Procedure for Bleaching In Dentistry - Essay Example

Bleaching In Dentistry s In today’s times people are growing becoming concerned about their personal aesthetic value and teeth are regarded as a must have. Hence most people who have dark teeth want to undergo dental procedure to remove the problem and obtain amore whiter set of teeth. Keeping up with the demand the field of dental care has also evolved to suit the needs and there are many procedures which can help whiten and brighten one’s darkened set. Bleaching is the procedure that is primarily done to lighten the color of teeth and make them appear more pleasing. It is done by a number of bleaching agents and procedures. One may either opt for a treatment at the dentist’s office or use an OTC treatment tray in-house. Research studies have shown the there is not much difference between the two. Ghalili et al (2014) conducted a study to see the efficacy of novel in-house bleaching procedure using OTC bleaching tray system. They aimed to study the change in color, gingival irritation and tooth sensitivity in patients who opt for undergoing in-house bleaching process. For the study 43 participants within the age group of 18 -65 years and without teeth restorations were selected. Post exclusion, color shade, sensitivity and gingival measurement were done. The participants were given at-home bleaching systems containing 9% HP and treatment was done for 5 days. Assessment was done after treatment on day and day 5. It was seen that after day 1 of treatment significant color change was seen in all but only7 participants complained of discomfort while 2 suffered from buccal mucosal blanching. After Day 5, radical change in color was seen and 82% did not report any pain or discomfort at all. The study thereby concluded that home systems were effective on all in terms of restoring teeth whiteness however people should consult a dentist prior using such systems because some may suffer from discomfort or pain. Some studies have tried to understand if the bleaching mechanism of these agents could be enhanced with the help of energy supplied through heat or radiation. Cardoso et al (2012) conducted an experiment to measure the efficacy of bleaching agents activated by ultrasonic waves. Bleaching agents such as hydrogen peroxide are extremely efficient in producing free radicals which degrade the long chains pigments that make the tooth appear darker. Research showed that if these agents could be supplied with heat energy they would become much more efficient in breaking down teeth pigmentation to make the teeth appear lighter in color. In their experiment Cardoso et al (2013) used human canine teeth were prepped by calculus removal and polishing and stored for a month in thymol. Post this period they were artificially stained. The coloration was measured using a spectrophotometer. The 50 teeth were then divided into groups of 10 namely SP, CP, HP, CPUS and HPUS. While SP group served as control and CP and HP were treated by using conventional bleaching agents, group CPUS and HPUS were treated with agents energized by ultrasonic vibrations. The entire bleaching process was repeated and the ultimate coloration was again measured. Tukey’s test revealed that HPUs group post the second session had greatest coloration difference. However, group CPUS, CP and SP had similar results. The test results could not confirm the hypothesis that the application of ultrasonic energy to bleaching agents made them more permeable thereby enhancing their bleaching action. Hence, using simple chemicals or chemicals treated with ultrasonic waves do not make significant difference in the process. It must be remembered that many of us suffer from numerous teeth problems and therefore have had restorations done. Teeth with restorations when exposed to chemical agents are bound to have certain effects as well. The chemical agents cause oxidation of the surface of the materials especially in those with high amount of resin matrix. Bonafe et al (2013) studied the efficacy of in-office bleaching on restored teeth and also measured the sensitivity since this is a common side effect of the bleaching procedure. The researchers selected people within the age group of 18-34 years and who had central incisors of A2 or a darker shade. 30 participants were finally selected after they had met all the criteria that had been set. Participants without restored teeth were kept as control and were taken as one group while the other group consisted of participants who had went under at least one restorative procedure. Both these groups were made to undergo the bleaching treatment in an in-office setting. The bleaching procedure was done in 2 sessions using 35% hydrogen peroxide. The gel was refreshed 3 times in a 45minutes application period. For evaluation of tooth sensitivity the participants kept a record of the sensitiveness for each day up to 7 days after bleaching session. Post the bleaching treatment the color of the teeth was evaluated using both a shade guide and a spectrophotometer. The results showed that almost all participants had suffered from tooth sensitivity while those with restored teeth reported greater intensity of the tooth sensitivity. However, the researchers did not find a significant difference in the coloration change of the teeth of either group. Thus, the study established that even though the bleaching