Introduction to Tooth Whitening

Material used
Macintosh (Dwinelle 1850)
Invented chloride of lime (called bleaching powder)
Dwinelle (1850)
Chloride of lime
Nonvital teeth
Truman (1889)
Chloride and acetic acid, Labarraque’s solution (liquid chloride of soda)
Nonvital teeth
Woodnut (1861)
Advised placing the bleaching medicament and changing it at subsequent appointments
Latimer (1868)
Oxalic acid
Vital teeth
Chapple (1877)
Hydrochloric acid, oxalic acid
All discolorations
Taft (Haywood 1992)
Oxalic acid and calcium hypochlorite
Harlan (1884)
Used the first hydrogen peroxide (called hydrogen dioxide)
All discolorations
Atkinson (1862)
3–25 % pyrozone used as a mouthwash, which also lightened teeth
Garretson (Haywood 1992)
Applied chlorine to the tooth surface
Nonvital teeth
Prins (Haywood 1992)
Applied 30 % hydrogen peroxide to teeth
Nonvital and vital
Kaine (Haywood 1992)
18 % hydrochloric acid (muriatic acid) and heat lamp
Fluorosed teeth
Fisher (1911)
Reported on the use of hydrogen peroxide with a heating instrument or a light source
Vital teeth
Prinz (1924)
First recorded use of a solution of perborate in hydrogen peroxide activated by a light source
Vital teeth
Younger (Haywood 1992)
5 parts of 30 % hydrogen peroxide heat lamp, anesthetic
Pearson (1958)
Used 35 % hydrogen peroxide inside tooth and also suggested 25 % hydrogen peroxide and 75 % ether, which was activated by a lamp producing light and heat to release solvent qualities of ether
Nonvital teeth
Spasser (1961)
Walking bleach technique; sodium perborate and water is sealed into the pulp chamber
Nonvital teeth
Bouschor (1965)
5 parts 30 % hydrogen peroxide, 5 parts 36 % hydrochloric acid, 1 part diethyl ether
Orange colored fluorosis stains
Stewart (1965)
Thermocatalytic technique; pellet saturated with superoxol is inserted into the pulp chamber and heated with a hot instrument
Nonvital teeth
Colon and McInnes (1980)
Repeats Bouschor’s technique using controlled hydrochloric acid-pumice abrasion
Nutting and Poe (1967)
Combination walking bleach technique, Superoxol in pulp chamber (30 % hydrogen peroxide)
Nonvital teeth
Klusmier (Haywood 1991)
Home bleaching concept started as an incidental finding; Gly-oxide which contains 10 % carbamide peroxide is placed in custom-fitted orthodontic positioner
Vital teeth
Cohen and Parkins (1970)
35 % hydrogen peroxide and a heating instrument
Tetracycline stains
Klusmier (Haywood 1991)
Used the same technique with Proxigel as it was thicker and stayed in the tray longer
Vital teeth
Chandra and Chawla (1975)
30 % hydrogen peroxide 18 % hydrochloric acid flour of Paris
Fluorosis stains
Falkenstein (Haywood 1992)
1-min etch with 30 % hydrogen peroxide 10 % hydrochloric acid 100 W (104 °F) light gun
Tetracycline stains
Compton (Haywood 1992)
30 % hydrogen peroxide heat element (130–145 °F)
Tetracycline stains
Harrington and Natkin (1979)
Reported on external resorption associated with bleaching pulpless teeth
Nonvital teeth
Abou-Rass (1982)
Recommended intentional endodontic treatment with internal bleaching
Tetracycline stains
Zaragoza (1984)
70 % hydrogen peroxide and heat for both arches
Vital teeth
Munro (Haywood 1992)
Used Gly-oxide to control bacterial growth after periodontal root planning. Noticed tooth lightening
Vital teeth
Feinman (1987)
In-office bleaching using 30 % hydrogen peroxide and heat from bleaching light
Vital teeth
Coastal Dental Study Club (Haywood 1992)
Mouth guard bleaching technique
Vital teeth
Munro (Darnell and Moore 1990)
Presented findings to manufacturer, resulting in first commercial bleaching product: White + Brite (Omnii Int)
Vital teeth
Croll (1989)
Microabrasion technique 10 % hydrochloric acid and pumice in a paste
Vital teeth, superficial discoloration, hypocalcification
Haywood and Heymann (1989)
Nightguard vital bleaching, 10 % carbamide peroxide in a tray
All stains, vital and nonvital teeth
Introduction of commercial, over-the-counter bleaching vital teeth products
Vital teeth
Bleaching materials were investigated while the FDA called for all safety studies and data. After 6 months the ban was lifted
Numerous authors
Power bleaching, 30 % hydrogen peroxide using a light to activate bleach
All stains, vital teeth
Garber and Goldstein (1991)
Combination of bleaching power and home bleaching
Vital teeth
Hall (1991)
Recommended no etching teeth before vital bleaching procedure
Vital teeth
American Dental Association (Engel 2011)
Safety and efficacy established for tooth bleaching agents under the ADA seal of approval
FDA approved ion laser technology: argon and CO2 laser for tooth whitening with patented chemicals
Reyto (1998)
Laser tooth whitening
Vital teeth
Settembrini et al (1997)
Inside/outside bleaching
Nonvital and vital teeth
Carrillo et al (1998)
Open pulp chamber, 10 % carbamide peroxide in custom tray
Miara (2000)
Compressed bleaching technique in patient’s own bleaching tray
Vital teeth
Gerlach (2000)
5–10 % hydrogen peroxide OTC tooth whitening strips
Vital teeth
Kurthy (2001)
Deep bleaching technique
Vital teeth
Lynch (2004)
Ozone whitening using ozone machine
Vital teeth
Kwon (2007)
Sealed bleaching: prevents evaporation of active agent by placing a wrap onto the power whitening gel
Vital teeth
Various whitening applications; use of brush applications, pens, and varnish
Vital teeth
ISO 28399 (2011)
International Standard Organization: Dentistry: Products for External Tooth Bleaching
Vital Teeth
Plasma arc, halogen, UV, LED and light-activated bleaching techniques; reduction in time with power gels for in-office bleaching; Laser-activated bleaching; home bleaching available in different concentrations and with new desensitizers
Vital teeth
Adapted and updated from data in Haywood (1992), with permission from Taylor & Francis Group, LLC

