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Clinical trial evaluating two peroxide whitening strips used by teenagers.

Double-blind clinical research was conducted to compare the clinical response of a thin, concentrated peroxide whitening strip (relative to a marketed control) among a teenage population with preceding safety and efficacy data. Informed consent and child assent was obtained from 48 teens, 13-17 years of age. After baseline measurements were taken, subjects were divded randomly into two groups, one using a thin 10% hydrogen peroxide whitening strip, the other using a 6.5% hydrogen peroxide strip with a thicker gel layer. Strip use was 30 minutes twice per day for 22 days on the maxillary arch, followed by 22 days on the mandibular arch. Efficacy was measured objectively based on L*a*b* color change from digital images taken every 11 days, where L* indicates lightness and b* indicates blue-to-yellow shade. The mean age was 15.1 (+/-1.5) years. Relative to baseline, both strip groups experienced significant (p < 0.0001) color improvement for yellowness (deltab*) and lightness/brightness (deltaL*) beginning at the first visit (Day 11). Continued use resulted in significant color improvement through Day 22. Groups did not differ significantly (p > 0.33) with respect to combined deltab* or deltaL* at end-of-treatment. Tooth sensitivity and oral irritation represented the most common adverse events. No subject discontinued early due to a treatment-related adverse event. Teenagers who used either 10% hydrogen peroxide gel or 6.5% hydrogen peroxide gel whitening strips twice a day for 44 days saw significant tooth whitening without serious adverse events.

Adolescent↗

Chlorhexidine-containing chewing gum. Clinical documentation.

A clinical documentation on chlorhexidine containing chewing gum is presented on the occasion of the launch of CHewX, a chewing gum containing 5 mg of chlorhexidine diacetate in Switzerland. Following an overview on functional chewing gum, the mechanism of action of chlorhexidine (CHX), its toxicity and safety are summarized and a review of clinical studies performed with CHX-containing chewing gum given. Indication, dosage, precautions and benefits of CHX chewing gum are described.

Adult↗

Whitening effect by stain inhibition from a chewing gum with sodium hexametaphosphate in a controlled twelve-week single-blind trial.

OBJECTIVE: A twelve-week clinical study was conducted to assess the effect of a chewing gum containing sodium hexametaphosphate (4%) on the inhibition of stain formation. METHODOLOGY: Fifty-four subjects were entered and completed all aspects of the study. Twenty-seven of the subjects were smokers, and the other half did not smoke. Subjects were randomly assigned to the test gum or no-gum group. Each participant received a full oral prophylaxis at the beginning of each period of observation. Those chewing the test gum agreed to chew four times a day, for five minutes each time, over twelve weeks. Those assigned to the no-gum group agreed not to chew any gum. After twelve weeks, participants were scored for stain deposits (Lobene Index), received a second oral prophylaxis, and joined the alternate group in this cross-over format. At the end of the twenty-fourth week, all subjects were again scored for stain deposits and the study was completed. In order to enhance stain formation during the entire 24-week study period, all participants received a supply of a chlorhexidine (0.12%) dentifrice without anionic agents to use three times a day. Stain levels were scored by the same examiner for all measurements and recorded on computer. The examiner was blinded to all treatment assignments. RESULTS: There were no reported problems associated with the chewing gum. The Lobene Index mean score for stain extent was 0.54 +/- 0.36) in the test-gum group and 0.81 +/- 0.47) for the no-gum group. The difference between the mean scores was highly significant with paired sample t-test (p < 0.001). Mean stain intensity was 0.57 +/- 0.38) in the test group and 0.95 (+/- 0.72) in the control group, with a statistically significant difference at p < 0.01. CONCLUSION: The results indicated that chewing gum containing sodium hexametaphosphate reduced induced stain formation by 33% compared to a no-gum treatment.

Adolescent↗

In vitro colorimetric evaluation of the efficacy of various bleaching methods and products.

OBJECTIVE: Various bleaching modalities are now offered to patients, either monitored by the dental office or self-directed, for which relative efficacy is unknown. The aim of this in vitro study was to evaluate the ability of different bleaching products and protocols to lighten enamel and dentin. METHOD AND MATERIALS: Bovine tooth samples of standardized thickness (2.5 +/- 0.025 mm with similar dentin and enamel thicknesses) were prepared and stained with whole blood and hemolysate before being submitted to 11 different bleaching regimens: home bleaching using 10%, 15%, 16%, or 20% carbamide peroxide, power bleaching using 15% hydrogen peroxide, 30% hydrogen peroxide, or 25% carbamide peroxide with or without light activation, and over-the-counter bleaching strips containing 5.3% hydrogen peroxide. Colorimetric measurements were performed on each sample side, according to the CIE L*a*b* system, before and after staining as well as after each series of 5 bleaching sessions (number of applications varied from 5 to 20 times, according to the bleaching protocol). RESULTS: All products and protocols produced a similar bleaching effect on enamel, while the home bleaching regimen proved largely superior to lighten dentin. CONCLUSION: In-office bleaching techniques proved less efficient than home bleaching for removing stains deposited in dentin.

