Resident’s Name: Brian Schmid DMD Date: 12/4/2009
Article title: Guidelines on Adolescent Oral Health Care
Author(s): Clinical Affairs Committee
Journal: Pediatric Dentistry
Month, Year: 2006-2007
Major topic: Adolescent health care
Type of Article: Review
Key points/Summary: Adolescent is loosely defined as patients 10-18 y.o. of which there are almost 40 million individuals in America. They have particular needs including: potentially high caries rate, increased risk for traumatic injury and periodontal disease, poor nutrition, increased esthetic desire and awareness, orthodontic treatment, dental phobia, initiation of tobacco use, pregnancy, eating disorders and unique social and psychological needs.
Fluoride supplements are recommended until age 16, after which fluoridated water and dentifrices provide appropriate systemic and topical coverage. Emphasis on oral hygiene is essential as many children will fall off the wagon come adolescence. Adolescent diet is often high in refined sugars and acdic beverages. Dietary analysis and coaching is important. Sealants are still recommended for patients of this age especially those at risk for pit and fissure caries. Recare and prophylaxis, including regular radiographs should be a part of adolescent life. In cases of ANUG or other acute soft tissue infection, referral to a specialist may be necessary; orthodontic care is often associated with periodontal disease putting adolescents at an even higher risk and necessitating even more preventive education. Evaluation of 3rd molars can be an acute or long term problem for adolescents and should be checked regularly and treated in due time. Treatment planning and referral are essential to properly treat TMJ, missing teeth or ectopically erupting teeth. A mouthguard should be fabricated for any adolescent participating in contact sports or any sport where significant oral and facial trauma is possible. The prevention of tobacco use, access t safe dental bleaching protocols, supporting positive life experiences, supporting the sometimes jarring effects of psychosial development of an adolescent and helping them transition to adult care is essential for a pediatric dentist treating an adolescent population.
Assessment of article: Very thorough and a good reference for adolescent care.
Friday, December 4, 2009
Infant Oral Health Care
Resident’s Name: Joanne Lewis Date: December 4, 2009
Guideline on Infant Oral Health
Background
- More than 40% of children have caries by the time they reach kindergarten.
- High caries rates occur in families; the children of mothers with high caries rates are at a higher risk of caries.
- It is well documented that there is vertical colonization of S mutans from mother to infant and that the acquisition of S mutans occurs at an average age of approximately 2 years.
- Modification of the mother’s oral flora at the time of the infants colonization can impact the child’s caries rate.
- The primary goal of early risk assessment is to screen for parent-infant groups who are at risk of ECC and who would benefit from early aggressive intervention.
- The ideal approach to infant oral health care is the early establishment of a dental home.
- Anticipatory guidance for the caregiver before and during the colonization process includes:
o Oral hygiene
o Diet
o Fluoride
o Caries removal
o Delay of colonization
o Xylitol gum
Recommendations
- All primary health care professionals who serve mothers and infants should provide caregiver education on the prevention of ECC. Oral health counseling during pregnancy is especially important.
- The etiology of ECC, oral health risk assessment, anticipatory guidance, and early intervention should be included in the curriculum of all medical, nursing, and allied health professional programs.
- Every infant should receive an oral health risk assessment from his/her primary health care provider by 6 months of age.
- Parents or caregivers should establish a dental home by 12 months of age.
- Health care professionals should support the establishment of a dental home for all infants by 12 months of age.
Thursday, December 3, 2009
Management of Persons With Special Health Care Needs
From Pediatric Dentistry vol. 28 No. 7 reference manual
Guideline on Management of Persons with Special Health Care Needs
Summary by Kris Hendricks
Purpose: AAPD accepts its responsibility to assist in treating this patient population
SHCN definition:
individuals who “have a physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention, and/or use of specialized services or programs. The condition may be developmental or acquired and may cause limitations in performing daily self-maintenance activities or substantial limitations in a major life activity. Health care for special needs patients is beyond that considered routine and requires specialized knowledge, increased awareness and attention, and accommodation.”
SHCN patients are more vulnerable to oral disease than the general population.
SHCN disorders that are specifically manifest in the orofacial complex:
- amelogenesis imperfecta
- dentinogenesis imperfecta
- cleft lip/palate
- oral cancer
Disorders that include orofacial problems:
- osteogenesis imperfecta
- ectodermal dysplasia
- epidermolysis bullosa
AwDA defines the dental office as a place of public accommodation. Failure to comply and accommodate SHCN patients is a violation of federal and/or state law.
