PATIENTS KNOWLEDGE AND OPINION OF IN-OFFICE AND HOME BLEACHING IN RIYADH ELM UNIVERSITY CLINICS

A dull smile has social repercussions. Demand for improved and beautiful smile has become an integral part of dental procedures (AlOtaibi et al., 2020). A large number of people, especially young females are concerned of their smiles and this is because of the reason that the first thing people notice when meeting a new person is their smile (Alshamrani and Wahid, 2018). In the present era, patients are increasingly demanding for a perfect smile due to a shift in priorities and the impact of the media (Hatherell et al., 2011, Pretty et al., 2006).


Introduction
Since tooth colour is interrelated to the aesthetics of each individual, therefore tooth discolouration is frequently reported complaints amongst patients seeking aesthetic treatment (Widodo et al., 2020). The practice of whitening the teeth is known as bleaching. Through bleaching, oxidation occurs within the enamel, making it look lighter than before (Joiner, 2006). Bleaching is a minimally invasive process used to treat discolored tooth (Matis et al., 2007). The popularity of teeth whitening has climbed many-fold with the availableness of over the counter bleaching agents. Recent advances in the field of aesthetic dentistry have led to a wide selection of teeth whitening products. These include toothpaste, dentifrices and the gels. Lifestyle habits like smoking, consumption of black tea, coffee, etc. may lead to darker-coloured teeth (Silva et al., 2018). Generally, bleaching products are classified into two categories, i.e., home and in-office bleaching products. Apart from hydrogen peroxide that is widely used as a bleaching agent, chlorides, peroxides, and chlorine are sometimes also used. Along with the active agent, inactive constituents such as glycerin to maintain moisture, gelling to enhance the viscosity, preservative such as methyl or sodium benzoate to prevent bacterial growth, and flavoring agents to improve taste are also used in the product (Alqahtani, 2014). A survey conducted revealed that 25.6% of the dental patients used saline and 10% used lemon as home-based dental whitening agents (Almas et al., 2000). Another study showed that the patients inclined to advertised and home bleaching products compared to professional bleaching (AlOtaibi et al., 2020). The study on the association between age, sex, level of education, marital status, and type of work on the perception and knowledge of patients' regarding teeth whitening products have also been conducted (Widodo et al., 2020). Regardless of the benefits of tooth bleaching, sadly, there are evident side effects such as increased tooth sensitivity (Watts and Addy, 2001), irritation of gingivae and mucous membrane (Li, 1996), weakening of the dentin and enamel damage (Haywood et al., 1991), and demineralization of the tooth surface (AlOtaibi et al., 2020). Assuming that most of the population of Saudi Arabia is not aware of the after effect. Therefore, this cross-sectional study aims to evaluate the level of awareness, knowledge and perception regarding tooth bleaching products amongst the general population in Saudi Arabia in respect to age, gender, level of education and socio-economic factor.

Materials and Methods
This analytical cross-sectional survey-based study was designed and targeted across Saudi Arabia to measure the level of awareness, knowledge and perception regarding teeth bleaching products amongst the population. A nonprobability convenience sampling method was adopted to collect the data from the population (aged 18 years or over), from March 2021 to May 2021. Participation in this survey would be voluntary. Informed consent would be taken from the participants, and the aim of this study was explained before participants' enrollment. Confidentiality of the participants would be assured throughout the study. An online structured questionnaire was developed using Google forms. The authors of this study shared the link of the survey using e-mails, WhatsApp and other social media applications to their contacts. The online questionnaire was designed in such a way that without filling-in the complete fields, it would be impossible to submit the form. The participants were encouraged to roll out the survey further to achieve maximal participation. The study proposal was submitted to the Research Center of Riyadh Elm University, Riyadh, Saudi Arabia, to obtain ethical approval/clearance. This cross-sectional study with snow-ball sampling method was carried out in all the regions Sultan Alshammrani et al.

International Journal of Medical and Biomedical Studies (IJMBS)
40 | P a g e of Saudi Arabia. A modified close-ended questionnaire in Arabic/English language was available for the participants. No personal data except gender, age, and level of education would be collected from the participants. A modified questionnaire based on research conducted by Alshamrani and Wahid would be designed to meet the research requirements (Alshamrani and Wahid, 2018). The questionnaire would be comprised of three parts: Part A: four questions related to socio-demographics Part B: Eight questions related to cause of discolouration and bleaching products' awareness Part C: Nine questions related to perception, knowledge about bleaching products and their hazardous effects.

Statistical Analysis
SPSS software (ver. 21.0; SPSS Inc., Chicago, IL, USA) would be used to analyze the data. Descriptive statistics with frequencies was calculated and tabulated. Chi-square test was performed to compare the level of knowledge among the participants concerning age, gender, and education level. Pvalues < 0.05 were considered statistically significant.

Results
A total of 2065 participated in the study. The average age of the study subjects was 20 -50 years. The number of male and female respondents was 1124 and 941 respectively.

Conclusion
Age and gender are the factors that influence patients' level of aesthetic satisfaction while educational level had no effect on their aesthetic perception. Knowledge about tooth discoloration is more concentrated on extrinsic etiologies, and majority of the participants demonstrated poor knowledge about the intrinsic causes of tooth discoloration. Most patients considered bleaching to be a safe procedure, and their preferred technique is that which is performed at the dental office. Their awareness of potential side effects and post bleaching instructions is acceptable. Their knowledge about the chemicals used and the mechanism of bleaching is poor, and their main source of information about dental bleaching is the media