Bleaching teeth: practitioner trends.
Since the mid-1980s, bleaching teeth has grown significantly in popularity. This article provides an overview of current practitioner trends relative to this procedure.
Carbamide Peroxide↗
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Dentist-monitored bleaching: a discussion of combination and laser bleaching.
The traditional power bleaching and matrix bleaching systems offer many advantages for patients. However, each technique also has some drawbacks. This article recommends a combination approach, which uses the best of both systems. The article also discusses the use of lasers and their possible role in bleaching teeth.
Hot Temperature↗
Enamel microabrasion: observations after 10 years.
Enamel microabrasion has become accepted as a conservative, nonrestorative method of improving the appearance of teeth with superficial dysmineralization and decalcification defects. This article reviews the technique of enamel microabrasion using a commercially available compound of hydrochloric acid and fine-grit silicon carbide particles in a water-soluble paste. It also describes a method of combining enamel microabrasion with carbamide peroxide home bleaching. Finally, it presents the cases of representative patients who underwent enamel microabrasion (alone or in combination with dental bleaching).
Adult↗
Restorative considerations with vital tooth bleaching.
This paper explores the implications of bleaching procedures on restorative dentistry. The effects of tooth whitening systems on the bond strength, marginal integrity, color and other properties of restorative materials are reviewed. Also, clinical considerations in combining bleaching and aesthetic restorative techniques are discussed.
Carbamide Peroxide↗
Ceramic veneers: state of the art, 1999.
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Dental Porcelain↗
The role of cosmetic dentistry in restoring a youthful appearance.
BACKGROUND: Dentistry is faced with a population that is getting older and keeping more of its natural teeth. Smiles show physical and esthetic signs of aging. Advances in the area of cosmetic dentistry now offer the dental profession new opportunities in conservative and esthetic restorative procedures that have the potential to reverse the signs of dental aging, thereby making patients appear younger. CASE DESCRIPTION: The physical and esthetic attributes of an aged dentition are identifiable. Tooth wear over time alters the appearance of the teeth and smile in a way that is perceptible to dentists and laypeople. Bonding and adhesive ceramic restorative procedures have the potential of reversing the esthetic manifestations of the aging process for teeth. Specific diagnostic tools, including a composite resin mock-up and construction of an incisal putty matrix, allow for previsualization of possible treatment outcomes and allow clinicians to resolve occlusal as well as esthetic treatment concerns before initiating actual treatment. CLINICAL IMPLICATIONS: The ability to make patients look younger through cosmetic enhancement of teeth and smiles has tremendous implications for the future practice of dentistry. Dentists who have the training and skills to meet the increasing demand for esthetic procedures by patients seeking to restore a youthful appearance may find an expanded role within their practices for this type of treatment.
Dental Veneers↗
A clinical evaluation of 10 percent vs. 15 percent carbamide peroxide tooth-whitening agents.
BACKGROUND: Agents with carbamide peroxide, or CP, in various concentrations are widely prescribed for at-home tooth whitening. It is not clear, however, if the more concentrated gels will whitening teeth to a greater extent, as no controlled clinical trials have been reported. The authors conducted a double-blind study of human subjects to evaluate whether a 15 percent CP tooth-whitening system was more effective than a 10 percent CP system, and to determine if tooth sensitivity increased with use of the higher concentration. METHODS: The authors recruited 57 subjects with maxillary anterior teeth of shade A3 or darker (as gauged against a value-oriented shade guide). The subjects were 18 to 65 years of age and in good general and dental health. After matching the subjects by sex and age, the authors randomly assigned them to either a control group, which used a 10 percent CP whitening agent, or an experimental group, which used a 15 percent CP agent. RESULTS: The results indicated that there was no significant difference in shade change between the groups after one week of treatment (t = 1.455, P = .05), but there was a significant difference at the end of the treatment period (t = 2.303, P < .05), as well as two weeks after treatment concluded (t = 2.248, P < .05). There was no significant difference in sensitivity (t = 1.399, P > .05). CONCLUSIONS: There was a significant difference in color change between the 10 percent CP and 15 percent CP groups at the end of the study period. There was no significant difference in level of tooth sensitivity between the two groups, and the incidence was equal; there was, however, a significant difference in variability of tooth sensitivity between the two groups. CLINICAL IMPLICATIONS: If performed under the careful guidance of a dentist, at-home whitening is an effective treatment, regardless of whether 10 percent CP or 15 percent CP is used. There may be added color change and varying sensitivity with the use of 15 percent CP.
