- Over 92% of American adults agree that an attractive smile is an important social resource
- 88% always remember someone with an especially attractive smile
- 85% agree that an unattractive smile is not attractive to the opposite sex
- 74% agree that an unattractive smile can decrease the chances of career success
- Only 50% of Americans are satisfied with their smile
Teeth whitening can be performed at a set of teeth committed either aesthetically or a single tooth that may have darkened after a root canal or dental trauma
(in non-vital teeth only) internal tooth whitening
external tooth whitening
INTERNAL WHITENING
If it is a root canal treated tooth is used to the technique of internal bleaching (developed in another section and several articles about it "access to professional" are included) that can be supplemented in turn with the techniques of external bleaching.
EXTERNAL WHITENING
Current bleaching techniques are based on the use of two products:
- Carbamide peroxide (usually outpatient treatments)
- Hydrogen peroxide (basically Clinical treatment)
These products are able (through activation by heat and / or special light) to detach H²O² molecules that are able to "leak" through the enamel of the teeth by the dentinal tubules. There are approximately 15000 dentin / mm² tubules. Thus, the internal tissue (dentin) that gives color to the teeth, it undergoes oxidation resulting in bleaching of the dental tissues. Thus, it is a bleaching from "inside" the tooth.
The intensity of bleaching depends on each patient, their particular color to be reviewed by the specialist to determine expectations whitening.
They respond well almost all teeth except those with tetracycline staining (brown or gray colors). Ambulatory whitening is recommended for a longer period of up to three or six months. Thus safe and gradual whitening is obtained although still difficult to make a prediction on the final color.
Example: In one type color A 3.5 the estimated whitening is about 6 or 7 tones, up to the A1. Each person has a specific color, can be equated to guide dental colors and so make a rough estimate of the final result after bleaching.
Currently, Dr. Ilzarbe (Spain) -see section being tested Links- bleaching by ozone. The bleaching process is carried out necessarily in Clinical and mechanism of action is the same as mentioned peroxides, oxidation of the internal tooth tissue by forced oxygen supply to the teeth. It also investigates the possibility of utiizar tetracycline ingested as a vehicle agent for bleaching products (given the affinity of this antibiotic with dental tissues).
Important preliminary considerations
All whitening techniques work, only we choose a reputable product or of which we have good references and know which patients are appropriate for good results.
It is immaterial whether the treatment is done at home or in the clinic or in mixed media. It is unimportant that the gel is activated by laser light halogen light or plasma. The mechanism of action is always the same.
We just need to carefully assess the case and especially never give false expectations to the patient.
In patients with dentin hypersensitivity treatment clinic should be performed only because there we can isolate and protect exposed dentin applying the product only where we are interested. A meticulous procedure is required.
Indications vital bleaching
- aging
habits - pulp calcification - fluorosis - tetracyclines - dentinogenesis imperfecta
Specific contraindications for vital bleaching
- Sensitive Teeth
- Dentin exhibits
- Root exhibitions
- Open CEJ (10% of the population)
General contraindications for bleaching (vital or non-vital)
- Dental trauma
- Root resabsorción
- Developmental defects of enamel
- Significant loss of enamel
- Cracks or fissures
- decay
- Untreated periodontal disease
- Pigmentation caused by corrosion of amalgams (only leave removing them with a strawberry)
- Composites maladjusted
- Teeth with large restorations or fillings repeated on the same tooth
- Very dark teeth
- Abnormal tooth morphology (its internal structure may be rare)
Given the possibility that some of the teeth to treat infectious process present an apical do bleaching until this problem is resolved. If we ignore this warning we then find ourselves in trouble.
We will spend one month leave from bleaching to perform comosites in the patient.
Whitening Techniques
Depending on where you perform the whitening will be called:
Clinical Whitening
Outpatient or home bleaching (with professional supervision)
Clinic + home whitening whitening (mixed or combined technique)
House or Outpatient
The simple home whitening is one that the patient performs with the means at its disposal without professional supervision through products that can acquire as varnishes, mouthwashes, pastas, etc. Have limited the best effect. In many cases the patient spends money on pasta or rinses remove stains but are not authentically bleaches.
Then try the whitening at home, at home under the supervision of professional.
Molds of the patient's mouth are made and assembled in the laboratory splints (flexible plastic structure) that conform to the shape of the teeth. One for the upper teeth and one for the lower teeth. They are transparent, no bother at all and you can talk with them on.
