Bleaching

Cosmetic whitening

1. COSMETIC WHITENINGCOSMETIC WHITENING
Dr. Fazal ur Rehman QaziDr. Fazal ur Rehman Qazi
BDS,FCPSBDS,FCPS
Asst. ProfAsst. Prof
DEPT OF OPERATIVE DENTISTRYDEPT OF OPERATIVE DENTISTRY

2. Discoloration of teethDiscoloration of teeth
Intrinsic discoloration
Extrinsic discoloration

3. Extrinsic stains
““located on the surface of the tooth located on the surface of the tooth
and are most easily removed by and are most easily removed by
external cleaning.”external cleaning.”

Extrinsic color changes may be due to: Extrinsic color changes may be due to:

poor oral hygienepoor oral hygiene

ingestion of chromatogenic foods and drinksingestion of chromatogenic foods and drinks

tobacco use.tobacco use.

4. Intrinsic stainsIntrinsic stains
““located within the tooth and are located within the tooth and are
accessible only by bleaching.”accessible only by bleaching.”

Intrinsic color changes may be caused by :Intrinsic color changes may be caused by :

agingaging

ingestion of chromatogenic foods and drinkingestion of chromatogenic foods and drink

tobacco usagetobacco usage

microcracks in the enamelmicrocracks in the enamel

tetracycline medicationtetracycline medication

excessive fluoride ingestionexcessive fluoride ingestion

severe jaundice in infancysevere jaundice in infancy

dental cariesdental caries

restorationsrestorations

5. FEW FACTSFEW FACTS

Aging is most common cause of Aging is most common cause of
discoloration.discoloration.

Yellow discoloration of aging responds Yellow discoloration of aging responds
quickly to bleaching. quickly to bleaching.

Tetracycline stained teeth are the slowest Tetracycline stained teeth are the slowest
to respond to bleaching.to respond to bleaching.

Brown-fluoresced teeth are moderately Brown-fluoresced teeth are moderately
responsive.responsive.

7. Tetracycline StainingTetracycline Staining
•First degree First degree
Light yellow, brown or gray uniformly distributed Light yellow, brown or gray uniformly distributed
throughout the crown, with no evident banding.throughout the crown, with no evident banding.
•Second degree Second degree
Darker or gray uniform staining, with no banding.Darker or gray uniform staining, with no banding.
•
Third degree Third degree
Dark gray or blue staining with marked banding. Dark gray or blue staining with marked banding.
•Fourth degree Fourth degree
These stains are too dark. These stains are too dark.

8. VITAL BLEACHINGVITAL BLEACHING
Commonly known as, Commonly known as, tooth whiteningtooth whitening is a is a
noninvasive method of lightening dark or noninvasive method of lightening dark or
discolored teeth.discolored teeth.

9. Vital BleachingVital Bleaching
AdvantagesAdvantages
Low costLow cost
High success rateHigh success rate
No tooth alterationNo tooth alteration

10. Vital Bleaching Vital Bleaching
DisadvantagesDisadvantages

Unpredictable resultsUnpredictable results

Need Re-treatmentNeed Re-treatment

Possible side effectsPossible side effects
Transient sensitivity sensitivity

11. Dental bleaching agentsDental bleaching agents

CompositionComposition

Carbamide peroxideCarbamide peroxide 5% to 40%5% to 40%

Carbopol ( slow oxygen releasing)Carbopol ( slow oxygen releasing)

Glycerin (thickening agent)Glycerin (thickening agent)

Sodium hydroxideSodium hydroxide

Flavors and fluorideFlavors and fluoride

12. Mode of actionMode of action

In saliva Carbamide peroxide converts to In saliva Carbamide peroxide converts to
hydrogen peroxide, the active bleaching agent, hydrogen peroxide, the active bleaching agent,
and urea.and urea.

