At-Home Versus In-Office Whitening Techniques - Assignment Example

Programme At-home versus in-office whitening techniques: A quantitative study 5/29 It is proposed to conduct a study which would address the questions raised about the relative benefit of using at home bleaching tooth whitening product (containing 10% hydrogen peroxide) over in office tooth whitening bleaching product ( containing 35% hydrogen peroxide). The superiority of the product (and procedure) would be tested in terms of efficacy, side-effects and patient acceptance. The study would be conducted in the form of two groups’ pretest-posttest experiment with a longitudinal form of sampling. The eligibility of the subjects for this programme would essentially be good dental and general health, with six healthy permanent maxillary anterior teeth of a Vita shade score of A2 or darker. Above all they should be willing for dental bleaching. The study teeth will be the four maxillary central and lateral incisors. The shade of the teeth will be evaluated using the Vita shade guide and photographs. The participants will be randomly assigned to one of the two experimental study groups. The dental shade, GI, PI, TV and tooth sensitivity of each participant will be assessed before application of dental bleaching, after two weeks, and after six months of treatment. The results would be arrived at by the quantitative analysis of the data procured. Introduction Tooth discoloration may be due to several different types of causes and may vary in appearance, localization and severity. It may be classified as intrinsic, extrinsic, and a combination of both intrinsic and extrinsic (Hattab & Qudeimat, 1999) Stubborn extrinsic discoloration and intrinsic stain are generally removed by the use of various bleaching techniques. Bleaching refers to the treatment, usually involving an oxidative chemical, that alters the light absorbing and/or light reflecting nature of a material structure, thereby increasing its value (whiteness).Vital tooth bleaching refers to external application of bleaching gel/ solution and is also known as night guard vital bleaching. For vital tooth bleaching procedures, there is a wide array of whitening products available containing the whitening agent hydrogen peroxide (or one of its precursors, notably carbamide peroxide) which penetrates the tooth structure and oxidizes the colored compounds in the dentin (the second layer of the tooth). Products containing a concentration of 10% carbamide peroxide, come in a ‘tray’ which could be used by patients at home while the results and concentrations are monitored by a dental professional. Other materials based on higher concentrations of hydrogen peroxide are available only for in-office bleaching by a dentist. The two categories of tooth whitening products which form the basis of the proposed research are professionally applied (in the dental office) are dentist-prescribed/dispensed (patient home-use). Additionally, dentist-dispensed bleaching materials are sometimes used at home after dental office bleaching to maintain or improve whitening results. (ADA Council of Scientific Affairs, 2009). Such products are also counted as patient home-use products. In general, most in-office and dentist-prescribed, at-home bleaching techniques have been shown to be effective. However, concerns have remained about the long-term safety, efficiency, patient acceptance, and adverse effects of in-office and at-home tooth whitening techniques. The question addressed in this study is whether the use of 10% hydrogen peroxide (HP) at-home bleaching techniques is better than using the 35% HP in-office methods in terms of efficiency, side effects, and patient acceptance. Literature Review Tooth colour can be improved by a number ways such as whitening toothpastes, scaling and polishing to remove stain and tartar, internal bleaching of non-vital teeth, external bleaching of vital teeth, microabrasion of enamel with abrasives and acid and placement of crowns and veneers (Joiner, Pickles, Matheson, Weader, Noblet, & Huntingdon, 2002) (Sarrett, 2002) The scope of the current literature review is restricted to the external bleaching of vital teeth and will focus on the following topics; in vivo evaluation of at home and in-office bleaching methods, and factors influencing the efficacy and safety of both the bleaching processes. Bleaching is a decolourisation or whitening process that can occur in solution or on a surface. The colour producing materials in solution or on a surface are typically organic compounds known as chromophore. Bleaching and decolourisation of the chromophore can occur by destroying one or more of the double bonds in the conjugated chain, by cleaving the conjugated