Adolescent↗
Pink teeth resulting from Russian endodontic therapy.
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Humans↗
The tooth-whitening revolution.
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Dental Devices, Home Care↗
Light augments tooth whitening with peroxide.
BACKGROUND: The authors tested the adjunctive use of light with a 15 percent peroxide gel as a single-visit, in-office tooth whitening system. METHODS: Subject (N = 87) with stained (> shade D4, Vita Zahnfabrik, Bad Säckingen, Germany) anterior teeth were randomly assigned to test (peroxide and light), peroxide control (peroxide gel) or light control (placebo gel and light) groups and were treated for one hour. The researchers evaluated tooth shade, color and subject response at baseline and posttreatment and at three and six months posttreatment. RESULTS: The initial shade unit reduction of combined light and peroxide treatment (8.4) was greatest compared with that of peroxide alone (5.9) and of light alone (4.9). Approximately 88 percent of these effects persisted for six months. Lightness was increased and yellowness decreased to a significantly greater extent in the test group than in either control. These findings were corroborated by subject evaluation. One week after treatment, moderate to greatly increased tooth sensitivity occurred in 20 percent of test subjects, 21.7 percent of peroxide control subjects and none of the light control subjects. Neither tooth sensitivity nor gingival redness was present at the three- and six-month visits. CONCLUSIONS: Peroxide and light treatment significantly lightened the color of teeth to a greater extent than did peroxide or light alone, with a low and transient incidence of tooth sensitivity. CLINICAL IMPLICATIONS: Light can increase the tooth-whitening effect of peroxide, thereby increasing the effectiveness of tooth-whitening procedures.
Adolescent↗
An evaluation of a technique to remove stains from teeth using microabrasion.
BACKGROUND: Microabrasion using a paste made of acid and pumice is a technique that has been used to remove white, yellow and brown stains from enamel. The authors evaluated the technique by studying the effectiveness of a proprietary microabrasion product. METHODS: One author used microabrasion to remove white, yellow and brown stains from within the outermost layer of the tooth enamel of 32 subjects. Standardized slides of the teeth were taken before and one week after treatment. Four prosthodontists evaluated the paired images, using a standardized questionnaire and visual analog scales ranging from 1 (no improvement in appearance or stain not removed at all) to 7 (exceptional improvement in appearance or stain totally removed). The evaluators were calibrated and blinded. RESULTS: The evaluators always identified a difference between the pretreatment slides and posttreatment slides; they found no difference between the control slides. In all cases but one (97 percent), the treated teeth had improved in appearance with more uniformity in color. Analysis of variance revealed no differences between evaluator ratings (P = .146). The intraclass correlation coefficient for ratings of individual cases by different evaluators was 0.72, representing a "good" level of correlation of the ratings for improvement of appearance and for stain removal. Mean (+/- standard deviation) ratings were 5.38 (+/- 1.26) for improvement of appearance and 5.06 (+/- 1.26) for stain removal. CONCLUSIONS: This study showed that enamel microabrasion could remove stains from within the outermost layer of tooth enamel, thereby improving the appearance of the teeth. CLINICAL IMPLICATIONS: This study supports recommendations that enamel microabrasion is an effective, atraumatic method of improving the appearance of teeth with stains in the outermost layer of enamel.
Analysis of Variance↗
Using microabrasive material to remove fluorosis stains.
BACKGROUND: Increased public access to fluoride has decreased the prevalence of caries and increased the prevalence of fluorosis staining. This article provides a case report involving a conservative method of removing fluorosis stain, as well as describes an in vitro test of the method. CASE DESCRIPTION: A healthy man sought treatment at New York University College of Dentistry for removal of severe, dark brown fluorosis staining on his anterior teeth. To remove the stain, the treating clinician used a microabrasive material, which leaves enamel intact, instead of a tooth-whitening agent, which requires removal of all affected enamel. METHODS: To demonstrate that enamel structure is not disturbed by the microabrasive material, the authors performed a study using scanning electron microscopy, or SEM. They viewed enamel structure under SEM at x1,000 magnification. They viewed untreated microabraded enamel and compared it with enamel that had been treated for 20 seconds with 37 percent phosphoric acid. RESULTS: An etch pattern was not discernible on the tooth treated with the microabrasive material. The enamel prisms remained intact and the cores were not exposed. CLINICAL IMPLICATIONS: Microabrasion removes intrinsic fluorosis stain effectively while protecting enamel. In this case, an enamel shade of brown not in the range of any tooth color shade guide was reduced.
