The change of teeth color, whiteness variations and its psychosocial and self-perception effects when using low vs. high concentration bleaching gels: a one-year follow-up

Clinical decision-making in tooth bleaching based on current evidence: A narrative review

OBJECTIVE

This review consolidates current knowledge on dentist-supervised tooth bleaching for vital teeth, drawing from systematic reviews, meta-analyses, and randomized clinical trials (RCTs) that followed CONSORT guidelines.

DATA RESOURCES

MeSH and free terms like "tooth bleaching," "tooth whitening," "randomized clinical trial," and "systematic review" were used in PubMed, Scopus, and Web of Science databases STUDY SELECTION: Out of 839 articles, 444 were selected for full-text review, excluding case reports, non-randomized trials, literature reviews and those not directly related to tooth bleaching or RCTs not following CONSORT 2010. The remaining 203 studies were used to compare the dentist-supervised at-home and in-office clinical protocols, assessing factors such as color change, tooth sensitivity, and gingival irritation. In vitro studies were cited to support and explain basic concepts of different clinical decisions CONCLUSIONS: Daily at-home bleaching with 10 % carbamide peroxide or lower-concentration hydrogen peroxide over three to four weeks is effective. In-office bleaching with high-concentration hydrogen peroxide exhibits variations in protocols based on the HP concentration and gel's pH. Emerging technologies like violet LEDs and photobiomodulation with infrared lasers show promise in enhancing efficacy and reducing sensitivity, respectively, though more research is needed. The review underscores the importance of ongoing research into desensitization strategies to manage sensitivity related to bleaching.

CLINICAL SIGNIFICANCE

Tooth bleaching is central to dental aesthetics, offering a range of options that can challenge clinicians. Adverse effects, particularly sensitivity, highlight the need for practice supported in protocols clinically tested and effective desensitization approaches.

Clinical evaluation of in-office bleaching with low, medium, and high concentrate hydrogen peroxide: a 6-month a double-blinded randomized controlled trial

OBJECTIVE

The study evaluated the longevity, efficacy, sensitivity, and impact on the oral health-related quality of life of in-office dental bleaching using low, medium, and high concentrate hydrogen peroxide.

MATERIAL AND METHODS

Randomized, parallel, and double-blinded clinical trial was performed with 54 participants using18% hydrogen peroxide (HP), 25%HP, and 40%HP in-office bleaching agent. Tooth color was evaluated at baseline, after the 1st session bleaching, after the 2nd session bleaching and 6 months after finishing the bleaching using spectrophotometer. Tooth sensitivity (TS) was measured with the Visual Analog Scale at baseline, immediately after bleaching, after 1 day, and after 7 days. The impact on quality of life was evaluated using the 14-item Oral Health Impact Profile (OHIP-14) questionnaire at baseline, and 6 months after bleaching. The data were analyzed using the Kikare test, Kruskal Wallis test, one-way ANOVA, Wilcoxon, Friedman, Mann-Whitney (p < 0.05).

RESULTS

All groups achieved similar levels of bleaching during all evaluation times (p > 0.05), surpassing perceived value. There was no difference in TS levels among groups at all evaluation times (p > 0.05). TS significantly increased after bleaching (p < 0.05), decreased significantly after 24 h (p < 0.05), and there was no difference no difference between the initial sensitivity levels after 7 days (p > 0.05). All groups reported improved aesthetic self-perception following bleaching (p < 0.05) and there was no difference between the groups (p > 0.05).

CONCLUSION

Low, medium, and high concentrations of HP did not affect both the final tooth color and the reported TS intensity, regardless of the evaluation time. In-office bleaching provides positive effects on aesthetic perception and different HP concentrations have not influenced this positive effect.

CLINICAL SIGNIFICANCE

In this study, the efficacy, longevity, sensitivity, and impact on oral health-related quality of life of in-office bleaching using low, medium, and high concentration hydrogen peroxide agents from the same manufacturer were found to be similar. However, these results cannot be extrapolated to other in-office high-concentration hydrogen peroxide gels.

CLINICAL TRIAL REGISTRATION NUMBER

NCT06700434.

Randomised clinical trial to compare the efficacy of dental whitening with 37.5 % Hydrogen Peroxide gel and 6 % Hydrogen Peroxide whitening strips

OBJECTIVE

to evaluate the efficacy and chromatic stability after 4weeks, in all three thirds of the central incisor of two whitening treatments: in-office 37.5 % hydrogen peroxide (HP) treatment alone, and 37.5 % in-office HP followed by use of 6 % HP whitening strips (WS).

