Tooth Bleaching and Its Effect on Diagnosing P&F Caries

Tooth whitening is currently one of the most popular cosmetic dental procedures, and pit and fissure caries is one of the most common problems in dentistry. Objectives: This study investigates if tooth whitening has any affect on the shade of pit and fissure stains and whether this alters the dentist's ability to diagnose pit and fissure caries. Methods: Ninety-six extracted molars were randomly divided into six groups for whitening using a 10% carbamide peroxide solution (Opalescence) or a 22% carbamide peroxide solution (Nite White Excel 3), or tap water for a control. Three of the groups utilized reservoirs in their custom bleaching trays, three did not. Twice three participating dentists prior to and following bleaching evaluated the darkest occlusal area of pit and fissure stain for shade and caries into dentin. Measurements were also recorded for the occlusal surface using the DIAGNOdent before and after bleaching. After all evaluations, any areas with suspected caries were prepared using minimally invasive techniques to determine if the suspected carious lesions extended into dentin. Results: Pairwise comparison of average stain shade showed significant lightening of shade for each group treated with one of the bleaching systems (p<0.0005). Bleaching did not result in a significant decrease in number of teeth diagnosed with caries following treatment (p>0.05). DIAGNOdent readings were significantly lowered (mean 7 units, minimum 2, maximum 16) for all teeth (p<0.0005). There was no significant difference in stain shade lightening following treatment between those groups utilizing reservoirs in the custom trays and those without reservoirs (p=0.658). Conclusions: 1) Bleaching lightens pit and fissure stains; 2) DIAGNOdent readings were reduced for all teeth; 3) Custom trays with reservoirs do not effectively contain bleaching solution away from the occlusal surface. Funded by NIDCR grant DE 007057