Advanced Technologies in Tooth Whitening

1. Advanced Technologies in Tooth Whitening The demand for whiter teeth has prompted the development of many innovations in professional oral health care technologies, as well as in over-the-counter products. Discoloration can present in different ways and, depending on the nature of the discoloration, the treatment approach and result can vary significantly. When discussing tooth whitening, it is important to acknowledge the work of many inventors who enabled the profession to offer tooth whitening as a conservative, alternative treatment to whiten and lighten discolored teeth that otherwise would have to be treated with veneers or crowns— with concomitant removal of sound tooth structure. In history, professional whitening procedures were performed in the dental office, typically using concentrated hydrogen peroxide (H2O2) and by isolating surrounding soft tissue to avoid contact with the whitening agent. Although this proved effective, drawbacks included lengthy chair time, cost, and the risk of dentinal hypersensitivity. These downsides were addressed by Haywood and Heymann in 1989, with the introduction of night guard vital bleaching using 10% carbamide peroxide in a custom tray worn at night.1This technique offered the possibility of whiter vital teeth at a reduced cost, and with fewer side effects. It also marked an evolutionary step in tooth whitening, as the patient took on the responsibility of performing the procedure at home.

2. TOOTH COLOR AND TYPES OF DISCOLORATION Tooth color is primarily determined by the reflectance of the dentin, modified by the absorption, scattering, and thickness of the enamel.4 Tooth color varies among individuals, among teeth in the same individual, and even within the same tooth.5 Furthermore, tooth color is not constant over a lifetime, and can change for various reasons.4 DO-IT-YOURSELF (DIY) WHITENING Do-it-yourself (DIY) whitening is promoted on myriad news outlets that provide information about at-home whitening remedies, including rubbing crushed strawberries, apples, or activated charcoal on teeth. The advocated use of these fruits is based on anecdotal perception, with the rationale being that they contain malic acid. The argument for using charcoal is based on its abrasiveness in removing stains. IN-OFFICE WHITENING In-office whitening is the initial form of tooth whitening, and is performed with H2O2-based materials at concentrations of up to 40%. It is an alternative for patients who cannot tolerate trays, or who desire an instant whitening outcome and prefer to have the procedure performed in the office. CONCLUSION Teeth whitening is a dynamic process initiated by the movement of the active ingredient through the tooth structure, where it interrelates with stain molecules and persuades micro morphologic alterations on the tooth surface—and within the tooth—to affect the dentition’s optical properties. The development of, and continuous advances in, whitening materials and techniques reflect the efforts of the dental profession and industry toward preserving tooth structure and enhancing esthetics. Clinicians and patients who initiate professional whitening treatment, as well as consumers who elect OTC therapy, will benefit from future innovations in whitening technology that are based on an improved considerate of the chemistry behindhand the tooth whitening process.