Regular and simple brushing twice can do lot..its the simplest oral treatment.Brushing keeps your mouth healthy and hygienic.....and this is proved by a lot of surveys and studies.
Although hard work tends to pay off in other areas of life, forceful toothbrushing appears to be no better at ridding the mouth of plaque than a medium effort. A group of European researchers discovered that the most efficient means of reducing plaque appears to be brushing for about two minutes at a medium force.
More vigorous teeth cleaning may actually do more harm than good, said Dr. Peter A. Heasman of the University of Newcastle upon Tyne, UK. Research suggests that heavy brushing can damage gums and wear down teeth, both potentially serious oral health problems, he said.
"Although we found that you have to brush your teeth reasonably long and hard to get rid of the harmful plaque which causes dental diseases, our research shows that once you go beyond a certain point you aren't being any more effective," Heasman said in a statement.
"You could actually be harming your gums and possibly your teeth," he added.
Heasman and his colleagues designed the study, published in the Journal of Clinical Periodontology, to determine the most efficient way to brush away plaque. Plaque is a sticky substance that can contain more than 300 species of bacteria, which adhere to tooth surfaces and produce cavity-causing acid. Plaque is a leading cause of gum disease.
During the study, Heasman and his colleagues measured plaque levels in the mouths of 12 people after they brushed their teeth using four different forces and for four periods of time -- 30 seconds, 60 seconds, 120 seconds, and 180 seconds.
The study participants brushed using a power toothbrush, which exerted set forces of between 75 grams and 300 grams. All spent 24 hours without cleaning their teeth before testing how well each technique stripped their mouths of plaque.
Heasman said that a force of 75 grams feels much lighter than one of 300 grams. However, he recommended that people visit their dentist to determine how different brushing forces feel.
"It is very difficult for a lay person to differentiate between brushing forces," Heasman told Reuters Health.
Longer brushing generally appeared better, but the researchers found that 120 seconds of brushing was roughly just as effective at removing plaque as longer brushing. And during those longer sessions, people removed about the same amount of plaque using a force of 150 grams as when they employed forces of 225 and 300 grams.
Although different people may require more or less time to get at all the plaque-ridden nooks and crannies in their mouth, spending around two minutes brushing your teeth seems "about right", Heasman said.
And applying a force beyond 150 grams -- somewhere in between light and forceful brushing -- "offered little benefit to plaque removal," Heasman added.
Furthermore, in toothbrushing, it is possible to have too much of a good thing, the researcher said.
"In the short term, gum changes may become apparent, but in the longer term, tooth wear or toothbrush abrasion is likely with too abrasive a technique, toothpaste, brush or force," Heasman said.
Saturday, August 14, 2010
Friday, July 9, 2010
vaccine for dental caries
dental caries......probably the most significant disease of mouth,,,,in this disease the enamel is degraded and some small holes on the tooth surface are visible, These holes are very dangerous as food particles and other edibles get jammed here and decay here causing bacterial and microbial growth. Our mouth in this situation becomes a carrier of sever infectious diseases of stomach and liver..with mouth and oral cancer
.
To fight this though sever surgical and clinical medicines are available but the basic to fight a disease is its vaccination,,,like polio or TB.....depending ob various pathogens several vaccinations are prepared and several are on the way...explore them below......
vidence of a specific bacterial cause of dental caries and of the function of the salivary glands as an effector site of the mucosal immune system has provided a scientific basis for the development of a vaccine against this highly prevalent and costly oral disease. Research efforts towards developing an effective and safe caries vaccine have been facilitated by progress in molecular biology, with the cloning and functional characterization of virulence factors from mutans streptococci, the principal causative agent of dental caries, and advancements in mucosal immunology, including the development of sophisticated antigen delivery systems and adjuvants that stimulate the induction of salivary immunoglobulin A antibody responses. Cell-surface fibrillar proteins, which mediate adherence to the salivary pellicle, and glucosyltransferase enzymes, which synthesize adhesive glucans and allow microbial accumulation, are virulence components of mutans streptococci, and primary candidates for a human caries vaccine. Infants, representing the primary target population for a caries vaccine, become mucosally immunocompetent and secrete salivary immunoglobulin A antibodies during the first weeks after birth, whereas mutans streptococci colonize the tooth surfaces at a discrete time period that extends around 26 months of life. Therefore, immunization when infants are about one year old may establish effective immunity against an ensuing colonization attempts by mutans streptococci. The present review critically evaluates recent progress in this field of dental research and attempts to stress the protective potential as well as limitations of caries immunization.,
Streptococcus mutans has been identified as the major etiological agent of human dental caries. The first step in the initiation of infection by this pathogenic bacterium is its attachment (i.e., through bacterial surface proteins such as glucosyltransferases, P1, glucan-binding proteins, and fimbriae) to a suitable receptor. It is hypothesized that a mucosal vaccine against a combination of S. mutans surface proteins would protect against dental caries by inducing specific salivary immunoglobulin A (IgA) antibodies which may reduce bacterial pathogenesis and adhesion to the tooth surface by affecting several adhesins simultaneously. Conventional Sprague-Dawley rats, infected with S. mutans at 18 to 20 days of age, were intranasally immunized with a mixture of S. mutans surface proteins, enriched for fimbriae and conjugated with cholera toxin B subunit (CTB) plus free cholera toxin (CT) at 13, 15, 22, 29, and 36 days of age (group A). Control rats were either not immunized (group B) or immunized with adjuvant alone (CTB and CT [group C]). At the termination of the study (when rats were 46 days of age), immunized animals (group A) had significantly (P < 0.05) higher salivary IgA and serum IgG antibody responses to the mixture of surface proteins and to whole bacterial cells than did the other two groups (B and C). No significant differences were found in the average numbers of recovered S. mutans cells among groups. However, statistically fewer smooth-surface enamel lesions (buccal and lingual) were detected in the immunized group than in the two other groups. Therefore, a mixture of S. mutans surface proteins, enriched with fimbria components, appears to be a promising immunogen candidate for a mucosal vaccine against dental carie.
.
To fight this though sever surgical and clinical medicines are available but the basic to fight a disease is its vaccination,,,like polio or TB.....depending ob various pathogens several vaccinations are prepared and several are on the way...explore them below......
