-=,-' ,-=,-' =' ~

Athome v|ta| b|each|ng a

compar|son of hydrogen perox|de
and carbam|de perox|de treatments
IN1kCDUC1ICN
W uenLal bleachlng ls a LherapeuLlc procedure LhaL enables
denLal dlscolouraLlon Lo be removed Lhus glvlng a colour ln
keeplng wlLh Lhe paLlenL's aesLheLlc demands 1he LreaLmenL
ls Lherefore presenLed as a nonlnvaslve conservaLlve
procedure LhaL also favours perlodonLal healLh and hyglene
and does noL alLer Lhe naLural shape of Lhe LeeLh sulLable for
LeeLh affecLed by colour problems whlch presenL no oLher
denLal or perlodonLal paLhology and reLaln a correcL anaLomy
and approprlaLe poslLlon ln Lhe arch
W 1he resulLs largely depend on Lhe Lype of dlscolouraLlon lLs
causes and Lhe Llme LhaL has elapsed slnce lL occurred
W Iarlous agenLs can be used Lo whlLen LeeLh some have an
oxldanL effecL some acL Lhrough eroslon some are
abraslve and oLhers use a comblnaLlon of Lhese meLhods
W 1he oxldanL agenLs are Lhe mosL effecLlve as Lhey have Lhe
ablllLy Lo peneLraLe lnLo Lhe enamel and Lhe denLlne once
Lhere Lhey oxldlse Lhe molecules of Lhe subsLances
responslble for Lhe denLal dlscolouraLlon
W 1he agenLs of Lhls Lype mosL commonly used nowadays are
hydrogen peroxlde aL concenLraLlons ranglng from 3 Lo
30 and carbamlde peroxlde also known as urea
peroxlde whlch ls usually used aL beLween 1 and 43
8oLh can be encounLered ln dlfferenL commerclal
presenLaLlons gels mouLhwashes LooLhpasLes or
varnlshes
W n 1989 Paywood and Peymann developed Lhe aLhome
Lechnlque of denLal bleachlng uslng 10 carbamlde peroxlde
ln plasLlc nlghLguards Lhey recommended 68 hour
appllcaLlons 1hls Lype of LreaLmenL achleved saLlsfacLory
whlLenlng ln 26 weeks
W n 1991 Lhese same auLhors revlewed Lhe sLudles publlshed
Lo daLe on Lhe safeLy and sldeeffecLs of Lhls Lechnlque and
reached Lhe concluslon LhaL lL ls as safe as oLher denLal
bleachlng procedures provlded lL ls carrled ouL properly
W Slnce Lhen aLhome Lray bleachlng has become one of Lhe
mosL frequenLly used whlLenlng Lechnlques wheLher as a
sLandalone LreaLmenL for sllghL Lo moderaLe dlscolouraLlon
or ln Lhe case of more severe dlscolouraLlon Lo complemenL
an lnofflce bleachlng Lechnlque ln whlch case Lhe Lerm
employed ls comblnaLlon bleachlng
W Poward laLer publlshed a cllnlcal Lrlal of 10
carbamlde peroxlde uslng Lhe same bleachlng
Lechnlque Pe concluded LhaL lL was an
effecLlve LreaLmenL buL LhaL Lhe flnal resulLs
depended on dlfferenL varlables such as Lhe
gulde employed Lo measure Lhe colour and
Lhe monlLorlng carrled ouL among oLhers Pe
also hlghllghLed LhaL ln all Lhe cases Lhe
adverse effecLs on Lhe LeeLh and sofL Llssues
were mlld and reverslble
,A1LkIALS AND ,L1nCDS
W 6 paLlenLs were selecLed from Lhose who came Lo Lhe unlL
wlLh dlscolouraLlons LhaL could be LreaLed by Lhe chosen
Lechnlque and producLs 1hey were randomly asslgned Lo Lhe
Lwo LreaLmenL groups
W 1wo dlfferenL producLs were used Cne lku (kln) ls based
on 33 hydrogen peroxlde and Lhe oLher IlvaSLyle (voclar
IlvadenL) on 10 carbamlde peroxlde 8oLh are sulLable for
aLhome Lraybased LooLh bleachlng LreaLmenLs
W rlor Lo LreaLmenL cusLomflLLed Lrays for boLh arches wlLh 1
mm bleachlng agenL reservolrs for Lhe LeeLh Lo be bleached
(rlghL canlne Lo lefL canlne) were made from Sof1ray sheeLs
(ulLradenL)
W 1he hydrogen peroxlde producL was applled for 3 hours a day
and Lhe carbamlde peroxlde producL for 2 hours a day
W L Lhe sLarL of LreaLmenL and aL each checkup Lhe paLlenLs
were glven a card on whlch each day Lhey had Lo wrlLe
down Lhe producL appllcaLlon Llme and any senslLlvlLy Lhey
percelved and were lnsLrucLed ln Lhe need Lo comply wlLh
normal sLandards of oral hyglene and Lhe lmporLance of noL
smoklng or lngesLlng plgmenLconLalnlng foods or drlnks
