Various Aspects Involved in the Study of Tooth Bleaching Procedure: A Questionnaire–Based Study

Effect of a novel Low-Concentration Hydrogen Peroxide Bleaching Gel Containing Nano-Sized Sodium Trimetaphosphate and fluoride

OBJECTIVES

To evaluate in vitro the effects of nano-sized sodium trimetaphosphate (TMPnano) and sodium fluoride (F) added to a 17.5% hydrogen peroxide (H2O2) bleaching gel on the color change, enamel mechanical and morphological properties, and H2O2 transamelodentinal diffusion.

MATERIALS AND METHODS

Bovine enamel/dentin discs (n = 180) were divided according to the bleaching gel: 17.5% H2O2 (17.5% HP); 17.5% H2O2 + 0.1% F (HP/F); 17.5% H2O2 + 1% TMPnano (HP/TMPnano); 17.5% H2O2 + 0.1% F + 1% TMPnano (HP/F/TMPnano) and 35% H2O2 (35% HP). The gels were applied for 40 min on three sessions, each session spaced 7 days apart. The total color change (ΔE*ab) according to the Commission Internationale de l'Eclairage (CIE) L*a*b* color change measured by CIEDE2000 (ΔE00), whitening index (ΔWID), surface hardness (SH), surface roughness (Ra), cross-sectional hardness (ΔKHN), and transamelodentinal diffusion were assessed. Enamel surfaces were examined using Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray (EDS) analysis. The data were analyzed using ANOVA, followed by the Student-Newman-Keuls test (p < 0.05).

RESULTS

ΔE*ab, ΔE00, and ΔWID values were comparable among the gels that produced a bleaching effect post-treatment (p < 0.001). The HP/F/TMPnano group exhibited lower mineral loss (SH and ΔKHN), Ra, and H2O2 diffusion compared to the 17.5% HP and 35% HP groups, which had the highest values (p < 0.001). SEM/EDS analysis revealed surface changes in all bleached groups, though these changes were less pronounced with F/TMPnano.

CONCLUSIONS

The 17.5% HP gel containing F/TMPnano maintains the bleaching effect while reducing enamel demineralization, roughness, H2O2 diffusion, and enamel morphological changes.

CLINICAL RELEVANCE

Low-Concentration H2O2 bleaching gel containing F/TMPnano can be used as a novel approach to enhance safety and maintain the performance of aesthetic effects.

In vitro evaluation of the tooth bleaching efficacy and safety of high-concentration hydrogen peroxide with cold atmospheric plasma

BACKGROUND

Using hydrogen peroxide (HP) for tooth bleaching may induce various side effects. Cold atmospheric plasma (CAP) is a promising solution. We aimed to evaluate and compare the efficacy and safety of tooth bleaching using high-concentration HP with CAP with conventional in-office bleaching.

METHODS

Fifty-one discolored extracted human teeth were assigned to three groups: Group 1 (light-emitting diode with 35 % HP), Group 2 (CAP with 35 % HP), and Group 3 (only CAP). Bleaching was conducted over three sessions for a total of 20 min. The bleaching effect was evaluated based on the changes in color (ΔE00 and WID) and lightness (ΔL⁎ and ΔG). Safety was assessed by examining the dark areas on the enamel and monitoring the pulp chamber temperature. The study analyzed how different bleaching methods and durations affected ΔE00 and ΔWID using repeated-measures analysis of variance (ANOVA). The Kruskal-Wallis and Mann-Whitney tests were used for ΔL⁎ and dark areas, and one-way ANOVA for ΔG after 20 min of bleaching.

RESULTS

The ΔE00 and WID demonstrated an interaction based on the bleaching method and time, with Group 1 exhibiting the highest ΔE00 and WID at all treatment times (p < 0.001). ΔL⁎ and ΔG did not differ significantly between Groups 1 and 2 (p = 0.056 and 0.062, respectively) and were lowest in Group 3 (p < 0.001). Group 1 exhibited the darkest areas and highest pulp chamber temperatures (p < 0.001). Group 1 exhibited statistically significant color changes. Group 2 demonstrated similar effects, but with enhanced safety profiles.

CONCLUSIONS

Group 2, although displaying a slightly less pronounced color change compared with Group 1, achieved a color alteration readily discernible to the naked eye. This suggests that CAP with 35 % HP could be an interesting area for further investigation as an alternative to traditional in-office bleaching methods.

