A comparison of three whitening protocols for mild-to-moderate dental fluorosis in anterior teeth

Abstract

Objective: This research compares the effectiveness of three whitening treatments for mild-to-moderate dental fluorosis in the front teeth.

Method: This retrospective study analysis is based on 51 mild-to-moderate dental fluorosis cases. The patients who visited the Dental Hospital of Ningxia Medical University from August 2020 to August 2021 were enrolled as research cases. The patients were classified into three groups according to their treatment plans: Group A (19 cases), Group B (17 cases), and Group C (15 cases). The upper anterior teeth color was assessed immediately after treatment and then at one week, one month, three months, and six months using the VITA Easyshade^® V shade guide. Tooth sensitivity was evaluated with a visual analog scale (VAS scale).

Results: Three options were applied to treat mild and moderate dental fluorosis. Moderate fluorosis showed higher ΔE and ΔL values but lower Δa and Δb values compared to mild fluorosis, with significant differences noted (P<0.05). In cases of mild dental fluorosis, ΔE and ΔL values from the combination of micro-grinding and home bleaching were significantly higher. Conversely, Δa and Δb values for both micro-grinding with home bleaching and micro-grinding with combined bleaching were significantly lower (P<0.05). In moderate dental fluorosis cases, ΔE and ΔL values were higher for both micro-grinding combined with bleaching and micro-grinding combined with home bleaching. In contrast, Δa and Δb values for micro-grinding combined with bleaching were lower, showing statistically significant differences (P<0.05). The sensitivity of micro-grinding + home bleaching was less than that of micro-grinding + in-office bleaching and micro-grinding + combined bleaching immediately post-op, 1 week after the operation, with statistically significant differences (P<0.05).

Conclusion: All three options achieve sound whitening effects for mild to moderate dental fluorosis in anterior teeth. The whitening effect is more effective in cases of moderate dental fluorosis than in mild cases. Among the three treatment options, microabrasion combined with home bleaching achieves the best whitening effect for mild dental fluorosis and minimizes sensitivity. When considering the three treatment options for moderate dental fluorosis, both microabrasion combined with home bleaching and microabrasion combined with in-office bleaching can yield better whitening effects. However, it is essential to note that the latter option is linked to higher sensitivity.

Keywords: Dental fluorosis; combined bleaching; home bleaching; in-office bleaching; microabrasion; sensitivity.

Figure 1

Comparison of ΔE values at different postoperative time points for different treatment methods, tooth types, and dental fluorosis severity. Note: A: Comparison of ∆E values for different postoperative treatment; B: Comparison of ∆E values between different teeth after treatment; C: Comparison of ∆E values between different severities of postoperative Fluorosis.

Figure 2

The changes in ΔL (A, B), Δa (C, D), Δb (E, F), and ΔE (G, H) at 5 evaluation time points for the three treatment schemes in mild and moderate dental fluorosis. Note: A’: Micro-polishing + In-Office Whitening. B’: Micro-polishing + Home Whitening. C’: Micro-polishing + Combined Whitening. (A) ΔL of mild dental fluorosis. (B) ΔL of moderate dental fluorosis. (C) Δa of mild dental fluorosis. (D) Δa of moderate dental fluorosis. (E) Δb of mild dental fluorosis. (F) Δb of moderate dental fluorosis. (G) ΔE of mild dental fluorosis. (H) ΔE of moderate dental fluorosis.

Figure 3

Comparison of tooth sensitivity at five time points after light and moderate dental fluorosis treatment with three whitening protocols. Note: imm, 1W, 1M, 3M, 6M refer to immediately postoperatively, 1 week, 1 month, 3 months, and 6 months postoperatively, respectively. VAS refers to the median VAS value of patients at different time points after treatment. A: VAS of moderate fluorosis; B: VAS of mild fluorosis.