The effects of at-home whitening on patients’ oral health, psychology, and aesthetic perception

Abstract Background The aesthetic self-perception and psychosocial impact of whitening is poorly explored in the literature; it is even less clear whether the effect of whitening may influence the psychology or social relations of patients. Therefore, the aim of this trial is to evaluate the impact of an at-home whitening procedure on patients’ quality of life. Also, this study’s secondary objective is the adaptation and validation of the Spanish version of the OES questionnaire (OES-SP). Methods Fifty eight patients underwent whitening with 10% carbamide peroxide (CP) gel for 1 h daily for 3 weeks. For these participants, the OHIP-Esthetics, PIDAQ, and OES surveys were applied before, one week after, and one month after the whitening procedure. Oral health-related quality of life was measured using the OHIP-Esthetics survey and the psychosocial impact using the PIDAQ survey. The orofacial aesthetics was measured by OES and validated for the Spanish Chilean context. The treatment efficacy (ΔE and ΔSGU) and data from the OHIP-Esthetics PIDAQ and OES surveys were compared using the Wilcoxon Signed-Rank test. Results The whitening procedure was effective (ΔE = 5.9 ± 1.8). The OHIP-Esthetics results were significant when comparing the initial baseline survey prior to the treatment and one week after whitening (p < 0.001) and when comparing the baseline and one-month results (p < 0.001). The overall score on the PIDAQ, after one week post-whitening, was separated into factors and all factors were statistically significant (p < 0.03); the factors for the one-month results were also all statistically significant (p < 0.001), except the social impact factor. The OES questionnaire had statistically significantly increased scores both one week and one month post-treatment (p < 0.0001). The reliability, validity, and responsiveness of the OES-SP were satisfactory. Conclusion The at-home whitening procedure with carbamide peroxide 10% had a positive effect on patients’ oral health-related quality of life, psychology, and aesthetic perception after one month post-whitening. The Chilean Spanish version of the OES showed satisfactory psychometric characteristics to evaluate dental whitening. Trial registration NCT02605239. Date that the study was retrospectively registered: 11-11-2015

Percepción de estudiantes respecto al recambio de restauraciones

Introduction: The replacement of defective restorations, which leads to a greater loss of the dental remnant before each replacement, represents the large majority of the dentist's practice.Objective: To determine if there is any variation in students´ clinical criterion in relation to the decision of replacement of composite resin restorations prior to and following reconditioning.Material and Methods: A cross-sectional analytical study was conducted. The sample was composed of 40 fifth-year students in a universe of 72.  A set of photographs showing defective restorations in one or more parameters evaluated according to RYGE / USPHS criteria was used.  They were later reconditioned, so there were photographs prior to and following conservative treatment. Based on the photographs shown, a survey in which they had to indicate the choice of treatment was performed.Results: We observed that there is a great variation in the choice of treatment prior to the repair with conservative treatments (38%) and non-conservative ones (62%), compared to the same resin restoration after the choice of conservative treatment (83%) and non-conservative one (17%). Using the McNemar Test, p<0.0001 was obtained between the choice of conservative treatment over the non-conservative one after the restoration reconditioning had been performed.Conclusions: There is a change in perception of the indication of treatment to repair defective restorations towards a conservative alternative after they have undergone minimally invasive procedures.Introducción: El reemplazo de restauraciones defectuosas representa la mayor parte de la práctica del odontólogo, lo que lleva a una perdida mayor del remanente dentario ante cada reemplazo.Objetivo: Determinar si existe variación del criterio clínico en alumnos frente a la decisión de recambio en restauraciones de resina compuesta previo y posterior al reacondicionamiento.Material y Métodos: Estudio analítico transversal. Se contó con una muestra de 40 estudiantes de quinto año de un universo de 72. Se utilizó un set fotográfico, que contaba con restauraciones defectuosas, en uno o más parámetros según los criterios RYGE/USPHS, las cuales posteriormente se reacondicionaron, por lo que se contaba con las fotografías del antes y del después del tratamiento conservador. Se realizó una encuesta a partir de las fotografías mostradas en la cual debían indicar la elección de tratamiento.Resultados: Se observó que hay una gran variación de elección de tratamiento previo a ser reparadas con tratamientos conservadores: 38 % y no conservador de 62 % y frente a la misma restauración de resina posterior a haber sido intervenida la elección de tratamiento conservador fue de 83 % y no conservador 17 %. Mediante el Test de McNemar se obtuvo un p<0.0001 entre elección de tratamiento conservador por sobre el no conservador posterior a haber sido realizada el reacondicionamiento de la restauración.Conclusiones: Existe un cambio en la percepción sobre la indicación de tratamiento de restauraciones defectuosas, a favor de una alternativa conservadora, después de que han sido intervenidas con procedimientos mínimamente invasivos

