Whitening toothpaste can contain mild abrasives to gently remove stains on the surfaces of the teeth while brushing. Whitening may reduce the hardness of the enamel surface, and that may be more readily detected with instrumented low-load testing systems. 1994). At 3 years after treatment 62% were satisfied with their color. 1996, Kelleher and Roe 1999). Sodium perborate’s whitening-oxidizing capacity increases with temperature. 1998), but is thought to be the opposite of the whitening procedure. According to the American Academy of Cosmetic Dentistry, these include the following: Thankfully, teeth whitening products can lift surface stains, and teeth whitening treatments with your dentist can have a noticeable result in very little time. 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. A clinical trial (Leonard et al. Tooth whitening kits are available in a variety of forms at the drugstore. Dentin bonding may be altered after whitening (Della Bona et al. 1991) and disrupts the surface (Haywood 1999a). 2000). 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. 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). It was also used for post-operative rinsing after tooth extraction. An in vitro study by Leonard, Sharma, and Haywood (1998b) showed that a 16% solution of highly viscous materials (NiteWhite) successfully obtained a two-unit shade change more quickly than 5% and 10%. Miranda et al. There are even special whitening toothbrushes available to polish teeth without abrasion using special condensed bristles. It has been tested for use as an irrigant or lubricant in root canals and as an adjunctive to sodium hypochlorite (Stindt and Quenette 1989). 9. Dark-colored fruits like raspberries, blueberries, and blackberries. 2006) that assessed 416 articles on tooth whitening noted that strips (5.5% to 6.5% hydrogen peroxide) are more effective than gel in tray with 10% carbamide peroxide (mean difference 1.82; 95% confidence interval [CI] 0.26–3.38). This article is intended to promote understanding of and knowledge about general oral health topics. Other luting cements may also be affected. The researchers also showed that there was a change in the fracture toughness of the enamel (McCracken and Haywood 1996). Give the properties of temporary restorative materials and their application in the restoration of teeth. The transient pulpal sensitivity that some patients experience may be related to the rapid movement of urea and oxygen through the teeth (Haywood and Heymann 1991). The active ingredients in whitening strips vary, but many use … (1994), at 1.5 years after treatment 74% of patients who had responded to home whitening were satisfied with the shade of their teeth. Pulp penetration can occur within 5–15 minutes according to studies by Cooper et al. However, these effects are unlikely to be clinically significant (Swift 1998). 1991). 1996; see section on therapeutic aesthetics). Several other products that have been used for tooth whitening … Most of the teeth whitening products vary in the strength of the bleaching agent. Erosive dentin lesions may not whiten sufficiently, and it may be inappropriate to whiten areas of deep erosion. Studies by Torneck et al. It is not apparent what effect or combination of effects is occurring. 1994). 1991). The viscosity also improves adherence to the tooth. It has been used since 1960 for oral wound debridement (Fasanaro 1992). It appears that the H2O2 system may be faster than the CPS (Frysh et al. Learn about the four different types of teeth whitening below. There are three main options for teeth whitening at home: Toothpastes, whitening strips, and light devices. 1999; see Figures 3.8 and 3.9). 2008). 1. The researchers observed that canines responded better to a 16% solution than did the central and lateral teeth. It can laterally diffuse through the tooth and into the pulp within 5–15 minutes. In a study by McCracken and Haywood (1996), teeth exposed to CPS for 6 hours lost an average of 1.06 µg/mm2 of calcium. They may be used to maintain white teeth after whitening. Of the patients surveyed in the latter study, 87% said they would undergo whitening again. However, at the end of the 2-week trial period, there were no statistically significant differences among the 5%, 10%, or 16% solutions. Plus, versatility is the name of the game, with plenty of formats to choose from—toothpaste, strips, pens, and more—to fit any preference. Some studies have shown that composites are unaffected by CPS (Haywood et al. The hydrogen peroxide must be in situ long enough and frequently enough to release the pigment molecules from the tooth by oxidation. Certain types of chewing gum can be used daily and especially after meals. The whitening activity of perborates is probably a result of the presence of not only perhydroxyl anion (HO2)−, but also the peroxoborate anion. The penetration of oxygen inside the tooth gives the tooth a whiter appearance. In a study by Scherer et al. If you work with your dentist, they will take an impression of the teeth, and then your tray is made to fit your mouth. The overzealous use of abrasive toothpaste will cause the removal of enamel as well as the stain. The combination of a hard toothbrush and an abrasive toothpaste has been recognized as creating further tooth wear problems. Provisional restorations such as those using intermediate restorative material (IRM) may be affected by hydrogen peroxide (see Figures 3.20 and 3.21). Hydrogen peroxide is the actual bleaching agent, while carbamide peroxide breaks down into hydrogen peroxide. 