Tooth whitening for the under-18-year-old patient

Long-term complications and management of dental trauma in the adult patient - Part 2: discoloured, displaced and missing teeth

The second paper in this two-part review series aims to outline the long-term complications of dental trauma in the adult patient in relation to discoloured, displaced or missing teeth. A brief overview of the cause of discolouration is outlined, followed by assessment and management options. These can include bleaching, veneers, or crown restorations to mask the discolouration. Displacement of teeth from the socket can occur due to luxation injuries. Management can include simple digital manipulation, surgical repositioning, or orthodontic extrusion based on the severity of extrusion and the time from injury. Teeth can be lost early or in the long-term following dental trauma and associated hard and soft tissues deficiencies may also ensue. Replacement options can include a removable partial prosthesis, resin-retained bridge or dental implants. Often, hard and soft tissue augmentation procedures may be required to address any defects and rebuild lost anatomical contours. A thorough assessment followed by the development of a sound management plan which takes patients' general and local factors into account can ensure a predictable and successful treatment outcome. This would end in an aesthetically pleasing and a functionally stable result for the patient.

A Bibliometric Study of Trends, Indicators, and Characteristics in the Global Scientific Production on Fluorosis

AIM

To perform an analysis of the trends, indicators, and characteristics of the world scientific production on fluorosis, and to evaluate its impact on scientific research in this field.

MATERIALS AND METHODS

A descriptive, cross-sectional study was conducted with a bibliometric approach of the worldwide scientific production on fluorosis published during the years 2018-2023. All metadata were extracted from the Scopus database. The articles were exported in .csv format to SciVal (Elsevier). Of the collected articles, 69 were original, 17 were reviews, 2 were conference papers, 6 were book chapters, among others.

RESULTS

It was found that among the journals with the highest number of articles were Biological Trace Element, Caries Research, Children, Fluoride, and Indian Journal of Forensics. In addition, the highest percentage of authors have published between 1 and 2 articles, with a smaller proportion having 3-4 publications. Among the journals with the highest number of articles are Biological Trace Element, Caries Research, Children, Fluoride, and Indian Journal of Forensics. The Universidade de São Paulo has the most publications, although it is also one of those with the lowest citation-weighted impact in relation to the global average (FWCI: 0.9).

CONCLUSION

The collaboration map shows a wide international cooperation network, with an active participation of Brazil among Latin American countries. Scientific production in fluorosis has a negative trend from 2018 to 2023 and is mainly concentrated in high-impact scientific journals.

CLINICAL SIGNIFICANCE

The study shows a wide network of international cooperation on fluorosis, so the results provide important information to guide future clinically focused research on fluorosis and its impact on public health.

Effectiveness of Teeth Whitening after Regenerative Endodontics Procedures: An In Vitro Study

Discolouration resulting from regenerative endodontic procedures may have a negative impact on the quality of life of treated patients; therefore, it is recommended to minimize this risk by selecting appropriate scaffolds and barrier materials, and if discolouration occurs, the use of a simple, cost-effective and minimally invasive technique, such as whitening, should be considered. This in vitro study aimed to evaluate tooth discolouration after two- and single-visit regenerative endodontic procedures and the effectiveness of subsequent whitening procedures with carbamide peroxide. Two hundred bovine incisors were included in this study and divided into twenty groups based on the tested material combinations. Two groups were control groups, one with saline and the other group with blood. In the 12 groups, the experiment was designed to be consistent with the two-visit regenerative endodontic procedures. Triple antibiotic paste or calcium hydroxide were placed in the root canal, and then scaffolds (e.g., blood or platelet-rich fibrin) and barrier materials (Biodentine, OrthoMTA or MTA Repair HP) were applied after rinsing the disinfectant pastes. In the six groups that corresponded to the single-visit regenerative endodontic procedure, the use of a disinfectant paste was omitted. Subsequently, the specimens were bleached twice with carbamide peroxide at a 7-day interval. Colour change measurements were performed using a spectrophotometer (VITA Easyshade Compact 5.0, VITA Zahnfabrik, Bad Säckingen, Germany). Statistical analysis was performed with the Kruskal−Wallis H test, the independent t-test and t-test for related samples. Tooth discolouration was noticed after two- and single-visit regenerative endodontic procedures, except for the platelet-rich fibrin+MTA Repair HP group. After the first and second whitening procedures, all of the tested two- and single-visit regenerative endodontic procedures groups showed a change in the colour of the crown, which was noticeable to the naked eye (∆E > 3.3). When analysing the ∆E value between the first and second bleaching procedures, no changes in the colour of teeth were visually noticed in the calcium hydroxide and platelet-rich fibrin +MTA Repair HP groups (∆E < 3.3). Single-visit regenerative endodontic procedures are suggested if possible; however, if two-visit regenerative endodontic procedures are performed, it is recommended to use calcium hydroxide as the disinfectant paste because of the lower staining potential. In the context of discolouration, platelet-rich fibrin is advisable for use as a scaffold. The whitening procedure is worth considering, but does not guarantee a return to the original tooth colour, especially when triple antibiotic paste is used.

