Tooth whitening

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Teeth whitening (called teeth whitening when using bleach), is natural tooth color recovery or whitens outside the natural color.

The restoration of underlying natural shade is possible by simply removing surface stains caused by extrinsic factors, stainers such as tea, coffee, red wine and tobacco. Stacking of rocks and tartar can also affect dye coloring. The restoration of natural tooth color is achieved by making teeth cleaned by a dental professional (usually called "scaling and polishing"), or at home with various oral hygiene methods. Calculus and tartar are difficult to remove without professional clean.

To whiten natural tooth color, bleaching is recommended. This is a common procedure in cosmetic dentistry, and a number of different techniques are used by dental professionals. There are a large number of products that are marketed for home use to do this as well. Techniques include whitening strips, bleaching pens, whitening gels and laser tooth whiters. The bleaching method generally uses hydrogen peroxide or carbamide peroxide which decomposes into hydrogen peroxide. Common side effects associated with bleaching include increased tooth sensitivity and gum irritation.

Video Tooth whitening

Natural tooth color

Perception of tooth color is the result of complex interactions of factors such as: lighting conditions, translucency, opacity, light scattering, gloss, human eyes and brain. Teeth consist of a layer of surface enamel, which is whiter and semitransparent, and the underlying dentine layer, which is darker and less transparent. This is calcification, a hard tissue comparable to bone. The natural color of the tooth is best thought of; white color outside the bone, not pure white. Public opinion about the color of normal teeth tends to be distorted. Commonly reinforced cosmetic dental images in the media. In one report, the most common dental color in the general population ranged from A1 to A3 in the classic VITA A1-D4 shading guide.

Women generally have slightly whiter teeth than men, partly because women's teeth are smaller, and therefore there is less dentine, partly seen through the enamel layer. For the same reason, larger teeth such as molars and canine teeth (cuspid) tend to be darker. The baby's teeth (first teeth) are generally whiter than the adult teeth that follow, again because of the difference in the enamel ratio to dentine. As people of adult teeth often become darker due to changes in mineral tooth structure, as the enamel becomes less porous and lacks phosphate. Email layers can also be gradually thinned or even perforated by various forms of tooth wear.

Maps Tooth whitening

Staining and discoloration of teeth

Teeth can be darkened by a buildup of surface stains (extrinsic coloring), which conceals the color of natural teeth; or the tooth itself can discolor (intrinsic dyeing).

Extrinsic color change

Extrinsic dyes may become internalized through defects or cracks in the enamel or as a result of exposed dentine but most extrinsic stains appear to be deposited on or inside the tooth enamel. Causes of extrinsic staining include:

• Dental plaque: although usually almost invisible on tooth surfaces, plaque may become tarnished by chromogenic bacteria such as the Actinomyces species .
• Calculus: negligible plaque will eventually harden, and lead to the formation of hard deposits on the teeth, especially around the gumline. The color of the calculus varies, and can be gray, yellow, black or brown
• Tobacco: tar in smoke from tobacco products (as well as smokeless tobacco products) tends to form a yellow-brown-black stain around the tooth's neck above the gum line
• Chew betel.
• Certain foods and drinks. foods and vegetables are rich in carotenoids or xanthonoids. Swallowing colored fluids such as sports drinks, cola, coffee, tea, and red wine can damage teeth.
• Certain topical medications. Chlorhexidine (antiseptic mouthwash) binds tannins, which means that long-term use in people who consume coffee, tea or red wine is associated with extrinsic staining (ie dye removable) teeth.
• Metallic compounds. Exposure to such metal compounds may be in the form of drugs or other environmental exposures. examples include iron (black stain), iodine (black), copper (green), nickel (green), cadmium (yellow-brown).

