1. Tooth Whitening
DA 122 Dental Materials

2. Tooth-whitening

3. Background/History Also called “Bleaching”
Process discovered during WWI
Soldiers developed “trench mouth” from poor diets
Military dentists had them clean with carbamide perioxide solution to improve periodontal conditions
Noticed side effect: tooth color lightened
1920’s dentists tried various combinations of perioxide solutions to light people’s teeth, for both cosmetic and therapeutic uses
Today: over 90% of dental offices offer some sort of whitening service

4. World War I
Mobile dental clinic
Mobile equipment

5. Reasons for Bleaching Teeth: Staining
Intrinsic Staining:
within the tooth
due to chemicals ingested during tooth development
Example:
Tetracycline staining
Fluoride staining
Dental decay, trauma (injury), endodontic treatment
Aging
Genetic predisposition
Extrinsic Staining
From outside the body
Chromogenic foods:
Coffee, tea, cola, red wine (blueberries, soy sauce, balsamic vinegar, tomato sauce)
Tobacco products
Poor oral hygiene

6. Intrinsic Staining Tetracycline Staining: Fluorosis:
blue-grey or brown shading
Fluorosis:
chalky-white to brown stains

7. Extrinsic Staining
Chromogenic foods
Tobacco Stains

8. Types of Bleaching Treatments
In-Office Non-vital
In-Office Vital
Home-Bleaching Treatment

9. In-office Non-vital
Tooth has had endodontic treatment and has darkened
Involves a single tooth
“walking bleach”
Sodium hydroxide paste placed into pulp chamber; left in for a period of time; may involve 2 or more visits

10. In-Office Vital Usually involves all teeth “power bleaching”(Zoom)
Can be single tooth or single arch
“power bleaching”(Zoom)
Sodium hydroxide paste placed on tooth surface and activated with a heat/curing lamp (sometimes)
Must use dental dam to protect gingiva

11. Home Bleaching Treatment
Custom tray is made for patient
Dentist dispenses gel for in-home use. Carbamide peroxide most common bleach used.
Patient does self-treatment at home with gel in custom tray
Patient may purchase tooth-whitening kits over-the-counter; results vary

12. Side-Effects of Tooth-whitening
1. thermal sensitivity
Teeth become sensitive to hot and cold
2. gingival irritation
Localized irritation to gingival tissues
Gingiva appears white or reddened, as if burned

13. Patient Evaluation for Tooth-whitening
Evaluation by dentist BEFORE treatment is necessary
Patient must have good oral health, especially gingival health
Check medical history for
Allergies
TMJ disorders
Pregnancy or lactating (contraindicated)
Dental radiographs and examination
Dentist must evaluate condition of teeth, to determine if tooth-whitening is indicated: cause and degree of stains, vital/nonvital, presence of restorations or poor oral hygiene
Patient with gag reflex not good candidate

14. Pre-Treatment Visit Take Intra-oral photos “before” shots
Select and record shade:
Beginning shade
Goal shade (about 3-5 shades lighter)
Dentist and patient should agree on reasonable shade goal
Take alginate impressions of arch or arches to be treated

15. Pre-Treatment Visit
Intraoral Photograph
Select and Record Shade

16. Fabrication of Custom Bleaching Tray
1.Pour alginate impression without a base
2.Trim model to horse-shoe shape
3.Label model with
Patient full name
Date that impression was taken
Doctor’s name
BLEACH TRAY
4.Trace gingival margins on model, with pencil or permanent marker
5.Lightly spray model with silicone lubricant to prevent tray material from sticking to model during vacuformer process

17. Tray Fabrication

18. Making the tray (steps continued)
Armamentarium:
Vacuformer
Plastic tray material (.020, .035, .040)
Prepared model
Lab scissors
Heated knife or surgical scissors
6.Follow vacuformer directions
7.Let tray cool completely before removing from model
8.cut away excess tray material
Cut along gingival area (leaving 2mm beyond CEJ) with knife or scissors
9. Check for roughness along edges, try onto model
10.Disinfect tray before delivering to patient

19. Delivery of Custom Bleach Tray to Patient
Try-in tray in patient’s mouth
Check for fit and patient comfort
Review home-instructions with patient
Verbally
Give written copy
Demonstrate loading the tray with the gel (avoid overfilling)
Reappoint for follow-up visits

20. Patient care follow-up
Patient should be checked for progress every 1-2 weeks
Check for thermal sensitivity and gingival irritation, also
When patient has reached the goal shade:
Take and record shade
Take intra-oral photos
Make plans for maintenance and possible touch-ups
Give instructions for maintenance
To avoid relapse, caution patient about:
Chromogenic foods and beverages
Smoking