Bleaching of root-filled teeth : a review of the literature

Na Odontologia contemporânea, a estética do sorriso recebeu uma valorização significativa, ganhando destaque e importância. Nesse contexto, a beleza é influenciada pelo contorno, forma, simetria, alinhamento e, principalmente, pela cor dos dentes. O clareamento interno de dentes anteriores desvitalizados escurecidos tem se tornado uma terapia muito requisitada na prática odontológica, uma vez que o escurecimento dos dentes é motivo de grande preocupação por parte dos pacientes. Esta revisão de literatura tem como objetivo analisar os dados disponíveis na literatura sobre este assunto, uma vez que a associação entre o clareamento interno e a reabsorção radicular externa cervical é uma questão que ainda gera dúvidas na prática odontológica. A etiologia do escurecimento de dentes desvitalizados é bem conhecida, tendo como causas principais a presença de materiais restauradores na coroa, hemorragia no interior da câmara pulpar, decomposição de tecidos ou detritos situados no interior da câmara pulpar, medicamentos de uso intracanal e materiais de obturação do canal radicular. O clareamento interno apresenta resultados esteticamente satisfatórios, no entanto, apresenta como possível efeito colateral a reabsorção radicular cervical externa, o que prejudica ou até mesmo inviabiliza a permanência do elemento dental na cavidade bucal. A etiologia da reabsorção radicular externa relacionada ao clareamento interno é complexa, no entanto acredita-se que o agente clareador alcance os tecidos periodontais através dos túbulos dentinários, desnature a dentina, que passa a ser considerada como um tecido imunologicamente diferente, sendo reconhecida como um corpo estranho e inicia uma reação inflamatória que resulta na perda localizada de tecido dental. Outra limitação do clareamento de dentes tratados endodonticamente é a recidiva da cor obtida inicialmente. O re-escurecimento pode ser devido a uma redução química dos produtos gerados durante a ação dos agentes clareadores, infiltração marginal de restaurações, produtos químicos ou bacterianos e trauma dental. Apesar deste tipo de procedimento ter um alto índice de sucesso, os resultados do clareamento são diferentes daqueles observados a longo prazo, ou seja, a recidiva de cor é um fato que deve ser estudado e melhor compreendido.In modern Dentistry, the smile aesthetics has gained importance and prominence. In this context, the beauty of the smile is determined by contour, shape, alignment, symmetry and, more importantly, the color of the teeth. Internal bleaching of anterior endodontically treated darkened teeth has become a sought after therapy in the clinical practice of Dentistry, because stained teeth is of great concern to patients. This review of literature aims to analyze the available data on the subject, since the association between internal bleaching and external cervical root resorption remains a debatable issue in dental practice. The etiology of the darkened non-vital teeth is well-known, its main causes being the presence of restorative materials in the dental crown, internal pulp bleeding, decomposition of tissues or debris into the pulp chamber, intracanal medication and root canal filling material. The internal bleaching is a successful procedure aesthetic, however, this technique is associated with a risk of external root resorption, which hinders or prevents the maintenance of the tooth in the oral cavity. The etiology of the external root resorption related to the internal bleaching is complex. However it is believed that the bleaching chemicals diffuse from the pulp chamber through patent dentinal tubules to the surrounding periodontal tissues, denaturing the dentin, which then starts to be considered a tissue with immunological differences, becoming therefore recognized as a strange body. This process results in an inflammatory reaction which leads to the located loss of tissue. Discoloration is yet another limitation of the internal bleaching of root-filled teeth. Darkening after internal bleaching can be due to chemical reduction of the resulting products during the action of the bleaching agents, diffusion of staining substances and penetration of bacteria through marginal gaps between the fillings and the tooth, and dental trauma. Although this procedure has a high success rate, the results are different from those seen at long-term follow-up. It can be concluded, therefore, that color regression is a fact that must be studied and better understood

