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Options for Teeth Whitening

There are different types of teeth whitening designed to adapt to the needs of each person. Each of them has different specifications that must be taken into account. Whitening healthy teeth is not the same as whitening teeth for someone that has various dental issues or that has gone through certain procedures, such as endodontics.

“Tooth discoloration is one of the most commonly reported complaints in patients seeking aesthetic treatment. Variation in tooth color can be influenced by intrinsic and extrinsic factors, ranging from chemical ingestion to consumption of foods that cause staining.

Currently, there are several products on the market that remove stains and claim to whiten teeth.”1

“There has been an increasing demand for whiter teeth. Home-based whitening products with a bleaching action have become popular and are prescribed to people by the dentist or purchased over-the-counter. A variety of whitening products are available which include hydrogen peroxide, carbamide peroxide, sodium percarbonate, sodium hexametaphosphate, sodium tripolyphosphate, and calcium peroxide. These agents are supplied in different concentrations and are used with different methods of application (gel in tray, strips, paint-on gel, chewing gum, and mouthwash), which have varying application times and duration of treatment.

Aesthetic dentistry has received increased attention in recent years, especially because people are more concerned about the aesthetic appearance of their smile. Technological innovations in dentistry have been added due to patients’ desire to improve the aesthetics of their teeth, which is an important aspect of quality of life

Based on the survey conducted by the American Academy of Cosmetic Dentistry in 2012, discolored, stained or yellow teeth were the main reason for an unattractive smile. The same survey reported that there was a 29% increase in patients receiving tooth whitening in a span of 1 year and was expected to increase to 45% and more in the years to come. 70% of patients who opted for bleaching were females. 75% of respondents reported the use of at-home or over-the-counter whitening products. 18% of dentists in the US recommended home-based bleaching method.”2

Nowadays, we have the possibility of whitening our teeth in our own home. However, we have to be aware that the result will not be the same as what we would get if we go to the dentist or a clinic that is specialized in whitening.

In this article, we will mention 4 types of teeth whitening used the most. We will observe their characteristics, in which cases they are not recommended, and the expected results that we can obtain from each one of them.

“Tooth discoloration can be described as any change in the color or translucency of a tooth and can be classified based on etiology as extrinsic or intrinsic discolorations. Extrinsic discolorations adhere to the tooth surface (superficial stains), while intrinsic discolorations are integrated into the structure of teeth. However, in some cases, both intrinsic and extrinsic discolorations may affect tooth enamel, dentine or pulp.

This usually results from the accumulation of chromogenic substances on the external tooth surface. These include smoking, pigments in foods and beverages, and metals such as iron or copper which lead to dark, brownish discolorations. These stains are localized mainly in the pellicle and are either generated by the reaction between sugars and amino acids or acquired from the retention of exogenous chromophores in the pellicle. This reaction is called Maillard reaction or the non-enzymatic browning reaction. Most extrinsic stains can be removed by routine prophylactic procedures. With time, these stains darken and become more persistent but they are highly responsive to bleaching.”2

Teeth Whitening at Home

“The popularity of home dental whitening has increased extensively in recent years. Although the first report on vital tooth whitening dates back to 1848 with the use of chloride of lime, the contemporary demand for whiter teeth has driven the development of numerous methods and products available. Amongst these is Carbamide Peroxide (CP). The use of CP for home teeth whitening was first reported by Haywood and Haymann in 1989 as a 10% gel delivered via a custom fabricated appliance. Carbamide peroxide (CO (NH2)H2O2) is an organic white crystalline compound formed by urea and hydrogen peroxide. It is also known as urea peroxide, urea hydrogen peroxide (UHP), cortizon and per carbamide.”3

There are several brands that offer the option to whiten your teeth from the comfort of your home. This is the most affordable option suitable for all budgets and offers good results. The process of whitening teeth at home usually consists of using a whitening gel or toothpaste, and a dental splint, which is left on the teeth for some minutes. When you remove it, your teeth will be slightly whiter.

“With this increased demand for whiter teeth, tooth whitening products have been exponentially increasing in the past few decades. Presently, tooth whitening products are the most popularly marketed oral care products.”2

“Although tooth whitening kits have become increasingly popular, their impacts on dentinal collagen cannot be underestimated. Despite confirming an improvement in tooth whitening using the 10% CP, a clear impact on the quaternary structure of the dentinal collagen was recorded for all CP concentrations and application protocols.”3

Performing this process only once will not give results. It must be repeated several times, which can last from a few days to weeks depending on the product instructions. The problem is that when you stop using it, your teeth will begin to lose the whiteness you obtained and you might even suffer from heightened tooth sensitivity.

