At-home bleaching versus whitening toothpastes for treatment of tooth discoloration: a cost-effectiveness analysis

Abstract Objectives This study aimed to analyze the cost-effectiveness of whitening toothpastes and at-home bleaching for the treatment of tooth discoloration. Methodology A cost-effectiveness economic analysis was conducted, and eight randomized clinical trials were selected based on the whitening agent product used: blue covarine dentifrices (BCD), hydrogen peroxide dentifrices (HPD), dentifrices without bleaching agents (CD, negative control), and 10% carbamide peroxide (CP10, positive control) for at-home bleaching. The consumer/patient perspective was adopted, macro-costing techniques were used and a decision tree model was performed considering the costs in the American and Brazilian markets. The color change evaluation (ΔE*ab) was used to calculate the effectiveness of tooth bleaching. A probabilistic analysis was performed using a Monte Carlo simulation and incremental cost-effectiveness ratios were obtained. Results CP10 resulted in the highest cost-effectiveness compared to the use of dentifrices in both markets. In Brazil, HPD was more cost-effective than BCD and CD. In the US, the increased costs of HPD and BCD did not generate any whitening benefit compared to CD. Conclusions CP10 was more cost-effective than BCD and HPD for tooth bleaching from the perspectives of the Brazilian and American markets. Decision-making should consider the use of CP10 for treating tooth discoloration.

Desensitizing Agent Previously Applied During In-Office Bleaching: A Double-Blind Randomized Clinical Trial

Abstract Objective: To compare the clinical effect of two desensitizing agents used before the application of a bleaching gel based on 35% hydrogen peroxide (HP). Material and Methods: 30 patients were selected, and two desensitizing agents with different mechanisms of action were applied: Fluorine Neutral 2% (FN), which acts by blocking dentinal canaliculi while Potassium Nitrate 5% with 2% Sodium Fluoride (PN/SF) that acts in nerve transmission and blockade. Desensitizers were used before the application of 35% HP. For whitening, three clinical sessions were performed, with an interval of seven days, with three applications of the bleaching gel for 15 minutes, totaling 45 minutes/session. Tooth sensitivity (TS) was assessed with the numerical analog scale, and a spectrophotometer was used to obtain the color variation (ΔE). ΔE were submitted to ANOVA and Tukey test (p<0.05), and TS data were submitted to a two-way ANOVA analysis. Results: For sensitivity experience, the Tukey test indicated differences between PN/SF and the placebo I, but there was no statistically significant difference between FN and the placebo II. The TS was lower when the desensitizing gel was used during the bleaching procedure compared to after treatment, regardless of the desensitizing agents. Conclusion: PN/SF before in-office tooth bleaching can reduce TS intensity, and the use of desensitizing gel before bleaching did not affect the bleaching efficacy.

Does the combination of whitening toothpaste and hydrogen peroxide bleaching increase the surface roughness and change the morphology of a nanofilled composite?

Aim: To evaluate changes in the surface roughness and morphology of a nanofilled composite following toothbrushing with a whitening (WT) or regular toothpaste (RT), alone or combined with 35% hydrogen peroxide bleaching (HP). Methods: Seventy disc-shaped nanofilled composite (Filtek Z350XT) specimens were randomly divided into groups (n=10): WT, RT, TB (without toothpaste ­ control) or the combinations WT/ HP, RT/HP, TB/HP and HP. All groups underwent toothbrushing simulation (60,000 cycles) and bleaching treatment (4 sessions). Mean surface roughness (Ra, µm) was measured before (T0) and after treatments (TB). Surface morphology was assessed by scanning electron microscopy (SEM) at TB. Mean Ra was analyzed using general mixed models and multiple comparisons by the Tukey-Kramer test (α=5%). Results: HP caused no surface roughness changes on the nanofilled composite after treatment (p>0.05). RT toothbrushing, combined or not with HP, increased the surface roughness (p<0.05). WT and WT/ HP protocols had no effect on the surface roughness of the composite (p>0.05). The nanofilled composite submitted to RT toothbrushing combined with HP (RT/HP) presented substantial surface alterations under SEM, showing deep depressions and round-shaped defects. Toothbrushing with RT combined with the bleaching agent increased exposure of the inorganic fillers. Conclusion: WT toothbrushing, regardless of HP combination, or the single HP protocol had no effect on the surface roughness of the nanofilled composite. However, RT combined with HP negatively affected surface roughness and presented the most noticeable surface changes among groups

Influence of repositioning guides' color and usage on precision in tooth color measurement with a clinical spectrophotometer

Abstract Repositioning guides are commonly employed in clinical studies to ensure consistent tooth color measurements. Yet, their influence on measured color remains uncertain. Objective This study evaluated the impact of repositioning guides' color and usage on tooth color measurement using a clinical spectrophotometer. Methodology In total, 18 volunteers participated in this study, in which the color of their upper left central incisor and upper left canine was measured with or without repositioning guides (control). The guides were made from pink, blue, or translucent silicone, as well as an acetate-based bleaching tray. Tooth color was measured in triplicates using a clinical spectrophotometer based on the CIELAB system. The standard deviations of these readings were used to estimate reproducibility, and color differences (ΔE00) between the measurements with guides and the control were calculated. Results Repositioning guides had a minimal effect on L* values and no effect on b* values. The use of pink silicone increased a* values, whereas blue or translucent silicone reduced them. Irrespective of the evaluated tooth, the lowest ΔE00 values were observed for the translucent silicone and bleaching tray. The usage of guides only affected data variability for the L* color coordinate. Conclusion Using repositioning guides can significantly impact the precision of tooth color measurement with a clinical spectrophotometer.

In-office dental bleaching in adolescents using 6% hydrogen peroxide with and without gingival barrier: a randomized double-blind clinical trial

Abstract At low concentrations used for in-office bleaching gels, such as 6% HP, gingival barrier continues to be performed. If we take into account that, in the at-home bleaching technique, no barrier is indicated, it seems that the use of a gingival barrier fails to make much sense when bleaching gel in low concentration is used for in-office bleaching. Objective This double-blind, split-mouth, randomized clinical trial evaluated the gingival irritation (GI) of in-office bleaching using 6% hydrogen peroxide (HP) with and without a gingival barrier in adolescents, as well as color change and the impact of oral condition on quality of life. Methodology Overall, 60 participants were randomized into which side would or would not receive the gingival barrier. In-office bleaching was performed for 50 minutes with 6% HP in three sessions. The absolute risk and intensity of GI were assessed with a visual analogue scale. Color change was assessed using a digital spectrophotometer and color guides. The impact of oral condition on quality of life was assessed using the Brazilian version of the Oral Health Impact Profile (α=0.05). Results The proportion of patients who presented GI for the "with barrier" group was 31.6% and for the "without barrier" group, 30% (p=1.0). There is an equivalence for the evaluated groups regarding GI intensity (p<0.01). Color change was detected with no statistical differences (p>0.29). There was a significant impact of oral condition on quality of life after bleaching (p<0.001). Conclusions The use or not of the gingival barrier for in-office bleaching with 6% HP was equivalent for GI, as well as for bleaching efficacy, with improvement in the impact of oral condition on quality of life.

