Prevalence of self-assessed tooth discolouration in the United Kingdom

Dental aesthetic perception of patients submitted to activated charcoal-based bleaching agents: A randomized clinical trial

OBJECTIVE

To evaluate the effects of activated charcoal-based products used in two presentation forms (powder or toothpaste), compared to 10 % carbamide peroxide and conventional toothpaste on aesthetic perception and psychosocial impact before and after treatment.

METHODS

Fifty-six participants were divided into 4 experimental groups (n = 14). Activated charcoal-based powder (PW); Activated charcoal-based dentifrice (AC); Conventional fluoride toothpaste (CD) and 10 % carbamide peroxide (CP). All products were used for 14 days. Psychosocial impact on dental esthetics (PIDAQ), oral health impact profile (OHIP- Esthetics) and orofacial esthetics scale (OES) questionnaires were applied before and after treatment. Descriptive and exploratory data analyses were performed and analyzed using linear mixed models for repeated measures over time considering significance level of α = 0.05.

RESULTS

For PIDAQ, the CP group showed significant decrease in psychological impact, aesthetic perception domains and overall score, while in the PW group, there was only a significant decrease in the psychological impact domain. Decrease in OHIP was observed for the functional limitation domain scores for treatments with CP and PW, in the psychological discomfort domain, decrease was observed for all groups, while for the OES questionnaire, significant increase in the color domain was observed for the CP group.

CONCLUSION

Activated charcoal-based products showed lower scores in all questionnaires when compared with carbamide peroxide; thus, charcoal-based products promoted lower impact on quality of life and aesthetic perception.

CLINICAL RELEVANCE

In this randomized clinical trial, charcoal-based OTC products had inferior quality of life and aesthetic perception results compared to conventional carbamide peroxide bleaching.

Effectiveness of violet LED dental bleaching compared to 35% hydrogen peroxide: An in vitro study

AIM

This in vitro study assessed the efficacy and adverse effects of violet LED bleaching with or without bleaching agents.

MATERIAL AND METHODS

Dental blocks (n=40) were randomly distributed in 4 groups: violet LED (VL), 35% hydrogen peroxide (HP35), the association of hydrogen peroxide 35% with violet LED (VHP35) and the association of hydrogen peroxide 35% with blue LED (BHP35). Specimens were analyzed for Vickers microhardness initially, immediately after and seven days after ending bleaching protocol. The color analysis of the specimens was evaluated for bleaching effectiveness (ΔE2000, ΔE1976) and whiteness index (ΔWID) with EasyShade spectrophotometer, before bleaching protocol and seven days after ending bleaching protocol. The mineral composition of the enamel was evaluated by percentage of phosphorus and calcium on the enamel surface with energy dispersive spectroscopy (EDS). The color and the microhardness data were analyzed using one-way ANOVA with post-hoc Tukey (α=0.05).

RESULTS

The microhardness test showed a difference among the groups only immediately after the completion of the protocol, in which there was a reduction in the value for the groups HP35 from 277,36 ± 21,56 to 198,76 ±32,2 (p<0,01); and BHP35 from 261,14 ± 36,01 to 212,66 ± 25,99 (p<0,01), but the microhardness was reestablished after seven days. Regarding EDS analysis, a reduction in the mineral percentage immediately after bleaching with the use of VL was observed, however, after seven days it was reestablished. Regarding the color analysis, there was no difference among the groups evaluated.

CONCLUSIONS

The use of VL was effective as a dental bleaching tool and did not adversely affect the enamel surface after seven days of the ending of the bleaching protocol.

Present status and future directions - Managing discoloured teeth

Managing tooth discolouration involves a range of different protocols for clinicians and patients in order to achieve an aesthetic result. There is an increasing public awareness in the appearance of their teeth and management of tooth discolouration may be inter-disciplinary and involve both vital and nonvital teeth. Vital teeth can be easily treated with low concentration hydrogen peroxide products safely and effectively using an external approach and trays. For endodontically treated teeth, the walking bleach technique with hydrogen releasing peroxide products is popular. However, there is an association with external cervical root resorption with higher concentrations of hydrogen peroxide of 30%-35%. There are also regulatory considerations for the use of hydrogen peroxide in certain jurisdictions internationally. Prosthodontic treatments are more invasive and involve loss of tooth structure as well as a life cycle of further treatment in the future. This narrative review is based on searches on PubMed and the Cochrane library. Bleaching endodontically treated teeth can be considered a safe and effective protocol in the management of discoloured teeth. However, the association between bleaching and resorption remains unclear although there is likely to be a relation to prior trauma. It is prudent to avoid thermocatalytic approaches and to use a base/sealer to cover the root filling. An awareness expectations of patients and multidisciplinary treatment considerations is important in achieving the aesthetic result for the patient. It is likely that there will be an increasing demand for aesthetic whitening treatments. Bleaching of teeth has also become increasingly regulated although there are international differences in the use and concentration of bleaching agents.

In vitro procedures for color stability evaluation of dental resin-based composites exposed to smoke: A scoping review

The objective of this study was to review the experimental in vitro procedures employed to assess the color stability of resin-based composites exposed to smoke. A literature search was performed on four databases (Pubmed, Scopus, Embase, and Web of Science). The quality of the included papers was assessed with the Cochrane risk-of-bias tool (RoB 2). In total, 25 studies were selected for full-text reading, from which 12 were included in the review. The assessed variables were: dimensions, shape, time before exposure, finishing, smoke-type, exposure time, brushing simulation, color, measuring system, repolishing. A disk-shaped specimen was used in most studies (n=10) with a 2 mm thickness (n=7) in custom made devices equipped with vacuum pumps or in Vitrocell systems. Spectrophotometers were the most used devices (n=11). Color differences were quantified with ΔE (n=12), ΔE00 (n=1). The large variety of staining procedures suggests the need for standardization.

Effects of conventional and heated tobacco product smoking on discoloration of artificial denture teeth

STATEMENT OF PROBLEM

Cigarette smoke can cause discoloration of artificial denture teeth. However, studies on the effects of heated tobacco product smoke on artificial denture teeth are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the effects of conventional cigarette and heated tobacco product smoke on the color stability of artificial denture teeth.

MATERIAL AND METHODS

Ninety maxillary central incisor denture teeth (Endura Anterior HC5 A3; Shofu) were randomly divided into 3 groups (n=30). Teeth in the control group were exposed to air; those in group CC were exposed to conventional cigarette (Marlboro Medium; Philip Morris) smoke, and those in group HT were exposed to heated tobacco product (IQOS 2.4 plus holder, Marlboro Heets Silver; Philip Morris) smoke. Before the experiment, the shade of the artificial denture teeth was evaluated in accordance with the Commission International de I'Eclairage (CIELab) color system by using a spectrophotometer (Shadepilot; DeguDent GmbH). The average CIELab value was estimated by scanning the entire labial surface of each specimen. To simulate smoking, standard conditions described by the Coresta Recommended Method N°22 were used-the puff duration was 2 seconds, with a 60-second interval between puffs. For each cigarette, 6 puffs and 6 intervals were simulated across 372 seconds. A total of 105 cigarettes were used based on a smoking simulation of 15 cigarettes each day for 7 days. The teeth in the control group were stored in fresh air in the smoke chamber for the same period as those in the experimental groups. After the experiment, L∗, a∗, and b∗ values were measured, and ΔE was calculated to evaluate the color change. All statistical analyses were performed with a statistical software program using a paired t test to determine discoloration after exposure to cigarette smoke. One-way ANOVA and the Tukey test were used to evaluate the significant differences between groups (α=.05).

