Tray bleaching may improve oral health of elderly, special-needs patients

Standard oral hygiene, such as brushing and flossing, can be difficult or impossible for patients with mental challenges or impaired manual dexterity. Additionally, when health problems or medications cause xerostomia, or dry mouth, the lack of saliva reduces the mouth's natural protective mechanisms. These problems lead to plaque accumulation, cavities and periodontal disease, and could further impact the patient's health.

A report featured on the cover of this month's Journal of the American Dental Association noted that applying the tooth whitener carbamide peroxide through a custom-fit mouth tray might combat those problems. The report was based on a literature review and the authors' clinical experiences with special-needs patients and tooth bleaching.

"What we've noticed through whitening patients' teeth over the years is that as they bleached, their teeth got squeaky clean and their gingival health improved," said Dr. Van Haywood, professor in the Medical College of Georgia School of Dentistry and co-author of the report.

Dentists have used carbamide peroxide, or urea peroxide, for decades to whiten teeth, but its original use was as an oral antiseptic. It removes plaque, kills bacteria and elevates the mouth's pH above the point at which enamel and dentin begin to dissolve, which results in fewer cavities.

"All these benefits lead us to believe that tray bleaching can be a very effective supplemental method of oral hygiene for patients facing greater challenges keeping their mouths clean," said Dr. David Lazarchik, associate professor in the Western University of Health Sciences College of Dental Medicine and the report's co-author.

The trick is in the tray, Haywood said. After a complete dental exam, the dentist can make the custom-fit tray that the patient can wear comfortably at night or for several hours during the day. The carbamide peroxide gel can be prescribed or purchased over-the-counter.

Lazarchik said further research is needed to determine a specific protocol for using tray-applied carbamide peroxide specifically to improve oral health.

Haywood will lecture on the topic in October at the American Dental Association's 151st Annual Session and World Marketplace Exhibition in Orlando, Fla.