Difficulties for SHCN patients:
- lack of financial resources
- lack of timely care can lead to more costly episodic care
- medical benefits don’t extend to cover the dental needs
- other health care needs may seem more important than dental
- limited transportation
- complex behavioral problems
- anxiety
- tough to transition these patients from care of pediatric dentist to generalist as they mature
Recommendations:
- strong phone triage at initial contact
- create a dental home--makes SHCN pts less likely to suffer from dental disease
- patient and parent education
- complete med history--updated at every recall
- comprehensive exam and caries risk assessment
- med consults as needed
- must make attempts to communicate with hearing/speaking impaired
- informed consent
- proper behavior management/protective stabilization/sedation/general anesthesia
- be cognizant of psychological well-being of SHCN patients
- make appropriate referrals for things you cannot treat
Preventative strategy
- education of patient and parent
- daily supervision of OH regimen
- Fluoride dentifrice
- electric toothbrush
- dietary counseling
- sealants
Monday, November 30, 2009
Guideline on Oral and Dental Aspects of Child Abuse and Neglect
LUTHERAN MEDICAL CENTER
Dental Residency Program
Literature Review Form
Resident: Boboia Date: 12/4/09
Article title: Guideline on Oral and Dental Aspects of Child Abuse and Neglect
Author(s):
Journal: Pediatric Dentistry Reference Manual
Volume #; Number; Page #s): 28:7
Year: 2007
Purpose Review the oral and dental aspects of physical/sexual abuse and dental neglect and the role of physicians and dentists in evaluating such conditions.
Abstract
In all 50 states, physicians and dentists are required to report cases of abuse and neglect to law enforcement agencies. This report addresses: bite marks, perioral and introral injuries, infections, and disease suspicious for child abuse or neglect. Physicians recieve minimal training in oral health and dental injury and may therefore not detect certain aspects of abuse as readily as they do on other parts of the body.
Physical Abuse:
Craniofacial, head, face, and neck injuries occur in more then half of the cases of child abuse. Signs of neglect (caries, gingivitis, and other oral health problems) should also be reported. Some authorities believe the oral cavity may be a central focus for physical abuse because of its significance in communication and nutrition. Injuries may be inflicted with instruments such as eating utensils, bottle (during force feeding), hands, fingers, scalding liquids, or caustic substances. Contusions, burns, oral lacerations, fractured / displaced teeth, and facial bones / jaw fractures are all common findings among abuse cases. One study showed the lips were the most common site (54%) for inflicted injuries (followed by the oral mucosa, teeth, gingiva, and tongue). Unintentional or accidental injuries to the mouth must be distinguished from abuse by using the history, timing, and mechanism of injury (as well as the child’s developmental capabilities and characteristics of the injury).
Sexual Abuse:
Oral-genital contact suspicion necessitates a referral to a specialized clinic equipped to conduct a comprehensive examination. Oral / perioral gonorrhea in prepubertal children is pathognomonic for sexual abuse but rare among prepubertal girls evaluated for sexual abuse. Pharyngeal gonorrhea is usually asymptomatic. HPV is a little tricky when attempting to determine a mode of transmission to the oral region. Vertical and horizontal modes of transmission through non-sexual contact does occur.
Bite Marks:
Should be suspected when ecchymoses, abrasions, or lacerations are found in an elliptical or ovoid pattern. Animal bites tear flesh and human bites compress flesh (rarely causing tissue avulsion). Photographs should be taken where the angle of the camera lens is directly over the bite and perpendicular to the plane of the bite to avoid distortion. Swabbing the bite for DNA and taking a PVS impression of it are also very helpful forensic tools. Photographs and documentation should be repeated for at least 3 days to document the evolution of the bite. Involvement of a forensic odontologist or pathologist to evaluate and document the bite pattern is appropriate.
Dental Neglect:
Def: “willful failure of a parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection”. “The point at which to consider a parent negligent and to begin intervention occurs after the parent has been properly alerted by a health care professional about the nature and extent of the child’s condition, the specific treatment needed, and the mechanism of accessing the treatment”.
Conclusions:
The Prevent Abuse and Neglect Through Dental Awareness phone # is (501) 661-2595 or email Lmouden@healthyarkansas.com
Dental Residency Program
Literature Review Form
Resident: Boboia Date: 12/4/09
Article title: Guideline on Oral and Dental Aspects of Child Abuse and Neglect
Author(s):
Journal: Pediatric Dentistry Reference Manual
Volume #; Number; Page #s): 28:7
Year: 2007
Purpose Review the oral and dental aspects of physical/sexual abuse and dental neglect and the role of physicians and dentists in evaluating such conditions.
