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Sensitivity from whitening procedures
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Kirk Blanchard



Joined: 24 May 2005
Posts: 138
Location: Halifax Canada

PostPosted: Sun Oct 09, 2005 8:21 am    Post subject: Reply with quote

Is this your letter? Is there an online version available?

J Am Dent Assoc. 2003 Jul;134(7):814, 816, 818 passim; author reply 820, 822.
Swift EJ Jr, Heymann HO, Kugel G, Kanca J 3rd.


I found a number of Kugel references. They should do the trick. Thanks.




Compend Contin Educ Dent. 2002 Apr;23(4):335-8, 340, 343-4 passim; quiz 348. Related Articles, Links


Clinical evaluation of a 35% hydrogen peroxide in-office whitening system.

Papathanasiou A, Kastali S, Perry RD, Kugel G.

Department of Restorative Dentistry, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA.

This study evaluated the effectiveness of light-curing (heat conversion) vs no light-curing (no heat conversion) of a 35% hydrogen peroxide in-office tooth whitening system. Twenty patients with sound medical history (without tooth sensitivity) participated in this randomized, parallel clinical evaluation. Only six maxillary anterior teeth with discoloration and a tooth shade of A3 or darker were selected. Patients received a complete prophylaxis and were evaluated for initial (baseline) shade by three independent evaluators, precalibrated at 85% rater reliability in determining shades before the experiment began. Participants received a 20-minute chairside whitening treatment with a 35% hydrogen peroxide agent using a reflective resin barrier for gingival isolation. During the whitening treatment, the 35% hydrogen peroxide agent was light-activated with a halogen curing light on teeth Nos. 6 through 8 (Group I), but was not light-activated on teeth Nos. 9 through 11 (Group II). All patients returned 24 hours after the whitening application for shade evaluation. Although there were isolated instances (7 out of 20 patients) of greater degrees of lightening in the light-curing group, there was no statistically significant difference using the Mann-Whitney U test (P > .05). This study indicates that light-curing is optional with this 35% tooth whitening system.




Compend Contin Educ Dent. 2001 Apr;22(4):289-94, 296, 298; quiz 300. Related Articles, Links


A clinical study evaluating a new chairside and take-home whitening system.

Papathanasiou A, Bardwell D, Kugel G.

Advanced Technology Center, Department of Restorative Dentistry, Tufts University School of Dentistry, Boston, Massachusetts, USA.

This study evaluated the efficacy of tooth color modifications with a 15% hydrogen peroxide in-office whitening system when applied for a 30-, 45-, or 60-minute period and combined with a 10% carbamide peroxide take-home system. Twenty-four patients participated in this randomized, parallel clinical evaluation. Six maxillary anterior teeth with a shade of A3 or darker were selected. Patients were randomly divided into 3 groups of 8: Group I patients received a 30-minute application, Group II received a 45-minute application, and Group III received a 60-minute application of the initial in-office treatment. All patients returned at 24 hours for shade evaluation and receipt of a whitening tray with a 10% carbamide peroxide for 7 consecutive days. Patients returned at 24 hours, 72 hours, and on the 8th day of take-home treatment for shade evaluation. Kruskal-Wallis ANOVA showed no statistically significant difference between the groups (P > .10) at completion of treatment. When all three groups were combined, a mean shade change > 8 was seen. No significant difference existed for tooth color modifications when varied application times of 30-, 45- or 60-minute in-office whitening with 15% hydrogen peroxide was used in combination with 10% carbamide peroxide take-home whitening.




J Mass Dent Soc. 2005 Winter;53(4):34-7. Related Articles, Links


The art and science of tooth whitening.

Kugel G, Ferreira S.

Tufts University School of Dental Medicine, USA.