RESULTS

Lightness was significantly lower in the CC and HT groups (P<.001). All CIELab values showed statistically significant differences in the CC group. The greatest color change was observed in the CC group (ΔE=6.93 ±0.59), whereas the HT group showed a clinically imperceptible color change (ΔE=0.79 ±0.21). Discoloration was minimal in the CC group (ΔE=0.34 ±0.13).

CONCLUSIONS

Conventional cigarette and heated tobacco product smoke can change the color of denture teeth. Heated tobacco product smoke causes less discoloration of denture teeth.

Tooth Shade Relationship with Age, Gender, and Skin Color in a Saudi Population: A Cross-Sectional Study

Objectives: The aim of this study was to assess the relationship between tooth shade among different groups of patients according to their age, gender, and skin color in a Saudi population. Materials and methods: Participants were divided based on age into Group 1 (10–20 years), Group 2 (21–30 years), Group 3 (31–40 years), and Group 4 (41+ years), and according to gender. Tooth shade was measured by Vita easyshade, Shade scanner, 3D Master shade system. The skin color was determined according to the Firzpatrick Scale. It consists of six shades, namely: I, II, III, IV, V, and VI. The skin complexion of the participants was divided into six categories: white/very fair, fair, light brown, moderate brown, dark brown, and black. Results: One hundred and ninety-eight individuals were recruited. Around 70% were males. Females had 25.4% A2 followed by 22% A1, and 22% A3 shade types, while males had B3 shade (18%) followed by A2 and A3 (15.8%). A statistically significant difference was observed between shade and gender (p < 0.05). A statistically significant difference was observed between shade and age group (p < 0.05), where increased age was correlated with darker teeth shades. Shade A1 was correlated with type I skin color in 57.1% of individuals. Skin color type II had A2 as a dominant shade by 34.1%. A2 and A3 shades were equally observed in skin color III by 20.3%. Overall, statistically significant differences were observed between shade and skin color groups (p < 0.05). Conclusions: In conclusion, the most frequent classical shade noted among male and female participants was shade type A, which represents reddish brownish. Group 2 (21–30 years) had the B3 shade as the most prominent shade type among age groups. Gender, age, and skin types all showed a significant relation with the tooth shade.

Dental Bleaching: 'Now I can Smile for my Selfies' - Paediatric Patients' Perspectives

Children presenting with discoloured teeth commonly suffer from low self-esteem. This paper reports the findings from a questionnaire evaluating changes brought about by dental bleaching and the psychosocial effects of bleaching on 22 patients. All patients reported to like the overall appearance of their teeth following bleaching and reported a significant improvement in mental wellbeing. In the current climate where positive mental health is at the forefront of the minds of commissioners, health care providers, and the general public alike, this service evaluation demonstrates the positive effect that carefully planned dental bleaching can have on the mental wellbeing of under 18-year-olds with discoloured teeth.

Knowledge, Practices, and Perceptions about Tooth Whitening among Female Population in Saudi Arabia - A Cross-Sectional Study

Background:

Tooth-whitening procedures have gained wide popularity among the Saudi population. The present study aimed to assess the knowledge, attitude, and perception about tooth-whitening procedures among Jeddah's general population.

Materials and Methods:

A face-to-face interview was conducted on randomly selected female patients attending dental clinics. A pretested and structured questionnaire was used to record the response by calibrated interviewers. The responses regarding knowledge, attitude, and perceptions were recorded and subjected to statistical analysis.

Results:

The findings showed that the prevalence of tooth whitening among the participants was 43.7%, and about 8.7% reported that they did it once every year. In-office bleaching was the most preferred method (31.4%), followed by whitening toothpaste (8.7%). An increased frequency of bleaching was reported by participants belonging to younger age group (P < 0.001).

Conclusion:

The knowledge related to the mechanism of action and adverse effects was average among the participants. Younger age groups were more concerned about tooth-whitening procedures compared to the older ones.

Resin infiltration and remineralization interventions in management of moderate dental fluorosis: A quantitative light-induced fluorescence-based randomized controlled trial

Context

Aesthetic concerns due to dental fluorosis (DF) considerably impact pyschosocial health in young children and requires aesthetic microinvasive treatment.

Aims

The aim of this study was to use quantitative light-induced fluorescence to evaluate two intervention protocols: microabrasion with resin infiltration and microabrasion with remineralization and assess which brings about more fluorescence gain; better colour masking and greater patient satisfaction among subjects with dental fluorosis.

Methods and Material

120 maxillary central incisors with Grade 3 DF (Dean's Fluorosis Index) were randomly distributed into four groups: I-microabrasion + resin infiltration (fluorosis with stains); II microabrasion + remineralization (fluorosis with stains); III-microabrasion + resin infiltration (fluorosis without stains); IV microabrasion + remineralization (fluorosis without stains). At baseline, post-microabrasion and post-intervention Quantitative light-induced fluorescent images were captured. Fluorescence gain (ΔF) was analysed from the blue light images. The white light images were used to evaluate post intervention colour difference (ΔE = [(ΔL*) 2+(Δa*) 2+(Δb*) 2]1/2) and child satisfaction was evaluated.

Statistical Analysis Used

Collected data was analysed using repeated measures ANOVA and Independent t-test.

Results

Intra-group comparison of ΔF values showed statistically significant improvement in ΔF value in all the four groups (P < 0.001, 0.002). Inter-group comparison of ΔF values based on intervention showed statistically significant fluorescence gain (P < 0.004) indicating resin infiltration intervention being better than remineralization in unstained grade III fluorosis. The colour difference was statistically significantly better with resin infiltration in both stained and unstained Grade III DF (P < 0.001).

Conclusions

Resin infiltration intervention showed better fluorescence gain and colour masking compared to remineralization intervention.

Reduction of extrinsic tooth stain by a toothpaste containing 10% high cleaning silica, 0.5% sodium phytate and 0.5% sodium pyrophosphate: an 8-week randomised clinical trial

Objective

To assess the effects for controlling extrinsic tooth stain of a whitening toothpaste containing 10% high cleaning silica, 0.5% sodium phytate and 0.5% sodium pyrophosphate, in comparison with a negative control toothpaste.

Methods

A total of 86 adults who met with the inclusion and exclusion criteria were invited to take part in the study. They were distributed into test and control groups randomly. At baseline, 4 weeks and 8 weeks, the same examiner provided the clinical examinations, including evaluations of oral soft and hard tissues and measurements of tooth stain of the anterior teeth using the Lobene Stain Index. Adverse events and any changes in general health conditions of the patients were monitored.

Results

When the study was completed, comparisons between patients in test and control groups yielded statistically significant differences in Lobene stain adjusted mean area score [0.83 (0.05) vs. 1.13 (0.05)], Lobene stain adjusted mean intensity score [0.99 (0.06) vs. 1.32 (0.06)] and Lobene stain adjusted mean composite score [1.45 (0.13) vs. 2.50 (0.13)] (All, P < 0.001). Patients in the test group exhibited reductions of 26.55%, 25% and 42%, respectively in Lobene stain area, intensity and composite scores, relative to patients in the control group. Comparisons within groups showed that all three Lobene scores at 8 weeks in both groups were lower than those at baseline (All, P < 0.001).

