Introduction to Teeth Whitening and process of In Office Teeth Bleaching

The process of Tooth Whiteninig or in office bleaching lightens the color of tooth. The process of whitenining can be done by either changing the color intrinsically or controlling formation of extrinsic stains. The chemical degradation of the chromogens within or on the tooth is called bleaching or teeth whitening.Bleaching is done by applying Hydrogen Peroxide on the tooth. It is the most commonly used whitening product. The bleaching gels or bleaching creams used in home bleach contains Carbamide peroxide. Hydrogen peroxide is analogous to carbamide peroxide as it is released when the stable complex is in contact with water. When it diffuses into the tooth, hydrogen peroxide acts as an oxidising agent that breaks down to produce unstable free radicals. In the spaces between the inorganic salts in tooth enamel, these unstable free radicals attach to organic pigmented molecules resulting in small, less heavily pigmented components. Reflecting less light, these smaller molecules create a “whitening effect. For achieving success in teeth whitening using Hydrogen Peroxide dentists should correctly diagonise the type and location where discoloration has happened.

The perception of tooth colour is multi-factorial. Reflection and absorption of light by the tooth can be influenced by a number of factors including specular transmission of light through the tooth; specular reflection at the surface; diffuse light reflection at the surface; absorption and scattering of light within the dental tissues; enamel mineral content; enamel thickness; dentine colour, the human observer, the fatigue of the eye, the type of incident light and the presence of extrinsic and intrinsic stains. The combination of intrinsic colour and the presence of extrinsic stains on the tooth surface influence the colour and thus the overall appearance of teeth. The scattering of light and absorption within enamel and dentine determine the intrinsic colour of teeth and because enamel is relatively translucent, the dentinal properties can play a major role in determining the overall tooth colour. On the other hand, extrinsic stain and colour is the result of coloured regions that have formed within the acquired pellicle on the enamel surface and can be influenced by lifestyle behaviours or habits. For example, dietary intake of tannin-rich foods, poor toothbrushing technique, tobacco products and exposure to iron salts and chlorhexidine can affect the colour of a tooth.

There are two types of stains extrinsic stains and intrinsic stains. Extrinsic stains can be easily treated by using in office bleaching processes. Intrinsic stains like tooth wear and aging,tooth decay, restorative materials, internal resorption, enamel hypoplasia, pupal hyperemia, fluorosis and similar issues are intrinsic stains. These stains are very difficult to treat and it will always be better to use smile design techniques.

Process of conducting In Office Bleaching or In office Teeth Whitening

  • Step 1: Conducting scaling and polishing on day one.
  • Step 2: Call patient and check if there is any sensitivity. If sensitivity is there due to scaling, then apply desinsitiser gel and call for next appointment.
  • Step 3:To start the process of bleaching, identify areas to be bleached.
  • Step 4:Apply cheek retractor. Click preoperative photos.
  • Step 5:Isolate gums and tongue using cotton rolls.
  • Step 6:Apply Gingival Barrier which is like flowable material and generally in fluorescent or bright blue colored.
  • Step 7: Cure the Gingival Barrier using either your light cure unit or Teeth Whitening System. If you are using bleaching system then the curing time will be two minutes. In case of light cure unit curing time will be 10 minutes.
  • Step 8: After time for curing gingival barrier is completed, check whether gingival barrier is cured with a dental probe.
  • Step 9: Apply Hydrogen peroxide Gel on upper and lower arch. Use either the Light cure unit or Teeth Whitening System and place infront the teeth. In case of light cure unit, curing time will be more than 10 minutes. In case of Teeth Whitening System the curing time will be 10 minutes.
  • Step 10: After 10 minutes remove the hydrogen peroxide gel with cotton. Please note that do not use water to clean the gel, since this may cause sensitivity to the patient. If you are planning to have second cycle based on the results of bleaching you may only wipe the gel with cotton.
  • Step 11: You may reapply the gel for better result using the same technique.
  • Step 12: Remove the Gel using water.
  • Step 13: Remove Gingival Barrier using probe and water.
  • Step 14 Dry the mouth
  • Step 15: Click post operative photographs

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