Evaluation of bleaching agent effects on color and microhardness change of silver diamine fluoride-treated demineralized primary tooth enamel: An in vitro study

BACKGROUND

The present study aimed to assess the impact of application of fluoridated- 10% carbamide peroxide (CP) with or without potassium iodide (KI) on silver diamine fluoride (SDF)-treated enamel surface in the primary teeth.

METHODS

After stained-remineralized caries lesions (s-RCLs) creation, 96 teeth were randomly allocated to four experimental groups: Group 1:SDF-treated enamel followed by 8-h/day application of 10% CP for 2 weeks; Group 2: SDF-treated enamel followed by 15-min/day application of 10% CP for 3 weeks; Group 3: SDF + KI-treated enamel followed by 8-h/day application of 10% CP for 2 weeks; and Group 4: SDF + KI-treated enamel followed by 15-min/day application of 10% CP for 3 weeks. Enamel microhardness (EMH) test (n = 12) and spectrophotometric color assessment (n = 12) was performed at four stages: baseline (intact enamel), demineralized enamel, aged remineralized-stained enamel, and after final intervention. Sixteen samples were used for SEM evaluation. Data were analyzed with the paired t-test, one-way ANOVA, and Tukey's post-hoc test (p < 0.05).

RESULTS

EMH values in all groups showed significant decrease after demineralization (all, p < 0.00001). All samples showed complete recovery of EMH values (%REMH) after SDF application compared to demineralization (%REMHSDF) (p = 0.971). Bleaching caused a slight decrease in %REMH for all groups. However, the differences were not statistically significant (p = 0.979). SEM findings revealed no changes in enamel porosity after bleaching. Bleaching application ameliorated the discoloration in all groups (all, p < 0.00001). All samples in Groups 2 and 4 had significantly lighter color after 21 days as compared to 14-day exposure to the bleaching material (both, p < 0.00001).

CONCLUSIONS

SDF application on demineralized primary tooth enamel completely recovered enamel microhardness. 10% carbamide peroxide effectively bleached SDF stain without causing significant decrease in EMH values. Color improvement was more evident with the use of KI immediately after SDF application. Both 15-min and 8-h application of fluoridated CP resulted in statistically similar color enhancement in primary teeth.

Patient-reported outcome measures for children and adolescents having dental bleaching in the UK

PURPOSE

Dental bleaching in paediatric patients can be used to address discolouration of teeth due to trauma, endodontic treatment, or enamel and dentine defects. Despite being a minimally invasive and successful treatment, the use of bleaching products in children and young people remains controversial. This evaluation was designed to provide insight into the child's perspective on dental bleaching and the influence that this treatment has upon their life.

METHOD

A dental bleaching patient reported outcome measure (PROM) was developed and piloted in 2019. Data were collected from 3 UK units (January-March 2020). Children attending these units for bleaching reviews were invited to complete the PROM.

RESULTS

Twenty seven PROM questionnaires were completed including 19 courses of external bleaching and 8 courses of internal/external bleaching. The average age was 14 years old (9-17 years). The common indications for bleaching were Amelogenesis Imperfecta, dental trauma and Molar Incisor Hypomineralisation. Patients reported improvements in their appearance (89%) and self-confidence (81%). Sensitivity was the most common side effect, reported in 63% of cases.

CONCLUSION

This PROM supports the use of dental bleaching in children and young people when treating dental disease that causes discolouration. Bleaching not only improved the appearance of teeth, but also patients' self-confidence. Sensitivity is a common side effect and clinicians should discuss this common risk and its management with patients and their families.

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.

Patient-reported outcome measure for children and young people with amelogenesis imperfecta

Background Amelogenesis imperfecta (AI) is a genetic enamel defect that can affect both the primary and permanent dentition. It has a range of clinical phenotypes, and children and young people often present with challenging oral health needs. Patient-reported outcome measures (PROMs) can identify key patient concerns.Methods This was a multi-centre service evaluation across several specialist paediatric dentistry services in the UK. A PROM questionnaire was created with clinician and patient input, through peer review with the national AI Clinical Excellence Network, as well as piloting the PROM with ten children and young people with AI. The final PROM questionnaire was distributed to all patients with AI attending each unit between January and March 2020.Results Sixty children and young people (aged 5-17 years) across four specialist units participated, with 72% reporting that they 'often' or 'sometimes' experienced pain or sensitivity and 76% reporting that they 'often' or 'sometimes' felt unhappy with the way their teeth look. Of the patients who were post-treatment, 81% indicated that they were happy with their teeth, compared to just 41% of patients who were mid-treatment and 33% of patients who were pre-treatment.Conclusion Children and young people with AI experience a range of issues related to their function and psychosocial wellbeing. This simple PROM demonstrates the range of issues this group of patients face, and could be used to monitor an individual's progress to ensure that treatment is planned to address the patient's individual concerns and needs.