Conclusion

This study demonstrates that 8-week use of a toothpaste containing 10% high cleaning silica, 0.5% sodium phytate and 0.5% sodium pyrophosphate can effectively reduce extrinsic tooth stain.

Trial registration NCT04238429 (before enrollment of the first participant). Data register: March 4, 2018.

Analysis of chemical deposits on tooth enamel exposed to total particulate matter from cigarette smoke and tobacco heating system 2.2 aerosol by novel GC-MS deconvolution procedures

Tobacco smoking contributes to tooth discoloration. Pigmented compounds in the smoke generated by combustion of tobacco can cause discoloration of dental hard tissues. However, aerosols from heated tobacco products cause less discoloration than cigarette smoke (CS) in vitro. The objective of the present study was to optimize a method for extracting the colored chemical compounds deposited on tooth enamel following exposure to total particulate matter (TPM) from CS or a heated tobacco product (Tobacco Heating System [THS] 2.2), analyze the extracts by gas chromatography coupled to time-of-flight mass spectrometry, and identify the key chemicals associated with tooth discoloration. Sixty bovine enamel blocks were exposed for 2 weeks to TPM from CS or THS 2.2 aerosol or to artificial saliva as a control. Brushing without toothpaste and color measurements were performed each week. Noticeable discoloration of enamel was observed following exposure to CS TPM. The discoloration following exposure to THS 2.2 aerosol TPM or artificial saliva was not distinguishable to the eye (ΔE < 3.3). Carbon disulfide was used to extract surface-deposited chemicals. Untargeted analyses were followed by partial least squares correlation against discoloration scores (R2 = 0.96). Eleven compounds had variable importance in projection scores greater than 2. Discriminant autocorrelation matrix calculation of their mass spectral information identified eight of the eleven compounds as terpenoids. None of the compounds were related to nicotine. Several of these compounds were also detected in THS 2.2 aerosol TPM-exposed enamel, but at lower levels, in line with our findings showing less discoloration. Compared with CS TPM exposure, THS 2.2 aerosol TPM exposure resulted in lower deposition of color-related compounds on enamel surface, consistent with minimal discoloration of dental enamel.

"How I whiten my teeth": YouTube™ as a patient information resource for teeth whitening

BACKGROUND

YouTube™ is the world's second most popular website after Google on the Internet. The aim of this study was to assess the quality and content of information YouTube™ videos for patients seeking information about teeth whitening.

METHODS

The keyword 'teeth whitening' was searched on YouTube™. YouTube™ was filtered by the relevance, and the first 100 videos that met the inclusion criteria were evaluated. The included videos were analyzed for views, duration, time since video upload, likes/dislikes, number of comments, source, material types (dental, natural, and other). Also, video purpose was analyzed under nine categories (definition, material preparation, the procedure of application, material comparison, before/after comparison, symptoms, post-op experience, commercial, educational). Each video was classified according to the quality of information content as 'good', 'moderate', or 'poor'. The Kruskal-Wallis test, Fischer's Exact test and Spearman correlation analyses were performed.

RESULTS

Most videos were uploaded by laypersons (60.0%). The definition of teeth whitening was the most commonly covered topic (74.0%), followed by the procedure of application (54.0%), and post-op experience (36.0%). Only 12% of videos were classified as having good information quality content, 53% moderate, and 35% were rated as poor information content. Poor-information content videos had a significantly higher number of viewing rates than the other groups (P = 0.002), besides the duration was significantly higher in poor-information content videos (P =0.002). There was a significant relationship between the quality of video information and material types (P <0.001).

CONCLUSIONS

YouTube™ should not be used as a thoroughly reliable and accurate source for patient information about teeth whitening. More informative and reliable content YouTube™ videos about teeth whitening should be uploaded by professionals.

Novel in-office peroxide-free tooth-whitening gels: bleaching effectiveness, enamel surface alterations, and cell viability

To evaluate the bleaching ability, the effect on enamel surface and cytotoxicity of novel tooth-whitening formulations containing papain, ficin, or bromelain. Forty bovine dental discs (6 cm ×4 cm) were pigmentated and randomly allocated into the following groups (n = 10): Group 1, 20 wt% carbamide peroxide (control); group 2, 1% papain-based whitening; group 3, 1% ficin-based whitening; and group 4, 1% bromelain-based whitening. The whitening gels were prepared and applied on the enamel three times per day once a week, for 4 weeks. Color measurement was obtained by CIEDE2000. Enamel Knoop microhardness and roughness were evaluated. The WST-1 assay was used to evaluate the cell viability of mouse fibroblast cells (L929). Data were statistically analyzed by one-way analysis of variance (ANOVA) and Student Newman Keuls's post hoc test at α = 0.05 significance level. Bromelain, ficin-based, and carbamide peroxide bleaching gels showed a similar color change (p < 0.001). Higher enamel hardness decrease and higher enamel roughness were caused by the carbamide peroxide (p < 0.05). The experimental whitening gels did not affect cell viability. Tooth bleaching gels containing bromelain, papain, or ficin have substantial clinical potential to be used in the development of peroxide-free tooth whitening gels.

Effect of Remineralizing Agents on Tooth Color after Home Bleaching

Objectives:

The purpose was to investigate the effect of casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) paste, Remin Pro paste, and 0.05% sodium fluoride (NaF) mouthwash on teeth discoloration after home bleaching.

Materials and Methods:

In this in-vitro study, 48 intact and unstained human incisors were divided into four groups (n=12): control (Group 1), CPP-ACPF paste (Group 2), Remin Pro paste (Group 3), and 0.05% NaF mouthwash (Group 4). The specimens were bleached using 20% carbamide peroxide gel for 21 days and were subjected to pH cycling and surface treatment with remineralizing agents for one month. The color of the specimens was determined according to the CIELAB color space at baseline, after bleaching, and after surface treatment. Data were analyzed using one-way analysis of variance (ANOVA), post-hoc least significant difference (LSD) test, and one-sample t-test (P=0.05).

Results:

ANOVA showed a significant difference in the mean ΔE of the four groups after surface treatment (P<0.05). Post-hoc LSD test showed a significant difference between the mean ΔE of the control group and those of the treatment groups (P<0.05) with no significant difference between the treatment groups, except for Remin Pro. The mean ΔE and ΔL of the Remin Pro group showed less change than those of the CPP-ACPF and NaF groups, indicating that Remin Pro has the lowest potential for post-bleaching tooth discoloration.

Conclusion:

CPP-ACPF paste, Remin Pro paste, and 0.05% NaF mouthwash cause noticeable teeth discoloration immediately after bleaching. Remin Pro has less effect on tooth color than the other two products.

The effect of oral anti-inflammatory drugs on reducing tooth sensitivity due to in-office dental bleaching: A systematic review and meta-analysis

BACKGROUND

The authors' aim was to evaluate the effectiveness of anti-inflammatory drugs on tooth sensitivity (TS) during and after in-office dental bleaching procedures.

TYPES OF STUDIES REVIEWED

The authors selected randomized controlled trials in which the investigators compared anti-inflammatory drugs with a placebo to evaluate in-office dental bleaching TS. The authors performed an electronic search by using PubMed, ScienceDirect, and Embase. In addition, the authors searched other Web sites, such as ClinicalTrials.gov, to identify ongoing studies.