vidence of a specific bacterial cause of dental caries and of the function of the salivary glands as an effector site of the mucosal immune system has provided a scientific basis for the development of a vaccine against this highly prevalent and costly oral disease. Research efforts towards developing an effective and safe caries vaccine have been facilitated by progress in molecular biology, with the cloning and functional characterization of virulence factors from mutans streptococci, the principal causative agent of dental caries, and advancements in mucosal immunology, including the development of sophisticated antigen delivery systems and adjuvants that stimulate the induction of salivary immunoglobulin A antibody responses. Cell-surface fibrillar proteins, which mediate adherence to the salivary pellicle, and glucosyltransferase enzymes, which synthesize adhesive glucans and allow microbial accumulation, are virulence components of mutans streptococci, and primary candidates for a human caries vaccine. Infants, representing the primary target population for a caries vaccine, become mucosally immunocompetent and secrete salivary immunoglobulin A antibodies during the first weeks after birth, whereas mutans streptococci colonize the tooth surfaces at a discrete time period that extends around 26 months of life. Therefore, immunization when infants are about one year old may establish effective immunity against an ensuing colonization attempts by mutans streptococci. The present review critically evaluates recent progress in this field of dental research and attempts to stress the protective potential as well as limitations of caries immunization.,
Streptococcus mutans has been identified as the major etiological agent of human dental caries. The first step in the initiation of infection by this pathogenic bacterium is its attachment (i.e., through bacterial surface proteins such as glucosyltransferases, P1, glucan-binding proteins, and fimbriae) to a suitable receptor. It is hypothesized that a mucosal vaccine against a combination of S. mutans surface proteins would protect against dental caries by inducing specific salivary immunoglobulin A (IgA) antibodies which may reduce bacterial pathogenesis and adhesion to the tooth surface by affecting several adhesins simultaneously. Conventional Sprague-Dawley rats, infected with S. mutans at 18 to 20 days of age, were intranasally immunized with a mixture of S. mutans surface proteins, enriched for fimbriae and conjugated with cholera toxin B subunit (CTB) plus free cholera toxin (CT) at 13, 15, 22, 29, and 36 days of age (group A). Control rats were either not immunized (group B) or immunized with adjuvant alone (CTB and CT [group C]). At the termination of the study (when rats were 46 days of age), immunized animals (group A) had significantly (P < 0.05) higher salivary IgA and serum IgG antibody responses to the mixture of surface proteins and to whole bacterial cells than did the other two groups (B and C). No significant differences were found in the average numbers of recovered S. mutans cells among groups. However, statistically fewer smooth-surface enamel lesions (buccal and lingual) were detected in the immunized group than in the two other groups. Therefore, a mixture of S. mutans surface proteins, enriched with fimbria components, appears to be a promising immunogen candidate for a mucosal vaccine against dental carie.
Thursday, July 8, 2010
Relatives......Aids and Dentistry
wondered...but that's not fake...now a days every diseases which involves a surgical treatment is a relative of aids..AIDS is highly dangerous sexually transmitted disease[STD]..IT IS DANGEROUS TO BOTH THE DOCTOR AND TO THE PATIENT. The disease requires complete precaution to be prevented from further spreading,,as a dental clinic is very sophisticated,,it is advised to all practitioners to be very careful while doing oral surgical processes...a complete through case history of the patient involving the history of present illness and past illness is highly recommended...more relations of aids and dentistry are as follows......
There are approximately about 1,00,000 AIDS cases in India and 2 million people infected with HIV, according to the statistics from the WHO and the Indian government. According to experts, if the trend continues, India could have as many as 30 million people with HIV by the year 2010- about twice today’s worldwide count.
AIDS specialist Dr.Peeyush Tripathi had mentioned in his speech, "Many experts believe that India will soon have the unfortunate distinction of being the AIDS capital of the world."
AIDS, or Acquired Immunodeficiency Syndrome, is a highly lethal, progressively epidemic viral infection that destroys the immune system, increasing the individual’s susceptibility to infectious disease and cancer.
A sensitive immunodetection assay has been developed, which is used to identify antibodies in HIV infected patients and as a tool for studying and measuring the levels of CD4 T cells(lymphocytes that fight infection) present during the course of the disease. A normal CD4 cell count is usually above 600 cells/mm3. Severe immune suppression defined as a CD4 cell count below 200cells /mm3 is, as of Jan 1993, an AIDS diagnosis. For most HIV infected patients, there is a long clinical latency period, often extending to seven to eight years.
There are at least 10 genetic types or clades of the human immunodeficiency virus, each antigenically distinct, with different clades predominant in different parts of the world.
At a recent international conference on AIDS, a new triple drug therapy has been declared to be effective. It combines indinavir(it attacks the viral enzyme, HIV-protease, which the virus needs to replicate itself ) with AZT(or zidovudine, an inhibitor which attacks the virus through the enzyme called reverse transcriptase) and 3TC (or lamivudine, another HIV inhibitor), to reduce or eliminate HIV copies in the plasma of infected patients.
The expanding role of the dentist in the acquired immunodeficiency syndrome era can be classified into six issues.
The HIV virus must get into the blood stream to infect a person. In order for infection to occur, 3 things must happen.
3. Transmission should go directly from one person to the other very quickly. The virus does not survive more than a few minutes outside the body.
The non specific symptoms of AIDS, which can include fevers, fatigue, weight loss, severe diarrhea, do not begin until an average of 10 years after infection. Generally, any symptoms that last for more than 2 weeks and do not go away, or any symptoms that are very severe, need medical attention.
The ADA strongly affirms that Universal precautions are an effective and adequate means of preventing transmission of HIV virus from dental health care workers to patients and vice versa. Based on the experience of numerous general dentists over the last 10 to 15 years, patients infected with HIV can safely be treated in general dental settings.
However, establishment of dedicated clinics for HIV infected patients may be justified because clinical staff in such settings develop increased clinical experience and will be able to manage more complex patients with greater confidence.
To minimize complications after dental procedures, a thorough and appropriate medical assessment is necessary. The main concern for dentists treating HIV infected cases are;
-increased bleeding tendencies,
-post operative infections.
-drug interactions
-adverse reactions and
-prognosis for survival.
The mode of HIV transmission influence the provision of dental care. Hemophiliacs demand modifications of dental care, moreover, they have a high prevalence of hepatitis B, hepatitis C, and hepatitis delta virus infection.
Intravenous drug users(IVDUs) also have a high prevalence of hepatitis B and hepatitis C viral infections. IVDUs are highly susceptible to develop bouts of bacterial endocarditis. The use of appropriate analgesics is another concern while treating IVDUs.
Homosexual men show a propensity to develop certain types of oral lesions, such as necrotizing ulcerative periodontitis, oral hairy leukoplakia, and Kaposi’s sarcoma. Prevalence of hepatitis B virus infection is also high in this patient population.
Children with perinatally acquired HIV are considered to be at greater risk for caries than their siblings, more so with advancing disease.
During the course of HIV disease, patients take increasing number of medications. Dentists need to be aware of the medications that can cause neutropenia and anemia. These include zidovudine and trimethoprim- sulphamethoxazole (Septra, Bactrim). Zidovudine may also cause reduced salivary flow.
Many HIV infected patients are started on trimethoprim- sulphamethoxazole when their CD4 cell count drops below 200 cells/ mm3. More than 50%, however, develop severe adverse reactions and need to stop taking the medication. Patients also show increased adverse reactions toward other antibiotics, including amoxicillin-clavulanic acid, ciprofloxacin, dicloxacillin, erythromycin and clindamycin, when their CD4 cell count decreases.
During the course of HIV disease, all patients develop oral alterations, but none of these lesions are specific for HIV disease, and they can be present in other immune suppressed individuals. These lesions range from asymptomatic, subtle changes of the oral mucosa that are secondary to a decreased salivary flow or candidiasis to rapidly destructive lesions, such as necrotizing stomatitis, necrotizing ulcerative periodontitis, deep mycoses, and cancers.
The treatment of some of these oral lesions can be handled in a dental office on an outpatient basis. When treatment includes radiation, cancer chemotherapy, and long term intravenous medication for neoplasms, it is advantageous for the dentist to be a part of the treatment team instead of being the primary provider.
The treatment team may have a general internal medicine specialist who takes care of the patient’s non- infectious needs, and an infectious disease specialist to attend to all HIV related care. Community based organizations and social support networks are also involved with a multitude of services, including psychological counseling and drug rehabilitation.
Based on the current epidemiological evidences, Epstein and others have reported that infectious diseases, specially blood borne pathogens such as hepatitis B, hepatitis C and HIV are not transmitted from patient to patient via dental instruments.
