The thixotropic nature of Carbopol allows better retention of the slow-releasing gel in the tray. The bottom line: For a more affordable, more convenient, more comfortable option, at-home whitening products are the way to go. The whiteness may occur because the tooth has become dehydrated (Darnell and Moore 1990) after the whitening procedure. Pulp penetration can occur within 5–15 minutes according to studies by Cooper et al. 2012). • Pronounce, define, and spell the Key Terms. This may be a result of the copper content of the amalgam (Haywood 2007). Yellow stains are the easiest to whiten. Patient perceptions of the whitening technique are positive. Encourage the patient to refrain from smoking during treatment (Larson 1990). Moreover, sodium perborate is stabilized with complex ethylenediaminetetraacetic acid (EDTA) in such a way that it is not broken down by ions. Drinking one can of a cola drink produced a comparable calcium loss of about 1 µg/mm2. According to the American Dental Association (ADA), whitening mouthrinse can include hydrogen peroxide or other whitening ingredients. 1991). As we have seen, whitening with peroxide reduces the bond strength of enamel by about 20% in the immediate effect. 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 … Whitening sugarless chewing gum helps to remove food residue after eating. This would reduce the associated staining. Carbamide peroxide home whitening products are recommended to be used overnight. Tooth whitening products. 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). Whitening is a dental procedure- help patient select best tx option 3. In general, however, the hydrogen peroxide oxidizes the pigments in the tooth. 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 sensitivity appears to be dose related rather than pH related. Patients in the latter study rewhitened on average at 25 months. 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. 1998a). 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. The application of fluoride improved remineralization of enamel. Sodium perborate is not simply a mixture of sodium metaborate and hydrogen peroxide, but rather an entirely different molecule with its own chemical properties. However, a study using a whitening/remineralization cycle showed that 10% carbamide peroxide treatment significantly decreased enamel hardness. Each strip is worn for 30 minutes, removed, and discarded, and the procedure is performed twice a day for 14 days. 1997). The currently available formula of Opalescence has more Carbopol than previously. Others have shown that surface hardness is altered (Bailey and Swift 1991, Friend et al. First, your dentist will place a protective coating on the gum tissue and lips to protect them from the harsh whitening ingredients. 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. The chemical degradation of the chromogens within or on the tooth … The bonding between glass ionomer and dentin may also be affected (Titley et al. as closely as possible, the risk of enamel microhardness decrease as a result of whitening treatments seems to have been reduced. Enamel surface hardness is apparently unaffected by the whitening agent (Zalkind et al. Teeth whitening results are not permanent and typically require touchups and further treatment to maintain whitening. 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. However, whitening treatment at your dentist's office can have longer-lasting results. The use of acetone- or alcohol-based adhesive systems or roughening the surface may counteract these effects of peroxides on bond strength. 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. 1997). 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. 1992). Toothpastes have become more specialized and sophisticated in the last decade (Koertge et al. Some eating, drinking, and lifestyle habits can affect the shade of your teeth over time. Carbamide peroxide also has an antibacterial effect (Gugan et al. 1999), which may result in different levels of tooth sensitivity or whitening efficacy. demand for esthetics, has produced a tremendous market for tooth whitening. Tooth color is primarily determined by the dentin and can be changed by whitening treatments. This results in the tooth appearing more yellow because the enamel layer is removed and the dentin-to-enamel ratio is changed (Haywood 1996). Once this level has been determined, tray wearing times can be scientifically calculated. Sodium perborate has been banned in Europe for use in tooth whitening because it is considered to be fetotoxic and cytotoxic. There is evidence that whitening products work when compared with placebo or/no treatment. A lower concentration of carbamide peroxide will also work, but it will take longer. Resin tags in whitened enamel are less numerous, less defined, and shorter than those in unwhitened enamel (Titley et al. That means it has been tested to be safe and effective for teeth whitening. (1991) have shown that there is a reduced bond strength of composite to enamel immediately after whitening with a 35% solution of hydrogen peroxide. Surface roughening and etching may occur (Singleton and Wagner, 1992) and tensile strength is affected (Cullen et al. 2. 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 … These materials have different properties. 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 hydrogen peroxide acts as an oxygenator and an oxidant. A dark black crack line on the central incisors caused by grinding and smoking may not be lightened with whitening (see Figure 3.12). However, at the end of the 2-week trial period, there were no statistically significant differences among the 5%, 10%, or 16% solutions. There has not been that much clinical research conducted on these products, which concerned the American Dental Association Council on Therapeutics (1994). Existing amalgams may change color from black to silver (see Figure 3.19). There was no significant difference between the two materials tested, which were Opalescence and NiteWhite. RELATIVE MERITS OF H2O2 VERSUS CARBAMIDE PEROXIDE SYSTEMS. 1992). 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. When the oxygen becomes saturated inside the tooth, it appears bright. 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. •  Not dehydrate the oral tissues or teeth. Store-bought whitening products are cost-effective and easy-to-use. 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. Participants were instructed to wear the guard at night or during the day for 2–4 hours for 6 weeks of total treatment time. Consumer Reports investigates whether OTC products help lighten your smile. 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). Restorations may need to be replaced after whitening owing to the color change in the tooth. There are even special whitening toothbrushes available to polish teeth without abrasion using special condensed bristles. 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. •  It can break up a large macromolecular stain into smaller stain molecules, which are expelled to the surface by diffusion. The color stability may be related to the extended treatment time of 6 months. and oxygen and for brief periods forms the free radical HO2• perhydroxyl. CPS is used in a variety of external-use OTC products such as ear drops and hair dyes. 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). 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). 1991). 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. There is the potential side effect that the teeth can be etch-whitened (Bartlett and Walmsley 1991). After 2 weeks, the oxygen has dissipated and the tooth demonstrates the actual lightened shade. CPS has been incorporated into a chewing gum with inhibition of plaque formation (Moss 1999). What causes discoloration of teeth… Hasson et al. Whitening on lower teeth can be slower. Some studies have shown that composites are unaffected by CPS (Haywood et al. 1991). Color regression occurred within the first month after whitening in a study by Matis and coworkers (1998). 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