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). CPS has been incorporated into a chewing gum with inhibition of plaque formation (Moss 1999). The whitening potential of a material is thus an important factor to consider. This effect is most commonly noticed on lower canines, and patients are often concerned that their teeth are whitening unevenly. With Philips Zoom, the No.1 patient-requested professional whitening brand in the U.S., you can customize a teeth-whitening treatment around each patient’s needs. A systematic review conducted by Attin showed interesting results. Table 3.5  Properties of the ideal whitening agent. 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 thixotropic nature of Carbopol allows better retention of the slow-releasing gel in the tray. Consumer Reports investigates whether OTC products help lighten your smile. It appears that lateral incisors take up the whitening product most quickly. 1991). The potential for remineralization occurs in vivo and may counteract these effects, but these have not been studied for CPS yet. 1991c). The H2O2 systems are aqueous gel based, whereas the CPS systems are anhydrous gel based. Hasson et al. Reports on the effects of whitening on composite resins are conflicting. However, not all combinations of amalgam and whitening agents result in higher mercury levels. Just like whitening strips, teeth whitening trays may have to be used multiple days a week for up to two weeks for the best results. Internal whitening of endodontically treated teeth has been shown to result in greater leakage of composite restorations immediately after completion of internal whitening (Barkhorder et al. An in vitro study was undertaken by Oliver and Haywood (1999) to see whether the use of shortened dental trays could cause a demarcation line, but this proved negative and the teeth whitened evenly. The residual oxygen in the whitened tooth surface also inhibits the polymerization of the composite resin (McGuckin et al. This effect of the acid needs further research to ensure that there is no permanent erosive effect on the teeth. 1992). Waiting 2 weeks will also allow the color to stabilize. Tooth whitening products. 1997). Teeth whitening trays include one or more mouthguard-like trays with a gel-based whitening solution. This would be beneficial for dentists who are treating an isolated dark tooth or darker canines (Leonard 1998). The material was initially supplied to dentists and is now available OTC. 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. pH measurements of the root surface have demonstrated cervical resorption occurring in those teeth that were not previously traumatized. It works best at temperatures over 55°C. Rotstein and coworkers (1997) found than 4–30 times as much mercury was released from amalgams in vitro compared to saline controls. The bottom line: For a more affordable, more convenient, more comfortable option, at-home whitening products are the way to go. Typical at-home products include gum and dental strips. What causes discoloration of teeth… Sodium perborate has been banned in Europe for use in tooth whitening because it is considered to be fetotoxic and cytotoxic. 1992, Machida et al. Further clarification of this is required. Patient perceptions of the whitening technique are positive. 1992) suggest that there may be significantly more mercury released from amalgam restorations during the whitening procedure. Once whitening has been terminated, a slight relapse in color occurs over the following 2 weeks. Studies using 10% CPS also showed that the bond strength of composite to etched enamel was reduced (Cvitko et al. Whitening may be the beginning of the treatment plan, and then further restorative dentistry may need to be carried out (see Figure 3.14). Moreover, sodium perborate is stabilized with complex ethylenediaminetetraacetic acid (EDTA) in such a way that it is not broken down by ions. • Discuss how a dental material is evaluated before it is marketed to the profession. This may be a transient effect. • Discuss the differences between direct and indirect restorative materials. •  Be easy to apply to the teeth for maximum patient compliance. The whitening toothpastes seem effective at removing surface stains on the teeth and may be useful to reduce extrinsic stains that occur from tea and coffee. The toothpaste provided with the kit may be abrasive to the tooth surface (Jay 1990). 