Intrinsic discoloration

Changes in tooth tissue thickness will result in intrinsic color change. There are several causative factors that can act locally or systematically, affecting only one tooth or all teeth and causing discoloration as a result. Several diseases known to affect tooth growth especially during enamel and dentin formation can cause discoloration. The causes of intrinsic staining include:

• Dental caries (tooth decay)
• Tooth trauma that can cause staining either as a result of pulp necrosis or internal resorption. Or teeth can become darker without pulp necrosis
• enamel hypoplasia
• Hyperemia
• Fluorosis
• Dentinogenesis imperfecta Amelogenesis imperfecta
• Tetracycline and minocycline. Tetracycline is a broad-spectrum antibiotic, and minocycline derivatives are common in acne treatments. This drug is able to chelate the calcium ions and put into the teeth, cartilage and bone. Ingested during the dental development years causes yellow-green coloration of the dentin seen through the fluorescent enamel under ultraviolet light. Then, tetracycline is oxidized and the staining becomes more brown and no longer fluoresces under UV light.
• Porphyria
• Hemolytic disease in newborns
• Root ingestion
• Alkaptonuria: Metabolic disorders that increase the accumulation of homogentisic acid in the body and can cause brown pigmentation of teeth, gums and buccal mucosa.

Causes of extrinsic and intrinsic staining include:

• Age: tooth enamel becomes thinner over time, allowing dentin to shine through
• Bruxism (grinding and gnashing of teeth) can cause micro-cracks on the incisal tip of the tooth. Extrinsic stains can more easily settle in this gap, and a thin layer of enamel can be left behind. This thin enamel layer is partially transparent, allowing a dark background from the mouth to glow, giving a darker appearance than the incisal edge.

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Method

Bleaching methods include office bleaching (applied by professional dentists), and individual home care (either provided by the dentist or available at the counter). In some countries non-dental professionals also perform teeth whitening procedures for consumers.

Bleaching solutions generally contain hydrogen peroxide or carbamide peroxide, which whitens tooth enamel to change its color. The off-the-shelf product usually relies on a solution of carbamide peroxide which varies in concentrations from 10% to 44%. The bleaching solution can be applied directly to the tooth, embedded in a plastic strip placed on the tooth or using gel held in place by the protective mouth. Carbamide peroxide reacts with water to form hydrogen peroxide. Carbamide peroxide has about one-third of the hydrogen peroxide strength. This means that a 15% solution of carbamide peroxide is the rough equivalent of 5% of the hydrogen peroxide solution. The peroxide oxidizing agent penetrates porosity in crystal structures such as enamel rods and breaks stain deposits in dentine.

Other bleaching agents include 6-phthalimido peroxy hexanoic acid (PAP) (however, no evidence for its effectiveness) and sodium perborate.

In-office

Prior to treatment, the dentist may examine the patient: taking a medical and dental history (including allergies and sensitization), observing hard and soft tissues, placement and restoration conditions, and sometimes x-rays to determine the nature and depth of possible irregularities..

A white color guide is used to measure tooth color. These colors determine the effectiveness of bleaching procedures, which can vary from two to seven colors. The effects of bleaching may last for several months, but may vary depending on the patient's lifestyle. Consuming dye food or beverages that have strong color can jeopardize the effectiveness of the treatment. These include; coffee, soft drinks, red sauce, etc.

Bleaching procedures in the office generally use a healed, light-treated protective layer on the gums and papilla (the gum end between the teeth) to reduce the risk of chemical burns in the soft tissues. The bleaching agent is a carbamide peroxide, which decomposes inside the mouth to form hydrogen peroxide, or hydrogen peroxide itself. The bleach gel usually contains between 10% and 44% carbamide peroxide, which is roughly equivalent to a 3% to 16% hydrogen peroxide concentration. The legal percentage of hydrogen peroxide allowed to be administered is 0.1-6%. Bleaching agents are only allowed to be given through dental practitioners, dentists and dentalists.