Abstract
In all 50 states, physicians and dentists are required to report cases of abuse and neglect to law enforcement agencies. This report addresses: bite marks, perioral and introral injuries, infections, and disease suspicious for child abuse or neglect. Physicians recieve minimal training in oral health and dental injury and may therefore not detect certain aspects of abuse as readily as they do on other parts of the body.
Physical Abuse:
Craniofacial, head, face, and neck injuries occur in more then half of the cases of child abuse. Signs of neglect (caries, gingivitis, and other oral health problems) should also be reported. Some authorities believe the oral cavity may be a central focus for physical abuse because of its significance in communication and nutrition. Injuries may be inflicted with instruments such as eating utensils, bottle (during force feeding), hands, fingers, scalding liquids, or caustic substances. Contusions, burns, oral lacerations, fractured / displaced teeth, and facial bones / jaw fractures are all common findings among abuse cases. One study showed the lips were the most common site (54%) for inflicted injuries (followed by the oral mucosa, teeth, gingiva, and tongue). Unintentional or accidental injuries to the mouth must be distinguished from abuse by using the history, timing, and mechanism of injury (as well as the child’s developmental capabilities and characteristics of the injury).
Sexual Abuse:
Oral-genital contact suspicion necessitates a referral to a specialized clinic equipped to conduct a comprehensive examination. Oral / perioral gonorrhea in prepubertal children is pathognomonic for sexual abuse but rare among prepubertal girls evaluated for sexual abuse. Pharyngeal gonorrhea is usually asymptomatic. HPV is a little tricky when attempting to determine a mode of transmission to the oral region. Vertical and horizontal modes of transmission through non-sexual contact does occur.
Bite Marks:
Should be suspected when ecchymoses, abrasions, or lacerations are found in an elliptical or ovoid pattern. Animal bites tear flesh and human bites compress flesh (rarely causing tissue avulsion). Photographs should be taken where the angle of the camera lens is directly over the bite and perpendicular to the plane of the bite to avoid distortion. Swabbing the bite for DNA and taking a PVS impression of it are also very helpful forensic tools. Photographs and documentation should be repeated for at least 3 days to document the evolution of the bite. Involvement of a forensic odontologist or pathologist to evaluate and document the bite pattern is appropriate.
Dental Neglect:
Def: “willful failure of a parent or guardian to seek and follow through with treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection”. “The point at which to consider a parent negligent and to begin intervention occurs after the parent has been properly alerted by a health care professional about the nature and extent of the child’s condition, the specific treatment needed, and the mechanism of accessing the treatment”.
Conclusions:
The Prevent Abuse and Neglect Through Dental Awareness phone # is (501) 661-2595 or email Lmouden@healthyarkansas.com
Friday, November 20, 2009
Microabrasion
Resident’s Name: Joanne Lewis Date: November 20, 2009
Article title: Microabrasion: effect of time, number of applications, and pressure on enamel loss
Author(s): Daniel P. Dalzell, DDS, MS, et al
Journal: Pediatric Dentistry
Volume (number): 17(3)
Month, Year: 1995
Major topic: microabrasion
Type of Article: scientific article
Main Purpose: To evaluate the effect that time, number of applications, and pressure has on the amount of enamel loss seen in micoabrasion using hydrochloric acid and pumice.
Overview of method of research: 27 extracted premolars with no visible signs of decalcification, fluorosis, or any other defect were used in the investigation. The teeth were hand rubbed with an 18% HCL-pumice mixture at time intervals of 5, 10, and 20 sec and 5, 10, and 15 applications under pressures of 10, 20, and 30g. Longitudinal sections were cut from the treated sections and measured for enamel loss.
Findings: Enamel loss significantly increased as each variable increased. The combination of 10 ten-sec applications or 15 five-sec applications with 20g of pressure resulted in enamel loss of slightly less than 250 mm.
Key points/Summary: When using this procedure, keep the applications below 10 ten-sec applications or 15 five-sec applications.
Assessment of article: I have never used this procedure – anyone else?
Thursday, November 19, 2009
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.
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.
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.
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.
Wednesday, November 18, 2009
Tooth Whitening in Children and Adolescents: A Literature Review
Dan Boboia
Article Review 10/2/09
Title: Tooth Whitening in Children and Adolescents: A Literature Review
Author: Lee et al.
Pediatric Dentistry: 27:5, 2005
Major Topic / Purpose: To summarize the findings of a lit. review on the use of peroxide-based tooth whitening agents in children and adolescents
Primary Teeth Whitening:
· Rarely done in children younger then 6
· In a 2004 study 32% of 2,495 children were dissatisfied with their tooth color. No evidence / studies state that bleaching is unsafe to use in children.
