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This article reviews the history of bleaching teeth to lighten tooth color. The last 2 years have seen a dramatic increase in new bleaching methods and bleaching chemicals. The following categorizes bleaching chemicals and methods in relation to their use in treating common tooth discolorations. Special attention is given to home bleaching methods.
OBJECTIVE: This study evaluated the influence of polishing on enamel color change after in-office bleaching treatment on tooth morphology and sensitivity. MATERIALS AND METHODS: A total of 50 volunteers were randomized into two groups (n = 25): in-office bleaching with 35% hydrogen peroxide gel for 45 min without polishing (GSEM) or with polishing (GP). Color analysis was performed four times, at the beginning of the starting line and immediately after the first, second, and third bleaching sessions with a spectrophotometer. A qualitative analysis of enamel morphology was performed under a scanning electron microscope. Tooth sensitivity was assessed daily using the Visual Analog Scale (α = 0.05). RESULTS: There was no statistically significant difference (p > 0.05) in tooth color change when comparing ΔE, ΔE00, and ΔWID between the groups. The enamel surface showed larger areas of irregularities and depressions in the GP group than in the GSEM group. There was no difference in tooth sensitivity (p > 0.05) between the groups. CONCLUSIONS: Polishing after whitening in the office does not change the color and sensitivity of the tooth but promotes greater changes in the morphology of the enamel, such as increased surface roughness. CLINICAL RELEVANCE: Polishing immediately after teeth whitening causes greater changes in enamel surface morphology.
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BACKGROUND: Tooth whitening is one of the fastest growing areas in cosmetic and restorative dentistry. An increasing number of patients are demanding faster ways to bleach their teeth. Therefore, clinicians are being pushed to seek quicker and easier means to bleach their patients' teeth, while maintaining safety in bleaching procedures. METHODS: The authors included in the clinical trial 10 subjects 18 years of age or older, each of whom had six caries-free maxillary anterior teeth without restorations on the labial surfaces and no tooth sensitivity. For each subject, one-half of the maxillary arch received a 35 percent hydrogen peroxide (Group 1) gel application for 30 minutes, and the other one-half of the maxillary arch received a 38 percent hydrogen peroxide (Group 2) gel application for 30 minutes. The in-office bleaching treatment was maintained and reinforced using a 10 percent carbamide peroxide at-home bleaching agent for 60 minutes. Subjects repeated both the in-office and take-home bleaching treatments for three consecutive days. RESULTS: The shade change was 8.5 for Group 1 and 9 for Group 2. There was no statistically significant difference between the two groups (P = .3434). An average shade rebound of two shades was recorded at seven days for both treatment systems. No sensitivity was reported during or after the bleaching treatment. CONCLUSIONS: When combined with 10 percent carbamide peroxide at-home applications, use of the Group 1 and Group 2 bleaching materials resulted in significant tooth lightening. CLINICAL IMPLICATIONS: By using the clinical technique presented, clinicians can reduce the time required to complete tooth-whitening treatment. Using the correct tray design and improved chemical formulations of tooth whiteners may reduce gingival and tooth sensitivity, thus increasing safety.
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The safety and efficacy of a home-use carbamide peroxide tooth-whitening procedure were evaluated in a double-blind experimental design. Fifty-two adults were randomly assigned to experimental and control (placebo gel) groups. The products were applied in a custom-fitted tray and used for 5 consecutive nights in accordance with the manufacturer's recommendations. Tooth color changes from baseline were measured with a small-area colorimeter. Concurrently, electric pulp test and periodontal indices were measured. At the end of 6 months, the teeth in the active group had a statistically significant greater mean color change that did the placebo controls. The mean color change differed significantly by tooth type. No statistically significant changes in vitality, sulcus depth, or Gingival Index were found in the treatment group.
The purpose of this study was to investigate the effect of long-period exposure of 30% hydrogen peroxide on bovine enamel. Polished labial surfaces were scanned using an atomic force microscope after bleaching for 120 hours. Compositional change and microhardness of the enamels were evaluated using a Fourier transform Raman spectrophotometer and Vickers hardness tester. The same tests were performed on enamels stored in distilled water. In the FT-Raman spectra of both the unbleached and bleached enamels, peaks remained unchanged except for negligible decrease in intensity. As for microhardness, it significantly decreased after bleaching when compared to the original value (p < 0.0001). However, the microhardness values of enamels stored in the bleaching agent and distilled water did not show any statistical difference. Based on the results of this study, the use of 30% hydrogen peroxide solution for dental bleaching should be safe due to its negligible effects on tooth morphology and structure.
The main purpose of this laboratory study was to determine the tooth whitening effect of a baking soda dentifrice containing stabilized 1% hydrogen peroxide following repeated applications to intrinsically stained teeth. Additional objectives were to investigate (1) the influence of tooth surface curvature and moisture on color measurements, (2) preliminary treatment parameters using 1% hydrogen peroxide solution, and (3) the relationship between Vita shade guide standards and instrumental color readings. Human tooth specimens with intrinsic stain were specially prepared and measured for color (L*a*b*) by means of diffuse reflectance spectrophotometry. Specimens were measured under wet and dry conditions with natural and flattened enamel surfaces. A preliminary test was conducted with 1% H2O2 solution to establish tooth whitening versus treatment time. Then, new tooth specimens were treated repeatedly with slurries of silica, baking soda, or baking soda/peroxide dentifrices at 30-minute intervals, and color measurements were taken under both wet and dry conditions after 4, 8, 16 and 24 hours. L*a*b* color measurements of the Vita shade guide teeth were also made in order to relate laboratory color changes to clinical effects. The parameter testing results showed that flattening the enamel surface had no effect on tooth color, but the teeth rapidly became lighter and less yellow upon air-drying. The 1% H2O2 solution caused both a significant decrease in yellow (b*) and an increase in lightness (L*). Since the reduction for b* occurred more rapidly and to a greater extent than the L* factor, the b* component may be the more important indicator of tooth whitening by bleaching. Compared to the silica and baking soda dentifrices, the baking soda/peroxide dentifrice significantly decreased the yellow color (b*) of the teeth after 8 or more hours of topical treatment. The instrumental color readings of the Vita Shade guide teeth showed that the color differences between the standards were not linear or consistent, and their accuracy for assessing clinical changes in tooth whiteness is questionable.
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Esthetic restorative procedures are routine in most dental practices. The procedures considered to be standard and acceptable by practitioners are bleaching teeth outside the dental office; bonding; intracoronal direct resin restorations; tooth-colored inlays and onlays; porcelain veneers; all-ceramic crowns; and PFM crowns. Unfortunately, some third-party payment organizations do not pay adequately for numerous esthetic restorative procedures, and continued education of these groups about the reliability of esthetic restorative procedures is necessary.
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