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.