Bleaching is most ineffective when the original tooth color is greyish and may require a special bleach tray. Bleaching is most effective with teeth that turn yellow. If severe stains or tetracycline damage are present in the patient's teeth, and whitening is ineffective (tetracycline staining may require prolonged bleaching, as it takes longer to bleach to reach the dentine layer), there are other methods of masking the stain. The bond, which also covers tooth stains, is when a thin layer of composite material is applied to the front of one's teeth and then healed with blue light. Veneer can also cover the discoloration of teeth.

The advantage of this technique is that the result occurs when sitting in a dentist, it does not take longer for the results shown as when the home bleaching technique is used. This is great if fast, effective results are needed.

But the disadvantage of this technique is that this is one of the treatments and if further bleaching is necessary the treatment will need to be done again. However, with bleaching at home, more bleach gel can be purchased from dentists and the same tray can be used, as long as they are intact and have no holes in them.

Light acceleration bleaching

Bleaching or bleaching with acceleration, sometimes colloquially referred to as laser bleaching (a common misconception as a laser is an old technology used before the technology is currently developed), uses light energy intended to speed up the bleaching process in the dental office. Different types of energy can be used in this procedure, with the most common being halogen, LED, or plasma arc. The use of light during bleaching increases the risk of tooth sensitivity and may be no more effective than lightless bleaching when high concentrations of hydrogen peroxide are used. Recent research has shown that the use of light activators does not improve bleaching, has no measurable effects and is likely to increase the temperature of related tissues, resulting in damage.

The ideal energy source is the high energy to stimulate the peroxide molecules without overheating the dental pulp. Lamps are usually in the blue light spectrum because these have been found to contain the most effective wavelengths to start the hydrogen peroxide reaction. A bleaching treatment usually involves soft tissue isolation with resin-curable, resolvable barriers, the application of professional-grade hydrogen peroxide gelling gel (25-38% hydrogen peroxide), and light source exposure for 6-15 minutes. Recent technical advances have minimized heat and ultraviolet emissions, allowing shorter patient preparation procedures.

In the office, the tooth is polished using a pumice stone, whitening agent is added. His teeth are washed with plenty of water and then polished again.

It is advisable to avoid smoking, drinking red wine, eating or drinking any colorful food after this because the teeth will be stained immediately after treatment.

Nanoparticle Catalyst to Reduce Hydrogen Peroxide Concentration

The recent addition to the field is a new light acceleration bleaching agent containing lower concentrations of hydrogen peroxide with a titanium oxide nanoparticle-based catalyst. The reduced hydrogen peroxide concentration causes a lower incidence of dental hypersensitivity. Nanoparticles act as photocatalysts, and their size prevents them from spreading into the teeth. When exposed to light, the catalyst produces rapid and localized breakdown of hydrogen peroxide into highly reactive radicals. Because of the very short lifespan of free radicals, they are able to produce a bleaching effect similar to a much higher concentration of bleaching agents in the outer layer of the tooth where the nanoparticle catalyst is located. This provides effective teeth whitening while reducing the required hydrogen peroxide concentration and other reactive byproducts on the dental pulp.

Internal bleaching of non-vital teeth.

Dentin internal coloring can darken the tooth from the inside out. Internal bleaching can improve this in teeth that are treated to the root canal of the tooth. Internal bleaching procedures are performed on devitalized teeth that have undergone endodontic treatment (root canal treatment) but are color-change due to internal staining of the tooth structure by blood and other leaky fluids. Unlike external bleaching, which brightens the teeth from the inside out, internal bleaching brightens the teeth from the inside out. Internal tooth whitening involves drilling a hole into the pulp chamber no more than 2mm below the gingival margin, clearing the infected dentin or discoloration, sealing, and filling the root canal with gutta percha points, cleaning the inside of the duct using the etchant and placing the peroxide or sodium gel perborate tetrahydrate into the pulp chamber so that they can work directly inside the tooth in the dentine layer. In this bleaching variation, the bleach material is sealed within the teeth for several days and replaced as needed, called the "bleach path" technique. The seal should be placed on top of the root filler to minimize micro leakage. There is a small risk of external resorption.

