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Tooth whiteners--the legal position.
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A study to assess the efficacy of a new detergent free, whitening dentifrice in vivo using QLF planimetric analysis.
OBJECTIVE: To determine the effects of a detergent-free, whitening dentifrice using an in vivo plaque regrowth model with the novel application of QLF as a planimetric analysis tool. METHOD: A total of 20 subjects took part in a double blind, single-centre, crossover study in which slurry rinses were the only form of plaque control over a 5-day period. Following a washout and prophylaxis the subjects used 2 daily rinses in the absence of all other plaque control methods. Subjects returned to the clinic on the afternoon of day 5 when plaque was disclosed and assessed by the plaque index and area using both a photographic and novel fluorescent planimetric technique. A further 9-day washout was carried out and the rinse period repeated to ensure that each subject had used both experimental and comparator slurries. RESULTS: Twenty subjects completed the trial. The test product showed a significant inhibition of plaque re-growth (16.9%) compared with a fluoride-matched comparator using the Turesky index (P < 0.0001), the photographic planimetric technique (17.5%) (P < 0.0001) and the novel QLF technique (18.4%) (P < 0.0001). CONCLUSION: The results confirm that plaque inhibition capability of a detergent-free whitening dentifrice is at least as effective as a fluoride matched comparator. QLF is a promising tool for disclosed plaque quantification.
Advances in biomaterials from 1957 to 1997.
The developments in biomaterials over the past 40 years were listed in a questionnaire. Groups of dentists with and without a Master's degree ranked each development on the basis of the impact they believed it has had on the practice of dentistry. The results of the questionnaires were analysed and the rankings were discussed and used as a guide to the projection of the probable future needs and developments in biomaterials, based on the needs of current and future dental patients.
The effect of disinfectant solutions on the hardness of acrylic resin denture teeth.
This investigation studied the effects of disinfectant solutions on the hardness of acrylic resin denture teeth. The occlusal surfaces of 64 resin denture teeth were ground flat with abrasives up to 400-grit silicon carbide paper. Measurements were made after polishing and after the specimens were stored in water at 37 degrees C for 48 h. The specimens were then divided into four groups and immersed in chemical disinfectants (4% chlorhexidine; 1% sodium hypochlorite and sodium perborate) for 10 min. The disinfection methods were performed twice to simulate clinical conditions and hardness measurements were made. Specimens tested as controls were immersed in water during the same disinfection time. Eight specimens were produced for each group. After desinfection procedures, testing of hardness was also performed after the samples were stored at 37 degrees C for 7, 30, 60, 90 and 120 days. Data were analysed using two-way analysis of variance (anova) and Tukey's test at 95% confidence level. According to the results, no significant differences were found between materials and immersion solutions (P > 0.05). However, a continuous decrease in hardness was noticed after ageing (P < 0.05). It was conclude that the surfaces of both acrylic resin denture teeth softened upon immersion in water regardless the disinfecting solution.
Enamel colour changes following whitening with 10 per cent carbamide peroxide: a comparison of orthodontically-bonded/debonded and untreated teeth.
The purpose of this study was to determine if a colour difference exists between teeth that had orthodontic appliances bonded to and debonded from them and untreated controls subjected to whitening with 10 per cent carbamide peroxide. The sample consisted of 20 pairs of first and second premolars extracted for orthodontic reasons. The contralateral surfaces were divided into an experimental and control group. The experimental group underwent orthodontic bonding/debonding procedures. Both groups were subjected to 4 hour whitening and 20 hour hydration sessions for 30 days. The L*a*b* colour system was chosen to evaluate any colour change and these changes were calculated by determining the delta E from the L*a*b* values using a colorimeter. Colour change readings were taken before and after each 4 hour whitening. Additional readings were taken at 48 hour intervals for 30 days following the cessation of active whitening. The results were analysed using statistical (ANOVA) and graphical analyses (alpha = 0.05). A colour change difference of 2 CIELAB units was set as being clinically significant. A mean clinical colour difference was found for enamel surfaces subjected to orthodontic bonding/debonding of attachments relative to control sites after whitening. Bonding and debonding procedures resulted in a significant colour difference between orthodontic bonded and control sites at the end of the active period, which became insignificant at the end of the 30 day period of monitoring. Both the control and debonded sites responded to whitening; however, the control sites responded initially to a greater extent; the orthodontic debonded sites did not respond until after 2 weeks of continuous whitening. After the 2 week period the improved response of the debonded sites decreased the colour difference between the two groups.
Cosmetic dentistry: tooth whitening.
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Influence of whitening on the degree of conversion of dental adhesives on dentin.