1.2 Current Tooth Whitening Techniques

Tooth whitening is now the most common elective dental procedure (Dutra et al. 2004), and has proven to be safe and effective when supervised by the dentist (American Dental Association Council on Scientific Affairs 2009). More than 1 million Americans whiten their teeth annually, resulting in nearly $600 million in revenues for dental offices (Dutra et al. 2004). Considering the numerous over-the-counter whitening products available and the heightened consumer interest in whiter teeth, it is the responsibility of the dental profession to educate the public about the efficacy and adverse effects of different tooth whitening modalities, suggest or provide appropriate options based on patient’s needs and preference, and establish reliable and valid monitoring tools for the whitening process.
The variety of methods and products available reflects the high demand for whiter teeth. Traditionally tooth whitening could be classified into three categories: (1) professionally applied in-office whitening with high-concentration materials (Fig. 1.1a); (2) dentist-dispensed patient-applied home-whitening with custom fabricated trays (Fig. 1.1b); and (3) over-the-counter products (Fig. 1.1c) like strips, paint-on gels, or brush-on adhesive liquids (Kwon and Li 2013). With the increased demand and a quest for less expensive options, protocols for do-it-yourself (DIY) whitening (Fig. 1.1d) are now found on the Internet, using natural ingredients such as lemons, apples, and strawberries (Kwon and Li 2013; Natural Teeth Whitening Solutions). The availability of OTC products and various DIY methods has provided the general population better access to whitening, but use without the supervision of a dentist has raised several potential concerns. Tooth discoloration can be the secondary effect of an undiagnosed illness, overuse of whitening materials can damage the enamel surface, and the at-home process might go unmonitored (Hammel 1998; Kwon and Li 2013; Natural Teeth Whitening Solutions). Therefore, the supervision of a dentist or use of custom fabricated trays should be the treatment modality of choice. The patient’s final decision, however, will most likely depend on preference. Although at-home whitening with 10 % carbamide peroxide is safe and effective under a dentist’s supervision (American Dental Association Council on Scientific Affairs 2009), in-office whitening has its merits, especially in elderly patients who may prefer the convenience and in young children who may require full supervision during the entire procedure. Also, patients who cannot tolerate wearing trays and those who desire an immediate effect might also prefer an in-office treatment.

Fig. 1.1

(a) In-office whitening procedure with light activation. (b) At-home whitening with custom fabricated trays. (c) Over-the-counter whitening with strips. (d) Do-it-yourself whitening with strawberry puree
Several studies have compared the efficacy, side effects, and patient acceptance of in-office, at-home, or over-the-counter whitening. Patient opinion was found to depend on the whitening product, study design, application time, and methods of color assessment. One study evaluated the time required to achieve a six-tab difference on a Vita Classical shade guide, and found this occurred the fastest with in-office whitening, followed by at-home whitening, with over-the-counter whitening requiring the most time (Auschill et al. 2005). The various techniques caused similar levels of gingival or tooth sensitivity, and patients tended to prefer at-home whitening, as previously reported (Bizhang et al. 2009; Da Costa et al. 2010; Giachetti et al. 2010; Serraglio et al. 2016). In vitro studies comparing all four whitening techniques showed in-office, at-home, and over-the-counter whitening produced good results, whereas do-it-yourself whitening with strawberry puree was ineffective (Kwon et al. 2015a, b). Despite the equivalencies in endpoint whiteness, a concern remains that DIY whitening could reduce tooth microhardness values (Kwon et al. 2015a). A complete summary, including a comparison of the characteristics of current vital tooth whitening technologies, is listed in Table 1.2. It must be noted that this presents an overall comparison and may vary based on the specific material employed.

Sep 10, 2016 | Posted by in General Dentistry | Comments Off on Introduction to Tooth Whitening
Premium Wordpress Themes by UFO Themes