Evaluation of Turkish Dentists' Approach to Over-the-Counter Whitening Agents: A Questionnaire-Based Study

AIM

Over-the-counter teeth-whitening products have become popular in accordance with the increasing demands of patients. These products can also be recommended to patients by dentists. The aim was to determine the rates of recommendation of over-the-counter teeth whitening products by dentists in Turkey divided into different categories for their patients and to interpret them based on a cause-and-effect relationship.

MATERIAL AND METHODS

After obtaining ethics committee approval, the survey questions were created using Google Forms (Google Inc., Mountainview, CA) and delivered to dentists via social media. Dentists who signed the informed consent form completed the survey. Within the study's scope, statistical analyses were conducted using IBM SPSS Statistics for Windows, version 26.0 (IBM Corp., Armonk, NY). Values were expressed as frequency (n) and percentage (%). A chi-square test was used to compare participants' teeth-whitening recommendations according to their demographic characteristics. The statistical significance level was accepted as p <0.05 throughout the study.

RESULTS

A total of 57.9% of dentists working in Turkey did not recommend over-the-counter teeth-whitening products to their patients. When the answers to the question "Which whitening products sold on the market do you recommend to your patients?" were compared according to the participants' place of work, there was a statistically significant difference between the place of work and the recommended whitening product (p <0.05). Participants working in the private sector answered "I do not recommend" at a higher rate than participants working in the public sector. Among those who recommended toothpaste, more dentists with five or fewer years of experience recommended toothpaste to their patients than dentists with greater than five years of experience. Additionally, more dentists working in the public sector recommended toothpaste to their patients than dentists working in the private sector, and more specialist dentists recommended toothpaste to their patients than general practitioner dentists.

CONCLUSION

Most dentists in Turkey do not recommend over-the-counter teeth-whitening products to their patients. Among those who recommend such products, toothpaste has been determined to be the first choice. The results of this study may raise awareness among dentists about over-the-counter teeth-whitening products and encourage new studies.

Correlation between patient satisfaction and color changes after tooth bleaching

OBJECTIVE

This study aimed to investigate the relationship between patient satisfaction of outcomes and tooth color changes during and after tooth bleaching.

METHODS

In this clinical trial, 63 volunteers participated in an in-office bleaching procedure using a 40% hydrogen peroxide gel. The treatment consisted of two sessions, each comprising two 30-min applications of the bleaching gel. The L*, a*, and b* values of six maxillary anterior teeth were measured at baseline (T1), after the first bleaching session (T2), after the second bleaching session (T3), 1 week after the second in-office bleaching session (T4), and 3 weeks after the second in-office bleaching session (T5). The color differences (ΔE00 ) were calculated using CIEDE2000. A satisfaction scale with a score ranging from 0 to 3 was used to record participants' level of satisfaction with their tooth color at each time point. The data were statistically analyzed using repeated measures analysis of variance and logistic regression (α = 0.05).

RESULTS

Significant correlations were observed between ΔL*, Δb*, and ΔE00 values at T3 and patient satisfaction (all p < 0.05). The regression model indicated a more pronounced impact of Δb* on patient satisfaction compared to ΔL*. The established regression models were as follows: Logit (PL*b* ) = -4.354 + 0.271ΔL* - 0.585Δb* and Logit (PΔE00 ) = -2.552 + 0.521ΔE00 . The findings suggested a minimum ΔE00 value of 4.90 for satisfactory results. A minimum ΔE00 value of 3.9, 5.0, and 6.8 was necessary for central incisors, lateral incisors, and canines, respectively, to achieve a satisfactory result.

CONCLUSIONS

The ΔL*, Δb*, and ΔE00 values were found to be significantly correlated with patient satisfaction after bleaching. Δb* was identified as having a greater influence on patient satisfaction than ΔL* values in the regression model. Furthermore, attaining a minimum ΔE00 value of 4.90 is necessary to achieve satisfactory outcomes. A greater ΔE00 value is needed for canines than for incisors to achieve equivalent patient satisfaction.

CLINICAL SIGNIFICANCE

This study emphasizes the importance of considering the extent of color change needed to achieve patient satisfaction after tooth bleaching procedures.

In vitro evaluation of the effect of different bleaching varnishes: Hydrogen peroxide penetration into the pulp chamber and color change

OBJECTIVE

To evaluate the penetration of hydrogen peroxide (HP) into the pulp chamber and the color change of different bleaching varnishes in low concentrations used for at-home bleaching.