efficacy was not different among individuals with and without restored teeth; people with restored teeth suffered from greater instances of tooth sensitivity. Teeth restorations are made from certain compounds each of which are prepared form different concentrations and therefore respond differently to the action of bleaching. Kurtulmus-Yilmaz et al (2013) investigated the effect of home bleaching agents on the color and translucency of 5 resin composites. It had been noticed that even though home bleaching agents effectively removed dark coloration of teeth, teeth restoration if present was also exposed to the same bleaching action and in most cases resulted in altered coloration of the restorative material as well owing to oxidation. Resin composites owing to their organic matrix were more prone to the bleaching action. The researchers used 5 resin composites (Reflexion, grandio, gadia direct, Clearfil majesty aesthetic and ceram-X mono). 30 disc shaped resin composites of each kind were taken were prepared and their color and translucency was measured before bleaching. Each kind of composite was further sub-divided into 3 groups and each group was treated to one of the bleaching procedure. The procedures used consisted of a storage in distill water (this group was the control group), treatment with10% CP for 8 hours per day for 14 days and treatment with 10% HP agent for 60 min per day for 14 days. Post treatment each specimen was examined and it was seen that each of them showed unacceptable color changes.CXM resin composite showed maximum color change. Thus the study concluded that there was a significant color change after in-house bleaching treatment on teeth restorative materials and that the patients need to understand this effect of the bleaching process. It is not only the color of these restorations that are effected but they also effect the durability of the restorations. Microleakage is a major problem since it results in irritation, discoloration and hypersensitivity of the tooth. Sharafeddin et al (2013), aimed to study the effect that in-house bleaching had on micro-leakage of fiber reinforced and particle-filled composite resin. They prepped 90 intact bovine incisors and artificially made cavities in them. They were then divided into 6 groups-G1, G2, G3, G4, G5 and G6. They filled the cavities with Z100 in G1 and G2, Z250 in G3 and G4and Nulite F in G5 and G6. The restored teeth were then exposed to bleaching action. G2, G4 and G6 were treated with 22% CP according to manufacturer’s instructions of the bleaching agent. G1,G3 and G5 were not bleached. Post procedure of bleaching microleakage was analyzed and it was seen that G2 and G4 had more microleakage than G6. The bleaching procedure may follow 2 different processes and each of them bears different results. Ke Zhao et al (2013), conducted a comparative study to establish the difference between combined bleaching technique (CBT) and deep bleaching technique (DBT). CBT consists of an in-office treatment with 35%HP followed by a 7 day in-house treatment with 7% HP while DBT includes a 7 day in-house treatment with 6% HP followed by the same procedure as CBT. 36 subjects selected were between the ages of 18-35 years. They were split in 2 groups and a split mouth study was done. One group was for CBT and the other for DBT. Before initiation of the bleaching process, assessment of tooth color and sensitivity was done. The end results showed a significant difference between CBT and DBT .CBT showed less color change and DBT. However, tooth sensitivity problem occurred in about 36% of subjects given CBT while 57% DBT subjects suffered from the problem. Gingival sensitivity was also seen to be high among the DBT subjects. The study thereby established that within given limits efficiency of color restoration by DBT was slightly more than that of CBT however; the problem of tooth and gingival sensitivity was much more in the DBT procedure. Therefore, the bleaching of teeth is done not only by different reagents but by different processes as well. Studies have established the positives and negatives of each agent used for bleaching of teeth and the effects on people with normal intact teeth as well as on people with restored teeth. The choice of a bleaching treatment varies from individual to individual but everyone must understand the problems associated and opt for an appropriate treatment for teeth whitening. REFERENCES Bonafe et al (2013). Tooth sensitivity and efficacy of in-office bleaching in restored teeth. j o u r n a l of de n t i s t ry, 41, 363-369. Cardoso et al (2013). Ultrasonic activation of internal bleaching agen. International Endodontic Journal, 46, 40-46. Ghalili et al (2014). Clinical study of the safety and effectiveness of a novel over-the-counter bleaching tray system. Clinical, Cosmetic and Investigational Dentistry, 6, 15-19. Kurtulmus-Yilmaz et al (2013). The effect of home-bleaching application on the color and translucency of five resin composites. j o u r n a l o f d e n t i s t r y, 41, 70-75. Sharafeddin et al (2013). Effect of Home Bleaching on Microleakage of Fiber-reinforced and Particle-filled Composite Resins. Dental Research, Dental Clinics, Dental Prospects,7(4), 211-217. Zhao et al (2013). Clinical comparison between two bleaching techniques: A 180-day follow-up study. Qunitessence International, 44(8), 601-607. Read More