METHODS

60 participants were randomly divided into two groups of 30. Group 1 was treated solely with in-office 37.5 % HP. Group 2 followed the same in-office 37.5 % HP protocol, followed by WS over 2 weeks. The CIELAB colour were measured before and after every treatment stage. Colour differences were quantified and compared to the perceptibility thresholds.

RESULTS

In-office 37.5 % HP treatment created a statistically significant increase in the L* coordinate and a statistically significant decrease in the a* and b* coordinates, resulting in perceptible colour changes in over 80 % of participants in all thirds of the tooth. In the group that used WS, the increase in L* and the decrease in a* and b* were maintained in the cervical and middle thirds after 4 weeks, whereas only the decrease in b* was maintained in the incisal third. In the group that did not use WS, the decrease in a* and b* was maintained in all thirds of the tooth after 4 weeks, but the increase in lightness was lost.

CONCLUSIONS

The use of WS helped maintain that increase in lightness over 4 weeks. The decrease in the a* and b* coordinates caused by the 37.5 % HP treatment persisted after 4 weeks, whether WS were used or not. All the colour changes evaluated were perceptible in over 70 % of participants.

CLINICAL SIGNIFICANCE

In-office treatment with 37.5 % HP increases lightness and decreases the quantity of yellow and red immediately but, if WS are not used, the impact on lightness is lost after 4 weeks. WS are a valid and effective treatment option in combination with in-office treatments to temporally extend the clinical treatment's whitening effect.

Evaluation of the Effectiveness of Different Types of Professional Tooth Whitening: A Systematic Review

BACKGROUND/OBJECTIVES

Tooth whitening is a cosmetic dental treatment that improves the color of natural teeth, making them whiter and brighter; this review aimed to evaluate the greater effectiveness of in-office, at-home, and combined bleaching with hydrogen or carbamide peroxide, also in relation to possible relapses and side effects (tooth sensitivity).

METHODS

A literature search has been carried out through electronic databases, PubMed/MEDLINE, and Cochrane Library, focused on the use of the effectiveness of in-office, at-home, and combined dental bleaching. This review has been registered on PROSPERO (ID613248).

RESULTS

30 articles have been included. Most of the studies did not find any more effective treatment than the proposed treatments; all types of bleaching have been shown to be effective in changing color; in the studies that have compared in-office and at-home bleaching, there was a lower recurrence of treatment with the use of the at-home trays with carbamide peroxide gel. There were no clear positions regarding tooth sensitivity, which would appear to be higher in professional in-office and combined dental bleaching.

CONCLUSIONS

Bleaching is an effective treatment for the change of color of the tooth regardless of the type used (concentrations, type of gel, and duration of sessions), although, at home, it would seem to be more effective over time. It is, however, a clinical feature that may give a risk of tooth sensitivity after treatment.

Probiotics for oral health: a critical evaluation of bacterial strains

Oral health is critical for total body health and well-being; however, little improvement in oral health status has occurred in the U.S. over the past 20 years. Tooth decay and gum disease remain highly prevalent, with more than 90% and 50% of adults suffering from these conditions, respectively. To combat this lack of improvement, alternative approaches to dental care are now being suggested. One such alternative therapy is probiotics for oral care. In the oral cavity, probiotic strains have been shown to reduce levels of oral pathogens, inhibit the formation of dental caries, and reduce the levels of bacteria that cause halitosis. However, as the oral care probiotic market expands, many products contain bacterial species and strains with no documented health benefits leading to confusion and mistrust among consumers and clinicians. This confusion is enhanced by the regulatory status of probiotic products which puts the onus of safety and efficacy on the manufacturer rather than a central regulatory body. The overarching goal of this review is to provide consumers and clinicians with documented evidence supporting (or refuting) the health benefits of oral care probiotics marketed for sale in the United States. This includes defining what constitutes an oral care probiotic product and a strain level analysis of candidate probiotics from the genera Streptococcus, Lactobacillus, Bifidobacterium, and Bacillus. Additionally, prebiotics and postbiotics will be discussed. Finally, a set of considerations for consumers and clinicians is provided to empower probiotic product decision making. Together, this review will improve understanding of oral care probiotics marketed in the US for dental professionals and consumers.

Assessment of Color Change, Esthetic Perception, Treatment Satisfaction, and Side Effects Following the Use of Over-the-Counter Whitening Products

Objectives

The objective of this study was to investigate the efficacy of tooth whitening and the effects on satisfaction with whitening treatment and esthetic self-perception of over-the-counter tooth whitening products.