Analysis of Variance↗

Comparison of the clinical efficacy and safety of carbamide peroxide and hydrogen peroxide in at-home bleaching gels.

OBJECTIVE: The aim of this study was to evaluate the clinical efficacy of home-administered vital bleaching procedures and possible adverse effects derived from their use. One gel containing 3.5% hydrogen peroxide with a 5% potassium nitrate component (FKD, Kin Lab) was compared with a carbamide peroxide-based gel with a concentration of 10% (Opalescence, Ultradent). METHOD AND MATERIALS: Two sample groups were designed, each composed of 8 patients. All patients employed both bleaching products, 1 in the maxillary arch and the other in the mandibular arch on a random basis. The treatment was applied for 3 hours a day for 4 weeks. The degree of bleaching was evaluated using the Vita guide arranged by brightness. Dental sensitivity was measured with a specially designed 4-point scale. Gingival irritation was registered by the presence or absence of lesions in the marginal gingiva related to treatment. RESULTS: The degree of bleaching was similar with both products (4.8 Vita shade tabs). The hydrogen peroxide product with potassium nitrate provoked less dental sensitivity, although the difference between the 2 products was insignificant (P = .063). Gingival irritation appeared in 6 subjects, but was unrelated to the applied product. CONCLUSION: Under the conditions of this study, no statistically significant differences were detected between 3.5% hydrogen peroxide containing 5% potassium nitrate (FKD) and the 10% carbamide peroxide-based product (Opalescence).

Acrylic Resins↗

[Tooth bleaching].

Explore the source record for details and available documents.

Carbamide Peroxide↗

Randomized clinical trial on the efficacy of 2 over-the-counter whitening systems.

OBJECTIVE: The purpose of this clinical trial was to evaluate the efficacy of 2 over-the-counter whitening systems: a liquid whitening gel (5.9% hydrogen peroxide, twice a day for 15 minutes), and a sodium chlorite-based whitening gel applied in a tray system (10 minutes twice a day). METHOD AND MATERIALS: Sixty volunteers (minimum shade A3 on 1 maxillary tooth) were selected to participate in this single-blind (examiner-blinded), single-center, 2-group trial. The subjects were randomly divided into 2 groups (n = 30 each) and instructed to bleach their teeth for 2 weeks. Efficacy was measured using the Vita Classical shade guide and a spectrophotometer at baseline, as well as after 2 weeks and 6 months. RESULTS: For the subjectively measured tooth shades, improvement for maxillary canines was 2.03 +/- 3.67 tooth shades in group 1 and 1.08 +/- 2.19 tooth shades in group 2 after 2 weeks; the maxillary incisors revealed a tooth shade improvement of 0.83 +/- 1.71 tabs in group 1 and 0.73 +/- 2.22 tabs in group 2 (P < .05, except maxillary incisors in group 2; t test). Objectively measured tooth shade scores revealed a change of 0 +/- 0.25 tooth shade tabs (P > .05). CONCLUSIONS: The bleaching gel containing hydrogen peroxide achieved a slight improvement, and the sodium chlorite-based bleaching gel achieved only a small tooth color improvement. Moreover, subjectively and objectively measured tooth shades revealed considerably different results in the clinical situation.

Adult↗

Effects of hydrogen peroxide bleaching strips on tooth surface color, surface microhardness, surface and subsurface ultrastructure, and microchemical (Raman spectroscopic) composition.