Adult↗
Perceptions of desirable tooth color among parents, dentists and children.
BACKGROUND: As part of a large-scale fluoridation cessation study, standardized examiners assessed 8,281 school-aged children for dental fluorosis using the Thylstrup Fejerskov index, or TFI, in which scores range from 0 (no fluorosis) to 9 (severe loss of enamel with change of anatomical appearance). METHODS: Dentists, parents and children were asked to respond to a statement, "The color of these teeth (mine or my child's) is pleasing and looks nice." Agreement or disagreement with the statement was indicated on a five-level scale, with a rating of 1 representing total agreement with the reference statement. The authors used repeated-measures analysis of variance to ascertain differences in satisfaction with the esthetic appearance of the subject's tooth color across dentists', parents' and subjects' perceptions. RESULTS: Girls were more critical of their tooth color than were boys; however, parents and dentists were more critical of boys' tooth color than of girls'. While younger subjects were more critical than older subjects, parents of younger subjects were less critical than those of older subjects. Dentists' ratings were not significantly associated with subjects' age group. Subjects with a TFI score of 1 or 2 were not significantly more critical than subjects with a TFI score of 0, while those with a TFI score of 3 of higher were. Similarly, only parents of subjects with a TFI score of 3 of higher had significantly different ratings. CONCLUSIONS: The three stakeholders in the esthetic treatment of children-parents, dentists and patients-appear to see the potential outcome of such treatment differently. CLINICAL IMPLICATIONS: Dentists should ensure that parents and children agree about the course of treatment, the rationale for undertaking it and the results that could reasonably be expected.
Adolescent↗
Prevalence of black tooth stains and dental caries in Brazilian schoolchildren.
This study evaluated the correlation between the presence of black extrinsic tooth stains and caries in Brazilian schoolchildren. The target population consisted of 263 children aged 6-12 years. Clinical examinations were performed by four dentists calibrated for the World Health Organization criteria for caries diagnosis. The c(2) test was used to compare the prevalence of caries between groups of children with and without black tooth stains. Spearman's correlation test was used to analyze the relationship between the presence of black stains and caries severity. Black stains were observed in 14.8% of the children. The number of children with caries-free permanent dentition was not statistically different between groups. The mean DMF-T was 1.46 +/- 1.39 for children with black stains and 2.42 +/- 2.09 for children without black stains. A negative correlation was observed between the presence (r = -0.16; p<0.05) and severity (r = -0.15; p<0.01) of black stains and DMF-T.
Brazil↗
Effectiveness of treatment with carbamide peroxide and hydrogen peroxide in subjects affected by dental fluorosis: a clinical trial.
Dental fluorosis is an endemic dental health problem around the world; so, it is important to develop clinical alternatives that are non-invasive and inexpensive. In this study, nightguard vital bleaching technique (NVBT), using carbamide and hydrogen peroxide as active agents, has shown itself to be effective in whitening teeth affected by dental fluorosis. Carbamide peroxide at 10 and 20% and hydrogen peroxide at 7.5% showed good clinical effectiveness in improving clinical appearence, but it is important to point out that clinical success is only in cases of class 1 to 3 of the Tooth Surface Index of Fluorosis. When comparing 10 and 20% concentrations of carbamide peroxide, there was no difference in the clinical effectiveness (p > 0.05); but when comparing both concentrations of carbamide peroxide against hydrogen peroxide, results showed that carbamide peroxide was more effective in whitening in cases of dental fluorosis, the difference being statistically significant (p < 0.05). NVBT has two advantages: it is a non-invasive technique and the relationship cost/benefit is excellent; only a few patients reported tenderness or mild tooth sensitivity.
Adolescent↗
The clinical effectiveness of a new prophylaxis device.
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Adult↗
Structure of surface coatings on teeth. A review.
Classification by origin and structure of the many different coatings which occur on the surfaces of teeth and artificial surfaces exposed to the oral environment necessitate a revision of the terminology used to describe these coatings. Numerous gaps still exist in our understanding of the origin, morphological structure and chemical composition of many of these structures, notably the ones in the "acquired" category. The proposed classification of surface coatings, although not definitive, may provide a more accurate categorization of these structures in the light of contemporary knowledge.
Dental Cementum↗