Prashant Babaji1*, Pooja Bhagwat2, Mahesh Melkundi2 and Vanitha Mehta3
Received: November 29, 2018; Published: December 17, 2018
*Corresponding author: Prashant Babaji, Department of Pedodontics, Karnataka, India
In the modern era, aesthetic dentistry is becoming famous. The demand of tooth bleaching is increasing day by day and it has become the treatment of choice for tooth discoloration. If there is deposition of chromatogenic material into dentin and enamel during the tooth development stage or after eruption, it leads to intrinsic tooth discoloration . Among various bleaching techniques for intrinsic tooth discoloration, vital and non-vital bleaching techniques are common one. They use oxidizing agents such as hydrogen peroxide to remove intrinsic stains. They are widely used agents as they have safe to use. These properties have made them popular. Further modifications in these agents have opened multiple options for dentists in managing tooth discoloration . Carbamide peroxide (CP) is a perhydrol-urea and hydrogen peroxide carbamide compound which degrades to urea and hydrogen peroxide. This agent with ‘‘night guard’’ bleaching technique, have proved effective and efficient in providing good results. However, altered surface morphology, decreased microhardness and loss of dental hard tissue volume are among few side effects of bleaching as shown by various authors. 10% CP has been proved to decrease the enamel microhardness as compared to higher level . However, a study performed by Potocnik et al.  found that 10% CP causes local microstructural changes and there is no affect on enamel microhardness. 10% CP is a safest bleaching agent as demineralization is not clinical evident, moreover, it is soon followed by remineralization. Fluoridated bleaching agents are considered to reduce the adverse effects of tooth whitening. Topical fluoride is used to increase the hardness and acid resistance of demineralized teeth. It may be used in tooth sensitivity peripherally by occluding the dentinal tubules and reducing dentinal fluid flow. Hence, fluoride application may be used for treating post-bleaching sensitivity . The present study was conducted to assess the effects of bleaching agents with and without fluoride as well as the post-bleaching fluoridation on bovine surface enamel.
The present study was conducted in the department of Endodontics in year 2015. It included 60 non-carious anterior teeth specimens. The specimens were stored in buffered saline. These teeth were cut into halves using a slow speed rotary saw under water irrigation. After cutting teeth, specimens were embedded in epoxy resin with the labial surface parallel to the horizontal plane. The enamel surfaces were then ground with 320-grit silicon carbide abrasive paper using a mechanical grinder to create a flat surface of approximately 5 mm. The specimens were then smoothed with 600- and 1000-grit silicon carbide abrasive paper and polished with a series of 30, 9, 6 and 1mm diamond suspension. The specimens were then divided into five treatment groups:
a) Group I: It consisted of 12 control specimens soaked in Hank buffer saline solution (HBSS) at 37 degree C for 2 weeks.
b) Group II: It consisted of 12 specimens treated with 10% opalescence fluoride-free bleaching agent.
c) Group III: It consisted of 12 specimens treated with 10% opalescence fluoride-free bleaching agent with additional 2% neutral sodium fluoride gel for 3min.
d) Group IV: It consisted of 12 specimens treated with 10% opalescence PF bleaching agent with 0.11% fluoride.
e) Group V: It consisted of 12 specimens treated with an experimental bleaching agent Ex-037 containing 0.37% fluoride.
The specimens of group II, III, IV and V were bleached 8 h/day X 14 days. The bleaching agents were applied on the enamel and stored at 100% humidity at 37 degree C. Rinsing with tap water was done after application of bleaching agent to each specimen for 1 minute and was stored in HBSS at 37 degree C. The color change, microhardness and surface topography were evaluated after 14 days. The color of each specimen was measured as baseline data on Day 0. The color of each specimen was assessed by the CIE– Lab system in L a b mode using a dental colorimeter. The assessed area was the cervical area, 1 mm occlusal to the cemento-enamel junction. After the bleaching treatment, the specimens were again inspected on Days 7 and 14 to measure the color changes. ‘‘L’’ represents the degree of gray and corresponds to a value of brightness. The ‘‘a’’ is a parameter in the red-green spectrum and ‘‘b’’ is a parameter in the blue-yellow spectrum. The microhardness of the specimens used for color measurement was determined with a microhardness tester. Knoop hardness (KHN) was measured with a Knoop indenter three times at a load of 50g for 5s. Specimens from all groups were examined for the surface morphology change on Day 14. All specimens were thoroughly cleaned and air-dried in a desiccator for 24h. Following the desiccating procedure, the specimens were gold sputtered then observed under a SEM.