An alternative to the bleaching procedure is an inner bleaching where the bleaching cavity is left open and the patient removes a specially formed tray to place and maintain the agent, usually a carbamide peroxide gel in the cavity. Patients replace the gel for 24 hours and use the tray to keep it, they return to the dentist where it is sealed. In reviews after enough shade changes have occurred access cavities can be sealed, usually with dental composites.

At home

Bleaching methods at home include gel, chewing gum, rinsing, toothpaste, paint-on film, and whitening strips. Most over-the-counter methods utilize either carbamide peroxide or hydrogen peroxide. Although there is some evidence that the product will whiten teeth compared to placebo, the majority of published scientific studies are short-term and have a high bias risk because the research is sponsored or performed by the manufacturer. There is no long-term evidence of the effectiveness or potential risks of the product. The apparent difference in the short-term efficiency of the product appears to be related to the concentration of the active ingredient.

Vital night-guard bleaching

Night bleaching is another increasingly popular method that dentists prescribe at home teeth whitening. These methods have gained popularity due to the fact that significant results can be achieved overnight without removal of dental tissue which makes it a conservative method of toothbrush color. The process of preserving the vital night bleaching involves the impression of alginate from a patient's teeth in the first Visits, this is then casted onto a stone and a specially made vacuum shape tray. The patient is given a bleaching solution, which is placed into a tray for overnight use. The number of night trays used will depend on the level of dyeing and shadows desired by the patient. Due to the recent surge in use of home teeth whitening products there is a lack of research on long-term implications such as side effects and yield duration. Research has found that 'vital nightguard bleaching' is a safe, effective, and predictable method for brightening teeth. The bleaching effect lasted up to 47 months in 82% of patients, with no reported adverse events at the end of the study.

Whiten toothpaste

Whitening toothpaste is different from ordinary toothpaste in a way that contains higher abrasive and detergent content to combat tougher stains. Most contain low concentrations of carbamide/hydrogen peroxide rather than bleach - this brightens the color of the teeth. This whitening toothpaste makes the teeth one to two colors brighter. Toothpaste (toothpaste) advertised as "bleach" rarely contains carbamide peroxide, hydrogen peroxide or other bleach ingredients. Instead, they are abrasive (usually containing alumina, dicalcium phosphate dehydration, calcium carbonate or silica), intended to remove surface stains from the tooth surface. Sometimes they contain enzymes supposedly to break down the biofilms on the teeth. Unlike bleach, whitening toothpaste does not change the intrinsic color of the teeth. The use of excessive or long-term abrasive toothpastes will cause tooth abrasion, thinning of the enamel enamel and slowly darken the look of the teeth as the dentine layer becomes more visible. An alternative method of bleaching at home, which competes with the use of whitening paste, is the use of patent bleach gargle. Mouthwashes show a slightly better effort on whitening compared to paste use.

Over-the-counter (OTC) Bleach Strip and Gel

The bleaching strip works by placing the peroxide gel coating on the labial surface of the tooth through the use of a plastic strip formed to fit there. Many types of whitening strips are available in the market, after being introduced in the late 1980s. Each type of whitening strip has its own set of instructions to customize the product, for example, different strips can be used at different frequencies to achieve the same bleaching end point.

The bleach gel is also peroxide-based, like strips, and applied directly to the tooth surface through the use of a small brush. Following the manufacturer's instructions, they can lighten the tooth with 1-2 colors.

Whitening Rinses

Another method used by people at home to whiten teeth is the use of a bleach solution - it contains an oxygen source, such as hydrogen peroxide. To see 1 -2 dental improvements can take up to 3 months.

Natural (alternative) method

One recognized method of teeth whitening naturally is through the use of malic acid. Apple juice, especially green apples, contains malic acid. On the other hand, excessive consumption of acidic beverages will slowly dissolve the enamel layer, making the underlying dentin yellower demonstrate through more vivid, leading to the darkening of the tooth appearance. One study showed that malic acid is a weak tooth whitening agent.

