Dentaltown February 2013 - (Page 96)

cosmetic feature by Rod Kurthy, DMD In the last three articles* you’ve learned about the science of teeth whitening, why problems occur and about how to overcome obstacles to whitening. In this fourth and final article of this series, Dr. Kurthy will discuss how the science of whitening sensitivity can be utilized to reduce the incidence of whitening sensitivity and the steps he has taken to utilize this science. Science-Based Solutions to Whitening Sensitivity Solutions to teeth whitening sensitivity include the following: 1. Creation of whitening gels with the lowest osmolality possible, to reduce the osmotic gradient between whitening gel and dentinal tubular fluid, thereby reducing intratubular fluid flow and sensitivity.16,17,33,34,63,66,80,81,91-93 a. Whitening gels should not only be aqueous,16 but 100 percent aqueous (lowest possible osmolality17,80,91-93). To extend shelf life and aqueous gel stability during storage, constant refrigeration must be used instead of the use of anhydrous gels3,8,14-16,30,32 (anhydrous gels have much stronger osmolality). b. Whitening gels should be entirely neutral or even slightly alkaline (lowest possible osmolality17,80,91-93).16,89 To extend shelf life and neutral gel stability during storage, constant refrigeration must be used instead of adding acidifiers to whitening gels3,8,14-16,30,32 (acidified gels have much stronger osmolality). By utilizing constant refrigeration to lengthen shelf life, instead of using the mentioned chemical stabilizing, not only are the whitening gels more unstable (more effective14-17) when placed in the warm mouth, but the osmolality can be as little as 1/11th that of gels that are chemically stabilized.17,80,91-93 That means 11 times less pull on the dentinal tubular fluid, and therefore significantly less sensitivity. * Visit www.dentaltown.com/rodkurthy to view the three previous articles. 3. 8. 14. 15. 16. 17. 30. 32. 33. 34. 96 Christensen G, Tooth Bleaching, State-of-Art ’97. Clinical Research Associates Newsletter 1997;21(4). McCaslin AJ, Haywood VB, Potter BJ, Dickinson GL, Russell CM. Assessing dentin color changes from nightguard vital bleaching. Journal of the American Dental Association. 1999;130. Andrea Freire, Lucí Regina Panka Archegas, Evelise Machado de Souza, Sérgio Vieira. Effect of storage temperature on pH of in-office and at-home dental bleaching agents. Vol. 22 Nº 1 / 2009 / 27-31 ISSN 0326-4815 Acta Odontol. Latinoam. 2009 Scientific Committee on Consumer Products (SCCP). Opinion on hydrogen peroxide in tooth whitening products 2005. Margeas RC. New advances in tooth whitening and dental cleaning technology. The Academy of Dental Therapeutics and Stomatology Dental Continuing Education Peer-Reviewed Web site. Accessed 2010;March. Papathanasiou A, et al. Clinical evaluation of a 35% hydrogen peroxide in-office whitening system. Comp. 2002;23:335–346. Greenwall, L. Bleaching Techniques in Restorative Dentistry. Martin Dunitz. London: 2001. Chang, R. Quimica. Lisboa (Port): McGraw-Hill; 1994. Gillam DG, Aris A, Bulman JS, et al. Dentine hypersensitivity in subjects recruited for clinical trials: clinical evaluation, prevalence and intra-oral distribution. J Oral Rehabil. 2002;29. Drisko CH. Dentine hypersensitivity: dental hygiene and periodontal considerations. Int Dent J. 2002;52:385-393. FEBRUARY 2013 » dentaltown.com 63. 66. 80. 81. 89. 91. 92. 93. Marvin K. Bright, White, and Sensitive: An Overview of Tooth Whitening and Dentin Hypersensitivity. Dentistry Today.com. 2009 Sept. Pashley DH, Tay FR, Haywood VB, Collins MA, Drisko CL. DENTIN HYPERSENSITIVITY: Consensus-Based Recommendations for the Diagnosis & Management of Dentin Hypersensitivity. Inside Dentistry (supp). 2008 Oct: 4(9) (special issue). Abd-Elmeguid A, Yu DC. Dental Pulp Neurophysiology: Part 1. Clinical and Diagnostic Implications. JADC. 2009;75(1):55. Braennstroem M, Astroem A. A study on the mechanism of pain elicited from the dentin. J Dent Res. 1964;43:619–25. Reeder OW Jr, Walton RE, Livingston MJ, Pashley DH. Dentin permeability: determinants of hydraulic conductance. J Dent Res. 1978 Feb;57(2):187-93. Anderson DJ, Matthews B, Shelton LE. Variations in the sensitivity to osmotic stimulation of human dentine. Arch Oral Biol. 1967; 12(1):43–7. Narhi M, Kontturi-Narhi V, Hirvonen T, Ngassapa D. Neurophysiological mechanisms of dentin hypersensitivity. Proc Finn Dent Soc. 1992; 88 Suppl 1:15–22. Narhi MV, Hirvonen T. The response of dog intradental nerves to hypertonic solutions of CaCl2 and NaCl, and other stimuli, applied to exposed dentine. Arch Oral Biol. 1987;32(11):781–6. http://www.dentaltown.com/rodkurthy http://www.dentaltown.com

Table of Contents for the Digital Edition of Dentaltown February 2013

Dentaltown.com Highlights
Howard Speaks: The SWOT Analysis
Professional Courtesy: Get Off the Hamster Wheel
Continuing Education Update
Second Opinion: Predicting the Future of Dental Amalgam Use and FDA Regulation
Nuts & Bolts Full Arch Case Dissected… Tips, Tricks & Stuff
Employee Embezzlement, Not Sure Which One
Corporate Profile: GC America
Sleep Dentistry Section
Product Profile: Sleep Optima
Breathe Easy: The Advent of CPAP
ACSDD Consortium
Sleep Apnea
Townie Meeting 2013 Last Call!
Do-it-Yourself Finance, Part III: Debt
The Most Effective Presentation Process Ever
“Patient Friendly Dentistry” to the Rescue
Does Kissing Affect Oral Health?
Can Groundhog Day Make a Difference?
Top 10 Tips to a Successful Practice Start-up
How to Build Up the Perfect Tooth
Why We See Problems with Teeth Whitening: The Science of Whitening Part IV – Whitening Sensitivity Solutions
Continuing Education: Full-Arch Appliance Use for Nighttime Parafunction Management
Ad Index
In This Issue: Implants Are Growing in Popularity
Perio Reports
Continuing Education: A.I.M. for Implant Success
Scaling on Patients with Implants
Dentally Incorrect

Dentaltown February 2013