RESULTS

The authors included 7 randomized controlled trials (324 adults) in the review. According to the extracted data, the authors performed the meta-analysis by using risk ratios and their 95% confidence intervals or by using the mean difference with a 95% confidence interval. The authors used the Cochrane Collaboration's tool to assess study quality. After the evaluation, the authors considered 6 studies to be high quality and a single study to be low quality. The overall results of the evaluation process revealed the absence of a clinically significant effect of anti-inflammatory drugs.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The results of this analytic process indicated that anti-inflammatory drugs have no clinically significant effect on the TS that occurs due to in-office bleaching. Readers must analyze these results carefully given the limitations of this review, such as the small samples size and the heterogeneity among the studies in some stages of the evaluation process. The results of this analytical study highlight the need for more clinical studies to reach a significant conclusion because TS is one of the most important reasons for the cessation of bleaching treatment.

Desire of university students for esthetic treatment and tooth bleaching

Aim: The aim of this study was to investigate the prevalence of the desire of university students for esthetic treatment and tooth bleaching, and associated factors. Methods: A cross-sectional study was performed in 2016 with first-semester university students in Pelotas. Data was collected via a self-administered questionnaire including demographic, socioeconomic and psychosocial characteristics. Oral Impact on Daily Performance (OIDP) was assessed and Poisson regression models were used to evaluate the association between the following outcomes: prevalence of desire for esthetic treatment and the tooth bleaching, and exposure variables. A p-value of ≤ 0.05 was considered significant. Results: A total of 2,058 students participated in the study. Refusals represented a mere 1.4% of the total sample. Of the individuals interviewed, 16.1% underwent tooth bleaching and 74.4% reported a desire for esthetic dental treatment. Models showed students with higher family income and with the intention to use private dental services had 65% and 47% higher prevalence of tooth bleaching, respectively. Individuals satisfied with dental color and appearance exhibited a higher prevalence of tooth bleaching, as did those who smoked. On the other hand, students satisfied with dental color (PR= 0.77, 95% CI: 0.73-0.80) and with their dental appearance (PR= 0.82, 95% CI 0.78-0.87) demonstrated less desire to undergo esthetic dental treatment. Moreover, individuals who suffered some impact in OIDP reported a greater desire for esthetic treatment (PR= 1.07, 95% CI: 1.02-1.13). Conclusion: General and psychosocial characteristics were associated with the desire for esthetic treatment and tooth bleaching in university students.

Oral and Dental Status of Lebanese and Syrian Refugees Living in Proximity to Deir Kanoun Ras El Ain Dump in Lebanon

Aims:

In this study, we aimed at investigating the oral and dental health conditions of Lebanese and Syrian refugees living in proximity to Deir Kanoun Ras El Ain dump whereby its leachates influx into a canal used for irrigation and drinking purposes.

Materials and Methods:

This observational study involved oral and dental examinations of 589 Lebanese and Syrian Refugees participants living in the three villages: Deir Kanoun Ras El Ain, Klayleh, and Smaiyeh. Differences in oral and dental examination results were analyzed between different villages, sexes, nationalities, and age groups. Correlation tests were conducted between dental fluorosis, staining, papilla swelling, and several sociodemographic factors.

Results:

Dental fluorosis, staining, and papilla swelling were the most prominent problems among total participants. The highest percentages of individuals with the studied diseases were shown to be in Klayleh village, among females, and individuals aged between 21 and 40 years. Significant associations were observed between dental fluorosis and nationality; between dental staining and gender, nationality, age, and smoking; as well as between papilla swelling and age, smoking, and diabetes.

Conclusions:

Our study investigated and highlighted the prevalence of several oral and dental diseases among Lebanese and Syrian inhabitants that are related to environmental, social, and economic determinants and not just by individual behaviors. It also showed gaps of oral and dental health knowledge that recommend implementing health systems that focus on preventing oral diseases.

Is a Single Preliminary Session of In-office Bleaching Beneficial for the Effectiveness of At-home Tooth Bleaching? A Randomized Controlled Clinical Trial

OBJECTIVES

To evaluate the effect of combining in-office with at-home bleaching procedures in terms of the time required to obtain satisfactory tooth color, final color changes, and tooth sensitivity (TS) reported by patients.

METHODS AND MATERIALS

Twenty-six patients enrolled in this study used 10% carbamide peroxide in a bleaching tray for 1 h/d until satisfactory tooth color was obtained. One-half of the participants underwent a preliminary session of in-office tooth bleaching with 35% hydrogen peroxide for 45 minutes. The time in days for the patients to obtain satisfactory tooth color by at-home bleaching procedures was recorded. The color change of the maxillary canines was assessed using the Vita Bleachedguide 3D Master scale and a spectrophotometer at 1 week and after the end of bleaching procedures. Participants' satisfaction with their smile was recorded using a visual analog scale, and TS was determined throughout the entire treatment. Data were analyzed by t-test, Mann-Whitney test, or Fisher exact test (α=0.05).

RESULTS

The combined protocol reduced (by an average of 3.7 days) the time required to obtain satisfactory tooth color but increased the risk and level of TS. No difference in the final tooth color change (around 5.0 shade guide units; ΔE=11.6-14.9), or the level of patients' satisfaction with their smile, was observed.

CONCLUSIONS

A preliminary session of in-office bleaching reduced the time necessary to obtain satisfactory tooth color with at-home bleaching but increased the risk and level of TS.

Changes in plaque and gingivitis levels after tooth bleaching: A systematic review

OBJECTIVES

The primary aim of this systematic review was to evaluate the effect of external tooth-bleaching products on plaque indices and to compare it to a placebo or a negative control.

METHODS

A protocol was developed aimed to answer the next focused question: What is the effect of tooth bleaching compared to no treatment or a placebo, in subjects without periodontitis aged ≥18 years in the levels of plaque and gingivitis? Two electronic databases were used as sources in the search for studies satisfying the inclusion criteria: (a) The National Library of Medicine (MEDLINE via PubMed); (b) Cochrane Central Register of Controlled Trials.

RESULTS

Only randomized controlled trials were included. The initial search found 382 potential publications. Seven of them were finally included, and six were used in the meta-analyses. The use of bleaching products showed higher reductions in plaque (n = 6; standardized mean difference [SMD] = 0.47; 95% confidence interval [CI] = 0.06, 0.88; P < 0.001) and gingivitis indices (n = 4; SMD = 0.47; 95% CI = 0.22, 0.73; P < 0.001), when compared to a control group (no treatment or placebo).

CONCLUSIONS

External tooth bleaching is associated with statistically significant short-term reductions in plaque and gingivitis indices. However, no data were available to evaluate long-term effects.

Home-based chemically-induced whitening (bleaching) of teeth in adults

BACKGROUND

With the increased demand for whiter teeth, home-based bleaching products, either dentist-prescribed or over-the-counter products have been exponentially increasing in the past few decades. This is an update of a Cochrane Review first published in 2006.

