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PubMed2003

A clinical pilot study of the time-dependent composition of tooth bleaching systems.

This pilot study was undertaken to determine the compositional changes in tooth bleaching materials as a function of time in vivo. Ten patients were recruited and two bleaching systems were used - one a paste and the other a gel. Each material was placed in a custom bleaching tray and worn by each patient for each of four times - 15, 30, 60 and 120 min. The material was collected and chemically analysed for water by Karl Fischer titration and titrated for carbamide peroxide by the US Pharmacopoeia method. The paste material contained 18.66% water as supplied, and after 2 h this rose to between 28.6 and 64.4%. The gel material contained 2.85% water as supplied, and after 2 h this was diluted to between 28.5 and 73.4%. There was considerable difference in saliva uptake by the custom tray between patients. Most water uptake usually occurred within the first 30 min. Peroxide concentrations decreased in an approximately linear manner with time. There was a significant difference between the materials from baseline to 30 min and thereafter (P < 0.0009). This pilot study is an effective technique for chemical evaluation of bleaching materials. The effect of saliva is an important factor to consider, and is one that has hitherto not always been appropriately emphasized.

Analysis of Variance↗
PubMed1997

Vital tooth bleaching: sensitivity and pulpal considerations.

For some patients, sensitivity and discomfort follow vital tooth bleaching. Clinical observations, however, suggest these are reversible episodes with no irreversible long-term effects. Using milder peroxide formulations or gels diminishes postoperative discomfort. The author recommends careful treatment when patients have large restorations, cervical erosion or enamel cracks. Fluoride treatment, sealing restorations and premedication may lessen discomfort.

Animals↗
PubMed1997

Vital tooth bleaching with Nightguard vital bleaching.

Between July 1994 and May 1996, several landmark articles were published concerning the safety and efficacy of vital tooth bleaching with 10% carbamide peroxide in a customfitted tray. The American Dental Association (ADA) published guidelines for ADA acceptance, and three products received approval. Long-term clinical trials on 38 patients indicated 92% successful bleaching after 6 weeks of treatment. Results were stable in 74% of the patients at 1.5 years, and in 62% of the patients at 3-year follow-up with no further treatment. Clinical pulpal studies and periodontal studies indicated no detrimental safety problems, although some laboratory cell studies suggested concerns. The noncarcinogenic potential of 10% carbamide peroxide was established in animal studies. Successful bleaching of tetracycline-stained teeth was achieved after 6 months of treatment, with no tooth problems detected clinically or by scanning electron micrograph. Extended treatment times are effective on other stains from dentinogenesis imperfecta or nicotine. On insertion in the mouth, 10% carbamide peroxide elevated the pH in the tray and saliva. After 4 hours of clinical wear, over 60% of the newer, thicker materials (Opalescence [Ultraclent Products, South Jordon, UT] and Platinum [Colgate Oral Pharmaceuticals, Canton, MA]) was present and active in the tray. Nightguard vital bleaching seems to be the most cost-efficient, user-friendly, patient-accepted method of bleaching teeth available to the profession and is safe and effective. Over-the-counter products can have harmful effects on tooth structure and may not lighten teeth.

Carbamide Peroxide↗
PubMed2006

Vital tooth bleaching in dental practice: 1. Professional bleaching.

UNLABELLED: As dental health improves, with the concurrent drop in the provision of basic restorative care, patients are now asking their dentists to provide aesthetic treatments rather than the treatment of disease. Tooth bleaching is one such treatment that is frequently described in consumer magazines and television shows, driving consumer interest in this, apparently, benign therapy. This three-part series demonstrates the techniques that can be employed, within the dental practice or under the supervision of a clinician, those systems that can be bought by patients over the counter and, finally, a discussion of the biological effects of peroxide-containing solutions and the legal position on such products in the UK. In this section, we will describe the common methods by which teeth can be bleached, either by the clinician directly, or under his/her supervision by the use of'at home' kits. Efficacy and safety issues will be described. CLINICAL RELEVANCE: Clinicians should be able to discuss the merits, risks and likely success of a variety of bleaching treatments with their patients and, in doing so, assist in the process of obtaining informed consent.

Dental Devices, Home Care↗
PubMed2005

Surface and intra-pulpal temperature rises during tooth bleaching: an in vitro study.

