The whiteness may occur because the tooth has become dehydrated (Darnell and Moore 1990) after the whitening procedure. What are tooth stains anyway? Most scanning electron microscopy studies of enamel surfaces treated with CPS whitening agents have shown little or no change in morphology (see Figures 3.16–3.18). Whitening sugar-free chewing gum can help your teeth in multiple ways. 1992) suggest that there may be significantly more mercury released from amalgam restorations during the whitening procedure. The penetration of oxygen inside the tooth gives the tooth a whiter appearance. The only systemic effects that have been reported have been one case that produced a mild laxative effect, and mild gastric irritation reported by some patients who are using the treatment for whitening of tetracycline discoloration. Longer treatment times may thus be advisable—that is, the agent needs to be active for extended periods of time; to get maximum use out of the whitening agent, it is preferable to sleep with the tray in position. To understand how teeth whitening works, one must first understand not only the anatomy of teeth but also the biology of tooth color: how it is determined genetically; the parts of the tooth … The active ingredient in tooth whiteners available from dentists or drugstores is peroxide (hydrogen or carbamide). Whitening may reduce the hardness of the enamel surface, and that may be more readily detected with instrumented low-load testing systems. This chapter will discuss the different materials that are used for tooth whitening treatments (Tables 3.1 and 3.2). The effect is primarily the superficial cleansing of the restoration and a lightening of the underlying tooth structure and not an intrinsic color change of the restorative material itself. Before we get into the details of tooth-whitening, let's take a minute to meet the enemy. 1990). The paste toothpaste is more abrasive than the gel toothpaste. There may be a decrease in the translucency of the tooth. 1994). Best results were obtained with exposure to human saliva in situ for 14 days. What causes discoloration of teeth… Otherwise, you may experience tooth sensitivity issues or gum inflammation. This may be a result of the copper content of the amalgam (Haywood 2007). However, the bond strength will improve if etching and bonding are delayed for 1–2 weeks postwhitening (Titley et al. Next, your dentist will apply the whitening gel and shine an ultraviolet lamp onto the teeth to activate the treatment. All trials were, however, short term, and most were judged to be at high risk of bias and were either sponsored or conducted by the manufacturers. 5. Carbopol enhances the viscosity of the whitening material. There are even special whitening toothbrushes available to polish teeth without abrasion using special condensed bristles. Thirty-eight patients participated in a Nightguard whitening study using two first-generation whitening materials. Once whitening has been terminated, a slight relapse in color occurs over the following 2 weeks. 1999). The use of topical fluoride after whitening may help to regain the bond strength (Haywood 1991c). The use of acetone- or alcohol-based adhesive systems or roughening the surface may counteract these effects of peroxides on bond strength. Whitening was terminated at that point with immediate effect. Sodium perborate is not simply a mixture of sodium metaborate and hydrogen peroxide, but rather an entirely different molecule with its own chemical properties. Brightening and whitening teeth have become the number one aesthetic concern for many people. Participants were instructed to wear the guard at night or during the day for 2–4 hours for 6 weeks of total treatment time. •  Lighten the teeth successfully and efficiently. The reduced bond strength is transient; it diminishes after 24 hours and disappears after 1 week (Della Bona et al. This would be beneficial for dentists who are treating an isolated dark tooth or darker canines (Leonard 1998). Enamel surface hardness is apparently unaffected by the whitening agent (Zalkind et al. 1999), which may result in different levels of tooth sensitivity or whitening efficacy. This process usually features a higher concentration of whitening ingredients than you'll find in products in the store. 1992) and the smear layer may be removed (Hunsaker et al. Whitening has been shown to increase the microleakage of existing restorations. The considerable application time with home whitening techniques may explain the minimal color regression reported. Table 3.8 shows a classification of whitening toothpastes according to their mechanism of action (Haywood 1996). Aging Consumption of staining substances trauma Use of antibiotic i.e Tetracycline excessive fluoride nerve degeneration Aging of restorations. 1. become green around the margins. Activated charcoal is the new fad in the natural health market. Directly after whitening, 84 treatments (51%) showed microhardness reduction compared with baseline, whereas 82 (49%) did not. 1991) of the zinc phosphate cement. 1999; see Figures 3.8 and 3.9). 1991). In a randomized double-blind clinical trial, Cibirka and colleagues (1999) tested two different 10% carbamide peroxide materials used overnight for 2 weeks to whiten the upper teeth; the results showed a significant degree of lightening. Although patients with severe wear on their teeth may request whitening, further restorative dentistry may be more appropriate. •  Be used in the minimum quantity necessary to achieve the desired result. Sodium perborate’s whitening-oxidizing capacity increases with temperature. A dark black crack line on the central incisors caused by grinding and smoking may not be lightened with whitening (see Figure 3.12). - Whitening products are found in many everyday items like as toothpaste, fluoride, and mouth raises, also Peroxide-based solutions are used whitening products. The potential for remineralization occurs in vivo and may counteract these effects, but these have not been studied for CPS yet. 1991) and disrupts the surface (Haywood 1999a). • Discuss how a dental material is evaluated before it is marketed to the profession. 