|Year : 2021 | Volume
| Issue : 4 | Page : 408-413
|Influence of professional teeth whitening on oral hygiene: Long-term results
Natalia Vlasova1, Vadim Samusenkov2, Irina Novikova1, Denis Nikolenko2, Nikita Nikolashvili2, Marina Knyazeva1
1 Department of Therapeutic Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
2 Prosthetic Dentistry, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
|Date of Submission||03-Mar-2021|
|Date of Decision||24-Mar-2021|
|Date of Acceptance||26-Apr-2021|
|Date of Web Publication||30-Jul-2021|
Dr. Natalia Vlasova
I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Str., 8/2, Moscow, 119991
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aims: The aim of this article is to estimate the long-term influence of professional dental bleaching on quality of oral hygiene (year after procedure). Materials and Methods: A randomized controlled prospective clinical repeated study was carried out 6 months after the previous one, i.e., 1 year after the oral hygiene procedure, among 60 patients divided into two groups. In the first group, professional oral hygiene and bleaching using 25% hydrogen peroxide were performed. In the second group only, oral hygiene was performed. Dynamics of hygienic index of Quigley-Hein modified by S. Turesky was estimated. Results: In the first group, the average value of the hygienic index of Quigley-Hein modified by S. Turesky was significantly lower a year after procedure than before (1.33±0.09 and 2.34±0.14, respectively). In the second group, this index exceeded 2.45 and nearly returned to the initiated level (2.45±0.07 and 2.44±0.08, respectively). Patients underwent professional teeth whitening in the long-term period, and the level of oral hygiene was significantly higher than that in the control group. Conclusion: Professional dental bleaching has good long-term influence on the level of oral hygiene and serves as a significant motivation factor for maintaining health of oral cavity.
Keywords: Oral hygiene index, professional bleaching, professional oral hygiene
|How to cite this article:|
Vlasova N, Samusenkov V, Novikova I, Nikolenko D, Nikolashvili N, Knyazeva M. Influence of professional teeth whitening on oral hygiene: Long-term results. J Int Soc Prevent Communit Dent 2021;11:408-13
|How to cite this URL:|
Vlasova N, Samusenkov V, Novikova I, Nikolenko D, Nikolashvili N, Knyazeva M. Influence of professional teeth whitening on oral hygiene: Long-term results. J Int Soc Prevent Communit Dent [serial online] 2021 [cited 2021 Oct 23];11:408-13. Available from: https://www.jispcd.org/text.asp?2021/11/4/408/322662
| Introduction|| |
Oral hygiene is essential for health of oral cavity; also it is the most important condition of efficiency of treatment and prophylaxis of dental diseases. Level of individual oral hygiene first of all depends on motivation to maintain gained result and also on the level of knowledge of dental care and psycho-motor skills of every patient. Motivation level is sufficiently influenced by social state, psycho-emotional status, gender, and patient age. Wish of having beautiful smile is also one of the motivations for maintaining oral health.
Today, patients are giving much attention to teeth color, so dental bleaching is one of the popular dental procedures.,, According to several studies, correction of esthetic smile properties has good influence on psycho-emotional state and helps to improve life quality of patients.,, Several scientific researches show good influence of dental bleaching on individual oral hygiene right after the procedure and in the period of use of individual home bleaching kits. But, estimation of long-term effects is quite rarely depicted.
Possible influence of dental bleaching on the level of individual oral hygiene is associated with changes of plaque formation due to enamel surface modification after the influence of bleaching agent. Also, it may be associated with direct influence of bleaching agent on microorganisms and stimulation of patients’ motivation in maintaining high level of individual oral hygiene. In the previous study, we have already estimated the influence of dental bleaching on oral hygiene 2 weeks, 1 month, and 6 months after the procedure. This research serves as a continuation of the previous one and demonstrates long-term interaction between dental bleaching and oral hygiene 1 year after the procedure. The purpose of our study is to estimate the influence of dental bleaching on the level of individual oral hygiene the year after the procedure.
| Materials and Methods|| |
At the base of Department of Therapeutic Dentistry of First Moscow State Medical University of I.M. Sechenov (Sechenov University), a randomized controlled prospective clinical study was reperformed. It was performed in the group of 60 patients with diagnosis “Change of color of dental crown” (code of MCB-10), who had already taken part in previous equal study.
Inclusion criteria were: age 21–40 and teeth discoloritis. Non-inclusion criteria were: severe general pathologies (diabetes, neuropsychiatric, and oncological diseases), partial secondary adentia, numerous caries lesions, acute periodontal pathology, prosthetic constructions, sufficient enamel loss resulted from pathological or physiological abrasion, enamel erosions, orthodontics treatment, smoking, pregnancy and lactation, and allergy on used medicines and materials.
