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There is a rising public demand for aesthetic dentistry, including dental bleaching or teeth whitening has increased in recent years. I’m sure you’re familiar with dental whitening products such as whitening toothpaste, strips and even the gel form which comes with a tray.

In such context, clinicians, and dental professionals are acutely aware of the importance of dental bleaching in daily clinical practice.

Nowadays, there are two types of dentist-supervised techniques: at home or in-office bleaching. Although at-home bleaching has been the most frequent treatment for vital teeth, some patients do not want to use a bleaching tray on a daily basis for several weeks; so they request in-office bleaching, which produces more immediate results.

There’re several different methods for whitening teeth, each with their mechanism of action. The efficacy of these various methods is dependent upon the particular tooth discoloration that is being treated.

First, how do our teeth get stained?

Causes of tooth discoloration can be categorized into two main groups: Intrinsic and extrinsic staining.

Intrinsic staining, sometimes called internal staining, can be attributed to factors such as genetics, age (from enamel wear over time exposing yellower dentin), antibiotics, high levels of fluoride, and developmental disorders and can start before the tooth has erupted. After the eruption of the tooth, some dental restorations can cause tooth staining.

Extrinsic staining, sometimes called external staining, is due in large part to environmental factors including smoking, pigments in beverages and foods, antibiotics, and metals such as iron or copper. Colored compounds from these sources are absorbed into acquired dental pellicle or directly onto the surface of the tooth causing a stain to appear.

Tooth stains consist of compounds that have color or darker shades called chromogens that are accumulated in the tooth (intrinsic) or on the tooth (extrinsic). Chromogens fall into two categories: large organic compounds that have conjugated double bonds in their chemical structure; and metal containing compounds. Bleaching of the organic
compounds by hydrogen peroxide involves reacting with the double bonds to oxidize the double bond.

This causes the chromogen to become a lighter colored compound. Bleaching of the metallic compounds is much more challenging; better aesthetic options may be veneers, bonding, or crowns. There are some professional products that contain sodium hypochlorite (NaOCl) which reacts with the double bonds of the chromogen in much the same way as peroxide.

Many people are unsure of which products serve them the best to get the results they desire. Whitening toothpaste typically can lighten tooth color by about one or two shades. These are available in the supermarkets and pharmacies.

On the other hand, there are whitening strips. Whitening strips were introduced into the market in the late 1980’s. They deliver a thin layer of peroxide gel on plastic strips shaped to fit onto the buccal surfaces of the teeth. There are a variety of white strip products on the market with varying instructions. A typical set of instructions is to apply the strips twice daily for 30 minutes for 14 days. Tooth lightening can be seen in several days, and this method can lighten the teeth by 1 or 2 shades. There are some newer whitening strip products that require only one 30-minute application per day that have the same whitening end point as the two-a-day products.

Another favorite method is mouth rinses. Whitening rinses contain oxygen sources such as hydrogen peroxide to react with the chromogens. Manufacturer’s instructions are for twice a day rinsing for 60 seconds each. It takes up to 3 months to see a 1 or 2 shade improvement in tooth color.

Last but not least, if you opt to do the treatment yourself in the comfort of your home is the Tray-based tooth whitening systems. These are available both professionally and OTC. This method involves use of a fitted tray containing carbamide peroxide bleaching gel worn for 2 to 4 hours a day or overnight. Usually, by following the manufacturer instructions tooth whitening is noticeable in a few days, lightening the teeth by 1 or 2 shades.

However, there are minimal risks associated with teeth whitening. There include tooth mineral degradation, increased susceptibility to demineralization. No doubt some may be put off by the risks, the benefits may outweight the potential side effects. Still, there are positive effect from fluoride which is contained by modern bleaching products, for example, products from Ultradent.

Throughout the years, we’ve found that the optimal regimen to obtain persistence of tooth whitening is to follow an in-office treatment with monthly home-based touch-up treatments using OTC products. This regime will work best to ensure you get the optimal result and be truly satisfied with the whitening treatment,

In conclusion, dental whitening is an excellent cosmetic procedure. Supervision of the tooth whitening strategy by an oral healthcare professional will reduce the potential risks and optimize benefits of tooth bleaching. Be a well informed consumer in the process of surveying for the best teeth whitening treatment for yourself.

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