Bleaching of root-filled teeth : a review of the literature

Na Odontologia contemporânea, a estética do sorriso recebeu uma valorização significativa, ganhando destaque e importância. Nesse contexto, a beleza é influenciada pelo contorno, forma, simetria, alinhamento e, principalmente, pela cor dos dentes. O clareamento interno de dentes anteriores desvitalizados escurecidos tem se tornado uma terapia muito requisitada na prática odontológica, uma vez que o escurecimento dos dentes é motivo de grande preocupação por parte dos pacientes. Esta revisão de literatura tem como objetivo analisar os dados disponíveis na literatura sobre este assunto, uma vez que a associação entre o clareamento interno e a reabsorção radicular externa cervical é uma questão que ainda gera dúvidas na prática odontológica. A etiologia do escurecimento de dentes desvitalizados é bem conhecida, tendo como causas principais a presença de materiais restauradores na coroa, hemorragia no interior da câmara pulpar, decomposição de tecidos ou detritos situados no interior da câmara pulpar, medicamentos de uso intracanal e materiais de obturação do canal radicular. O clareamento interno apresenta resultados esteticamente satisfatórios, no entanto, apresenta como possível efeito colateral a reabsorção radicular cervical externa, o que prejudica ou até mesmo inviabiliza a permanência do elemento dental na cavidade bucal. A etiologia da reabsorção radicular externa relacionada ao clareamento interno é complexa, no entanto acredita-se que o agente clareador alcance os tecidos periodontais através dos túbulos dentinários, desnature a dentina, que passa a ser considerada como um tecido imunologicamente diferente, sendo reconhecida como um corpo estranho e inicia uma reação inflamatória que resulta na perda localizada de tecido dental. Outra limitação do clareamento de dentes tratados endodonticamente é a recidiva da cor obtida inicialmente. O re-escurecimento pode ser devido a uma redução química dos produtos gerados durante a ação dos agentes clareadores, infiltração marginal de restaurações, produtos químicos ou bacterianos e trauma dental. Apesar deste tipo de procedimento ter um alto índice de sucesso, os resultados do clareamento são diferentes daqueles observados a longo prazo, ou seja, a recidiva de cor é um fato que deve ser estudado e melhor compreendido.In modern Dentistry, the smile aesthetics has gained importance and prominence. In this context, the beauty of the smile is determined by contour, shape, alignment, symmetry and, more importantly, the color of the teeth. Internal bleaching of anterior endodontically treated darkened teeth has become a sought after therapy in the clinical practice of Dentistry, because stained teeth is of great concern to patients. This review of literature aims to analyze the available data on the subject, since the association between internal bleaching and external cervical root resorption remains a debatable issue in dental practice. The etiology of the darkened non-vital teeth is well-known, its main causes being the presence of restorative materials in the dental crown, internal pulp bleeding, decomposition of tissues or debris into the pulp chamber, intracanal medication and root canal filling material. The internal bleaching is a successful procedure aesthetic, however, this technique is associated with a risk of external root resorption, which hinders or prevents the maintenance of the tooth in the oral cavity. The etiology of the external root resorption related to the internal bleaching is complex. However it is believed that the bleaching chemicals diffuse from the pulp chamber through patent dentinal tubules to the surrounding periodontal tissues, denaturing the dentin, which then starts to be considered a tissue with immunological differences, becoming therefore recognized as a strange body. This process results in an inflammatory reaction which leads to the located loss of tissue. Discoloration is yet another limitation of the internal bleaching of root-filled teeth. Darkening after internal bleaching can be due to chemical reduction of the resulting products during the action of the bleaching agents, diffusion of staining substances and penetration of bacteria through marginal gaps between the fillings and the tooth, and dental trauma. Although this procedure has a high success rate, the results are different from those seen at long-term follow-up. It can be concluded, therefore, that color regression is a fact that must be studied and better understood

Oral health in the children’s preventive health care initiative : indicators and goals in a primary health care service

O objetivo foi avaliar o cumprimento das metas de saúde bucal da Ação Programática da Criança em 12 Unidades de Saúde (US) de um Serviço de Atenção Primária à Saúde, Porto Alegre-RS, através de um estudo analítico transversal sobre a cobertura das consultas odontológicas anuais na primeira infância. Foram incluídas no estudo 660 crianças nascidas em 2010. Em relação à cobertura das consultas odontológicas a cada ano de vida da criança, as unidades de saúde não atingiram as metas estabelecidas (100%). A maior parte das crianças (35%) realizou sua primeira consulta no primeiro ano de vida. Em relação ao número total de consultas, 22% das crianças nunca as tiveram e apenas 8% realizaram as quatro preconizadas. Houve correlação positiva entre a razão da população total e de crianças de 0-4 anos da área adscrita com o número de profissionais da odontologia e a cobertura no primeiro ano de vida de cada US. Apesar de poucas crianças terem o acompanhamento adequado em relação à meta estabelecida, os percentuais de cobertura foram superiores aos encontrados na literatura.The objective of this study is to assess fulfillment of the oral health goals of the Children’s Preventive Health Care Initiative in 12 Health Units (HU) of a Primary Health Care Service, in Porto Alegre, in the state of Rio Grande do Sul, through a cross-sectional analytical study on the annual dental visit coverage in early childhood. The study was comprised of 660 children born in 2010. In relation to the coverage of dental visits for each year of life of children, the health units did not achieve the set targets (100%). However, a considerable number of children (35%) had their first dental visit during the first year of life. In relation to the total number of visits, 22% of the children had never gone to the dentist and only 8% did the recommended four visits. There was a positive correlation between the ratio of the total population and children from ages 0 to 4 years in the area enrolled in the initiative, on the one hand, and the number of dental professionals and coverage in the first year of life in each health unit, on the other. Although few children had adequate follow-up visits in relation to the set targets, the percentage of coverage was higher than that found in the literature

