College of Dental Medicine, Western University of Health Sciences, 309 E. Second St., Pomona, CA 91766-1854, USA.
J Am Dent Assoc. 2010 Jun;141(6):639-46. doi: 10.14219/jada.archive.2010.0251.
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.
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.
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.
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.
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.
在有特殊护理需求的患者中，牙菌斑的积累以及由此导致的龋齿或牙周病是一个常见问题。托盘应用的 10%过氧化脲（CP）是一种牙齿漂白剂，对菌斑、牙龈健康和龋齿有积极作用。
作者回顾了 CP 的抗菌特性以及 CP 对唾液、菌斑、龋齿和牙龈健康的影响。他们还回顾了托盘制作的选择和技术、应用方法、安全性和副作用。最后，他们解决了在特殊护理患者中使用托盘应用 CP 材料所涉及的挑战和研究需求。
在他们的文献回顾和临床经验中，作者发现，在定制托盘内使用 10% CP 对口腔卫生状况较差的患者的龋齿有显著疗效。通过 CP 的尿素成分引起的唾液和菌斑 pH 值升高，以及通过物理去垢和过氧化氢的直接化学作用产生的可能的抗菌作用，CP 抑制菌斑和控制龋齿。
托盘应用的 10% CP 可能为改善许多特殊护理患者的口腔健康带来巨大希望，包括老年患者、癌症患者和口干患者。需要进一步的研究来验证潜在的益处、具体的治疗时间和方案以及最具成本效益的产品，以用于各种患者群体。
在定制托盘内应用 10% CP 可能通过将 pH 值升高到龋齿过程发生的水平以上来减少龋齿，同时还可以对牙齿进行去垢并改善牙龈健康。