Though it has been suggested that dental handpieces are capable of transmitting HIV in a dental setting, there has never been any reports that such a transmission has occurred.
Special attention should be paid to dentists who are more susceptible to diseases potentially transmitted in a dental setting, They include pregnant women, due to their immunologic changes and the developing foetus; dentists with the habit of excessive alcohol intake; those who had undergone splenectomy, radiotherapy, and long term corticosteroid therapy; also, dentists suffering from diseases that have an impact on the first and secondary defense against infections such as diabetes mellitus, chronic renal failure, leukemia or HIV.
There are approximately about 1,00,000 AIDS cases in India and 2 million people infected with HIV, according to the statistics from the WHO and the Indian government. According to experts, if the trend continues, India could have as many as 30 million people with HIV by the year 2010- about twice today’s worldwide count.
AIDS specialist Dr.Peeyush Tripathi had mentioned in his speech, "Many experts believe that India will soon have the unfortunate distinction of being the AIDS capital of the world."
AIDS, or Acquired Immunodeficiency Syndrome, is a highly lethal, progressively epidemic viral infection that destroys the immune system, increasing the individual’s susceptibility to infectious disease and cancer.
A sensitive immunodetection assay has been developed, which is used to identify antibodies in HIV infected patients and as a tool for studying and measuring the levels of CD4 T cells(lymphocytes that fight infection) present during the course of the disease. A normal CD4 cell count is usually above 600 cells/mm3. Severe immune suppression defined as a CD4 cell count below 200cells /mm3 is, as of Jan 1993, an AIDS diagnosis. For most HIV infected patients, there is a long clinical latency period, often extending to seven to eight years.
There are at least 10 genetic types or clades of the human immunodeficiency virus, each antigenically distinct, with different clades predominant in different parts of the world.
At a recent international conference on AIDS, a new triple drug therapy has been declared to be effective. It combines indinavir(it attacks the viral enzyme, HIV-protease, which the virus needs to replicate itself ) with AZT(or zidovudine, an inhibitor which attacks the virus through the enzyme called reverse transcriptase) and 3TC (or lamivudine, another HIV inhibitor), to reduce or eliminate HIV copies in the plasma of infected patients.
The expanding role of the dentist in the acquired immunodeficiency syndrome era can be classified into six issues.
- Provision of routine dental care .
- Oral lesions- screening, diagnosis, treatment, and recognition of their significance.
- Collaboration with other health care workers and social support systems.
- Education of other health care workers.
- Education in the community.
- Resource to HIV infected health care workers.
The HIV virus must get into the blood stream to infect a person. In order for infection to occur, 3 things must happen.
- One must be exposed to blood, pre-cum, semen, vaginal secretions, or breast milk.
3. Transmission should go directly from one person to the other very quickly. The virus does not survive more than a few minutes outside the body.
The non specific symptoms of AIDS, which can include fevers, fatigue, weight loss, severe diarrhea, do not begin until an average of 10 years after infection. Generally, any symptoms that last for more than 2 weeks and do not go away, or any symptoms that are very severe, need medical attention.
The ADA strongly affirms that Universal precautions are an effective and adequate means of preventing transmission of HIV virus from dental health care workers to patients and vice versa. Based on the experience of numerous general dentists over the last 10 to 15 years, patients infected with HIV can safely be treated in general dental settings.
However, establishment of dedicated clinics for HIV infected patients may be justified because clinical staff in such settings develop increased clinical experience and will be able to manage more complex patients with greater confidence.
To minimize complications after dental procedures, a thorough and appropriate medical assessment is necessary. The main concern for dentists treating HIV infected cases are;
-increased bleeding tendencies,
-post operative infections.
-drug interactions
-adverse reactions and
-prognosis for survival.
The mode of HIV transmission influence the provision of dental care. Hemophiliacs demand modifications of dental care, moreover, they have a high prevalence of hepatitis B, hepatitis C, and hepatitis delta virus infection.
Intravenous drug users(IVDUs) also have a high prevalence of hepatitis B and hepatitis C viral infections. IVDUs are highly susceptible to develop bouts of bacterial endocarditis. The use of appropriate analgesics is another concern while treating IVDUs.
Homosexual men show a propensity to develop certain types of oral lesions, such as necrotizing ulcerative periodontitis, oral hairy leukoplakia, and Kaposi’s sarcoma. Prevalence of hepatitis B virus infection is also high in this patient population.
Children with perinatally acquired HIV are considered to be at greater risk for caries than their siblings, more so with advancing disease.
During the course of HIV disease, patients take increasing number of medications. Dentists need to be aware of the medications that can cause neutropenia and anemia. These include zidovudine and trimethoprim- sulphamethoxazole (Septra, Bactrim). Zidovudine may also cause reduced salivary flow.
Many HIV infected patients are started on trimethoprim- sulphamethoxazole when their CD4 cell count drops below 200 cells/ mm3. More than 50%, however, develop severe adverse reactions and need to stop taking the medication. Patients also show increased adverse reactions toward other antibiotics, including amoxicillin-clavulanic acid, ciprofloxacin, dicloxacillin, erythromycin and clindamycin, when their CD4 cell count decreases.
During the course of HIV disease, all patients develop oral alterations, but none of these lesions are specific for HIV disease, and they can be present in other immune suppressed individuals. These lesions range from asymptomatic, subtle changes of the oral mucosa that are secondary to a decreased salivary flow or candidiasis to rapidly destructive lesions, such as necrotizing stomatitis, necrotizing ulcerative periodontitis, deep mycoses, and cancers.
The treatment of some of these oral lesions can be handled in a dental office on an outpatient basis. When treatment includes radiation, cancer chemotherapy, and long term intravenous medication for neoplasms, it is advantageous for the dentist to be a part of the treatment team instead of being the primary provider.
The treatment team may have a general internal medicine specialist who takes care of the patient’s non- infectious needs, and an infectious disease specialist to attend to all HIV related care. Community based organizations and social support networks are also involved with a multitude of services, including psychological counseling and drug rehabilitation.
Based on the current epidemiological evidences, Epstein and others have reported that infectious diseases, specially blood borne pathogens such as hepatitis B, hepatitis C and HIV are not transmitted from patient to patient via dental instruments.
Though it has been suggested that dental handpieces are capable of transmitting HIV in a dental setting, there has never been any reports that such a transmission has occurred.
Special attention should be paid to dentists who are more susceptible to diseases potentially transmitted in a dental setting, They include pregnant women, due to their immunologic changes and the developing foetus; dentists with the habit of excessive alcohol intake; those who had undergone splenectomy, radiotherapy, and long term corticosteroid therapy; also, dentists suffering from diseases that have an impact on the first and secondary defense against infections such as diabetes mellitus, chronic renal failure, leukemia or HIV.
Wednesday, July 7, 2010
WHITENING YOUR TEETH,,,,,CONCEPTS AND CONCEPTIONS
Everyone in this world want a shining pearl like teeth and a glittering smile .General scaling of tooth is very common these days and also there are a lot of products in the market which guarantee whitening and refreshing your mouth. discoloration of tooth is the major problem and concerning one.There are several whitening methods are available which are discussed below with there merits and demerits.
