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Editorial

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  The dental profession is evolving rapidly, integrating new technologies and methods to improve patient care. As demand for dental bleaching grows, it is essential to provide treatments that prioritize both safety and efficacy. This special issue of the American Journal of Dentistry presents the latest research and ethical considerations in dental bleaching, examining the intersection of technological innovation, natural whitening options, and ethical standards.

      The articles in this issue underscore the importance of safety and effectiveness in dental bleaching. Recent advance-ments, from artificial intelligence to optimize protocols to new methods like violet LED bleaching and non-peroxide based dental bleaching have transformed treatment options. However, each innovation requires rigorous clinical testing and research to ensure it meets safety and efficacy standards across diverse patient populations.

      On the other end, the rising popularity of natural remedies and  over-the-counter  products,  such  as  pineapple enzymes, banana peels, and charcoal toothpaste, poses both opportunities and challenges. Many patients perceive these alternatives as safer or more natural, yet, as the research in this issue suggests, their efficacy varies, and long-term effects are still uncertain.

      Ethical considerations are central to responsible dental bleaching practices. With numerous treatment options available, informed consent is crucial. Dentists must thoroughly explain the benefits and risks of each option, including potential enamel erosion, tooth sensitivity, and soft tissue damage.

      As such, dental professionals play a key role in educating patients on these trends, helping them distinguish between anecdotal successes and evidence-based treatments. It is our hope that this special issue will guide the clinician in making evidence-based choices and recommendations.

 

 

 

Daniel C.N Chan, DMD, MS, DDS

So Ran Kwon, DDS, MS, PhD, MS

Michael Meharry, DDS, MS

 

 

 

 

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                                                                                                                                                 Review Article

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Ethical considerations in dental bleaching: Patient rights, informed consent, and professional responsibility

 

Megha Rao, mds, bds  &  Subrata Saha, phd

 

Abstract: Dental bleaching, a popular cosmetic procedure projected to drive a global industry worth USD 10.6 billion by 2030, necessitates thorough ethical consideration, including patient rights, informed consent, and professional responsibility. Dentistry's commitment to patient well-being requires balancing esthetic goals with ethical principles of beneficence, non-maleficence, autonomy, and justice. Ethical frameworks, rooted in documents like the Nuremberg Code and the Declaration of Helsinki, guide dental practice. Bleaching agents such as hydrogen peroxide and carbamide peroxide break down chromogenic molecules to whiten teeth. Despite general safety under professional supervision, ethical concerns include ensuring informed consent, managing expectations, and preventing overuse. Access and equity issues reveal disparities in dental bleaching availability, influenced by socioeconomic status and insurance coverage, affecting self-esteem and well-being. Addressing these requires systemic interventions, expanded coverage, and promoting acceptance of diverse dental appearances. For minors and vulnerable populations, careful assessment of bleaching appropriateness is necessary, considering dental maturity and psychological implications. Responsible disposal of bleaching agents is crucial to mitigate environmental risks. (Am J Dent 2025;38 Sp Is A:4A-8A).

 

 

 

 

Mail: Dr Megha Rao, Department of Restorative Dentistry, University of Washington School of Dentistry, Seattle, WA 98105, USA.  E-mail:  raomegha@uw.edu

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                                                                                                                                                   Review Article

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Artificial intelligence’s role in dentistry and dental bleaching

 

Ken Hooi, bds, mdsc, Chao Dong, ms  &  Daniel C. N. Chan, dmd, ms, dds

 

Abstract: This article has two aims: (1) To review the role of artificial intelligence (AI) in dentistry and teeth whitening. This is completed via discussion of technical descriptions, accuracy of AI, patients’ trust in AI, teledentistry, benefits and risks of AI, and teeth whitening color and interpretation; and (2) To introduce a new project developed by the School of Dentistry, University of Washington (UW), one which enables access to datasets of images acquired through clinical treatment with patients, to those individuals and organizations interested in research and development of AI systems in teeth whitening. Access to the data repository is publicly available as a global online service, free of charge. A detailed synopsis of the 70-year history of AI is provided for comprehensive technical, social and clinical context of technologies and innovations previously and currently available commercially, and for those reported in dental and health care scientific literature. The UW project is relevant during this time where unprecedented levels of interest exist in esthetic dentistry, the technological progress and social impacts of artificial intelligence, and readily available datasets of actual patient outcomes. (Am J Dent 2025;38 Sp Is A:9A-15A).

