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Biomedical subjects

Daniel J Caplan

Publications and source records attributed to Daniel J Caplan.

At least 19 recordsLinked to original sources
PubMed2006

In vitro assessment of cone beam local computed tomography for proximal caries detection.

OBJECTIVES: To compare the accuracy of local computed tomography (LCT) and conventional radiography for proximal caries detection and depth assessment. STUDY DESIGN: An in vitro model was used consisting of 20 extracted posterior teeth with 18 caries lesions. Local computed tomography slices were reconstructed in axial and parasagittal planes from 100 basis projections. Conventional radiographs were also acquired. Eight observers determined the presence and depth of caries lesions. Receiver operating characteristic analysis and weighted kappa statistics were used. RESULTS: Local computed tomography had a mean A(z) score of 0.82 (SD = 0.07) and conventional radiography of 0.79 (SD = 0.08; analysis of variance: P > .05). Interobserver agreement was moderate. The mean kappa for depth assessment was 0.68 (SD = 0.06) for LCT and 0.47 (SD = 0.08) for conventional radiography (analysis of variance: P < .05). Local computed tomography resulted in substantial and conventional radiography in moderate interobserver agreement. CONCLUSIONS: There is no difference between LCT and conventional radiography for proximal caries detection. Local computed tomography was more accurate for assessing caries lesion depth.

Adult↗
PubMed2006

Predictors of root canal treatment in teeth with full coverage restorations.

This case-control study sought to identify variables predictive of subsequent root canal therapy (RCT) in teeth receiving full coverage restorations. The University of North Carolina School of Dentistry's computerized treatment database was used to identify all patients receiving a single-unit crown on a nonendodontically treated permanent tooth from January 1, 1998 through December 31, 2002. These patients then were classified either as cases (those whose crowned teeth received RCT before July 1, 2004) or controls (those whose crowned teeth did not). Computerized data, chart entries, and dental radiographs were examined to determine pre-, intra-, and postoperative factors of interest. In the final multivariable logistic regression model that included 66 cases and 71 controls, younger age (p = 0.005) and greater extent of coronal and root destruction (p = 0.020) remained statistically significant predictors of case status, though many potentially important predictors were unavailable through chart review. Patients could benefit if prospective studies were conducted to identify factors predictive of subsequent endodontic involvement in newly crowned teeth.

Age Factors↗
PubMed2006

Detection and quantitation of E. faecalis by real-time PCR (qPCR), reverse transcription-PCR (RT-PCR), and cultivation during endodontic treatment.

Enterococcus faecalis is frequently recovered from refractory endodontic infections and has been implicated in endodontic treatment failures. This study compared real-time quantitative PCR (qPCR) assay to cultivation for E. faecalis detection and quantitation during endodontic treatment. A reverse-transcription PCR (RT-PCR) assay was also developed to detect the bacterium clinically in the viable but nonculturable (VBNC) state. Intra-canal samples (n = 87) were collected upon access, post-instrumentation/irrigation and postcalcium hydroxide treatment from 15 primary and 14 refractory infections involving 29 single-rooted teeth, and analyzed by the three methods. The bacterium was up to three times more prevalent in refractory than primary infections at each collection step. Overall, qPCR detected significantly more E. faecalis-positive teeth and samples than cultivation (p < 0.001). VBNC E. faecalis was detected by RT-PCR in four samples that were negative by cultivation. These findings support qPCR and RT-PCR as more sensitive methods than cultivation for detecting E. faecalis in endodontic infections.

DNA, Bacterial↗
PubMed2006

Reducing the bias of probing depth and attachment level estimates using random partial-mouth recording.

