Brighter teeth without bleaching?

Brighter teeth without bleaching?

By Rabia Mughal, Contributing Editor

November 13, 2008 -- A perfect pearly white smile is a priority for many patients, and that usually means a dose of at-home or in-office bleaching. But what about situations in which bleaching is not an option?

One possible treatment in such cases is "tooth lightening." Developed in 2000 at the University of Queensland in Brisbane, Australia, this technique avoids peroxide altogether, instead relying on remineralization to change tooth color.

“It's a partner to whitening, not an alternative.”

Basically, a dentist or hygienist polishes and smoothes the tooth surface, making it reflect more light and appear brighter. This is followed by at-home remineralization therapy to strengthen enamel.

"There is no oxidation chemistry at work; rather, it is remineralization chemistry, so the enamel and dentin color is not changed dramatically," said Laurence J. Walsh, Ph.D., D.D.Sc., the head of dentistry at the University of Queensland and an inventor of the technique, in an interview with DrBicuspid.com. "It's a partner to whitening, not an alternative."

The concept exploits the optical properties of the tooth, particularly the enamel, and the influence of water present in the enamel.

"The scientific foundations of the tooth-lightening concept rest largely on altering the short wavelength (blue) scatter of enamel and reducing its transmission of yellow light," Dr. Walsh wrote in Australasian Dental Practice (March/April 2008, Vol. 192, pp. 48-50). "The more porous the enamel, the less it scatters short (blue) wavelengths of light. The more the enamel scatters blue light, the lighter it appears."

During the procedure, the patient first receives a gentle microabrasion procedure using 37% phosphoric acid etching for 20 seconds, followed by gentle application of flour of pumice or graded abrasive pastes at low rotational speeds. This process enhances not only the scatter of the shorter wavelengths but also the subsequent subsurface mineral changes, Dr. Walsh explained in the article.

The patient then uses MI Paste each night immediately before bed for at least two weeks. This process results in a reduced yellow transmission and increased backscatter of blue light from the enamel, making teeth appear brighter, he explained furthur in the article.

MI paste contains Recaldent, which is touted by makers to have remineralization qualities -- a claim that has been refuted by many researchers but upheld by others.

Where did the idea for tooth lightening come from?

"When we began working with topical preparations of Recaldent about eight years ago, we realized that several changes in the optical properties of enamel occurred," Dr. Walsh said. "We were interested in applications of this material for altering enamel, and when we started to analyze before/after images of patients we had treated to reverse their enamel demineralization, it became clear that there were other effects as well as reducing the areas of opacity."

The tooth-lightening procedure can be used on patients with minor enamel opacities prior to whitening to achieve a consistent enamel shade, explained Dr. Walsh.

"We also use the lightening method on patients with very light baseline shades, such as A1 or B1, to maximize the reflective light appearance of their teeth -- since there would be limited benefit in attempting whitening in such patients," he said.

According to Dr. Walsh, likely candidates for tooth lightening include:

• Patients with mild fluorosis
• Patients who have small enamel opacities from previous whitening treatments that have caused overbleaching
• Patients who have just been debanded after fixed orthodontic treatment
• Pediatric patients, who you would not consider for bleaching treatment

The technique was developed in Australia and has been in clinical use there for many years. It is also popular in Southeast Asia and New Zealand, Dr. Walsh explained. However, it has yet to garner much attention in the U.S.

Edward J. Swift Jr., D.M.D., M.S., professor and chair of the department of operative dentistry at University of North Carolina at Chapel Hill and associate editor of the Journal of Esthetic and Restorative Dentistry, told DrBicuspid.com that he had not heard of tooth lightening and so could not comment on it.

Lynn Ramer, L.D.H., president-elect of the American Dental Hygienists' Association, said that patients should ask their oral healthcare professional about all whitening options and whether they are an ideal candidate for this procedure.

"Experts agree that peroxide is usually the way to go," she added.

300,000 patient records hacked at Florida dental college

300,000 patient records hacked at Florida dental college

By DrBicuspid Staff

November 12, 2008 -- University of Florida officials have notified about 330,000 current and former dental patients that an unauthorized intruder recently accessed a College of Dentistry computer server storing their personal information, according to a university press release.

The breach was discovered October 3, while college information technology staff members were upgrading the server and found software had been installed on it remotely.

Information stored on the server included names, addresses, birth dates, Social Security numbers, and, in some cases, dental procedure information for patients dating back to 1990.

While there is no evidence the intruder has used any confidential information stored on the server for fraudulent purposes, letters were sent to patients to alert them of the breach. The mailings included a brochure listing preventive steps they can take to obtain copies of their credit reports and avoid identity theft or other illegal uses of their personal data.

"It's unfortunate that, like many large institutions, we were targeted. We work hard to continually fine-tune our security protections, and maintaining our patients' trust and confidence is of utmost importance," said Teresa Dolan, dean of the University of Florida College of Dentistry. "We cannot stress enough how seriously we take this matter. As soon as we learned of this situation, we launched an investigation and implemented additional safeguards designed to protect personal information."

FBI officers are also investigating the data security breach.

Dental implants effective for orthodontic treatment

Dental implants effective for orthodontic treatment

By DrBicuspid Staff

November 12, 2008 -- Orthodontists have been straightening teeth for decades, relying on the ancient physics principle "every action has a reaction," in which tooth displacement in one part of the jaw causes movement on the other as well.

Use of dental implants as orthodontic anchors, however, is changing that principle by expediting treatment times and expanding possibilities for previously untreatable cases, according to research presented at the 2008 American Academy of Implant Dentistry (AAID) meeting taking place in New Orleans this week.

"Dental implants are changing the way orthodontics is being practiced," said Frank Celenza, D.D.S., an associate clinical professor at the New York University College of Dentistry, in an AAID press release. "In conventional orthodontics, teeth are used to move other teeth, but implants can serve as excellent anchors from which force is applied to move the targeted teeth without causing shifts in other teeth."

In his plenary session presentation, Dr. Celenza explained that the use of implants as sources of orthodontic anchorage is a powerful technique that has just begun to be explored. "In our studies, we're already seeing cases in which implants simplify and streamline orthodontic therapy, decrease treatment times, and eliminate dependence on patient compliance in making adjustments and wearing orthodontic appliances," he said.

"Because the anchor systems are so much more predictable and stronger when implants are incorporated, the temporal sequencing of tooth movements is eliminated and teeth can be moved en masse or all together," Dr. Celenza said. "Consequently, treatment times easily can be reduced by a third."

Dr. Celenza added that implants can be used in any orthodontic case that requires tooth replacement, as well as for fully dentate patients. "Cases progress faster when implants are used as anchorage, but not because teeth are subject to higher force levels. Rather, it's is the result of a more efficient appliance design that provides the ability to move multiple teeth simultaneously rather than individually, as is necessary in conventional orthodontics," he said.

Dental implants also make it possible for some patients to receive orthodontic treatment that previously would not be feasible. "Patients with severe orthodontic deformities now can be re-evaluated to determine if orthodontic dental implants could provide successful outcomes," Dr. Celenza said. "In one case of a 63-year-old woman with severe protrusions and very unattractive dentition, I was able to retract her entire maxillary dentition, which improved overall alignment and facial profile and achieved a very impressive and satisfying result with relative ease."