Color regression and maintenance effect of intracoronal whitening on the quality of life: RCT—A one-year follow-up study

Objective: This randomized clinical study evaluated two parameters: 1) the clinical color rebound of whitening patients’ tooth discoloration using thewalking bleaching technique and 2) the impact on psychological and aesthetic self-perception at the one-year follow-up of patientswho underwent bleaching of nonvital teeth. Methods and Materials: Fifty study participants with nonvital tooth discoloration were recruited. Teeth were assigned randomly into one of two groups: 1) 35% hydrogen peroxide (n=25) and 2) 37% carbamide peroxide (n=25). Intracoronal bleaching was carried out over the course of four sessions using the walking bleach technique. Tooth color was evaluated after each session in order to measure the total color variation (DE). The guide was arranged from highest (B1) to lowest values (C4) for evaluating color, and color changes using Vita Classical Shade (DSGUs) units were calculated. Subjective and objective assessments were compared with the counterpart of the tooth. Aesthetic perception and psychosocial factors were evaluated before and after treatment by the Oral Health Impact Profile (OHIP) and Psychological Impact of Dental Impact Questionnaire (PIDAQ) surveys. Results: Color changes (DE) were 15.48 6 5.17 and 14.02 6 4.85 for carbamide and hydrogen peroxide groups, respectively. There were no significant differences (p.0.05) between these two groups at the one-year follow-up. There was a decrease in the PIDAQ scores after treatment compared to baseline values (p,0.05). The majority of OHIP values regressed to baseline values. Conclusion: The technique of walking bleaching was highly effective and showed minimal color rebound in nonvital teeth and had a positive effect on patients’ psychological impact at the one-year follow-up

Effectiveness and effect of non-vital bleaching on the quality of life of patients up to 6 months post-treatment: a randomized clinical trial

Objectives The aim of this study was to evaluate the esthetic perception of patients at 6 months after bleaching of non-vital teeth with 35% of hydrogen peroxide and 37% of carbamide peroxide using a walking bleach technique. We also assessed psychosocial impacts as well as the clinical effectiveness and stability of the color change. Materials and methods The teeth bleaching treatment was randomly assigned to two groups according to the bleaching agent used: G1 HP = 35% of hydrogen peroxide (n = 25) and G2 CP = 37% of carbamide peroxide (n = 25). The non-vital bleaching was performed in four sessions using the walking bleach technique. The color was objectively (ΔE) and subjectively (ΔSGU) evaluated. The esthetic perception and psychosocial factors were evaluated before treatment as well as one and 6 months post-treatment using Oral Health Impact Profile (OHIP) esthetics and Psychosocial Impact of Dental Esthetics Questionnaire (PIDAQ). Results The color change (ΔE) at 6 months (G1 = 14.53 ± 5.07 and G2 = 14.09 ± 6.61) for both color groups remained stable until the 6-month post-treatment (p > 0.05). There was a decrease in the values of OHIP esthetics and PIDAQ after treatment compared to the baseline (p < 0.05), and this effect was maintained 6 months post-treatment. Conclusions Both agents were highly effective and maintained the color stability at 6 months; this positively affected the esthetic perception and psychosocial impact of patients who also remained stable over time. Clinical relevance Non-vital bleaching produces a positive and stable impact on the esthetic perception and psychosocial factors at medium-term follow-ups

