Older teeth, because of the more complex dentin structure, take longer to lighten (see Figures 3.1, 3.10, and 3.11). It is not apparent what effect or combination of effects is occurring. Other luting cements may also be affected. This amount was significantly greater than in controls. Hydrogen peroxide appears to change the surface chemistry. Whitening is frequently used in combination with other forms of restorative dentistry that require bonding to enamel. Occasionally an allergy to hydrogen peroxide may be noted. 1997). Both systems contain hydrogen peroxide and work well. It was noted that the more times the whitening tray was replenished, the greater the likelihood of sensitivity. 8. • List the properties of dental materials and ways that they affect their application. Patient perceptions of the whitening technique are positive. (See further discussion later.). • Discuss how a dental material is evaluated before it is marketed to the profession. 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. The sensitivity appears to be dose related rather than pH related. Have questions about your smile? 2008). 1999). Colgate Reaches Children in Need Across the Globe With the Power of a Bright Smile. 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. The whitening strips and products with high concentrations of hydrogen peroxide caused more users to report tooth sensitivity. You can easily swap your regular toothpaste and mouthwash for whitening toothpaste and mouthrinse. Pulp penetration can occur within 5–15 minutes according to studies by Cooper et al. 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. The H2O2 systems are aqueous gel based, whereas the CPS systems are anhydrous gel based. Composition of composites that gives and match the color of the tooth… Plus, versatility is the name of the game, with plenty of formats to choose from—toothpaste, strips, pens, and more—to fit any preference. Whitening on lower teeth can be slower. 2009). 1991, Baughan et al. •  It can attach to inorganic structure and protein matrix (Fasanaro 1992). Whitening is a dental procedure- help patient select best tx option 3. 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 … 1991). They can be reassured that this demarcation line usually fades after a few days of further whitening treatment. This chapter will discuss the different materials that are used for tooth whitening treatments (Tables 3.1 and 3.2). Table 3.5 lists the properties of the ideal whitening agent, and Table 3.6 summarizes the factors affecting the rate of color change. This is very rare. Teeth whitening results are not permanent and typically require touchups and further treatment to maintain whitening. Some amalgam restorations that are exposed to the tooth whitening materials may become green around the margins. After 2 weeks, the oxygen has dissipated and the tooth demonstrates the actual lightened shade. No patient felt the need to have the teeth re-treated as a result of color regression. Thirty-eight patients participated in a Nightguard whitening study using two first-generation whitening materials. Sodium perborate is not simply a mixture of sodium metaborate and hydrogen peroxide, but rather an entirely different molecule with its own chemical properties. This process usually features a higher concentration of whitening ingredients than you'll find in products in the store. Next, your dentist will apply the whitening gel and shine an ultraviolet lamp onto the teeth to activate the treatment. • Discuss the differences between direct and indirect restorative materials. 1991). Give the properties of temporary restorative materials and their application in the restoration of teeth. Owing to the possibility of overuse of CPS by the patient at home, it is prudent to ensure that the patient follows the prescribed regimen for tray wearing. However, clinically this may be difficult to achieve because patients may not tolerate the application of ascorbic acid to the teeth for such a long period of time. If your patients aren’t using activated charcoal for tooth whitening, they may be using it for a variety of other purposes. The penetration of oxygen inside the tooth gives the tooth a whiter appearance. 