Patients, who agreed to take part in the research, were divided into two groups of 30 members each using a simple randomization method, as shown in the previous study. In the second study, the groups were retained and all patients remained under the study.
All patients answered the questionnaire about methods and means of individual oral hygiene once more. In the first group (estimation group), professional oral hygiene and professional dental bleaching were performed 1 year ago using the clinical bleaching system Philips ZOOM! White Speed based on 25% hydrogen peroxide, LED lamp with cold diode origin with function of individual power control, which fully helps to avoid tooth and periodontal tissue overheating. Such lamp does not affect dentin. Another specific property of this system is alkaline gel рН (pН 7.5–8.5) and the presence of amorphous calcium phosphate, reducing post-bleaching teeth hypersensitivity. According to the producer recommendation, this system may be used in the group of patients with teeth hypersensitivity. Dental bleaching system Philips ZOOM! White Speed was used according to the Philips ZOOM! WhiteSpeed recommended company protocol.
The second group (control) contained patients who had undergone professional only oral hygiene at the same time.
All patients were performed professional hygiene and educated to use the Bass method of individual dental hygiene; also they were recommended to use soft toothbrushes and toothpaste with abrasion not more than 70 RDA., Estimation of level of oral hygiene was performed with the index of Quigley-Hein modified by S. Turesky. Vestibular and oral surfaces were colored with solution for indication of dental plaque CURAPROX PCA 260. Plaque value was estimated by the following criteria: 0—plaque absence; 1—a few plaque spots in the cervical region; 2—thin line of plaque in the cervical area (less than 1 mm); 3—line of plaque in the cervical region wider than 1 mm, covering less than 1/3 of the dental crown; 4—plaque covers more than 1/3, but less than 2/3 of the dental crown; 5—plaque covers 2/3 of the dental crown or more.
Estimation of oral hygiene was performed at the first visit, after professional oral hygiene, after 2 weeks, 1 month, 6 months, and 1 year after the procedure. In every case, hygienic index was calculated for all teeth (28 teeth, 56 surfaces), and separately for teeth that underwent professional bleaching (20 teeth, 40 surfaces), and molars (8 teeth, 16 surfaces).
All patients answered 12 questions of the questionnaire developed by the authors one more time on methods and means of individual oral hygiene. The questions in the questionnaire related to the frequency, time, and method of brushing teeth, oral hygiene products used, bleeding gums when brushing teeth, the frequency of consuming coloring food (tea, coffee, etc.), smoking, patient assessment of the state of the oral cavity, compliance with the dentist’s recommendations to improve hygiene oral cavity.
Statistical analysis of gained data was made using SPSS (USA). For data comparison, we used analysis of variance test and t-criteria. Result differences were declared to be statistically true on the level of statistical importance p<0.05.
| Results|| |
Results of estimation of hygienic index are given in [Table 1] and [Figure 1]. As we may see from [Table 1], hygienic index in both groups before the study may be characterized as satisfactory; also there are no statistically significant differences between groups. Besides, we should note that this index is significantly lower at the teeth in esthetically significant area than on molars.
|Table 1: Dynamics of hygienic index Quigley-Hein in Turesky modification (M ± m)|
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|Figure 1: Dynamics of hygienic index in the estimated and control groups|
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After 2 weeks, hygienic index in the first group was characterized as good (it was not higher than 1). In the second group, the index level also improved to 0.934±0.13 after professional oral hygiene and education in individual oral hygiene; therefore, good levels of oral hygiene were maintained, but the average index level was slightly higher than that in the first group. As in the beginning of our study, average index of esthetically significant area was significantly lower than that in the molar region. Six months after the procedure, average hygienic index in the first group stayed significantly lower than that before treatment (1.244±0.11 and 2.34±0.143, p<0.05). In the second group, the treatment index after 6 months became higher than 2.0 and nearly returned to the initial level (2.052±0.063 and 2.44±0.084, respectively).
Year after the procedure, we noted a gradual increase of average hygienic index in both groups, and also we noted permanent significant difference between the first and second groups. According to the repeated study, average hygienic index in Group No. 1 is significantly lower than that at the beginning of the research (1.33±0.09 and 2.34±0.14, p<0.05). In Group No. 2, a year after the beginning of the study, it became higher than 2.45 and returned to initial meanings (2.45±0.07 and 2.44±0.08). In addition, the hygienic index of the front teeth in both groups remained significantly lower than that of the molars.
