Use of tray-applied 10 percent carbamide peroxide gels for improving oral health in patients with special-care needs.
BACKGROUND
Plaque accumulation and resulting caries or periodontal disease is a frequent problem in patients with special-care needs. Tray-applied 10 percent carbamide peroxide (CP) is a tooth-bleaching agent that has positive effects on plaque, gingival health and caries.


METHODS
The authors review the antibacterial properties of CP and the effects of CP on saliva, plaque, caries and gingival health. They also review tray fabrication options and techniques, application methods, safety and side effects. Finally, they address the challenges involved in and research needed regarding use of tray-applied CP materials in special-care patients.


RESULTS
In their literature review and clinical experience, the authors found 10 percent CP delivered in a custom-fitted tray to be an effective treatment for caries in patients with compromised oral hygiene. Plaque suppression and caries control result from a CP-induced increase in salivary and plaque pH caused by CP's urea component, and from possible antimicrobial action via physical debridement and the direct chemical effect of hydrogen peroxide.


CONCLUSIONS
Tray-applied 10 percent CP may hold great promise for improving the oral health of many special-care patients, including elderly patients, patients with cancer and patients with dry mouth. Further research is needed to verify the potential benefits, specifics of treatment times and protocols and most cost-effective products for use in various patient groups.


CONCLUSIONS
Application of 10 percent CP in a custom-fitted tray may reduce caries by elevating the pH above the level at which the caries process can occur, in addition to debriding the teeth and improving gingival health.
Lazarchik
David A
DA
College of Dental Medicine, Western University of Health Sciences, 309 E. Second St., Pomona, CA 91766-1854, USA. dlazarchik@westernu.edu
Haywood
Van B
VB
D000287:Administration, Topical; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D000077463:Carbamide Peroxide; D002327:Cariostatic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003731:Dental Caries / Q000517:prevention & control; D003773:Dental Plaque / Q000517:prevention & control; D006233:Persons with Disabilities; D005782:Gels; D005881:Gingiva / Q000187:drug effects; D006801:Humans; D006863:Hydrogen-Ion Concentration; D009909:Oral Health; D009910:Oral Hygiene; D010545:Peroxides / Q000008:administration & dosage / Q000627:therapeutic use*; D012463:Saliva / Q000187:drug effects; D014508:Urea / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000891:Anti-Infective Agents, Local; D002327:Cariostatic Agents; D005782:Gels; D010545:Peroxides; D000077463:Carbamide Peroxide; D014508:Urea