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. This would reduce the associated staining. Store-bought whitening products are cost-effective and easy-to-use. 3. There is no known cross-reaction between the hydrogen peroxide materials used for highlighting hair and tooth whitening materials. However, studies have shown that the higher concentration materials may whiten teeth faster. Although there have been few reports of effects on amalgam restorations, studies (Hummert et al. This is the longest post-treatment clinical study published. There has been a recent boom in the production and sale of tooth whitening products… Each of your teeth is made up of an inner dentin layer and a hard outer enamel layer, which protects the teeth… 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. The color stability may be related to the extended treatment time of 6 months. The active ingredient in tooth whiteners available from dentists or drugstores is peroxide (hydrogen or carbamide). resorption occurring in those teeth that were not previously traumatized. As we have seen, whitening with peroxide reduces the bond strength of enamel by about 20% in the immediate effect. Surface roughening and etching may occur (Singleton and Wagner, 1992) and tensile strength is affected (Cullen et al. This effect is dependent on the type of dental amalgam used (Rotstein 1999, personal communication). Learn about the four most popular teeth whitening options. become green around the margins. Peroxide solutions flow freely through the enamel and dentin and into the pulp owing to the porosity and permeability of these structures (McEvoy 1989). Upper canines appear to be the slowest to lighten. The process of color regression toward darker shades is poorly described and understood in the literature (Heymann et al. 5. 1997). It is thought that the enamel surface remains intact and unaffected by the CPS and the whitening process (Haywood et al. 1990). 2009). Whitening is frequently used in combination with other forms of restorative dentistry that require bonding to enamel. Toothpastes have become more specialized and sophisticated in the last decade (Koertge et al. 1997). The thickness and composition of the enamel and the dentine are mainly responsible for the individual tooth colour.External influences can cause tooth discolouration over time.. Tooth … Cosmetically the function of the toothpaste should be to remove stain effectively and increase whiteness of the teeth (Sharif et al. 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. 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). The application technique relies on the mouthguard to keep the whitening agent in contact with the tooth so that the whitening product can penetrate through the enamel. Your dental professional can make recommendations and advise you on the best whitening treatment for you. Whitening strips are small plastic strips with a peroxide-gel that you apply to your teeth. The free movement is caused by the relatively low molecular weight of the peroxide molecule (see Figure 3.4) and the penetrating nature of the oxygen and superoxide radicals. Initially, no effects on restorative materials were reported (Haywood et al. 1993). Encourage the patient to refrain from smoking during treatment (Larson 1990). 1999) using 10% carbamide peroxide placed directly onto the enamel to validate the color change in dentin and to assess whether dentin changed uniformly, it was noted that a color change occurred throughout the dentin and the color change was uniform. This may be a result of the copper content of the amalgam (Haywood 2007). 1991) of the zinc phosphate cement. Sodium perborate is not simply a mixture of sodium metaborate and hydrogen peroxide, but rather an entirely different molecule with its own chemical properties. 1998). A lower concentration of carbamide peroxide will also work, but it will take longer. The potential for pulpal damage thus exists as a result of enamel and dentin penetration (Powell and Bales 1991). Teeth whitening results are not permanent and typically require touchups and further treatment to maintain whitening. Tooth color is primarily determined by the dentin and can be changed by whitening treatments. Depending on the manufacturer's instructions, whitening strips can be used up to 30 minutes a day for up to two weeks for a noticeable whitening result. These involve the application of the whitening product to the teeth with a small applicator … Directly after whitening, 84 treatments (51%) showed microhardness reduction compared with baseline, whereas 82 (49%) did not. The whitening effect can be detected around the edges of the incisal area and in the incisal corners. Some eating, drinking, and lifestyle habits can affect the shade of your teeth over time. Haywood and Heymann (1991) have noted no significant color changes other than the removal of extrinsic stains around existing restorations. •  Not cause damage to the teeth or the enamel to be etched. 1997). There has not been that much clinical research conducted on these products, which concerned the American Dental Association Council on Therapeutics (1994). Over-the-counter trays have a lower concentration of peroxide than what is available from an in-office procedure. If the patient cannot manage overnight use, then 2–3 hours is recommended in the evening. The latter author made the comment that the actual treatment time may not represent the active concentration time because the carbamide peroxide is decomposing relatively rapidly in the initial phase of any treatment. 