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Clareamento dental a Laser? Isso é bom?

A necessidade de clarear os dentes atende o desejo de muitos de nós que nos preocupamos com que os nossos sorrisos tenham um aspecto saudável e bonito. São várias as técnicas disponíveis para a realização de clareamento, mas um agente se destaca como sendo o principal agente para a promoção desta alteração de cor dos dentes: o peróxido de hidrogênio. Na Odontologia, este agente é utilizado sob diferentes formas e concentrações desde 1884. Portanto, ao longo do tempo foram muitas as técnicas propostas para seu uso, mas a maioria delas caiu por terra ao longo do tempo em função da observação de seus efeitos negativos.

Clareadores são usados na Odontologia desde o século XIX. A compreensão sobre os riscos e quais técnicas são efetivas e seguras é mais recente.

Em 1963 foi proposta a técnica de clareamento termocatalítico. O clareador era colocado no interior e sobre o dente. Com uma espátula aquecida sobre a chama de uma lamparina o peróxido de hidrogênio era “ativado” e seu poder clareador era potencializado. O sinal de que a técnica estava sendo bem executada dependia da observação de que fumaça saia da superfície do dente após a aplicação do calor. Esta técnica é hoje reconhecida como agressiva e extremamente prejudicial, e resultou na perda de muitos dentes.

As técnicas de clareamento tornaram-se muito populares a partir dos anos 1980, e surgiu uma outra alternativa para o clareamento dos dentes em que se empregava a luz do aparelho fotopolimerizador (aparelho presente ainda hoje em todos os consultórios, que é destinado para que o dentista polimerize – endureça – a resina usada em uma restauração). Esta técnica recebeu o nome de fotocatalítica. De novo, o clareador (peróxido de hidrogênio) era posto sobre os dentes e a luz do aparelho “ativava” o produto. Estes aparelhos fotopolimerizadores, como a maioria das fontes de luz, emitem calor. Assim, temos uma técnica que pode provocar dano ao dente caso o calor gerado promova uma reação inflamatória na polpa, que é o tecido vivo presente no interior dos dentes. Com esta técnica os relatos de sensibilidade se tornaram mais frequentes, o que indica a possibilidade de dano irreversível a polpa que pode resultar na necessidade de tratar o canal do dente e/ou em outros processos inflamatórios graves.

 

A técnica de clareamento à laser sucedeu a técnica de clareamento com o uso do fotopolimerizador. Houve um grande impacto na percepção dos pacientes que associaram o uso do laser a algo inovador, seguro e mais efetivo no objetivo de clarear os dentes. No entanto, apesar de todo o apelo mercadológico, a efetividade do laser não difere da que se observa quando do uso apenas do fotopolimerizador. Da mesma forma, os aspectos negativos quanto à sensibilidade dental também se repetem com o laser.

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A literatura científica demonstra que o uso de qualquer agente para acelerar o processo de clareamento não torna o processo mais efetivo, torna-o apenas mais arriscado. O laser, como qualquer outra fonte de calor, aumenta o risco de dano aos dentes

Estudos demonstram que a ativação por calor, luz ou laser afeta a polpa, já que pode aumentar a temperatura da mesma de até 5,5 graus centigrados (Buchalla W, Attin T. External bleaching therapy with activation by heat, light or laser–a systematic review. Dent Mater. 2007 May;23(5):586-96). Ao mesmo tempo, o resultado alcançado não é mais efetivo do que quando se usa o clareador sem a aplicação destas fontes de calor (Marson FC et al., Clinical evaluation of in-office dental bleaching treatments with and without the use of light-activationn sources. Oper Dent. 2008 Jan-Feb;33(1):15-22).

A sensibilidade durante o clareamento dentário não é normal! A dor é sinal de que alguma agressão está ocorrendo. Isto determina que o processo deve ser interrompido de imediato.

Fica a questão. Se o uso das fontes de luz não melhora o clareamento, e só potencializa os riscos associados com o clareamento, o que é correto fazer? O correto é não usar estas técnicas que aumentam a temperatura do dente. A técnica de clareamento a laser já está contra indicada há muitos anos. No entanto, o apelo mercadológico e nada científico, contribui para que estas técnicas ultrapassadas sigam sendo propaladas como algo vantajoso para os pacientes que desejam dentes mais claros.

O correto é, quando indicado, usar uma técnica que se vale do mesmo produto clareador e que necessita do mesmo tempo empregado na “técnica à laser”, mas sem empregar qualquer fonte de claro para “acelerar” o processo.

Por último, é importante notar que a avaliação do tipo de alteração de cor dos dentes e a correta seleção da técnica clareadora são fundamentais para que o resultado final seja positivo. Esta tarefa de diagnóstico não é simples, e depende da avaliação correta de um dentista.

Clareamento dental de qualidade.

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