Efeito do pH do gel clareador de consultório na cor e na sensibilidade dentária / Effect of the pHof the in-office tooth bleaching gelon color and tooth sensitivity / Efecto del pH del gel blanqueador dental de consultorio sobre el color y la sensibilidad dental

Introdução:Sabe-se que a busca pela estética é algo cada vez mais crescente. Dentre os procedimentos mais procurados na odontologia estética, destaca-se o clareamento dental de consultório. Diante disso, ainda são poucos os estudos que avaliam os efeitos dos agentes clareadores de diferentes pHs na efetividade clareadora e na sensibilidade dentária.Objetivo:Avaliar a sensibilidade dentária e a eficácia clareadora de géis clareadores à base de peróxido de hidrogênio a 35% com diferentes pHs.Metodologia:Trata-se de um relato de três casos, descritivo e observacional, do tipo boca dividida (split-mouth) para cada estratégia clareadora (gel clareador com pH básico e gel clareador com pH ácido). Foram avaliados três pacientes de25, 26e 27anos de idade.Realizou-se registro de cor por meio da escala VITAClassical e avaliação da sensibilidade dentária pela escala visual analógica. Resultados:Todos os pacientes avaliados apresentaram cor A3 no registro de cor inicial e, após o clareamento dental,atingiram a cor A1. Todos relataram uma maior sensibilidade no hemiarco direito (local onde foi aplicada o gel clareador Whiteness HP que possui pH ácido. Dois pacientes relataram sensibilidade dentária no hemiarco esquerdo em que foi aplicado o gel clareador de pH básico. Conclusões:Observa-se a eficácia clínica dos géis clareadores de consultório à base de peróxido de hidrogênio a 35% na estabilidade de cor após o tratamento clareador, independente do seu pH. Ademais, nota-se que o gel clareador de pH básico promoveu menor sensibilidade pós-operatória (AU).

Introduction:It is known that the search for aesthetics is something increasingly growing. Among the most sought-after procedures in cosmetic dentistry, in-office tooth bleaching stands out. Therefore, there are still few studies that evaluate the effects of bleaching agents ofdifferent pHs on bleaching effectiveness and tooth sensitivity.Objective:To evaluate tooth sensitivity and bleaching efficacy of 35% hydrogen peroxide-based tooth bleaching gels with different pHs.Methodology:This is a report of three cases, descriptive and observational, of the split-mouth type for each bleaching strategy (bleaching gel with basic pH and bleaching gel with acidic pH). Three patients aged 25, 26 and 27 years were evaluated. Color registration was performed using the VITA Classical scale and tooth sensitivity was evaluated using the visual analogue scale.Results:All evaluated patients presented color A3 in the initial color registration and, after tooth bleaching, reached color A1. All reported greater sensitivity in the right hemi-arch (place where the Whiteness HP bleaching gel with an acid pH was applied. Two patients reported tooth sensitivity in the left hemi-arch where the basic pH bleaching gel was applied.Conclusions:The clinical efficacy of in-office tooth bleaching gels based on 35% hydrogen peroxide in terms of color stability after bleaching treatment is observed, regardless of its pH. In addition, it is noted that the basic pH bleaching gel promoted less postoperative sensitivity (AU).

Introducción: Se sabe que la búsqueda de la estética es algo cada vez más creciente. Entre los procedimientos más populares en odontología estética, se destaca el blanqueamiento dental en consultorio. Ante esto, aún existen pocos estudios que evalúen los efectos de agentes blanqueadores de diferentes pHs sobre la efectividad del blanqueamiento y la sensibilidad dental.Objetivo: Evaluar la sensibilidad dental y la eficacia blanqueadora de geles blanqueadores a base de peróxido de hidrógeno al 35 % con diferentes pH. Metodología: Este es un reporte de tres casos, descriptivo y observacional, del tipo boca partida para cada estrategia de blanqueamiento (gel blanqueador con pH básico y gel blanqueador con pH ácido). Se evaluaron tres pacientes de 25, 26 y 27 años. El registro de color se realizó con la escala clásica VITA y la sensibilidad dental se evaluó con la escala analógica visual.Resultados: Todos los pacientes evaluados presentaron color A3 en el registro de color inicial y, después del blanqueamiento dental, alcanzaron el color A1. Todos refirieron mayor sensibilidad en la hemiarcada derecha (lugar donde se aplicó el gel blanqueador de pH ácido Whiteness HP). Dos pacientes refirieron sensibilidad dental en la hemiarcadaizquierda donde se aplicó el gel blanqueador de pH básico.Conclusiones: Se observala eficacia clínica de los geles blanqueadores de consultorio a base de peróxido de hidrógeno al 35% en cuanto a la estabilidad del color tras el tratamiento blanqueador, independientemente de su pH. Además, se observa que el gel blanqueador de pH básico promovió una menor sensibilidad postoperatoria (AU).

Effects of the application of sodium ascorbate after in-office bleaching on the penetration of hydrogen peroxide, color change, and microtensile bond strength

Abstract This study aimed to evaluate the effects of the application of 10% sodium ascorbate (SA) after in-office bleaching on the penetration of hydrogen peroxide (HP) into the pulp chamber, color change, and microtensile bond strength (µTBS) to the resin-enamel interface. Thirty premolars and thirty molars were randomly divided into three groups (n = 20 each). One group was exposed to deionized water (negative control). The other two groups were bleached with 35% HP in a single session for 3x15 minutes for each application. However, in only one of them, SA was applied for 10 minutes after bleaching. After, the concentration (µg/mL) of HP in each pulp chamber was evaluated by UV-Vis spectrophotometry. Color changes (ΔEab, ΔE00, and ΔWID) were evaluated with a digital spectrophotometer before and in the first week after bleaching. After treatment, molars were restored and sectioned to obtain resin-enamel interface sticks for µTBS at a crosshead speed of 1 mm/min until failure. The HP concentration and µTBS data were analyzed using one-way ANOVA and Tukey tests, and color changes were analyzed by t-tests (α = 0.05). SA application significantly improved the µTBS values and reduced the HP concentrations within the pulp chambers (p < 0.0001). The application of SA significantly interfered with the color changes after bleaching when compared to the control group (p < 0.05). Application of 10% SA after in-office bleaching successfully reduced the penetration of HP into the pulp chamber; however, it decreased color change.

