Critical appraisal: tooth whitening in children and adolescents.
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Journal Article↗
Biomedical subjects
Kevin J Donly
Publications and source records attributed to Kevin J Donly.
Glass ionomer cement restorations for contemporary pediatric dentistry.
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Child↗
Remineralization effects of a sodium fluoride bioerodible gel.
PURPOSE: To evaluate the effectiveness of a 5% sodium fluoride (NaF) bioerodible gel to remineralize demineralized enamel. METHODS: Artificial enamel lesions were created at the gingivofacial surface of 36 extracted teeth. Longitudinal sections were obtained through the lesions, photographed under polarized light microscopy, and the demineralized areas were quantitated. Sections were painted with an acid-protective varnish, leaving only the facial surface of the enamel lesion exposed, and positioned naturally into the tooth from which they were obtained. Teeth were randomly mounted in sets of four that simulated a natural anterior arch form. Equal numbers were subjected to a NaF gel, control gel dr received no treatment, with the gel being placed and retained by the interproximal embrasures of the teeth. Following 30 days exposure to artificial saliva, the lesions were photographed and quantitated in the same manner as prior to treatment. RESULTS: The NaF gel showed significantly more remineralization than the control groups (P< 0.05), with a 68.9% (+/- 17.7) mean lesion remineralization.
Analysis of Variance↗
Contemporary pediatric restorative dentistry.
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Child↗
Potential remineralization of demineralized enamel after application of fluoride varnish.
PURPOSE: To evaluate remineralization effects of a topical fluoride varnish applied over a caries-like lesion compared to around a caries-like lesion. METHODS: Caries-like lesions were created on 30 molar surfaces. Sections were cut through each lesion, photographed under polarized light microscopy, and quantitated with a computerized imaging system. The sections were repositioned with only the lesion exposed. Half were painted with a 5% NaF varnish, including the surface of lesion. The remaining half were painted excluding the surface of the lesion. The sections were placed in artificial saliva for 30 days, re-photographed and re-quantitated. RESULTS: Using a student t-test for analysis, the results demonstrated the mean (+/- S.E.) percent remineralization of lesion size to be 10.8 (4.8) for lesions completely covered by the fluoridated varnish and 9.5 (2.9) for lesions that had the fluoridated varnish surrounding the lesion. Both application techniques indicated remineralization effects, yet there was no significant difference between the two application techniques evaluated in this study (P < 0.05). The data from this in vitro study indicated that there was no significant difference in methods of application for fluoridated varnish. Both application techniques demonstrated effective remineralization.
Cariostatic Agents↗
Fluoride varnishes.
Fluoride varnishes are available in the United States, and the Federal Drug Administration has approved a fluoride varnish for use as a cavity preparation lining varnish and as a tooth desensitizing agent. The literature, however, supports the use of fluoride varnishes to inhibit tooth demineralization and enhance remineralization. The purpose of this paper is to present an overview of literature and make recommendations according to the available scientific evidence. Findings support the use of fluoride varnishes as a safe and effective topical fluoride agent.
Cariostatic Agents↗
Caries management by risk assessment: consensus statement, April 2002.
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Adolescent↗
The adolescent patient: special whitening challenges.
Vital tooth bleaching has become increasingly popular, even with the adolescent patient. Tooth whitening may be performed in adolescent patients with typical bleaching agents; with severe discolorations, it may be more appropriate to use the microabrasion technique with subsequent bleaching to achieve desirable esthetics.
Adolescent↗
Enamel demineralization inhibition by cements at orthodontic band margins.
PURPOSE: To examine the demineralization inhibition effects of glass ionomer cement and polyacid-modified resin-based composite cement, in comparison to non-fluoride releasing zinc phosphate cement. METHODS: Twenty-seven extracted molars were obtained and randomly assigned to three groups. An orthodontic band was sized and cemented using one of three cements. The teeth were painted with an acid-protective varnish, excluding a 1 mm area gingival to the orthodontic band. The teeth were placed in separate closed environments of a non-fluoridated acid challenge to induce demineralization for 5 days. The teeth were then sectioned two times buccolingually and two times mesiodistally. The sections were photographed with polarized light microscopy in an imbition media of water. The body of each lesion was measured with a computerized imaging system. The areas of the lesions, from each cement group, were compared. RESULTS: An analysis of variance (ANOVA) indicated significance in variance among groups (P < 0.001). Results of a multiple comparison analysis demonstrated significantly less demineralization adjacent to the glass ionomer cement group compared with the polyacid-modified resin cement group and non-fluoride releasing zinc phosphate control group (P < 0.05). There was no significant difference in adjacent demineralization inhibition between the zinc phosphate cement group and polyacid-modified resin cement group (P < 0.05).
Analysis of Variance↗
Tooth whitening in children.