 

 

Mail: Dr. Ken Hooi, Kingsway Prosthodontics, Kingsway Specialist Medical Centre, Unit 19/Level 4/Suite 407, 531-533 Kingsway, Miranda NSW 2228, Australia.  E-mail:  ken.hooi@gmail.com

 

 

 

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                                                                                                                                             Research Article

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Efficacy of natural teeth whitening remedies: Pineapple and banana

 

Stephanie Lee, rdh,  Desiree Mercado, rdh,  Cristina Feceu, rdh,  Camille Davalos, rdh, Nadia Rahgozar, rdh,  Udochukwu Oyoyo, mph  &  So Ran Kwon, dds, ms, phd, ms

 

Abstract: Purpose: To determine how effective plant-based natural teeth whiteners are in comparison to the gold standard of at-home teeth whiteners. Methods: Human molars (N= 64) were embedded and placed in artificial saliva. Experimental groups consisted of NC: Negative control consisting of immersion in water for 5 minutes; PA: Rubbing teeth with pineapple core for 5 minutes; BA: Rubbing teeth with a banana peel for 5 minutes; HW: 10% carbamide peroxide in custom-fitted tray for 8 hours. All groups were treated for 10 days and consisted of 16 specimens each. The Kruskal-Wallis test was used to assess the difference in overall color change among groups at alpha= 0.05. Results: Lightness and chroma measured at 1 day and 1 week post whitening showed a statistically significant difference among the groups (P< 0.001). Only HW and PA showed an increase in lightness and a decrease in chroma. Overall color change was highest for HW followed by PA, BA, and NC. (Am J Dent 2025;38 Sp Is A:16A-19A).

 

 

 

Mail: Dr. So Ran Kwon, School of Dentistry, Loma Linda University, 11092 Anderson St. Loma Linda CA 92350, USA. E-mail: sorankwon@llu.edu

 

 

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                                                                                                                                             Research Article

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Effect of brushing using different dentifrices on discoloration and roughness of resin composites with different compositions

 

Patrick Nabholz, dds,  Jeffery Scott Nordin, dds, ms,  Brian R. Morrow, ms &  Franklin Garcia-Godoy, dds, ms, phd, phd

 

Abstract: Purpose: To evaluate the changes in color, translucency, roughness, and depth loss of various composites with different formulations (Filtek One Bulk Fill, Admira Fusion X-tra Bulk-fill, and XRV Herculite) after toothbrushing using dentifrices containing charcoal and charcoal-free. Methods: 32 resin composite discs (8.0 x 1.5 mm) were prepared for each Filtek One Bulk Fill, Admira Fusion X-tra Bulk-fill, and XRV Herculite. Discs were evaluated with a spectrophotometer for color and roughness measurements before and after treatments. Sample treatment included toothbrushing on a V-8 toothbrushing machine for 10,000× to simulate daily oral care with four different dentifrices (Colgate Total SF, Crest Pro-Health Complete Protection Intensive Cleaning+Whitening, Colgate Total Whitening Charcoal, and Crest Charcoal 3D White). After toothbrushing, color (ΔE₀₀), roughness (Ra and Rz), depth loss (DL), and translucency (TP₀₀, and ΔTP₀₀) were remeasured and deduced from initial measurement for the standard difference in each respective parameter. Data were calculated and statistically analyzed independently using a two-way repeated measures ANOVA and Holm-Sidak post-hoc test with P< 0.05 significance. Results: Admira and Filtek, when brushed with Colgate Total SF resulted in less roughness and DL when compared to both charcoal dentifrices. Admira was found slightly rougher than Herculite and Filtek with Crest Pro-Health and similar to both charcoal groups. However, Admira with Crest Pro-Health was similar to Herculite and Filtek but significantly different from both charcoal groups. All dentifrices had a significant staining effect on all composites relative to the baseline color. Admira and Filtek composites were above the clinical acceptance threshold (AT) of 1.8 for ΔE₀₀, with Herculite only surpassing the limit with Crest Charcoal. Lastly, Herculite with all dentifrices was below the clinical perceptibility threshold (PT) for translucency difference. Both Admira and Filtek were above the ΔTP₀₀ PT but less than the AT for all dentifrices except Colgate Charcoal. (Am J Dent 2025:38 Sp Is A:20A-25A).

