For some time, there has been consistent consumer demand for whiter, brighter teeth and an attractive smile.1-3 Professionally administered (in-office) tooth whitening, also known as dental bleaching, remains a popular esthetic procedure and can be performed using a wide range of techniques and application protocols. Another common approach is at-home whitening with custom-fitted trays, which patients use to apply professional-strength bleaching gel (for use at night or during the day). Numerous over-the-counter (OTC) whitening products (e.g., strips, gels, rinses, chewing gums, or paint-on films) are also widely available for self-application at home.4
Onuge are exported all over the world and different industries with quality first. Our belief is to provide our customers with more and better high value-added products. Let's create a better future together.
Extrinsic vs. Intrinsic Stains
Tooth (and dental) discoloration are terms used to describe any change in the color or translucency of a tooth,1 as well as discoloration in multiple teeth or the entire dentition. Tooth discolorations are typically classified as extrinsic, intrinsic, or a combination of both types.5
Extrinsic stains commonly result from an accumulation of colored compounds on enamel. Extrinsic discoloration is primarily associated with environmental factors or individual behaviors, such as tobacco use, exposure to metal salts (e.g., iron or copper), or the consumption of highly pigmented foods (e.g., dark fruits) or beverages (e.g., red wine, coffee, tea, or cola drinks).1, 6-11
Extrinsic tooth stains vary widely in color and severity, and can be exacerbated by lifestyle habits (e.g., smoking or chewing tobacco), poor oral hygiene, or frequent consumption of pigmented food or beverages.12, 13 A wide range of extrinsic stains can be effectively reduced with mechanical interventions such as brushing with a whitening toothpaste or professional prophylaxis.6, 7, 14 Some OTC whitening products (e.g., toothpastes, chewing gums) are effective primarily in removing extrinsic (surface) stains on enamel, and will not have a significant impact on intrinsic stains or the intrinsic color of the tooth.4, 15
Intrinsic stains occur inside the tooth (within the enamel or the underlying dentin), and can arise due to systemic causes such as genetic disorders (e.g., dentinogenesis imperfecta, amelogenesis imperfecta) or local factors during tooth development or after eruption (e.g., fluorosis).1, 16, 17 Aging is another common etiology of intrinsic discoloration. With increasing age, enamel becomes more translucent and thinner, which allows the yellower dentin to show through and the overall tooth color may darken.1, 18 Other causes of intrinsic discoloration include certain antibiotic use in childhood (e.g., tetracycline),19 caries, amalgam restorations, and pulpal hemorrhage, decomposition or necrosis.5, 7, 20 Intrinsic discoloration can also occur with prolonged use of antiseptic mouthrinse (e.g., chlorhexidine rinse).21
Whitening Agents
Reducing intrinsic stains involves a chemical reaction that changes the color of the tooth. The most common ingredients used in bleaching are carbamide peroxide and hydrogen peroxide, which are used at different concentrations depending on the products or regimens used.22
The bleaching action in chemically induced whitening is due primarily to the effects of carbamide peroxide, which releases about one-third of its content as hydrogen peroxide, a strong oxidizing agent.23, 24 Hydrogen peroxide diffuses easily through interprismatic spaces in the enamel, allowing for passage from enamel and dentin to pulp within 15 minutes of exposure.25, 26 The bleaching process is generally believed to occur when reactive oxygen molecules (generated from hydrogen peroxide) interact with organic chromophores (colored compounds) within enamel and dentin through a chemical oxidation process, which is influenced by various environmental factors (e.g., pH, temperature, light).17, 25, 27
The extent of whitening attained through bleaching may be influenced by the type of intrinsic stain being addressed. For example, brown stains due to fluorosis or tetracycline28, 29 may be more responsive to bleaching than white stains associated with fluorosis or orthodontic treatment, which may appear less noticeable as the background of the tooth lightens.30 The type of stain also can affect the length of and/or number of treatments required to arrive as close as possible to the desired result. For example, although stains due to tetracycline may be diminished, treatment can require three to four months of nightly treatment (on average).28, 31
Patient Considerations and Preferences
