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      Preferences on Vital and Nonvital Tooth Bleaching: A Survey Among Dentists from a City of Southern Brazil

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          Abstract

          This study evaluated the preferences of general dentists regarding vital and nonvital tooth bleaching therapies and investigated whether the time of clinical practice and post-graduate training influence these options. A cross-sectional study was conducted using a questionnaire with closed questions applied to dentists (n=276) of a mid-sized city of the southern Brazil (Pelotas, RS). Information was collected regarding sociodemographic variables, level of specialization and time since graduation. In addition, options regarding bleaching therapies including the first choice of material, technique and clinical practice for vital and nonvital tooth bleaching therapies were included. Data were submitted to descriptive analysis and the associations were evaluated using chi-square and Fisher exact tests (α=0.05). The response rate was 68% (n=187). At-home bleaching therapy was broadly preferred (78.1%) over in-office (21.9%) bleaching. For at-home bleaching, most dentists answered to use 10% carbamide peroxide (CP) (40.2%) and >30% hydrogen peroxide (HP) (31.7%) for nonvital therapies. The majority of dentists with post-graduation training preferred at-home bleaching techniques (p=0.003). At-home bleaching therapy was also more indicated by younger dentists. No association was found between the choice for nonvital bleaching therapies and time since graduation (p=0.532) or continuous education (p=0.083). In conclusion, at-home bleaching was preferred over in-office therapies; 10% CP and >30% HP were chosen as first option agents to treat discolored vital and nonvital teeth, respectively. The time in clinical practice and the level of specialization affected dentists' choices only for vital tooth bleaching treatment.

          Translated abstract

          Este estudo avaliou as preferências de cirurgiões-dentistas sobre o clareamento de dentes vitais e não-vitais. Também investigou a possível relação entre o grau de formação profissional e as decisões clínicas tomadas por estes profissionais. Para isso, realizamos um estudo transversal. Cirurgiões-dentistas (n=276) de uma cidade de médio porte do sul do Brasil (Pelotas, RS) receberam um questionário contendo perguntas sobre informação sócio-demográfica, nível de especialização e ano de graduação. Adicionalmente, foram realizadas perguntas sobre o material de primeira escolha, técnicas e práticas clínicas relacionadas a clareamento de dentes vitais e não vitais. Os dados obtidos foram submetidos à análise descritiva e as possíveis associações entre variáveis foram avaliadas utilizando o teste Qui-Quadrado e teste Exato de Fisher (p<0,05). A taxa de resposta foi de 68% (187). A técnica de clareamento caseiro supervisionada foi preferida (78,1%) em detrimento da técnica em consultório (21,9%). Os dentistas escolheram preferentemente o peróxido de carbamida (PC) a 10% para clareamento vital caseiro (40,2%) e o peróxido de hidrogênio (PH) >30% para o clareamento de dentes despolpados (31,7%). A maioria dos dentistas que realizaram cursos de pós-graduação preferiram o clareamento caseiro (p=0,003). Além disso, o clareamento caseiro foi mais indicado pelos dentistas mais jovens. Não foi encontrada relação entre as escolhas para clareamento de dentes despolpados e ano de graduação (p=0,532) ou grau de formação (p=0,083). O clareamento vital caseiro foi escolhido em detrimento das técnicas de consultório; CP a 10% e HP > 30% foram os agentes de escolha para o tratamento de dentes vitais e não vitais escurecidos, respectivamente. O tempo de prática clínica e o nível de especialização foram associados com as escolhas dos dentistas somente para clareamento de dentes vitais.

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          The bleaching of teeth: a review of the literature.