Hydrogen peroxide, typically generates short-Hydrogen peroxide, typically generates short-
lived oxygen intermediates, such as hydroxyl lived oxygen intermediates, such as hydroxyl
radicalradical

It enters enamel or dentine and diffuse to areas It enters enamel or dentine and diffuse to areas
of discoloration and breaks down some of the of discoloration and breaks down some of the
double bonds in discolored or stained double bonds in discolored or stained
compounds, results in whitened appearance.compounds, results in whitened appearance.

13. Hydrogen
peroxide
URE
ACarbamide
peroxide
hydroxyl
radical
DOUBLE
BONDS

14. Bleaching Techniques
In-office bleaching technique
Laser bleaching
Dentist-prescribed, home applied bleaching
tray method
whitestrips method
Non vital bleaching

15. In-office bleaching technique

Also known as power bleachingAlso known as power bleaching

This application technique uses a higher This application technique uses a higher
concentration of hydrogen peroxide.concentration of hydrogen peroxide.

Require isolation and close patient monitoring Require isolation and close patient monitoring
throughout the procedure.throughout the procedure.

Local anesthesia is contraindicated b/c they Local anesthesia is contraindicated b/c they
hinder pts communication abt procedural hinder pts communication abt procedural
discomfort (gingival burning, improper rubber discomfort (gingival burning, improper rubber
dam clamp placement).dam clamp placement).

16. In-office bleaching technique

Ideal for pts who need quick results or for Ideal for pts who need quick results or for
those who have stubborn unresolved those who have stubborn unresolved
stains.stains.

17. In-office BleachingIn-office Bleaching
(Clinical Protocol)(Clinical Protocol)
Clean teeth with pumiceClean teeth with pumice
Record pre-op shadeRecord pre-op shade
Isolate teeth as close to the Isolate teeth as close to the
gingival margin as gingival margin as
possible with rubber dam possible with rubber dam
(no tears, leakage, fully (no tears, leakage, fully
inverted)inverted)

18. Mix the thickening Mix the thickening
agent with 35% agent with 35%
hydrogen peroxide to a hydrogen peroxide to a
non-slumping non-slumping
consistency.consistency.
Place the gel material Place the gel material
on the teeth for 30 minon the teeth for 30 min

19. May need to “refresh” May need to “refresh”
with hydrogen with hydrogen
peroxide liquid if the peroxide liquid if the
gel appear too drygel appear too dry
Rinse and clean; Rinse and clean;
remove rubber dam remove rubber dam
and record post-op and record post-op
shadeshade

20. Laser bleaching

Lasers are also used within the clinical Lasers are also used within the clinical
setting for dental bleaching.setting for dental bleaching.

The laser generates heat that increases The laser generates heat that increases
the resorption rate of hydrogen peroxidethe resorption rate of hydrogen peroxide

Time-consumingTime-consuming

Quick resultsQuick results

Very expensiveVery expensive

21. Dentist-prescribed, home applied
bleaching
Tray method
First step is fabrication of
trays
Tray design include soft
or rigid, reservoir or
nonreservoir, and
scalloped or non-
scalloped trays

22. 
Soft trays are preferred for Soft trays are preferred for
ease of fabrication and pt ease of fabrication and pt
comfort.comfort.

Reservoir are used with Reservoir are used with
the more highly viscous the more highly viscous
bleaching material.bleaching material.

Scalloped prevents from Scalloped prevents from
gingival irritation from gingival irritation from
bleaching gel.bleaching gel.

The patient should wear The patient should wear
the nightguard for 2 to 6 the nightguard for 2 to 6
hrs a day.hrs a day.

23. Side effects of home bleachingSide effects of home bleaching

Thermal sensitivityThermal sensitivity ;;
result of permeation of peroxide into dentinal result of permeation of peroxide into dentinal
tubules.tubules.
can be prevented by decreasing the wear can be prevented by decreasing the wear
time, decreasing solution concentration.time, decreasing solution concentration.