OBJECTIVES: To evaluate the bias and precision of probing depth (PD) and clinical attachment level (CAL) estimates of random and fixed partial examination methods compared with full-mouth examinations. METHODS: PD and CAL were calculated on six sites for up to 28 teeth (considered to be the gold standard with no bias) and three fixed-site selection methods (FSSMs) that resulted in a partial examination of sites: the Ramfjord method, and the NIDCR methods used in NHANES I, and NHANES 2000. Finally, seven random-site selection methods (RSSMs) were created by sampling the following number of sites: 84, 42, 36, 28, 20, 15, 10 and 6. To compare bias and precision of the methods we calculated percent relative bias and relative error. RESULTS: Estimates of means, standard deviations (SD), relative bias and relative error for RSSMs were almost identical to the full-mouth examination, but SDs increase slightly when fewer than 28 sites were sampled and relative bias and error increase for methods sampling fewer than 20 sites. The FSSMs had very low relative error, but much higher relative bias indicating underestimation. The FSSM with the smallest bias and error was the Ramfjord method, but the Random 36 method had less bias and less relative error. The NHANES 2000 method was the FSSM with the lowest bias and relative error for estimates of Extent Scores (percent of sites > or =3, 4, 5, or 5 mm PD or CAL) but random methods sampling fewer sites performed just as well. Both FSSMs and RSSMs underestimated prevalence, especially prevalence of less frequently occurring conditions, but most RSSMs were less likely to underestimate prevalence than the FSSMs. CONCLUSION: The promise of reducing bias and increasing precision of the estimates support the continued development and examination of RSSMs.

Aged↗
PubMed2006

The cost-effectiveness of large amalgam and crown restorations over a 10-year period.

OBJECTIVE: To assist clinical decision making for an individual patient or on a community level, this study was done to determine the differences in costs and effectiveness of large amalgams and crowns over 5 and 10 years when catastrophic subsequent treatment (root canal therapy or extraction) was the outcome. METHODS: Administrative data for patients seen at the University of Iowa, College of Dentistry for 1735 large amalgam and crown restorations in 1987 or 1988 were used. Annual costs and effectiveness values were calculated. Costs of initial treatment (large amalgam or crown), and future treatments were determined, averaged and discounted. The effectiveness measure was defined as the number of years a tooth remained in a state free of catastrophic subsequent treatment. Years free of catastrophic treatment were averaged, and discounted. The years free of catastrophic treatment accounted for individuals who dropped out or withdrew from the study. RESULTS: Teeth with crowns had higher effectiveness values at a much higher cost than teeth restored with large amalgams. The cost of an addition year free of catastrophic treatment for crowns was 1088.41 dollars at 5 years and 500.10 dollars at 10 years. Teeth in women had more favorable cost-effectiveness ratios than those in men, and teeth in the maxillary arch had more favorable cost-effectiveness ratios than teeth in the mandibular arch. CONCLUSIONS: Neither the large amalgam or crown restoration had both the lowest cost and the highest effectiveness. The higher incremental cost-effectiveness ratio for crowns should be considered when making treatment decisions between large amalgam and crown restorations.

Adult↗
PubMed2006

Treating cervical dentin hypersensitivity with fluoride varnish: a randomized clinical study.

BACKGROUND: This subject-blind randomized clinical trial tested the efficacy of a new 5 percent sodium fluoride varnish (AllSolutions Fluoride Varnish, Dentsply Professional, York, Pa.) for treatment of cervical dentin hypersensitivity. The authors also compared the test varnish with a control fluoride varnish (Duraphat, Colgate Oral Pharmaceuticals, New York City). METHODS: The study involved application of the test or control varnish to 19 subjects (59 teeth) with tooth sensitivity. The authors applied each product once to each tooth, following manufacturers' instructions. They used a visual analog scale (VAS) to assess subjects' responses to compressed air and ice stimuli at six weeks before baseline, at baseline and at two, eight and 24 weeks after treatment. RESULTS: Mean VAS scores for teeth receiving the test varnish dropped from 34.9 (air) and 68.0 (ice) at baseline to 26.3 (air) and 54.7 (ice) at two weeks after treatment. Mean scores at 24 weeks were 20.6 (air) and 34.8 (ice), representing statistically significant differences from baseline values. For the control varnish, mean VAS scores dropped from 36.9 (air) and 64.2 (ice) at baseline to 32.9 (air) and 47.2 (ice) at two weeks, and to 20.8 (air) and 40.3 (ice) at 24 weeks. The authors analyzed the data for statistical significance, accounting for clustering of teeth within subjects. CONCLUSION AND CLINICAL IMPLICATIONS: The test varnish was effective in reducing cervical dentin hypersensitivity. However, the efficacy was not significantly different from that of the control varnish.

Adolescent↗
PubMed2005

Incidence of oral candidiasis and oral hairy leukoplakia in HIV-infected adults in North Carolina.