OBJECTIVE: To measure the surface and intra-pulpal temperature increases in vitro on upper and lower anterior teeth during tooth whitening procedures. METHOD: A thermocouple was used to measure the temperature increase on the surface of an extracted upper central incisor tooth. Intra-pulpal temperature readings were made on upper and lower central incisors, lateral incisors and canines. Four lamps recommended for tooth bleaching were tested; a plasma arc lamp, a xenon-halogen lamp, a standard halogen lamp and a diode laser lamp. Temperature measurements were made with and without the bleaching agent present on the labial tooth surface. RESULTS: The increase in surface temperature readings ranged from 0.44 degrees C (luma arch) to 86.3 degrees C (laser) with no bleaching gel present. Intra-pulpal temperature increases ranged from 0.30 degrees C to 15.96 degrees C. The presence of the bleaching gel reduced temperature increases seen at the tooth surface and within the pulp. CONCLUSIONS: The increase in the intrapulpal temperature with most bleaching lamps was below the critical threshold of a 5.50 degrees C increase thought to produce irreversible pulpal damage. The only lamp that produced an intrapulpal temperature increase above this threshold was the laser-based lamp and caution is advised when using this equipment.

Body Temperature↗
PubMed2004

Effects of the hydroxyl radical and hydrogen peroxide on tooth bleaching.

The mechanisms of bleaching of discolored coronal teeth using hydrogen peroxide (H2O2) were investigated. In a scanning-electron-microscopy study, the intertubular dentin and peritubular dentin were dissolved by high concentrations of H2O2, which is used for bleaching. The X-ray diffraction study showed that hydroxyapatite was not influenced by H2O2. In an electron-spin-resonance study, more hydroxyl radical (* OH) was detected as the H2O2 concentration was increased. When amino acids that are core components of dentin proteins, such as proline and alanine, were added to H2O2, the generation of * OH decreased, but there was no change when glycine was added. A nuclear-magnetic-resonance study showed that proline was degraded completely by H2O2, the structure of alanine changed slightly, and glycine was not affected by H2O2. It is suggested that H2O2 and * OH do not influence the inorganic tissue of dentin but attack the organic component of dentin. These facts suggest that * OH has the main role in tooth bleaching with H2O2.

Alanine↗
PubMed2005

An exposure-based risk assessment approach to confirm the safety of hydrogen peroxide for use in home tooth bleaching.

Hydrogen peroxide has a long history of safe use in a wide variety of medical and consumer products, including oral care products. The use of hydrogen peroxide in tooth bleaching has been extended to home use. Because this represents a new use, questions have been raised regarding safety, particularly the potential for peroxide tooth-whitening products to increase the risk of oral cancer in high-risk individuals (e.g., smokers and drinkers). These concerns are based on limited experimental data in animals that hydrogen peroxide has extremely weak tumor promoting activity and a lack of publicly available data on exposure to peroxides from the home use of tooth-whitening products. This paper provides a weight-of-evidence cancer hazard characterization for hydrogen peroxide and presents a quantitative risk assessment that confirms a favorable human safety profile risk associated with low levels of exposure to hydrogen peroxide from the use of tooth-whitening products. This includes a lack of tumor promotion risk which is important because tooth-whitening products are often used by chronic smokers and drinkers, who may represent a susceptible subpopulation because of their exposure to other known carcinogens.

Alcohol Drinking↗
PubMed2002

Whitening paradigms 1 year later: introduction of a novel professional tooth-bleaching system.

The recent development of a novel "trayless" delivery system for vital bleaching shifted treatment paradigms and spurred surprising growth in tooth whitening. New research on a professional-only system (Crest Professional Whitestrips) further expands treatment options. This easy-to-use hydrogen peroxide strip system represents an effective and safe approach for increased whitening. Clinical applications are extensive, ranging from general, point-of-entry whitening to chronic use in difficult case types.

Humans↗
PubMed2006

Spectrophotometric and visual evaluation of vital tooth bleaching employing different carbamide peroxide concentrations.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). SIGNIFICANCE: 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.

Carbamide Peroxide↗
PubMed2004

Effects of removing residual peroxide and other oxygen radicals on the shear bond strength and failure modes at resin-tooth interface after tooth bleaching.