Resumo Este estudo teve como objetivo avaliar os efeitos da aplicação do ascorbato de sódio a 10% (AS) depois do clareamento em consultório na penetração do peróxido do hidrogênio (PH) na câmara pulpar, mudança de cor e resistência de união (RU) da interface resina-esmalte. Trinta pré-molares e trinta molares foram divididos aleatoriamente em três grupos (n = 20). Um grupo foi exposto em água deionizada (controle negativo). Os outros dois grupos foram clareados com 35% PH numa única sessão de 3x15 minutos para cada aplicação. Porém, só um grupo recebeu AS durante 10 minutos depois do clareamento. Depois, a concentração (µg/mL) do PH no interior de cada câmara pulpar foi avaliado com espectrofotometria UV-Vis. A mudança de cor (ΔEab, ΔE00 and ΔWID) foi avaliada como espectrofotômetro digital antes e depois de uma semana do clareamento. Após de cada tratamento, os molares foram restaurados e seccionados em espécimes com interface resina-esmalte para o teste de RU por microtração a uma velocidade de 1 mm/min até a fratura. Os dados da concentração de PH e RU foram analisados usando ANOVA de uma via e teste de Tukey, e a mudança de cor com o teste t (α = 0.05). A aplicação de AS melhorou significativamente a RU e reduziu a concentração de PH na câmara pulpar (p < 0.0001). A aplicação de AS interferiu significativamente na mudança de cor depois do clareamento comprado com o grupo controle (p < 0.05). A aplicação de SA a 10% depois do clareamento em consultório reduziu significativamente a penetração do PH na câmara pulpar e interferiu na mudança de cor.

Fracture resistance and bonding performance after antioxidants pre-treatment in non-vital and bleached teeth

Abstract This study aimed to evaluate the effect of antioxidant solutions on fracture strength and bonding performance in non-vital and bleached (38% hydrogen peroxide) teeth. One hundred and eighty dentin specimens were obtained, 60 for each test: fracture strength, hybrid layer thickness, and bond strength. The groups (n=10) were randomly composed according to post-bleaching protocol: REST - restoration, without bleaching; BL - bleaching + restoration; SA - bleaching, 10% sodium ascorbate solution, and restoration; AT - bleaching, 10% α-tocopherol solution, and restoration; CRAN - bleaching, 5% cranberry solution, and restoration; CAP - bleaching, 0.0025% capsaicin solution, and restoration. Data were analyzed with ANOVA, Kruskal-Wallis, Dunn, and Qui-Square tests (α=0.05). The highest fracture strength values were observed in REST (1508.96 ±148.15 N), without significant difference for the bleached groups (p>0.05), regardless of the antioxidant use. The hybrid layer thickness in the group that was not subjected to bleaching (REST) was significantly higher than in any other group. The bond strength in the bleached and antioxidants-treated groups (SA, AT, CRAN, CAP) has no differences with the bleached group without antioxidants (BL). Adhesive failures were predominant in the groups that did not receive the antioxidant application. In conclusion, the evaluated antioxidants did not show an effect on the fracture strength, hybrid layer thickness, or bond strength of dentin bleached after endodontic treatment. The application of 10% sodium ascorbate, 10% alpha-tocopherol, 5% cranberry, or 0.0025% capsaicin solutions is not an effective step and should not be considered for the restorative protocols after non-vital bleaching.

Resumo Este estudo teve como objetivo avaliar o efeito de soluções antioxidantes na resistência à fratura e resistência de união em dentes tratados endodonticamente e clareados (38% de peróxido de hidrogênio). Cento e oitenta espécimes de dentina foram obtidos, 60 para cada teste: resistência à fratura, espessura da camada híbrida e resistência de união. Os grupos (n=10) foram compostos aleatoriamente de acordo com o protocolo pós-clareamento: REST - restauração, sem clareamento; BL - clareamento + restauração; SA - clareamento, solução de ascorbato de sódio a 10% e restauração; AT - clareamento, solução de α-tocoferol a 10% e restauração; CRAN - clareamento, solução de cranberry a 5% e restauração; CAP - clareamento, solução de capsaicina 0,0025% e restauração. Os dados foram analisados ​​com os testes ANOVA, Kruskal-Wallis, Dunn e Qui-Quadrado (α=0,05). Os maiores valores de resistência à fratura foram observados em REST (1508,96 ±148,15 N), sem diferença significativa para os grupos clareados (p>0,05), independente do uso de antioxidantes. A espessura da camada híbrida no grupo que não foi submetido ao clareamento (REST) foi significativamente maior do que em qualquer outro grupo. A resistência de união nos grupos clareado e tratado com antioxidantes (SA, AT, CRAN, CAP) não apresentou diferenças com o grupo branqueado sem antioxidantes (BL). As falhas adesivas foram predominantes nos grupos que não receberam a aplicação do antioxidante. Em conclusão, os antioxidantes avaliados não mostraram efeito sobre a resistência à fratura, espessura da camada híbrida ou resistência de união à dentina clareada após tratamento endodôntico. A aplicação de soluções de ascorbato de sódio 10%, alfa-tocoferol 10%, cranberry 5% ou capsaicina 0,0025% não é uma etapa eficaz e não deve ser considerada para os protocolos restauradores após clareamento não vital.