durlng Lhe LreaLmenL ln order noL Lo affecL lLs progress
W L each vlslL Lhe colour was measured wlLh Lhe IlLapan
Classlcal shade gulde Lo check Lhe percenLage of colour
change broughL abouL by Lhe producL employed ln each
case and Lo compare Lhe resulLs aL each sLage of Lhe
LreaLmenL 1he flnal examlnaLlon was performed one week
afLer concludlng Lhe bleachlng LreaLmenL ln order Lo allow
deflnlLlve sLablllsaLlon of Lhe LooLh colour
kLSUL1S
W 1he flrsL group of paLlenLs was LreaLed wlLh 10 carbamlde
peroxlde (IlvaSLyle) n all cases Lhe dally lengLh of
appllcaLlon was 2 hours
W n Lhe flrsL case Lhe LreaLmenL lasLed for 24 days Lhere was no
pre or posLoperaLlve senslLlvlLy and Lhe LooLh shade
changed from 4 (canlnes) 33 (lnclsors) Lo 2 (canlnes)
1 (lnclsors)
W n Lhe second case Lhe duraLlon of LreaLmenL was
slmllar (28 days) no senslLlvlLy was shown durlng
LreaLmenL and Lhe shade changed from 33
(canlnes) 3 (lnclsors) Lo 1
W Case 3 presenLed a change ln shade from 4
(canlnes) 3 (lnclsors) Lo 2 (canlnes) 1
(lnclsors) afLer only 20 days ln Lhls case Lhe paLlenL
dld menLlon sllghL senslLlvlLy ln Lhe anLerlor
mandlbular LeeLh LhroughouL Lhe LreaLmenL
W 1he second group of paLlenLs recelved Lhe 33 hydrogen
peroxlde (lku) bleachlng LreaLmenL n all Lhese cases Lhe
bleachlng producL was applled for 3 hours a day
W n Lhe flrsL case Lhe shade changed from Lhe lnlLlal 3
(canlnes) 2 (lnclsors) Lo 2 (canlnes) 1 (lnclsors) ln 28
days wlLh sllghL LooLh senslLlvlLy durlng Lhe second half of Lhe
LreaLmenL perlod
W 1he second case requlred 26 days' LreaLmenL
Lo change from shade 4 (canlnes) 3
(lnclsors) Lo 2 (canlnes) 1 (lnclsors) no
senslLlvlLy was menLloned durlng Lhe
bleachlng process
W 1he Lhlrd case ln Lhls group changed from
shade 83 Lo 81 ln 47 days and experlenced
very sllghL locallsed senslLlvlLy ln Lhe laLeral
mandlbular lnclsor for one day durlng Lhe
lnlLlal sLage of Lhe LreaLmenL
W n Lhe slx paLlenLs LreaLed Lhe changes ln
colour observed ranged from one Lo Len
shades of Lhe IlLa shade gulde's brlghLness
based classlflcaLlon Lhe whlLenlng success"
percenLage was beLween 31 and 100 on
Lhe !ane8olg scale whlch ls based on Lhe
greaLesL percenLage of whlLenlng LhaL can be
achleved ln a LooLh dependlng on lLs lnlLlal
colour
DISCUSSICN AND CCNCLUSICNS
W n Lhe carbamlde peroxlde LreaLmenL group Lhls perlod
ranged from 20 Lo 28 days and ln Lhe hydrogen peroxlde
LreaLmenL group lL was 26 days for Lhe flrsL paLlenL and 28
days for Lhe second paLlenL buL Lhe Lhlrd paLlenL requlred
48 days owlng Lo Lhe presence of composlLe resln veneers a
pplled dlrecLly Lo Lhe enamel surface of Lhe LeeLh Lo be
whlLened whlch hlndered Lhe effecL of Lhe bleachlng
producL and Lhe measuremenL of colour change Lhus
lengLhenlng Lhe LreaLmenL compared Lo Lhe oLher Lwo
paLlenLs
W CLher Lhan Lhls excepLlon lL was found LhaL Lhe LreaLmenL
Llme varled beLween 3 and 4 weeks ln boLh groups as
lnlLlally posLulaLed by Paywood and Peymann
W lLhough 10 hydrogen peroxlde was Lhe bleachlng agenL
orlglnally used for Lhls Lechnlque hlgher concenLraLlon
producLs are now avallable as are ones LhaL employ dlfferenL
concenLraLlons of carbamlde peroxlde lnsLead of hydrogen
peroxlde
W 1hls enables Lhe concenLraLlon and lengLh of appllcaLlon of
each producL Lo be modlfled ln response Lo Lhe paLlenL's
senslLlvlLy aL hlgher concenLraLlons Lhe appllcaLlon Llme ls
shorLer aL lower concenLraLlons lL ls longer
W n Lhls sLudy Lhe appllcaLlon Llme employed for Lhe hydrogen
peroxlde was 3 hours as recommended by Lhe manufacLurer
W 1he appllcaLlon Llme of Lhe carbamlde peroxlde however was
lncreased from Lhe manufacLurer's suggesLed one hour perlod
Lo Lwo hours as lL was consldered LhaL Lhe producL's acLlvlLy