MATERIALS AND METHODS

Ninety healthy premolars were used, randomly distributed into nine groups (n = 10) according to bleaching varnish (PL, PolaLuminate; VS, VivaStyle Paint On Plus; CA, Cavex Bite&White whitening pen and; AW AlignerWhite) and time (10 and 30 min), and a control group (no bleaching). The penetration of HP was evaluated by UV-Vis spectroscopy. To evaluate the color change (ΔEab , ΔE00 , ΔWID ) a digital spectrophotometer was used (α = 0.05).

RESULTS

The AW group in 10 min and the control group showed similar and lower HP penetration in the pulp chamber when compared to the other groups (p = 0.003). Increasing the application time to 30 minutes elevated the amount of HP inside the pulp chamber for all groups (p = 0.003), except for PL (p > 0.05). When applied for 30 min all bleaching varnishes showed higher color change (ΔWID ) when compared to 10 min (p = 0.04).

CONCLUSIONS

For all bleaching varnishes evaluated, PolaLuminate applied for 30 min showed lower penetration into the pulp chamber and higher bleaching effects.

CLINICAL SIGNIFICANCE

The use of bleaching varnishes seems promising for teeth bleaching, but it varies according to user product and protocol.

Effect of Over-the-counter Whitening Toothpaste and Mouthwash in Orthodontics: A Literature Review

Aim

To summarize and analyze all the available literature on the use of over-the-counter toothpaste and mouthwashes with whitening agents and their possible effects on orthodontic treatment.

Background

Tooth color change frequently occurs during orthodontic treatment and represents a self-perceived need. According to the patient's perspective, there is a preference for the use of toothpaste and mouthwashes with some whitening effect.

Materials and methods

An electronic bibliographic search in English was carried out until June 2022, in PubMed, Scopus, and Web of Science databases. Randomized or nonrandomized clinical trials and experimental laboratory studies were included.

Review results

A total of 57 papers were obtained from an electronic search and 11 studies were included in the review. Outcomes such as strength force elastomeric, color stability, frictional resistance, ion release, shear bond strength (SBS), and adhesive remnant index (ARI) were evaluated.

Conclusion

Toothpaste and mouthwashes with whitening action did not have a favorable effect on most of the outcomes evaluated. In some cases regular toothpaste showed a better effect and in other cases, there were no differences with the control group. Only in the outcome release of ions from wires to whitening effect in teeth with or without attached brackets, they have a better performance.

Clinical significance

Due to the unfavorable effects of over-the-counter whitening toothpaste and mouthwashes on orthodontic materials and appliances, their use should be justified during treatment.

How to cite this article

Chinchay-Ruesta S, Ortiz-Pizarro M, Rodríguez-Díaz DR, et al. Effect of Over-the-counter Whitening Toothpaste and Mouthwash in Orthodontics: A Literature Review. Int J Clin Pediatr Dent 2023;16(S-3):S311-S316.

Effects of Dental Bleaching Agents on the Surface Roughness of Dental Restoration Materials

Background and Objectives: This study aimed to evaluate the surface roughness evolution of several finished and polished composites when bleaching materials are applied. The research was conducted on four microhybrid or nanofilled composites that are used in dental restorations. Materials and Methods: For each composite type, 5 samples were selected for control, 5 samples were subjected to the bleaching protocol "office bleach" with 40% hydrogen peroxide, and 5 other samples were subjected to the "home bleach" protocol with 16% carbamide peroxide, resulting in a total number of 60 samples. The surfaces of all the samples were tested for roughness, and the values of the most relevant parameter (Ra), were collected. Comparisons between composites and samples were performed using one-way ANOVA (in Statistical Package for Social Sciences). Results: After the bleaching protocol with 40% hydrogen peroxide gel, it was found that the roughness of the group increased considerably compared to the control group, so the highest roughness was found at GC Gradia direct anterior group, and the lowest value was registered for the 3M ESPE Valux Plus group. Following the bleaching protocol with 16% carbamide peroxide (home bleach), it was noted that the sample surfaces were not as affected. In this case, the lowest roughness was found at 3M ESPE Valux Plus group, and the highest roughness was registered for the GC G-aenial anterior group. Following the interpretation of the results, all four types of dental composites tested showed significant surface roughness differences between the groups subjected to bleaching protocols and those kept as control (p < 0.05). Conclusions: The surfaces of the samples were affected by the bleaching protocols by increasing the roughness compared to the control samples.