Ozone gas therapy for tooth bleaching preserves enamel microhardness, roughness and surface micromorphology / Ozonioterapia gasosa para clareamento dental preserva a microdureza, rugosidade e micromorfologia superficial do esmalte

ABSTRACT After ozone therapy for bleaching, it is important to evalúate enamel surface properties, to ensure that bleaching provides adequate conditions for sound dental substrate. Aim: The aim of this in vitro study was to evaluate the effects of a bleaching treatment with 10% carbamide peroxide (CP), with or without ozone (O), on the microhardness, roughness and micromorphology of the enamel surface. Materials and Method: Bovine enamel blocks were planed and distributed among the following three bleaching treatment groups (n=10): CP - 1 hour per day/14 days (Opalescence PF 10%/ Ultradent); O - 1 hour per day every 3 days/3 sessions (Medplus VPhilozon, 60 mcg/mL and oxygen flow rate of 1 L/min); and OCP - CP with O, 1 hour per day every 3 days/3 sessions. Enamel surface microhardness (Knoop), roughness (Ra), and micromorphology by scanning electron microscopy (5,000x magnificaron) were determined before and after the treatments. Results: ANOVA and Tukey-Kramer's test showed that enamel microhardness remained unchanged by treatment with O and OCP (p=0.0087), but decreased by treatment with CP. Treatment with O promoted higher enamel microhardness than the other groups (p=0.0169). Generalized linear mixed models for repeated measures over time indicated treatment with CP increased enamel roughness more than OCP or O (p=0.0003). CP produced slight irregularities in enamel micromorphology after the whitening treatment. O, with or without CP, maintained the mechanical and physical properties of microhardness and enamel surface micromorphology, and either maintained or reduced surface roughness, compared to the conventional tray-delivered CP bleaching treatment. Conclusions: Treatment with 10% carbamide peroxide in trays promoted greater changes in enamel surface properties than treatments with ozone and with 10% ozonized carbamide peroxide in the office.

RESUMO É importante avaliar as propriedades da superficie do esmalte após a aplicagao da ozonioterapia para clareamento, para garantir que o efeito clareadorproporcione condigoes adequadaspara um substrato dentário higido. Objetivo: O objetivo deste estudo in vitro foi avaliar os efeitos de um tratamento clareador com peróxido de carbamida (PC) a 10%, associado ou nao ao ozonio (O), na microdureza, rugosidade e micromorfologia da superficie do esmalte. Materials e Método: Blocos de esmalte bovino foram aplainados e distribuidos entre tres grupos de tratamento clareador (n=10): PC - 1 hora por dia/14 dias (Opalescence PF 10%/ Ultradent); O - 1 hora por dia a cada 3 dias/3 sessoes (Medplus VPhilozon, 60 mcg/mL e fluxo de oxigenio de 1 L/min); e PCO - CP com O, 1 hora por dia a cada 3 dias/3 sessoes. A microdureza (Knoop), a rugosidade (Ra) e a micromorfologia da superficie do esmalte avaliada por microscopia eletronica de varredura (aumento de 5.000x) foram analisadas antes e após os tratamentos. Resultados: ANOVA e teste de Tukey-Kramer mostraram que O e PCO mantiveram os valores de microdureza do esmalte ao final do tratamento (p=0,0087), enquanto PC promoveu diminuigao da microdureza. O promoveu maiores valores de microdureza do esmalte do que os outros grupos ao final do tratamento (p=0,0169). Modelos lineares generalizados mistos para medidas repetidas no tempo indicaram um aumento na rugosidade da superficie para PC, levando a maior rugosidade do esmalte ao final do tratamento, em comparagao com PCO ou O (p=0,0003). PC apresentou pequenas irregularidades na micromorfologia do esmalte após o tratamento clareador. O, com ou sem PC, manteve as propriedades mecánicas e fisicas de microdureza e micromorfologia da superficie do esmalte, e manteve ou reduziu a rugosidade da superficie, em comparagao com o tratamento clareador a base de PC aplicado em moldeira convencional. Conclusoes: O tratamento com peróxido de carbamida a 10% para uso em moldeiras promoveu maiores alteragoes nas propriedades de superficie do esmalte do que aquelas observadas nos tratamentos com ozonio e com peróxido de carbamida ozonizado a 10% para uso em consultório.

Tooth Bleaching: A bibliometric analysis of the top 100 most-cited papers

Abstract This study analyzes the characteristics of the top 100 most-cited papers related to tooth bleaching. A literature search was performed on the Web of Science up to March 2022. The number of citations was cross-matched with the citation count on Scopus and Google Scholar. The following data were collected: number and density of citations; authorship; year and journal of publication; study design and thematic; keywords; institution and country of origin. Spearman's correlation and Poisson regression were used to determine associations between the number of citations and study characteristics. The VOSviewer software was used to generate collaborative network maps for the authors and keywords. The number of citations ranged from 66 to 450. Papers were published between 1981 and 2020. The most frequent study design and topic were laboratory-based studies and 'interaction of the bleaching agent with dental tissues', respectively. Cochran M, Loguercio AD, Matis B, Reis A, and Suliman M were the authors with the highest number of papers. The countries with the most papers were the United States of America (USA) (28%) and Brazil (20%). Indiana University and State University of Ponta Grossa were the institutions with the most papers (6% each). There was a very strong correlation among the number of citations of the three databases. The 100 most-cited papers related to tooth bleaching were mainly published by the USA and Brazil, with laboratory-based studies addressing topics related to the effects of bleaching agents on tooth structure being the most prevalent.

Resumo Este estudo analisa as características dos 100 artigos mais citados relacionados ao clareamento dental. Uma pesquisa bibliográfica foi realizada na Web of Science até março de 2022. O número de citações foi cruzado com a contagem de citações na Scopus e na Google Scholar. Foram coletados os seguintes dados: número e densidade de citações; autoria; ano e periódico de publicação; desenho do estudo e temática; palavras-chave; instituição e país de origem. A correlação de Spearman e a regressão de Poisson foram usadas para determinar associações entre o número de citações e as características do estudo. O software VOSviewer foi utilizado para gerar mapas de rede colaborativa para os autores e palavras-chave. O número de citações variou de 66 a 450. Os artigos foram publicados entre 1981 e 2020. O desenho e o tópico de estudo mais frequentes foram estudos laboratoriais e interação do agente clareador com tecidos dentários, respectivamente. Cochran M, Loguercio AD, Matis B, Reis A e Suliman M foram os autores com maior número de artigos. Os países com mais artigos foram os Estados Unidos da América (EUA) (28%) e o Brasil (20%). A Universidade de Indiana e a Universidade Estadual de Ponta Grossa foram as instituições com mais artigos (6% cada). Houve uma correlação muito forte entre o número de citações das três bases de dados. Os 100 artigos mais citados relacionados ao clareamento dentário foram publicados principalmente pelos EUA e Brasil, sendo os estudos laboratoriais que abordaram tópicos relacionados aos efeitos dos agentes clareadores na estrutura dentária os mais prevalentes.