Delivered to the patient and the two splints Kit syringes containing bleach with bleach product. It is convenient to keep in a refrigerator.
Every night for 20-30 days (the time depends on the product and concentration thereof), after brushing a small amount is deposited in the splint, at the height of each whiten teeth, and put into mouth.
The next morning mouth splints are removed and cleaned with cold water to remove excess product and inactive (product activity in the mouth is about three hours). It is normal to feel some sensitivity to cold to rinse the teeth.
After a week the patient attend the consultation to assess the color obtained. We will see the evolution and advise accordingly. Normal is to review a week.
There are more concentrated products that are able to achieve excellent results in two weeks.
In some rare cases treatment should be continued for several months.
Clinico (Clinical and under professional supervision)
The entire treatment lasts approximately 1 hour (if performed with full arch lamps that activate the product on all teeth whitening at the same time), with three or four short breaks to renew the whitening product we put on the teeth. There are products that are activated by a halogen plasma arc light simultaneously activates all the teeth to be treated. Others are activated diode lamp. Everything depends on the photoinitiator to bring the product. In any case the whitening by
Other products are activated by mixing the "base" and "catalyst". In these cases does not provide any non-luminous.
If using conventional methods using flashlights to illuminate the tooth one on one process drags on much longer because it must be done tooth to tooth, renew the product and re-applied multiple times for a total of 5 to activate the whitening gel minutes per tooth. The procedure often tedious for both the patient and the operator.
Mixed Media dental whitening or combined
Those procedures that combine clinical sessions with home whitening. They usually consist of one or two clinical sessions to continue the rest of home treatment for a short period of time. They have the advantage over the pure outpatient the patient in the first session can see and whitening teeth treated. Given the importance of this technique and its progressive implementation as the most successful procedure detailed below.
VITAL TOOTH WHITENING COMBO: A USEFUL ALTERNATIVE TO CONSIDER
Tooth whitening combined in this vital case is used to try to shorten the home treatment and a better final result in less time. The result tends to be more stable over time and has the advantage that to perform successive annual reminders (Post whitening booster) the patient already has splints and only require whitening gel provided by your dentist.
It consists of two phases:
· Phase in the query:
Where the dentist performs an initial session in the dental office by chemical activation technique, technique headquartered in consultation or photoactivated technique, either with hydrogen peroxide or carbamide high concentration
· Phase in home:
The treatment is completed by the patient at home, under the supervision and periodic monitoring by professionals. The professional (who has previously taken a few models or records from your mouth) provide patient splints (individualized trays thermoplastic) and a bleaching agent: hydrogen peroxide and / or carbamide.
The concentration and type of bleaching agent will be chosen by the practitioner depending on several factors such as the type of bleaching that has undergone clinical and lowest or best result in this first phase bleaching.
In some cases as in technical Britesmile whitening obtained in the dental surgery is usually so great that then usually sufficient 4-7 days reinforcement at home to optimize the results (sometimes much less).
In fact many professionals take for good whitening obtained in the initial phase when good clinical results.
Thus, this period home treatment to be highly variable dependent on the technique that has been used in the query, the judgment of professional, patient expectations and concentration of product that is used in home phase. It may be three to four weeks or 3 to 7 days. While the process of whitening at home is advisable to eliminate (or minimize) where possible meals or drinks with many pigments, whether natural or artificial (coffee, tea, spinach, etc) for not negatively interfere with the process. In this phase and the immediate end whitening teeth are slightly more likely to attract external pigments.
Precautions before bleaching
Is indispensable mouth care before treatment to eliminate all extrinsic stains (external) and the product has high efficiency.
Sector undergoing teeth whitening is between teeth 15 to 25 and 35 to 45, that is, two each back canine (canine) and forward. Already have fillings in your mouth will not change color so you may need to change them to match the color posteriori regarding the achieved whitening.
Crowns not bleach so it will need to be replaced if they are within the bleached sector.
Must be changed before or defective fillings filtered (with poor or leaks sealed cavities) in the area of 5-5, from 15 to 25 and 35 to 45. Failure to do so could cause severe problems postoperative sensitivity after whitening.
It is advisable to discontinue toothpastes or mouthwashes with fluoride 15-30 days before bleaching to optimize treatment outcomes (fluorine "reinforces" the enamel by transforming the hydroxyapatite fluorapatite). The more recent literature seems to belie this criterion that logic, initially seems irrefutable.
