By: Stella Grimm Samantha Fernung Natalie Glenn Whitening Products By: Stella Grimm Samantha Fernung Natalie Glenn

Whitening is the most requested cosmetic dental procedure asked for by patients What is professional whitening?

Your choices at the dental office are an in-office whitening or a “take home” professional whitening Many different brands you can choose also Whitening gel and Light sources/lasers

In-office whitening procedures usually a use hydrogen peroxide solution with a light source for activation  “Power bleaching” can bleach your teeth in a single visit with peroxide and the light source

Hydrogen peroxide formula contains 15-38% peroxide  In clinical studies, results show when the light source is added the results are better  As much as a 2 shade improvement with the light source

Study by britesmile: One group of subjects with hydrogen peroxide, one group with just the light, and then one group with combined peroxide and light. 96.6% with the combined product said it greatly whitened their teeth 39.3% with peroxide alone said moderately whiter 53.5% with light alone said moderately whiter also

Stains best removed from in-office whitening: Aging, foods (coffee, red wine, sodas), tobacco use Stains that are resistant to in-office whitening: Inorganic stains, trauma which causes dentin to be darker, tetracycline antibiotics, overexposure to fluoride

Disadvantage: sensitivity 3 months after clinical study subjects were asked how sensitivite their teeth had become Peroxide and light group and the peroxide alone group had a greater sensitivity than the light treatment group

Costs: in-office treatment $650 compared to $100 or less for over the counter treatments This is not a permanent solution so follow up appointments are necessary also

Teeth Whitening Trays

Variety of Methods Do-it-yourself at home methods Professional in-office whitening Professional at home whitening

D.I.Y. at home trays Include: moldable thermofitting trays (can be found on Amazon 3 for $0.70) 5 syringes of teeth whitening gel can be purchased on amazon for $24.99 Aquafresh: offers prefilled soft trays for a comfortable fit for all size dentition

In-office Whitening Trays At beginning of appointment teeth are polished with a grainy material used to remove any plaque Teeth are isolated with gauze to keep dry during the procedure Barrier is used to protect gums In office whitening takes 30 to 60 minutes Hydrogen peroxide or carbamide peroxoide solutions

Professional at home whitening trays Generally cheaper than in office whitening Impressions are made for custom fitting whitening trays Usually prescribed for one hour a day for 2 weeks Overnight solutions can be prescribed for convenience

Pros and Cons Advantages Disadvantages Whiter, brighter dentition Cheaper than Laser whitening Night time solutions are available to whiten while you sleep Demineralization of enamel> increased risk of decay Teeth may become sensitive (hot & cold) Effect of bleach may not be the same for every tooth (splotchy look) Sensitive or irritated gingiva may occur Allergic reaction to chemicals in whitening solutions possible

When should whitening trays be avoided? If the patient is under 15 On patients who are pregnant or lactating People who are allergic to some of the ingredients of the product People who had recent surgical treatment on their periodontal tissues People with existing inflamed periodontium People with serious gum disease

Contraindications Continued People who have enamel and/ or dentin anomalies that could hide a risk for teeth vitality People with acute teeth fluoridation *Existing problems such as cavities, tooth abrasion, attrition, exposed tooth roots, broken fillings, exposed dentin, have to be diagnosed and treated before bleaching (left untreated they would compromise whitening process)

General facts (not necessarily trays we can put this anywhere in the pwrpt if you want!) Whitening should be accompanied with remineralizing techniques (fluoride and calcium phosphate applications) Potential demineralization effects from a daily whitening regimen is comparable to drinking a cola beverage or glass of orange juice

What causes discoloration of the teeth? Staining, aging or chemical damage Some most common: meds, coffee, tea or cigs -Genetics Some individuals have brighter enamel than others

Whitening Strips

What are Whitening Strips Over-the-counter remedy that bleaches for a whiter smile Compared to other whitening methods, consumer prefer strips because they are easy to use, comfortable to wear, are more cost effective and provide more consistent results

How do they work? Apply a thin strip of plastic to the front of both the upper and lower teeth One side of the plastic is coated with a bleaching agent called hydrogen peroxide Once the plastic strips are in place, press them against the teeth for maximum contact The strip is kept for a certain period of time depending on the concentration of hydrogen peroxide and the brand being used

Different Brands( Remembrandt versus Crest) Differing brands will have different concentrations of hydrogen peroxide within their strips

Crest whitening strips Examples: Crest 3D White Professional Effects, Crest 3D White Advanced Uses 6.5% concentration of hydrogen peroxide in most of their products Studies have supported that Crest Whitening strips remove both extrinsic stains (coffee, soda) and intrinsic stains (tetracycline)

Crest Whitening Effectiveness: A study involving 25 candidates used Crest Whitening strips Advanced Vivid for 1 month. Candidates were instructed to note any change in their tooth coloring on a daily basis for the duration of the study. Candidates reported that they noticed a significant change within the first week and still better results within the preceding weeks

Before and After results:

Cost Effectiveness: One of the reasons consumers prefer whitening strips above other whitening methods is the fact that they are cost effective Crest Whitening strips, for example, are between $40.00-$60.00 In dental treatment, however can be up to $450 to $500 depending on location!!!

Remembrandt: Example: Remembrandt Intense Stain dissolving strips Noticeably whiten tough surface stains, like coffee, tea and wine and conveniently dissolve on teeth Cost varies from approximately $20.00-$30.00

Remembrandt cont.

Advantages to whitening: Extremely easy to use by using a step-by-step procedure Convenient and comfortable to wear Provide quick results More cost effective Gives the wearer a whiter and brighter smile Boosts self-esteem

Disadvantages: There are several side effects that are caused by whitening products/whitening strips The most two prevalent being tooth sensitivity and gingival irritation.

Tooth Sensitivity: A layer of hard enamel protects the crowns of your teeth A layer of cementum protects the tooth root under the gum line. Gum tissue is a protective blanket that covers the tooth roots. Underneath the hard enamel, or cementum, is the porous dentin which is made up of tiny openings, called tubules or channels

Tooth sensitivity cont. Inside each tubule lies a nerve that comes from the tooths pulp When the dentin loses its protective covering or is exposed, it may cause hypersensitivity and discomfort when you drink cold or hot liquids, eat sweet or sour foods, or when you breathe through your mouth The nerves inside the tooth get stimulated causing everything from discomfort to a sharp, sudden, shooting pain deep into the nerve endings of your teeth

Gingival irritation: Gingiva irritation is caused by the high levels of hydrogen peroxide in the whitening products touching the gingiva This causes a burning sensation and is uncomfortable for the user

Other adverse effects: Mucosal irritation, alteration of the enamel surface, and negative effects on restorations (not as common) It is important to note that a woman who is pregnant should not use whitening products because, although there is no evidence of this, could cause damage to the fetus