Dental Tooth Whiteners

teeth whitening

Science

Home – 10% or 16% carbmide peroxide, 20% for difficult cases or very dark single tooth Power – 9% hydrogen peroxide 1% hydrogen peroxide = 3% carbmide peroxide Gels work from incisal tips and then work down tooth from the inside, release oxygen to lighten teeth, no damage to enamel, or permanent sensitivity

Products – Home

Nite white – ACP – phosphate makes it less sensitive Opalescence – has fluoride and potassium nitrate – less sensitive

Products – Power

Day white – discuss dental Deep white – optident

Examination and assessment

Pre consent forms signed, photos with current shade and predicted shade Some cases may need more than 2 weeks home care – grey shades (C1/C2/C3), sensitive teeth, dark gingival third (warn dentine never whitens to same extent as enamel), excessive white spots, bruxism or TMJ dysfunction (use thicker trays and extend to all molars), translucent teeth, exposed root surfaces, tetracycline staining Take rads of any dark teeth to check apical pathology Warn that restorations will not whitten

Impression technique

Apply alginate with fingers to surfaces of teeth prior to tray insertion Border moulding – critical Tooth mousse purchased to reduce sensitivity (increase price of whitening and include in package) Trays need no reservoirs or scallops

Trays and gels picked up

Show amount of gel on discuss dental card or extrude yourself on tray and where, trays and teeth need to be dry Insert trays and press against buccal surfaces Check that have used tooth mousse, if not warn of extra sensitivity Can use invisalign aligners as whitening trays

Side effects

Sensitivity – see below Gingival irritation – gels too strong or trays overextended or too much gel placed Soft tissue irritation – too much gel Altered taste sensation – older products and only temporary Occlusal disharmony – poor fitting trays and not extended to all molars Incomplete whitening – splodge effect – need to do for longer Black star on trays from oxygenation of old amalgams

Sensitivity

Is always temporary,67% will experience this Active – Tooth mousse used 2 weeks prior to starting home whitening – ACP – plugs tubes with calcium phosphate and also reduces fade back after 6/12

Fluoride in trays – blocks dentinal tubes

5% potassium nitrate – depolarises nerve

Passive – Do not do all night – 2/3 hours

Use less gel

If severe miss 1 day, but need to make up prior to power whitening

Cut back trays from gingival margin

Power whitening

On alone not as effective as home whitening, only 25% get better than A2 Rehydrate between sessions, to reduce sensitivity Always have assistant in surgery 25% hydrogen peroxide

Post care

Need to wait 2 weeks before restoring as bond strength is affected

Single dark vital tooth

10% CP for 2/52 on all teeth and then 20% CP for 4/52 on difficult teeth only

Internal whitening

remove gutta percha 2/3mm below CEJ 20% CP in canal and cotton wool over and then GI Leave for 2/52, this method preferred to inside/outside technique