Although tooth whitening is one of the most popular dental procedures, it is also one of the least understood. We are still unclear as to its mechanism of action. There is little data as to the effects of both concentration and dose on outcome. The techniques for measuring color change have been brought into question. The cause(s) of sensitivity and the effects of long-term exposure to hydrogen peroxide are not clear. The issue of rebound in color has not been well examined, and issues related to maintenance of the whitening effect are also poorly understood. The immediate placement of composite resin on bleached teeth has been controversial. According to a study evaluating the shear bond strength of composite restorations placed on bleached and nonbleached teeth, there was no statistically significant difference when the composites were placed at 24 hours, 48 hours, four days, or six days. A different study, which evaluated the effects of take-home bleaching systems on enamel surfaces, suggests that a period of four days must elapse before bonding to a tooth bleached with a peroxide material, while no delay is necessary for a non-peroxide-based bleaching system. Most recently, there has been a push to find ways to accelerate and improve the delivery of the whitening process. These include the application of a number of different light sources believed to accelerate the breakdown of peroxide and thus speed up the whitening process. However, the research in this area has been controversial, with publications having quite different conclusions as to the efficacy of light-activated bleaching. Finally, the issues of adverse events and possible side effects were reviewed. The toxicological side effects of tooth bleaching systems seem to be minimal. However, tooth sensitivity can be quite significant. Although its causes are poorly understood, tooth sensitivity is most often seen as the result of tooth dehydration. So while patient demand for tooth whitening is at an all-time high, and dentists have more options for treatment, it's important that dentists evaluate which of these options is most ideal for their patients, factoring in the patients' cost and time issues, as well as sensitivity to the procedure.
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john kanca



Joined: 14 May 2005
Posts: 6345

PostPosted: Sun Oct 09, 2005 10:47 pm    Post subject: Reply with quote

0287 Clinical Trial Assessing Light Enhancement of In-Office Tooth Whitening
G. KUGEL1, S. FERREIRA1, S. SHARMA1, M.L. BARKER2, and R.W. GERLACH2, 1 Tufts University, Boston, MA, USA, 2 Procter & Gamble Co, Mason, OH, USA
Objective: This clinical study evaluated a light-enhanced, in-office tooth whitening system, in order to assess whether light enhancement of the peroxide gel affected tooth color and safety. Methods: 33 adults were randomly assigned to one of three treatment groups balancing for age and starting color. Professional treatment involved application of a 25% hydrogen peroxide gel (Discus Dental® Zoom!™) with light enhancement, peroxide gel alone, or the light alone with no peroxide. The 12 anterior teeth were treated 3 times for 20 minutes each. Efficacy was measured objectively as L*a*b* color change using digital images, tooth shade was measured, and safety was evaluated immediately after treatment, and at post-treatment Day 7 and Day 30. Results: After adjusting for baseline and age, immediate (end-of-treatment) means (SE) for b* (yellowness) were –3.1 (0.25) for the combination group, –2.0 (0.25) for the gel only group, and –2.4 (0.25) for the light only group. Significant (p < 0.05) color rebound was evident at post-treatment Day 7. By Day 30, adjusted means (SE) for b* were –1.7 (0.20) for the combination group, –1.1 (0.20) for the gel only group, and –0.5 (0.20) for the light only group. Both peroxide groups differed significantly (p < 0.05) from light alone on Db* and DL*. Vita shade results were generally similar. Tooth sensitivity represented the most common adverse event in the two gel groups. In the combination group, 91% of subjects experienced tooth sensitivity, the majority of which was moderate or severe. This resulted in 3 subjects discontinuing treatment early during the application visit. Adverse events were low in the light only group. Conclusion: Use of light enhancement for in-office whitening lead to immediate color change, after which, there was significant color and shade rebound within 7 days, as well as, moderate-to-severe tooth sensitivity during and after treatment.

2005
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Kirk Blanchard



Joined: 24 May 2005
Posts: 138
Location: Halifax Canada

PostPosted: Mon Oct 10, 2005 6:54 am    Post subject: Reply with quote

Thank you. That one will do nicely.
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