Influence of daily usage times on patients' compliance during at-home bleaching: a randomized clinical trial

Abstract The effectiveness of at-home dental bleaching treatments depends on the time that bleaching products are in contact with the teeth surface and, consequently, on the adequate use of associated custom acetate trays. Objective This randomized single-blinded trial aimed to analyze if the daily usage time of these products influences the patient's compliance behavior when submitted to monitored at-home dental bleaching. Secondary outcomes were color change and tooth sensitivity. Methodology Sixty-six volunteers were randomly distributed into three groups (n=22): patients were instructed to use the trays for 2 (G2), 4 (G4), and 8 (G8) hours daily. The daily dental bleaching compliance behavior was measured using a microsensor inserted into the trays. Subjective and objective color evaluation assessments were adopted at baseline (T0), one (T1), two (T2), and three weeks (T3) after the beginning of the bleaching treatment, as well as two weeks after the treatment (T4). Tooth sensitivity was analyzed using the VAS scale, ranging from T1 to T4. Results G2 showed a greater degree of cooperation than G8 and cooperation was inversely proportional to the recommended usage time. Significantly higher color change was observed in the upper arch for G8 when compared to G2 in subjective analysis, from T1 to T4. There were no statistical differences between the groups in objective analysis. Conclusion Shorter recommended usage time of the bleaching product may improve the patient's compliance with at-home dental bleaching treatments. However, increased daily usage time may promote better subjective color change. Bleaching sensitivity was more significant in the first week for a longer time of use.

Conservative smile enhancement: a case report and brief review on multidisciplinary approach in aesthetic dentistry / Tratamento conservador de sorriso: um relato de caso e breve revisão sobre abordagem multidiscplinar na odontologia estética

ABSTRACT The gingival contour, the color of the teeth and the presence of interincisal diastema are seen as unsightly factors, being highly harmful from a social point of view. The present study aimed to report a comprehensive and conservative esthetic treatment executed with a multidisciplinary approach in a 20-year-old female patient that presented darkened teeth with poor spacing and excessive gingival display while smiling, as well as present a brief literature review on multidisciplinary approach in esthetic dentistry. After clinical examination and diagnosis, a treatment plan was elaborated to meet the patient's expectations with a conservative approach. After patient consent, therapy began with supervised home-based tooth whitening with 22% carbamide peroxide applied one hour/daily for 14 days, followed with gingival recontouring surgery and, after a healing period of 30 days, diastemas closure with direct composite resin technique, occlusal adjustment, finishing, and polishing. The multidisciplinary approach was fundamental for the accomplishment of the proposed treatment, achieving satisfactory esthetic and functional results.

RESUMO O contorno gengival, a cor dos dentes e a presença de diastemas interincisivos são vistos como fatores antiestéticos, sendo altamente prejudicial do ponto de vista social. O presente estudo teve como objetivo relatar um tratamento estético conservador executado com abordagem multidisciplinar em uma paciente do sexo feminino de 20 anos que apresentava dentes escurecidos com pouco espaçamento e exposição gengival excessiva ao sorrir, bem como apresentar uma breve revisão de literatura sobre à abordagem multidisciplinar em odontologia estética. Após exame clínico e diagnóstico, foi elaborado um plano de tratamento para atender as expectativas do paciente com abordagem conservadora. Após consentimento do paciente, foi iniciada o clareamento dental supervisionado com peróxido de carbamida 22% aplicado uma hora/dia por 14 dias, seguido de cirurgia de recontorno gengival e, após um período de cicatrização de 30 dias, fechamento de diastemas com técnica de resina composta direta. Neste caso, a abordagem multidisciplinar foi fundamental para a realização do tratamento proposto, alcançando resultados estéticos e funcionais satisfatórios.

In-office dental bleaching in adolescents using 6% hydrogen peroxide with different application tips: randomized clinical trial

Abstract Despite the availability of in-office bleaching gels with a 6% concentration of hydrogen peroxide (HP), these gels have not been evaluated in younger patients. They are commercially available with a tip, associated or not with a brush, where the tip with a brush spreads the gel over the entire surface to have a smaller thickness (thin layer) since the manufacturers indicate the application of a thin layer of gel. Objective This randomized, split-mouth, double-blind clinical trial evaluated the efficacy of in-office bleaching with 6% HP in adolescents using different application tips, as well tooth sensitivity (TS) and aesthetic self-perception. Methodology Sixty participants were randomized for 6% HP self-mixing bleaching gel tip design: without brush and with brush. In-office bleaching was performed in 3 sessions of 50 minutes. Color change was evaluated using a digital spectrophotometer (ΔE ab , ΔE 00 , and ΔWI D ) and color guide (ΔSGU), the absolute risk and intensity of TS with a visual analogue scale and aesthetic self-perception with the oral aesthetic scale (a=0.05). Results The groups achieved similar bleaching regardless of the application tip (p>0.05). However, only for ΔWI D , a significant mean difference (MD) was observed in the third week (MD 2.3; 95% CI 1.2 to 3.3; p < 0.001) and at one month (MD 1.6; 95% CI 0.6 to 2.6; p < 0.03) favoring the tip without brush. Regarding TS, 45% in the tip-without-brush group and 33% in the tip-with-brush group reported TS (odds ratio 0.61; 95% CI 0.29 to 1.28; p<0.02), with low TS intensity (MD 0.05; 95% CI -0.06 to 0.17; p>0.36). All patients reported improved aesthetic self-perception after bleaching (MD -1.3; 95% -1.8 to -0.9; p<0.001). Conclusions Regardless of the tip used bleaching with 6% HP achieved a bleaching efficacy and improved the aesthetic self-perception. However, a lower risk of TS for application using the tip with brush was observed.

Academics knowledge about tooth bleaching: technical and ethical issues / Conhecimento de acadêmicos acerca do clareamento dental: questões técnicas e éticas

ABSTRACT Objective: The aim of this study was to evaluate the level of knowledge of UFES dental students about home bleaching treatment. Methods: As a methodology, a descriptive and cross-sectional study was carried out through the application of practice to 109 students, containing questions about home tooth whitening, technical care and possible complications of the treatment. Data were tabulated and submitted to descriptive statistics. Results: Of the total number of students, 88.99% said they knew the factors that limit or contraindicate the bleaching treatment, 16.51% of students recognize hydrogen peroxide as a possible inducer of oral cancer, 30.27% of the students had their teeth whitened inside the University, 44.03% had their teeth whitened outside the University without professional supervision. In addition, 56.88% believe anamnesis and clinical examination are necessary before the bleaching treatment. Conclusion: It is concluded that students have limited knowledge about certain points of at-home tooth whitening. Students know the risk factors of bleaching treatment, except regarding hydrogen peroxide being a possible inducer of oral cancer. It can be inferred that academics highlight the importance of associating the clinical examination with the patient's anamnesis before performing the bleaching treatment. Most students have had their teeth whitened outside the University, which calls attention to reinforce knowledge about the ethical issues of the profession.

