title: Enamel alteration following tooth bleaching and remineralization.
abstract: The purpose of this study was to compare the effects of professional tooth whitening agents containing highly concentrated hydrogen peroxide (with and without laser activation), on the enamel surface; and the potential of four different toothpastes to remineralize any alterations. The study was performed on 50 human molars, divided in two groups: treated with Opalescence(®) Boost and Mirawhite(®) Laser Bleaching. Furthermore, each group was divided into five subgroups, a control one and 4 subgroups remineralized with: Mirasensitive(®) hap+, Mirawhite(®) Gelleѐ, GC Tooth Mousse™ and Mirafluor(®) C. The samples were analysed by SEM/3D-SEM-micrographs, SEM/EDX-qualitative analysis and SEM/EDX-semiquantitative analysis. The microphotographs show that both types of bleaching cause alterations: emphasized perikymata, erosions, loss of interprizmatic substance; the laser treatment is more aggressive and loss of integrity of the enamel is determined by shearing off the enamel rods. In all samples undergoing remineralization deposits were observed, those of toothpastes based on calcium phosphate technologies seem to merge with each other and cover almost the entire surface of the enamel. Loss of integrity and minerals were detected only in the line-scans of the sample remineralized with GC Tooth Mousse™. The semiquantitative EDX analysis of individual elements in the surface layer of the enamel indicates that during tooth-bleaching with HP statistically significant loss of Na and Mg occurs, whereas the bleaching in combination with a laser leads to statistically significant loss of Ca and P. The results undoubtedly confirm that teeth whitening procedures lead to enamel alterations. In this context, it must be noted that laser bleaching is more aggressive for dental substances. However, these changes are reversible and can be repaired by application of remineralization toothpastes.
authors.affiliation: Department of Paediatric and Preventive Dentistry, Faculty of Dental Medicine, University 'Ss Cyril and Methodius' Skopje, Skopje, Republic of Macedonia.
authors.forename: Emilija
authors.initials: E
authors.lastname: Coceska
authors.affiliation: Department of Paediatric and Preventive Dentistry, Faculty of Dental Medicine, University 'Ss Cyril and Methodius' Skopje, Skopje, Republic of Macedonia.
authors.forename: Elizabeta
authors.initials: E
authors.lastname: Gjorgievska
authors.affiliation: Faculty of Engineering and Science, University of Greenwich, Chatham, Kent, UK.
authors.forename: Nichola J
authors.initials: NJ
authors.lastname: Coleman
authors.affiliation: Faculty of Dentistry, University of Zagreb, Zagreb, Croatia.
authors.forename: Dragana
authors.initials: D
authors.lastname: Gabric
authors.affiliation: Faculty of Engineering and Science, University of Greenwich, Chatham, Kent, UK.
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Slipper
authors.affiliation: Department of Paediatric and Preventive Dentistry, Faculty of Dental Medicine, University 'Ss Cyril and Methodius' Skopje, Skopje, Republic of Macedonia.
authors.forename: Marija
authors.initials: M
authors.lastname: Stevanovic
authors.affiliation: St. Mary's University, Twickenham, London, UK.
authors.forename: John W
authors.initials: JW
authors.lastname: Nicholson
mesh_terms: D002118:Calcium / Q000032:analysis / Q000172:deficiency; D003743:Dental Enamel / Q000737:chemistry* / Q000187:drug effects*; D006801:Humans; D006861:Hydrogen Peroxide / Q000009:adverse effects*; D007834:Lasers; D008274:Magnesium / Q000032:analysis; D008963:Molar / Q000737:chemistry / Q000187:drug effects*; D010758:Phosphorus / Q000032:analysis / Q000172:deficiency; D012964:Sodium / Q000032:analysis / Q000172:deficiency; D014073:Tooth Bleaching / Q000009:adverse effects*; D058205:Tooth Bleaching Agents / Q000009:adverse effects*; D014089:Tooth Remineralization / Q000379:methods; D014100:Toothpastes
chemical_list: D058205:Tooth Bleaching Agents; D014100:Toothpastes; D010758:Phosphorus; D012964:Sodium; D006861:Hydrogen Peroxide; D008274:Magnesium; D002118:Calcium
keywords: Bioactive glasses; CPP-ACP; fluoride; hydroxyapatite; remineralization; tooth whitening