PURPOSE: To investigate the effects of removing residual peroxide on the bond strength and the failure mode at the interface of resin-based composite and enamel after tooth bleaching. METHODS: Standard-sized light-cured resin cylinders were formed on, and bonded to the flattened bleached enamel surfaces of 60 human canine and premolars which had previously been subjected to three different surface treatments for 3 minutes: (1) catalase; (2) 70% ethanol; (3) sprayed water. For each experimental group (n=12), non-bleached teeth and 2-week post-bleached teeth without any surface treatment were used for negative and positive control respectively. Specimens were thermocycled, tested in shear until failure, and the results statistically analyzed. All fractured specimens were examined by scanning electron microscopy. RESULTS: Pretreatment of bleached surface with the catalase and the ethanol prior to bonding significantly improved the composite-enamel bond strength compared to the water-sprayed group (P< 0.05). However, the bond strength level of the ethanol group did not return to the level recorded for the non-bleached negative control group. Scanning electron microscopic examination of randomly selected, fractured specimens indicated that the peroxide-induced reduction in bond strength was related to alterations in both attachment-surface area at the resin-enamel interface and resin quality.

Analysis of Variance↗
PubMed2004

Effect of light energy on peroxide tooth bleaching.

BACKGROUND: Light-activated bleaching is a method of tooth whitening. The authors conducted a study to compare the whitening effects and tooth temperature changes induced by various combinations of peroxide bleaches and light sources. METHODS: The authors randomly assigned 250 extracted human teeth halves into experimental groups (n = 10). A placebo gel (control), a 35 percent hydrogen peroxide or a 10 percent carbamide peroxide bleach was placed on the tooth surface and was irradiated with no light (control); a halogen curing light; an infrared, or IR, light; an argon laser; or a carbon dioxide, or CO2, laser. Color changes were evaluated immediately, one day and one week after treatment using a value-oriented shade guide and an electronic dental color analyzer. The outer enamel and inner dentin surface temperatures were monitored before and immediately after each 30-second application of light using a thermocouple thermometer. RESULTS: Color and temperature changes were significantly affected by an interaction of the bleach and light variables. The application of lights significantly improved the whitening efficacy of some bleach materials, but it caused significant temperature increases in the outer and inner tooth surfaces. The IR and CO2 laser lights caused the highest tooth temperature increases. CONCLUSIONS: Dentists performing an in-office bleaching technique with the use of an additional light source to accelerate tooth whitening should consider the specific bleaching agent being used, as well as the potential risks of heating teeth. CLINICAL IMPLICATIONS: A specific combination of bleach and light that demonstrates good color change and little temperature rise should be selected for in-office tooth bleaching.

Argon↗
PubMed1991

The safety and efficacy of tooth bleaching: a review of the literature 1988-1990.

Two hundred fifty-six major medical and dental journals were searched, and a comprehensive study was completed on the chemistry of hydrogen peroxide and carbamide peroxide. The results indicate that safety and efficacy of hydrogen peroxide is well established, while carbamide peroxide is much more complicated and no long-term safety studies are available for tooth bleaching using carbamide peroxide.

Carbamide Peroxide↗
PubMed2006

Vital tooth bleaching in dental practice: 3. Biological, dental and legal issues.

UNLABELLED: The final section of this series examines both the evidence for the safety of external bleaching with hydrogen peroxide and related products and the legal position in the UK with regard to their sale and use in general dental practice. Potential side-effects are examined, including biological effects and dental effects, with a review of the current evidence. The EU Cosmetics and Medical Device Directive are both described and their impact on the provision of tooth bleaching in the UK is explained. The legal position in the UK renders the sale and supply of solutions containing >0.1% peroxide illegal, and practitioners must be aware of the underlying legislation and the basis upon which a prosecution may be pursued. CLINICAL RELEVANCE: Clinicians considering using hydrogen peroxide products must be aware of the safety issues surrounding their use and be able to explain to patients the nature of the risk and also the likelihood of any given patient experiencing them.

Consumer Product Safety↗
PubMed1999

Nonvital tooth bleaching: a 2-year case report.

A discolored, nonvital maxillary right central incisor was bleached with sodium perborate and water, used as a "walking" bleach. An excellent result was obtained, proving the efficiency of both the intracoronal bleaching technique and the materials employed. A clinical evaluation performed 2 years later revealed that the tooth was slightly stained but esthetically satisfactory.

Adult↗
PubMed1991

[Tooth bleaching].

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Carbamide Peroxide↗