OBJECTIVE: This study examined the effects of hydrogen peroxide tooth bleaching strips on the surface hardness and morphology of enamel and the ultrastructure and chemical composition of enamel and dentin in vitro. METHODOLOGY: Sound human molars were ground and polished to prepare a uniform substrate for bleaching treatments. A cycling treatment methodology was employed which alternated ex vivo human salivary exposures with bleaching treatments under conditions of controlled temperature and durations of treatment. Bleaching treatments included commercial Crest Whitestrips bleaching strips, which utilize hydrogen peroxide in a gel as the in situ bleaching source at 6.0 and 6.5% concentrations of H2O2. Control treatments included an untreated group. Crest Whitestrips bleaching included treatment exposures simulating 2x the recommended clinical exposures (28 hours bleaching). Surface color measurements were taken prior to and following bleaching to ensure tooth bleaching activity. The effects of bleach on physical properties of enamel were assessed with microhardness measures. Ultrastructural effects were classified by surface and subsurface confocal laser scanning microscopy (CLSM) and scanning electron microscopy (SEM) techniques. In addition, the effects of bleaching on tooth microchemical composition was studied in different tooth regions by coincident assessment of Raman spectroscopic signature. RESULTS: Color assessments confirmed significant ex vivo tooth bleaching by Whitestrips. Surface microhardness and SEM measures revealed no deleterious effects on the enamel surfaces. CLSM micromorphological assessments supported the safety of hydrogen peroxide bleaching strips both on surface and subsurface enamel, DEJ, and dentin ultrastructure. Raman spectroscopy analysis demonstrated no obvious effects of bleaching treatments on the microchemical composition of enamel and dentin. CONCLUSION: These results confirm that tooth bleaching with hydrogen peroxide whitening strips does not produce changes in surface/subsurface histomorphology or in surface microhardness and ultrastructure of treated teeth. In addition, for the first time, these results confirm the safety of hydrogen peroxide bleaching strips to tooth microchemical composition as measured by Raman spectroscopy.

Dental Enamel↗

The stain removal performance of a new anti-hypersensitivity dentifrice.

OBJECTIVE: To investigate the stain removal potential in vitro of a new anti-hypersensitivity dentifrice. The dentifrice contains a low level of abrasive, the zwitterionic surfactant cocamidopropyl betaine, and potassium nitrate. It has been developed to be as gentle as possible to tooth surfaces and oral soft tissues, while effectively treating dentinal hypersensitivity. METHODOLOGY: The Relative Dentine Abrasivity (RDA) method was used to measure abrasivity. The Pellicle Cleaning Ratio (PCR) and the Natural Extrinsic Stain Removal (NESR) methods were used to test stain removal performance against suitable controls. RESULTS: The RDA value for the formulation was 34 +/- 2 (Mean +/- S.E.). The PCR value was 46 +/- 4, comparable with Elmex Sensitive. The NESR test, which has previously been shown to give better clinical correlation than the PCR, demonstrated that the new formulation gave superior stain removal performance compared with both Sensodyne MultiCare and a conventional nonsensitivity formulation, and similar stain removal performance to Elmex Sensitive. CONCLUSION: The new formulation has been shown, in these studies, to combine low abrasivity with an in vitro stain removal performance comparable with that of benchmark marketed pastes.

Animals↗

[Clinical and laboratory evidence for effectiveness of whitening toothpastes].

The article presents clinical and laboratory data concerning application of whitening toothpastes "Rembrandt". The effects of these pastes on the soft tissues status, the content of mineral substances in enamel biopsy liquid, enamel surface were evaluated. The results confirm the necessity of differential application of agents for tooth whitening and also of using whitening toothpastes for improvement of teeth color.

Data Interpretation, Statistical↗

Effect of tooth-bleaching on the tensile strength and staining by caries detector solution on bovine enamel and dentin.

