallis and Dunn's tests (p=0.05).
The experimental groups presented statistically similar bleaching results (p>0.05) at the end of 7, 14 and 21 days. These groups presented significantly higher bleaching efficacy than control group (G4) (p<0.05). The mixture CP16% + SP promoted return of original color in 100% of teeth at the end of 21 days.
It was concluded that three bleaching agents were effective in bleaching of stained teeth with blood products, especially at the end of 21 days.
Clinical Relevance
The results of this double-blind, placebo-controlled clinical trial have direct relevance to clinical practice and provide evidence that the addition of low levels of potassium nitrate and/or potassium nitrate and fluoride significantly reduce postoperative sensitivity relative to products that do not contain either agent.
To review current knowledge with respect to tooth colour and its measurement.
'Medline' database for the period 1966 to the present day and 'ISI Web of Science' database for the period 1974 to the present day were searched electronically with key words tooth, teeth, colour and color.
The colour and appearance of teeth is a complex phenomenon, with many factors such as lighting conditions, translucency, opacity, light scattering, gloss and the human eye and brain influencing the overall perception of tooth colour. The measurement of tooth colour is possible via a number of methods including visual assessment with shade guides, spectrophotometry, colourimetry and computer analysis of digital images. These methods have successfully been used to measure longitudinal tooth colour changes when the dentition has undergone tooth whitening procedures.
This work was undertaken to explore the effect of saliva addition on the rheological properties of two contrasting tooth bleaching systems, one of which was a paste (Colgate Platinum) and the other a gel (Zaris, 3M ESPE). Using a dynamic stress rheometer with cone and plate geometry, it was shown that addition of artificial saliva reduced the apparent viscosity of each material. However, in some cases this was accompanied by an increase in elasticity. It is suggested that saliva may not have a deleterious effect on the ability of the materials to remain in the bleaching tray.
Comparative clinical research was conducted to evaluate the efficacy and safety of three peroxide-containing tooth whitening products having different peroxide delivery.
A total of 43 healthy adults who met entrance criteria were randomly assigned to either a dual-phase, anticavity, 1% hydrogen peroxide dentifrice with a manganese gluconate activator, an 18% carbamide peroxide paint-on gel, or a 5% carbamide peroxide professional custom tray system. Following manufacturer's instructions, the activated dentifrice was used at least twice daily for two minutes, while the paint-on gel was applied twice daily. The custom tray, a barrier system and the experimental control for this study, was worn continuously for six to eight hours daily. Tooth color (L*a*b*) was measured on the maxillary anterior teeth from standard digital images, while safety was assessed from examination and subject report.
At Day 15, the custom tray group had a significant (p < 0.002) reduction in yellowness and increased lightness, with adjusted mean (SE) deltab* of -1.83 (0.210) and deltaL* of 1.45 (0.292). The custom tray group experienced on average greater color improvement compared to either the paint-on gel or activated peroxide whitening dentifrice, differing significantly (p < 0.01) from either of the barrier-free systems with respect to deltab*, deltaL*, deltaE*, and deltaW*. In comparison, 14-days' use of the paint-on gel and activated dentifrice did not result in significant (p > 0.10) color improvements from baseline for deltab*, deltaL*, or deltaW*, with these two barrier-free systems not differing significantly (p > 0.26) with respect to any individual or composite color parameters. Tooth sensitivity and oral irritation were the most common safety findings in the tray and dentifrice groups (there were no adverse events in the paint-on group), and no subject discontinued treatment early because of a treatment-related adverse event.
In head-to-head 14-day testing, a low concentration (5% carbamide peroxide) barrier-based tray system yielded superior tooth color improvement compared to two barrier-free delivery systems-an 18% carbamide peroxide paint-on gel and a 1% hydrogen peroxide dentifrice with a metal activator.
Tray bleaching of vital teeth performed at home by the patient under the dentist s supervision, whether alone or in combination with any of the in-office techniques, provides an interesting alternative to other methods employed in this type of dental treatment. This bleaching procedure applies low-concentration peroxides to the enamel by means of a custom-made mouth tray specifically designed for this purpose. The aim of this study is to examine and compare two commercially-available bleaching products, at equivalent concentrations, for use in this technique: VivaStyle (Vivadent) and FKD (Kin); the former is a 10% carbamide peroxide and the latter a 3.5% hydrogen peroxide formulation. It examines the parameters that must be monitored during the application of this type of procedure and presents 6 cases (3 treated with one of the above-mentioned products and the other 3 with the other), establishing the bleaching power of the products and the appearance and intensity of post-operatory hypersensitivity. The results obtained show that both products are effective for the purpose for which they were designed. In general, dental hypersensitivity was minimal.
To review current knowledge of tooth whitening with respect to external bleaching methods.
The scope is the external bleaching of vital teeth and focuses on mechanisms; in vivo and in vitro measurement methods, and factors influencing the efficacy of the whitening process.
"Medline" and "ISI Web of Science" databases from 1966 and 1974, respectively were searched electronically with key words tooth, teeth, colo*r, white*, bleach* and peroxide.
