The Effects of Etching,Micro-abrasion,and Bleaching on Surface Enamel

Abstract

Conservative techniques for improving the appearance of discolored teeth have become popular in the past decade. These include: in-office bleaching with 30% hydrogen peroxide, which is applied on etched enamel with a gauze pad and then exposed to a bleaching light; home bleaching with a mild form of peroxide, such as 10% carbamide peroxide, which is applied on the tooth surface with custom-made mouthguards; and enamel micro-abrasion with 18% hydrochloric acid, which is applied in a pumice slurry. In this study, the in-office bleaching and enamel micro-abrasion techniques were performed on extracted teeth for investigation of their microscopic effects on the surface enamel. Specimens treated only with 37% phosphoric acid showed an enamel loss of 5.7 ± 1.8 μm. The specimens treated with 37% phosphoric acid followed by 30% hydrogen peroxide showed enamel loss of 5.3 ± 1.6 μm; this loss was probably not caused by the hydrogen peroxide, but rather by the etching with 37% phosphoric acid which preceded the hydrogen peroxide application. A direct application of 18% hydrochloric acid for 100 s resulted in a loss of 100 ± 47 μm. The extent of enamel loss was much greater when the 18% hydrochloric acid was applied in a pumice slurry for the same period of time (360 ± 130 μm), and the effect was time-dependent. Thus, the pumice and rotary prophy cup used in conjunction with the 18% hydrochloric acid contributed markedly to the loss of surface enamel, enhancing the non-selective stain-removing action of the hydrochloric acid. Therefore, the hydrochloric acid-pumice technique must be used clinically with caution.

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References

Ames JW ( 1937). Removing stains from mottled enamel. J Am Dent Assoc 24:1674-1677.

Arens DE , Rich JJ , Healy HJ (1972). A practical method of bleaching tetracycline-stained teeth. Oral Surg 34:812-817.

Arwill T. , Myrberg N. , Soremark R. (1969). Penetration of radioactive isotopes through enamel and dentine II. Transfer of 22Na in fresh and chemically treated dental tissues . Odontol Revy 20:47-54.

Atkinson HF (1947). An investigation into the permeability of human enamel using osmotic methods. Br Dent J 83:205-214.

Bailey RW , Christen AG (1968). Bleachingofvital teeth stained with endemic fluorosis . Oral Surg 26:871-878.

Baumgartner JC , Reid DE , Pickett AB (1983). Human pulpal reaction to the modified McInnes bleaching technique. J Endo 9:527-529.

Beckelman JH , Gingold NL (1964). Developmental dental defects associated with systemic tetracycline therapy-review of literature and case report. NY State J Dent 34:377-380.

Bertolotti RL , Lacy AM ( 1988). Treatment of discolored vital teeth: bleaching and laminate veneers. In: Wei SHY , editor. Pediatric dentistry: total patient care. Philadelphia (PA): Lea & Febiger, 246-247.

Bevelander G. , Nakahara H. (1966). The effect of diverse amounts of tetracycline on fluorescence and coloration of teeth. J Pediatr 68:114-120.

10.

Black GV , McKay FS (1916). Mottled teeth: an endemic developmental imperfection of the enamel of the teeth heretofore unknown in the literature of dentistry . Dent Cosmos 58:129-156.

11.

Bowles WH , Ugwuneri Z. (1987). Pulp chamber penetration by hydrogen peroxide following vital bleaching procedure. J Endo 3:375-377.

12.

Chandra S. , Chawla TN (1975). Clinical evaluation of the sandpaper disk method for removing fluorosis stains from teeth. JAm Dent Assoc 90:1273-1276.

13.

Christensen GJ (1978). Bleaching vital tetracycline stained teeth. Quint Int 9:13-19.

14.

Colon PG (1971). Removing fluorosis stains from teeth. Quint Int 2:89-93.

15.

Colon PG (1973). Improving the appearance of severely fluorosed teeth. J Am Dent Assoc 86:1329-1331.

16.

Croll TP (1989). Enamel microabrasion: the technique. Quint Int 20:395-400.

17.

Croll TP (1990). Enamel microabrasion for removal of superficial dysmineralization and decalcification defects. J Am Dent Assoc 120:411-415.

18.

Croll TP , Cavanaugh RR (1986a). Enamel color modification by controlled hydrochloric acid-pumice abrasion. I. Technique and examples. Quint Int 17:81-87.

19.

Croll TP , Cavanaugh RR (1986b). Enamel color modification by controlled hydrochloric acid-pumice abrasion. II. Further examples. Quint Int 17:157-164.

20.

Eisenberg E. , Bernick SM (1975). Anomalies of the teeth with stains and discolouration . J Prev Dent 2:7-20.

21.

Jablonski NG , Quackenbush LE , Lee SL , Dimmer A. , McKenna Jji , McDonald DF , Renson CE , Fearnhead RW (1986). Establishment of a large collection of extracted teeth for research. J Dent Res 65:123-124.

22.

Jordan RE , Boksman L. (1984). Conservative vital bleaching treatment of discolored dentition. Compend Contin Educ Dent 5 :803-808.

23.

Kendell RL (1989). Hydrochloric acid removal of brown fluorosis stains: clinical and scanning electron micrographic observations. Quint Int 20:837-839.

24.

King NM , Wei Shy (1986). Developmental defects of enamel: a study of 12-year-olds in Hong Kong. J Am Dent Assoc 112:835-839.

25.

McCloskey RJ (1984). A technique for removal of fluorosis stains. J Am Dent Assoc 109:63-64.

26.

McEvoy SA (1989a). Chemical agents for removing intrinsic stains from vital teeth. I. Technique development. Quint Int 20 :323-328.

27.

McEvoy SA (1989b). Chemical agents for removing intrinsic stains from vital teeth. II. Current techniques and their clinical application. Quint Int 20:379-384.

28.

Mello HS (1967). The mechanism of tetracycline staining in primary and permanent teeth. J Dent Child 34:478-487.

29.

Nathanson D. , Parra C. (1987). Bleaching vital teeth: a review and clinical study . Compend Contin Educ Dent 8:490-497.

30.

Pang KM , Mok YC , Tong SM , King NM ( 1989). The effect of bleaching on the morphology of surface enamel. In: Fearnhead RW, editor. Tooth enamel V. Proceedings of the Fifth International Symposium on the Composition, Properties, and Fundamental Structure of Tooth Enamel, and Related Tissues, 21-25 Aug 1989, Yokohama. Yokohama (Japan): Florence, 519-523.

31.

Powell KR , Craig GG (1982). A simple technique for the aesthetic improvement of fluorotic-like lesions. J Dent Child 49:112-117.

32.

Raper HR , Manser JG (1941). Removal of brown stain from fluorine mottled teeth . Dent Digest 47:390-396.

33.

Seale NS , Thrash WJ (1985). Systematic assessment of color removal following vital bleaching of intrinsically stained teeth. J Dent Res 64:457-461.

34.

Smith HV , McInnes JW (1942). Further studies on methods of removing brown stain from mottled teeth. J Am Dent Assoc 29:571-576.

35.

Susman HS (1959). Bleaching excessively fluorosed anterior teeth . Dent Digest 65:248-249.

36.

Tong Lsm , King NM ( 1991). A simple acid-pumice enamel microabrasion technique for removal of superficial discolouration. Asian Pacific Dent Fed Newsletter XX (Apr): 5,7.