chain, or by oxidation of other chemical moieties in the conjugated chain (Howe & Grant, 1992). Hydrogen peroxide oxidises a wide variety of organic and inorganic compounds. The mechanisms of these reactions are varied and dependent on the substrate, the reaction environment, and catalysis (Howe & Grant, 1992). In general, the mechanism of bleaching by hydrogen peroxide is not well understood and its usage in higher quantities would result better results is debatable. Two of the key factors in determining overall tooth whitening efficacy from peroxide containing products are the concentration of the peroxide and duration of application. There are evidences that efficacy of the procedure may change based upon the hydrogen peroxide content in the whitening gel/solution. Studies indicate that higher the concentration of the hydrogen peroxide, lower the number of gel applications required to produce uniform bleaching (Sulieman, Addy, MacDonal, & Rees, 2004). However, certain researches also claim that beyond a period of time ( usually six weeks) the differences in tooth lightness by using different concentrations were no longer of statistical significance (Kihn, Barnes, Romberg, & Peterson, 2000) There is still a debate on whether bleaching is a safe procedure or not. Certain published studies tend to suggest that bleaching is a relatively safe procedure (Nathoo & Gaffar, 1995), yet there are many researchers who have reported adverse effects of bleaching on hard tissue, soft tissue, and restorative materials (Attin, Hanning, Wiegand, & Attin, 2004), (Dahl & Palesan, 2003), (Goldberg, Grootveld, & Lynch, 2009). Safety issues have been raised regarding the effects of bleaching on the tooth structure, pulp tissues, and the mucosal tissues of the mouth, as well as systemic ingestion. (ADA Council of Scientific Affairs, 2009). Number of patients opting for tooth whitening products and procedures has dramatically increased in recent times. Concomitantly, there has been a rapid increase of published in vivo and in vitro tooth whitening studies. However, some of this literature is conflicting which requires further evaluation. Hence this study is proposed to probe into the efficacy, side effects and patient acceptance aspects of at home and in office bleaching procedures with different levels of hydrogen peroxide. Methods Design: In order to compare the two interventions, longitudinal design of research is chosen. Since the sample of respondents would remain the same, it would enable to detect and measure change due to application of bleaching products with relatively high accuracy. Randomized two group pretest-posttest experimental design will be used. The independent variable will be the whitening treatment used to enhance the shade of the participants’ teeth and it will include two levels; at-home bleaching and in-office bleaching. There will be three dependent variables - dental shade, side effects, and patient acceptance. All three variables will be measured before the treatment, after two weeks of the treatment, and after six months of the treatment. Subjects or Participants: The eligibility of the subjects for this programme would essentially be good dental and general health, with six healthy permanent maxillary anterior teeth of a Vita shade score of A2 or darker, not to mention that they should be willing for dental bleaching. Interested candidates who have dental problems such as active dental caries, periodontitis, or big restorations in the anterior teeth or those who are undergoing orthodontic treatment will be excluded because such conditions become extraneous variables which may affect the results. In addition, the exclusion criteria will include candidates who have a medical problem or condition, such as pregnancy, that may interfere with bleaching results or may make it unsafe for them to undergo bleaching. Approximately 30 patients will be recruited from the dental department at King Abdul-Aziz Medical City. Communication regarding the recruitment of subjects would be done by posting advertisements on the wall of the patients’ waiting areas in the dental department (convenience sampling). This method will help in recruiting subjects who are eligible to receive dental treatment in the institution. Volunteers who meet the selection criteria will receive a letter that will include information about the study (such as why and what is being is studied by whom) and their rights (such right to ask for more information on the research being conduct and the right to withdraw from the study without affecting their eligibility to be treated in the institution). Institutional ethics approval will be also obtained. Materials/Instruments: The study teeth will be the four maxillary central