OBJECTIVES

To evaluate the effects of home-based tooth whitening products with chemical bleaching action, dispensed by a dentist or over-the-counter.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 12 June 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library (searched 12 June 2018), MEDLINE Ovid (1946 to 12 June 2018), and Embase Ovid (1980 to 12 June 2018). The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (12 June 2018) and the World Health Organization International Clinical Trials Registry Platform (12 June 2018) were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included in our review randomised controlled trials (RCTs) which involved adults who were 18 years and above, and compared dentist-dispensed or over-the-counter tooth whitening (bleaching) products with placebo or other comparable products.Quasi-randomised trials, combination of in-office and home-based treatments, and home-based products having physical removal of stains were excluded.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials. Two pairs of review authors independently extracted data and assessed risk of bias. We estimated risk ratios (RRs) for dichotomous data, and mean differences (MDs) or standardised mean difference (SMD) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We included 71 trials in the review with 26 studies (1398 participants) comparing a bleaching agent to placebo and 51 studies (2382 participants) comparing a bleaching agent to another bleaching agent. Two studies were at low overall risk of bias; two at high overall risk of bias; and the remaining 67 at unclear overall risk of bias.The bleaching agents (carbamide peroxide (CP) gel in tray, hydrogen peroxide (HP) gel in tray, HP strips, CP paint-on gel, HP paint-on gel, sodium hexametaphosphate (SHMP) chewing gum, sodium tripolyphosphate (STPP) chewing gum, and HP mouthwash) at different concentrations with varying application times whitened teeth compared to placebo over a short time period (from 2 weeks to 6 months), however the certainty of the evidence is low to very low.In trials comparing one bleaching agent to another, concentrations, application method and application times, and duration of use varied widely. Most of the comparisons were reported in single trials with small sample sizes and event rates and certainty of the evidence was assessed as low to very low. Therefore the evidence currently available is insufficient to draw reliable conclusions regarding the superiority of home-based bleaching compositions or any particular method of application or concentration or application time or duration of use.Tooth sensitivity and oral irritation were the most common side effects which were more prevalent with higher concentrations of active agents though the effects were mild and transient. Tooth whitening did not have any effect on oral health-related quality of life.

AUTHORS' CONCLUSIONS

We found low to very low-certainty evidence over short time periods to support the effectiveness of home-based chemically-induced bleaching methods compared to placebo for all the outcomes tested.We were unable to draw any conclusions regarding the superiority of home-based bleaching compositions or any particular method of application or concentration or application time or duration of use, as the overall evidence generated was of very low certainty. Well-planned RCTs need to be conducted by standardising methods of application, concentrations, application times, and duration of treatment.

Concerns about dental aesthetics are associated with oral health related quality of life in Southern Brazilian adults

Abstract It aims to evaluate the association between dental appearance and Oral Health Related Quality of Life. Fifteen primary care services with dental services were selected in Porto Alegre, Brazil. Individuals were interviewed from a random sampling of households in the catchment area of the health centres. The outcome was having an OHIP14 score > 0 (any impact). The main exposures included self-reported tooth colour and position, perception of oral health and concern with dental aesthetics. Data were analysed with stepwise logistic regression. Of 1943 individuals contacted, 433 used public dental services in the last year. Seventy-three percent had some impact on quality of life, 35.2% and 47.5% reported stained and crowded teeth, respectively. Also, 22.2% had already tried bleaching their teeth. Individuals concerned with colour were 2.56 times (95% CI: 1.34-4.89) more likely to report any impact after adjusting for number of teeth, smoking and education. Concerns about tooth position, reporting stained or crowded teeth, age, sex and income were not significant (p > 0.30). There is a direct and independent association between concerns with tooth colour and quality of life. The effect of tooth colour on quality of life may be mediated by individuals’ perceptions of aesthetics.

Power bleaching enhances resin infiltration masking effect of dental fluorosis. A randomized clinical trial

OBJECTIVES

Patients with moderate dental fluorosis often feel esthetically compromised. Aim of this RCT was to evaluate the objectively and self-assessed masking effect of resin infiltration alone or in combination with in-office bleaching on dental fluorosis in adults.

METHODS

Twenty-seven patients (9 male, 18 female, 24.81 ± 3.7 yrs) with 410 fluorotic teeth (TF 1-4) were randomly assigned to a treatment (BLI) or control group (NBLI). Patients underwent in-office bleaching (25% H₂O₂) in the BLI or a placebo bleaching (ACP gel) in the NBLI group followed by resin infiltration after two weeks. Standardized digital photographs were obtained at baseline; after bleaching; before and after resin infiltration and after 1, 3, and 6 months. Color differences (ΔE) between sound and fluorotic areas were calculated and patient satisfaction was evaluated using a VAS (1-10).

RESULTS

Statistical analysis revealed significant differences in the mean ΔE values 6 months after resin infiltration between the BLI (ΔE = 1.41) and the NBLI group (ΔE = 4.33) (p = 0.024). VAS values increased after resin infiltration (p < 0.05) in both groups. After 3 months patients in the BLI group had higher VAS values than in the NBLI group (p = 0.029).

CONCLUSIONS

Findings of this study suggest that resin infiltration alone can effectively mask mild to moderate dental fluorosis in young adults. In-office bleaching with 25% H₂O₂ before resin infiltration provides significantly better masking effects.

CLINICAL SIGNIFICANCE

Resin infiltration is a safe and efficient treatment option for masking fluorotic opacities. A priori in-office bleaching with 25% H₂O₂ enhances the masking effect. This controlled clinical trial is registered in the German Clinical Trials Register #DRKS00010465.

Desire for tooth bleaching and treatment performed in Brazilian adults: findings from a birth cohort

Population-based studies estimating the prevalence of tooth bleaching desire or the percentage of individuals who had performed this treatment are rare. Thus, the aim of this study was to evaluate the desire to perform tooth bleaching and the prevalence of adult individuals who had performed the treatment and investigate the association of these outcomes. A subsample (n = 536) of the 1982 Pelotas birth cohort in southern Brazil was investigated at the ages 15, 24 and 31 by clinical examinations and interviews. The prevalence of bleaching at 31 years was 15.6% [95%CI 12.6-18.9] while 85.9% [95%CI 82.7-88.7] reported they desired the treatment. Multivariate Poisson regression analysis showed that individuals who have visited the dentist within the last year showed a treatment prevalence ratio (PR) 2.31 times [95%CI 1.40-3.83] higher compared with those who had the last dental visit more than a year before the interview. Similarly, individuals with smoking habits presented an elevated PR of 1.60 [95%CI 1.00-2.55], and the low-income trajectory group showed the largest PR of desire for tooth bleaching (1.17 [95%CI 1.07-1.28]). Moreover, individuals from the high-risk caries trajectory group presented a higher prevalence of desire for tooth bleaching than individuals from low caries trajectory group. Individuals who have declared being "dissatisfied" with their dental color presented a prevalence of desire for tooth bleaching 16% greater than "satisfied" ones. Thus, the present findings confirm that tooth bleaching has become a frequently desired dental treatment to improve dental aesthetics in the population and a considerable rate of adults has performed the treatment.

Effectiveness of a new non-hydrogen peroxide bleaching agent after single use - a double-blind placebo-controlled short-term study

Tooth whitening represents perhaps the most common aesthetic procedure in dentistry worldwide. The efficacy of bleaching depends on three aspects: bleaching agent, bleaching method, and tooth color.

Assessment of the influence of gender and skin color on the preference of tooth shade in Saudi population

Aim

The aim of the study was to evaluate the influence of gender and skin color on the preference of different teeth shades in general population.