RESUMO Objetivo: O objetivo deste estudo foi avaliar o nível de conhecimento dos acadêmicos de odontologia da UFES sobre o tratamento clareador caseiro. Métodos: Como metodologia, foi realizado um estudo descritivo e transversal por meio da aplicação de questionário a 109 estudantes contendo perguntas sobre o clareamento dental caseiro, cuidados técnicos e possíveis riscos do tratamento. Os dados foram tabulados e submetudos à estatística descritiva. Resultados: Do total de estudantes, 88,99% disse conhecer os fatores que limitam ou contraindicam o tratamento clareador; 16,51% dos estudantes reconhecem o peróxido de hidrogênio como possível indutor de câncer bucal; 30,27% dos estudantes realizaram o clareamento dental dentro da Universidade, 44,03% realizaram o clareamento dental fora da Universidade sem supervisão profissional. Além disso, 56,88% acreditam que são necessários anamnese e exame clínico antes de realizar o tratamento clareador. Conclusão: Conclui-se que os alunos têm conhecimento limitado sobre determinados pontos do clareamento dental caseiro. Os estudantes conhecem os fatores de risco do tratamento clareador, exceto a respeito do peróxido de hidrogênio ser um possível indutor de câncer bucal. Pode-se inferir que os acadêmicos relevam a importância da associação do exame clínico com a anamnese do paciente antes de se realizar o tratamento clareador. A maioria dos estudantes tem realizado o clareamento dental fora da Universidade, o que chama atenção para reforçar o conhecimento sobre as questões éticas da profissão.

Bleaching gel volume influences hydrogen peroxide diffusion, inflammation, and the presence of nitric oxide in the pulp tissue: in vitro and in vivo model

Abstract Objective To assess whether bleaching gel volume influences chromatic changes, hydrogen peroxide (HP) diffusion, inflammation, and oxidative stress in the pulp tissue. Methodology A total of 60 bovine teeth were divided into four groups, according to bleaching gel volume (n=15): without gel (WG); V30 (30 µL of 35% HP); V60 (60 µL); and V120 (120 μL). HP diffusion analysis was performed in the first session (T1). Chromatic changes (ΔE, ΔE00, and WID) were assessed after the first (T1), second (T2), third (T3) sessions, and 15 d (T4) after the end of treatment. Moreover, 20 rats were randomly divided into four groups (n=10) and their upper first molars were treated with different gel volumes: control (no treatment); V2 (2 μL of 17.5% HP); V4 (4 μL); and V8 (8 μL). After 24 h, rats were euthanized and the specimens processed for histological and immunohistochemical (nitric oxide synthase) evaluation. Data were analyzed using the Wilcoxon and Mann-Whitney tests (p<0.05). Results In vitro (bovine teeth), chromatic changes were not influenced by bleaching gel volume, showing similar values in all groups and sessions, except for the control group (p<0.05). The V120 group had the highest HP diffusion values (p<0.05). In vivo (pulp tissue), the V4 and V8 groups showed the highest inflammatory infiltrate in the pulp and significant oxidative stress (p<0.05). Conclusion The adverse effects on the dental pulp related to HP diffusion, pulp inflammation, and oxidative stress depend on bleaching gel volume, while the bleaching effect is not proportional to the volume used.

One-year clinical observation of the effect of internal bleaching on pulpless discolored teeth / 华西口腔医学杂志

OBJECTIVES@#This study aimed to observe the color rebound and rebound rates of non-pulp discolored teeth within 1 year after routine internal bleaching to guide clinical practice and prompt prognosis.@*METHODS@#In this work, the efficacy of bleaching was observed in 20 patients. The color of discolored teeth was measured by using a computerized colorimeter before bleaching; immediately after bleaching; and at the 1st, 3rd, 6th, 9th, and 12th months after bleaching. The L*, a*, and b* values of the color of cervical, mesial, and incisal parts of the teeth were obtained, and the color change amounts ΔE*, ΔL*, Δa*, and Δb* were calculated. The overall rebound rate (P*) and the color rebound velocity (V*) were also analyzed over time.@*RESULTS@#In 20 patients following treatment, the average ΔE* of tooth color change was 14.99. After bleaching, the neck and middle of the teeth ΔE* and ΔL* decreased in the 1st, 3rd, 6th, 9th, and 12th months, and the differences were statistically significant. Meanwhile, from the 9th month after bleaching, the rebound speed was lower than that in the 1st month, and the difference was statistically significant. The incisal end of the tooth ΔE* and ΔL* decreased in the 6th, 9th, and 12th months after bleaching, and the differences were statistically significant. No significant difference was found in the rebound speed between time points. However, this rate settled after the 9th month, with an average color rebound rate of 30.11% in 20 patients.@*CONCLUSIONS@#The results indicated that internal bleaching could cause a noticeable color change on pulpless teeth. The color rebound after bleaching was mainly caused by lightness (L*), which gradually decreased with time, and it was slightly related to a* and b*. The color of the teeth after internal bleaching rebounded to a certain extent with time, but the color rebound speed became stable from the 9th month. Clinically, secondary internal bleaching can be considered at this time according to whether the colors of the affected tooth and the adjacent tooth are coordinated and depending on the patient's needs.

Effects of applying procyanidins on the bond strength of bleached dentin to composite resin / 口腔疾病防治

Objective@#To study the influence of procyanidins on the bonding strength of dentin bleached by carbamide peroxide to composite resin.@*Methods @#By applying different treatments to dentin bonding interfaces, 120 human third molars were randomly divided into 12 groups (n = 10): W group (no bleaching+deionized water), Wa group (no bleaching+deionized water+aging), WT1 group (no bleaching+5% procyanidins for 1 min), WT1a group (no bleaching+5% procyanidins for 1 min+aging), WT2 group (no bleaching+5% procyanidins for 5 min), WT2a group (no bleaching+5% procyanidins for 5 min+aging), C group (carbamide peroxide+deionized water), Ca group (carbamide peroxide+deionized water+aging), CT1 group (carbamide peroxide+5% procyanidins for 1 min), CT1a group (carbamide peroxide+5% procyanidins for 1 min+aging), CT2 group (carbamide peroxide+5% procyanidins for 5 min), and CT2a group (carbamide peroxide+5% procyanidins for 5 min+aging). The bond strength to composite resin was measured by universal mechanical testing machine, microstructure and the nanoleakages were measured by scanning electron microscope immediately or after the thermal cycling aging test.@*Results@#The immediate bond strength of the bleached groups pretreated with procyanidins for 1 min (P<0.001) and 5 min (P<0.001) was higher than that of Group C, and the difference was statistically significant. Meanwhile, there was no statistically significant difference between Group CT1 and Group CT2 (P = 1.000). After the thermal cycles, the bond strength of each group declined. The differences between Group W and Group Wa (P<0.001) and Group C and Group Ca (P<0.001) were statistically significant, but no significant differences between Group CT1 and Group CT1a (P = 0.052) or Group CT2 and Group CT2a (P = 0.053) were found. The main effects of “aging” (P<0.001), “bleaching” (P<0.001) and “procyanidins” (P<0.001) and the second-order interaction effects of “bleaching * procyanidins” (P = 0.008), “bleaching * aging” (P = 0.024), and “aging * procyanidins” (P<0.001) were statistically significant. SEM observations showed that the hybrid layers in Groups C, CT1 and CT2 were not clear, and the hybrid layers in Groups Ca, CT1a and CT2a were partially destroyed and disintegrated. Under backscattering mode, it was observed that there were a large number of silver nitrate particles in the hybrid layer of Group Ca, and the residual silver ions in the hybrid layer of Groups CT1a and CT2a were decreased. @*Conclusion@# Pretreatment with 5% procyanidins for 1 min can improve the immediate bond strength of dentin bleached by carbamide peroxide to composite resin and maintain bonding durability.