The aim of this study was to analyze the extent of polymerization of different adhesive systems on whitened dentin. One adhesive of each class was investigated: Adper Scotchbond Multi Purpose (3M ESPE); One-Step (Bisco); Clearfil Protect Bond (Kuraray); and Xeno III (Dentsply DeTrey). Dentin disks were treated with Opalescence Xtra Boost (Ultradent) for 30 min and bonded immediately after 24 h or after 14 d of storage in 100% humidity at 37 degrees C. Unbleached dentin disks were prepared as controls. The extent of polymerization of bonded interfaces was obtained with differential scanning calorimetry (DSC) at 20, 40 and 60 s, and the data were statistically analyzed. The extent of polymerization obtained from DSC exotherms of adhesives applied immediately after whitening was significantly lower compared with controls. An increased extent of polymerization after storage was confirmed for all adhesives, and no difference with controls was found after 14 d. A prolonged irradiation time increased the curing rate for all the tested adhesives. This study supports the hypothesis that polymerization of the adhesive is reduced after dentin whitening and that delayed adhesive application reverses the polymerization inhibition. Prolonged polymerization intervals may counteract the inhibition of polymerization caused by the whitening procedure. Nevertheless, further in vivo studies should validate this issue.
Effect of carbamide peroxide and hydrogen peroxide on the surface morphology and zinc oxide levels of IRM fillings.
The effect of 10% carbamide peroxide or 10% hydrogen peroxide on the surface morphology and zinc oxide levels of IRM fillings was tested. Ninety IRM samples were treated with either 10% carbamide peroxide, 10% hydrogen peroxide or phosphate buffer which served as control. Treatment consisted of placing the samples in a dry incubator at 37 degrees C for 1, 3 or 7 days. At each time point, the samples were removed from the test solutions, dried and prepared for surface scanning electron microscopy and energy dispersive spectrometric analysis. After 3 days, 10% carbamide peroxide significantly reduced the zinc oxide levels as compared to the 10% hydrogen peroxide group (<0.01) and the controls (p<0.01). 10% hydrogen peroxide reduced the zinc oxide levels similarly to the control. No significant changes in the zinc oxide levels were found between 3 and 7 days in any of the groups tested. Microscopy examination of the carbamide peroxide group revealed granular surface with well defined crystalline areas. In the hydrogen peroxide group, numerous cracks with multiple sun burst-like areas were found. At the macroscopic level, the samples of this group appeared cracked and more swollen, as compared to controls and samples treated with carbamide peroxide. In conclusion, both 10% carbamide peroxide and 10% hydrogen peroxide altered the surface morphology and the zinc oxide levels of IRM fillings, but their modes of action differed.
Esthetic improvement of "white spot" enamel stains.
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Clinical evaluation of a 3% hydrogen peroxide tooth-whitening gel.
PURPOSE: The purpose of this randomized double-blind investigation was to clinically evaluate the effectiveness of a commercially available 3% hydrogen peroxide tooth-whitening material (ADS Tooth Whitening Gel, Applied Dental Sciences, Inc., Lee, MA). The material was used over 2 weeks in a dentist-supervised, patient-applied application. MATERIALS AND METHODS: The evaluation was carried out in accordance with American Dental Association (ADA) Council on Scientific Affairs Acceptance Program Guidelines for Home-Use Tooth Whitening Products (May 1998). Sixty-five participants were randomized into two groups (active and placebo) for a double-blind, placebo-controlled study. A custom application tray, scalloped without reservoirs, was fabricated for each participant. Tooth shades were documented by matching with the Vita shade guide ordered according to value and assigned a numeric ranking from 1 to 16, darkest to lightest. Participants were supplied with the treatment solutions to use in the application tray. Duration of active treatment was 30 minutes 3 times a day for 2 weeks. Participants were evaluated at baseline, 1 week and 2 weeks treatment, and 12 and 26 weeks post-treatment. The statistical analysis used at each time point to determine the difference between the active and placebo groups based on the change in value was the two-sample t-test. Plaque and soft tissue indices were also recorded. RESULTS: The teeth treated with 3% hydrogen peroxide were significantly lighter at 2, 12, and 26 weeks (p < or = .0140, .0004, and .0001, respectively) compared with the placebo group. The mean shade change was 4.2 Vita shade tabs at 2 weeks. At 26 weeks (6 months), the degree of whitening was 4.1 tabs.
Color measurement symposium 2003.
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Tooth color measurement using Chroma Meter: techniques, advantages, and disadvantages.