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. This article is intended to promote understanding of and knowledge about general oral health topics. The application of fluoride improved remineralization of enamel. well as the stain. However, at the end of the 2-week trial period, there were no statistically significant differences among the 5%, 10%, or 16% solutions. The reduction of hardness may reflect the loss of mineral from enamel, which could also result in reduced wear resistance (Seghi and Denry 1992). Dentin bonding may be altered after whitening (Della Bona et al. Although patients with severe wear on their teeth may request whitening, further restorative dentistry may be more appropriate. The use of acetone- or alcohol-based adhesive systems or roughening the surface may counteract these effects of peroxides on bond strength. The hydrogen peroxide breaks down to water and oxygen and for brief periods forms the free radical HO2• perhydroxyl. Whitening products contain one of two tooth bleaches (hydrogen peroxide or carbamide peroxide). Ninety-five per cent of patients are genuinely glad they went through the procedure and 97% recommended the procedure to their friends (Leonard 1998). There may be a decrease in the translucency of the tooth. Others have shown that surface hardness is altered (Bailey and Swift 1991, Friend et al. 1998), but is thought to be the opposite of the whitening procedure. Using Opalescence whitening material, Matis and coworkers (1999) have shown that carbamide peroxide degrades in an exponential manner after the first hour and that the degradation rate is higher in areas closer to the tooth structure. Most of the teeth whitening products vary in the strength of the bleaching agent. The calcium/phosphate ratio of dentin was significantly decreased by whitening with 30% hydrogen peroxide and 10% carbamide peroxide in a study by Rotstein and colleagues (1996). 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. 2. The initial color of the affected teeth seems to determine the success or failure of the technique (Arens 1989). Get a list of all ADA-Accepted at-home bleaching products. Treatment with sodium ascorbate gel for 60 minutes may be recommended if patients cannot wait for at least 7 days for adhesive techniques to be performed. 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. 1999). 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. The sensitivity is transient and lasts only for the duration of the whitening treatment (Basting et al. 4. 1991). 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. It is suggested that adhesive dentistry be delayed for 2 weeks after whitening (Powell and Bales, 1991). Shade retention can be expected in up to 90% of patients at 1 year post-treatment, 62% at 3 years, and at least 35% at 7 years (Haywood et al. 1996, Kelleher and Roe 1999). It is not intended to be a substitute for professional advice, diagnosis or treatment. 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. Keeping a healthy smile is of utmost importance, and maintaining good oral hygiene will keep your smile looking brighter longer. Cosmetically the function of the toothpaste should be to remove stain effectively and increase whiteness of the teeth (Sharif et al. A lower concentration of carbamide peroxide will also work, but it will take longer. 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%. 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. The whitening activity of perborates is probably a result of the presence of not only perhydroxyl anion (HO2)−, but also the peroxoborate anion. The yellow pigments (xanthopterin) are oxidized to white pigments (leucopterin) (see Figures 3.1, 3.2, and 3.5). These involve the application of the whitening product to the teeth with a small applicator … According to the American Dental Association (ADA), whitening mouthrinse can include hydrogen peroxide or other whitening ingredients. Haywood and Heymann (1991) have noted no significant color changes other than the removal of extrinsic stains around existing restorations. The urea that is present in the gels assists with wound healing and contains a soft tissue protectant. 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. There is no long-lasting sensitivity. The CPS moves freely through the tooth in a multidirectional manner. Try these best teeth whitening products … Inform pt what to expect (realities) 4. 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. 1994). Dehydration of the hard tissue is less likely to occur with hydrogen peroxide treatment. •  It can break up a large macromolecular stain into smaller stain molecules, which are expelled to the surface by diffusion. Drinking one can of a cola drink produced a comparable calcium loss of about 1 µg/mm2. This results in the tooth appearing more yellow because the enamel layer is removed and the dentin-to-enamel ratio is changed (Haywood 1996). Some of the OTC whitening agents have a very low pH (5.6), and this may cause erosion of the enamel. On scanning electron microscopy, focal areas of shallow erosion were found to have developed in human teeth exposed to CPS, but no changes in the composition of the enamel were found. Significantly, in those studies that simulated the intraoral conditions as closely as possible, the risk of enamel microhardness decrease as a result of whitening treatments seems to have been reduced. The color stability may be related to the extended treatment time of 6 months. Other restorative treatment may be more appropriate for these patients (see Figure 3.15). Tooth color is primarily determined by the dentin and can be changed by whitening treatments. 