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Indication

• Common dye coloring
• Extrinsic coloring caused by smoking or diet
• Fluorosis
• White and brown spots
• Tetracycline staining, although the color change may not be fully corrected

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Counter-indication

Some groups are advised to do teeth whitening carefully because they are at higher risk of side effects.

• Patients with unrealistic expectations
• Allergy to peroxide
• Pre-existing sensitive teeth
• Cracked/exposed dentin
• enamel development defects
• Acid erosion
• Receding gums (gingival recessions) and yellow roots, because the roots are not as white as the crown
• Sensitive gums
• Dental defects
• Tooth decay. White spot decalsification can be highlighted and become more noticeable directly following the bleaching process, but with further applications other parts of the tooth usually become whiter and less visible spots.
• Active periapical pathology
• untreated periodontal disease
• Pregnant or lactating women
• Children under 16 years of age. This is because the pulp chamber, or tooth nerve, grows up to this age. Tooth whitening under these conditions may irritate the pulp or cause it to become sensitive. Younger people are also more prone to abuse bleaching.
• People with visible white patches or crowns. Teeth whitening usually does not change the color of patches and other restorative materials. It does not affect porcelain, other ceramics, or gold teeth. However, it can slightly affect the restoration made with composite materials, cement and dental amalgams. Teeth whitening will not restore the color of patches, porcelain, and other ceramics when stained with food, drink and smoking, as these products are only effective on natural tooth structure. Thus, color mismatches can occur because the surface of the natural teeth increases in white and the restoration remains the same color. Bleach does not work where the bonding has been used and is not also effective at filling the teeth. Another option for handling such cases is porcelain veneer or tooth bond.

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Risk

The most common side effects associated with teeth whitening are increased tooth sensitivity and gum irritation, which tend to disappear after bleaching is stopped.

Hypersensitivity

Low pH of bleach opens the dentinal tubules and can cause dentin hypersensitivity, causing hypersensitivity of the teeth. It manifests as an increase in sensitivity to stimuli such as hot, cold or sweet. 67 - 78% of patients experience tooth sensitivity after office bleaching with hydrogen peroxide in combination with heat. Dental sensitivity can last up to 4 days after teeth whitening stops. However, it varies from person to person. Longer duration of hypersensitivity has been reported 39 days post-bleaching.

Repeated treatment or use of desensitis toothpastes can reduce discomfort, although there may be instances where the severity of pain stops further treatment. Potassium nitrate and sodium fluoride are used to reduce tooth sensitivity after bleaching.

Irritation of mucous membranes

Hydrogen peroxide is irritant and cytotoxic. At concentrations of 10% or higher, hydrogen peroxide is potentially corrosive to mucous membranes or skin and may cause burning sensation and tissue damage. Chemical burns from gel bleaching (if a high-concentration oxidizing agent contacts unprotected tissue, which can whiten or discolor the mucous membrane). The tissue irritation most often occurs due to an inappropriate mesh tray compared to the teeth whitening agent.

Uneven results

After teeth whitening, it is normal to get uneven results. Over time, the colors will appear more evenly. To avoid this happening, it is important to avoid making some common post-bleaching errors, such as eating foods and drinks that stain the surface of your teeth.

Return to the previous color of care

Nearly half of the initial color changes provided by intensive care at the office (ie, 1 hour of dental care) may disappear within seven days. Rebound is experienced when most teeth whitening comes from dehydrated teeth (also an important factor in causing sensitivity). When the teeth rehydrate, the color of the tooth "rebound", back to where it started.

Over-bleaching

Overbleaching, known in the profession as a "bleached effect", especially with intensive care (products that provide major changes in tooth color during very short maintenance periods, for example, one hour). Too much bleaching will cause the teeth to look very translucent.

Damage to enamel

Treatment of teeth whitening at home can have a significant negative effect on tooth enamel. Studies have been conducted and there is evidence that high concentrations of carbamide peroxide can damage enamel surfaces. Although the effects on emails are less harmful than those seen after phosphoric acid etch, increased surface roughness can make teeth more susceptible to extrinsic color changes after bleaching.