Tooth color change promoted by different whitening toothpastes under alternate cycles of staining and brushing

OBJECTIVES

To compare the effect of whitening toothpastes with different mechanisms of action on discolored teeth subjected to additional staining/or not.

METHODS

One hundred twenty tooth specimens were stained for 14 days (staining broth under constant agitation and pH=7) and then allocated into the groups of toothpastes with different whitening ingredients (n=10): 1. Regular - Colgate Total 12 Clean Mint; 2. CLWI - Colgate Luminous White Instant (blue pigment); 3. CLWA - Colgate Luminous White Advanced Expert (hydrogen peroxide); 4. CLWAC - Colgate Luminous White Activated Charcoal (activated charcoal); 5. OB3D - Oral-B 3D WHITE Brilliant Fresh (abrasive); 6. TW - Teeth Whitening (charcoal powder). Specimens were submitted to two experimental models: A. Daily staining-toothbrush cycling: staining solution (5min), toothbrushing (45 strokes) and artificial saliva (3h), 2x/day, for 5days; B. Only toothbrushing (30.000 brushing strokes). Color change was determined with a spectrophotometer (CIEDE2000 and Whitening Index for Dentistry - WID) and statistically analyzed (α=0.05).

RESULTS

For both models, ΔE00 and Δa did not differ significantly between the whitening toothpastes and the regular. All groups showed a decrease in tooth yellowness (-Δb) and an increase in WID. Group Teeth Whitening exhibited a decrease in luminosity (-ΔL). In model A, Groups did not differ significantly from the Regular in terms of ΔL (p=0.35) and Δb (p=0.74). Groups CLWI and OB3D exhibited a decrease in luminosity. Reduced redness (-Δa) occurred only in Group CLWI. In Model B, Groups OB3D (p=0.021) and CLWA (p=0.001) exhibited higher change in luminosity than in Group Teeth Whitening. All exhibited increased redness (+Δa) and lightness (+ΔL), except the Regular, CLWAC and Teeth Whitening. Group OB3D had a significantly higher change in Δb than the Regular (p=0.021).

CONCLUSIONS

Irrespective of the mechanism of action, all toothpastes reduced tooth yellowness and promoted similar overall color change. Exposure of the teeth to additional staining during the toothbrushing cycles did not influence the effect of the whitening toothpastes.

CLINICAL SIGNIFICANCE

Whitening toothpastes should be tested in conditions that more closely simulate their use in a clinical scenario, in which alternate cycles of staining and brushing occur on a daily basis. However, even in such conditions, they were unable to promote a color change that differed from that of a regular toothpaste.

The Potential of Trigona spp. Propolis as an Antioxidant Agent to Reduce Residual Peroxide after Intra-Coronal Bleaching Treatments

The present study aimed to determine the effectiveness of Trigona spp. propolis as an antioxidant to reduce residual peroxide after intra-coronal bleaching treatments. Thirty-five maxillary central incisors were divided into seven groups: five samples without antioxidants; sodium ascorbate 10% combined with Tween 80 0.2%; and Trigona spp. propolis 10%. The lengths of the application time were 1 h, 24 h, and 48 h. Each application time consisted of five samples. Root resection followed by artificial discoloration was performed in the samples. Then, intra-coronal bleaching using 35% hydrogen peroxide was applied. After the tooth color changed, the bleaching material was cleared, and this was followed by the applications of sodium ascorbate 10% combined with Tween 80 0.2% and Trigona spp. propolis 10%. The peroxide residue was measured by assessing dissolved oxygen using a titration analysis with either the Winkler or iodometric method. Data were analyzed using the ANOVA test and Tukey’s HSD test. The lowest peroxide residue amount was found with the application of antioxidants for 48 h after the intra-coronal bleaching treatment using 35% hydrogen peroxide. However, there was no significant difference between sodium ascorbate 10% combined with Tween 80 0.2% and Trigona spp. propolis 10% to reduce peroxide residues after the intra-coronal bleaching treatment (p > 0.05). Therefore, these findings indicate that Trigona spp. propolis 10% effectively reduces peroxide residues after intra-coronal bleaching treatments, which can interfere with the bond of the composite to the tooth surface and shorten the wait time for composite restorations after bleaching treatments.