Although there are several case reports of vital tooth bleaching in children, there is limited clinical trial evidence of the safety or efficacy of this practice. Accordingly, a new clinical trial was conducted to evaluate the effects of 2 different bleaching systems, a 6.5% hydrogen peroxide strip system and a 10% carbamide peroxide tray system, in a population of preteens and teens. A total of 106 volunteers, aged 11 to 18 years, took part in this 8-week study. Patients were randomized by a ratio of 2:1 to the strip or tray groups, with each group treating the maxillary arch first and then the mandibular arch for 4 consecutive weeks each. Individuals assigned to the strip group used the system twice daily for 30 minutes (a total of 56 contact hours over the 8-week study). Those assigned to the tray group used that system overnight (approximately 448 contact hours). Digital images were obtained at baseline and after every 2-week treatment period. Average tooth color was determined in L*, a*, b* color space, where L* indicated lightness, a* indicated red-green, and b* indicated yellow-blue. Both systems significantly whitened teeth (P < 0.0001). While there were no significant differences between groups with respect to the primary whitening response (delta b*) on the maxillary teeth, 4 weeks of overnight treatment with the 10% carbamide peroxide tray (approximately 224 contact hours) yielded statistically significant whitening (P < 0.05) on the mandibular teeth compared with the 6.5% hydrogen peroxide strip used for 28 hours. Both tooth-whitening systems had similar sensitivity/irritation reported after instructed use. This research demonstrates that tooth whitening in teens may be safely accomplished using either the short-contact-time hydrogen peroxide bleaching strips or the overnight carbamide peroxide tray systems tested in this study.
Adolescent↗
Fluoride release and caries inhibition associated with a resin-modified glass-ionomer cement at varying fluoride loading doses.
PURPOSE: To measure, over time, the release of fluoride from a resin-modified glass-ionomer cement, loaded with different levels of fluoride, then to evaluate the adjacent dentin demineralization inhibition relative to these fluoride levels. MATERIALS AND METHODS: (Phase I) 25 standardized discs were fabricated from a non-fluoridated resin-based composite (control), resin-modified glass-ionomer cement and resin-modified glass-ionomer cement loaded with sodium fluoride at 1%, 2% and 3% by weight fluoride. Fluoride release was evaluated over 30 days. (Phase II) 50 restorations, from the materials listed in Phase I, were placed as Class V restorations in teeth, the teeth were acid-challenged, then dentin margins adjacent to restoration margins were evaluated for demineralization. RESULTS: As sodium fluoride additions increased, fluoride release increased. Evaluation of demineralization indicated the resin-modified glass-ionomer cement inhibited adjacent demineralization in a direct relationship with sodium fluoride concentration where 3% fluoride exhibited significantly less adjacent demineralization than all other groups; 2% and 1% fluoride exhibited significantly less adjacent demineralization than the non-loaded resin-modified glass-ionomer cement and non-fluoridated resin-based composite control (P< 0.05).
Acid Etching, Dental↗
Dental plaque removal with a novel battery-powered toothbrush.
PURPOSE: To compare the plaque removal efficacy of a positive control power toothbrush (Oral-B Ultra Plaque Remover) to an experimental power toothbrush (Crest SpinBrush) following a single use. MATERIALS AND METHODS: This study was a randomized, controlled, examiner-blind, 2-period crossover design which examined plaque removal with the two toothbrushes following a single use in 38 completed subjects. Plaque was scored before and after brushing using the Turesky Modification of the Quigley-Hein Index. RESULTS: Baseline plaque scores were 1.89 and 1.91 for the experimental toothbrush and control toothbrush treatment groups, respectively. With respect to all surfaces examined, the experimental toothbrush delivered an adjusted (via analysis of covariance) mean difference between baseline and post-brushing plaque scores of 0.46 while the control toothbrush delivered an adjusted mean difference of 0.45. These results were not statistically significant (P=0.645). A 95% one-sided upper confidence limit on the Ultra Plaque Remover minus SpinBrush difference in amount of plaque removed was calculated as 9.4% of the Ultra Plaque Remover adjusted mean. A common criterion for what is known as an "at least as good as" test is that the 95% one-sided confidence limit on the product difference is below 10% of the control product mean. Using this criterion, the SpinBrush is at least as good as the Oral-B Ultra Plaque Remover. With respect to buccal and lingual surfaces, the experimental toothbrush delivered very similar results relative to the control toothbrush. These results were also not statistically significant (P> 0.564).
Adult↗
Dental plaque removal with two battery-powered toothbrushes.
PURPOSE: To compare the plaque removal efficacy of a positive control power toothbrush (Colgate Actibrush) to an experimental power toothbrush (Crest SpinBrush) following a single use. MATERIALS AND METHODS: This study was a randomized, controlled, examiner-blind, 4-period crossover design which examined plaque removal with the two toothbrushes following a single use in 39 completed subjects. Plaque was scored before and after brushing using the Turesky Modification of the Quigley-Hein Index. RESULTS: Baseline plaque scores averaged 2.18 and 2.16 for the experimental toothbrush and control toothbrush treatment groups, respectively. With respect to all surfaces examined, the experimental toothbrush delivered an adjusted (via analysis of covariance) mean difference between baseline and post-brushing plaque scores of 0.66 while the control toothbrush delivered an adjusted mean difference of 0.43. This represents an increase of 55% plaque removal relative to the control power toothbrush. The difference between brushes was statistically significant (P < 0.001). With respect to buccal and lingual surfaces, the experimental toothbrush delivered very consistent results relative to the control toothbrush. The differences between brushes were also statistically significant (P < 0.001).