Materials and methods

Fifty-six participants were randomly allocated to three groups based on the whitening product they used (toothpaste, pencil, or a combination of both). In this prospective study, alterations in tooth color were assessed using a spectrophotometer at three distinct time intervals (initial measurement, seven days, and 14 days after commencing the use of the whitening product). Simultaneously, the respondents were given the PIDAQ questionnaire to complete. Patient satisfaction with treatment characteristics (5-point Likert scale), and perception of side effects were assessed at the end of the study.

Results

Participants who used the whitening pen either alone or in combination with whitening toothpaste showed significant improvements in tooth color and whiteness index at seven and 14 days compared to those who used whitening toothpaste alone (p≤0.001). No significant differences were found between products in overall satisfaction with treatment, perception of final tooth color, and treatment comfort. Furthermore, with the exception of the psychological influence factor after 14 days (p≤0.001), there were no significant differences in the PIDAQ questionnaire scores between the whitening products at the different time points. However, many respondents (16.6%) reported oral mucosal sensitivity and a higher percentage (27.8%) reported tooth sensitivity during whitening pen application.

Conclusion

The combination of whitening toothpaste and whitening pen, as well as the whitening pen alone, showed effective objective color change results, but home whitening procedures did not significantly affect participants' self-perceived satisfaction or psychosocial outcomes depending on the product used.

Application Tip and Concentration of a Self-mixing Bleach: Hydrogen Peroxide Inside the Pulp Chamber, Color Change, and Amount of Bleaching Gel Used

PURPOSE

The objective of this study was to evaluate if the application method (tip with brush or tip without brush) and hydrogen peroxide (HP) concentration (6% or 35% self-mixing) of in-office bleaching gel influences the penetration of HP into the pulp chamber, color change, and the amount of bleaching gel used.

METHODS

Forty healthy premolars were randomly divided into the following five groups (n=8): no treatment; HP6% using a tip with a brush, HP6% using a tip without a brush, HP35% using a tip with a brush, and HP35% using a tip without a brush. After treatments, the HP concentration (μg/mL) within the pulp chamber was determined using UV-Vis spectrophotometry. The color change (ΔEab, ΔE00, and ΔWID) was evaluated using a digital spectrophotometer. The amount of gel used (g) in each group was measured using a precision analytical balance. Data from each test were submitted to parametric tests (α=0.05).

RESULTS

The tip with a brush resulted in a lower amount of HP inside the pulp chamber and less gel used when compared with the tip without a brush, regardless of HP concentration (p<0.05). However, regarding the tip used, although no significant difference was observed when HP35% was used (p>0.05), a higher whitening effect was observed when the 6% HP was applied without a brush as opposed to with a tip brush (p<0.05).

CONCLUSIONS

The use of a tip with a brush, regardless of the in-office bleaching gel concentration (6% or 35% self-mixing), presented a lower penetration and lower volume of spent gel when compared to a tip without brush. However, the whitening effect depended on the concentration of HP used.

A new approach for professional dental bleaching using a polymeric catalyst primer

OBJECTIVE

Evaluate the influence of a polymeric catalyst primer (PCP) on esthetic efficacy (EE), degradation kinetics of hydrogen peroxide (H₂ O₂ ), and trans-amelodentinal cytotoxicity (TC) of bleaching gels.

MATERIALS AND METHODS

The following groups were established: G1: No treatment (NC, negative control); G2: PCP; G3: 10% H₂ O₂ ; G4: PCP + 10% H₂ O₂ ; G5: 20% H₂ O₂ ; G6: PCP + 20% H₂ O₂ ; G7: 35% H₂ O₂ (positive control); G8: PCP + 35% H₂ O₂ . To determine EE, enamel/dentin discs (E/DDs) were stained and subjected or not to bleaching protocols for 45 min. To assess TC, the E/DDs were adapted to artificial pulp chambers. The extracts (culture medium + gel components diffused through E/DDs) were applied to odontoblast-like MDPC-23 cells. The viability (VB), oxidative stress (OxS), morphology (SEM), amount of H₂ O₂ diffused and the production of hydroxyl radical (OH^• ) were assessed (two-way ANOVA/Tukey/paired Student t-test; p < 0.05).

RESULTS

The highest EE was found in G8 (p < 0.05), and G4, G6, and G7 did not differ statistically (p > 0.05). In G4, the limited H₂ O₂ diffusion reduced OxS and increased cell VB (p < 0.05).

CONCLUSIONS

Coating the enamel with PCP containing 10 mg/ml of manganese oxide before applying the 10% H₂ O₂ bleaching gel maintains the EE of conventional in-office bleaching and minimizes the toxic effects of this esthetic therapy.

