dental whitening revolution

7/28/2019 Dental Whitening Revolution

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Dental Whitening Revolution

By Trisha OHehir,Hygienetown Magazine

It seems the number of whitening products increases daily. Consumer-whitening products

began with gels in trays and now include whitening strips, paint-on products, and felt-tip applicatorswith whitening substances. In fact, in a recent e-mail survey of dental hygienists conducted by

Hygienetown, nearly all respondents (95%) recommended home-use whitening to patients and 70%

said oral hygiene products were sold in their offices. The market is growing, the products are selling

and the number of choices keeps increasing.

With all of the attention to tooth whitening today, it seems odd to think that it wasnt too

long ago dentists discouraged their patients from wanting white teeth, saying: Teeth are shades

from yellow to gray; Pure white teeth arent natural; Really white teeth are probably dentures.

With no solution being offered by the dental profession, consumers decided to take matters into

their own hands, using Ajax or Comet cleanser to whiten their teeth.

When professional whitening products first entered the market, dentists were reluctant to

offer the procedure because it was considered cosmetic rather than therapeutic and thereforewas unprofessional. The perception of tooth whitening changed with the publics desire for whiter

teeth.

For some, their first experience with whitening is done to lighten an endodontically treated

tooth that has darkened. The tooth is opened up from the lingual, a cotton pellet soaked with

hydrogen peroxide is placed inside, and a photo flood light is used to speed the bleaching process.

The high concentration of peroxide used destroys the interdental papilla in the process, even with

the use of a rubber dam. From those crude beginnings, bleachinghas evolved into whiteningand

with it has come a revolution of change.

How does whitening work?

Just as peroxide products lift color from hair, peroxide whitening products lift stain from

tooth surfaces. Hydrogen peroxide is a combination of hydrogen and oxygen. There is an extra

oxygen molecule that hunts for another molecule to attach to, in this case molecules of color within

the enamel. The oxidation reaction breaks down the color trapped in the enamel surface into smaller

particles that are released from the enamel.

Carbamide peroxide is a combination of hydrogen peroxide and urea. Adding urea to

hydrogen peroxide stabilizes the formulation, produces a longer shelf life and improves taste.

According to the research, both products whiten comparably, since the whitening is achieved by

hydrogen peroxide in both cases.

Although the concentration for hydrogen peroxide products appear to be lower thancarbamide peroxide products, carbamide peroxide consists of one-third hydrogen peroxide and two-

thirds urea. Therefore, a 10% carbamide peroxide product contains only 3% hydrogen peroxide and

7% urea. From the other side, a 9% hydrogen peroxide product is equivalent to 27% carbamide

peroxide.

Whitening is achieved with a time/concentration approach. The shorter the time, the higher

the concentration needed. The higher the concentration, the shorter the time needed. In-office

products generally use peroxide at concentrations of 20-35% for short periods of time. At-home

products are generally lower concentrations used over a longer time period.

Most in-office whitening is not sufficient to achieve the desired results in a single visit.

According to a study reported in the February 2006 issue of Quintessence International, one to four

visits are needed to achieve patient satisfaction with whitening results. Home-use products areprovided to supplement and extend the in-office results and for touch-ups later. The primary

advantage of in-office procedures is time. However, according to research published by Dr. Van


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Haywood of the Medical College of Georgia, whitening achieved with a lower concentration over a

longer period of time is more stable than that achieved with a high concentration applied for a short

time.

Even tetracycline staining can be altered with whitening over an extended period of time, or

deep bleaching. Researchers have shown significant effects when the home-use whitening process

is extended to six months or more. Other clinicians have found that preconditioning the teeth with

several weeks of home-use whitening followed with a high concentration, in-office treatmenteffectively lightens tetracycline staining and/or fluorosis. According to Dr. Marshall White, the

slow preconditioning of enamel with home-use whitening makes the enamel surface more receptive

to greater color change later using a higher concentration, in-office procedure.

Teeth can be lightened from one to several shades. Patients should be prepared for some

rebound as whitening procedures often dehydrate the enamel, leaving it lighter than it will be when

again saturated with saliva. Explaining this to patients will prevent disappointment later.

According to research, the lights and lasers provide very little, if any, advantage over the

whitening products used alone. The heat from the light will speed the effect of the peroxide and also

will dehydrate tooth surfaces. More recently, whitening products have incorporated photo-activating

substances to enhance the effect of the light or laser. The lights and lasers provide a psychological

stimulus that patients find trendy and therefore desirable.Pain or sensitivity associated with whitening procedures is generally transient, lasts no more

than 24 hours and can be alleviated with ibuprofen. Recommending the lowest concentrations of

peroxide will help in minimizing sensitivity. Still, the best approach is to prevent pain and

sensitivity by recognizing problems prior to whitening. Ill fitting trays and overfilling trays with

whitening gel can irritate and sting gingival tissues. Floss cuts and tissue abrasions are prime targets

for peroxide irritation. A jolt or shock, often called a zinger, to a single tooth may be due to direct

access of the peroxide to the dentin, due to cracked or chipped teeth or leaking margins on

restorations.

In addition, some manufacturers are adding sodium fluoride and potassium nitrate to

whitening products to control sensitivity. Furthermore, some clinicians have their patients use a

fluoride, sensitivity toothpaste or a remineralizing product for a couple of weeks prior to whitening.

Others have patients use one of these products in the bleaching trays for 30 minutes before

whitening or just after. Several new products and whitening formulations have been introduced

recently to address the problem of sensitivity. Products containing amorphous calcium phosphate

(ACP) not only reduce sensitivity, they also have been shown in laboratory studies to reduce

susceptibility to enamel caries. Whitening doesnt have to be painful when effective preventive

measures are taken.

Conclusion

The whitening revolution is here to stay. Products are improving and more options areavailable now than ever before. It is the professionals duty to inform patients about the proper

choices emphasizing potential problems and helping them to make the right choice before they

decide to start the teeth whitening procedures, be this at home or in the surgery.

The patient itself should on the other hand understand the responsibility attached to his or

her choice of beginning and, more importantly, continuing the procedures at all times, irrespective

of any alterations in lifestyle and to maintaining a close relationship with the dental hygienist, who

should be consulted as often as problems occur or the patient intends to undergo changes in

products.

Whitening should not, therefore, be opted for only on aesthetic grounds but on a careful

assessment which requires the dental professional the evaluation of the patients general health,

dental status as well as social status. Many patients presenting a serious psychological problemsmay require the dentist or hygienist the onset of such procedures without taking into account his/her

own ability to continue treatment.


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dental whitening revolution

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