OBJECTIVES: To establish incidence rates and risk factors for HIV-associated oral candidiasis (OC), oral hairy leukoplakia (OHL), and any HIV-associated oral diseases (HIV-OD). DESIGN: This prospective, cumulative case-control study followed 283 initially oral disease-free HIV-1-infected men and women for 2 years. Incidence rate ratios (IRR) and incidence proportions for OC, OHL, and HIV-OD were estimated. Multivariable analyses using Poisson regression determined the most parsimonious best-fitting model explaining the outcomes. RESULTS: Incidence rate (per 1000 person-months) was 9.3 for OC, 6.8 for OHL, and 13.5 for HIV-OD. Incidence of OC was associated with low CD4 count (adjusted IRR = 3.0 (95% CI = 1.7, 5.1)), smoking (IRR = 1.9 (1.0, 3.8)) and combination antiretroviral therapy (IRR = 0.3 (0.1, 0.8)). Incidence of OHL was associated with low CD4 count, conditional upon smoking status. Conclusions Low CD4 count and smoking are important risk factors for HIV-associated OC and OHL. Antiretroviral medications are protective for OC but not for OHL.

AIDS-Related Opportunistic Infections↗
PubMed2005

Risk indicators for oral candidiasis and oral hairy leukoplakia in HIV-infected adults.

OBJECTIVES: Oral candidiasis (OC) and oral hairy leukoplakia (OHL) are the most common oral mucosal diseases associated with HIV infection. Independent risk indicators associated with these sentinel opportunistic diseases have not been established in mixed race and gender adult populations in the southeast USA. The purposes of this study were 1) to estimate prevalence of OC and OHL among an HIV-1 positive adult population, and 2) to develop explanatory multivariable models for each disease outcome. METHODS: This cross-sectional study evaluated 631 adult dentate HIV-1 seropositive persons examined for HIV-associated oral mucosal diseases between 1995 and 2000 at University of North Carolina Hospitals in Chapel Hill, North Carolina using data collected from medical record review, interview questionnaire and clinical examination. We analyzed the data using t-tests, anova, and unconditional logistic regression. RESULTS: Prevalent OC was associated with low CD4+ cell count [<200 cells/microl, adj. OR = 12.7 (95%CI: 4.9-32.9)], antiretroviral combination therapy [OR = 0.6 (0.3-0.9)], and current smoking [OR = 2.5 (1.3-4.8)]. Prevalent OHL was associated with low CD4+ cell count [<200 cells/microl, OR = 7.2 (2.7-18.9)], antifungal medication use [OR = 1.8 (1.1-2.9)], current recreational drug use [OR = 2.5 (1.3-4.9)], and male gender [OR = 2.5 (1.3-4.8)]. CONCLUSIONS: While CD4+ cell count, and antiretroviral medication were important risk indicators for OC, and OHL, cigarette smoking appears to be an important risk indicator for OC in HIV-1-infected populations.

AIDS-Related Opportunistic Infections↗
PubMed2005

Root canal filled versus non-root canal filled teeth: a retrospective comparison of survival times.

OBJECTIVE: This matched cohort study used data from a large dental HMO in the Pacific Northwest to evaluate the degree to which pulpal involvement and subsequent endodontic therapy affects tooth survival. Root canal filled (RCF) teeth were used as an indicator of pulpal involvement. Our hypothesis was that RCF teeth would be extracted sooner than non-RCF teeth matched within subjects, controlling for tooth-level variables of interest. METHODS: The HMO's treatment databases and a subsequent chart audit were used to identify 202 eligible subjects, each of whom had one tooth endodontically treated in 1987-88 and a similar contralateral tooth that was non-RCF at that time. Both teeth were followed from the endodontic access date through the extraction date, the endodontic access date (for initially non-RCF teeth), or 12/31/94, whichever was earliest. Time-to-event analyses were carried out, with Kaplan-Meier curves generated and multivariable marginal proportional hazards regression models fitted to describe the effect of RCF status on tooth survival. All statistical analyses accounted for the complex sampling strategy used in generating the dataset. RESULTS: Teeth were followed for up to eight (median = 6.7) years. RCF teeth had substantially worse survival than their non-RCF counterparts (p < 0.001), with a greater effect of RCF status evident among molars than non-molars. Adjusted hazard ratios (95% confidence intervals) for loss of RCF versus non-RCF molars and non-molars were 7.4 (3.2-15.1) and 1.8 (0.7-4.6), respectively. CONCLUSION: Though endodontic therapy can prolong tooth survival, pulpal involvement still may hasten tooth loss, underscoring the importance of caries prevention and prompt restorative care.