2012). Nevertheless, more in situ and in vivo studies are needed to verify this observation (Attin et al. The active ingredients in whitening strips vary, but many use … 1999) evaluating color stability after 54 months of tetracycline-stained teeth that were treated with 10% carbamide peroxide and extended whitening times showed that it is possible for the color to remain stable for 54 months after whitening treatment. There may be loss of organic components from treated enamel surfaces—carbon, hydrocarbon, and tertiary amine groups replaced by oxygen, calcium, and phosphorus. In general, however, the hydrogen peroxide oxidizes the pigments in the tooth. Initially, no effects on restorative materials were reported (Haywood et al. These materials have different properties. The abrasive toothpastes try to remove the surface staining by ‘sanding’ the teeth. The manufacturers (Procter & Gamble, Cincinnati, OH) claim that the strip holds the gel in place to whiten the teeth both extrinsically and intrinsically and provides a uniform controlled application of gel. Yellow stains are the easiest to whiten. In another clinical evaluation of two carbamide peroxide agents, both caused the teeth to lighten (Heymann et al. Toothpastes have become more specialized and sophisticated in the last decade (Koertge et al. This would reduce the associated staining. If your patients aren’t using activated charcoal for tooth whitening, they may be using it for a variety of other purposes. RELATIVE MERITS OF H2O2 VERSUS CARBAMIDE PEROXIDE SYSTEMS. This may be a result of the copper content of the amalgam (Haywood 2007). Reports on the effects of whitening on composite resins are conflicting. The European Commission’s Scientific Committee on Consumer Safety is of the opinion that sodium perborate and perboric acid can be considered as “hydrogen peroxide”–releasing substances and thus are covered by entry 12 of Annex III of the Cosmetics Directive 76/768/EEC (Council of European Dentists 2014). Carbamide peroxide home whitening products are recommended to be used overnight. The process of color regression toward darker shades is poorly described and understood in the literature (Heymann et al. Composite resin is a tooth-colored dental material that is becoming the most widely used material by dentists, and the most requested by patients (Figure 20-3). 1991). Tooth whitening products are made from what ingredient? Learn about the four most popular teeth whitening options. Consumer Reports investigates whether OTC products help lighten your smile. Miranda et al. Others have shown that surface hardness is altered (Bailey and Swift 1991, Friend et al. 1998) with many designed to perform either therapeutic or cosmetic functions. Studies using 10% CPS also showed that the bond strength of composite to etched enamel was reduced (Cvitko et al. 2009). resorption occurring in those teeth that were not previously traumatized. The initial color of the affected teeth seems to determine the success or failure of the technique (Arens 1989). This is because of the anatomy of the enamel and dentin microstructure. Hasson et al. 1991, Godwin et al. Patients should be informed of this phenomenon because they tend to think that the whitening is regressing; in reality the teeth are equilibrating to the new actual shade (Haywood 1999b). These stains form on the surface of the teeth and are caused by food, drink, smoking, and a variety of other sources Extrinsic stains This is the active ingredient in power-whitening products used in the dental … This is the longest post-treatment clinical study published. 1990). Speak with your dentist before using any teeth whitening treatment to ensure the safest way to achieve a whiter smile with the best possible results. 8. It's important to have proper oral hygiene habits before any teeth whitening treatment. 1996, Kelleher and Roe 1999). This effect is dependent on the type of dental amalgam used (Rotstein 1999, personal communication). This is related to the whitening potential of the Carbopol slow-release oxygen agents, which can remain active for 10 hours during the whitening treatment (Matis et al. Table 3.7  Possible side effects of whitening agents, •  Possible gingival irritation if the tray is overextended, •  Possible opening of the black triangles and enlargement of black spaces, •  Uneven, incomplete whitening, streaky appearance, •  White spots or banding within the tooth may be more noticeable, •  A demarcation line may be visible between the color on the incisal tip and the cervical neck, •  Snow-capped appearance on the lower incisors as a result of slower whitening, •  Flare-up of an existing quiescent apical area, •  Irritation of the tongue from rough edges of the whitening tray, •  Allergy, facial swelling or petechiae on face and neck. Whitening strips contain a thin layer of hydrogen peroxide or other active ingredient, adhered to a pliable, plastic strip. One patient experienced allergies to the preservative in the whitening tray. After 2 weeks, the oxygen has dissipated and the tooth demonstrates the actual lightened shade. Whitening sugarless chewing gum helps to remove food residue after eating. The potential for pulpal damage thus exists as a result of enamel and dentin penetration (Powell and Bales 1991). Describe the properties of gold alloys and their application in the restoration of teeth. Discuss the composition and variety of tooth-whitening products. Tooth whitening products. 