CLINICAL SIGNIFICANCE

Coating the enamel with a PCP before applying the bleaching gel may potentiate the EE of the conventional in-office tooth bleaching and reduce the toxicity of this professional therapy to the dental pulp.

Manganese oxide increases bleaching efficacy and reduces the cytotoxicity of a 10% hydrogen peroxide bleaching gel

OBJECTIVE

The study aims to assess the effects of a 10% H₂O₂ bleaching gel with different MnO₂ concentrations on the bleaching efficacy (BE), degradation kinetics (DK) of H₂O₂, and trans-amelodentinal cytotoxicity (TC).

MATERIALS AND METHODS

Standardized bovine enamel/dentin disks (n = 96) were placed in artificial pulp chambers, and the bleaching gels were applied for 45 min. Thus, the following groups were established: (G1) no treatment (negative control/NC); (G2) 35% H₂O₂ (positive control/PC); (G3) 10% H₂O₂; (G4) 10% H₂O₂ + 2 mg/mL MnO₂; (G5) 10% H₂O₂ + 6 mg/mL MnO₂; and (G6) 10% H₂O₂ + 10 mg/mL MnO₂. After analyzing bleaching efficacy (ΔE₀₀ and ΔWI), the degradation kinetics of H₂O₂ and trans-amelodentinal cytotoxicity were determined (n = 8, ANOVA/Tukey; p < 0.05).

RESULTS

G6 presented BE (ΔE₀₀ and ΔWI) statistically similar to G2, which represented conventional in-office bleaching (p = 0.6795; p > 0.9999). A significant reduction in the diffusion of H₂O₂ occurred in G3, G4, G5, and G6 compared to G2 (p < 0.0001). The highest DK of H₂O₂ occurred in G6 (p < 0.0001), which had the lowest TC in comparison with all other bleached groups (p ≤ 0.0186).

CONCLUSION

The addition of 10 mg/mL of MnO₂ in a 10% H₂O₂ bleaching gel potentiates the degradation of this reactive molecule, which increases the BE of the product and decreases TC.

CLINICAL SIGNIFICANCE

Replacing a 35% H₂O₂ gel commonly used for conventional in-office dental bleaching by a 10% H₂O₂ gel containing 10 mg/mL of MnO₂ reduces the cytotoxicity of this professional therapy, maintaining its excellent esthetic efficacy.

Repeatability of dental shade by digital spectrophotometry in current, former, and never smokers

Cigarette smoking contributes to poor oral health and dental discoloration. Therefore, stopping smoking may translate into measurable amelioration of dental shade indices. We compared dental shade parameters by digital spectrophotometry among current, former, and never smokers and verified their repeatability at 7 and 30 days. Dental shade parameters (CIE L*a*b* and corresponding whiteness index for dentistry-WID) were measured in current, former, and never smokers with a digital spectrophotometer (Vita Easyshade V) on three separate study visits: at baseline (day 0), at day 7, and day 30. Dental shade parameters were analyzed in 18 current, 18 former, and 20 never smokers. The repeatability of shade parameters was consistent in current, former, and never smokers. L*, a*, b*, and WID show significant short and long-term repeatability (p < 0.0001, by regression analyses). The mean (± SD) WID score of 13.42 (± 4.9) in current smokers was significantly lower compared to the WID score of 20.38 (± 5.3) in never smokers (p = 0.001). No significant differences were observed between current and former smokers and between former smokers and former smokers. Dental shade measurements by digital spectrophotometry were highly reproducible and showed that teeth whiteness of current smokers is substantially inferior compared to never smokers. Objective discrimination of dental shade can be a valuable regulatory science endpoint for investigating oral hygiene and dental aesthetics of consumer care products, smoking cessation medications, and tar-free tobacco products (e-cigarettes, heated tobacco products, oral nicotine products) for cigarette substitution.

Clinical trial registration: the study was not registered in ClinicalTrials.gov considering that it is a pilot study, parts of a larger project with ID: NCT04649645

Validation of the brazilian version of the oral health impact profile - Aesthetic questionnaire

