Kugel Gerard, Ferreira Susana
Tufts University School of Dental Medicine, USA.
J Mass Dent Soc. 2005 Winter;53(4):34-7.
Although tooth whitening is one of the most popular dental procedures, it is also one of the least understood. We are still unclear as to its mechanism of action. There is little data as to the effects of both concentration and dose on outcome. The techniques for measuring color change have been brought into question. The cause(s) of sensitivity and the effects of long-term exposure to hydrogen peroxide are not clear. The issue of rebound in color has not been well examined, and issues related to maintenance of the whitening effect are also poorly understood. The immediate placement of composite resin on bleached teeth has been controversial. According to a study evaluating the shear bond strength of composite restorations placed on bleached and nonbleached teeth, there was no statistically significant difference when the composites were placed at 24 hours, 48 hours, four days, or six days. A different study, which evaluated the effects of take-home bleaching systems on enamel surfaces, suggests that a period of four days must elapse before bonding to a tooth bleached with a peroxide material, while no delay is necessary for a non-peroxide-based bleaching system. Most recently, there has been a push to find ways to accelerate and improve the delivery of the whitening process. These include the application of a number of different light sources believed to accelerate the breakdown of peroxide and thus speed up the whitening process. However, the research in this area has been controversial, with publications having quite different conclusions as to the efficacy of light-activated bleaching. Finally, the issues of adverse events and possible side effects were reviewed. The toxicological side effects of tooth bleaching systems seem to be minimal. However, tooth sensitivity can be quite significant. Although its causes are poorly understood, tooth sensitivity is most often seen as the result of tooth dehydration. So while patient demand for tooth whitening is at an all-time high, and dentists have more options for treatment, it's important that dentists evaluate which of these options is most ideal for their patients, factoring in the patients' cost and time issues, as well as sensitivity to the procedure.
尽管牙齿美白是最受欢迎的牙科治疗手段之一，但也是人们了解最少的治疗手段之一。我们仍不清楚其作用机制。关于浓度和剂量对治疗效果的影响，几乎没有相关数据。测量颜色变化的技术也受到了质疑。敏感度的成因以及长期接触过氧化氢的影响尚不清楚。牙齿颜色反弹的问题尚未得到充分研究，与美白效果维持相关的问题也了解甚少。在漂白后的牙齿上立即放置复合树脂一直存在争议。根据一项评估放置在漂白和未漂白牙齿上的复合修复体剪切粘结强度的研究，当在24小时、48小时、四天或六天后放置复合材料时，没有统计学上的显著差异。另一项评估家用漂白系统对牙釉质表面影响的研究表明，在用过氧化物材料漂白牙齿后，必须经过四天才能进行粘结，而对于非过氧化物基漂白系统则无需延迟。最近，人们一直在努力寻找加速和改善美白过程的方法。这些方法包括应用多种不同的光源，据信这些光源能加速过氧化物的分解，从而加快美白过程。然而，该领域的研究一直存在争议，不同的出版物对于光激活漂白的效果得出了截然不同的结论。最后，对不良事件和可能的副作用问题进行了综述。牙齿漂白系统的毒理学副作用似乎很小。然而，牙齿敏感度可能会相当明显。尽管其成因尚不清楚，但牙齿敏感度最常被视为牙齿脱水的结果。因此，虽然患者对牙齿美白的需求空前高涨，牙医也有更多的治疗选择，但重要的是，牙医要考虑患者的成本和时间问题以及对治疗的敏感度，评估哪种选择对患者最为理想。