Is it time to reconsider the use of vital teeth bleaching in children and adolescents in Europe?

PURPOSE

The aim of this study was to determine whether carbamide peroxide is effective in bleaching vital permanent teeth in children.

METHODS

A literature search was conducted using all keywords relevant to the research subject. The outcome measures were identified as colour change, tooth sensitivity, oral irritation and patient satisfaction. The certainty of evidence for each outcome was assessed using the current GRADE guidelines.

RESULTS

Of 115 potentially relevant articles, 112 were excluded, as they did not exclusively involve children, intervention involved additional treatment such as microabrasion or restorative work, or case studies. Patient satisfaction was not assessed in the three articles so no analysis could be made with regards to this outcome. The GRADE assessment showed that all of the three articles demonstrated very low certainty of evidence for the other assessed outcomes. The overall findings from the studies suggest that a 10% carbamide peroxide overnight tray system is effective at bleaching vital permanent teeth in children and associated tooth sensitivity and oral irritation are found to be in a similar range compared to those reported in adult studies. However, due to the very low certainty of the evidence, it is not possible to draw these conclusions.

CONCLUSION

Better quality randomised controlled trials are needed to investigate the indication, short and long term effectiveness and side effects of carbamide teeth in vital permanent teeth in children.

Efficiency of Teeth Bleaching after Regenerative Endodontic Treatment: A Systematic Review

The aim of this review is to evaluate of effectiveness of bleaching procedures used to treat discolored teeth subsequent to regenerative endodontic procedures (REPs) based on the review of in vitro and in vivo studies. This literature review was carried out according to the PRISMA guidelines. Four databases (PubMed, Scopus, the Cochrane Library, and Web of Science databases) were searched electronically, until 30 January 2020 without a year limit. The quality of studies was assessed using a modified methodological index for non-randomized studies. After analyzing 1405 studies, 6 in vitro and 9 in vivo studies were eligible for this review. In in vitro studies, effectiveness of bleaching was assessed in teeth discolored by antibiotic pastes, blood, and barrier materials in various combinations. In all analyzed studies, bleaching was effective in teeth discolored by antibiotic pastes as well as by blood and barrier materials. Of 26 treated teeth in the in vivo studies, 17 teeth were bleached successfully. In six cases, there was improvement of the shade. In three cases, bleaching was not sufficient. Bleaching material, techniques, and times differed between studies. Whitening of discolored teeth after REPs is achievable. However, to establish precise guidelines, further long-term clinical studies should be performed.

Vital bleaching for children with dental anomalies: EAPD members' survey

AIM

Understand EAPD members' practices of vital bleaching for children with dental anomalies.

METHODS

An anonymous online survey sent via EAPD in January 2019, consisting of 13 questions with possible multiple answers and free text.

RESULTS

110 responses from 24 countries were obtained. The majority worked in hospitals/universities (n = 69, 63%) or private practices (n = 50, 46%) and were specialists (n = 62, 57%) or senior academics (n = 35, 32%). Most respondents (n = 74 68%) did not provide vital bleaching for children. 88 respondents (80%) belonged to EU: of these, 46 (52%) were not aware of bleaching regulations. For respondents who provided bleaching 26 (72%) undertook home bleaching, using 10% carbamide peroxide (n = 21, 58%), most commonly for 2 weeks (n = 14, 39%), following establishment of the permanent dentition (n = 21, 58%). Deciding factors included: extent (n = 27, 75%) and shade (n = 26, 72%) of discolouration and child being teased by peers (n = 23, 64%). Main reasons for not bleaching included: concerns with side effects (n = 41; 55%) and not agreeing with bleaching (n = 23, 31%). Dentists who did not bleach managed a range of conditions, most frequently molar-incisor hypomineralisation (n = 57; 77%). The majority provided composite restorations with removal of tooth structure (n = 50; 68%) with a number opting for no treatment (n = 27, 37%).

CONCLUSION

This study shows wide variations in treatment of children's dental anomalies across Europe. Fears of adverse effects and personal beliefs seemed to be the main deterrents to bleaching in children. Clinicians who provided bleaching tended to opt for more conservative techniques and to take children's concerns into consideration.

Management of discolouration following revitalization endodontic procedures: A case series

AIM

To discuss the causes and management of tooth crown discolouration following regenerative/revitalization endodontic therapy (RET) and to present the decision-making process affecting three RET-related cases of crown discolouration.

SUMMARY

This case series outlines several approaches used in the management of post-RET discolouration. The cases highlight the influence of the material used in creating a coronal seal on the choice and success of the management techniques provided. The first two cases highlight successful management of post-RET discolouration through the use of internal-external bleaching. The use of internal bleaching in the third case was not recommended; therefore, external bleaching followed by a direct composite veneer was carried out.