PURPOSE: To evaluate the tensile strength and staining of enamel and dentin after extracoronal or intracoronal bleaching using conventional bleaching agents. METHODS: Extracted bovine incisors were divided into eight groups of 10 specimens. Individual groups were treated by extracoronal bleaching (E) using in-office and home techniques with different concentrations of hydrogen peroxide (H2O2) and carbamide peroxide (CP); no bleaching (EN), 35% H2O2 and 10% CP (E35H-10C), 35% H2O2 and 20% CP (E35H-20C), 35% CP and 10% CP (E35C-10C), 35% CP and 20% CP (E35C-20C). Intracoronal "walking bleaching" (I) was performed after 24 hours of root canal treatment in the three remaining groups; no bleaching (IN); sodium perborate dissolved in 35% H2O2 (ISP-35H); and sodium perborate in distilled water (ISP-W). Mini dumbbell shapes of enamel and dentin with central cross-section diameters of 1.5 x 0.5 mm and 3 x 1 mm respectively were prepared for tensile testing using an Instron machine. Fracture surfaces were examined using SEM. Bleached enamel and dentin specimens were stained and evaluated using Caries Detector solution. Staining scores were analyzed using Kruskal-Wallis H and Mann-Whitney test (P < 0.05). RESULTS: Tensile strengths (mean +/- SD) of enamel and dentin respectively for each group in MPa were: EN = 30.5 +/- 3.3 and 85.4 +/- 3.0, E35H-10C = 14.8 +/- 2.3 and 58.9 +/- 2.0, E35H-20C = 10.6 +/- 2.6 and 55.5 +/- 2.2, E35C-10C = 25.4 +/- 3.4 and 70.8 +/- 2.5, E35C-20C = 20.3 +/- 4.1 and 67.2 +/- 3.3, IN = 26.5 +/- 4.1 and 85.9 +/- 2.5, ISP-35H = 13.6 +/- 3.1 and 46.7 +/- 2.3, ISP-W = 21.7 +/- 3.3 and 68.3 +/- 4.4. ANOVA and Tukey HSD test found statistically significant differences among and between groups respectively (P < 0.05). No significant difference was found between non-bleached groups (IN and EN) of enamel and dentin. Mean tensile strengths of all bleached groups were significantly lower than those of non-bleached groups. Fracture surfaces demonstrated the different morphologies for bleached and non-bleached enamel and dentin.

Analysis of Variance↗

The effect of 16 percent carbamide peroxide on enamel staining susceptibility.

STATEMENT OF PROBLEM: Recently, vital bleaching by carbamide peroxide has become more popular; therefore, it is necessary to study the effect of this agent on enamel and dentin. PURPOSE: The purpose of this study was to evaluate the effect of a 16 percent carbamide peroxide bleaching gel, Vivastyle, on enamel staining susceptibility. MATERIALS AND METHODS: Thirty bovine specimens were selected and randomly divided into two groups of 15. The experimental group was subjected to Vivastyle gel and then was immersed in coffee for half an hour daily for three weeks. The control group was only immersed in coffee. The teeth were evaluated using a colorimeter to measure L*, a*, b* of each tooth. Value (black to white) is denoted as L*, wheres chroma (a* b*) is denoted as red (+a*), green (_a*), yellow (+b*), and blue (_b*). Total color differences between two colors (deltaE) were calculated using the following formula: deltaE = [(deltaL*)2 + (deltaa*)2+(deltab*)2]: deltaE1.Bleached, AE2: bleached and immersed in coffee, deltaE3: immersed in coffee. RESULTS: Mean differences were: deltaE1 = 9.478, deltaE2 = 13.808 and deltaE3 = 7.230. Paired comparison by use of Duncan test showed there was a significant difference between deltaE1 and deltaE2 (P0.000); and t test showed there was no significant difference between deltaE3 and deltaE1. (P0.08 > 0.05), but deltaE3 showed a significant difference with deltaE2(P0.000). CONCLUSION: After vital bleaching, the enamel staining susceptibility significantly increased.

Animals↗

[Shape and/or colour anomalies of anterior teeth].

Many esthetically unpleasant positions of teeth can be improved by orthodontic treatment but can also be camouflaged by built-ups with composite resins in combination with grinding of enamel. With this method orthodontic results can also be improved and relapses corrected. The technique and different possibilities are described and demonstrated with clinical examples.

Adolescent↗

Dental bleaching.

Bleaching techniques of both vital and nonvital teeth are reviewed. Current techniques and their origins are investigated, and the appropriate uses for various methods examined. The current research shows that bleaching, while highly effective, must be viewed with caution. The bleaching process cannot be viewed as entirely benign. The influx of bleaching agents prescribed for home-administration use by dentists is particularly deficient in the amount of independent, refereed research on their long-term effects on oral tissues.

Dental Pulp Devitalization↗

In vitro tooth color change with repeated bleaching.

The interest of patients in vital tooth bleaching has created a demand for treatment. However, few objective data are available to help determine the number of bleaching appointments necessary and the lightening that can be expected. The purpose of this study was to measure color changes in bleached extracted teeth and compare these to control groups. Group A was etched and bleached with 35% stabilized hydrogen peroxide. Group B was treated the same as group A, but the bleaching solution was replaced with distilled water. Group C was not treated, but was stored in water. Mean color difference after one treatment was 3.33 for group A, 1.67 for group B, and 0.48 for group C. After six treatments, the overall color difference was 3.82, 2.41, and 1.38 for groups A, B, and C, respectively (P less than .01). Color changes beyond those found after the first treatment were small, suggesting that there was little benefit in repeated bleachings under the conditions of this study.

Acid Etching, Dental↗