          To review current knowledge of tooth whitening with respect to external bleaching methods. The scope is the external bleaching of vital teeth and focuses on mechanisms; in vivo and in vitro measurement methods, and factors influencing the efficacy of the whitening process. "Medline" and "ISI Web of Science" databases from 1966 and 1974, respectively were searched electronically with key words tooth, teeth, colo*r, white*, bleach* and peroxide. The importance of tooth whitening for patients and consumers has seen a dramatic increase in the number of products and procedures over recent years, with a concomitant rise in publications on this topic. Literature suggests that the mechanisms of tooth whitening by peroxide occur by the diffusion of peroxide through enamel to cause oxidation and hence lightening of coloured species, particularly within the dentinal regions. A number of approaches are available for measuring changes in tooth colour. These include visual measurements by trained clinicians and instrumental measurements using spectrophotometry, chromameters and digital image analysis. The key factors that affect tooth whitening efficacy by peroxide containing products are concentration and time. In general, higher concentrations are faster than lower concentrations. However, lower concentrations can approach the efficacy of higher concentrations with extended treatment times. Alternative bleach systems to peroxide have received only minor attention. The efficacy of light activated systems versus non-light activated controls in clinical studies is limited and conflicting. Other factors which can influence tooth bleaching outcome include type of stain, initial tooth colour and subject age.
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            External bleaching therapy with activation by heat, light or laser--a systematic review.

            External bleaching procedures utilizing highly concentrated 30-35% hydrogen peroxide solutions or hydrogen peroxide releasing agents can be used for tooth whitening. To enhance or accelerate the whitening process, heat-activation of the bleaching agent by light, heat or laser is described in the literature. The aim of the present review article was to summarize and discuss the available information concerning the efficacy, effects and side effects of activated bleaching procedures. Information from all original scientific full papers or reviews listed in PubMed or ISI Web of Science (search term: (bleaching OR brightening OR whitening OR colour) AND (light OR laser OR heat OR activation)) were included in the review. Existing literature reveals that activation of bleaching agents by heat, light or laser may have an adverse effect on pulpal tissue due to an increase of intra-pulpal temperature exceeding the critical value of 5.5 degrees C. Available studies do not allow for a final judgment whether tooth whitening can either be increased or accelerated by additional activation. Therefore, application of activated bleaching procedures should be critically assessed considering the physical, physiological and patho-physiological implications.
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              Clinical evaluation of in-office dental bleaching treatments with and without the use of light-activation sources.

              This study clinically evaluated the alteration of color, color stability, dental sensitivity and gingival irritation on patients undergoing dental bleaching using varying bleaching methods and light-activation sources. According to pre-established criteria, 40 patients were selected and randomly divided into four groups (n=10): Group 1--35% Hydrogen Peroxide (HP); Group 2--35% HP plus Halogen Curing Light XL 3000 (3M/ESPE); Group 3--35% HP plus Demetron LED (Kerr) and Group 4--35% HP plus LED/LASER (Bio-art). For all groups, there were two sessions of bleaching with 35% HP, with a one week break between sessions. At each bleaching session, three applications of the bleaching gel were used. Two methods of shade evaluation were performed before and after the first week, second week, first month and after six months of the bleaching treatment. These methods were VITA Easyshade Spectrophotometer and Vita Classical Shade Guide. Statistical analysis using ANOVA demonstrated equality between the participating groups when evaluating the group and time variables. The In-Office dental bleaching treatments of vital teeth with 35% HP did not prove to be more effective when light sources were used. There was no difference in color stability between groups until the sixth month of evaluation.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                bdj
                Brazilian Dental Journal
                Braz. Dent. J.
                Fundação Odontológica de Ribeirão Preto (Ribeirão Preto )
                1806-4760
                October 2013
                : 24
                : 5
                : 527-531
                Affiliations
                [1 ] Universidade Federal de Pelotas Brazil
                [2 ] Universidade Federal de Pelotas Brazil
                Article
                S0103-64402013000500527
                10.1590/0103-6440201302152
                3261c7f0-6ebf-4e2f-bcfe-87f5f179e6d2

                http://creativecommons.org/licenses/by/4.0/

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                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0103-6440&lng=en
                Categories
                DENTISTRY, ORAL SURGERY & MEDICINE

                Dentistry
                tooth bleaching,dentist,carbamide peroxide,hydrogen peroxide
                Dentistry
                tooth bleaching, dentist, carbamide peroxide, hydrogen peroxide

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