Efetividade da ação clareadora dos dentifrícios no clareamento dental: uma revisão Integrativa / Effectiveness of teeth whitening action in dental bleaching: an Integrative review

Objetivo: Avaliar a efetividade dos dentifrícios categorizados como do tipo clareadores no clareamento dental, por meio de um levantamento da evidência científica. Métodos: Foram utilizadas as bases de dados eletrônicas Pubmed, Embase, Web of Science e Scopus para a busca dos estudos até o mês de agosto de 2021. Estudos clínicos que compararam os dentifrícios mencionados como clareadores com os dentifrícios não clareadores na mudança de cor dos dentes foram incluídos. As palavras-chaves utilizadas na estratégia de busca foram: "whiteningtoothpastes", "whiteningdentifrice", "toothpastes", "dentifrice", "color change", "colorationanalysis" e "toothbleaching". Os dados foram analisados por meio de uma síntese qualitativa, detalhando os principais resultados dos estudos incluídos. Após a etapa de leitura e seleção dos artigos, foram incluídos 5 artigos para essa revisão integrativa. Resultados: O creme dental mais utilizado foi o Close Up White Now (n = 3). A metodologia de cor mais utilizada foi a espectrofotometria, o tipo de estudo que predominou foi o ensaio clínico randomizado, avaliando o esmalte dental humano. No que se refere ao RDA (Relative Dentin Abrasitity), os dentifrícios clareadores apresentam um índice entre 60-100, por vezes superior à 100, sendo considerados abrasivos. Conclusão: Nos resultados de alguns estudos incluídos, os dentifrícios clareadores não apresentaram efeito de clareamento intrínseco, apenas o efeito de remoção de manchas extrínsecas foi observado.

Aim: To evaluate the effectiveness of dentifrices categorized as whitening in tooth whitening, through a survey of scientific evidence. Methods: The Pubmed, Embase, Web of Science, and Scopus electronic databases were used to search for studies up to August 2021. Clinical studies that compared dentifrices mentioned as whitening with non-whitening dentifrices in the change of tooth color were also included. The keywords used in the search strategy were: "whiteningtoothpastes", "whiteningdentifrice", "toothpastes", "dentifrice", "color change", "colorationanalysis", and "toothbleaching". Data were analyzed using a qualitative synthesis, detailing the main results of the included studies. After reading and selecting the articles, five articles were included in this integrative review. Results: The most used widely toothpaste was Close Up White Now (n = 3). The most commonly used color methodology was spectrophotometry, while the predominant type of study was the randomized clinical trial, evaluating human dental enamel. Regarding the RDA (Relative Dentin Abrasitity), whitening toothpastes have an index between 60-100, sometimes higher than the 100, and are considered abrasive. Conclusion: In the results of some of the included studies, whitening dentifrices did not have an intrinsic whitening effect; only the effect of removing extrinsic stains was observed.

Influência do tipo de agente espessante e da suplementação de cálcio e fósforo no efeito desmineralizante de géis clareadores a base de peróxido de hidrogênio / Influence of the type of thickening agent and supplementation of calcium and phosphate on the demineralizing effect of bleaching gels based on hydrogen peroxide

O estudo avaliou o efeito da adição de cálcio (Ca) e fósforo (P), em quantidade correspondente ao ponto de saturação (PS) e ao coeficiente de solubilidade (CS), a géis clareadores contendo diferentes agentes espessantes na desmineralização do esmalte dentário. Foram manipulados géis clareadores contendo peróxido de hidrogênio (PH) a 35% e utilizados os espessantes carbopol 980 (CB); aerosil 200 (SP); poloxamer 407 (PX); goma guar (GG) e hidroxietilcelulose (HEC). Foram realizadas leituras iniciais da microdureza Knoop do esmalte empregando um microdurômetro, da rugosidade superficial em um perfilômetro de contato e da cor utilizando espectrofotômetro colorimétrico de reflectância. Os espécimes foram divididos em 5 grupos experimentais de acordo com o tipo de espessante. Cada grupo foi dividido em três subgrupos (n=20), de acordo com a suplementação mineral (0- nenhuma suplementação; PS ­ adição de Ca e P de acordo com o PS calculado para aquele espessante; CS ­ adição da quantidade máxima de Ca e P de acordo com o CS). Além disso, três grupos controles (n=20) foram preparados, sendo eles: CN (controle negativo ­água ultrapura); CP (controle positivo ­ PH a 35% sem a adição de qualquer mineral); CC (controle positivo comercial - gel comercial Whiteness HP). Sobre cada espécime foram aplicados 0,050 g dos respectivos géis clareadores, durante 45 min. Os dados dos grupos experimentais foram analisados estatisticamente com ANOVA a 2 fatores (TIPO DE ESPESSANTE x ADIÇÃO DE SAIS DE CA E P) e teste de Tukey. A comparação com os grupos controle foi realizada com o teste de Dunnett ( = 5%). Para todas as mensurações realizadas, a ANOVA mostrou diferenças significativas para os dois fatores (p<0,05). Para a alteração da microdureza, os resultados do teste de Tukey foram: TIPO DE ESPESSANTE (p=0,0001): HEC ­ 15,40(6,97)a, GG - 10,31(5,78)b, CB - 7,49(2,87)c, PX - 4,60(4,96)d, SP - 0,57(2,43)e; ADIÇÃO (p=0,0001): 0 - 12,34(7,22)a, S -10,31(5,76)b, CS -7,49(6,09)c. Para a alteração da rugosidade (p=0,0001), os resultados foram: TIPO DE ESPESSANTE (p=0,0001): SP - 5,19(23,36), GG - 9,70(17,75)ab, PX - 15,95(20,79)b, HEC - 53,58(71,82)c, CB - 55,49(63,69)c; ADIÇÃO (p=0,0001): 0 - 79,62(58,70)a, S - 3,23(12,08)a, CS - 1,09(9,44)b. Para a mudança de cor (ΔE), os resultados foram: TIPO DE ESPESSANTE (p=0,0001): SP - 5,40(2,92)a, GG - 3,13(1,83)a, PX - 3,18(2,57)ab, HEC - 3,82(2,05)bc, CB - 4,79(3,26)c. ADIÇÃO (p=0,2853): 0 - 4,37(2,60)a, S - 4,04(3,07)a, CS - 3,79(2,42)a. Os resultados para o teste de Dunnett para a microdureza: os grupos SP, SP-S e SP-CS não demonstraram diferenças com o grupo CN, e apenas os grupos GG e HEC-S não demostraram diferenças com o grupo CP e o grupo HEC-S para o CPC. Para a rugosidade, os grupos CB-CS, SP, PX-S, PX-CS, GG-S e GG-CS não demonstraram diferenças em relação ao grupo CN e todos os grupos apresentaram diferenças significativas para os grupos CP e CPC. Mediante os resultados desse estudo, podemos concluir que: A adição de cálcio e/ou fósforo em quantidades correspondente ao PS ou ao CS apenas do grupo SP impediu a queda da dureza e o aumento da rugosidade. Os demais grupos apresentaram alterações, porém sem afetar o tratamento clareador. (AU)