Oral health in the children’s preventive health care initiative : indicators and goals in a primary health care service

O objetivo foi avaliar o cumprimento das metas de saúde bucal da Ação Programática da Criança em 12 Unidades de Saúde (US) de um Serviço de Atenção Primária à Saúde, Porto Alegre-RS, através de um estudo analítico transversal sobre a cobertura das consultas odontológicas anuais na primeira infância. Foram incluídas no estudo 660 crianças nascidas em 2010. Em relação à cobertura das consultas odontológicas a cada ano de vida da criança, as unidades de saúde não atingiram as metas estabelecidas (100%). A maior parte das crianças (35%) realizou sua primeira consulta no primeiro ano de vida. Em relação ao número total de consultas, 22% das crianças nunca as tiveram e apenas 8% realizaram as quatro preconizadas. Houve correlação positiva entre a razão da população total e de crianças de 0-4 anos da área adscrita com o número de profissionais da odontologia e a cobertura no primeiro ano de vida de cada US. Apesar de poucas crianças terem o acompanhamento adequado em relação à meta estabelecida, os percentuais de cobertura foram superiores aos encontrados na literatura.The objective of this study is to assess fulfillment of the oral health goals of the Children’s Preventive Health Care Initiative in 12 Health Units (HU) of a Primary Health Care Service, in Porto Alegre, in the state of Rio Grande do Sul, through a cross-sectional analytical study on the annual dental visit coverage in early childhood. The study was comprised of 660 children born in 2010. In relation to the coverage of dental visits for each year of life of children, the health units did not achieve the set targets (100%). However, a considerable number of children (35%) had their first dental visit during the first year of life. In relation to the total number of visits, 22% of the children had never gone to the dentist and only 8% did the recommended four visits. There was a positive correlation between the ratio of the total population and children from ages 0 to 4 years in the area enrolled in the initiative, on the one hand, and the number of dental professionals and coverage in the first year of life in each health unit, on the other. Although few children had adequate follow-up visits in relation to the set targets, the percentage of coverage was higher than that found in the literature

Dental visit in the healthcare program for kids : strategies and challenges in the view of oral health teams in basic health units of Porto Alegre, Brazil

Objective: To analyze the perceptions and strategies influencing the achievement of dental visit targets in the Healthcare Program for Kids in the view of the oral health team in basic health units in Porto Alegre, Brazil. Material and Methods: Qualitative study of the descriptive-exploratory type with two focus groups at 12 Health Units in Porto Alegre, RS, with participation of 17 members of oral health teams from different units. Results: The collected data suggest the use of strategies to meet the goals of the Oral Health Program, such as an open schedule, education and health groups, days on which families attend the health unit because of the Bolsa Família Program, vaccination campaign days and home visits. The data also suggest, in order to meet the goals, working jointly with the multiprofessional team and formation of ties, allowing for a greater interaction with patients at the Health Unit, in addition to listening to the life stories of the population and the community. A better understanding of the proposal by health teams for the actions to be carried out horizontally and the greater difficulty in having children at the appointments on days when their mothers work turned out to be challenges. Conclusion: The use of these strategies tends to help and influence the maintenance and implementation of public policies oriented to dental care at an early age and reorient health practices so as to contribute to the strengthening of collectivities

Dental visit in the healthcare program for kids : strategies and challenges in the view of oral health teams in basic health units of Porto Alegre, Brazil

Objective: To analyze the perceptions and strategies influencing the achievement of dental visit targets in the Healthcare Program for Kids in the view of the oral health team in basic health units in Porto Alegre, Brazil. Material and Methods: Qualitative study of the descriptive-exploratory type with two focus groups at 12 Health Units in Porto Alegre, RS, with participation of 17 members of oral health teams from different units. Results: The collected data suggest the use of strategies to meet the goals of the Oral Health Program, such as an open schedule, education and health groups, days on which families attend the health unit because of the Bolsa Família Program, vaccination campaign days and home visits. The data also suggest, in order to meet the goals, working jointly with the multiprofessional team and formation of ties, allowing for a greater interaction with patients at the Health Unit, in addition to listening to the life stories of the population and the community. A better understanding of the proposal by health teams for the actions to be carried out horizontally and the greater difficulty in having children at the appointments on days when their mothers work turned out to be challenges. Conclusion: The use of these strategies tends to help and influence the maintenance and implementation of public policies oriented to dental care at an early age and reorient health practices so as to contribute to the strengthening of collectivities