1998a). 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. 1992, Machida et al. Keep records (before/after photos) 5. •  Be used in the minimum quantity necessary to achieve the desired result. The hydrogen peroxide acts as an oxygenator and an oxidant. Fired porcelain showed a slight change after being immersed in the whitening gels for three 2-hour periods a day for 5 weeks (Hunsaker et al. Of the first category, 100% of patients experienced tooth lightening compared with 80% of those with brown fluorosis and 75% of the tetracycline patients. It was also used for post-operative rinsing after tooth extraction. The thixotropic nature of Carbopol allows better retention of the slow-releasing gel in the tray. In the latter study most of the teeth were associated with previous trauma, and it is not known whether the trauma predis-posed the tooth to the resorption or whether it was caused by the effects of the whitening agent. It appears that the H2O2 system may be faster than the CPS (Frysh et al. There are three main options for teeth whitening at home: Toothpastes, whitening strips, and light devices. •  Be easy to apply to the teeth for maximum patient compliance. 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. This would be beneficial for dentists who are treating an isolated dark tooth or darker canines (Leonard 1998). A systematic review conducted by Attin showed interesting results. Upper teeth whiten more quickly and have fewer side effects than lower teeth. When the oxygen becomes saturated inside the tooth, it appears bright. Dentists should encourage their patients to stop smoking for general health improvement and to enroll in a smoking cessation program. 1. Whitening sugarless chewing gum helps to remove food residue after eating. 1998) with many designed to perform either therapeutic or cosmetic functions. No effect on gold has been reported. Brightening and whitening teeth have become the number one aesthetic concern for many people. Mild to moderate tooth sensitivity and gingival irritation were the most common side effects. 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 … Whitening sugar-free chewing gum can help your teeth in multiple ways. Some parts of the tooth may be difficult to whiten. 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). 1991, Godwin et al. Enamel surface hardness is apparently unaffected by the whitening agent (Zalkind et al. 5. This is because of the anatomy of the enamel and dentin microstructure. There was no significant difference between the two materials tested, which were Opalescence and NiteWhite. There is evidence that whitening products work when compared with placebo or/no treatment. Carbamide peroxide is a bifunctional derivative of carbonic acid. Whitening toothpaste can contain mild abrasives to gently remove stains on the surfaces of the teeth while brushing. Once this level has been determined, tray wearing times can be scientifically calculated. 2000). Hydrogen peroxide is the actual bleaching agent, while carbamide peroxide breaks down into hydrogen peroxide. It appears that the lighter the tooth, the easier it is to whiten. 1991), with a faster treatment and exposure time. 10. 1994). Studies by Torneck et al. 1990). The potential for pulpal damage thus exists as a result of enamel and dentin penetration (Powell and Bales 1991). 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). The potential for remineralization occurs in vivo and may counteract these effects, but these have not been studied for CPS yet. Restorations may need to be replaced after whitening owing to the color change in the tooth. Jonathan B. Levine, DMD. Macroscopically, IRM exposed to hydrogen peroxide appears cracked and swollen, whereas carbamide peroxide does not appear to have an effect. The studies using CPS have shown promising results. There were no significant differences in bond strength among the different whitening gels. The introduction of whitening toothpastes has been very rapid. The toothpaste provided with the kit may be abrasive to the tooth surface (Jay 1990). 1997). Directly after whitening, 84 treatments (51%) showed microhardness reduction compared with baseline, whereas 82 (49%) did not. Aging Consumption of staining substances trauma Use of antibiotic i.e Tetracycline excessive fluoride nerve degeneration Aging of restorations. However, whitening treatment at your dentist's office can have longer-lasting results. All these techniques rely on adequate adhesion of the composite to the enamel. Discuss the composition and variety of tooth-whitening products. The active ingredients in whitening strips vary, but many use … © YYYY Colgate-Palmolive Company. 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. 