and lateral incisors. The shade of the teeth will be evaluated using the Vita shade guide and photographs. Shade guide usage is one of the most opted for method for evaluating colour change (Van der, Ten, Borsboom, & Kortsmit, 1990). Radiographs will be taken to identify any changes in tooth structure. Safety issues and adverse effects will be identified using the gingival index (GI), and the plaque index (PI). Patient acceptance, tooth sensitivity, gingival irritation, and any other side effects will also be evaluated using a questionnaire. An individualized nightguard tray and whitening agent will be given to the at-home group of participants along with use instructions. For the in-office group, the whitening agent will be applied directly to the teeth by a dentist. Procedures: A meeting will be arranged with subjects in the auditorium of the dental department in King Abdul-Aziz Medical City. The participants will be randomly assigned to one of the two experimental study groups. The dental shade, GI, PI, TV and tooth sensitivity of each participant will be assessed before application of dental bleaching, after two weeks, and after six months of treatment. Participants will complete a questionnaire about side effects and treatment acceptance. Participants will receive prophylaxes treatment prior to bleaching. Results The results would be arrived at by the quantitative analysis of the data procured. Statistical techniques which would be employed for the analysis purpose would be the ones which examine the differences in variables(example efficacy of whitening procedures) as well the magnitude of the relationships between variables( example: concentration of hydrogen peroxide and the whitening induced by its application). Discussion This research study would be an endeavour to seek clarity regarding the worth of in office procedures with respect to efficacy, safety and patient acceptance received in home procedures. However, the major limitation while conducting this research would be at the developmental stage of the project. Since general public may not understand what a research study is; to convince the eligible population of the importance of the project and to assure of them of the safety and convenience is a task which is yet to be achieved. Above all, once recruited, the sample should be cooperative enough to follow the instructions, give appropriate feedback and turn-up on time to record the observations. This study is an opportunity for the researcher to enhance his understanding of the bleaching procedures and their effects. It would enable the author to look into the viability of comments made by other scholars on the subject and make the researcher worthy of contributing to this field of knowledge. Last but not the least; the proposed study would be an ideal way to experience the ground realities while conducting a research project. Reference List ADA Council of Scientific Affairs. (2009). Tooth Whitening/Bleaching: Treatment Considerations for Dentists and Their Patients. Washington DC: American Dental Association. Attin, T., Hanning, C., Wiegand, A., & Attin, R. (2004). Effect of bleaching on restorative materials and restorations—a systematic review. Dent Mater , 852-861. Dahl, J. E., & Palesan, U. (2003). Tooth bleaching-a critical review of the biological aspects. Crit Rev Oral Biol Med , 292-304. Goldberg, M., Grootveld, M., & Lynch, E. (2009). Undesirable and adverse effects of tooth-whitening products: a review. Clin Oral Invest , [Epub ahead of print]. Hattab, F. N., & Qudeimat, M. A. (1999). Dental Discoloration: An Overview. J Esthet Dent , 291-310. Howe, & Grant, M. (1992). Encyclopedia of chemical technology. New York: John Wiley & Sons. Joiner, A., Pickles, M., Matheson, J., Weader, E., Noblet, L., & Huntingdon, E. (2002). Whitening toothpastes: effects on tooth. International Journal of Dentistry , 424-430. Kihn, P., Barnes, D., Romberg, E., & Peterson, K. (2000). A clinical evaluation of 10 percent vs 15 percent carbamide peroxide tooth whitening agents. Journal of the American Dental Association , 1478-1484. Nathoo, S. A., & Gaffar, A. (1995). Studies on Dental Stains Induced by Antibacterial Agents and Rational Approaches for Bleaching Dental Stains. Advances In Dental Research , 462-470. Sarrett, D. (2002). Tooth whitening today. Journal of the American , 1535-1538. Sulieman, M., Addy, M., MacDonal, E., & Rees, J. (2004). The effect of hydrogen peroxide concentration on the outcome of tooth whitening: an invitro study. Journal of Dentistry , 295-299. Van der, B. T., Ten, B. J., Borsboom, P., & Kortsmit, W. (1990). A comparison of new and conventional methods for quantification of tooth colour. Journal of Prosthetic Dentistry , 155-162. Read More