Teeth whitening with 6% hydrogen peroxide and its impact on quality of life: 2 years of follow-up

This study aimed to evaluate color longevity after 2 years of whitening gel (6% hydrogen peroxide (HP), blue LED/infrared laser activation system) in comparison to a control 35% concentration in a split-mouth study and investigate the long-term effect on quality of life (QOL).Thirty-one patients were treated. Whitening using 6% or 35% HP gel was performed on half of the upper jaw in each patient. The color was measured at baseline and 1 week, 1 month, 1 and 2 years after treatment using the Easyshade Vita spectrophotometer and the Vita Bleached and Vita Classical Shade Guides organized by value. During 2 years of follow-up, color was evaluated before and after dental prophylaxis. Oral Health of Impact Profile (OHIP 14) and Psychosocial Impact Dental Aesthetics Questionnaire (PIDAQ) surveys measured QOL. Nineteen patients were evaluated at the 2-year follow-up. Significant differences in ΔE were measured between the two groups at all time points (p<0.05). No significant differences in ΔSGU were observed at any time point (p>0.05). The positive effect of bleaching on QOL was maintained in patients treated with a low concentration of the whitening gel. The two compounds remained effective after 2 years. An objective color difference was found between the groups, but no difference was observed in subjective reports. The positive effect on QOL remained after 2 years of follow-up in this cohort of patients

One-year bleaching efficacy using two HP products with different pH: A double-blind randomized clinical trial

Objectives: This split-mouth, double-blind, randomized clinical trial evaluated the 1-year bleaching efficacy produced by two hydrogen peroxide gels with different pHs. Materials and Methods: Twenty-eight patients were divided into two groups corresponding to two different products: Pola Office (pH = 2.0/SDI) and Pola Office Plus (pH = 7.0/SDI). The treatment was assessed during and after the bleaching procedure up to 12 months post-treatment. The assessment consisted of two bleaching scales shade guide units (ΔSGU) and spectrophotometric device (ΔE, ΔE00, and Whiteness Index) of both maxillary quadrants. Results for ΔSGUs in both scales and ΔE00 and Whiteness Index were compared using Mann Whitney test and ΔE measurements through the t-Student test for paired samples in each evaluation time. The color rebound (1- vs 12-month postbleaching data) was evaluated with Wilcoxon test (alpha = .05). Results: During the different times of evaluation, the color variation was similar for both products (P > .05), both for subjective (ΔSGUs) and objective assessments (ΔE, ΔE00, and Whiteness Index). Also, both products showed a slight rebound after 12-month postbleaching (P > .05). Conclusions: Concerning the stability of color, in-office dental whitening with two hydrogen peroxide gels of different pHs produced similar results, with no significant of regression, for 12 months postwhitening. Clinical Significance: Bleaching using a neutral (pH = 7.0) in-office gel demonstrated similar stability and rebound effect than an acidic one (pH = 2.0)