 

 

 

 

Mail: Dr. Franklin Garcia-Godoy, Department of Bioscience Research, College of Dentistry, University of Tennessee Health Science Center, 875 Union Ave, Memphis, TN  38163 USA.  E-mail: fgarciagodoy@gmail.com

 

 

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                                                                                                                                             Research Article

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Color change, intrapulpal temperature variation, and surface roughness of different bleaching protocols associated with violet LED

 

Bruna Almeida Resende, dds, msc Matheus Kury, dds, msc, phd, Mayara Zaghi Dal Picolo, dds, msc, phd, Roberta Tarkany Basting, dds, msc, phd  &  Vanessa Cavalli, dds, msc, phd

 

Abstract: Purpose: To evaluate the laboratory color change, intrapulpal temperature variation and enamel surface roughness after tooth bleaching using violet LED light (LED), with or without high concentration bleaching gels. Methods: Dental crowns of bovine incisors were submitted to whitening protocols: Control (without treatment), 35% hydrogen peroxide (HP) and 37% carbamide peroxide (CP) associated or not with LED (LED/HP and LED/CP) or only LED. The whitening protocol consisted of three sessions of bleaching gels application for 30 minutes every 7 days or eight sessions with LED protocol. Groups (n= 10) were assessed for color (ΔE₀₀) and whiteness index changes (ΔWI_D), temperature variation (Δ˚C) and surface roughness (Ra), prior to the beginning of the whitening treatment, in the last session and 14 days later. Data were analyzed by generalized linear models, Kruskal Wallis, Dunn and Mann Whitney tests (α= 0.05). Results: HP and CP, with or without LED, promoted greater color change than LED. LED/CP promoted higher color change than CP. LED significantly increased intrapulpal temperature compared to non-irradiated groups. No protocol promoted a significant increase in surface roughness. (Am J Dent 2025;38 Sp Is A:26A-31A).

 

 

 

 

Mail: Dr. Vanessa Cavalli, Department of Restorative Dentistry, University of Campinas, Av. Limeira, 901, Piracicaba, São Paulo, Brazil, Zip code:13414-903.  E-mail: cavalli@unicamp.br

 

 

 

 

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                                                                                                                                                 Review Article

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Updates on non-peroxide dental bleaching agents

 

Daniel C.N. Chan, dmd, ms, dds  &  Densen Cao, phd

 

Abstract: This article critically examines the most recent developments in peroxide-based and non-peroxide bleaching agents, with a focus on phthalimido-peroxy-caproic acid (a peroxyl derivative), cysteine proteases and sodium dithionites (non-peroxide agents). The rationale for seeking non-peroxide agents, elucidating their mechanisms of action, and potential safety concerns are addressed. While newer non-peroxide agents show promise in laboratory studies, clinical studies are essential to determine their safety and efficacy in a real-world setting. (Am J Dent 2025;38 Sp Is A:32A-37A).

 

 

 

Mail: Dr. Daniel C.N. Chan, Department of Restorative Dentistry, University of Washington, 1959 NE Pacific Street, Seattle, Washington, 98195 USA.  E-mail: dcnchan@uw.edu

 

 

 

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                                                                                                                                             Research Article

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Assessments of a novel bleaching agent containing sodium dithionite: A laboratory study

 

James Newman, ba, dds, Tyler Youn, ba, Michael Suk, bs, Chao Dong, bs, ms, Jason Lu, bs, Morgan Sample, dds , Iris Yang, dds  &  Daniel C.N. Chan, dmd, msd

 

Abstract: Purpose: To initially evaluate the efficacy of a novel non-peroxide-based whitening strip (Dithionite White) on beverage colorants and doxycycline-stained teeth. Methods: In the evaluation of the beverage-stained teeth, two small areas (incisal-enamel and cervical-dentin) were exposed on bovine teeth for staining; the samples were divided into six treatment groups (n= 90) and three treatment protocols. The teeth were immersed for 14 days into six treatment groups: red wine, coffee, cola, tea, soy sauce, and an equal-part cocktail of previously listed colorants. The control group (n= 3) remained immersed in de-ionized water. The teeth were treated twice daily with Crest Whitestrips for 30 minutes and a whitening agent Dithionite White (DW) for 30 and 60 minutes on days 1, 3, 5, 7, and 14; the tetracycline-stained teeth were divided (80 teeth in the study) into eight groups (n= 10). These teeth were bleached daily. The bleaching effectiveness of the blue LED and Red infrared lights was evaluated as well as the use of mouthwash to enhance the bleaching environment. For all groups, the color change was assessed with a spectrophotometer. For the beverage-stained teeth, measurements were taken at baseline pretreatment, post-stain, 1 day, 3 days, 5 days, 7 days, and 14 days posttreatment. For the tetracycline-stained teeth, weekly measurements were obtained for 11 weeks. In each study L*, a*, b* at each period of bleaching was compared to the baseline. The color difference (ΔE) was calculated. The means ΔE were compared with multiple ANOVA tests and a MANOVA test. Results: In the beverage-stained and doxycycline-stained teeth, both bleaching systems showed color improvement. (Am J Dent 2025;38 Sp Is A:38A-43A).

