Bleaching Primary Teeth with 10% Carbamide Peroxide

Department of Pediatric Dentistry

Lutheran Medical Center

Date: 11/20/2009

Article title: Bleaching primary teeth with 10% carbamide peroxide

Author(s): Brantley, Barnes, Haywood

Journal: Pediatric Dentistry

Volume (number): 23:6

Month, Year: 2001

Major topic: Bleaching

Minor topics: Primary tooth trauma

Type of Article: case report

Main Purpose: Review of a case in which primary teeth were bleached.

Overview of method of research: case report

Findings:

Primary teeth can be safely bleached

Key points/Summary :

Parents requested treatment to lighten anterior teeth in their 4 year old daughter after a trauma caused darkening of the teeth.

A custom suckdown beaching tray was fabricated.

10% carbamide peroxide was used

10% carbamide peroxide is also used in infants for throat infections and is thought to be safe for ingestion.

There were no radiographic abnormalities in the injured teeth.

The teach were bleached for 1 hour a day for 2 weeks and produced some whitening, but not significantly.

After the 2 week period, the parents began having the child sleep with the tray in every 3rd night. for 2 more weeks . (total wear time 47 hours)

The teeth brightened to a satisfactory level after the 4 week period.

The teeth exfoliated normally and there were no noted side effects.

Assessment of article: I’m definitely going to try this in the clinic. I’ve had parents complain about dark teeth post trauma and this seems harmless. I’ve also had parents request bleaching for their kids with naturally ugly teeth. I think some people will find this ridiculous.

Fabricating a better mouthguard. Part II: The effect of color on adaptation and fit

Resident: Adam J. Bottrill
Date: 20NOV09
Region: Providence
Article title: Fabricating a better mouthguard. Part II: The effect of color on adaptation and fit.
Author(s): Del Rossi et al
Journal: Dental Traumatology
Volume #; Page #s: 24, pp. 197-200
Year: 2008

Major topic: Mouthguard adaptation and fit
Minor topic(s): NA
Type of Article: Statistical analysis of the effect of mouthguard color on fit and adaptation.

Main Purpose: The purpose of this study was to establish if material color affected the adaptation and fit of custom-made mouthguards.



















Overview of method of research:
A. Manually-driven, vertically oriented strain gauge apparatus fabricated in order to measure the level of adaptation. Used to measure the amount of force needed to remove the mouthguard from the corresponding model. Block of wood at base was placed either at 0 or 45 degrees angulation.
B. 12 individuals used for stone model fabrication. Each model was tested 3 times at both different angles. The 45 degree angle was chosen to best-mimic the angle of actual removal.
C. ANOVA and t-test used in analysis.

Key points in the article discussion:
A. General
1. Knowing that mouthguards are formed using a thermoforming process, it seems logical that the fit of the mouthguard would be effected by the material’s ability to absorb heat.
2. Pressure-formed is preferred of vacuum formed (also uses higher heat in the process).
3. Color may influence ability of material to absorb and attain the proper heat for best fit.

















B. Results
1. Significant difference between force required to remove the clear and dark-colored mouthguards.
2. No significant difference between “similarly-colored” mouthguards.
C. Discussion
1. Mouthguards must fit properly and firmly (imagine that).
2. Ability of the material to fit the model is a function of the pliability of the material, which in turn is a function of the material’s ability to absorb heat and internal temperature.
a. it seems expected that dark-colored mouthguards would be able to absorb the most heat and possibly form a tighter fit to the model.
b. clear colored mouthguards showed least suitable fit of all the colors tested.
3. Applies to us as dentists when considering which color mouthguard to fabricate for a patient.
4. Because comfort seems to play a role in pt compliance, a better fitting mouthguard may increase compliance.
5. Note: pulling the mouthguard at a 45 degree angle ALSO reduced the force needed to remove the mouthguard from the model.
6. Limitations:
a. all mouthguards made from same vendor
b. not ALL colors tested
c. did not test a variation in heating temperature or times.
7. The findings of this study SUGGEST that, all else being equal, dark-colored sheets of Ethylene Vinyl Acetate. achieve superior adaptation during the fabrication process. when compared to light-colored or transparent material. This increased firmness and retention may also increase user compliance and decrease the chances of displacement.

Assessment of article: Great conclusions but very limited in scope (see “limitations”). Serious potential for shenanigans, but useful none-the-less.

