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Home-use bleaching
DENTAL P R O D U C T
SPOTLIGHT
Home-use bleaching leaching is most successful on yellow, orange or light brown stains, while dark gray, blue and black stains are more tenacious. Successful lightening of darkly stained teeth has been reported with prolonged bleaching periods (six months to one year).1,2 The following table, adapted from the ADA Guide to Dental Therapeutics,3 describes the types of tooth discoloration and predicted success in bleaching them:
B
COLOR OF STAIN
Therefore, higher concentrations of peroxide result in a more rapid lightening, but lower concentrations can achieve the same lightening effect with longer use. Bleaching does not have the same lightening effect on resin-based composite restorations as it does on natural teeth. Therefore, patients should be advised that restorations might have to be replaced after the bleaching process. Restorations should not be replaced for at least three weeks after bleaching is completed,
ETIOLOGY
EASE OF BLEACHING
White
Fluorosis
Success depends on extent of fluorosis
Blue-gray
Dentinogenesis imperfecta, erythroblastosis fetalis, tetracycline
Deeply stained blue-gray discolorations, especially those associated with tetracycline, are more difficult to treat than are yellow stains
Gray
Silver oxide from endodontic sealers, tetracycline
Dark stains from endodontic sealers seldom are bleachable, should be treated restoratively
Yellow
Fluorosis, physiological changes due to aging, obliteration of the pulp chamber, tetracycline
Mild uniform yellow discoloration associated with aging or mild uniform fluorosis is easiest to treat
Brown
Fluorosis, caries, porphyria, tetracycline, dentinogenesis imperfecta
Stains that are deeper in color are more difficult to treat
Black
Mercury (amalgam) stain, caries, fluorosis
Very dark or black stains from silver-containing endodontic sealers or from mercury seldom are bleachable, should be treated restoratively
Pink
Internal resorption
Bleaching is not indicated; treatment consists of endodontics and calcium hydroxide treatment
Carbamide peroxide is the most common home-use bleaching agent. Ten percent carbamide peroxide, which breaks down to hydrogen peroxide and urea, is equivalent to approximately 3.6 percent hydrogen peroxide. The longevity of bleaching effects is somewhat unpredictable. Staining does tend to reoccur in one to four years. Home-use bleaches are available in various concentrations of carbamide peroxide (from 10 to 22 percent). Lower concentrations of carbamide peroxide applied for longer periods have been shown to have the same whitening effect as higher concentrations applied for a shorter duration.4 For example, teeth whitened with 16 percent carbamide peroxide for one week were significantly lighter than teeth whitened with 10 percent carbamide peroxide for one week; however, after two weeks, there was no difference between teeth whitened with 10 percent or with 16 percent carbamide peroxide.4
because there is evidence that bond strength is reduced immediately after bleaching,5 and time is needed to allow for any rebound of tooth color that may occur during that time. ■ 1. Patient information on cosmetic, adhesive, and restorative dentistry. Adept Report 1991;2(1):1-24. 2. Leonard RH. Nightguard vital bleaching: dark stains and long-term results. Compend Contin Educ Dent 2000;21(supplement 28):S18-S27. 3. Byrne BE. Bleaching agents. In: Ciancio SG, ed. ADA guide to dental therapeutics. 2nd ed. Chicago: American Dental Association; 2000:250-6. 4. Matis BA. Degradation of gel in tray whitening. Compend Contin Educ Dent 2000;21(supplement 28):S28-S35. 5. Titley K, Torneck CD, Smith DC. The effect of concentrated hydrogen peroxide solutions on the surface morphology of human tooth enamel. J Endod 1988;14:69-74.
JADA, Vol. 132, September 2001 Copyright ©1998-2001 American Dental Association. All rights reserved.
1293
SPOTLIGHT
Home-use bleaching leaching is most successful on yellow, orange or light brown stains, while dark gray, blue and black stains are more tenacious. Successful lightening of darkly stained teeth has been reported with prolonged bleaching periods (six months to one year).1,2 The following table, adapted from the ADA Guide to Dental Therapeutics,3 describes the types of tooth discoloration and predicted success in bleaching them:
B
COLOR OF STAIN
Therefore, higher concentrations of peroxide result in a more rapid lightening, but lower concentrations can achieve the same lightening effect with longer use. Bleaching does not have the same lightening effect on resin-based composite restorations as it does on natural teeth. Therefore, patients should be advised that restorations might have to be replaced after the bleaching process. Restorations should not be replaced for at least three weeks after bleaching is completed,
ETIOLOGY
EASE OF BLEACHING
White
Fluorosis
Success depends on extent of fluorosis
Blue-gray
Dentinogenesis imperfecta, erythroblastosis fetalis, tetracycline
Deeply stained blue-gray discolorations, especially those associated with tetracycline, are more difficult to treat than are yellow stains
Gray
Silver oxide from endodontic sealers, tetracycline
Dark stains from endodontic sealers seldom are bleachable, should be treated restoratively
Yellow
Fluorosis, physiological changes due to aging, obliteration of the pulp chamber, tetracycline
Mild uniform yellow discoloration associated with aging or mild uniform fluorosis is easiest to treat
Brown
Fluorosis, caries, porphyria, tetracycline, dentinogenesis imperfecta
Stains that are deeper in color are more difficult to treat
Black
Mercury (amalgam) stain, caries, fluorosis
Very dark or black stains from silver-containing endodontic sealers or from mercury seldom are bleachable, should be treated restoratively
Pink
Internal resorption
Bleaching is not indicated; treatment consists of endodontics and calcium hydroxide treatment
Carbamide peroxide is the most common home-use bleaching agent. Ten percent carbamide peroxide, which breaks down to hydrogen peroxide and urea, is equivalent to approximately 3.6 percent hydrogen peroxide. The longevity of bleaching effects is somewhat unpredictable. Staining does tend to reoccur in one to four years. Home-use bleaches are available in various concentrations of carbamide peroxide (from 10 to 22 percent). Lower concentrations of carbamide peroxide applied for longer periods have been shown to have the same whitening effect as higher concentrations applied for a shorter duration.4 For example, teeth whitened with 16 percent carbamide peroxide for one week were significantly lighter than teeth whitened with 10 percent carbamide peroxide for one week; however, after two weeks, there was no difference between teeth whitened with 10 percent or with 16 percent carbamide peroxide.4
because there is evidence that bond strength is reduced immediately after bleaching,5 and time is needed to allow for any rebound of tooth color that may occur during that time. ■ 1. Patient information on cosmetic, adhesive, and restorative dentistry. Adept Report 1991;2(1):1-24. 2. Leonard RH. Nightguard vital bleaching: dark stains and long-term results. Compend Contin Educ Dent 2000;21(supplement 28):S18-S27. 3. Byrne BE. Bleaching agents. In: Ciancio SG, ed. ADA guide to dental therapeutics. 2nd ed. Chicago: American Dental Association; 2000:250-6. 4. Matis BA. Degradation of gel in tray whitening. Compend Contin Educ Dent 2000;21(supplement 28):S28-S35. 5. Titley K, Torneck CD, Smith DC. The effect of concentrated hydrogen peroxide solutions on the surface morphology of human tooth enamel. J Endod 1988;14:69-74.
JADA, Vol. 132, September 2001 Copyright ©1998-2001 American Dental Association. All rights reserved.
1293