UNLABELLED: Tooth whitening has become a popular and routine dental procedure, and its efficacy and safety have been well documented. However, the measurement of tooth color, particularly in the evaluation of the efficacy of a system intended to enhance tooth whiteness, remains a challenge. One of the instruments used for assessing tooth color in clinical whitening studies is the Minolta Chroma Meter CR-321 (Minolta Corporation USA, Ramsey, NJ, USA). This article describes the instrument and discusses various measuring procedures and the Chroma Meter's advantages, limitations, and disadvantages. The available information indicates that, although Minolta Chroma Meter CR-321 provides quantitative and objective measurements of tooth color, it can be tedious to use with a custom alignment device. The Chroma Meter data are inconsistent with the commonly used visual instruments such as Vitapan Classical Shade Guide (Vita Zahnfabrik, Bad Säckingen, Germany), although in many cases the general trends are similar. It is also questionable whether the small area measured adequately represents the color of the whole tooth. A more critical challenge is the lack of methods for interpreting the Chroma Meter data regarding tooth color change in studies evaluating the efficacy of whitening systems. Consequently, at present the Chroma Meter data alone do not appear to be adequate for determining tooth color change in whitening research, although the quantitative measurements may be useful as supplemental or supportive data. Research is needed to develop and improve the instrument and technique for quantitative measurement of tooth color and interpretation of the data for evaluating tooth color change. CLINICAL SIGNIFICANCE: This paper will help readers to understand the advantages and limitations of the Minolta Chroma Meter used for evaluating the efficacy of tooth-whitening systems so that proper judgment can be made in the interpretation of the results of clinical studies.
High levels of hydrogen peroxide in overnight tooth-whitening formulas: effects on enamel and pulp.
PURPOSE: Limited data are available to assess the safety of high levels of hydrogen peroxide in overnight tooth-whitening formulas. The purpose of this study was to assess the effects of hydrogen peroxide on enamel microhardness, pulp penetration, and enamel morphology. MATERIALS AND METHODS: Colgate Platinum Professional Overnight Whitening System (Colgate Oral Pharmaceuticals, Inc., Canton, MA, USA) (10% carbamide peroxide, equivalent to 3.5% hydrogen peroxide) was compared with two prototype formulations containing either 7.0% or 12.0% hydrogen peroxide. In the pulp chamber studies, human extracted teeth were exposed to 3.5%, 7.0%, or 12.0% hydrogen peroxide for 30 minutes, 4 hours, or 7 hours. Microhardness, electron spectroscopy for chemical analysis, and atomic force microscopy evaluations were made from enamel blocks cut from human extracted molars. The enamel blocks were evaluated following 14 7-hour treatments (98 h total). RESULTS: At 7 hours' post-treatment, hydrogen peroxide penetrated the pulp chamber at 23.12 +/- 10.09, 24.58 +/- 6.90, and 26.39 +/- 5.43 microg for 3.5%, 7.0%, and 12.0% hydrogen peroxide, respectively. With regard to enamel morphology, pulp penetration, microhardness, and elemental composition, no statistically significant differences were observed between treatment groups following 98 hours of treatment. CONCLUSIONS: Hydrogen peroxide does not adversely affect enamel morphology or microhardness. The levels recovered in pulp indicate that hydrogen peroxide is not expected to inhibit pulpal enzymes. CLINICAL SIGNIFICANCE: Overnight tray products containing levels of hydrogen peroxide of 3.5%, 7.0%, and 12.0% are not expected to adversely affect the enamel or pulpal enzymes. Additional safety studies are needed to assess the potential for tooth sensitivity and gingival irritation.
The surface effect of dentifrices.
The aim of this study was to evaluate clinically three commercially available dentifrices and to determine any surface effects on tooth or gingival surfaces. Sixty-four participants were included in this study and were allocated randomly to one of four treatment groups by an independent person to ensure the investigators were unaware of the brushing material used. All toothbrushes and dentifrices were distributed by this independent person. The treatment groups were: Group 1--brush with water; Group 2--brush with Colgate (Baking Soda and Peroxide); Group 3--brush with Macleans (Whitening); Group 4--brush with Colgate (Sensation Whitening). All participants were requested to brush both morning and evening in their customary fashion using only the designated toothpaste, or water, for four weeks. All participants were required to use the same toothbrush type. No other oral hygiene products such as mouth rinses or dental floss were used during the trial period. Prior to commencement of the brushing period, all participants received a full clinical examination recording the status of the soft and hard tissues including a gingival index (Löe and Silness) to record gingival condition. A polyvinyl siloxane impression was taken of the six anterior teeth and gingival tissues at the commencement of the trial. After four weeks, a second full clinical examination was made and further silicone impressions were taken of the anterior teeth. All impressions were cast in epoxy resin for investigation with light and electron microscopy. Participants were also asked to answer a questionnaire relating to the toothpaste used. The results of this study indicated that no significant clinical differences were recorded for any dentifrice or water and there was no significant difference in gingival index scores over the four week period. Patient responses to each dentifrice varied according to individual patient preferences and expectations and no consistent findings could be determined. Light and electron microscopy indicated that tooth and gingival surface changes that occurred over the four week period with any of the dentifrices were similar to, and not significantly different from, changes seen with the use of water alone. These results indicate that none of the dentifrices tested was harmful to teeth or soft tissues.