Tooth whitening is a common elective procedure and a popular, less-invasive aesthetic treatment for patients seeking to enhance their smile and appearance. A clinical exam prior to the start of tooth bleaching procedures, with radiographs and other screening and diagnostic tests as appropriate, can help diagnose various factors contributing to the patient’s tooth discoloration.32 A standard dental exam, beginning with a health and dental history, may include questions about the patient’s perception of the cause of the dental discoloration, as well as allergies (which may include ingredients in bleaching materials), and any past or recent history of tooth sensitivity.32, 33
Patient dentition characteristics also influence the safe provision of care and the treatment’s level of success in whitening vital teeth. Patients who have tooth-colored restorations (including crowns or implants) should be aware that only natural teeth will be affected by the bleaching agent and treatment could result in differences between natural teeth and restorations, which will not change color.28 The American Academy of Pediatric Dentistry discourages full-arch cosmetic bleaching for child and adolescent patients in the mixed dentition and primary dentition.34 Additionally, some research suggests that bleaching protocols may alter the surface roughness of enamel, which may also reduce the shear bond strength between enamel and composite and ceramic restorative materials.35
Products Directly Available to Consumers
Bleaching compounds in over-the-counter whitening products are peroxide-based and typically contain carbamide peroxide or hydrogen peroxide at lower concentrations than in-office or dentist-prescribed, at-home bleaching techniques. A variety of OTC options are available with products that include toothpastes, whitening strips, and gels painted directly on teeth or delivered in trays. Products that bear the ADA Seal of Acceptance (a voluntary program for OTC oral care products), indicating that the company has demonstrated that the product meets ADA Seal Program requirements for safety and effectiveness when used as directed, include toothpastes and whitening strips.
Whitening toothpastes primarily rely on abrasives for mechanical removal of extrinsic surface stains, though some contain low levels of peroxide to help lighten tooth color.7, 36, 37 A systematic review found limited evidence that whitening dentifrices had similar efficacy to paint-on gel but less efficacy than whitening strips, with comparable adverse effects (e.g., sensitivity, oral irritation).38 Most whitening strips rely primarily on peroxide to bleach teeth.33, 39
In-Office Procedures and Products Available Through Dentists
Examples of products available through dentists include gels delivered in custom-made trays, either intended for at-home use or applied as an in-office treatment. In-office whitening treatment may involve application of a peroxide-containing gel, used with or without a light intended to accelerate and enhance the bleaching process (known as a light-activated system).40 Another in-office bleaching procedure, known as “power bleaching,” uses concentrated solutions of hydrogen peroxide in water (with or without light activation), which may be applied for up to 30 minutes.17
Dentist-supervised whitening approaches include at-home and in-office options (note: whitening products supplied by dentists for use at home or applied by dentists in the office are considered “professional products,” and are not eligible for the ADA Seal of Acceptance). At-home whitening with custom trays involves whitening gel placed in trays by the patient at home. The trays are made in the office to fit comfortably and minimize contact of the gel with the patient’s gingiva. Peroxide concentration in at-home systems typically ranges from 10% to 38% carbamide peroxide and treatment times are dictated primarily by the concentration used.41 A systematic review by de Geus et al. found daily treatment times ranging from 2 to 10 hours for periods of 6 to 28 days.42
Other in-office techniques for removing extrinsic stains include rubber-cup prophylaxis and enamel microabrasion, which may be completed before the provision of other in-office bleaching treatments that use gels with high peroxide concentrations or light-activated bleaching systems.15 Microabrasion uses an abrasive slurry (e.g., acidic gel with abrasive particles) to remove thin outer layers of the enamel surface.15 Microabrasion may also be supplemented by chemically induced whitening for enhanced stain removal and improved patient satisfaction with esthetic outcomes. This procedure is typically limited to treatment of extrinsic stains or defects that do not extend beyond the enamel.15, 43 Overall, the removal of intrinsic stains within the dentin is considered near impossible when using an external whitening procedure (i.e., chemical and/or mechanical) whitening treatments.17
Whitening of non-vital discolored teeth may be performed through intracoronal (internal) bleaching, a procedure that uses carbamide peroxide, hydrogen peroxide, or sodium perborate to provide adequate internal bleaching of non-vital teeth.44 In rare instances, non-vital tooth bleaching has been associated with reports of external cervical resorption, but the overall incidence of this adverse effect is not considered common.45, 46