Adult↗
PubMed2005

Teeth with large amalgam restorations and crowns: factors affecting the receipt of subsequent treatment after 10 years.

BACKGROUND: The authors evaluated the factors associated with the receipt of subsequent treatment by teeth restored with a large amalgam restoration or a large amalgam restoration and crown restoration after 10 years. METHODS: The authors used retrospective data from the University of Iowa College of Dentistry (Iowa City, Iowa) administrative database and patient records to evaluate patient and tooth factors for their association with the two primary outcomes: receipt of any subsequent treatment and receipt of catastrophic treatment (extraction, endodontic therapy). RESULTS: The authors followed 518 teeth over a 10-year period (49 percent with large amalgam restorations and 51 percent with crowns). Sixty-four percent of the large amalgam restorations and 32 percent of the crowns received subsequent treatment during the 10 years. In addition to restoration type, the patient's sex, history of grinding teeth and having a broken tooth were related to the tooth's receiving subsequent treatment. Twenty-two percent of large amalgam restorations and 12 percent of crowns received catastrophic treatment with the odds of teeth with large amalgam restorations receiving a catastrophic treatment being 2.1 times the odds of teeth with crowns receiving catastrophic treatment. CONCLUSIONS: Teeth with crowns were less likely to receive any treatment or catastrophic treatment over 10 years than were teeth with large amalgam restorations. Patient and tooth factors also were related to a tooth experiencing subsequent treatment. CLINICAL IMPLICATIONS: Teeth with crowns received less subsequent treatment than teeth with large amalgam restorations. This could be related to both the difference in longevity between the two restorations, as well as how appropriately treatment was planned for each procedure. Cost differences between the two restorations need to be factored into the decision-making process.

Adult↗
PubMed2004

Desensitizing agent efficacy during whitening in an at-risk population.

BACKGROUND: Nightguard vital bleaching (NGVB) has gained acceptance among dentists and patients as a simple and effective procedure to lighten discolored teeth. Although the efficacy and predictability of NGVB have been well established, it has been documented that patients undergoing the procedure may experience side effects such as tooth sensitivity (TS) and gingival irritation (GI). A previous NGVB study suggested that selected participants might benefit from a regimen of a desensitizing agent (DSA) to decrease or prevent TS during whitening. PURPOSE: The purpose of this study was to determine whether the daily use of an active DSA (UltraEZ, Ultradent Products Inc., South Jordan, UT, USA) during NGVB would decrease TS in a population at risk for TS when compared with a placebo. MATERIALS AND METHODS: Forty subjects participated in this single-blind randomized clinical trial. All participants had indicated that they had preexisting TS or other risk factors for TS during NGVB. To evaluate TS caused by the tray alone, participants wore custom-fitted maxillary whitening trays containing no DSA or whitening solution during week 1. Next, participants were randomly assigned to apply either the active DSA or placebo daily for 14 days in the trays for 30 minutes prior to whitening. The placebo was the same formulation as UltraEZ but without the desensitizing agents (3% potassium nitrate and 0.11% by weight fluoride ion). The bleaching solution was a 10% carbamide peroxide whitening solution (Opalescence, Ultradent Inc.). Post treatment, participants were followed up for 1 week, during which time they used neither trays nor solutions. Throughout the study, participants completed a daily diary to record their perceptions of TS and the time spent wearing the tray with the whitening solution. RESULTS: Forty-one percent of the active group had at least 1 day of TS during treatment compared with 78% of the placebo group. The difference was statistically significant (p = .027) using the two-tailed Fisher exact test. CLINICAL SIGNIFICANCE: This study suggests that the use of an active 3% potassium nitrate and 0.11% fluoride desensitizing agent for 30 minutes prior to whitening may decrease tooth sensitivity when compared with a placebo in a population at risk for tooth sensitivity.

Administration, Topical↗
PubMed2004

Salivary secretory leukocyte protease inhibitor and oral candidiasis in human immunodeficiency virus type 1-infected persons.