1990). The whiteness may occur because the tooth has become dehydrated (Darnell and Moore 1990) after the whitening procedure. Whitening toothpastes don’t use carbamide peroxide. Certain types of chewing gum can be used daily and especially after meals. The overzealous use of abrasive toothpaste will cause the removal of enamel as well as the stain. Hasson 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). Length of whitening time is an important predictor of success in teeth that have fluorosis staining (Seale and Thrash 1985). 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. The use of topical fluoride after whitening may help to regain the bond strength (Haywood 1991c). At the end of treatment, it is not possible to know which concentration of whitening gel was used. Appropriate patient selection and counseling is important for patient satisfaction. This may be a result of the copper content of the amalgam (Haywood 2007). One patient experienced allergies to the preservative in the whitening tray. 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. Encourage the patient to refrain from smoking during treatment (Larson 1990). (1992). It appears that lateral incisors take up the whitening product most quickly. The process of color regression toward darker shades is poorly described and understood in the literature (Heymann et al. WO2020035269A1 - Oral care composition - Google Patents Oral care composition ... Discuss… Second, the chewing gum's whitening ingredients can coat the teeth to prevent staining. Existing amalgams may change color from black to silver (see Figure 3.19). First, your dentist will place a protective coating on the gum tissue and lips to protect them from the harsh whitening ingredients. There is no known cross-reaction between the hydrogen peroxide materials used for highlighting hair and tooth whitening materials. 1998). 1990). The whitening effect can be detected around the edges of the incisal area and in the incisal corners. Activated charcoal is the new fad in the natural health market. 1998) during the first hour after treatment. (1994) reported that 92% experienced successful lightening of their teeth. The reduced bond strength is transient; it diminishes after 24 hours and disappears after 1 week (Della Bona et al. Nevertheless, more in situ and in vivo studies are needed to verify this observation (Attin et al. A total of 55 studies were identified, with 166 hardness measurements conducted directly after whitening and 69 measurements performed after a post-treatment episode. 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. In general, however, the hydrogen peroxide oxidizes the pigments in the tooth. CPS has been incorporated into a chewing gum with inhibition of plaque formation (Moss 1999). There may be loss of organic components from treated enamel surfaces—carbon, hydrocarbon, and tertiary amine groups replaced by oxygen, calcium, and phosphorus. There appears to be less penetration into the pulp from carbamide peroxide than from hydrogen peroxide. The combination of a hard toothbrush and an abrasive toothpaste has been recognized as creating further tooth wear problems. In these cases peracetic acid is formed as an intermediate compound. Tooth whitening or tooth bleaching is the process of lightening the color of human teeth. Reports on the effects of whitening on composite resins are conflicting. There are even special whitening toothbrushes available to polish teeth without abrasion using special condensed bristles. Whitening strips contain a thin layer of hydrogen peroxide or other active ingredient, adhered to a pliable, plastic strip. There is also the possibility of an allergy to the whitening materials or to the tray plastic material. The two main systems of tooth whitening delivery utilize either at home or in office bleaching systems or delivery via toothpastes. Provisional crowns made from methyl methacrylate may discolor and turn orange. 1990 ) what effect or combination of a hard toothbrush and an abrasive toothpaste has been used since 1960 oral! Or the enamel application in the fracture toughness of the technique ( Arens 1989 ) can break up a macromolecular... The function of the glass ionomer ( Jefferson et al for many.. However, studies ( Hummert et al toothpastes according to the color radicals, to cleave double! Water and oxygen and for brief periods forms the free radical is very reactive and great! Are anhydrous gel based retention of the bonded restoration ( Cvitko et al have. Mccracken and Haywood 1996 ) be noted whitening is a slow-release oxygen agent recommended to less! Option 3 include hydrogen peroxide breaks down to water and oxygen and for periods! 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Thought that the H2O2 system may be a substitute for professional advice, diagnosis or treatment reported, such ear. Cps is used in combination with other forms of restorative dentistry may be a decrease the...

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