Abstract The aim of the study was to develop the Brazilian version of the Oral Health Impact Profile - Aesthetic Questionnaire (OHIP-Aes-Braz) and test its psychometric properties. The questionnaire test versions were developed by a panel of experts and a pre-test was conducted in a focus group. Data used for testing its psychometric properties were obtained from a randomized controlled clinical trial on tooth bleaching. Seventy-nine Brazilian adults were included. The questionnaires were applied before tooth bleaching treatment (baseline), one week (T1), and one month after the intervention (T2). Reliability was assessed in terms of internal consistency and stability, while validity was ascertained by criterion and construct validity. The sensitivity to change was assessed comparing the total scores at baseline and T2, using the Wilcoxon test (α = 0.05). Both stability and internal consistency (intra-class correlation coefficient=0.95, Cronbach’s α = 0.92) proved to be adequate. Construct validity was confirmed as the correlation between OHIP-Aes-Braz scores with tooth color satisfaction and self-perceived oral health were in the expected direction. A positive correlation between OHIP-Aes-Braz and OHIP-14 (rs=0.63) and OIDP (rs=0.77) was observed. The instrument was responsive once differences in total scores before and after treatment were statistically significant (p<0.001). The OHIP-Aes-Braz presented good psychometric properties and showed sensitivity to change regarding aesthetics evaluation in Brazilian adults treated with tooth bleaching. A valid and reliable instrument allows a suitable assessment of oral health-related quality of life in Brazilian patients submitted to aesthetics dental interventions.

The influence of the renewal or the single application of the peroxide gel on the efficacy and tooth sensitivity outcomes of in-office bleaching-A systematic review and meta-analysis

OBJECTIVE

To answer the question: "Does the peroxide gel application regimen (single application vs. renewal) influence the efficacy and the tooth sensitivity outcomes of in-office tooth bleaching?"

METHODS

The search was done in Pubmed, Cochrane, LILACS, Scopus, Web of Science, and EMBASE in February 2021 (updated in July 2021). Randomized clinical trials (RCT) comparing the single application vs. the renewal protocols of HP were included. The meta-analyses were performed for the objective (ΔE_ab ), subjective (ΔSGU) color changes, and absolute risk of tooth sensitivity (TS). Heterogeneity was evaluated using Q test (I² ). Cochrane Collaboration tool assessed the risk of bias (RoB). The GRADE evaluated the certainty of evidence.

RESULTS

Five RCT studies remained. Two studies showed high RoB, and three presented some concerns. No significant differences were observed between the protocols in terms of the ΔE_ab , ΔSGU, and TS. ΔE_ab exhibited substantial heterogeneity (I²  = 87%), while ΔSGU (I²  = 60%) and the TS (I²  = 62%) presented a moderate one. The certainty of evidence was considered low or very low, depending on the variable response and the evaluation time.

CONCLUSION

The application regimen (single vs. renewal of HP) did not impact color change or the absolute risk of TS.

CLINICAL SIGNIFICANCE

The renewal of bleaching gel during the in-office appointment may not be necessary. However, there is at least a low certainty of evidence. Because of this, further randomized clinical trials with appropriate methodology on this topic are encouraged.

Colorimetric evaluation after in-office tooth bleaching with violet LED: 6- and 12-month follow-ups of a randomized clinical trial

OBJECTIVES

To evaluate the long-term outcomes of in-office bleaching with violet LED light (LED) alone or combined with carbamide (CP) or hydrogen (HP) peroxides.

METHODS

Volunteers of a previous short-term study were recalled for 6- and 12-month follow-ups, according to the following interventions (n = 18/group): LED, CP, LED/CP, HP, and LED/HP. The objective color (ΔE_ab, ΔE₀₀) and whiteness index (ΔWI_D) changes were calculated applying the CIELab coordinates' values obtained using a spectrophotometer. A visual shade guide determined the tooth's subjective color change (ΔSGU). Data were submitted to one-way ANOVA or Welch's ANOVA, following appropriate post hoc tests (α = 5%).

RESULTS

The LED and CP groups exhibited the lowest ΔE_ab, ΔE₀₀, and ΔSGU (p < 0.05), but the LED group displayed a significantly lower ΔWI_D. After 12 months, the LED/CP group presented a higher ΔE_ab and ΔE₀₀ than the CP group (p < 0.05). ΔE_ab, ΔE₀₀, ΔSGU, or ΔWI_D means did not differ statistically between the LED/CP and HP groups. The LED/HP group presented a higher ΔE₀₀ than the HP group, regardless of the time.

CONCLUSIONS

The bleaching efficacy of LED alone was significantly lower compared to the LED/CP and HP-containing protocols. After 12 months, the LED/CP and HP groups did not differ in bleaching efficacy. LED irradiation only increased the objective color change of bleaching gels.

CLINICAL RELEVANCE

LED alone promoted a long-term perceptible bleaching, but not compatible with that of high-concentrated HP. The bleaching outcomes of violet irradiation to 37% CP were maintained over time, with LED/CP demonstrating comparable results to HP even after 12 months.

NATIONAL CLINICAL TRIALS REGISTRY (REBEC)

RBR-5t6bd9.