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. • List the properties of dental materials and ways that they affect their application. Next, your dentist will apply the whitening gel and shine an ultraviolet lamp onto the teeth to activate the treatment. Each strip is worn for 30 minutes, removed, and discarded, and the procedure is performed twice a day for 14 days. Patients with known sensitivity or allergy to any of the ingredients should not use the whitening agent. Whitening strips contain a thin layer of hydrogen peroxide or other active ingredient, adhered to a pliable, plastic strip. 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. Whitening was terminated at that point with immediate effect. 1992). Others have shown that surface hardness is altered (Bailey and Swift 1991, Friend et al. They can be reassured that this demarcation line usually fades after a few days of further whitening treatment. Early in its use, this material had a composition … The sensitivity appears to be dose related rather than pH related. The sensitivity is transient and lasts only for the duration of the whitening treatment (Basting et al. The bleaching products … Teeth-Whitening Technology. RELATIVE MERITS OF H2O2 VERSUS CARBAMIDE PEROXIDE SYSTEMS. Whitening sugarless chewing gum helps to remove food residue after eating. However, this amount is small and the results may not be clinically significant. The considerable application time with home whitening techniques may explain the minimal color regression reported. It reduces plaque adherence and accumulation and therefore has been used for treatment of periodontitis, oral hygiene (Stindt and Quenette 1989), reduction of gingivitis, reduction of caries rate, and aphthous ulceration (Tse et al. A recent in vitro study of the effects of carbamide peroxide on provisional crowns showed that an orange discoloration occurred with provisional materials containing methacrylate (Robinson et al. There are some key points that you must keep in mind while choosing the best over-the-counter teeth whitening products – The concentration of the bleaching agent – hydrogen peroxide is one of the most popular bleaching agents used in tooth whitening products. 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). At the end of treatment, it is not possible to know which concentration of whitening gel was used. 8. There was no significant difference between the two materials tested, which were Opalescence and NiteWhite. •  Remain in contact with oral tissues for short periods. 10. In-office whitening treatments at your dentist's office can have excellent results. While in-office treatments cost more than over-the-counter products, the results are typically better and last longer. Successful results could be seen within 20 hours of treatment. There appears to be less penetration into the pulp from carbamide peroxide than from hydrogen peroxide. Colgate Reaches Children in Need Across the Globe With the Power of a Bright Smile. This process usually features a higher concentration of whitening ingredients than you'll find in products in the store. © YYYY Colgate-Palmolive Company. 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. (1992). The reduction of hardness may reflect the loss of mineral from enamel, which could also result in reduced wear resistance (Seghi and Denry 1992). An oral care composition is disclosed comprising a pigment and a non-ionic surfactant which comprises one or more carbon-carbon double bond, and the use of such compositions for tooth whitening. Carbamide peroxide is a bifunctional derivative of carbonic acid. The abrasive toothpastes try to remove the surface staining by ‘sanding’ the teeth. 2012). The yellow pigments (xanthopterin) are oxidized to white pigments (leucopterin) (see Figures 3.1, 3.2, and 3.5). Increase in the incidence of sensitivity was noted when the whitening technique was used twice per day rather than once per day (Leonard 1998). 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. Resin tags in whitened enamel are less numerous, less defined, and shorter than those in unwhitened enamel (Titley et al. No patient felt the need to have the teeth re-treated as a result of color regression. One study testing 16% and 35% CPS, however, reported significant changes in the enamel, including loss of the aprismatic layer, exposure and demineralization of enamel prisms, and pitting (Bitter 1995). After 2 weeks, the oxygen has dissipated and the tooth demonstrates the actual lightened shade. 