Adolescent↗
Clinical trials on the use of whitening strips in children and adolescents.
Vital tooth bleaching is becoming increasingly popular. Both professionally supervised and over-the-counter tooth whitening systems are being utilized. Recently, a tooth whitening system became available where a gel containing hydrogen peroxide was delivered via a flexible polythene strip. Three clinical trials were conducted using whitening strips to treat tooth discoloration on 132 children and adolescents. Results indicated the strip bleaching system to be an effective means for tooth whitening. Minimal sensitivity was associated with this whitening system, with most of the reported sensitivity being noted as mild. All sensitivity was relieved upon discontinuance of the whitening agent.
Adolescent↗
In vivo dental plaque pH variation with regular and diet soft drinks.
PURPOSE: Despite the presence or absence of artificial sweeteners in cola drinks, both regular and diet soft drinks still contain phosphoric and citric acid, which contributes to the total acidic challenge potential on enamel. The purpose of this study was to assess the plaque pH, in vivo, after a substrate challenge of diet and regular soft drinks. METHODS: Seventeen subjects were recruited for this study. All subjects were between the ages of 12 and 15 and had at least 4 restored tooth surfaces present. The subjects were given consent by their parents and were asked to refrain from brushing for 48 hours prior to the study. At baseline, plaque pH was measured from 4 separate locations using touch electrode methodology. Each subject was then randomly assigned to one of two groups. The first group was exposed to regular Coke followed by Diet Coke, while the second group was exposed to Diet Coke followed by regular Coke. Subjects were asked to swish with 15 ml of the respective soft drink for one minute. Plaque pH was measured at the 4 designated tooth sites at 5-, 10- and 20-minute intervals. Subjects then repeated the experiment using the other soft drink. RESULTS: The results showed that regular Coke had significantly more acidic plaque pH values at the 5-, 10- and 20-minute intervals compared to Diet Coke, (P = < .001), when subjected to a t test. The mean pH at 5 minutes for Coke and Diet Coke was 5.5 +/- 0.5 and 6.0 +/- 0.7, respectively. At 10 minutes, the pH for Coke and Diet Coke was 5.6 +/- 0.6 and 6.2 +/- 0.7, respectively. The pH at 20 minutes for Coke and Diet Coke was 5.7 +/- 0.7 and 6.5 +/- 0.5, respectively. CONCLUSIONS: These data suggest that regular Coke possesses a greater acid challenge potential on enamel than Diet Coke. However, in this clinical trial, the pH associated with either soft drink did not reach the critical pH which is expected for enamel demineralization and dissolution.
Adolescent↗
Dentin/enamel adhesives in pediatric dentistry.
The improvements in adhesives and composite technology have made resin-based composite resins and polyacid-modified resin-based composites (compomers) very popular as materials to restore primary and permanent anterior and posterior teeth. More conservative preparations can be performed maintaining more tooth structure due to the adhesive properties of the adhesives used with composites and compomers. Meticulous care in the placement of adhesives and, subsequently, resin-based composites and compomers is necessary to produce long-term satisfactory results.
Acid Etching, Dental↗
The use of resin-based composite in children.
Resin-based composites are an integral component of contemporary pediatric restorative dentistry. They can be utilized effectively for preventive resin restorations, moderate Class II restorations, Class III restorations, Class IV restorations, Class V restorations and strip crowns. Tooth isolation to prevent contamination is a critical factor, and high-risk children may not be ideal candidates for resin-based composite restorations. Important factors to consider during composite placement are isolation, polymerization shrinkage and extent of restoration. When utilized correctly, resin-based composites can provide excellent restorations in the primary and permanent dentition.
Child↗
Sealants: where we have been; where we are going.
Sealants are a critical component to the restorative dentistry armamentarium. The introduction of the acid-etch technique has made the sealing of occlusal surfaces effective. Rather than waiting for an occlusal surface to break down to the extent that an occlusal Class I amalgam restoration is indicated, extending preparations to include all caries-susceptible pits and fissures, an occlusal sealant can be placed to prevent caries. Sealants have been shown to be effective when used alone over acid-etched enamel or in conjunction with a methacylate-containing adhesive. Pit and fissure caries can be restored conservatively using resin composite or amalgam, utilizing sealant to prevent future caries. The increasing use of direct and indirect resin composites for Class I and Class II restorations includes the use of sealants over restoration margins and polished resin composite. A newly developed sealant, Clinpro, extends to all pits and fissures that are desirable to seal and is efficient and effective to place.
Acid Etching, Dental↗