Why Teeth Get Dark
There are many causes of tooth discoloration. The most common include genetics, aging, consumption of staining substances (smoking, coffee, tea, and colas), tetracycline (antibiotic) staining, excessive fluoride, and old fillings. Whitening toothpaste can remove stain that is on the outside of the teeth. Dentists call this extrinsic staining. However, whitening toothpaste and professional dental cleanings will not change the color or intrinsic staining of the teeth. That is why tooth whitening (sometimes called tooth bleaching) is so popular
Here's How Tray Teeth Whitening Works
A whitening gel is placed in a tray that fits over your teeth. As the active ingredient in the gel, carbamide peroxide, is broken down, oxygen enters the enamel and bleaches the colored substances. The structure of the tooth is not changed; only the tooth is made lighter and whiter. Fillings, Crowns, and Bonding will not lighten.
The fit of the tray is critical to success of treatment. Impressions are made by your dentist. Accurate models of your teeth are obtained from which custom fitting whitening trays can be made.
How Safe is This?
Dentists have known for years that tray whitening or bleaching is a fast, safe and predictable way to whiten teeth 2-5 shades in a matter of days.
What is the difference between laser whitening and custom mouthpieces?.
Laser is done by a dentist who applies a 35% Hydrogen Peroxide solution on your teeth. Once this solution is on, a light is held a couple of inches away from your teeth to speed up the chemical reaction of the Hydrogen Peroxide. Many dentists advertise that this works better than tray type whitening. There is NO clinical data to indicate the laser whitening works any better than tray whitening. NONE! The problem with this procedure is that after a year of your normal eating habits (drinking coke, tea, coffee, etc.) your teeth become slightly discolored again and develops a new stain. With the laser whitening, you will have to go and pay $500 plus to have white teeth again. With the custom mouthpieces, you already have the custom mouthpieces that you can wear a year later for a night to take off the new stain at no cost.
How Does the Tray Whitening System Compare to Crest Whitestripes?
Crest White Stripes are a new plastic strip that is coated with Hydrogen Peroxide and placed across the front teeth. The strips do work...sort of. Tests by Crest show that teeth are lightened an average of 1 to 2 shades They tend to whiten only the front teeth while and the visible premolars are still dark.
How Long will Whitening Results Last? For most people, the treatment is long-lasting. Exposure to coffee, smoking, red wines, and some medicine products will gradually darken teeth again over time. After an initial treatment, most people do touch-ups one day about every 3-6 months.
How long will it take and How white will they get?
When wearing the trays Carbamide Peroxide is slowly broken down to Hydrogen Peroxide which whitens the teeth. The 16% gel whitens more slowly but causes less tooth sensitivity. The 22% gel whitens quickly but can cause temporary sensitivity to temperatures. Both the 16% and 22% gels need to be worn for about 10-14 days to achieve maximum whiteness.
Virtually everyone who whitens their teeth will see improvement.
The ultimate whiteness will be determined by the length of time the teeth are exposed to the whitening gel and the mineral composition of the teeth. Teeth whitening is kind of like a reverse suntan. Some people get great results in only one or two days while others need more treatment time.
The American Dental Association (ADA) has recently made public a review by the Cochrane Collaboration of 25 studies of home-use tooth whitening products. The 25 clinical studies looked at the effectiveness of home-use whiteners including:
Why Teeth Get Dark
There are many causes of tooth discoloration. The most common include genetics, aging, consumption of staining substances (smoking, coffee, tea, and colas), tetracycline (antibiotic) staining, excessive fluoride, and old fillings. Whitening toothpaste can remove stain that is on the outside of the teeth. Dentists call this extrinsic staining. However, whitening toothpaste and professional dental cleanings will not change the color or intrinsic staining of the teeth. That is why tooth whitening (sometimes called tooth bleaching) is so popular
Here's How Tray Teeth Whitening Works
A whitening gel is placed in a tray that fits over your teeth. As the active ingredient in the gel, carbamide peroxide, is broken down, oxygen enters the enamel and bleaches the colored substances. The structure of the tooth is not changed; only the tooth is made lighter and whiter. Fillings, Crowns, and Bonding will not lighten.
The fit of the tray is critical to success of treatment. Impressions are made by your dentist. Accurate models of your teeth are obtained from which custom fitting whitening trays can be made.
How Safe is This?
Dentists have known for years that tray whitening or bleaching is a fast, safe and predictable way to whiten teeth 2-5 shades in a matter of days.
What is the difference between laser whitening and custom mouthpieces?.
Laser is done by a dentist who applies a 35% Hydrogen Peroxide solution on your teeth. Once this solution is on, a light is held a couple of inches away from your teeth to speed up the chemical reaction of the Hydrogen Peroxide. Many dentists advertise that this works better than tray type whitening. There is NO clinical data to indicate the laser whitening works any better than tray whitening. NONE! The problem with this procedure is that after a year of your normal eating habits (drinking coke, tea, coffee, etc.) your teeth become slightly discolored again and develops a new stain. With the laser whitening, you will have to go and pay $500 plus to have white teeth again. With the custom mouthpieces, you already have the custom mouthpieces that you can wear a year later for a night to take off the new stain at no cost.
How Does the Tray Whitening System Compare to Crest Whitestripes?
Crest White Stripes are a new plastic strip that is coated with Hydrogen Peroxide and placed across the front teeth. The strips do work...sort of. Tests by Crest show that teeth are lightened an average of 1 to 2 shades They tend to whiten only the front teeth while and the visible premolars are still dark.
How Long will Whitening Results Last? For most people, the treatment is long-lasting. Exposure to coffee, smoking, red wines, and some medicine products will gradually darken teeth again over time. After an initial treatment, most people do touch-ups one day about every 3-6 months.
How long will it take and How white will they get?
When wearing the trays Carbamide Peroxide is slowly broken down to Hydrogen Peroxide which whitens the teeth. The 16% gel whitens more slowly but causes less tooth sensitivity. The 22% gel whitens quickly but can cause temporary sensitivity to temperatures. Both the 16% and 22% gels need to be worn for about 10-14 days to achieve maximum whiteness.
Virtually everyone who whitens their teeth will see improvement.
The ultimate whiteness will be determined by the length of time the teeth are exposed to the whitening gel and the mineral composition of the teeth. Teeth whitening is kind of like a reverse suntan. Some people get great results in only one or two days while others need more treatment time.
The American Dental Association (ADA) has recently made public a review by the Cochrane Collaboration of 25 studies of home-use tooth whitening products. The 25 clinical studies looked at the effectiveness of home-use whiteners including:
- Home whitener kits given out by dentists
- Over-the-counter whiteners
- They looked at all forms of tooth whiteners except whitening toothpastes:
- Films (which are painted on the teeth)
- Gels (applied in trays)
- Strips (applied to the teeth)
Tuesday, July 6, 2010
tooth fluorosis problem
fluorosis is a tooth coloring disorder mainly,in it the outer surface of tooth gets discolored...the enamel is matted and patchy and sometimes flaky...the major cause is the excess intake of fluorides and its salts through food and water in the body....it also affects many other parts of the body.in INDIA several regions are affected with flourosis
Dental fluorosis is a common disease in punjab(india).it is due to an unusually high dose of fluorides during odontogenesis causing a structural modification of hard dental tissues and thereby resulting in a hypomineralisation of these tissues.fluorotic enamel is a hypocalcified, porous,brittle and most unaesthetic tissue. Bleaching has been suggested by several authors in order to treat the unaesthetic aspect of dental fluorosis, but many results are however unsatisfactory. This is a novel method which is based on the structural characteristics of the fluorotic ename & organic and exogenous nature of fluorotic enamel stains which includes four different stages:- 1) Cleansing the enamel surface with pumice 2) Enamel etching with hydrochloric acid 3) application of sodium hypochlorite. 4) application of dental adhesives.
