Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2015-02-16, 09:59:52 | version 1.33.01
news12 Show Preview IDS Cologne 2015 Adding to the already very strict laws and restrictions in the area of dental hygiene, on top of the con- stantly growing demands placed on dental practices, is yet another Euro- pean Union directive relevant to the daily work routine in dental practices. The 2011/84/EU directive, which be- cameeffectiveon1November2012,is intended to regulate the execution of tooth-whitening treatments. The pri- mary aims of the directive are to pro- tect patients from undesirable side-ef- fectsandtopreventnon-dentalprofes- sionals performing tooth-whitening treatments. The impact on the entire area of tooth whitening is manifold and far- reaching. The crux of the matter is the new 6.0% limit of hydrogen peroxide in tooth-whitening products. Even the sale of products containing more than 0.1% and up to 6.0% hydrogen perox- ide is restricted to dentists, who are only permitted to administer these products to patients after advising pa- tients in detail about the product and itsusage.Thedirectivewillalsoputan end to the online sale of tooth-whiten- ing products, which has generally been associated with adverse side-ef- fects. The new regulation has been in- terpreted differently in each Euro- peancountry.Somecountries,suchas the Netherlands and the UK, regard it as the maximum upper limit and re- strict the use of tooth-whitening gels with a higher concentration of hydro- genperoxide.Inthesecountries,even registered self-employed dental hy- gienists are not permitted to perform tooth-whitening procedures without the supervision of a dentist an im- practical state of affairs. This is also due to the new directive, which re- quires that a dental examination be conducted before commencing tooth whitening. Advantages Owing to these extreme interpre- tationsofthedirective,certainleading tooth-whitening products are no longeravailableorhavebeentakenoff the market in these countries. Ger- many has taken a much more prag- maticandpractice-orientedapproach: in general, tooth whitening is per- formed by dental professionals, but can be conducted under the supervi- sionofadentist.Evenbeforethedirec- tive,theSupremeCourthadrestricted cosmetic whitening treatments per- formed by non-dental professionals to a maximum hydrogen peroxide con- centration of 6.0%. The new EU direc- tive is very much to the advantage of the dentist, as it no longer allows non- dental professionals to perform cos- meticwhiteningprocedures.Italsoes- tablishes legal certainty that dentists can still use products with a hydrogen peroxide concentration higher than 6.0% for medical whitening in order to treat discolouration due to tetracy- cline,trauma,ortheuseofmedication or prolonged use of discolouring sub- stances,geneticallydeterminedexten- sive discolouration, or highly dis- coloured teeth with devitalised roots, among others. These treatments are therefore classified as medical indications and do not lie in the area of cosmetic indi- cations. Expertise In my opinion, high-quality whitening procedures should only be performed by dentists or highly quali- fieddentalnurses,hygienistsorthera- pists. The incidence of side-effects, es- pecially with products that contain a highconcentrationofhydrogenperox- ide, is simply too high and irritation of the gingiva and hypersensitivity can only be avoided with substantial knowledgeoftheproductsandexperi- ence in their use. Revolutionary Theimplementationofthenewdi- rective requires substantial changes indentalpractices,butalsooffersben- efits in everyday tooth-whitening pro- cedures by preserving tooth structure and rendering treatment more pleas- ant for the patient through new tech- nologies. Long before the new direc- tive came into effect, a number of for- ward-lookingcompanieswerealready seekingnotjustasimpletooth-whiten- ing alternative but a revolutionary new technology with novel treatment benefits. The new PrevDent CrWR tooth- whitening system, for example, illus- trates this new development clearly. For many years, PrevDent had distrib- uted the BriteSmile in-office whiten- ing system in many European coun- tries, but this product falls outside of the hydrogen peroxide limit set by the new EU directive in some of those countries. After intensive research and a paradigm shift, PrevDent’s de- velopment engineers developed an ideal combination based on the con- current development in the field of surface protection with nanotechnol- ogy. The result is a combination of a 6.0% low-level hydrogen peroxide gel and nano-hydroxyapatite (nHAp). The potential of this interesting and pio- neeringinventioncanonlybegrasped after an in-depth analysis of current studies on the topic of nanotechnol- ogy. Ground-breaking Current research in all areas of application of nHAp has provided ground-breaking results regarding theprotectionandlong-termpreserva- tion of the tooth structure. Remineral- isationoftheenamelsurface,detected withanelectronmicroscope,hasbeen observed,aswellasextensiveantibac- terial effects on the tooth surface that appear to protect against caries and periodontitis. Comparative studies at theUniversityofPisahaveshownthat nHAphasasimilarantibacterialeffect to chlorhexidine, which is considered the gold standard in the field of periodontology. Nano-hydroxyapatite technology has also found its way into the field of filling materials. Re- searchers at the University of Mary- land have already been using filling materials with nHAp for some time and the preliminary results are prom- ising. There are numerous successful applications of nHAp, including the following: 1. protection against caries by pre- venting Streptococcus mutans ad- hering to the tooth surface; 2. use in atraumatic restorative treat- ment as non-invasive caries ther- apy in countries with insufficient dental health care infrastructure; 3. addition of nHAp to composite ma- terials for longer durability of fill- ings; 4. remineralisationofearlycariousle- sions; 5. remineralisation of erosive enamel lesions; 6. regeneration and repair of enamel structures; 7. sealing of dentinal tubules and for- mationofaprotectivedentinelayer; 8. formation of a protective coating against acid and subsequent reduc- tion in hypersensitivity. Prevention In the field of tooth whitening, the newest application concerns the prevention of hypersensitivity. The University of Indianapolis has been very active in this area of research. Browning et al. have demonstrated that the use of nHAp reduces hyper- sensitivity substantially during whitening. Moreover, Deschepper et al.—also from Indianapolis—have demonstrated a reduction in surface roughness when nHAp was used, as well as simultaneous sealing of the surfaces. These findings correspond with that of Kawamata et al., who es- tablished that the application of nHAp after whitening resulted in the restoration of the enamel structure. Additionally, Takikawa et al., already early on, indicated the positive ef- fects of the use of an nHAp-contain- ing conditioner that is applied after tooth whitening. To date, patients with hypersensitive teeth, who had to be pretreated with amorphous cal- cium phosphate, fluoride or other de- sensitisers, with simultaneous use of analgesics in order to avoid severe side-effects, have been the greatest challenge for us. Owing to the nano- technology, we no longer need to be concerned about these side-effects and can perform whitening without any specific pretreatments. Tooth-whitening update:The crux of the matter By Prof.Martin Jörgens,Germany AD © lenetstan/Shutterstock.com ª