The aim of the study was to evaluate the effect of adding calcium (Ca) and phosphorus (P), in amounts corresponding to the saturation concentration (SC) and the solubility limit (SL), to bleaching gels containing different thickening agents on the demineralization of tooth enamel. Bleaching gels containing 35% hydrogen peroxide (PH) were manipulated and the thickeners were used: carbopol 980 (CB); aerosil 200 (SP); poloxamer 407 (PX); guar gum (GG) and hydroxyethylcellulose (HEC). The baseline readings of Knoop microhardness of the enamel using a microhardness, surface roughness using a contact profilometer and color using a colorimetric reflectance spectrophotometer were taken. The specimens were divided into 5 experimental groups according to the type of thickener. Each group was divided into three subgroups (n=20), according to mineral supplementation (0 - no supplementation; SC - addition of Ca and P according to the SC calculated for that thickener; SL - addition of the maximum amount of Ca and P according to SL). In addition, three control groups (n=20) were prepared, namely: NC (negative control ­ ultra pure water); PC (positive control ­ 35% pH without the addition of any mineral); CC (commercial positive control - commercial Whiteness HP gel). Were applied 0.050 g of the respective bleaching gels to each specimen for 45 min. The microhardness and surface roughness of the samples were measured immediately after bleaching. All samples were then immersed in artificial saliva for 7 days and the final color evaluated. Data from the experimental groups were statistically analyzed with 2-way ANOVA (THICKENER TYPE x MINERAL SUPPLEMENTATION) and Tukey test. Comparison with control groups was performed using Dunnett's test ( = 5%). For all measurements performed, ANOVA showed significant differences for the two factors (p<0.05). For microhardness change, the Tukey test results were: THICKENER TYPE (p=0.0001): HEC - 15.40(6.97)a, GG - 10.31(5.78)b, CB - 7.49(2.87)c, PX - 4 .60(4.96)d, SP - 0.57(2.43)e; ADDITION (p=0.0001): 0 - 12.34(7.22)a, SC -10.31(5.76)b, SL -7.49(6.09)c. For roughness change (p=0.0001), the results were: TYPE OF THICKENER (p=0.0001): SP - 5.19(23.36), GG - 9.70(17.75)ab, PX - 15.95(20.79)b, HEC - 53.58(71.82)c, CB - 55.49(63.69)c; ADDITION (p=0.0001): 0 - 79.62(58.70)a, SC - 3.23(12.08)a, SL - 1.09(9.44)b. For the color change (ΔE), the results were: TYPE OF THICKENER (p=0.0001): SP - 5.40(2.92)a, GG - 3.13(1.83)a, PX - 3.18(2.57)ab, HEC - 3.82(2.05)bc, CB - 4.79(3.26)c. ADDITION (p=0.2853): 0 - 4.37(2.60)a, SC - 4.04(3.07)a, SL - 3.79(2.42)a. The results for the Dunnett test for microhardness were: the SP, SP-S and SP-CS groups did not show differences with the CN group, and only the GG and HEC-S groups did not show differences with the CP group and the HEC-S for the CPC. For roughness, the CB-CS, SP, PX-S, PX-CS, GG-S and GG-CS groups did not show differences in relation to the CN group and all groups showed significant differences for the CP and CPC groups. By the results of this study, we can conclude that: The addition of calcium and/or phosphorus in amounts corresponding to the SC or to the SL of the aerosil group only prevented the drop in hardness and the increase in roughness. (AU)

Quality of Tooth-Whitening Videos Available on YouTube

ABSTRACT Objective: To compare how the quality of YouTube videos on tooth whitening uploaded by healthcare professionals and laypersons. Material and Methods: The video that was uploaded in a year was collected on YouTube using the keywords tooth whitening and dental bleaching. The exclusion criteria were duplicate videos, advertisements, no sound, too short duration, and lectures. The variables analyzed were likes/dislikes, viewers, interaction index, viewing rate, usefulness, global quality scale (GQS), and comprehensiveness score. Two observers reviewed the videos independently. Data were analyzed descriptively and analytically. Results: A total of 106 videos were selected, and most were uploaded by laypersons (70.8%). The observer reliability test showed excellent agreement with the intraclass correlation coefficient score minimum of 0.876. There were significant differences in dislikes (p=0.003), views (p=0.016), interaction index (p=0.010), usefulness (p=0.030), GQS (p<0.0001), and comprehensiveness (p=0.014) between healthcare professionals and laypersons. Videos made by laypersons had higher numbers of dislikes and viewing rates, whereas healthcare professionals were higher in usefulness, GQS, and comprehensiveness. Conclusion: Videos uploaded by laypersons provide low-accurate information despite being popular among viewers. Viewers need to be selective in seeking information from YouTube as a resource for oral healthcare decision-related tooth whitening.