The importance of tooth whitening for patients and consumers has seen a dramatic increase in the number of products and procedures over recent years, with a concomitant rise in publications on this topic. Literature suggests that the mechanisms of tooth whitening by peroxide occur by the diffusion of peroxide through enamel to cause oxidation and hence lightening of coloured species, particularly within the dentinal regions. A number of approaches are available for measuring changes in tooth colour. These include visual measurements by trained clinicians and instrumental measurements using spectrophotometry, chromameters and digital image analysis. The key factors that affect tooth whitening efficacy by peroxide containing products are concentration and time. In general, higher concentrations are faster than lower concentrations. However, lower concentrations can approach the efficacy of higher concentrations with extended treatment times. Alternative bleach systems to peroxide have received only minor attention. The efficacy of light activated systems versus non-light activated controls in clinical studies is limited and conflicting. Other factors which can influence tooth bleaching outcome include type of stain, initial tooth colour and subject age.
Tooth hypersensitivity has long been, and continues to be, the most commonly reported adverse effect of vital tooth whitening with peroxide gels. The complex etiology of whitening-induced tooth hypersensitivity has been a major obstacle in developing a definitive strategy for its prevention. This article reviews the multiple etiologic factors implicated in whitening-induced tooth hypersensitivity and the evidence for efficacy of various strategies for its management.
To evaluate two commercially available doctor-supplied, patient-applied, bleaching systems for their ability to whiten the maxillary anterior teeth while at the same time not causing sensitivity.
46 participants were randomly assigned to one of two groups: One group received Rembrandt Xtra-Comfort and the other group Nite White Excel 2Z. Bleaching stents were fabricated and the bleaching systems were used following manufacturers' instructions. Participants recorded tray use and any sensitivity on a daily basis. Participants bleached for 2 weeks followed by 2 weeks of no bleaching. Color was evaluated at the first, second and fourth week following the initial delivery of bleaching trays. Color change was measured using the Vita Classic Shade Guide arranged by value.
As a group, participants in the NW2Z group bleached for 302 days with a total of 48 days (16%) of sensitivity recorded. The Rembrandt Xtra Comfort group bleached for 313 total days with 97 days (31%) of sensitivity recorded. The difference in sensitivity between the two products proved to be statistically significant (Chi-square analysis, P < or = 0.0001). The median shade change for both products following 2 weeks of active treatment was six tabs. At the 4-week evaluation, the median shade change was 5.5 and 6.0 tabs respectively for Rembrandt and Nite White. There was no statistical difference between the products in respect to shade change.
Fluoride has been recognized as a desensitizer; however, no study has addressed its effects to decrease tooth sensitivity when compared with a placebo in a double-blind randomized clinical study.
The authors divided 30 participants into two groups: one that received a placebo and another that was treated with fluoride. All patients used 16 percent carbamide peroxide (CP) in a custom-fitted tray until their teeth achieved shade A1 or lighter. After daily removal of CP, the patients wore a tray containing either sodium fluoride or placebo for four minutes. The authors statistically analyzed the perception of the intensity of tooth sensitivity and the weekly shade changes for both groups, as well as the intensity of tooth sensitivity (alpha = .05).
The use of fluoride gel did not affect the whitening efficacy of the CP. The authors observed no difference between the groups receiving the placebo and the fluoride treatment in terms of tooth sensitivity experience (P > .05); however, patients who received the placebo had a higher-intensity tooth sensitivity than that of patients who received the fluoride (P < .001). CLINICAL IMPLICATIONS. The use of 1.23 percent sodium fluoride after each bleaching regimen does not affect the bleaching efficacy of CP. Also, the use of sodium fluoride gel reduces the intensity of tooth sensitivity.
It has been suggested that tooth whitening might cause considerable pain. The aim of this study was to evaluate subjective intensities of pain during bleaching of vital teeth and to assess the patients' contentment with the treatment outcome.
Thirty patients were treated for 1 week in a double-blind study design. Employing gels containing 17%, 10%, or 0% (control group) carbamide peroxide, patients wore bleaching trays for 2 hours per day and described subjective intensities of pain while wearing the trays by means of a visual analog scale. The patients' subjective contentment with the bleaching outcome was measured with an intermodal intensity comparison.
For the 17% gel, a median value of 3.5 U (max: 10; min: 1) for pain intensity was observed; this was statistically different from the value seen with the 10% group (2.0 U; max: 7; min: 0) (P < .05). Both test groups differed significantly from the control group, which had a median value of 0.0 U (max: 3; min: 0) (P < .05). Patients' contentment with the treatment outcome did not differ between the test groups (P > .05), although statistical differences were observed between the control and the test groups (P < .05) after bleaching for 1 week.
Application of carbamide peroxide-containing bleaching agents to vital teeth causes pain correlated with the agent's concentration. Since both highly and less concentrated gels might result in a similar contentment with the treatment outcome, the use of highly concentrated agents appears not to be justified to improve vital tooth color.
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