Bleaching of Endemically Fluorosed Teeth

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  • #11063
    drrajvanshi
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    Registered On: 16/04/2010
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    I wish that we start Clinical Trials on new dental products, carry out research and prepare an independent dental data base through the findings of Dental Practitioners. The authentic data based on Indian studies is not easily available on net search.

    Can anybody suggest ways and means of fluoride stain removal from teeth without causing noticeable damage? I have carried out study on this subject and am happy to claim that I have not found any parallel till date. Interested to share???????????????

    #16174
    drrajvanshi
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    I have carried out Microscopic Study and Clinical Trials on endemically fluorosed teeth. I am looking for a suitable partner to carry out the trial further and include my research product in an "IN OFFICE BLEACHING SYSTEM" OR develop a suitable "Toothpaste for Fluoride Stain Removal".

    #16176
    drrajvanshi
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    Bleaching of fluorosed Teeth Microscopic Study and Clinical Trials

    #16179
    Anonymous

     these attachments opened.

    good work and keep it up.

    regards,

    dr veerendra darakh

     

    #16181
    drmithila
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    Very commendable…..Thank you Sir for using our portal for your trial…very interesting pictures in the foremost branch of dentistry-AESTHETICS

    #16271
    Drsumitra
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    Most patients love their postbleach smiles but not the side effects that can accompany them. While adding remineralizing agents to bleaching gels can mitigate these side effects, there have been concerns that these agents may affect whitening efficacy.

    But research presented last month at the International Association for Dental Research (IADR) meeting in San Diego found that adding calcium and fluoride to bleaching gels does not interfere with the whitening effect of the gels.

    Adverse effects related to the use of bleaching agents on enamel include a reduction in enamel microhardness and some mineral alterations after bleaching procedures, Alessandra Bühler Borges, PhD, an assistant professor in the department of restorative dentistry at the University Estadual Paulista told DrBicuspid.com.

    Previous studies have reported a decrease in the calcium concentration of enamel surface when high-concentrated hydrogen peroxide gels are used, she said. However, the resulting reduction in microhardness of bleached enamel can be reversed through exposure to saliva, she added.

    "Nevertheless, these side effects can be reduced by adding fluoride or calcium to the bleaching gels," Borges said. "Besides, remineralizing agents are added in bleaching gels as an attempt to reduce enamel solubility and tooth sensitivity."

    Although the addition of remineralizing agents on bleaching gels has been proposed with the aim to reduce side effects, the effect of these agents on bleaching efficacy of gels has not been properly studied, noted Borges and her colleagues.

    "The action mechanisms of fluoride and calcium on enamel remineralization are based on the formation of a calcium-fluoride-rich surface layer and the precipitation of calcium-phosphate mineral phase on enamel surface, respectively, and these factors were supposed to interfere with the penetration of bleaching agents inside tooth structure, maybe reducing the bleaching efficacy of gels," they noted. "This motivated us to investigate the bleaching efficacy of hydrogen peroxide-based whitening gels that contains fluoride and calcium."

    The addition of fluoride has previously been reported in the literature, but the bleaching efficacy of calcium-added bleaching gels represents new data, Borges added.

    Calcium gluconate

    Different forms of calcium can be added to bleaching gels; for this study the authors used calcium gluconate.

    They prepared 45 enamel-dentin disks from bovine incisors and divided them into two groups. The groups were divided according to the concentration of bleaching agent which included 7.5% and 35% hydrogen peroxide gels.

    Each group was then subdivided into three subgroups:

    Control group with no remineralizing agents
    Addition of 2% calcium gluconate
    Addition of 2% sodium fluoride
    The bleaching gel was applied on the specimens for one hour a day for the home bleaching and 40 minutes a week for in-office bleaching, both for 14 days. In the intermediate periods, the specimens were immersed in artificial saliva. Color assessments were made 24 hours after the end of treatment. The color measurement was performed by a spectrophotometer using the CIE L*a*b*system.

    The data showed no significant differences for the presence of remineralizing agents, gel concentration, and interaction factors, Borges and her team noted.

    "The addition of calcium and fluoride in the bleaching gels does not interfere with their whitening effect, and both concentrations tested presented similar whitening effects," the authors concluded.

    These results can be considered favorable for the clinical performance of bleaching agents since the advantageous effects of adding remineralizing agents to reduce the possible adverse effects to enamel did not impair the bleaching result of gels tested, Borges noted.

    "Dentists can choose calcium or fluoride-enhanced bleaching gels to perform whitening treatments in order to combine the protective remineralizing action of these agents on enamel without reducing the bleaching efficacy of treatment," she concluded.