Treatment Considerations
Examples of whitening treatment considerations may include the patient lifestyle, socioeconomic status, and present oral health.32, 33 Since restorative materials generally do not change color, identifying and documenting existing tooth restorations as part of the dental examination can help promote and achieve an acceptable tooth bleaching outcome. Restorations can also be a cause of tooth discoloration: metallic and other restorative materials on the lingual or occlusal surface of the teeth may influence tooth color significantly. Patient expectations may not be met or may be unrealistic without addressing cosmetic issues with existing restorations.15
While OTC whitening products tend to be less expensive than at-home or in-office approaches, there is often a time trade-off in that OTC products may take significantly longer than either of the other options to achieve similar levels of whitening. Auschill et al. found that an OTC bleaching technique took 16 days to achieve the whitening level of a seven-day, at-home tray system and a one-day, in-office procedure.47
Sensitivity
One common adverse effect of OTC or dentist-dispensed, tray-based whitening is tooth sensitivity, which can be more prevalent with higher concentrations of active agents but is typically mild and transient.1 Risk of temporary dental sensitivity is associated with all forms of bleaching,42, 48-50 possibly due to inflammation of the pulp as a result of peroxide exposure during the procedure.51
Regarding dental hard tissues, transient mild to moderate tooth sensitivity can occur in up to two-thirds of users during early stages of bleaching treatment.52 With whitening strip or tray-based treatments, sensitivity may develop within two to three days after starting the program and usually resolves by the fourth day post-treatment.48
Factors that may influence the development or extent of tooth sensitivity associated with bleaching include concentration of carbamide or hydrogen peroxide, the presence of adhesive restorations53 or the contact time and intensity and duration of light use.48, 54, 55 However, a recent systematic review of in-office whitening found use of lower concentrations of hydrogen peroxide resulted in less tooth sensitivity and greater objective color change.56
A variety of approaches to prevent bleaching sensitivity have been explored, such as pretreatment use of nonsteroidal anti-inflammatory drugs57, 58 and pretreatment application of 5% potassium nitrate and 2% sodium fluoride gel.59, 60 Further research is needed to confirm the efficacy of these approaches in reducing tooth sensitivity.
Gingival Irritation
Gingival irritation can result from contact with peroxide-based gels when whitening strips or any gel-based product is used for whitening. It is typically due to poor-fitting trays or improper application of the protective barrier or gel.22, 48 Li suggests that use of local anesthesia be avoided during in-office bleaching so that patients can detect any burning sensations, which could indicate gel seepage through the barrier, and that patients be instructed to alert the dentist to any discomfort during the procedure so that integrity of the barrier can be checked.22
A Cochrane review on the use of home-based whitening products found that tooth sensitivity and oral irritation were the most common adverse effects, which were more prevalent at higher concentrations but also considered mild and transient.1 A comparative systematic review of tray-delivered carbamide peroxide gels versus hydrogen peroxide products (for at-home bleaching) found that both whitening systems had relatively equal levels of tooth sensitivity and gingival irritation.61 As with sensitivity, gingival irritation is typically transient and resolves shortly after completing the treatment.22 Additionally, a systematic review concluded that hydrogen peroxide-containing products used for tooth whitening do not appear to have carcinogenic effects on the oral mucosa.62
Teeth whitening is a procedure to lighten the color of your teeth and remove stains. You can have it done at a dentist's office, or do it yourself at home.
Tooth whitening is most often done using peroxide-based bleaching agents. At-home systems contain from 3% to 20% peroxide (carbamide or hydrogen peroxides). In-office systems contain from 15% to 43% peroxide.
Generally, the stronger the solution and the longer you keep it on your teeth, the whiter your teeth become. But the higher the percentage of peroxide in the whitening solution, the shorter it should stay on your teeth. Keeping it on longer will dehydrate teeth and increase tooth sensitivity.
There are pros and cons to each option, but before you try at-home tooth-bleaching kits, talk to your dentist. Not everyone will see good results. Bleaching will not whiten porcelain crowns or tooth-colored composite bondings.
