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Tooth Whitening 101 - Dropbox

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					                                     Tooth Whitening 101
                                  Derek R. Williams DDS, M.S.

Causes of Tooth Discoloration

Thinning of enamel
   - advancing age
   - abrasion
   - chemical erosion

Extrinsic Staining
   - food staining
   - tobacco products
   - oral habits

Intrinsic Staining
    - advancing age
    - metabolic drug staining
    - trauma *hemoglobin in blood, nerve-pulp products, dehydration of the tooth
    *well water may cause heavy minerals to settle in the tooth causing discoloration

Restorative materials
   - defective (leaking restorations)
   *metal in amalgams
   *composites show food and bacteria around the restoration
   *gutta percha visible in the tooth after the RC

Endodontic Therapy
   - tooth dehydration
   - effects of restorative materials


Tooth Whitening Mechanism

Enamel- a semitranslucent, prismatic, primarily inorganic material that forms the outer layer
of the tooth.

Dentin- a yellow opaque, tubular, primarily organic material that forms the core of each
tooth.

Hydrogen peroxide migrates through the enamel and breaks down organic pigment
molecules in the enamel and dentin (primarily dentin).

Thinning of enamel
- advancing age
- abrasion
- chemical erosion

Intrinsic Staining
- advancing age
- metabolic drug
  staining
- trauma

Endodontic Therapy
- tooth dehydration
- effects of restorative materials

In Office Whitening *this is a competitive industry and the manufacturers often make
dentists sign waivers to only represent one product.

Active ingredient- 38% Hydrogen Peroxide

-   Administered in three 15 minute sessions
-   Requires a barrier to protect gingival
-   Chemically initiated reaction
-   Some brands require light as a potentiator

Opalescence Boost PF (38% H202)-Ultradent *leaders in the professional whitening industry

Rembrandt Chairside Whitening Kit (36% H202)- Johnson and Johnson

Nupro White Gold In Office Tooth Whiteners (36% H202)- Dentsply

Colgate Visible White- Chairside Whitening w/o light
- pH activated
- 36% Hydrogen Peroxide
- Gingival barrier
- Post treatment gel
- Touch-up gel


In Office Whitening
(Light Activated)

Niveous (25% H202)- Shofu
(Light Optional)

Dash (30% H2O2)- Discus Dental

Zoom (25% H202)- Discus Dental *dehydrates thooth. Heat causes reaction to happen faster,
also heats the pulp and increases sensitivity.
Brite Smile (Discus Dental)

-    15% Hydrogen Peroxide
-     One hour treatment
-    Breakthrough ‘Blue Light Technology’
-‘   Whitens up to 14 shades’



Dentist Supervised Night Guard Vital Bleaching

*One of the Best ways to go
    applied with custome made soft plastic trays
    Worn for 2-6 hours/day
    Only 10% concentration
    Approved by the aDA
    Carbamide peroxide….
    ….

*patients usually notice the effect in 4-5 days
Typical white course?? about 2 weeks.
Color will rebound approximate y ½ shade
Composite restoration placement should be delayed two weeks after final whitening session
   - Shade stabilization
   - O2 leach out prior to composite restoration

Considered safe and effective by profession
Results are retained 6 months – 4 years.
Touch ups performed using additional gel or OTC strips.

Get a value oriented shade guide
By chroma A, B, C, D
Value numbers
Lightest  Darkest =
B1, A1, B2, D2, A2, C1, C2, D4, A3, D3, B3, A3.5, B4, C3, A4, C4

Opalescence (Ultradent)
10, 22% carbamide peroxide *22% will have more side effects but it will work faster

Nite White (Discus Dental)
10, 16, and 22% carbamide peroxide. *2 weeks on the 10% is safer and there are less
sensitivity problems.
Over the Counter Whitening Products

-   Active Ingredient-Hydrogen Peroxide

Delivery Method

-Whitening Strips

-Preformed Trays

-Brush-on Gels

*These products do work, they usually take longer to work and the patient can’t call the
dentist if they have questions, concerns, or aren’t seeing the results they want.

Colgate Visible White- Take Home Kit
- 30 minutes per day application
- 5%, 7%, 9% Hydrogen Peroxide *with hydrogen peroxide, the concentration can be
lower
- visibly whiter teeth in 3 days

Crest Whitestrips- Classic *Crest is the leader in this category, it has over 20 whitening
products (they are all very similar)
- 30 minutes twice a day (14 days duration)
- whiter teeth in 5 days
- Hydrogen Peroxide active ingredient

Crest Whitestrips- Premium
- 30 minutes twice a day (7 days duration)
- whiter teeth in 3 days
- Hydrogen Peroxide active ingredient

Crest Whitestrips- Renewal
- 30 minutes twice a day (7 days duration)
- whiter teeth in 3 days
- 9.5% Hydrogen Peroxide active ingredient
- more strips per box

Crest Whitestrips Pro Effect
- 30 minutes twice a day (10 days duration)
- whiter teeth in 3 days
- Hydrogen Peroxide active ingredient
Crest Whitestrips- Advanced Seal *this one differs from the other products, it has the
adhesive on the strips.
- 30 minutes once a day (14 days duration); may wear for 30 minutes twice a day (7 days
   duration)
- whiter teeth in 3 days
- Hydrogen Peroxide active ingredient and molds to teeth instantly
- Good Housekeeping seal

Crest Whitestrips Daily Whitening Multicare
- 5 minutes once a day for 6 weeks *only 5 minutes means there is increase Hydrogen
Peroxide in this product.
- act only on enamel
- Hydrogen Peroxide active ingredient

Crest Whitestrips Daily Whitening Tartar Control
- 5 minutes once a day for 38 days
- acts only on enamel
- Hydrogen Peroxide active ingredient

Aquafresh White Trays *more sensitivity has been associated with this product
- whitening in 3 days
- 45 minutes/day for 7 days
- active ingredient (?) *probably Hydrogen Peroxide

Aquafresh White Trays Pro Gentle System
- whitening in 3 days
- 45 minutes/day for 7 days
- Hydrogen Peroxide active ingredient (maybe 10%)
- use sensitivity toothpaste for two weeks (potassium nitrate)

Listerine Whitening Quick dissolving Strips
- dissolve in 10 minutes
- Hydrogen Peroxide active ingredients
- Strips dissolve in 5- 10 minutes
*work on enamel, extrinsic stains, cigarette smokers, wine drinkers, blueberry eaters.

Rembrandt
- Whitening Gel with mouth *tray whitens in two hours  bleaches the tooth stains on the
enamel.

Go Smile Advanced Formula B1
- 15 minutes twice a day for seven days
- 6% Hydrogen Peroxide
- Applied to teeth with brush

				
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posted:4/26/2012
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