The 60 teenagers of the final sample (groups case and control) were distributed, according to age from 14 to 19, in an equal numeric quantity (30), being for each age (<16, and 16 to 19 years) among pregnant and the not pregnant. Most pregnant teenagers were in its first gestation (86.7%), not planned (73.3%), owned a stable union (53.3%) or they were married. In the gestational time that was reported, 40.0% were in the third quarter, 33.3% in the second quarter and 22.7% in the first quarter. When questioned about the perception changes or oral alterations in the last six months until the interview moment, most teenagers affirmed not (53.3%), without statistically significant differences among groups (P>0.05). Gingival bleeding, orofacial pain and tooth ache had superior values, in the group case (P<0.05), but there was no difference between the oral hygiene computed by the teeth brushing daily. A little more of half (53.3%) of the women affirmed brush the teeth twice a day. Considering time elapsed since the last visit or consultation to the dentist were not verified significant differences (P>0.05). The biggest percentile (36.7%) it established for a period lower than a year. We noticed a fear or fright predominance by the pregnant teenagers and of anything worthy it denotes by the not pregnant teenagers. The gestation influence in the women’s oral health and of its offspring has been, for years, odontology researches object, particularly in the Pediatric Dentistry. However, the referred theme still keeps as current and controversial . This if there is observed the diversity of the methodologies, of the results and of the presented conclusions. Regarding the oral terms and the attention priorities for the pregnant teenagers, information gaps prevail; there is much to explore, in the search for scientific evidences with recommendation degrees and representative force, to base the strategies in the health promotion, during the prenatal . Leaving aside the considerations regarding the wish or not of be pregnant of these young women, it is reconciled  regarding the pregnancy planning lack in this stage of the human development, with negligence’s regarding the impact of this condition for life of these persons and of their children.
For a health service adequate orientation, during the prenatal, it should comprehend the teenager, from the interaction between experienced universe by the pregnant and the perception on the changes occurred in her body. In this way, the impact of this appreciation would act as stimulus for the adoption of more healthy habits . According to the results of this study, did not verify significant differences between groups, when argued about alterations in the last six months until the interview moment. That time was determined, because, besides the evidences lack high quality in interval favor of six month or in any other frequency, in the routine odontological exams accomplishment, patient of risk could have subclinical discoveries with the evolution and, consistently significantly shaken severity in this period, the prevention of the biggest damages being made viable by the accompaniment . It is recognized that oral illnesses, of singular way the dental caries, represent the main reason for teenagers’ consultation, in the public network of services in Brazil’s Health . It is worth stressing, however, that in the consultations sector did not occur the odontological attention, but the control of the prenatal in formed team by doctors, male nurses, psychologists and social workers. For Laine , the oral tissues could be affected by the pregnancy, worsening preexisting terms. A significant number of cariogenic microorganisms could increase in the gestation, due to the saliva pH decrease and of the tampon capacity. Changes in the salivate composition last gestacional quarter and during the lactation would predispose, temporarily, to the caries lesions and to the dental erosion, despite the action mechanisms if are not elucidated. There exists the same opinion that Melo et al. , that the alimentary habits, the negligence of the oral hygiene and the low frequency to the dentist can represent risk factors for the caries development and of the periodontal disease in pregnant, in spite, once again, of the effort for homogeneous groups, in the current study.
Regarding the feeling in front of the odontological consultation being more characterized as of fear, anxiety or fright by the pregnant teenagers, it arrives in consonance with Albuquerque, Abegg & Rodrigues . These, by means of qualitative study aiming at barriers comprehension to the odontological assistance of the pregnant, in Municipal districts of Pernambuco’s State, Brazil, related: Access difficulty, popular beliefs that dissuade to search the odontological treatment during the gestation and mostly the fear. This fear associates to the profile of strong and continuous toothache in the pregnancy, with the possibility much discomfort in the element extraction or dental unit. In question concerning about of a special odontological attention for the teenagers interviewees, it reaches an agreement to Costa, Saliba & Moreira , not only regarding the need to surgeon-dentist’s insert in the health team, in the attention during the prenatal, but in the attention in oral health entailed to the programs that attend this age group, by the presented peculiarities and possible benefits to life quality of this population-target.
The pregnancy in adolescence was associated with an increase of gingival bleeding, tooth ache and orofacial pain.
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