Materials and methods

Two standardized frontal smile photographs of male and female subjects were manipulated using photoshop to represent 4 skin colors [(type II, III, IV, and V) (Fitzpatrick scale)]. The teeth shades under each skin color were digitally manipulated to represent one of 6 teeth shades (BL1, BL2, BL3, BL4, B1 and A1). A questionnaire assessed demographic characteristics (age, nationality, gender, education level, occupation, and income) along with the satisfaction of their smiles. Male and female set of pictures with combination of skin colors and teeth shades were presented and participants were asked to select the most esthetically pleasing teeth shade with regard to gender and skin color. Cross-tabulations and chi-squared tests were used to perform the statistical analyses (α = 0.05).

Results

Three hundred and thirty-six (60.4% male; 39.6% female) individuals participated in the study. The difference in the preferred teeth shades was significant among the male and female photographs across all skin colors (p < 0.05). Lighter teeth shades were preferred among female subjects compared to male subjects with the same skin color. In addition, lighter teeth shades were preferred among subjects with a lighter skin color and vice versa (p < 0.05).

Conclusion

Gender and skin color influences the perception of teeth shades among general population. Therefore, lighter tooth shades (BL1, BL2) for lighter skin color and comparatively darker tooth shades (BL4, B1, A1) for darker skin individuals should be prescribed as these are perceived as natural among Saudi population.

An in vitro screening assay for dental stain cleaning

BACKGROUND

The present study aimed to develop an in vitro model for stain removal from natural enamel for the assessment and comparison of oral hygiene products.

METHODS

Bovine teeth (n = 8 per group) were ground/polished to provide flat enamel specimens and ferric-tannate deposits were precipitated onto the enamel surfaces. The ferric-tannate stained enamel specimens were brushed using an in vitro tooth-brushing simulator with slurries containing commercially available toothpaste products, dental abrasive particles, and sodium tripolyphosphate (STP) solutions of different concentrations. The colour of the enamel surfaces was measured using a spectrophotometer before and after stain application as well as after the brushing treatments.

RESULTS

Differences in stain removal efficacy were found between the toothpastes categorised as whitening and non-whitening comprising of different types of dental abrasives (hydrated silica and alumina). A mean value of 27% for stain removal was detected for the three non-whitening toothpastes and 59% of stain removal was detected for the three whitening toothpastes after 1000 strokes. Compared with the slurry with Zeodent 113 abrasive alone, the addition of STP provided better performance for stain removal under the same brushing conditions (mean value of 62% for Zeodent 113 abrasive alone and 72% with the addition of 5% (w/w) STP after 1000 strokes). No difference was evident between the STP concentration of 5% (w/w) and 10% (w/w).

CONCLUSIONS

The ferric-tannate/bovine enamel model reported here provides good stain retention, is rapidly and easily prepared, and is shown to be progressively and reproducibly sensitive to toothbrushing using different toothpastes and surfactant/chelating agent solutions. Importantly, it provides good discrimination between various oral hygiene products. The stain removal assay reported here has considerable potential to enable comparative assessments of different toothpaste types in terms of their cleaning capabilities.

Comparison of efficacy of tray-delivered carbamide and hydrogen peroxide for at-home bleaching: a systematic review and meta-analysis

OBJECTIVES

The aim of the study was to compare the color change produced by tray-delivered carbamide peroxide [CP] versus hydrogen peroxide products [HP] for at-home bleaching through a systematic review and meta-analysis.

MATERIALS AND METHODS

MEDLINE via PubMeb, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO), and Cochrane Library and Grey literature were searched without restrictions. The abstracts of the International Association for Dental Research (IADR) and unpublished and ongoing trial registries were also searched. Dissertations and theses were explored using the ProQuest Dissertations and Periodicos Capes Theses databases. We included randomized clinical trials that compared tray-delivered CP versus HP for at-home dental bleaching. The color change in shade guide units (SGU) and ΔE were the primary outcomes, and tooth sensitivity and gingival irritation were the secondary outcomes. The risk of bias tool of the Cochrane Collaboration was used for quality assessment.

DATA

After duplicate removal, 1379 articles were identified. However, only eight studies were considered to be at "low" risk of bias in the key domains of the risk bias tool and they were included in the analysis. For ΔE, the standardized mean difference was -0.45 (95 % CI -0.69 to -0.21), which favored tray-delivered CP products (p < 0.001). The color change in ΔSGU (p = 0.70), tooth sensitivity (p = 0.83), and gingival irritation (p = 0.62) were not significantly different between groups.

CONCLUSIONS

Tray-delivered CP gels showed a slightly better whitening efficacy than HP-based products in terms of ΔE, but they were similar in terms of ΔSGU. Both whitening systems demonstrated equal level of gingival irritation and tooth sensitivity.

CLINICAL SIGNIFICANCE

Tray-delivered CP gels have a slightly better whitening efficacy than HP-based products in terms of ΔE. This should be interpreted with caution as the data of ΔSGU did not show statistical difference between the products.

Satisfaction with Dental Appearance and Attitude toward improving Dental Esthetics among Patients attending a Dental Teaching Center

AIM

The aim of this study was to evaluate the factors influencing the satisfaction of dental appearance and attitude toward treatments to improve dental esthetics among patients attending a dental teaching center.

METHODS

A questionnaire was used to collect data of four background variables among 450 patients attended a dental teaching center in the city of Irbid in Jordan. The questionnaire enclosed self-reported questions about the appearance of anterior teeth, received esthetic treatment and desired treatment for improving esthetics. Descriptive, multiple logistic regression and Chi-square tests were used for data analysis (p ≤ 0.05).

RESULTS

The 450 participants consisted of (66.2%) male and (33.8%) female. Of these, 69.3% were satisfied with their dental appearance and 58.0% with the color of their teeth. Esthetic restorations were the most received treatment (39.8%) and whitening of teeth was the most desired treatment (55.3%). The patients' satisfaction with dental appearance was influenced by teeth color, crowding and receiving whitening (p < 0.05. r = 0.561, r(2) = 0.315). The most desired esthetic treatments influenced by the satisfaction with dental appearance were esthetic restorations and orthodontics (p < 0.05. r = 0.223, r(2) = 0.05). Significantly more female reported having esthetic restorations and orthodontics (p = 0.008, 0.000) and desired to have orthodontic, crowns or veneers and esthetic restorations (p = 0.000, 0.015, 0.028).

CONCLUSION

Satisfaction with dental appearance was affected by teeth color, feeling teeth are crowded, desire for esthetic restorations and orthodontic treatment. A high percentage of patients were not satisfied with the color of their teeth.

CLINICAL SIGNIFICANCE

Recognizing the factors that affect patients' satisfaction with their present dental appearance and attitude toward treatments to improve dental esthetic can guide clinicians to strategies to improve esthetics.

Esthetic failure in implant dentistry

The definition of failure for dental implants has evolved from lack of osseointegration to increased concern for other aspects, such as esthetics. However, esthetic failure in implant dentistry has not been well defined. Although multiple esthetic indices have been validated for objectively evaluating clinical outcomes, including failure of an implant-supported crown, only one author has determined a failure threshold. On the basis of objective indices, esthetic failures in implant dentistry can be categorized as pink-tissue failures and white-tissue failures. This article discusses esthetic failures, the factors involved in these failures, and their prevention and treatment.

Smile analysis: what to measure

Patients seek dental treatment to improve oral function as well as their attractiveness. In order to improve smile attractiveness, clinicians need to carry out a comprehensive smile assessment. The aim of this paper is to help clinicians to adopt a systematic approach toward smile assessment by introducing a smile assessment form.