Introduction
A frequent question asked by most of patients residing in the fluorotic belt of punjab (india) is "will my tooth turn white?" Usually the answer is a "yes" with the explanation that the modern dental treatment procedures are such as to esthetically synchronise the facial harmony of tooth structure.the reason for this discoloration is a high fluoride concentration in water in certain areas of punjab. the normal colour of permanent teeth is greyish yellow, greyish white or yellowish white but the number of people with this colour are usually limited owing to over aggressive tooth brushing and abrasive cleansing materials, acidic food and drinks and last but not the least,ageing. The elderly people thus, have more yellowish teeth as compared to younger persons.these alterations in colour maybe physiologic or pathologic and endogenous or exogenous in nature. the modern era is an era of esthetics. People having teeth with normal colour also want to have whiter teeth to improve their smile. So one cannot ignore the wishes of such patients and hence bleaching, as we know, has emerged as the simplest, most common, least invasive and least expensive means available to dentists to lighten discoloration.
History
Many agents have been used in the past and a number of new methods have continued to be introduced. It was oxalic acid first by chappel in 1877 which was followed by various forms of chlorine, until hydrogen peroxide was first used by harlan in 1884. Many advances continued focussing basically on the ways to facilitate the absorption of bleaching agent. The recent developments of hi-tech computer imaging have enhanced patient understanding, expectation and ultimately satisfaction.
Mode of action
Bleaching works by oxidation in which the bleaching agent enters the enamel &/or dentin of the discolored tooth and reduces the molecules containing discoloration. The bleaching depth depends on the cause of the stains and where and how deep the stain has permeated the tooth structure plus how deep the bleaching agent can permeate to the source of discoloration and remain there long enough to release deep stains.
Etiology of tooth discoloration
Extrinsic discolorations are found on outer surface of teeth and are usually Of local origin e.g. Tobacco, paan, tea, coffee, silver nitrate stains, oral intake of iron suspensions, continuous use of mouth washes and gum paint. Intrinsic the stains are found within the enamel and dentin and are caused by The deposition of the substances within these structures e.g. Tetracycline, Fluorosis stains, amelogenesis imperfecta, dentinogenesis imperfecta, pulp necrosis etc.
Histopathology
fluorosed teeth are also called mottled teeth . Such teeth appear when child ingests excessive fluoride during enamel formation or calcification in areas where drinking water contains more than 1ppm of Fluoride. The higher concentration of fluoride is believed to cause a metabolic alteration in the ameloblasts which results in defective matrix & improper calcification. 1ppm of fluoride has no biological side effects on The vital organs of human body i.e. Kidney, heart & lungs. Fluoride up to 4ppm in drinking water occasionally produces skeletal fluorosis but above 8ppm coupled with malnutrition positively causes not only skeletal fluorosis but irreversible bone changes & deformity as well.
Histology
histological examination shows hypomineralised, porous sub-surface enamel below a well mineralised surface layer. The most affected teeth (in decreasing order) are premolars, 2ndmolars, followed by maxillary incisors, canines & 1st molars. Mandibular incisors are affected least.
Stages of fluorosis
the appearance of teeth depends upon the severity of the lesion which in turn depends upon the fluoride contents consumed by a particular individual through the water supply.
1) the constant use of water having fluoride to the extent of 1ppm causes mildest grade of mottling in 10% of the population.
2) as concentration of fluoride increases, the effect worsens, so much so that when the concentration reaches 6ppm,incidence of mottling is 100%.
3) very mild :- in this type there are very small white areas occasionally seen on the tooth surfaces, but do not involve more than 25% of tooth surfaces.
(4) mild :- in this type there is more extensive tooth involvement and involves 50% of tooth surfaces.
(5) moderate :- more surfaces are involved here and are subjected to attrition. They show marked wear with yellow or brown pigmentation.
(6) severe :- all enamel surfaces are involved, so much so that the tooth mor phology is affected.there is discrete or confluent pitting of enamel surfaces. Brown stains are widespread & the tooth often presents a corroded surface.
Optimum fluoride levels
In cold climate, recommended fluoride levels may be as high as 1.2 ppm whereas in extremely hot climate, a level of 0.7 ppm is recommended. In moderate climate, the optimum fluoride level is 1 ppm. High temperature causes increase in mottling because there is increased consumption of water containing fluoride. Distribution of mottling in various areas of teeth has no relation with periods of mineralisation of crown. Teeth are only affected provided the child lives in the area of fluorosis during the time of enamel mineralisation. Brown tooth stains respond to treatment but white stains are not effectively resolved. It has been observed that teeth in process of eruption receive maximum benefit from optimum amount of fluoride plus teeth exposed to f shortly after eruption were also protected although to a lesser degree.
Different f levels in punjab & other states of india
I) Punjab
II) Andhra Pradesh
III) Gujarat
IV) Tamil Nadu 1) Coimbatore 2) Dharampur 3) Madurai 4) Narkot 5) Salem 6) Trichi
all 1.5 --- 5ppm
V) Kerala 1) Allepey 2) Eranakulam 3) Quillon 4) Trichur
all 0 -- 1.5 ppm
V) Rajasthan
VI) Uttar Pradesh
Treatment options
Basically for all these stains or in particular fluorotic stains the treatment options available to us include :-
1) Veneering / laminates or placement of porcelain crowns
2) Micro / macroabrasion
3) Bleaching - a) vital tooth inoffice bleaching b) nightguard home bleaching c) our novel method of inoffice bleaching
1) Veneering or laminates or ceramic crowns
Advantages:
1) esthetically more acceptable
2) Long lasting
3) Durable
4) Simple
5) Can be given over endodontically treated tooth
6) more strength and resistance to forces
Disadvantages:
1) brittle
2) less shear strengh
3) causes loss of tooth structure
4) patient may not be willing
5) susceptible to fracture
6) due to tooth reduction, pulp & other tissues may face trauma
7) overcontouring may make it appear & feel unnatural
8) vitality tests cannot be done once crowns are properly fit
9) post cementation caries difficult to detect
10) lab.procedure needs precision for proper marginal seal
11) gingival irritation- may cause hyperaemia & bleeding
2) Micro/ Macro abrasion :-
This technique involves applying of 18% hcl to soften the enamel And then abrading it with a controlled abrasive technique With pumice to remove superficial stains / defects. Instead of pumice, even silicon carbide may be used with 11%hcl.
Advantages:
1) improved method for superficial stains
2) safer method
3) involves physical removal of tooth structure
Disadvantages:
1) can cause sensitivity
2) causes wearing of tooth structure
3) patients might not allow cutting of tooth structure
4) defect may persist after finishing of technique for which a restorative alternative is needed
3) Bleaching :-
This procedure has many methods and techniques involving various solutions in each technique.
Advantages:
1) easy
2) time saving
3) cheaper
4) patient acceptance better
5) can be carried out both in office & at home
Disadvantages:
1) requires patient cooperation(especially for home bleaching)
2) cannot be used where teeth have large pulps
3) cannot be used where teeth are too dark
4) cannot be used where the patient expectations are too high
5) cannot be used in impatient patients
6) causes cervical resorption
7) cannot be used in attritioned teeth which might cause sensitivity
8) cannot be used where teeth are bonded, laminated or have extensive restorations
9) not a perfect technique & merely changes colour to variable depths
10) lasts for only 1 - 3 years (short period)
A) Vital tooth inoffice power bleaching
This technique uses a combination of 37% phosphoric acid & 35%hydrogen peroxide.the oxidation reaction is generally promoted by a heated instument or with intensive light.in this method, one application is carried out weekly for 2 - 6 appointments with each treatment lasting 30 minutes. Use of phosphoric acid by this technique is optional.
