The term teeth whitening indicates change of intensity (saturation) of the teeth in a human mouth compared to their previous condition. This is done under the influence of free radicals of peroxide (active component of the various bleaching systems) and causes the extraction of chromogenic substances from the tooth surface. These are the pigments in certain foods and beverages, and also a number of artificial coloring in food industry. Strong natural pigments (tannins, cysteine, etc.) contained in red wine, coffee, black tea, cocoa and coke. Causes of color change can be also: time (age), genetic color changes (mostly tetracycline - after use of tetracycline antibiotics during pregnancy, or periods of forming tooth nucleus; insufficiency of enamel and/or dentine; enamel hypoplasia; erythropoietic porphyria; hyperbilirubinemia; alkaptonuria and more.), cigarettes (substances of tar), chlorhexidine (in most mouth wash product), Dental fluorosis (in endemic areas with high substances of fluorine in water - over 1ppm), hemoglobin color distortions in cases of tooth bleeding caused by injury, necrotic teeth, low quality of canal filling materials
There are differences in the level that teeth can be whitened - influenced the most are brown, red, yellow and orange shades, less affected - greenish, blueish, grey. Internal coloring, resulted by change of dentine"s color, do not get affected by such whitening and in these cases more suitable are ceramic/porcelain veners and bonding
If unwanted changes of color are by the result of canal filling item or internal bleeding in treatment of dead tooth, results are accomplished after removal of cause, which is mostly orientated in the pulp cavity.Firstly, the closest highly colored dentine is being treated by borer, afterwards oxide substances are used. If final result are satisfactory, at the same visit, teeth are restored in their previous state of color
External Teeth Whitening
There are plenty of methods for this implementation, but only two are actually effective and completely safe - one of them.
Whitening toothpaste from a retailer for general use
These pastes have low concentration of carbamide peroxide (<1%) or sodium bicarbonate. They are not recommended for systematic use, because create allergic reaction and intoxicate by releasing locally and absorbing free radicals, even in low concentration.These toothpastes are recommended only for short use - about a month, and must be replaced with regular toothpaste. Such pastes come in handy for maintenance of controlled whitenings. If used by patients at home, they have small effect and is eventually expiring.
Teeth whitening pastes in the pharmaceutical network, given by prescription
They can be used only with recommendation by dentist and have the effect of the ones mentioned above, but have more expressive final result because of its higher concentration of oxide(up to 10%). Systematic uncontrolled usage can lead to teeth/gum over sensitivity. Used independently, have bigger whitening effect of the first ones we defined. Costs are higher than the conventional one. These pastes are not approved by ADA (American Dental Association).
Teeth whitening gels with standard splints in the pharmaceutical network, for common use
The most dangerous ones, because they are not controlled by dentist, gel is put on fabric splints and its concentration is unhealthy (10 to 16%). These splints do not allow dosage control and are spilled in mouth. They are not approved by ADA, because can cause enamel erosion, nausea if swollen, permanent over sensitivity. Are not recommended for pregnant patients.
Controlled teeth whitening
Home teeth whitening with office visits
Most common method of teeth whitening. In contrast to the mentioned above, here in use are not basic but individual splints, made in laboratory by mouth imprint. These splints do not touch the gums and the gel is thicker. These mechanisms are put for 30 min to 2 hours, and according to the concentration and type of peroxide (hydrogen or carbamide), during the day or over the full night - about 8 hours. Result here is achieved in about 3 days to 2 weeks, according to the system in use - for example with “ZOOM!” teeth are whitened over the weekend , but with “Nite White ACP”, “Day White ACP” or "Opalescence" – 1 or 2 weeks depending on how many times the procedure is repeated (10 times normal). These dental splints are invisible do not cause discomfort, that is why they are more accepted by patients, and final result lasts 2-5 years (some cases up to 7 years - specific types of teeth with smaller enamel pores) and is highly satisfactory, because drastic whitening is achieved, almost looking like laser or ultraviolet lightning treatment. A revolution in modern whitening systems is the addition of ACP - amorphous calcium phosphate, which remineralise enamel and makes it more shiny, and also increases the period of effect. Reducing teeth sensitivity is achieved by potassium nitrate.
Teeth whitening in office
The most modern method, and also quickest, called heavy whitening. This procedure consist of reacting of the gel with peroxide in high concentration (30-38%) by lamp - argon laser, ultra violet lightning, or without lightning (catalyst), for 45 minutes up to hour and a half. This procedure can be executed in other rooms, depending on the level of darkness or teeth coloring. Disadvantages here can be related with eventual reaction heating of of pulp and teeth nerves, as recent studies show. In addition to dental teeth whitening there is treatment where patients stay in the office room while whitening systems are in their mouths (dental splints as in home whitening) - this procedure is called assisted teeth whitening which plays the role of initial start up of following domestic treatments.
In conclusion teeth whitening can be summarised as a method of treatment choice for dental whitening before proceeding to more invasive treatments of grinding of teeth tissue - veneers and dental crowns.