Gingival irritationGingival irritation ;;
result of contact with bleaching solution and result of contact with bleaching solution and
ill fitted tray.ill fitted tray.
can be prevented by well fitted tray of can be prevented by well fitted tray of
trayless methods.trayless methods.

24. whitestrips method

Trayless methodTrayless method

Each application Each application
involves the involves the
alignment and folding alignment and folding
of the strip into place.of the strip into place.

25. whitestrips method

Advantages Advantages
convenienceconvenience
ease of useease of use
potential for better potential for better
tolerabilitytolerability
costcost

DisadvantagedDisadvantaged
less tooth coverageless tooth coverage
potential difficulty in potential difficulty in
keeping strips in keeping strips in
placeplace

26. Recommended agents for Recommended agents for
bleachingbleaching

35% hydrogen peroxide for in office 35% hydrogen peroxide for in office
bleaching bleaching

10% carbamide peroxide for home 10% carbamide peroxide for home
bleachingbleaching

27. Factors affecting bleaching Factors affecting bleaching
(in office and at home)(in office and at home)

Surface cleanlinessSurface cleanliness

Concentration of peroxideConcentration of peroxide

Temperature (in-office)Temperature (in-office)

pHpH

TimeTime

AdditivesAdditives

Sealed environment (non-vital)Sealed environment (non-vital)

28. Safety factorsSafety factors

Tooth and pulpal problemsTooth and pulpal problems

SensitivitySensitivity

Mineral lossMineral loss

Soft tissue responseSoft tissue response

Systemic effectsSystemic effects

29. Contraindications of bleachingContraindications of bleaching

Discoloration due to restorationsDiscoloration due to restorations

Children with large pulp horns and Children with large pulp horns and
cracks(In office)cracks(In office)

Pregnant and allergic pts (home Pregnant and allergic pts (home
bleaching) bleaching)

exposed roots and severe enamel loss(in exposed roots and severe enamel loss(in
office)office)

Pts with TMD (home bleaching)Pts with TMD (home bleaching)

30. Interference with composite Interference with composite
restorationsrestorations

Hydrogen peroxide interferes with bonding Hydrogen peroxide interferes with bonding
so a delay of 7-10 days is advised so a delay of 7-10 days is advised

Existing composite restorations may be Existing composite restorations may be
disked back to allow maximum exposure disked back to allow maximum exposure
of tooth surface for bleachingof tooth surface for bleaching

31. Non vital bleaching

  When the discoloration When the discoloration
is from within the pulp is from within the pulp
chamber, from necrotic chamber, from necrotic
pulp tissue or from pulp tissue or from
staining agents that are staining agents that are
present in the pulp present in the pulp
chamber, the bleaching chamber, the bleaching
treatment need to take treatment need to take
place within the pulp place within the pulp
chamberchamber

32. Techniques for non vital Techniques for non vital
bleachingbleaching

Thermocatalytic techniqueThermocatalytic technique

Walking bleachingWalking bleaching

Inside-outside bleachingInside-outside bleaching

33. RecommendationsRecommendations
Sodium Sodium
perborate mixed perborate mixed
with water with water
OROR
10% carbamide 10% carbamide
peroxideperoxide

34. Cervical resorptionCervical resorption

Occurs in 7% of casesOccurs in 7% of cases

Young ageYoung age

Deficiency in cementumDeficiency in cementum

Injury to PDLInjury to PDL

InfectionInfection

Lack of seal over GPLack of seal over GP

High conc. Of peroxideHigh conc. Of peroxide

HeatHeat

36. Potential ResultsPotential Results

38. Alternatives to bleachingAlternatives to bleaching

MicroabrasionMicroabrasion

MacroabrasionMacroabrasion

Veneers (Direct and Indirect)Veneers (Direct and Indirect)

Crowns Crowns

39. Direct Composite VeneersDirect Composite Veneers

44. Bleaching before and after Bleaching before and after
veneersveneers