Dentine Weak

Intrakoronal bleaching with 30% hydrogen peroxide decreases dentine micro-hardness. Thus, the weakening of mechanical properties.

Effects on existing restoration

Dental Amalgam - Exposure to carbamide peroxide solution increases mercury release for one to two days.

Composite resin - bond strength between enamel-based fillings and weakened resins.

Other glass and cement icons - Studies show that the solubility of these materials may increase.

Bleachorexia

When bleaching is abused and an individual develops an unhealthy obsession with bleaching, the term bleachorexia or whitening junky has been used. This condition is characterized by repeated bleaching even though the teeth are white and will not get whiter. This condition is somewhat similar to the dysmorphic disorder of the body. Individuals seeing their teeth are never quite white, despite repeated bleaching. A person with bleachorexia will usually continue to request more bleaching services or products from a professional dentist. It has been recommended that the target image be agreed before starting bleaching treatment to help with this problem.

Other risks

Hydrogen peroxide may act as a tumor promoter. Intracoronal internal bleaching may also cause cervical resorption, more frequently observed in treated teeth by thermo-catalytic bleaching method. Because of the extensive removal of intracoronal dentine, a dental crown fracture may occur after intracoronal bleaching.

The International Agency for Research on Cancer (IARC) has concluded that there is insufficient evidence for the city carcinogeni hydrogen peroxide. The chemicals are now under Group 3: Can not be classified as causing carcinogenesis in humans. The genotoxic potential of hydrogen peroxide has been evaluated recently. Oral health products containing or releasing hydrogen peroxide up to 3.6% H ₂ O ₂ are unlikely to increase the risk of cancer in individuals.

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Maintenance

Although treatment results can be rapid, stains may reappear within the first few months and years of treatment. To maintain a whitish appearance, there are ways to protect your teeth and extend your treatment.

• Brush or rinse mouth immediately after eating and drinking
• Gum
• Floss to remove the placard
• Use whitening toothpaste once or twice a week to avoid surface stains
• Drinking liquor through a straw
• Perform touch treatments

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History

There has been an interest in white teeth since ancient times. Ancient Romans used urine and goat's milk in an effort to make and keep their teeth whiter. Guy de Chauliac recommends the following to whiten teeth: "Clean the teeth gently with a mixture of honey and salt that has been added some vinegar." In 1877 oxalic acid was proposed to whiten, followed by calcium hypochlorite. Peroxide was first used for teeth whitening in 1884.

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Society and culture

Tooth whitening has become the most widely marketed and requested procedure in cosmetic dentistry. More than 100 million Americans whiten their teeth in one way or another; spent about $ 15 billion in 2010. The US Food and Drug Administration only approved a gel that was under 6% hydrogen peroxide or 16% or less of carbamide peroxide. The Scientific Committee for Consumer Protection The EU considers gels containing higher concentrations than unsafe ones.

According to the Council of Europe regulations, only qualified dentists can legally provide tooth whitening products using 0.1 - 6% hydrogen peroxide, and that the patient should be at least 18 years of age. Over the last few years, there has been increasing concern over unlicensed staff who provide poor quality teeth whitening care. Significant evidence has been gathered that the teeth whitening procedure has been offered by beauty salons and health clinics under unskilled staff without dental qualifications. A group of recognized board and dental organizations called The Tooth Whitening Information Group (TWIG) was established to promote safe and productive teeth whitening information and guidance for the benefit of the community. Reports can be made publicly for TWIG through their website about any individual who provides illegal dental whitening services, or if they are personally treated by incompetent staff who are not professional dentists.

In Brazil, all bleaching products are classified as cosmetics (Degree II) in the legislature. There is a concern that this will lead to increased abuse of bleaching products and consequently there is a call for reclassification.

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See also

• Gum depigmentation

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References

Source of the article : Wikipedia