Oropharyngeal candidiasis, typically caused by Candida albicans, is the most common oral disease associated with human immunodeficiency virus type 1 (HIV-1) infection. Secretory leukocyte protease inhibitor (SLPI), a 12-kDa antiprotease, suppresses the growth of C. albicans in vitro. To determine whether the mucosal protein plays a role in protecting oral tissues against fungal infection, we conducted a cross-sectional study investigating the oral and systemic health and salivary SLPI levels in 91 dentate HIV-1-infected adults receiving medical care in the southeastern United States. Participants with a self-reported history of clinical oropharyngeal candidiasis during the previous 2 years constituted the test group (n = 52), while the comparison group (n = 39) had no oropharyngeal candidiasis during that period. Data collected from medical records, oral examination, and SLPI enzyme-linked immunosorbent assay quantitation of whole saliva were analyzed by t test, analysis of variance, linear regression, and unconditional logistic regression. The test group had a significantly higher mean salivary SLPI level than the comparison group (1.9 microg/ml versus 1.1 microg/ml, P < 0.05). Linear regression modeling identified CD4 cell count and history of oropharyngeal candidiasis as key predictors of salivary SLPI and revealed a significant interaction (P < 0.05) between immunosuppression (CD4 cell count below 200 cells/ microl) and positive history of oropharyngeal candidiasis in predicting salivary SLPI level. By logistic regression modeling, a salivary SLPI level exceeding 2.1 microg/ml, low CD4 count, antiretroviral monotherapy, and smoking were key predictors of oropharyngeal candidiasis. These data support a key role for SLPI in the oral mucosal defense against C. albicans. The antimicrobial mucosal protein may serve as an indicator of previous oropharyngeal candidiasis infection among immunosuppressed persons.

AIDS-Related Opportunistic Infections↗
PubMed2003

Usefulness of AgNOR counts in diagnosing epithelial dysplasia.

BACKGROUND: Diagnosis of epithelial dysplasia has traditionally been subjective, and there is a need for a quantifiable and useful test. METHODS: In a double blind study, clinical leukoplakias from 52 people were diagnosed for presence (DLK) or absence (NDLK) of epithelial dysplasia using hematoxylin and eosin (H&E) stain as a gold standard criterion, and results were compared against their mean silver stainable nucleolar organizer region (AgNOR) counts. We used mean AgNOR count cut-point of 2.37 from our prior report as the diagnostic threshold (mean >or= 2.37 being DLK and mean < 2.37 being NDLK). RESULTS: The two methods (H&E and AgNOR) disagreed in 37% of the diagnoses. Both NDLK and DLK had high AgNOR counts. P-AgNOR was non-contributory for diagnosing epithelial dysplasia. CONCLUSIONS: Mean AgNOR count can be a useful tool in definitive diagnosis of epithelial dysplasia.

Analysis of Variance↗
PubMed2003

Nightguard vital bleaching of tetracycline-stained teeth: 90 months post treatment.

PURPOSE: The purpose of this longitudinal whitening study was to determine the stability, post-treatment side effects, and patient satisfaction at 90 months post treatment after 6 months of active treatment of tetracycline-stained teeth with 10% carbamide peroxide. MATERIALS AND METHODS: Fifteen of 21 participants enrolled in the study (71%) were contacted and asked to participate in a survey concerning their whitening experience. Participants were asked whether there had been any change in the shade of their teeth after treatment and if they had experienced any side effects that they believed were treatment related. Eight of the 15 participated in a clinical examination. RESULTS: Nine participants (60%) reported no obvious shade change or only a slight darkening not noticed by others. None reported darkening back to the original shade; however, four had re-treated their teeth. Examiners were in agreement with the participants' perception of shade change upon comparing pretreatment and post-treatment photographs and Vita shade (Vita Zahnfabrik D-79713, Bad Sackingen, Germany) values. The degree of improvement over the pretreatment shade was significant for the 90-month post-treatment shade (p < .01). All respondents (n = 15) denied having to have a crown or root canal or tooth sensitivity that they believed was treatment related. CLINICAL SIGNIFICANCE: The results of this study of nightguard vital bleaching indicate that tetracycline-stained teeth can be whitened successfully using extended treatment time and that shade stability may last at least 90 months post treatment (range 84-100 mo). Patients participating in this study were over-whelmingly positive about the procedure in terms of shade retention and lack of post-treatment side effects.

Adult↗
PubMed2002

AgNOR count as objective marker for dysplastic features in oral leukoplakia.