Questionnaire results showed that before the start of the study, 83.3% of the patients in the first group used additional oral hygiene products, and after bleaching, all patients (100%) began to use mouth rinses, floss, or interdental brushes. Moreover, patients began to use more than one additional personal hygiene product for the oral cavity, but several at once, for example, mouthwash and floss.
In the second group, only 80% of the patients constantly used additional oral hygiene products even after the procedure and dental hygiene training, which slightly exceeded the indicators before the study (77.4%).
The majority of the patients in the first group (94.2%) after the procedure began to brush their teeth more often and longer (twice a day in the morning and in the evening for more than 3 min). Besides, 80% of the patients in the first group limited consumption of coloring products (strong tea, coffee, fuzzy drinks). Such tendencies persisted in patients of this group even 1 year after the bleaching procedure.
In the second group, this tendency was weaker, so only 72.2% brushed their teeth two times a day, in 28.6%, the brushing time did not exceed 3 min. Some patients sometimes forgot to brush their teeth altogether and made up for it with chewing gum, mouthwash, or dental floss. Patients in this group had practically no limited consumption of coloring products.
At the same time, this group showed a decrease in the use of additional oral hygiene products in combination with a decrease in the time for individual oral hygiene 1 year after the procedure.
Thus, the patients of the first group were interested in maintaining the achieved teeth whitening result, which led to a higher oral hygiene index than the initial one, even a year after the procedure.
| Discussion|| |
As a result of repeated randomized, controlled clinical study, we noted that the hygienic index stays significantly lower after professional dental bleaching than that in the control group (1.33±0.09 vs. 2.45±0.07). Even during the year after procedure, we noted strong motivation for saving achieved bleaching results.
It is known that enamel superficial demineralization after bleaching may cause surface roughness and intense plaque formation, respectively. But this effect more likely depends on pH of the used system than on bleaching agent concentration., In this case, Xu et al. noted that pH neutral or alkaline systems do not affect enamel. Ittatirut et al. also think that bleaching systems based on 35% and 25% hydrogen peroxide, on the contrary, decrease enamel surface roughness. Besides, negative effect of bleaching easily decreases due to saliva remineralization activity and use of remineralization therapy in case of professional dental bleaching.
Antibacterial activity of bleaching systems is proved by various clinical studies. Napimoga et al. proved efficiency of the bleaching system against Streptococcus mutans, S. sobrinus, S. sanguinis, and Staphylococcus aureus in the microbiological study. Zheng et al. showed short-term decrease of plaque accumulation and quantity of cariogenic microorganisms after use of bleaching systems based on hydrogen peroxide. In 2014, the same authors proved during laboratory study that antibacterial effect of bleaching systems may be presented for 3 weeks after the procedure, but after this time significant growth of amount of plaque was noted. Gursoy et al. obtained the same results during clinical trials. Patients were offered to avoid individual dental hygiene for 5 days after dental bleaching. Speed of plaque formation during the first 3 days was significantly lower at surfaces, where bleaching agent had been used, than that at intact ones. Five days after the procedure, speed of plague accumulation significantly increased and plaque index was higher in the estimation group that that in the control one.
As far as we can see from the literature mentioned effects may be seen only for a short-term period. The only mechanism of maintaining good level of individual dental hygiene in the long-term period is patients’ motivation to save achieved result. During the last few years, many research works dedicated to patients’ motivation to maintain health and hygiene of oral cavity have been written. The majority of them agree that external motivation is not always effective especially in cases of prophylaxis of periodontal pathology. That is why it is necessary to give much intention to so-called inner motivation—to search for factor which may specifically affect concrete patient.,, In such cases, esthetic education of the surrounding society is quite important, because wish to have beautiful smile forms motivation of improvement of oral hygiene and dental treatment.,
We have found just a few publications dedicated to long-term influence of professional bleaching on individual oral hygiene. For example, Skorinova et al. in 2020 estimated results of home dental bleaching and found no significant differences in hygienic index in the estimated and control groups 6 months after the procedure. Fernández et al. were estimating psycho-emotional status of patients for 9 months after professional bleaching and, on the contrary, noted that bleaching had good influence on esthetic self-estimation of smile and motivated patients in maintaining health of oral cavity.