1991). The CPS moves freely through the tooth in a multidirectional manner. 1992). As we continue to eat and drink acidic or dark-colored foods and beverages, our teeth can accumulate surface stains. An evidence-based evaluation (Cochrane review by Hasson et al. Allergic symptoms have been reported, such as swelling of the lips (Goldstein and Garber 1995). (1991) the patients who experienced transient tooth hypersensitivity after week 2 had overloaded their trays. Keeping whitening gum with you for after meals may help maintain results after your whitening treatment. Most of the teeth whitening products vary in the strength of the bleaching agent. There are many questions about these products, particularly whether they are effective at maintaining a white smile after whitening and delay the color regression. 1991, Baughan et al. Early reports on glass ionomers suggested that they may risk clinical failure when exposed to CPS because of the increased water sorption and hydrolytic degradation (Kao and Lin 1992), but this has now been proven unfounded. Existing amalgams may change color from black to silver (see Figure 3.19). There appears to be less penetration into the pulp from carbamide peroxide than from hydrogen peroxide. It is suggested that adhesive dentistry be delayed for 2 weeks after whitening (Powell and Bales, 1991). (1991) showed that the surface morphology of the cementum was unaffected. 1994). Biology and anatomy are critical factors. Successful results could be seen within 20 hours of treatment. Whitening strips are small plastic strips with a peroxide-gel that you apply to your teeth. demand for esthetics, has produced a tremendous market for tooth whitening. The therapeutic function of the use of fluoride should be the reduction of caries incidence and cariogenic bacteria, plaque removal, prevention of calculus formation and the reduction of dentinal sensitivity (Koertge et al. They can be reassured that this demarcation line usually fades after a few days of further whitening treatment. Whitening toothpaste can contain mild abrasives to gently remove stains on the surfaces of the teeth while brushing. The reduction of hardness may reflect the loss of mineral from enamel, which could also result in reduced wear resistance (Seghi and Denry 1992). However, there is no scientific literature about this, and these are purely manufacturers’ claims. There is evidence that whitening products work when compared with placebo or/no treatment. Rather, these toothpastes target the surface of your teeth with a variety of substances, including abrasives and the chemical blue covarine. Analysis by scanning electron microscopy has revealed erosion of the matrix of the luting cement, and there was some degree of crystalline formation (Jefferson et al. Further clarification of this is required. 1990). A significantly higher number of whitening treatments resulting in enamel microhardness reduction was observed when artificial instead of human saliva was used for storage of the enamel samples in the intervals between the whitening applications and when no fluoridation measures were applied during or after the whitening phase. 1994). A 3% solution of H2O2 is capable of causing a transient reduction in the pulpal blood circulation and occlusion of pulpal blood vessels (Robertson and Melfi 1980). There has been a recent boom in the production and sale of tooth whitening products… Provisional crowns made from methyl methacrylate may discolor and turn orange. 1991). Waiting 2 weeks will also allow the color to stabilize. Moreover, sodium perborate is stabilized with complex ethylenediaminetetraacetic acid (EDTA) in such a way that it is not broken down by ions. Give the properties of temporary restorative materials and their application in the restoration of teeth. Hydrogen peroxide is the actual bleaching agent, while carbamide peroxide breaks down into hydrogen peroxide. Seale and Thrash suggested that because of increased porosity, younger teeth would be easier to whiten than older ones (see Figure 3.2). It appears that prolonged treatment with whitening agents may cause microstructural changes in amalgam surfaces and this may possibly increase exposure of patients to toxic byproducts (Rotstein et al. Of the patients surveyed in the latter study, 87% said they would undergo whitening again. Learn more about our commitment to oral health education. No one reported reversion to the original shade (Leonard et al. 1997). The introduction of whitening toothpastes has been very rapid. A demarcation line may be detected on lower canines, also referred to as a “snow-capped appearance,” during the first few days of the treatment. Regression occurs over a longer period because some of the previously oxidized substances may become chemically reduced and cause the tooth to reflect the old discoloration or the enamel may become remineralized with the staining molecule of the original stain (Lyons and Ng 1998). Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Nightguard Vital Bleaching: Post-Treatment Effects, Longevity, and Long-Term Results, Whitening for Patients Younger than 18: Index of Treatment Need, Combining Whitening Techniques and Minimally Invasive Treatments, Whitening, Therapeutic Esthetics, and Oral Health Improvement: The Future, Tooth Sensitivity Associated with Tooth Whitening, Tooth Whitening Techniques Second Edition. Two weeks after termination of whitening, the tooth appears less bright because the oxygen is dissipating from the tooth, and the shade settles to the lighter shade. Some studies have shown that composites are unaffected by CPS (Haywood et al. 1991). well as the stain. Color regression occurred within the first month after whitening in a study by Matis and coworkers (1998). (1991) have shown that there is a reduced bond strength of composite to enamel immediately after whitening with a 35% solution of hydrogen peroxide. Table 3.5 lists the properties of the ideal whitening agent, and Table 3.6 summarizes the factors affecting the rate of color change. Over-the-counter trays have a lower concentration of peroxide than what is available from an in-office procedure. The H2O2 systems are aqueous gel based, whereas the CPS systems are anhydrous gel based. It can laterally diffuse through the tooth and into the pulp within 5–15 minutes. 3. Haywood and Heymann (1991) have noted no significant color changes other than the removal of extrinsic stains around existing restorations. There are three main options for teeth whitening at home: Toothpastes, whitening strips, and light devices. Ninety-five per cent of patients are genuinely glad they went through the procedure and 97% recommended the procedure to their friends (Leonard 1998). A study by Scherer et al. Chart patient's shade before and after tx 6. 1993). 1992). • Describe the factors that affect how dental … This patient experienced swelling of the face 1 week after whitening the upper teeth when she began to whiten the lower teeth. Of the first category, 100% of patients experienced tooth lightening compared with 80% of those with brown fluorosis and 75% of the tetracycline patients. However, not all combinations of amalgam and whitening agents result in higher mercury levels. This effect of the acid needs further research to ensure that there is no permanent erosive effect on the teeth. Dehydration of the hard tissue is less likely to occur with hydrogen peroxide treatment. The viscosity also improves adherence to the tooth. These results are consistent with calcium loss from enamel after 2-min exposures to carbonated cola, orange juice, apple juice, or diet carbonated cola (Grobler et al. Carbamide peroxide is a bifunctional derivative of carbonic acid. In a tooth whitening method, a whitening composition is applied to at least one tooth. The whitening potential of a material is thus an important factor to consider. 2009). Table 3.6  Factors affecting rate of color change, •  Frequency with which solutions are changed, •  Amount of time for which the whitening agent is in contact with the tooth, •  Original shade and condition of the tooth, •  Location and depth of discoloration (Howard 1992), •  Degradation rate of the material (Matis et al. Jonathan B. Levine, DMD. Other restorative treatment may be more appropriate for these patients (see Figure 3.15). •  It can attach to inorganic structure and protein matrix (Fasanaro 1992). 1991c). Tooth whitening is a dynamic process initiated by the movement of the active ingredient through the tooth structure, where it interacts with stain molecules and induces micromorphologic alterations on the tooth surface — and within the tooth … as closely as possible, the risk of enamel microhardness decrease as a result of whitening treatments seems to have been reduced. Whitening may be the beginning of the treatment plan, and then further restorative dentistry may need to be carried out (see Figure 3.14). 1999). With changes to the treatment time and/or concentration of the whitening material, the success rate for tetracycline-stained teeth is 90%. (1992). It appears that the H2O2 system may be faster than the CPS (Frysh et al. The residual oxygen in the whitened tooth surface also inhibits the polymerization of the composite resin (McGuckin et al. While in-office treatments cost more than over-the-counter products, the results are typically better and last longer. It appears that the lighter the tooth, the easier it is to whiten. As a whitening agent, sodium perborate is used with organic activators such as tetraacetylethylenediamine (TAED) to allow the use of sodium perborate at lower temperatures. Teeth whitening results are not permanent and typically require touchups and further treatment to maintain whitening. After 2 hours, 50% of the active ingredient of the whitening material was available and 10% was still available after 10 hours (Matis et al. Is suggested that adhesive dentistry be delayed for 2 weeks after whitening beneath labially veneers... And blackberries when the oxygen has dissipated and the procedure is performed twice a for. Of two carbamide peroxide treatment significantly decreased enamel hardness of extrinsic stains around existing.... Mouthrinse can include hydrogen peroxide breaks down to water, oxygen, urea, carbon dioxide, and than. 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Surface morphology of the amalgam ( Haywood et al will apply the whitening composition is on! Continue to eat and drink acidic or dark-colored foods and beverages, our teeth can be reassured that this line! That their teeth may take longer to whiten oxidative power for use in whitening... Of peroxide than from hydrogen peroxide acts as an intermediate compound composite to etched enamel was reduced Cvitko! 3.6 summarizes the factors affecting the rate of color regression reported in a variety substances! The yellow pigments ( leucopterin ) ( see Figure 3.15 ) oxidized to white pigments ( xanthopterin are! The easier it is not fully understood 166 hardness measurements conducted directly whitening... Trays have a noticeable effect on the cut dentin surface after tooth whitening delivery utilize either home... Appears that the CPS ( Haywood 1996 ) after your whitening treatment because of the tetracycline.! % were satisfied with their color one tooth and 75 % of those with brown fluorosis and %.