Advantages:
1) caustic chemicals are totally under dentist's control.
2) soft tissue protection is better achieved by dentist.
3) bleaching of tooth is achieved more rapidly
Disadvantages:
1) slightly costly procedure.
2) unpredictable results.
3) uncertain duration of treatment
4) soft tissue damage possible for both dentist & patient.
5) rubber dam causes discomfort.
6) can cause post operative sensitivity.
B) Night guard home bleaching
This procedure involves making an impression of the teeth & pouring a cast of the same, trimming of the cast, application of a blockout resin & fabrication of a night guard tray by a vaccum former machine. After cooling, the tray is trimmed & a 10 - 15% gel of carbamide peroxide is recommended for the same. In this procedure the total treatment time is 2 - 6 weeks.
Advantages:
1) use of lower concentration.
2) ease of application.
3) minimal side effects.
4) lower cost (as compared to veneers)
5) lesser chair time.
6) much lesser labour intensive.
Disadvantages:
1) have to rely a lot on patient compliance for results.
2) longer treatment time.
3) unknown potential for soft tissue changes with excessive use.
4) treatment results are time & dose dependent.
5) peroxide solution may cause irritation of gingival papilla.
6) teeth become sensitive to temperature changes.
Another method using macken's solution has been described
1 part anaesthetic ether 0.2 ml - removes surface debris 5 parts hcl 38% 1ml --- etches 5 parts hydrogen peroxide 30% 1 ml --- bleaches
Our Approach For Inoffice Bleaching
Indications:
1) Fluorosis stains / systemic fluorosis
2) Tetracycline stains
Contra indications:
1) Hyperaemic gingiva
2) Persistant periodontal problem cases
3) Fractured incisors / anteriors
Clinical application
The various steps are
1) Cleansing
2) Isolating
3) Etching
4) Rinsing
5) Dehydration
6) Application of solution
7) Scrapping
8) Rinsing
9) Filling
The Steps in detail:
1) cleansing the tooth surface with a nylon tooth brush & a mixture of pumice and water to remove surface debris.
2) isolation is done by application of rubber dam.
3) then dry the tooth surface & do enamel etching with 35% hcl for 20 - 25 seconds.
4) copious rinsing is done to eliminate acid residues & the tooth is subjected to thorogh drying.
5) application of 95% ethyl alcohol to dehydrate the enamel surface.
6) now,the application of 30% hydrogen peroxide(h2o2) is done first for 1 minute followed by alternative application of 5.25% sodium hypochlorite (naohcl) is done for 5 minutes during which it can be re-applied to the tooth surface to keep it wet.
7) the removal of staining molecules can be accelerated by gently scrapping the tooth surface.
8) this is followed by thorough rinsing of tooth surface.
9) this procedure is repeated at the interval of three days for successive sittings till the results are satisfactory.
10) in the end, fill the microcavities caused in the tooth by this solution with a light cure dental adhesive.
Advantages:
1) HCl etches enamel,but does not penetrate.
2) Tooth structure is not damaged.
3) Very very few chances of post - operative sensitivity of tooth.
4) No heat / application is required.
5) Very economical as all the three solutions in quantity of 50 ml. Each cost rs. 250 - 300 (total ).
6) Very low quantity of solutions required at each sitting.
Disadvantages :
1) Fluorosed teeth require larger & repeated sessions to decolorise Them.
2) Some blanching of gingiva can occur which is reversible within Half an hour.
3) Transitory decrease in bond strengh occurs when composite is applied to bleached / etched enamel.however,after a week,no decrease is seen.
4) Unknown duration of treatment.
Discussion
The different hypothesis concerning the fluorotic stains removal are:
1) if a fluorotic tooth is put into a naohcl solution,it removes all the stains within a few hours.this confirms the organic & exogenous nature of fluorotic tooth stains which are due to elementary impregnation of a hypocalcified & porous tissue. said by :- triller m. Alterations des tissues by marie curie in 1984.
2) scanning electron microscope study (sem) study shows that Posteruptive calcified layer covers the fluorotic enamel surface ; hence the mineral layer removal is essential.
RESULT
In the end, i would like to conclude that this system of stains Removal seems to be clinically applicable & satisfactory with minimal abrasion of enamel surface.to make this technique Universally acceptable , lot of cases have to be treated with this technique.
Dental fluorosis is a common disease in punjab(india).it is due to an unusually high dose of fluorides during odontogenesis causing a structural modification of hard dental tissues and thereby resulting in a hypomineralisation of these tissues.fluorotic enamel is a hypocalcified, porous,brittle and most unaesthetic tissue. Bleaching has been suggested by several authors in order to treat the unaesthetic aspect of dental fluorosis, but many results are however unsatisfactory. This is a novel method which is based on the structural characteristics of the fluorotic ename & organic and exogenous nature of fluorotic enamel stains which includes four different stages:- 1) Cleansing the enamel surface with pumice 2) Enamel etching with hydrochloric acid 3) application of sodium hypochlorite. 4) application of dental adhesives.
Introduction
A frequent question asked by most of patients residing in the fluorotic belt of punjab (india) is "will my tooth turn white?" Usually the answer is a "yes" with the explanation that the modern dental treatment procedures are such as to esthetically synchronise the facial harmony of tooth structure.the reason for this discoloration is a high fluoride concentration in water in certain areas of punjab. the normal colour of permanent teeth is greyish yellow, greyish white or yellowish white but the number of people with this colour are usually limited owing to over aggressive tooth brushing and abrasive cleansing materials, acidic food and drinks and last but not the least,ageing. The elderly people thus, have more yellowish teeth as compared to younger persons.these alterations in colour maybe physiologic or pathologic and endogenous or exogenous in nature. the modern era is an era of esthetics. People having teeth with normal colour also want to have whiter teeth to improve their smile. So one cannot ignore the wishes of such patients and hence bleaching, as we know, has emerged as the simplest, most common, least invasive and least expensive means available to dentists to lighten discoloration.
History
Many agents have been used in the past and a number of new methods have continued to be introduced. It was oxalic acid first by chappel in 1877 which was followed by various forms of chlorine, until hydrogen peroxide was first used by harlan in 1884. Many advances continued focussing basically on the ways to facilitate the absorption of bleaching agent. The recent developments of hi-tech computer imaging have enhanced patient understanding, expectation and ultimately satisfaction.
Mode of action
Bleaching works by oxidation in which the bleaching agent enters the enamel &/or dentin of the discolored tooth and reduces the molecules containing discoloration. The bleaching depth depends on the cause of the stains and where and how deep the stain has permeated the tooth structure plus how deep the bleaching agent can permeate to the source of discoloration and remain there long enough to release deep stains.
Etiology of tooth discoloration
Extrinsic discolorations are found on outer surface of teeth and are usually Of local origin e.g. Tobacco, paan, tea, coffee, silver nitrate stains, oral intake of iron suspensions, continuous use of mouth washes and gum paint. Intrinsic the stains are found within the enamel and dentin and are caused by The deposition of the substances within these structures e.g. Tetracycline, Fluorosis stains, amelogenesis imperfecta, dentinogenesis imperfecta, pulp necrosis etc.