Whitening vs. bleaching
The terms "whitening" and "bleaching" are sometimes used interchangeably, but they don't always mean the same thing. Teeth whitening can be done with either bleaching or non-bleaching products. Bleaching is the type of whitening that involves using bleach containing peroxide. It cleans both deep and surface stains and can make teeth even whiter than their natural shade.
If you are looking for more details, kindly visit Is Teeth Bleaching Safe? | Expert Guide to Safe Whitening ().
You have tooth discoloration when your teeth are stained or darkened. It might affect the whole tooth or look like lines or spots on the tooth's surface. There are two basic types of tooth discoloration:
Intrinsic, or internal, discoloration happens inside the tooth. Things that can cause this type of discoloration include aging, tooth injuries, some health conditions, and certain medications.
Extrinsic, or external, discoloration happens when substances like foods, beverages, or tobacco stain the tooth's surface. Poor oral hygiene can also cause it.
Teeth whitening done by your dentist can get teeth brighter faster. The bleaching solution is usually much stronger than that in at-home kits. Also, your dentist can use heat, light, or a combination of the two to speed and intensify the whitening process.
The most dramatic results -- teeth generally get three to eight shades brighter -- usually take several 30- to 60-minute in-office visits. Some dentists use techniques that can be done in a single 2-hour appointment (such as the Zoom system). The cost of in-office teeth whitening varies, but can range from $500 to $1,000.
There are many choices for whitening teeth at home. Some common methods include:
- Tooth whitening strips and gels. Applied directly to the teeth with a brush or a thin strip, these peroxide-based tooth bleaching products usually need to be applied once or twice a day for 10 to 14 days. They can lighten your teeth by a shade or two. Results last four or more months. Products may cost from $10 to $55.
- Tray-based tooth bleaching systems. With this teeth whitening option, a mouth guard-like tray is filled with a peroxide-based bleaching gel or paste and placed over the teeth for one to several hours a day for up to 4 weeks. You can buy tray-based tooth whitening systems over-the-counter or have one custom-fitted by your dentist. The cost can range from $150 to $600.
- Tooth whitening toothpastes. Because they're mildly abrasive, every toothpaste helps remove stains from teeth. But whitening toothpastes also contain chemicals or polishing agents that help scrub stains without the aid of a bleaching agent. Tooth-whitening toothpastes are relatively inexpensive and brighten teeth by about one shade. Some contain peroxides, but they aren't left on the teeth long enough to have a strong whitening benefit.
- Whitening rinses. Rinse your teeth for 60 seconds twice a day with these products, which contain hydrogen peroxide, to make your teeth look slightly whiter.
- Whitening chewing gums. You chew these to help prevent stains after you use substances that can stain your teeth, such as tobacco, coffee, and tea.
The first step toward whiter teeth is to practice good oral hygiene at home. Brush your teeth with fluoride toothpaste or toothpaste with baking soda twice a day, floss at least once a day, and drink fluoridated water.
Some other at-home practices can also help teeth look cleaner and whiter.
Eat foods that help protect oral health
These include:
- Dairy products. Foods like milk and unsweetened yogurt contain calcium and phosphates that help protect and rebuild tooth enamel. Cheese boosts the production of saliva, which products your teeth against gum disease and cavities.
- Fruits and veggies. High-fiber foods like apples, celery, and broccoli not only help scrub away plaque, but also increase saliva flow. Strawberries contain a substance called malic acid that helps prevent stains on your teeth.
Brush your teeth with baking soda
Baking soda is slightly abrasive, which helps it scrub stains from your teeth. It's an ingredient in many toothpastes. You can also use it by itself. Just put a little on a wet toothpaste and brush gently. Be sure to rinse well. Don't do this more than a couple of times a week. Baking soda's abrasiveness could damage your tooth enamel.
Does activated charcoal work to whiten teeth?
Activated charcoal is another abrasive material that some people use to try to whiten their teeth. You can buy toothpastes and tooth polishes that contain it. But there's no strong evidence that it's effective or even safe. In fact, the American Dental Association warns that using abrasives on your teeth can wear down the enamel and they could end up looking more yellow.
What about oil pulling?