ln Lhe Lray afLer Lwo hours' LreaLmenL was sufflclenL Lo [usLlfy
Lhls move
W ,okhlls eL alll conducLed an ln vlvo double bllnd sLudy ln
whlch Lhey compared a producL conLalnlng carbamlde
peroxlde ln Lhelr case 20 wlLh a 73 hydrogen peroxlde
producL obLalnlng slmllar resulLs Lo Lhose presenLed ln Lhls
paper
W ,aLls eL alll who conducLed slmllar cllnlcal research Lo Lhe
above buL used 10 carbamlde peroxlde esLabllshed LhaL
afLer 6 weeks' LreaLmenL Lhe resulLs were saLlsfacLory
W CuelleL eL alll conducLed a furLher sLudy also wlLh a double
bllnd sLrucLure comparlng 10 carbamlde peroxlde wlLh a
placebo and a LooLhpasLe afLer four weeks Lhelr resulLs
showed a greaLer change ln colour wlLh Lhe bleachlng gel (3
shades) Lhan wlLh Lhe oLher producLs
W -aLhoo aL alll also carrled ouL a double bllnd sLudy ln paLlenLs
LreaLed for one week wlLh 3 and 10 carbamlde peroxlde
respecLlvely and found boLh agenLs Lo be equally effecLlve ln
Lerms of Lhelr ablllLy Lo modlfy LooLh colour
W n an ln vlLro sLudy comparlng Lhe effecLs of dlfferenL
concenLraLlons of carbamlde peroxlde (3 10 and 16)
Leonard eL alll concluded LhaL greaLer concenLraLlons
achleved fasLer bleachlng buL LhaL Lhe resulLs were equlvalenL
lf Lhe lower concenLraLlons were used for a greaLer lengLh of
Llme
W 8arnes eL alll assessed Lhe effecLlveness of anoLher bleachlng
agenL conLalnlng 10 carbamlde peroxlde carbopol sodlum
hydroxlde and waLer and reglsLered an average 696 colour
shade change uslng Lhe IlLa shade gulde
W oo eL alll sLudled paLlenLs uslng 10 carbamlde peroxlde for
2 weeks and found LhaL Lhe bleachlng effecL lncreased ln
proporLlon Lo Lhe lengLh of LreaLmenL Llme
W klhn eL alll used anoLher doublebllnd sLudy Lo compare Lwo
producLs wlLh dlfferenL concenLraLlons of carbamlde peroxlde
(10 and 13) afLer one week's LreaLmenL Lhey Loo found
LhaL Lhe bleachlng effecL achleved was slmllar buL LhaL Lhe
resulLs aL Lhe end of Lhe LreaLmenL were beLLer aL Lhe hlgher
concenLraLlon
W Peymann eL alll carrled ouL an ln vlvo bllnd analysls for a week
Lo sLudy dlfferenL bleachlng producLs conLalnlng 10
carbamlde peroxlde and also obLalned slmllar resulLs boLh
afLer flve days' LreaLmenL and afLer one week
W LasLly a cllnlcal Lrlal by mengual eL alll verlfled Lhe
efflcacy of a carbamlde peroxlde based producL applled
by alLernaLlng Lwo dlfferenL concenLraLlons (16 and
22) for Lwo weeks whlch achleved an average 333
shade llghLenlng measured wlLh a colorlmeLer
W 1he blbllographlcal revlew of aLhome Lray bleachlng
uslng 10 carbamlde peroxlde publlshed by
-lederman eL alll found LhaL a noLlceable change ln
colour (2 Lones on Lhe IlLa shade gulde) had been
achleved ln pracLlcally all Lhe cases LreaLed
W s regards Lhe LooLh senslLlvlLy presenLed by Lhe paLlenLs ln
Lhe presenL sLudy lL was sllghL dlsappeared sponLaneously
wlLhouL requlrlng Lhe LreaLmenL Lo be lnLerrupLed or Lhe
producL admlnlsLraLlon schedule Lo be modlfled and was ln
keeplng wlLh LhaL descrlbed by oLher auLhors under slmllar
condlLlons
W -oneLheless -aLhoo eL alll Leonard eL allland klhn eL alll all
showed LhaL hlgher concenLraLlons of hydrogen peroxlde are
assoclaLed wlLh greaLer senslLlvlLy Leonard eL alll Lherefore
recommended uslng low concenLraLlons of carbamlde
peroxlde as Lhey found LhaL alLhough Lhese lncrease Lhe LoLal
lengLh of LreaLmenL Lhey are assoclaLed wlLh lower
senslLlvlLy
W lrom an examlnaLlon of Lhe resulLs obLalned
lL may be sLaLed LhaL Lhe cllnlcal behavlour of
Lhe Lwo bleachlng producLs was slmllar under
Lhe condlLlons ln whlch Lhls sLudy was
conducLed achlevlng a degree of whlLenlng
LhaL saLlsfled boLh Lhe paLlenL and Lhe denLlsL
and generally dld noL cause any slgnlflcanL
LooLh senslLlvlLy