Histopathology
fluorosed teeth are also called mottled teeth . Such teeth appear when child ingests excessive fluoride during enamel formation or calcification in areas where drinking water contains more than 1ppm of Fluoride. The higher concentration of fluoride is believed to cause a metabolic alteration in the ameloblasts which results in defective matrix & improper calcification. 1ppm of fluoride has no biological side effects on The vital organs of human body i.e. Kidney, heart & lungs. Fluoride up to 4ppm in drinking water occasionally produces skeletal fluorosis but above 8ppm coupled with malnutrition positively causes not only skeletal fluorosis but irreversible bone changes & deformity as well.
Histology
histological examination shows hypomineralised, porous sub-surface enamel below a well mineralised surface layer. The most affected teeth (in decreasing order) are premolars, 2ndmolars, followed by maxillary incisors, canines & 1st molars. Mandibular incisors are affected least.
Stages of fluorosis
the appearance of teeth depends upon the severity of the lesion which in turn depends upon the fluoride contents consumed by a particular individual through the water supply.
1) the constant use of water having fluoride to the extent of 1ppm causes mildest grade of mottling in 10% of the population.
2) as concentration of fluoride increases, the effect worsens, so much so that when the concentration reaches 6ppm,incidence of mottling is 100%.
3) very mild :- in this type there are very small white areas occasionally seen on the tooth surfaces, but do not involve more than 25% of tooth surfaces.
(4) mild :- in this type there is more extensive tooth involvement and involves 50% of tooth surfaces.
(5) moderate :- more surfaces are involved here and are subjected to attrition. They show marked wear with yellow or brown pigmentation.
(6) severe :- all enamel surfaces are involved, so much so that the tooth mor phology is affected.there is discrete or confluent pitting of enamel surfaces. Brown stains are widespread & the tooth often presents a corroded surface.
Optimum fluoride levels
In cold climate, recommended fluoride levels may be as high as 1.2 ppm whereas in extremely hot climate, a level of 0.7 ppm is recommended. In moderate climate, the optimum fluoride level is 1 ppm. High temperature causes increase in mottling because there is increased consumption of water containing fluoride. Distribution of mottling in various areas of teeth has no relation with periods of mineralisation of crown. Teeth are only affected provided the child lives in the area of fluorosis during the time of enamel mineralisation. Brown tooth stains respond to treatment but white stains are not effectively resolved. It has been observed that teeth in process of eruption receive maximum benefit from optimum amount of fluoride plus teeth exposed to f shortly after eruption were also protected although to a lesser degree.
Different f levels in punjab & other states of india
I) Punjab
| 1) bhatinda - 4.5 ppm 2) mansa - 4.2 ppm 3) mukatsar - 3.3 ppm 4) faridkot - 3 ppm 5) ferozepur - 2.6 ppm 6) moga - 2 ppm 7) sangrur - 1.35 ppm 8) jalandhar - 0.55 ppm 9) amritsar - 0.45 ppm | 10) hoshiarpur - 0.44 ppm 11) nawanshahar - 0.4 ppm 12) fatehgarh sahib - 0.37 ppm 13) patiala - 0.35 ppm 14) ropar - 0.3 ppm 15) kapurthala - 0.25 ppm 16) ludhiana - 0.22 ppm 17) gurdaspur - 0.15 ppm |
| 1) nalgonda - 20.6ppm 2)prakasan - 12.0ppm 3)vishakhapatnam - 11.0ppm 4) anantpur - 10.1ppm 5)guntar - 10 ppm 6)medak - 9.8ppm 7)kunoor - 9.6ppm 8)nellore - 8 ppm 9)mehboobnagar - 6.4 ppm | 10)warrangal - 5.8 ppm 11) kareemnagar - 4.9 ppm 12) hyderabad - 4.8ppm 13) cuddapah - 4.6ppm 14) nizamabad - 3.0ppm 15) chittoor - 2.9 ppm 16) adkabab - 2.8 ppm 17) srikakalam - 2.8 ppm 18) Godavari - 1.6 ppm |
| 1) kutch - 1.2 -- 11 ppm 2) bhavnagar - 1.5 - 4ppm 3) jamnagar - 1.5 - 4ppm 4) rajkot - 2.5ppm 5) saurashtra - 1.5 - 2.5 ppm 6) rajpur - 0 - 2.5 ppm | 7) banakanta - 1.5 - 2ppm 8) godar - 1.6 - 1.7ppm 9) godhra - 0 - 1.6 ppm 10) surinderanagar - 0 - 1.5 ppm 11) surat - 0 - 1.3 ppm |
all 1.5 --- 5ppm
V) Kerala 1) Allepey 2) Eranakulam 3) Quillon 4) Trichur
all 0 -- 1.5 ppm
V) Rajasthan
| 1) Bharatpur - 28ppm 2) Tonk - 21ppm 3) Alwar - 20.6ppm 4) Sikar - 19.1ppm 5) Ajmer - 18.4ppm 6) Bhilwara - 16.5ppm 7) Swaimadhopur - 16.1ppm 8) Jhalawar - 16ppm 9) Churu - 16ppm 10) Jodhpur -16ppm 11) Sirohi - 15.8ppm 12) Jaipur - 15ppm 13) Nalpur - 14.2ppm | 14) kota - 14.2ppm 15) dungarpur - 12ppm 16) bikaner - 10.2ppm 17) barmer - 10ppm 18) pali -- 9.1ppm 19) ganganagar - 9ppm 20) jalour -- 8ppm 21) wagpur - 7.1ppm 22) chittorgarh - 6ppm 23) bundi - 5.8ppm 24) banswara - 4.3ppm 25) jhunjhunu - 2.2ppm |
| 1) Gorakhpur - 0.6-6.8ppm 2) Shahjahanpur - 4ppm 3) Lakhpur -0.1-4ppm 4) Rai bareilly - 0.6-3ppm 5) Banda - 0.6-3ppm 6) Agra - 0.2-3ppm 7) Kanpur - 0.2-3ppm 8) Varanasi - 0.2-3ppm 9) Unna - 0.1-3ppm 10) Aligarh - 0.4-2ppm 11) Allahabad - 0.2-2ppm 12) Itah -0.8-1.6ppm 13) Hamirpur - 0.6-1.6ppm 14) Azamgarh - 0.1-1.6ppm 15) Muradpur - 1.0-1.4ppm 16) Jamalpur - 1.0-1.2ppm 17) Lucknow - 0.8-1.2ppm 18) Meerut - 0.4-1.2ppm 19) Bulandshahar - 0.4-1.2ppm 20) Dijnor - 0.2-1.2ppm 21) Jhansi - 0.2-1.2ppm 22) Bareilly 0.1-0.9ppm 23) Balliya - 0.4-0.8ppm 24) Barabanki - 0.4-0.8ppm | 25) fatehgarh - 0.4-0.8ppm 26) mirzapur - 0.4-0.8ppm 27) gadhepur - 0.3-0.8ppm 28) gonda - 0.2-0.8ppm 29) basti - 0.2-0.8ppm 30) jalpum - 0.1-0.8ppm 31) dehradun - 0.1-0.8ppm 32) pratapgarh - 0.4-0.6ppm 33) manipuri - 0.4-0.6ppm 34) lahtpur - 0.1-0.6ppm 35) muzaffarnagar - 0.2-0.5ppm 36) rampur - 0.2-0.4ppm 37) pilibhit - 0.2-0.4ppm 38) bijnor - 0.1-0.4ppm 39) fatehabad - 0.1-0.4ppm 40) badari - 0.1-0.4 ppm 41) sitapur - 0.1-0.4ppm 42) saharanpur - 0.1-0.4ppm 43) mathura - 0.1-0.4ppm 44) faizabad - 0.2ppm 45) etawah - 0.1-0.2ppm 46) nainital - 0.1-0.2ppm 47) dahrich - 0.1-0.2ppm 48) sultanpur - 0.1ppm |
Basically for all these stains or in particular fluorotic stains the treatment options available to us include :-
1) Veneering / laminates or placement of porcelain crowns
2) Micro / macroabrasion
3) Bleaching - a) vital tooth inoffice bleaching b) nightguard home bleaching c) our novel method of inoffice bleaching
1) Veneering or laminates or ceramic crowns
Advantages:
1) esthetically more acceptable
2) Long lasting
3) Durable
4) Simple
5) Can be given over endodontically treated tooth
6) more strength and resistance to forces
Disadvantages:
1) brittle
2) less shear strengh
3) causes loss of tooth structure
4) patient may not be willing
5) susceptible to fracture
6) due to tooth reduction, pulp & other tissues may face trauma
7) overcontouring may make it appear & feel unnatural
8) vitality tests cannot be done once crowns are properly fit
9) post cementation caries difficult to detect
10) lab.procedure needs precision for proper marginal seal
11) gingival irritation- may cause hyperaemia & bleeding
2) Micro/ Macro abrasion :-
This technique involves applying of 18% hcl to soften the enamel And then abrading it with a controlled abrasive technique With pumice to remove superficial stains / defects. Instead of pumice, even silicon carbide may be used with 11%hcl.