Whitening in a Specialized Clinic

Although it’s more expensive, it’s probably the option that attracts most people. These are specialized clinics where they analyze the state of your teeth. Based on this analysis, they will provide a more permanent treatment. Dental professionals that dedicate themselves to this are of course very good at what they do, so this gives patients a certain type of assurance they cannot get if they treat themselves with products available in most pharmacies or drug stores.

First, the gums are protected with a special cover. Then, a whitening gel is applied on your teeth and then a fixed light is used to enhance the properties of the gel. The dentist or the assistant will usually put on protective glasses for you and themselves to protect their eyes during treatment. It is recommended not to drink coffee or smoke for 72 hours after the first sitting. A special paste for home use will be recommended by the specialist in order to ensure that the whitening that was achieved lasts much longer.

Mixed Teeth Whitening

This option of whitening combines dental whitening from a clinic with what we can perform at home. In many cases, the clinic will offer us a splint and whitening paste, which must be used as instructed. Mixed whitening is highly recommended for very yellow or deteriorated teeth, since a single consult may not be enough to achieve the desired effect. This is an intensive treatment, so if you follow the instructions, you should have guaranteed results.

Internal Teeth Bleaching

Internal Bleaching

 

This means that the whitening paste or gel is going to be applied from the inside of the tooth. This is an option designed for people who have had to go through endodontic treatments, which may cause the teeth to darken. For this reason, bleaching from the interior of teeth is a good option. However, it takes a while to get the desired results and several consults are needed.

“Tooth discolorations can be improved by several methods such as internal bleaching for non-vital teeth, or external bleaching for vital teeth or a combination of techniques.

It consists of walking bleach and thermocatalytic bleaching techniques and is done after endodontic treatment by the dentist and comprises of in-office techniques, which are not in the scope of this review.

External bleaching methods/vital bleaching.

 There are three fundamental approaches for bleaching vital teeth.

  1. In-office or power bleaching.
  2. At-home or dentist-supervised bleaching.
  3. Consumer-purchased or over-the-counter (OTC) products which are available in pharmacies or supermarkets without any prescription or professional monitoring.

Home-based bleaching methods (dentist-supervised and OTC) A variety of peroxide compounds, including hydrogen peroxide (HP), carbamide peroxide (CP) or urea peroxide, sodium percarbonate (SPC), sodium hexametaphosphate (SHMP), sodium tripolyphosphate (STPP), and calcium peroxide have been used as active ingredients in home-based bleaching methods. These agents are supplied in different concentrations, used with varying application times and duration of treatment, and delivered in various forms.

Whitening strips

These strips mainly contain hydrogen peroxide as the active agent in different concentrations. They are applied directly to the tooth surfaces and are thin flexible polyethylene strips coated with the bleaching gel. Continued research led to the development of strip-based whitening with very thin peroxide gels less than 0.20 mm in thickness. Disadvantages of the strip system are that it can reach only a finite number of teeth, cannot adapt well on malposed teeth, may interfere with speech patterns and can impinge on the gingiva.

Paint-on gels

 

Paint on Gels

Paint-on gels or varnishes are barrier-free whitening products that present hydrogen or carbamide peroxide in a suspension that is brushed by an applicator over the tooth surface and which adheres to the enamel. Some paint-on gels have sodium percarbonate as their active ingredient.

This method has gained popularity since the consumer just needs to paint a thin layer of whitening gel on their teeth (similar to nail polish application on fingernails). The added advantage is that the users can scallop the product around the gingiva and apply it to an unlimited number of teeth, regardless of the position in the arch.

Whitening mouth-rinses

Whitening mouth-rinses prevent stains and fight plaque buildup. Generally, a low concentration of hydrogen peroxide (1.5%), sodium hexametaphosphate have been included in the formulation to protect the teeth surface from new stains.

Whitening chewing gums

These are well accepted and enjoyed by many as a frequent activity among children and adults, therefore, may be a means for local drug administration into the oral cavity. Chewing gum-based products possess a number of therapeutic benefits, including increased saliva flow and removal of food debris, plaque, and surface stains. Baking soda, sodium hexametaphosphate, and sodium tripolyphosphate have been reported as the active ingredients in chewing gums.