     

    #16311
    Drsumitra
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    There has been a steady proliferation of whitening products for dentists and consumers, with some in-office products containing high concentrations (35%) of hydrogen peroxide.
    In a recent study, Brazilian researchers set out to bolster the lack of published data regarding how bleaching can impact the mechanical properties of dental tissues (Journal of Dental Research, December 14, 2012). They took a molecular-level approach and found that high concentrations of hydrogen peroxide can have a dramatic impact on dental hard and soft pulp tissue.

    "First, we are showing that 35% of hydrogen peroxide, used in commercial products, changes the enamel surface structure, increasing the roughness of these tissue," Fabio Nascimento, DDS, PhD, MS, a member of the research team from Biomaterials Research Lab at Universidade Bandeirante de São Paulo (UNIBAN), told DrBicuspid.com in an email. "The phosphate content in enamel and dentin also decreased after bleaching."

    For this study, Dr. Nascimento and his colleagues were interested in the potential effect of 35% hydrogen peroxide (H2O2) on in vivo activity of dentin cysteine proteases and matrix metalloproteinases (MMPs). Their assumption was that H2O2 would promote collagen degradation in dentin because it increased the activity of proteolytic enzymes.

    The study included 20 subjects (10 men, 10 women), ages 18-25, who were not tobacco users, had not received whitening treatment, had no gingival recession or restorations, and needed two to four first premolars extracted.

    The participants were divided into two groups: bleached and nonbleached (control). The bleached group had their right maxillary (n = 14) or mandibular (n = 14) first premolars bleached once per week with 35% H2O2 (Whiteness HP Maxx, FGM). Per the manufacturer’s instructions, there were three 15-minute applications during each session. The control group had their left upper (n = 14) or lower (n = 14) first premolars extracted without whitening treatment. In total, the subjects provided 56 teeth.

    Ten teeth from each group were separated; the rest were used for dentin powder preparation. The researchers collected gingival crevicular fluid from the gingival sulcus of these remaining teeth (n = 36) prior to extraction. Postextraction, the teeth were sectioned, had their pulp removed, and the dental hard tissues were frozen.

    Molecular analysis

    The researchers analyzed the effect of 35% H2O2 under clinical conditions using various imaging methods. Teeth from the experimental and control groups had enamel surface morphologies examined with atomic force microscopy (AFM). The researchers also collected infrared spectra from the enamel and dentin powders of both groups using a spectrometer and a spectrofluorometer. Then they analyzed dentin specimens from either group with confocal fluorescence microscopy. Finally, they measured the presence of reactive oxygen species in the pulp tissue with spectrofluorometry.

    The AFM images revealed a smooth surface on the control specimens, while the experimental set had "a much more irregular surface, with several spikes of larger size with deep microporosities," the researchers noted.

    The impact on dentin was noteworthy as well. "The expression of collagen degrading enzymes increased substantially, promoting further degradation in the organic matrix of dentin," Dr. Nascimento stated.

    Both the enamel and dentin were affected. "The bleaching agent containing 35% H2O2 induced a significant in vivo alteration in enamel and dentin, which could potentially trigger biological and/or mechanical responses of dental structures," the study authors wrote.

    Limiting the damage

    As a result of these findings, the researchers take issue with common characterizations of teeth whitening. "Despite reports that the use of bleaching agents at low concentrations has been considered absolutely safe, analysis of our data shows that the use of 35% H2O2 as a bleaching agent … can be clinically adverse in the long-term and/or after recurring bleaching treatments."

    According to Dr. Nascimento, ways to limit the amount of damage of high-concentration hydrogen peroxide to the inner layers of tooth tissue include the following:

    Reducing the hydrogen peroxide concentration
    Reducing the time of each application and increasing the time between applications
    Not using reaction catalysts, such as lamps or lasers
    He and his colleagues hope their study findings reach patients as well. "We would like to demonstrate that an in-office bleaching is far from a cosmetic procedure, and it would be great if the clinicians could explain better to their patients about the pros and cons of using this procedure," Dr. Nascimento noted.

    Dentists should also be aware that postbleaching sensitivity is mostly due to a slight inflammation into the pulp chamber (reversible pulpitis) that actually can progress for some undesirable pathology, he added.

    "[It] is important to say that bleaching is not at all a dangerous procedure, but the dentists and the patients should know that sometimes the price paid by a purely aesthetic treatment may be too high at the end if the dentist is not sufficiently cautious in applying the bleaching agents," Dr. Nascimento concluded.

     

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