CLINICAL RELEVANCE

Smile analysis is an essential part of smile diagnosis. A smile assessment form will assist clinicians in identifying and recording smile features for diagnosis and treatment planning.

Impact of remineralizing agents on enamel microhardness recovery after in-office tooth bleaching therapies

OBJECTIVE

It has been shown that bleaching with 35/38% hydrogen peroxides may alter both enamel morphology and mineral content. This study aimed to analyze the morphology and microhardness of enamel bleached with in-office hydrogen peroxides and exposed toremineralizing agents.

MATERIALS AND METHODS

After recording initial enamel morphology and microhardness, 60 bovine incisors were bleached using either a calcium-containing 35% hydrogen peroxide (Whiteness HP Blue) or a calcium-free 35% hydrogen peroxide (Whitegold Office) (n = 30). Then, the teeth were subjected to one of three post-bleaching remineralizing treatments (n = 10): storage in artificial saliva only, application of a sodium fluoride gel or application of a nanohydroxyapatite-based agent (Nano-P). After 24 h and 14 days of post-bleaching treatments, the enamel morphology and microhardness were re-evaluated. The microhardness data were analyzed by means of two-way ANOVA with repeated measurements and Tukey tests (p < 0.05), while the enamel morphology was analyzed descriptively.

RESULTS

Samples exposed to Nano-P presented statistically the highest microhardness 24 h after its application in comparison with other remineralizing agents. The microhardness recovery did not occur in any of the groups 14 days after treatment. The morphology of all samples 14 days after the application of all remineralizing agents presented a higher number of irregularities.

CONCLUSION

Although some remineralizing products provided microhardness recovery and a positive effect on enamel morphology at 24 h post-bleaching, none of them were able to maintain microhardness and enamel morphology at 14 days post-bleaching.

The Development of an Oral Health Charting System for Koalas (Phascolarctos Cinereus)

The koala is one of Australia's most highly specialized folivores with a diet exclusively of eucalyptus leaves to provide all nutritive needs and therefore requires to be free of oral disease as they are dependent on good dentition for optimal health and quality of life. We developed an oral examination methodology based on protocols for companion animals and human dentistry to chart the oral health of koalas. Thirty free-ranging koalas from South-East Queensland, Australia were examined for general body and oral health. Inspection of the oral cavity was conducted for the presence or absence of the indicators of oral disease such as caries or periodontal disease. Univariate and multivariate analyses were performed on the examination data and a prototype oral health chart developed. The prototype was then trialled and the methodology validated by the Kappa statistic using ten additional koalas examined by four multidisciplinary personnel involved in koala care. Trauma associated fractures, tooth displacement, abnormal occlusion and tooth wear, compacted vegetation, extrinsic stain deposits, periodontal bone loss, gingivitis, tooth mobility, and calculus were present in the oral cavities of the examined koalas. A system of scoring between 0 and 3 was constructed in accordance with current koala general health charting formats. Validation of the charting method using Kappa coefficients of agreement statistics indicated that there was a good agreement among observers on recorded results except for inflammation and calculus scoring. Modifications were made and visual aids and index scales produced to further assist observers. Oral health surveillance has been proven in other species to be significant in diagnosing physiological disturbances derived from environmental, genetic, and developmental causes. Veterinarians, dental researchers, and koala husbandry personnel will benefit in using this charting method and reporting the oral health of koala populations in their future findings. This unique form of oral health monitoring would be adaptable to other mammals.

Evidence to suggest that teeth act as human ornament displays signalling mate quality

Ornament displays seen in animals convey information about genetic quality, developmental history and current disease state to both prospective sexual partners and potential rivals. In this context, showing of teeth through smiles etc is a characteristic feature of human social interaction. Tooth development is influenced by genetic and environmental factors. Adult teeth record environmental and traumatic events, as well as the effects of disease and ageing. Teeth are therefore a rich source of information about individuals and their histories. This study examined the effects of digital manipulations of tooth colour and spacing. Results showed that deviation away from normal spacing and/or the presence of yellowed colouration had negative effects on ratings of attractiveness and that these effects were markedly stronger in female models. Whitening had no effect beyond that produced by natural colouration. This indicates that these colour induced alterations in ratings of attractiveness are mediated by increased/decreased yellowing rather than whitening per se. Teeth become yellower and darker with age. Therefore it is suggested that whilst the teeth of both sexes act as human ornament displays, the female display is more complex because it additionally signals residual reproductive value.

The effects of light on bleaching and tooth sensitivity during in-office vital bleaching: a systematic review and meta-analysis

OBJECTIVE

To evaluate the influence of light on bleaching efficacy and tooth sensitivity during in-office vital bleaching.

DATA SOURCES

We performed a literature search using Medline, EMBASE and Cochrane Central up to September 2011.

STUDY SELECTION

All randomised controlled trials (RCTs) or quasi-RCTs comparing the light-activated bleaching system with non-activation bleaching system were included. Reports without clinical data concerning bleaching efficacy or tooth sensitivity were excluded.

RESULTS

Eleven studies were included in the meta-analysis. A light-activated system produced better immediate bleaching effects than a non-light system when lower concentrations of hydrogen peroxide (15-20% HP) were used (mean difference [MD], -1.78; 95% confidence interval [CI]: [-2.30, -1.26]; P<0.00001). When high concentrations of HP (25-35%) were employed, there was no difference in the immediate bleaching effect (MD, -0.39; 95% CI: [-1.15, 0.37]; P=0.32) or short-term bleaching effect (MD, 0.25; 95% CI: [-0.47, 0.96]; P=0.50) between the light-activated system and the non-light system. However, the light-activated system produced a higher percentage of tooth sensitivity (odds ratio [OR], 3.53; 95% CI: [1.37, 9.10]; P=0.009) than the non-light system during in-office bleaching.

CONCLUSIONS

Light increases the risk of tooth sensitivity during in-office bleaching, and light may not improve the bleaching effect when high concentrations of HP (25-35%) are employed. Therefore, dentists should use the light-activated system with great caution or avoid its use altogether. Further rigorous studies are, however, needed to explore the advantages of this light-activated system when lower concentrations of HP (15-20%) are used.

Patients' perspective on dental aesthetics in a South-Eastern European community

OBJECTIVES

To assess the importance attributed to dental aesthetics by subjects from a Romanian community. In addition, the role played by dental color, the group-distributions based on the self-evaluation of dental color and the previous experience regarding whitening treatments are analysed.

METHODS

A multiple-choice questionnaire was administered to 540 patients in dental offices in Cluj-Napoca, Romania; the subjects were also asked to self-evaluate their dental shade, using a set of images as a comparison. Answers to the questionnaires were statistically analysed using Microsoft Excel and SPSS 13.00 (Pearson's chi-square test, Fisher's exact test, Kendall's tau b).

RESULTS

From the participants, 17.96% were motivated by aesthetic reasons to ask for treatment; most of the patients evaluated their smile as "acceptable" (38.51%) or "having some defects" (29.44%) and were self-included in groups of medium and dark shades (33.7% and 33.89%, respectively). Whilst 22.40% of the subjects considered the dental color as being the most evident defect of their dentition, 39.07% indicated a self-perception of "an abnormal dental shade". A strong correlation between darker self-assessed tooth color-groups and the self-perception of an abnormal tooth color was found (Chi square p≪0.001, Kendall's tau-c=0.44, with p≪0.001). Previous whitening treatments were reported by 8.88% of the subjects.