 

 

 

 

 

 

Mail: Dr. James Newman Jr., University of Washington School of Dentistry, D-770 HSB, 1959 NE Pacific Street, Box 357456,  Seattle, Washington  98195-7456, USA.  E-mail:  Newmanj2@uw.edu

 

 

 

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                                                                                                                                                              Epilogue

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      The idea of this dental bleaching special issue was conceived more than a year ago. The idea came about because dental bleaching is not a required curriculum topic, but much requested by dental students and private practitioners. Many dental personnel lack up-to-date knowledge about the appropriate application of dental bleaching. Though there are no laws in the US that require certification of dentists to perform bleaching, proper training is the best way to achieve competence and keep patients safe.

      Our first task was to seek sponsors and to contact potential guest editors. We were fortunate to have Drs. So Ran Kwon and Michael Meharry on board early in the project. They helped to suggest names of experts and reviewed the bulk of the manuscript submissions.

      The next task was to invite international experts in the field to contribute. There were certainly ups and downs. Some experts who promised to contribute were delayed because of special circumstances. In the end, we were lucky to have contributions covering the topics that we were interested in.

      We deliberately put ethics as the opening article. We routinely see general practitioners advertising using free examination and/or dental bleaching as a loss leader to attract new patients. Questions that need to be addressed are “do all patients really need bleaching?” and “are we doing the patient a service?”

      Artificial Intelligence (AI) needs special mentioning. AI is touted as the leading disruptive force in dentistry because it has the potential to significantly improve diagnostic accuracy, treatment planning, and analyses of large volumes of dental data with greater precision, enabling personalized treatment approaches. The AI article on bleaching looked at the validity of information patients can check on the internet, the proper methods to incorporate AI in dental education and the proposal to utilize large volumes of dental image data to predict bleaching treatment outcomes.

      LED light source for dental bleaching in theory acts as a secondary energy source to potentiate and accelerate the bleaching action through their photochemical impact on the tooth surface. Much depends on the power and wavelength compatibility of the specific LED. The use of the LED light may arise first as a gimmick pushed by marketing and patient demands. Many of the devices that one can get from online shopping seem to be too weak in power to affect any meaningful bleaching actions.

      The American Dental Association research has found that using an LED light to whiten teeth will result in an initial shade change which is mainly caused by tooth dehydration and will reverse after time. Pulpal irritation and tooth sensitivity may be higher with the use of bleaching lights or heat application. In fact, the effects on tooth color change were variable in studies carried out, and some differences were not detectable visually. Long term clinical studies are needed to confirm the usefulness of LEDs.

      Charcoal toothpaste with whitening power is a product that defies logic. One must fight discoloration by incorporating an ingredient that is dark in color. Again, controversies exist, and we are just introducing the readers to the possibility. One major US oral health product company has aggressively marketed such a product so there must be some magic behind the concept.

      One important issue concerning dental bleaching is that of public safety. To add to the confusion, the European Union regulations are much stricter than those in the USA. FDA classified dental bleaching as a cosmetic procedure and not under its supervision. We often see advertisements on cruise ships and shopping kiosks recruiting clients for “teeth whitening”. They are careful with the terminology since according to the FDA, whitening restores natural tooth color and bleaching whitens beyond the natural color.

      There is no doubt that hydrogen peroxide is effective in teeth whitening. The public must be reminded that tooth bleaching involves basic chemistry and is often not readily reversible. Side effects such as gum irritation and tooth sensitivity come with improper diagnoses. Therefore, ongoing searches for substitutions for hydrogen peroxide and its derivatives must be encouraged and supported. Recently, the search for substitutes included the family of natural remedies which usually involved long-chain carbon molecules. Such large organic molecules invariably are less effective in teeth whitening but may cause less sensitivity. Of these non-peroxide bleaching agents, a longtime reducing agent used primarily in the paper pulp industry showed promising laboratory data. Currently, there are multiple ongoing clinical studies and we will wait for conclusive clinical data to help guide us.

      Lastly, I would like to thank all the contributors and the editorial staff at the American Journal of Dentistry who were so patient with us through this process.  Without them, the issue would not be possible.

 

 

 

Daniel C.N. Chan, DMD, MS, DDS