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CURRENT STATUS OF AT-HOME BLEACHING

Tooth Whitening Video

The difference between an average smile and a fantastic smile is 
often attributed to the whiteness of the persons teeth

Procedure Application
How it works Sensitivity
Contraindications

We have two systems to choose from the meet your whitening needs

Whitening effect is entirely
dependent on peroxide concentration x time in contact with teeth

          Tooth whitening procedures bring about color changes in about 97% of discolored teeth.  Approximately 62 % of bleached teeth remain color stable between 1 to 3 years after "bleaching", with the administration of a maintenance regimen (like toothpaste).  

     The active ingredients in home applied gels include hydrogen and carbamide peroxide.  Through a chemical reaction with moisture the hydrogen peroxide forms free radicals that penetrate enamel and dentin  to oxidize the "chromogens".  This process works by combining exposure time of the bleaching product on the teeth and concentration of the bleaching agent. 

     The level of whitening is primarily based on the total duration of exposure to the bleaching agent, regardless of the regimen used.  The bleaching process is not just a surface treatment, the internal color of the tooth is changed as the bleaching process penetrates through the enamel, dentin and pulp.

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"Aged" teeth BEFORE whiteningBefore Whitening            "Younger" looking teeth AFTER whitening After Whitening

    Yellow to brown stains are easier to remove.  These stains are caused by years of consuming highly colored foods or drinks, smoking or poor oral hygiene and age.  Bleaching is less predictable in cases of intrinsic discolorations, pulpal trauma, congenital complication, genetic abnormalities and medication like tetracycline, or sulfa drugs.  Discoloration in these cases depend on the amount and duration of antibiotic administration.

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     Application of the gel could be done 8 hours a night for 2 to 6 weeks or 30-45 minutes twice a day for 2 weeks.  The length of treatment varies from person to person.  After two hours only 50% of the product is available to work and only 10% after 10 hours.  Bleaching for less than 2 hours expends the product and extends the duration of treatment.  

     The custom-fitted try ensures a perfect fit for patient teeth that optimizes bleach exposure and lessens the chance of leakage that can lead to serious sensitivity or oral tissues damage. Thus these products are usually quit safe under dentist-supervised at home bleaching which is also the most effective and most cost-effective method today. The only time these products are unsafe is if they are used inappropriately, abused or used with additional products.

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     Sensitivity is the most frequent complication. However tooth sensitivity decreases as the whitening treatment progresses. ^ 54% of all people report mild sensitivity by just having "something being in contact with their teeth" ** Some whitening gels come with fluoride and/or potassium nitrate to reduce sensitivity.  Potassium nitrate has an analgesic effect on the transmission of nerve impulses.  Fluoride reduces sensitivity by blocking dentin tubules.  Application of potassium nitrate for 10-30 minutes prior to or after whitening, or alternating night with whitening material, is more than 90% effective in reducing sensitivity. ***

     It is important to have professionally whitened teeth because dental professionals are the only ones who can diagnose the cause of the stain, type of stain, extinct color, and tooth vitality and to follow-up with dental care to ensure an aesthetic result.  Dentist can help you decide how whitening will affect your current dental conditions and restorations.  There can be many problems with the use of over the counter whitening products.

     It is professionally recommended that professional bleaching be avoided until you are at least 14 and your teeth are fully, formed. Because a tooth is translucent, and because of light reflection the same tooth can look a different color under a different light. This is why is is difficult to tell patients exactly how may shade changes they may reach with the whitening procedure.  Teeth all respond differently.  But remember this general rule to match the whites of your eyes for the most natural look. 

Contraindications/limitations of home bleaching: Comments
Extensive composite (white) & porcelain restorations Restorations will NOT bleach and you need to be informed about the cost of replacement
Pre-existing sensitivity 2/3 of these people will experience some sensitivity for 1-4 days; usually reversible upon termination of bleaching
Severe gray/blue banded tetracycline staining Guarded prognosis, may reduce amount of
"masking: required for future
Discoloration in gingival third or exposed yellow Guarded prognosis for whitening
Pregnant or lactating  No know adverse effects but avoid use as a precautionary measure
TMJ Consider bleaching one arch and monitor comfort
Translucent teeth May appear darker after bleaching
Amalgam restoration in front teeth Replace amalgams to avoid "greening effect"
Noncompliance or unrealistic expectation Determine realistic whitening results****
Q
uick bleaching lasts a shorter time and you willl
have to wear the trays to keep the quick bleach stable and to continue to have good results

Study shows Sensodyne® makes whitening patients more comfortable

"Sensitivity is the most common side-effect of tooth-whitening procedures.  This study showed participants using Sensodyne were significantly more sensitivity-free during the first three days of their treatment, which typically is when patients experience the greatest degree of whitening-related sensitivity. Patients also experienced significantly more sensitivity-free days overall. Further, those using Sensodyne were significantly more satisfied with
their whitening experience. Seventy percent of patients in the Sensodyne group reported they would be more willing to repeatwhitening treatment in the future compared to 52 percent in the control group.


Up to 75 percent of patients who undergo whitening procedures experience sensitivity. It is recommend that whitening patients brush with Sensodyne, two times a day, two weeks prior to and during whitening
treatment.
Recommending this brushing protocol can help make patients more comfortable.
http://rdh.pennnet.com/Articles/Article_Display.cfm?
 

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Maintenance of Whitening with a Power Toothbrush After Bleaching Treatment

Studies have shown that there is some shadow rebound over time.  However your eating and drinking habits are likely to affect rebound as extrinsic staining is caused by coffee, tea, tobacco, red wine and red grapes.  The Sonicare toothbrush has been  proven in this study to be a more effective tool than a manual toothbrush in maintaining the color of bleached teeth for 6 months.  
Maintenance of Whitening with a Power Toothbrush After Bleaching treatment.  Dr. Kugel, Dr Aboushala, Dr. Sharma, Dr. Ferreira, Dr. Anderson; pg 119-130 Compendium Vol 25, No.2 2/04

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***An Update on Tooth Whitening, Woman Dentist Journal, pg 10-22, Jan/Feb 2003

 Source.  
^
Incidence of Tooth Sensitivity After Home Whitening Treatment; Dr. Jorgensen, Dr. Carroll; JADA, Vol 133; pgs 1076-1082; Aug 2002.
Advanced Tooth Whitening Volume 1, March 2001.  Javaheri, Kugel, Janis
.
"
Whiteners put shine on dental care", Stacie Crozier, ADA News April 16, 2001 pg 8-10 stated by Dr. Heymann.
** Bleach Sensitivity, Dr Jorgensen, JADA, Dec. 2002

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February 06, 2008

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