Good influence of dental bleaching on psycho-emotional status and patients’ life quality was proved in many researches. Bersezio et al.,,, noted this influence on life quality not only during short-time period after procedure, but also 2 years after it. But Meireles et al. add that teeth hyperesthesia may have a negative effect on everyday life of patients right after the procedure. Besides patient’s satisfaction level, after-bleaching effects, first of all, depend on his/her individual and specific features.,
| Conclusion|| |
Therefore, professional dental bleaching has a positive influence on the level of individual oral hygiene in connection with psycho-emotional status and esthetic self-estimation for quite a long time after the procedure. Wish to save achieved result for long time may become important factor of inner patients’ motivation to maintain high level of oral hygiene for stable and long-lasting bleaching result.
This work was supported by the “Russian Academic Excellence Project 5–100.”
Financial support and sponsorship
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflicts of interest
The authors declare that they have no conflict of interest to disclose.
Data gathering and idea owner of this study: Natalia Vlasova. Study design: Vadim Samusenkov and Irina Novikova. Data gathering: Denis Nikolenko and Marina Knyazeva. Writing and submitting manuscript: Nikita Nikolashvili. Editing and approval of final draft: all authors.
Ethical policy and institutional review board statement
All the procedures have been performed as per the ethical guidelines laid down by Declaration of Helsinki (2019) to be mentioned.
Patient declaration of consent
All patients agreed and signed a consent to participate in the experiment.
Data availability statement
All data will be available on request.
| References|| |
Ramsay DS. Patient compliance with oral hygiene regimens: A behavioural self-regulation analysis with implications for technology. Int Dent J 2000;1:304-11. doi:10.1111/j.1875-595x.2000.tb00580.x
Staunton L, Gellert P, Knittle K, Sniehotta FF. Perceived control and intrinsic vs. extrinsic motivation for oral self-care: A full factorial experimental test of theory-based persuasive messages. Ann Behav Med 2015;49:258-68.
Walker K, Jackson R. The health belief model and determinants of oral hygiene practices and beliefs in preteen children: A pilot study. Pediatr Dent 2015;37:40-5.
Carey CM. Tooth whitening: What we now know. J Evid Based Dent Pract 2014;14:70-6. doi:10.1016/j.jebdp.2014.02.006
Martin J, Rivas V, Vildósola P, Moncada L, Oliveira Junior OB, Saad JR, et al
. Personality style in patients looking for tooth bleaching and its correlation with treatment satisfaction. Braz Dent J 2016;27:60-5.
Wilson NHF, Burke FJT, Brunton PA, Creanor S, Hosey MT, Mannocci F. Dental practice in the UK in 2015/2016. Part 2: Aspects of direct restorations, bleaching, endodontics and paediatric dentistry. Br Dent J 2019;226:110-4. doi:10.1038/sj.bdj.2019.50
Klages U, Claus N, Wehrbein H, Zentner A. Development of a questionnaire for assessment of the psychosocial impact of dental aesthetics in young adults. Eur J Orthod 2006;28:103-11.
Meireles SS, Goettems ML, Dantas RV, Bona ÁD, Santos IS, Demarco FF. Changes in oral health related quality of life after dental bleaching in a double-blind randomized clinical trial. J Dent 2014;42:114-21.
Bersezio C, Martín J, Mayer C, Rivera O, Estay J, Vernal R, et al
. Quality of life and stability of tooth color change at three months after dental bleaching. Qual Life Res 2018;27:3199-207.
Sanz-Sánchez I, Oteo-Calatayud J, Serrano J, Martín C, Herrera D. Changes in plaque and gingivitis levels after tooth bleaching: A systematic review. Int J Dent Hyg 2019;17:117-29.
Vlasova NN, Turkina AY, Prokhorov NI, Makeeva MK, Danilina AA, Nikolashvili NI. Effect of professional bleaching on the hygiene of the oral cavity: A randomized controlled study. Hyg Sanitation 2019;98:550-4. doi:10.18821/0016-9900-2019-98-5-550-554
Babina KS. Index assessment of the effectiveness of various means and methods of individual oral hygiene А. Author’s abstract of the dissertation, Moscow: PMGMU named after IM Sechenov; 2014.
Borovskij EV, Makeeva IM, Babina KS. The choice of the method of index assessment of the hygienic state of the oral cavity. Sechenovskiy Vestnik 2013;11:10-14.
Turesky S, Gilmore ND, Glickman I. Reduced plaque formation by the chloromethyl analogue of victamine C. J Periodontol 1970;41:41-3. doi:10.1902/jop.19184.108.40.206
Potocnik I, Kosec L, Gaspersic D. Effect of 10% carbamide peroxide bleaching gel on enamel microhardness, microstructure, and mineral content. J Endod 2000;26:203-6.
Sun L, Liang S, Sa Y, Wang Z, Ma X, Jiang T, et al
. Surface alteration of human tooth enamel subjected to acidic and neutral 30% hydrogen peroxide. J Dent 2011;39:686-92.