Whitening dentifrices

The active components of tooth whitening dentifrices include hydrogen peroxide or carbamide peroxide which break down the organic molecules of biological film. Additionally, abrasives such as alumina, dicalcium phosphate dihydrate, and silica are also present in the formulation to promote stain removal. Their stain removal ability is related to a large number of abrasives in their formulation, which removes superficial extrinsic stains. However, the toothpaste abrasiveness needs to be moderated in order to prevent excessive wear to the underlying enamel and dentine

All the above products are either prescribed by the dentist for use at home or purchased by the consumer over-the-counter without professional consultation.

The at-home technique offers many advantages

At Home Bleaching

 

  • Self-administration by the patient
  • Less chair-side time
  • A high degree of safety
  • Fewer adverse effects
  • Low cost.

However, there are certain disadvantages

  • Results dependent on active patient compliance and diligence of use
  • High dropout rates (Leonard 2003)

Excessive use by overzealous patients leads to thermal sensitivity, reported to be as high as 67%.”3

“Although peroxide bleaching materials are well-established for aesthetic tooth whitening, the use of these substances in dentifrices is quite limited. In addition to causing alterations in products, high concentrations of hydrogen peroxide need to be counterbalanced by the use of soft tissue protective barriers in order to maintain contact with dental surfaces, which is not the case with bleaching toothpaste. The presence of 1.0% hydrogen peroxide in the chemical formulation of dentifrices caused tooth coloration changes when compared with non-whitening toothpaste.

Therefore, it is important to consider the concentration of hydrogen peroxide and its contact time as important contributors to effective tooth whitening.”1

“The results depict that the majority of the study participants (59.1%) with low-income level were not satisfied with their tooth color and were willing to undergo tooth-whitening procedures. Coal was used by 21% of the respondent for teeth whitening, followed by olive oil 15%, and lemon 10%. Based on the information, it is clear that a group of people is still comfortable to use conventional methods to make their teeth look whiter.

Despite the advances in esthetic dentistry, traditional methods of teeth cleaning and whitening are still being practiced. The practice is without evidence and without any scientific rationale. It can cost individuals their oral as well as overall health.

New products and techniques are appearing day to day that is less harmful and relatively pleasing to dental tissues, which are being used to fulfill rising patient demands for esthetics.”4

 

References:

(1) Casado, B. G., Moraes, S. L., Souza, G. F., Guerra, C. M., Souto-Maior, J. R., Lemos, C. A., … & Pellizzer, E. P. (2018). Efficacy of Dental Bleaching with Whitening Dentifrices: A Systematic Review. International journal of dentistry2018. Available online at https://www.hindawi.com/journals/ijd/2018/7868531/

(2) Eachempati, P., Nagraj, S. K., Krishanappa, S. K. K., Gupta, P., & Yaylali, I. E. (2018). Home‐based chemically‐induced whitening (bleaching) of teeth in adults. Cochrane Database of Systematic Reviews, (12). Available online at https://www.researchgate.net/profile/Ibrahim_Yaylali3/publication/329764220_Home-based_chemically-induced_whitening_bleaching_of_teeth_in_adults/links/5c1a2b6c92851c22a33614f1/Home-based-chemically-induced-whitening-bleaching-of-teeth-in-adults.pdf

(3) Redha, O., Strange, A., Maeva, A., Sambrook, R., Mordan, N., McDonald, A., & Bozec, L. (2019). Impact of Carbamide Peroxide Whitening Agent on Dentinal Collagen. Journal of dental research98(4), 443-449. Available online at  http://discovery.ucl.ac.uk/10067485/1/Bozec_Impact%20of%20Carbamide%20Peroxide%20Whitening%20Agent%20on%20Dentinal%20Collagen_AAM2.pdf

(4)       Siddiqui, A. A. (2018). Measurements of Various Traditional Methods of Teeth Whitening among People of Hail, Kingdom of Saudi Arabia. World9(2), 1-4. Available online at https://www.researchgate.net/profile/Rashid_Mian/publication/323918683_MeasurementsofVariousTraditionalMethods_ofTeethWhiteningamongPeopleofHail_KingdomofSaudiArabia/links/5aba32ffaca272aac4c78353/MeasurementsofVariousTraditionalMethods-ofTeethWhiteningamongPeopleofHail-KingdomofSaudiArabia.pdf?origin=publication_detail

 

Robert Velasquez
13 October, 2018

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Hello everyone, my name is Robert Velazquez. I am a content marketer currently focused on the medical supply industry. I studied Medicine for 5 years. I have interacted with many patients and learned a lot...read more:

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