Similarly should be suspended 15- 30 days before the products in liquid or desensitizing toothpastes (Desensin, Sensodine, etc.) based on potassium nitrate and other components that might interfere with the bleaching.
Beverage intake should be discontinued fluorine content (water "Vichy Catalan", etc ...) as are most mineral waters. Check product labels. In Spain "Solan Goat" and "Bezoya" marketed as low salt, and therefore suitable for this period during or prior to treatment.
For tto.ambulatorio (which takes place over several weeks at home) suspend the use of harmful substances duration bleaching (see next paragraph). Could adversely affect the results.
Strongly that assessment of oral and dental state is performed by a dentist recommend, it will analyze all parameters and advise or definitely advise against this technique cosmetic dentistry.
General contraindications of tooth whitening
- Sensitive Teeth
- Dentin Exhibitions
- Root Exhibitions
- Union open cementoenamel (occurs in 10% of the population, is the kind of microscopic union which occurs - between dental enamel and cementum dental root, different biotypes)
- Pregnancy
- Breastfeeding
- Minors
- Dental Injuries
- Root resorption
- Defects of enamel development
- Significant loss of enamel
- Cracks or fissures
- Caries
- Untreated periodontal disease
Pigmentation caused by corrosion of amalgams (only leave removing them with a strawberry)
- Composites or filtered desdaptadados
- Teeth with large restorations or fillings repeated on the same tooth
- Very dark teeth
- Abnormal dental morphology (its internal structure may be rare)
Precautions during whitening
If bleaching is done exclusively on clinical follow professional, he is responsible for taking reasonable steps for the procedure so that it is comfortable measures.
If bleaching is performed in whole or in part at home, during this process will be advisable to eliminate (or minimize) where possible meals or drinks with many pigments, whether natural or artificial (coffee, tea, spinach, etc) not negatively interfere with the process. In this phase and the immediate end whitening teeth are slightly more likely to attract external pigments.
Precautions after bleaching
If sensitivity to cold or mild discomfort is advisable to take an anti-inflammatory type "Espidifen", "Saetil", "Algiasdín", etc. (except if allergy to ibuprofen, or aspirin-ac.acetilsalicílico-coagulation disorders, in which case they will recommend other). These annoyances are temporary. If persisted desensitizing mouthwash rinses and / or topicaciones with these products but under colorless formulations are made.
At the end whitening session may be necessary topicar transparent desensitizing gel if sensitivity to rinse with water. Those feelings are temporary and normal.
You can now make mouthwashes with fluoride and brushing with fluoridated toothpaste normal (but not colored, for two weeks).
It is recommended to avoid consumption of carbonated drinks and any product or food that cause stains or acidic foods (pineapple, kiwi, citrus) for 1 month. Follow "white diet" (no spinach, no red wine, no "tails", etc.)
In this period the tooth is particularly prone to "capture" spots. Then normal life. Continue with "white diet" if we extend much treatment outcome.
The final whitening obtained will remain unchanged in the mouth for about 2-7 years, depending on each patient, teeth, and their care. In any case, when bleaching decays never recovers the initial color always look whiter. It is sufficient in this case a "reminder" whitening treatment to recover the maximum initial bleaching (is discussed below).
External stains that may be appearing due to coffee, tea, snuff, cokes, spinach, drinkable vitamin complexes of iron, mouthrinses with chlorhexidine base, spinach, ... may be removed by dental cleaning or daily use toothpastes as Rembrandt, Dentiblanc, etc.
Once a week you can use toothpaste for Eucryl dust removal at home in these spots.
Miss 15 days before changing the seals need to be replaced in tooth bleaching sector (until complete removal of the bleaching product).
Consumption of these products or foods that can cause stains on teeth is discouraged.
Abuse of carbonated beverages or acidic products are also recommended.
Session "reminder"
It consists of a 20 minute session in Clinical or 1 week or even less at home, according to the technique used (clinical or outpatient). If the technique was initially performed a combined or mixed media you will usually suffice a reminder of two or three days. Will determine the concentration of product being used.
ATTENTION
Since current research has not assessed the possible effects on all types of patients, strongly discourages the bleaching:
- Pregnant
- Lactating women
- Diabetes or heart disease
- Minors
- Allergy peroxides
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