BACKGROUND: Dysplasia is an important feature of leukoplakia. Because agreement among oral pathologists is poor regarding lesional diagnosis, silver stainable nucleolar organizer regions (AgNORs) as replicatory markers may have a place in objectively characterizing dysplasia in tissue specimens. METHODS: We studied 41 normal oral epithelia, 51 oral leukoplakia (26 dysplastic, 25 non-dysplastic), and 51 cases of squamous cell carcinoma specimens for their mean AgNOR counts. RESULTS: Mean AgNOR counts increased gradually from normal epithelium to non-dysplastic to dysplastic leukoplakia to squamous cell carcinoma. Using ROC analysis, we determined a mean AgNOR count cut-point (2.37) that can be used to distinguish between dysplastic and non-dysplastic leukoplakia. The test had a sensitivity of 75% and specificity of 83% with area under the curve being 88%. CONCLUSIONS: Mean AgNOR count could be a valuable criterion for defining objective parameters for diagnosis/determination of dysplasia distinguishing between dysplastic and non-dysplastic leukoplakia.

Analysis of Variance↗
PubMed2002

Relationship between crown placement and the survival of endodontically treated teeth.

STATEMENT OF PROBLEM: Crowns have been considered the restoration of choice for endodontically treated teeth, but their selection has been based primarily on anecdotal evidence. PURPOSE: This study tested the hypothesis that crown placement (coronal coverage) is associated with improved survival of endodontically treated teeth when preaccess, endodontic, and restorative factors are controlled. MATERIAL AND METHODS: A University of Iowa College of Dentistry treatment database was used to identify permanent teeth that had undergone initial obturation between July 1, 1985, and December 31, 1987. Study patients were restricted to persons with at least 1 dental visit in each 2-year interval from 1985 to 1996; a simple random sample of 280 patients (n = 400 teeth) was selected. Dental charts, radiographs, and computerized databases were examined to ascertain variables of interest and to verify study inclusion criteria. Kaplan-Meier survival estimates were generated for the 203 teeth that satisfied study inclusion criteria. Multivariate Cox proportional hazards regression models were developed, with standard errors adjusted to account for clustering of teeth within patients. RESULTS: When tooth type and radiographic evidence of caries at access were controlled, the final Cox model showed that endodontically treated teeth not crowned after obturation were lost at a 6.0 times greater rate than teeth crowned after obturation (95% confidence interval: 3.2 to 11.3). CONCLUSION: Within the limitations of this study, a strong association between crown placement and the survival of endodontically treated teeth was observed. These results may impact treatment planning if long-term tooth retention is the primary goal.

Aged↗
PubMed2002

Safety issues when using a 16% carbamide peroxide whitening solution.

BACKGROUND: The scientific literature is lacking on the occurrence of side effects and other safety issues when using carbamide peroxide whitening solutions of concentrations greater than 10%. This double-blind nightguard vital bleaching study compares safety issues when using 16% carbamide peroxide against a placebo or 10% carbamide peroxide (Nite White Classic by Discus Dental Inc.). Evaluated were changes in gingival index, plaque index, nonmarginal gingival index, nongingival oral mucosal index, tooth vitality, and the patients' perceptions of tooth sensitivity and gingival irritation. MATERIALS AND METHODS: Twenty female dental hygiene students participated in the study. Each participant wore a maxillary treatment tray for 1 week without any solution and then for 8 to 10 hours per night for 14 nights, filling each quadrant with placebo, 10% carbamide peroxide, or 16% carbamide peroxide, using a split tray design. RESULTS: With respect to gingival index, plaque index, nonmarginal gingival index, nongingival oral mucosa index, tooth vitality, and tooth sensitivity, there were no statistically significant differences between the 16% carbamide peroxide solution and the other two solutions (p > .05). Quadrants receiving the 16% carbamide peroxide solution experienced more gingival irritation than quadrants receiving placebo or 10% carbamide peroxide solution (p > .05). CONCLUSIONS: When evaluating the above-mentioned safety issues, except for gingival irritation, there were no statistically significant differences between a 16% carbamide peroxide solution and 10% carbamide peroxide solution or a placebo when used as described here. CLINICAL SIGNIFICANCE: Among the 20 participants whose data were analyzed, it was found that a 16% carbamide peroxide whitening solution (Nite White Classic), when used as described in this study, can be effective in nightguard vital bleaching with no statistical differences in gingival index, plaque index, nonmarginal gingival index, nongingival oral mucosa changes, tooth vitality, or tooth sensitivity, compared with a 10% whitening solution (Nite White Classic). More gingival irritation was experienced with 16% carbamide peroxide. Additionally, 20% of the participants in this study self-reported sensitivity when wearing their treatment tray without any solution, and 36% of the participants reported sensitivity to the placebo solution.

Adult↗