CONCLUSIONS

Among patients who wanted to improve one of their oral functions, the majority requested changes in aesthetics. Dental shade is one of the aspects recognized as problematic by the participants, but nonetheless the percentage of patients who had previously benefited by whitening treatments was moderate.

Efficacy of a Novel At-home Bleaching Technique With Carbamide Peroxides Modified by CPP-ACP and Its Effect on the Microhardness of Bleached Enamel

This study was designed to evaluate in vitro the efficacy of a novel at-home bleaching technique using 10% or 16% carbamide peroxide modified by casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and its influence on the microhardness of bleached enamel. A total of 40 bovine incisors were divided into four groups (n=10) according to the bleaching agent used: 10% carbamide peroxide only; a blend of 10% carbamide peroxide and a CPP-ACP paste; 16% carbamide peroxide only; and a blend of 16% carbamide peroxide and a CPP-ACP paste. During the 14-day bleaching regimen, the samples were stored in artificial saliva. The Vickers microhardness and color of the teeth were assessed at baseline (T0) and immediately after the bleaching regimen (T14) using a microhardness tester and a spectrophotometer, respectively. The degree of color change was determined by the Commission Internationale de l'Eclariage (CIE) L*a*b* system (ΔE, ΔL*, Δa*, and Δb*) and Vita shade guide parameters. The data were analyzed by analysis of variance and the Tukey test (p&lt;0.05). The teeth that were bleached with a blend of peroxide (10% or 16%) and the CPP-ACP paste presented increased microhardness values at T14 compared with T0, whereas the samples that were bleached with peroxide only did not show any differences in their microhardness values. All of the bleaching agents were effective at whitening the teeth and did not show a statistically significant difference using the CIEL*a*b* system (ΔE, ΔL*, Δa*, and Δb*) or the Vita shade guide parameters. The use of a CPP-ACP paste with carbamide peroxide bleaching agents increased the bleached enamel's microhardness and did not have an influence on whitening efficacy.

Are oral health complaints related to smoking cessation intentions?

OBJECTIVE

Smoking influences oral health in several ways (such as the occurrence of periodontitis, teeth discolouration and oral cancer); therefore, smoking behaviour should be addressed in dental care. Dentists can play a role in primary and secondary prevention of tobacco dependence. They see their patients repeatedly over time. This study investigates whether oral health complaints can be seized as an opportunity to start smoking cessation counselling.

METHODS

A structured patient questionnaire in a sample of 1101 smokers (52.1% women, mean age 40.4 years) in a convenience sample of 87 primary care dental practices. The I-change model was used to describe factors influencing behavioural change. Dependent factors such as intention to quit smoking and related factors (attitude, social support and self-efficacy) were analysed in relation to independent factors such as oral health complaints (gingiva problems, gingiva inflammation, oral cancer and discoloured teeth) using a general linear model (univariate analysis), multinomial logistic regression analysis and multiple linear regression analysis.

RESULTS

A total of 56.3% had discoloured teeth, 27% of the smokers had a problem with their gums and 15.7% had gingiva inflammation. We found no direct relation between oral health complaints and the intention to quit smoking. However, teeth discolouration was positively related to attitudes towards smoking cessation [β, Confidential interval (95%); 1.92 (1.45-2.40 for advantages and -0.86(-1.18 to -0.53) for disadvantages] and negatively to self-efficacy regarding quitting [-2.69 (-3.49 to 1.88)].

CONCLUSIONS

We found no direct relation between oral health complaints and the intention to quit smoking, but oral health complaints and especially teeth discolouration were related to factors influencing the quit intention. Patients with discoloured teeth are more likely to have a positive attitude towards smoking cessation but are uncertain to persist smoking cessation. It is suggested that teeth discolouration can be a good entrance for addressing smoking cessation in daily dental practice.

Factors influencing patient satisfaction with dental appearance and treatments they desire to improve aesthetics

Background

We assessed factors influencing patients' satisfaction with their dental appearance and the treatments they desired to improve dental aesthetics.

Methods

A cross-sectional study was performed out among 235 adult patients who visited the Hospital Universiti Sains Malaysia dental clinic. A structured, interviewer-guided questionnaire was used to identify patient satisfaction with their general dental appearance, cosmetic elements and desired treatments.

Results

The 235 patients consisted of 70 males (29.8%) and 165 females (70.2%), of mean age 31.5 years (SD 13.0). Of these patients, 124 (52.8%) were not satisfied with their general dental appearance. In addition, 132 patients (56.2%) were not happy with the color of their teeth, 76 (32.3%), regarded their teeth were poorly aligned, 62 (26.4%), as crowded and 56 (23.4%) protruded. Dissatisfaction with tooth color was significantly higher in female than in male patients (odds ratio [OR] of 1.99 (95% confidence interval [CI] 1.13-3.50). Tooth whitening was the treatment most desired by patients (48.1%). Results of multiple logistic regression analysis showed that patient dissatisfaction with general dental appearance was significantly associated with female gender (OR = 2.18; 95% CI: 1.18-4.03), unhappiness with tooth color (OR = 3.05; 95% CI: 1.74-5.34) and the opinion that their teeth protruded (OR = 2.91, 95% CI: 1.44-5.91).

Conclusions

Most patients in this study were not satisfied with their dental appearance with a greater percentage of females expressing dissatisfaction than males. An age was not associated with satisfaction. Unhappiness with tooth color and feelings of having protruding teeth also had a significant negative influence on patient satisfaction with general dental appearance.

Factors influencing patient satisfaction with dental appearance and treatments they desire to improve aesthetics

BACKGROUND

We assessed factors influencing patients' satisfaction with their dental appearance and the treatments they desired to improve dental aesthetics.

METHODS

A cross-sectional study was performed out among 235 adult patients who visited the Hospital Universiti Sains Malaysia dental clinic. A structured, interviewer-guided questionnaire was used to identify patient satisfaction with their general dental appearance, cosmetic elements and desired treatments.

RESULTS

The 235 patients consisted of 70 males (29.8%) and 165 females (70.2%), of mean age 31.5 years (SD 13.0). Of these patients, 124 (52.8%) were not satisfied with their general dental appearance. In addition, 132 patients (56.2%) were not happy with the color of their teeth, 76 (32.3%), regarded their teeth were poorly aligned, 62 (26.4%), as crowded and 56 (23.4%) protruded. Dissatisfaction with tooth color was significantly higher in female than in male patients (odds ratio [OR] of 1.99 (95% confidence interval [CI] 1.13-3.50). Tooth whitening was the treatment most desired by patients (48.1%). Results of multiple logistic regression analysis showed that patient dissatisfaction with general dental appearance was significantly associated with female gender (OR = 2.18; 95% CI: 1.18-4.03), unhappiness with tooth color (OR = 3.05; 95% CI: 1.74-5.34) and the opinion that their teeth protruded (OR = 2.91, 95% CI: 1.44-5.91).

CONCLUSIONS

Most patients in this study were not satisfied with their dental appearance with a greater percentage of females expressing dissatisfaction than males. An age was not associated with satisfaction. Unhappiness with tooth color and feelings of having protruding teeth also had a significant negative influence on patient satisfaction with general dental appearance.