The best way to whiten teeth

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Key Points

Whitening treatments can be effective on both extrinsic & intrinsic staining.Only natural teeth can be whitened, not tooth-colored restorations.Whitening treatments include in-office bleaching procedures, dentist-supplied products for use at home, & over-the-counter (OTC) whiteners.Carbamide peroxide & hydrogen peroxide are commonly used in whitening interventions và can readily permeate dental hard tissues.Temporary tooth sensitivity & gingival inflammation are the most common adverse effects of vital tooth whitening.
Introduction

For some time, there has been consistent consumer demand for whiter, brighter teeth & an attractive smile.1-3 Professionally administered (in-office) tooth whitening, also known as dental bleaching, remains a popular esthetic procedure & can be performed using a wide range of techniques and application protocols.

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Another common approach is at-home whitening with custom-fitted trays, which patients use khổng lồ 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

Extrinsic vs. Intrinsic Stains

Tooth (and dental) discoloration are terms used lớn describe any change in the màu sắc 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 khổng lồ 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 màu sắc and severity, & 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, & 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), và can arise due khổng lồ 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.

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With increasing age, enamel becomes more translucent và thinner, which allows the yellower dentin khổng lồ show through và 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, & pulpal hemorrhage, decomposition or necrosis.5, 7, đôi mươi 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 màu sắc 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 kích hoạt 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 và 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 lớn 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 lớn arrive as close as possible khổng lồ the desired result. For example, although stains due khổng lồ tetracycline may be diminished, treatment can require three lớn four months of nightly treatment (on average).28, 31

Patient Considerations & Preferences

Tooth whitening is a common elective procedure and a popular, less-invasive aesthetic treatment for patients seeking to lớn enhance their smile & appearance. A clinical exam prior khổng lồ the start of tooth bleaching procedures, with radiographs & other screening và diagnostic tests as appropriate, can help diagnose various factors contributing to lớn the patient’s tooth discoloration.32 A standard dental exam, beginning with a health và 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), và any past or recent history of tooth sensitivity.32, 33

Patient dentition characteristics also influence the safe provision of care and the treatment’s màn chơi 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 & treatment could result in differences between natural teeth & restorations, which will not change color.28 The American Academy of Pediatric Dentistry discourages full-arch cosmetic bleaching for child & adolescent patients in the mixed dentition và 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 & composite và ceramic restorative materials.35