Effectiveness and Safety of Tooth Bleaching in Teenagers

Resident’s Name: Brian Schmid DMD Date: 11/20/09
Article title: Effectiveness and Safety of Tooth Bleaching in Teenagers
Author(s): Kevin J. Donly DDS, MS et al.
Journal: Pediatric Dentistry
Month, Year: 2005
Major topic: Bleaching in teens
Type of Article: Clinical Trial
Findings: Fifty seven 12-17 year olds were given either Crest White Strips (45) or peroxide gel (12) and bleaching trays to use for one week according to each products directions. Yellowness, lightness and redness were measured electronically, while clinical approval and complaints from the patients were recorded. 27% of the strip group brought complaints, while 42% of the tray group complained. Tooth sensitivity and gingival irritation were the most common complaints. None of the complaints were rated above mild and there was no significant difference in patient happiness with the results. Electronic results of tooth whitening also showed no differences.
Key points/Summary: In this case, the white strips performed as well as overnight trays with fewer complaints.
Assessment of article: Very supportive of Crest, perhaps because it was sponsored by Procter & Gamble.

Policy on Dental Bleaching for Children and Adolescent Patients 11/20/09

LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form

Resident: Murphy Date: 11/20/09 Region: Prov.
Article title: Policy on Dental Bleaching for Children and Adolescent Patients
Author(s): AAPD Council on Clinical Affairs
Journal: Pediatric Dentistry Reference Manual
Volume #; Number; Page #s): vol 31, no. 6. 51-53
Year: 2009
Major topic: The AAPD’s policy on tooth whitening
Minor topic(s):
Type of Article: review of policy

Findings: This policy put forth by the AAPD was compiled from a review of the current dental and medical literature related to dental bleaching. Now more than ever, both parents and children are wanting to have their teeth whitened. Clinical indications for whitening include 1) discoloration from trauma/infection2) enamel irregularities from trauma/infection3)Intrinsic staining (fluorosis, tetracycline)4) Negative self image Due to the difference in enamel thickness between primary and adult teeth, shades of teeth in the same arch may vary in the mixed dentition. The AAPD advocates bleaching via either in office or at home systems. The in office modality is considered better for numerous reasons. Including the patient getting a professional exam, professional control of the material, compliance, rapid results, and stability of results. Pretreatment assessment is imperative to ascertain the cause of the dental anomaly. Also, it identifies any existing restorations that will not be affected by the bleaching. Professional systems range from 10-38% carbamide peroxide. Home systems use lower concentrations. To bleach non-vital teeth, a mixture of sodium perborate and water can be used(no concentration given). Most common side effects of bleaching are teeth sensitivity, affecting 8-66% of people, and tissue irritation. Both effects are temporary and cease with the discontinuation of treatment. An internal bleaching complication is external root resobrtion. An additional side effect is increased marginal leakage on existing restorations. Use of the lowest possible concentrations is recommended due to a by product produced by the interaction of carbamide peroxide and hydrogen peroxide(a free radical that can damage periodontal tissue and cause root resorbtion).

Summary of conclusions: The AAPD’s stance is as follows1. The use of bleaching vital and no vital teeth is acceptable2. Patients should consult with their dentist to determine the proper bleaching treatment regime for them in addition to an overall treatment plan.3. Dentists and consumers should always consider the possible side effects of bleaching.4. Further research is needed on whitening agents and children5. The AAPD DISCOUSRAGES full arch cosmetic bleaching for patients in the mixed dentition.

Assessment of article: Good policy to know. Quick and to the point. Me Gusta.

Comparing comfort and wearability between Type 3 single layered and double layered EVA mouthgaurds

Resident: R oberts
Article title: Comparing comfort and wearability between TypeIII single-layered and double-layered EVA mouthgaurds
Author: Kenyon, Brian et al
Journal: General Dentistry
Volume: July-August
Year: 2005
Pages: 261 – 264
Findings:

Twenty two dental students from University of Pacific, School of Dentistry participated in a study to determine patient preference between single layered or double layered custom mouthgaurds. The students were involved playing basketball in a recreational league a few times a week. Half of the players used the single layered mouthgaurd for the first two weeks while the other half wore the double layered mouthgaurd. Then the switched to the other mouthgaurd type for another two weeks. A survey was then compiled and given to each of the student athletes. Results were as follows:






The double – layered mouthgaurd performed as well or better in fourteen out of seventeen categories than did the single layered mouthgaurd in areas of wearability, comfort, fit and patient preference; however some patients may object due to the thickness of the mouthgaurd which tends to have a negative impact on breathing, speaking and physical appearance of the athlete.

Assessment: This article was very readable. I liked that!