Instrumentación para el registro del color en odontología

Color is an important variable in cosmetic dentistry, and it has traditionally been measured by a visual method, comparing teeth with standard color guides. In recent decades, electronic instruments have been developed to eliminate the subjective factor of visual measurement. This objective method has mainly been performed with colorimeters, spectrophotometers and the analysis of images obtained with digital cameras. These instruments have proven to be reliable with a high degree of precision and accuracy. Its use is recommended as an adjunctive tool to assess color in direct and indirect restorations, in aesthetic treatments like bleaching, and to facilitate communication with the dental laboratory. The spectrophotometer is the device that has reported better “in- vitro “ and “in -vivo” performance, being the “Vita Easyshade “ the one with more reliable results.El color es una variable importante en la odontología estética, y su medición tradicionalmente ha sido por un método visual, al comparar los dientes con guías de color estándar. En las últimas décadas se han desarrollados instrumentos electrónicos que han logrado eliminar el factor subjetivo de la medición visual. Este método objetivo se ha realizado principalmente con colorímetros, espectrofotómetros y sistema de análisis de imágenes tomadas con cámaras digitales, instrumentos que han demostrado ser confiables con un alto grado de precisión y exactitud. Se recomienda su uso como un complemento de la medición visual, tanto en el análisis del color de restauraciones directas e indirectas, en la verificación de color en tratamientos estéticos como blanqueamientos, en la comunicación con el laboratorio dental. El espectrofotómetro es el dispositivo que hasta el momento ha reportado mejor rendimiento “in-vitro” e “in-vivo” siendo el “Vita Easyshade” el con resultados más confiables

Effectiveness and impact of the walking bleach technique on esthetic self-perception and psychosocial factors: A randomized double-blind clinical trial

Objective: This trial evaluates the impact of psychosocial and esthetic self-perceptions of patients undergoing nonvital tooth bleaching using the walking bleach technique. We also assessed the clinical effectiveness of bleaching tooth discoloration. Methods: Fifty volunteers with nonvital tooth discoloration were enrolled. Teeth were randomized into two groups: 35% hydrogen peroxide (n=25) and 37% carbamide peroxide (n=25). Intracoronal bleaching was performed over four sessions using the walking bleach technique. Tooth color was evaluated at each session to measure total color variation. The shade guide was arranged from highest (B1) to lowest (C4) values to assess the color and calculate the color change in the number of shade guide units. Subjective and objective assessments were compared with the tooth counterpart. Esthetic self-perception and psychosocial factors were assessed before and after treatment. Results: Color change was 15.48,5.17 for hydrogen peroxide and 14.02,4.85 for carbamide peroxide. There was no significant difference at any time point (p.0.05) except at sessions 3 and 4 (p,0.05). Overall, whitened teeth values were similar to those of counterpart teeth (p.0.05). There was a decrease in Oral Health Impact Profile and Psychosocial Impact of Dental Esthetics questionnaire scores after treatment compared with baseline (p,0.05). Conclusion: The walking bleach technique was highly effective on nonvital teeth and had a positive effect on self-esthetic perception and psychological impact for the patients

Longevity, esthetic perception, and psychosocial impact of teeth bleaching by low (6%) hydrogen peroxide concentration for in-office treatment: A randomized clinical trial

OBJECTIVE: The aim was to evaluate the color longevity after nine months of in-office bleaching with gel (6% hydrogen peroxide), to compare this to a control concentration of 35% in a split-mouth study model, and to assess the dental confidence and psychosocial impact on patients. METHODS AND MATERIALS: Twenty-seven patients were assessed at the nine-month recall. The bleaching procedure with 6% or 35% hydrogen peroxide gel was performed randomly in the upper hemi-arch of each patient. The color was measured at baseline and at one week, one month, and nine months after the procedure, using the Vita Easyshade spectrophotometer, the Vita classical shade guide organized by value, and Vita Bleach Guide 3DMaster. Moreover, two surveys, OHIP-Esthetics and PIDAQ, were used to assess the esthetic self-perception and psychosocial impact of the bleaching procedure. During the nine-month recall, the color was assessed before and after dental prophylaxis. RESULTS: Twenty-seven patients participated in the nine-month recall. There was a significant difference in ΔE between the two groups at all times assessed (p0.20). There was no significant difference in ΔSGU at all times (p>0.05). There was a significant difference in OHIP-Esthetics and PIDAQ sums compared with baseline scores (p<0.03). CONCLUSION: The two compounds remained effective at nine months, with a slight rebound of color, and maintained their objective color difference but not the subjective color difference. Patients were satisfied with the bleaching procedure, and this had a positive impact on esthetic perception and a positive psychosocial impact at the nine-month recall