Advantages:
1) improved method for superficial stains
2) safer method
3) involves physical removal of tooth structure
Disadvantages:
1) can cause sensitivity
2) causes wearing of tooth structure
3) patients might not allow cutting of tooth structure
4) defect may persist after finishing of technique for which a restorative alternative is needed
3) Bleaching :-
This procedure has many methods and techniques involving various solutions in each technique.
Advantages:
1) easy
2) time saving
3) cheaper
4) patient acceptance better
5) can be carried out both in office & at home
Disadvantages:
1) requires patient cooperation(especially for home bleaching)
2) cannot be used where teeth have large pulps
3) cannot be used where teeth are too dark
4) cannot be used where the patient expectations are too high
5) cannot be used in impatient patients
6) causes cervical resorption
7) cannot be used in attritioned teeth which might cause sensitivity
8) cannot be used where teeth are bonded, laminated or have extensive restorations
9) not a perfect technique & merely changes colour to variable depths
10) lasts for only 1 - 3 years (short period)
A) Vital tooth inoffice power bleaching
This technique uses a combination of 37% phosphoric acid & 35%hydrogen peroxide.the oxidation reaction is generally promoted by a heated instument or with intensive light.in this method, one application is carried out weekly for 2 - 6 appointments with each treatment lasting 30 minutes. Use of phosphoric acid by this technique is optional.
Advantages:
1) caustic chemicals are totally under dentist's control.
2) soft tissue protection is better achieved by dentist.
3) bleaching of tooth is achieved more rapidly
Disadvantages:
1) slightly costly procedure.
2) unpredictable results.
3) uncertain duration of treatment
4) soft tissue damage possible for both dentist & patient.
5) rubber dam causes discomfort.
6) can cause post operative sensitivity.
B) Night guard home bleaching
This procedure involves making an impression of the teeth & pouring a cast of the same, trimming of the cast, application of a blockout resin & fabrication of a night guard tray by a vaccum former machine. After cooling, the tray is trimmed & a 10 - 15% gel of carbamide peroxide is recommended for the same. In this procedure the total treatment time is 2 - 6 weeks.
Advantages:
1) use of lower concentration.
2) ease of application.
3) minimal side effects.
4) lower cost (as compared to veneers)
5) lesser chair time.
6) much lesser labour intensive.
Disadvantages:
1) have to rely a lot on patient compliance for results.
2) longer treatment time.
3) unknown potential for soft tissue changes with excessive use.
4) treatment results are time & dose dependent.
5) peroxide solution may cause irritation of gingival papilla.
6) teeth become sensitive to temperature changes.
Another method using macken's solution has been described
1 part anaesthetic ether 0.2 ml - removes surface debris 5 parts hcl 38% 1ml --- etches 5 parts hydrogen peroxide 30% 1 ml --- bleaches
Our Approach For Inoffice Bleaching
Indications:
1) Fluorosis stains / systemic fluorosis
2) Tetracycline stains
Contra indications:
1) Hyperaemic gingiva
2) Persistant periodontal problem cases
3) Fractured incisors / anteriors
Clinical application
The various steps are
1) Cleansing
2) Isolating
3) Etching
4) Rinsing
5) Dehydration
6) Application of solution
7) Scrapping
8) Rinsing
9) Filling
The Steps in detail:
1) cleansing the tooth surface with a nylon tooth brush & a mixture of pumice and water to remove surface debris.
2) isolation is done by application of rubber dam.
3) then dry the tooth surface & do enamel etching with 35% hcl for 20 - 25 seconds.
4) copious rinsing is done to eliminate acid residues & the tooth is subjected to thorogh drying.
5) application of 95% ethyl alcohol to dehydrate the enamel surface.
6) now,the application of 30% hydrogen peroxide(h2o2) is done first for 1 minute followed by alternative application of 5.25% sodium hypochlorite (naohcl) is done for 5 minutes during which it can be re-applied to the tooth surface to keep it wet.
7) the removal of staining molecules can be accelerated by gently scrapping the tooth surface.
8) this is followed by thorough rinsing of tooth surface.
9) this procedure is repeated at the interval of three days for successive sittings till the results are satisfactory.
10) in the end, fill the microcavities caused in the tooth by this solution with a light cure dental adhesive.
Advantages:
1) HCl etches enamel,but does not penetrate.
2) Tooth structure is not damaged.
3) Very very few chances of post - operative sensitivity of tooth.
4) No heat / application is required.
5) Very economical as all the three solutions in quantity of 50 ml. Each cost rs. 250 - 300 (total ).
6) Very low quantity of solutions required at each sitting.
Disadvantages :
1) Fluorosed teeth require larger & repeated sessions to decolorise Them.
2) Some blanching of gingiva can occur which is reversible within Half an hour.
3) Transitory decrease in bond strengh occurs when composite is applied to bleached / etched enamel.however,after a week,no decrease is seen.
4) Unknown duration of treatment.
Discussion
The different hypothesis concerning the fluorotic stains removal are:
1) if a fluorotic tooth is put into a naohcl solution,it removes all the stains within a few hours.this confirms the organic & exogenous nature of fluorotic tooth stains which are due to elementary impregnation of a hypocalcified & porous tissue. said by :- triller m. Alterations des tissues by marie curie in 1984.
2) scanning electron microscope study (sem) study shows that Posteruptive calcified layer covers the fluorotic enamel surface ; hence the mineral layer removal is essential.
RESULT
In the end, i would like to conclude that this system of stains Removal seems to be clinically applicable & satisfactory with minimal abrasion of enamel surface.to make this technique Universally acceptable , lot of cases have to be treated with this technique.
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