In this traditional Indian remedy, you swish a spoonful of sesame or coconut oil around your mouth for 15-20 minutes per day. Proponents say it can whiten teeth as well as improve your overall dental health. But there's little scientific evidence that it works.
There are all sorts of teeth whitening options. Which is best for you depends on your circumstances, needs, and budget. Talk to your dentist about which teeth whitening methods or products work well and are safe for your teeth and oral health.
In-office whitening is highly effective, safe, and long-lasting. But it's more expensive than over-the-counter options, and often isn't covered by dental insurance. Ask your dentist for a cost estimate before committing to teeth whitening.
Other factors that may determine the best teeth whitening method for you include:
- Your dental health. You'll need treatment for issues like gum disease or cavities before you whiten your teeth.
- The natural color of your teeth and how white you want then to be. Whitening can only lighten your teeth so far. Veneers or crowns might be the only way for you to get truly white teeth.
- What previous dental treatments you've had. Whitening won't work on bonding, tooth-colored fillings, crowns, or implants and could even damage them.
- Potential risks and side effects. Whitening can lead to temporary sensitivity in your teeth and gums. We need more research, but studies have shown some whitening products might change the surface of your teeth or even damage them.
- How quickly you want results. One professional treatment might do the trick. You may need to use at-home products every day for a week or more to get similar results.
Whether you use an at-home tooth-whitening system or have your teeth bleached by a dentist, you can help maintain the results by regularly brushing and flossing and keeping up with dental appointments.
Also, avoid acidic foods and beverages, those that are rich in tannins (substances found in plants that have an astringent quality), and deeply colored ones that could stain your teeth. These include:
- Black teas and coffee
- White and red wine
- Sports drinks
- Carbonated beverages (dark and light-colored sodas)
- Intensely colored foods like blueberries
- Sauces (soy, tomato, curries)
Tooth bleaching can make teeth temporarily sensitive -- or be uncomfortable for people who already have sensitive teeth. When used incorrectly, home kits can also lead to burned -- even temporarily bleached -- gums.
Tooth-whitening works best for people with yellow teeth and is less effective for people with brown teeth. If your teeth are gray or purple, tooth bleaching probably won't work at all.
To be sure tooth-whitening is worth your time and money, talk to your dentist before you use an over-the-counter tooth whitening kit.
When done correctly, teeth whitening is generally safe. But it can come with risks, depending on what you use to whiten your teeth and how often and how long you use it. The risks of overly aggressive teeth whitening include:
- Gum irritation
- Increased tooth sensitivity
- Softening of the tooth enamel
- Roughening of the teeth's surface
- Damage to or discoloration of dental restorations like crowns
We need more research on this, but some early studies indicate there could be additional risks, such as:
- Erosion (wearing away) of the teeth
- Loss of minerals from the teeth
- Damage to the pulp inside your teeth
To minimize the risks:
Follow your dentist’s recommendations for whitening your teeth.
Carefully follow the manufacturer's instructions for using whitening products.
Use only teeth whitening products whose labels say they're approved by the American Dental Association.
Tell your dentist if you notice undesirable changes in your teeth or health after teeth whitening.
Can teeth whitening damage teeth?
Teeth whitening can damage your teeth if the procedure or product is too harsh. This is due to dehydration of the teeth and the loss of essential minerals like calcium.
Teeth whitening lightens your teeth and removes stains using ingredients such as hydrogen peroxide. There are many safe and effective ways to whiten your teeth, including professional treatment at your dentist's office and over-the-counter products you use at home. Whichever method you choose, it's important to seek your dentist's advice and follow the directions carefully.
Can badly yellowed teeth become white again?
You can get badly yellowed teeth due to aging, certain foods and beverages, and poor oral hygiene. These yellowed teeth can become white again through dental care like teeth whitening, dental bonding, and crown procedures. Your dentist can help you choose what’s best for you.
What’s the most effective way to whiten teeth?
For long-lasting results, experts recommend a whitening treatment in your dentist's office, followed by monthly over-the-counter treatments for maintenance. But this may not be right for everyone.
For more information, please visit Build Your Customized Teeth Whitening Brand | Onuge OEM Solutions.
Comments
All Comments (0)