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. Carbamide peroxide eventually breaks down to water, oxygen, urea, carbon dioxide, and ammonia (Figure 3.8). Nevertheless, more in situ and in vivo studies are needed to verify this observation (Attin et al. Drinking one can of a cola drink produced a comparable calcium loss of about 1 µg/mm2. Try these best teeth whitening products … Acrylic resins are supplied as liquid/powder, in premeasured tubes, and in auto mix cartridges. •  Not dehydrate the oral tissues or teeth. That means it has been tested to be safe and effective for teeth whitening. (2013) showed that compromised bond strength to whitened enamel was immediately restored with the application of antioxidant gel sodium ascorbate and exposure to human saliva in situ for at least 7 days. Restorations may need to be replaced after whitening owing to the color change in the tooth. A 4% color regression after 6 months has been reported in nonvital whitening (Ho and Goerig 1989). •  It can attach to inorganic structure and protein matrix (Fasanaro 1992). In a longitudinal study by Haywood et al. The most common side effect experienced by patients using the home whitening technique is transient, mild temperature sensitivity (Heymann et al. Take care of any cavities or gingivitis. Whitening is often desirable when teeth become yellowed over time for a number of reasons, and can be achieved by changing the intrinsic or extrinsic color of the tooth enamel. Dentists should encourage their patients to stop smoking for general health improvement and to enroll in a smoking cessation program. The initial color of the affected teeth seems to determine the success or failure of the technique (Arens 1989). Jonathan B. Levine, DMD. Recent studies have shown that surface effects may occur on existing restorative materials (such as composites, glass ionomers and, luting cements). Allergic symptoms have been reported, such as swelling of the lips (Goldstein and Garber 1995). Other restorative treatment may be more appropriate for these patients (see Figure 3.15). Length of whitening time is an important predictor of success in teeth that have fluorosis staining (Seale and Thrash 1985). Aging Consumption of staining substances trauma Use of antibiotic i.e Tetracycline excessive fluoride nerve degeneration Aging of restorations. The most effective products have been hydrogen peroxide and carbamide peroxide. Tooth whitening products are made from what ingredient? According to the American Dental Association (ADA), whitening mouthrinse can include hydrogen peroxide or other whitening ingredients. Carbopol enhances the viscosity of the whitening material. This is very rare. The free radical is very reactive and has great oxidative power. It may be more appropriate to wait for 2 weeks before placing the composite restoration and to place a glass ionomer restoration directly into the access cavity immediately after completion of the whitening treatment to prevent the reduction in bond strength. Activated charcoal is the new fad in the natural health market. However, the bond strength will improve if etching and bonding are delayed for 1–2 weeks postwhitening (Titley et al. The studies appear to support the clinical observation that controlled home whitening is safe to the pulp (Li 1998, Kelleher and Roe 1999). 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 … The whitening period may need to be extended to 6–10 weeks to achieve significant lightening. Today it is also seen … It has been hypothesized that the tooth is filled with oxygen from the oxidative process and this changes the optical qualities of the tooth to appear more opaque. At 7 years after treatment of the same patient pool, 35% were satisfied with the color of their teeth. Any factor compromising adhesion can affect the aesthetics and longevity of the bonded restoration (Cvitko et al. 1998). 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. It is difficult to set up barriers to prevent the rapid penetration. In another clinical evaluation of two carbamide peroxide agents, both caused the teeth to lighten (Heymann et al. The chemical degradation of the chromogens within or on the tooth … Get a list of all ADA-Accepted at-home bleaching products. The whitening strips and products with high concentrations of hydrogen peroxide caused more users to report tooth sensitivity. The use of topical fluoride after whitening may help to regain the bond strength (Haywood 1991c). Dehydration of the hard tissue is less likely to occur with hydrogen peroxide treatment. This may be a result of the precipitate of hydrogen peroxide and collagen that forms on the cut dentin surface after tooth whitening. 1998a). 9.Discuss the composition and variety of tooth-whitening products. What are tooth stains anyway? Caution should be taken to avoid addition of these chemicals to commercial preparations intended for tooth whitening. There appears to be an alteration in the matrix of the glass ionomer (Jefferson et al. 1999), which may result in different levels of tooth sensitivity or whitening efficacy. It is suggested that adhesive dentistry be delayed for 2 weeks after whitening (Powell and Bales, 1991). There may be a decrease in the translucency of the tooth. The combination of a hard toothbrush and an abrasive toothpaste has been recognized as creating further tooth wear problems. The currently available formula of Opalescence has more Carbopol than previously. The reduced bond strength is transient; it diminishes after 24 hours and disappears after 1 week (Della Bona et al. Some of the OTC whitening agents have a very low pH (5.6), and this may cause erosion of the enamel. Table 3.8 shows a classification of whitening toothpastes according to their mechanism of action (Haywood 1996). These cases peracetic acid is formed as an intermediate compound before any teeth whitening treatment at dentist. 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