· Studies do of course indicate that dose, frequency, and duration of bleaching play a vital role in the safety of this material. Peroxide overuse could certainly have harmful effects in both adult and pediatric patient groups.
· All recommendations for whitening safety on pediatric patients are based off adult studies.
· Most safety data comes from short-term clinical observations.
· Increased sensitivity would be expected due to primary tooth characteristics (thinner enamel / large pulp chambers). This however was not consistent with the limited data available.
Whitening Safety Considerations:
· One study showed that dentin demineralization can occur from bleaching products; however the remineralizing effect of saliva reversed this process. Another study did not demonstrate this demineralizing effect.
· Another study stated that “overoxidation” and tooth structure break down could occur
· With low doses, proper exposure frequency, and short duration, tooth bleaching may not damage the enamel surface of the primary, mixed, or permanent dentition in children.
Carcinogenicity:
· Inadequate evidence regarding the carcinogenicity of hydrogen peroxide in humans
· Existing evidence does not support the concern of carcinogenicity of hydrogen peroxide
Suggested Approaches to Pediatric Whitening:
· Study shows younger children more critical of anterior tooth shade the older children
· So far there is no commonly accepted approach for whitening
· Due to compliance issue, at-home whitening discouraged until patient is 15 y/o
· Lower concentrations with higher frequency advised
· Custom trays with 10% carbamide peroxide is advised for adolescents who use at-home system
Considerations to take into account before bleaching:
1. dry mouth
2. resp. disorders
3. asthma mouth breathing
4. unrestored tooth decay
5. exposed root surfaces
6. broken teeth
7. grinding
8. poor OH
Reminders for Parents:
· Sensitivity is likely, especially if high concentration bleach is used
· Realistic whitening expectations
· A “slowing-down effect” occurs with higher frequency in any patient population
· Whitening tooth pastes can be used to maintain effects
· Do not use high concentration as effects on pulp have not been well determined
· Fluoride treatment after whitening can be use to promote remineralization
Assessment:
Great review. Great reference article for discussions with parents asking for this.
Article Review 10/2/09
Title: Tooth Whitening in Children and Adolescents: A Literature Review
Author: Lee et al.
Pediatric Dentistry: 27:5, 2005
Major Topic / Purpose: To summarize the findings of a lit. review on the use of peroxide-based tooth whitening agents in children and adolescents
Primary Teeth Whitening:
· Rarely done in children younger then 6
· In a 2004 study 32% of 2,495 children were dissatisfied with their tooth color. No evidence / studies state that bleaching is unsafe to use in children.
· Studies do of course indicate that dose, frequency, and duration of bleaching play a vital role in the safety of this material. Peroxide overuse could certainly have harmful effects in both adult and pediatric patient groups.
· All recommendations for whitening safety on pediatric patients are based off adult studies.
· Most safety data comes from short-term clinical observations.
· Increased sensitivity would be expected due to primary tooth characteristics (thinner enamel / large pulp chambers). This however was not consistent with the limited data available.
Whitening Safety Considerations:
· One study showed that dentin demineralization can occur from bleaching products; however the remineralizing effect of saliva reversed this process. Another study did not demonstrate this demineralizing effect.
· Another study stated that “overoxidation” and tooth structure break down could occur
· With low doses, proper exposure frequency, and short duration, tooth bleaching may not damage the enamel surface of the primary, mixed, or permanent dentition in children.
Carcinogenicity:
· Inadequate evidence regarding the carcinogenicity of hydrogen peroxide in humans
· Existing evidence does not support the concern of carcinogenicity of hydrogen peroxide
Suggested Approaches to Pediatric Whitening:
· Study shows younger children more critical of anterior tooth shade the older children
· So far there is no commonly accepted approach for whitening
· Due to compliance issue, at-home whitening discouraged until patient is 15 y/o
· Lower concentrations with higher frequency advised
· Custom trays with 10% carbamide peroxide is advised for adolescents who use at-home system
Considerations to take into account before bleaching:
1. dry mouth
2. resp. disorders
3. asthma mouth breathing
4. unrestored tooth decay
5. exposed root surfaces
6. broken teeth
7. grinding
8. poor OH
Reminders for Parents:
· Sensitivity is likely, especially if high concentration bleach is used
· Realistic whitening expectations
· A “slowing-down effect” occurs with higher frequency in any patient population
· Whitening tooth pastes can be used to maintain effects
· Do not use high concentration as effects on pulp have not been well determined
· Fluoride treatment after whitening can be use to promote remineralization
Assessment:
Great review. Great reference article for discussions with parents asking for this.
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