Sa Y, Chen D, Liu Y, Wen W, Xu M, Jiang T, et al
. Effects of two in-office bleaching agents with different pH values on enamel surface structure and color: An in situ
vs. in vitro
study. J Dent 2012;40(Suppl 1):e26-34.
Xu B, Li Q, Wang Y. Effects of pH values of hydrogen peroxide bleaching agents on enamel surface properties. Oper Dent 2011;36:554-62.
Ittatirut S, Matangkasombut O, Thanyasrisung P. In-office bleaching gel with 35% hydrogen peroxide enhanced biofilm formation of early colonizing streptococci on human enamel. J Dent 2014;42:1480-6.
Napimoga MH, de Oliveira R, Reis AF, Gonçalves RB, Giannini M. In vitro
antimicrobial activity of peroxide-based bleaching agents. Quintessence Int 2007;38:e329-33.
Zheng CY, Pan J, Wang L, Zhang CF. Effects of hydrogen peroxide-containing bleaching on cariogenic bacteria and plaque accumulation. Chin J Dent Res 2011;14:47-52.
Zheng CY, Pan J, Wang ZH, Wang Y. [Effects of hydrogen peroxide-containing bleaching on the growth of Streptococcus mutans
biofilm on enamel disc surface]. Beijing Da Xue Bao Yi Xue Ban 2014;46:30-4.
Gursoy UK, Eren DI, Bektas OO, Hurmuzlu F, Bostanci V, Ozdemir H. Effect of external tooth bleaching on dental plaque accumulation and tooth discoloration. Med Oral Patol Oral Cir Bucal 2008;13:E266-9.
Gao X, Lo EC, Kot SC, Chan KC. Motivational interviewing in improving oral health: A systematic review of randomized controlled trials. J Periodontol 2014;85:426-37.
Dikopova NZ, Volkov AG, Arakelyan MG, Makarenko NV, Soxova IA, Doroshina VJ, et al
. The study of the electrochemical potentials of metal structures in the oral cavity in diseases of the oral mucosa. New Armen Med J 2020;14:54-8.
Kumar PS, Doshi D, Kulkarni S, Reddy P, Reddy S, Srilatha A. Effect of motivation on oral hygiene and caries status among young adults in Hyderabad city. Indian J Dent Res 2019;30:15-20.
] [Full text]
Lin F, Ren M, Yao L, He Y, Guo J, Ye Q. Psychosocial impact of dental esthetics regulates motivation to seek orthodontic treatment. Am J Orthod Dentofacial Orthop 2016;150:476-82.
Skorinova KD, Kuzmenko VV, Vasilenko IA. The prospect of creating medicines based on selenium nanoparticles (review). Drug Dev Regist 2020;9:33-44. doi:10.33380/2305-2066-2020-9-2-33-44
Fernández E, Bersezio C, Bottner J, Avalos F, Godoy I, Inda D, et al
. Longevity, esthetic perception, and psychosocial impact of teeth bleaching by low (6%) hydrogen peroxide concentration for in-office treatment: A randomized clinical trial. Oper Dent 2017;42:41-52.
Bersezio C, Martin J, Peña F, Rubio M, Estay J, Vernal R, et al
. Effectiveness and impact of the walking bleach technique on esthetic self-perception and psychosocial factors: A randomized double-blind clinical trial. Oper Dent 2017;42: 596-605.
Bersezio C, Ledezma P, Estay J, Mayer C, Rivera O, Fernández E. Color regression and maintenance effect of intracoronal whitening on the quality of life: RCT—A one-year follow-up study. Oper Dent 2019;44:24-33.
Bersezio C, Martín J, Angel P, Bottner J, Godoy I, Avalos F, et al
. Teeth whitening with 6% hydrogen peroxide and its impact on quality of life: 2 years of follow-up. Odontology 2019;107:118-25.
Kirichuk VF, Tsymbal AA, Antipova ON, Tupikin VD, Maǐborodin AV, Krenitskiǐ AP, et al
. Correction of acute stress-induced disorders of hemostasis using the KVCh-NO apparatus. Meditsinskaia Tekhnika 2006;1:29-33. doi:10.1007/s10527-006-0035-5
Kirichuk VF, Tsymbal AA, Antipova ON, Tupikin VD, Maǐborodin AV, Krenitskiǐ AP, et al
. Changes in quality of life induced by tooth whitening are moderated by perfectionism: A randomized, double-blind, placebo-controlled trial. Int J Prosthodont 2018;31:394-6. doi:10.11607/ijp.5499