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Tray Tooth Bleaching Sclera of the Eyes best when they match the color of the 5 Tray tooth bleaching sclera of the eyes. The right thing at the right time Prior to bleaching, the dentist should conduct a proper 2 examination and analysis of By Van B. Haywood, DMD (according to the wisdom of my the smile. This examination should include: f you rob a bank and give the late esteemed colleague Dr. Dick t Evaluating how much of the money to the poor, have you Tucker). teeth are showing in a full smile done the right thing? If you When considering bleaching, the I most cost-efficient, safe and effica- because the gingival area of teeth restore teeth with the best possible do not bleach as well as the incisal porcelain veneers when the teeth do cious technique for both the dental portion. not need veneers, have you done the office and the patient is generally t Identifying the gummy smile be- right thing? recognized as tray bleaching using a cause whiter teeth make the gummy Bleaching teeth is one of the 10 percent carbamide peroxide (CP). smile more noticeable. Periodontal many treatments that everyone The following checklist on tray therapy for altered passive eruption should have in their treatment op- bleaching may be helpful. may be first indicated. tions in order to do the right thing Everybody’s teeth respond t Identifying the existing restora- at the right time. Once you have differently, both in how white tions revealed in a full smile because determined to do the right thing, 1they get and how quickly that the restorations do not change color. then you need to do the thing right whitening occurs. Tray bleaching t Evaluating the results of the expectations include: periodontal conditions because t Normally discolored teeth can exposed roots do not bleach. take three days to six weeks. t Recording all existing decay, t Nicotine-stained teeth can take gingival disharmony, history of sen- one to three months. sitivity or occlusal problems. t Tetracycline-stained teeth can take two to 12 months or longer. The dentist should take a The average for tetracycline-stained screening radiograph of the an- teeth is three to four months to get 3 terior teeth to be bleached and lighter, but not necessarily white. any single dark tooth to determine Once teeth reach their maximum the cause of the discoloration. That whiteness, further treatment or dif- cause could include: ferent products or concentrations will t An abscessed tooth. not improve that shade. Teeth look the 6HH%/($&+,1*SDJH DentalPracticeSuccess SPRING 2016 BLEACHING ide), so trays can be made that Continued from page 5 extend onto the tissue 1-2 mil- limeters for a more comfortable, better seal. The gingival health in t Internal or external resorption. research projects always improves t Calcific metamorphosis (the during bleaching. Concentra- pulp chamber obliterated by second- tions higher than 10 percent ary dentin). require scalloping the tray such t Different size pulp chambers. that there is no tissue contact to t Caries. avoid tissue burning. t Cysts or tumors. Spacers or reservoirs are There are two different bleach- not needed to bleach teeth ing materials that require as only a thin film of mate- 4 different instructions for the 7 rial is required with tray isola- patients. CP is composed of hydro- tion, but reservoirs account for geng peroxide and urea. CP is best tight or ill-fitting trays. A proper wornw overnight, as it is active for 6 to alginate impression (where the 101 hours. Hydrogen peroxide (HP) is adhesive has set for 10 minutes onlyo active for 30 to 60 minutes, so 6 in the tray before use, the impres- iti is applied during the day. A 10 per- sion is held in the mouth for one centc CP product is comparable to a minute past tacky and poured 3.53 percent HP product. Because CP patient should brush with a desen- within 15-45 minutes without has a long activity time, it takes fewer sitizing toothpaste to further reduce bubbles) creates an excellent fitting nights to reach the same shade as HP the chance of sensitivity. non-scalloped, no reservoir tray for worn during the day. Conversely, HP Because bleaching materi- 10 percent CP. worn during the day will take more als penetrate the tooth and days of less wear time to equal the Tooth sensitivity is a result of 11 release oxygen, the bond nighttime bleaching with CP. the easy passage of peroxide strengths of composite to enamel are 8 through intact enamel and reduced by 50 percent if bonding is The pH to get tooth decay dentin to the pulp in five to 15 on dentin is below 6.8 and in performed immediately after bleach- minutes. This easy passage changes 5 enamel is below 5.5. Because ing. The dentist should wait two the color of the dentin as well as CP has urea, the pH of the mouth weeks after bleaching for the oxygen the enamel. Sensitivity is a transient and in the tray is elevated above 8 to dissipate before initiating bonding pulpitis, and the higher the concen- within five minutes of insertion such procedures. tration, the greater the sensitivity. that patients cannot get tooth decay The oxygen released during while wearing the bleaching tray with In addition to a proper fitting bleaching also affects the CP. Hence CP in a tray may be used tray and low concentration 12 shade of the tooth, so the for caries control when fluoride in a 9 of CP, the best treatment for patient should not be bleaching for tray is not working. HP has a pH of sensitivity involves the tray applica- two weeks prior to a shade being 5, so does not favor tooth protection tion of 5 percent potassium nitrate taken for a crown or composite. for long-term wear. for 10 to 30 minutes prior or after Since some patients may be using bleaching. Potassium nitrate is found Different tray designs are im- over-the-counter products unknown in most desensitizing toothpastes in portant for different products, to the dental office, it is important the U.S. Professional products are 6 different concentrations and that the receptionist question the also available, as well as bleaching different patients. Ten percent CP patient before scheduling an appoint- products, which contain potassium was originally designed to treat the ment that involves bonding or shade nitrate. gingivae as an oral antiseptic (Glyox- matching. Bleaching should not Restorations will not change be started immediately color from any type of ! ? 10 after a prophylaxis. Before 13 bleaching. While the surface TIME FOR A SOCIAL MEDIA initiating bleaching and to reduce will be cleaned, which may result in a CHECKUP? page 10 sensitivity issues, it is best to wait more favorable-appearing restoration, two weeks, during which time the 6HH%/($&+,1*SDJH DentalPracticeSuccess SPRING 2016 BLEACHING Continued from page 6 the color is the same. Patients need to be informed of the cost of replacing unaesthetic restorations as a separate fee from the bleaching fee. A single dark tooth is best treated with a single tooth 14 bleaching tray rather than a full-mouth tray. This allows the single tooth to reach its maximum whitening before changes are attempted on the adjacent teeth. A single-tooth tray is fabricated by taking a full mouth tray extended further onto the tissue, and removing the tooth molds so that the bleaching material only contacts the single dark 7 tooth. hile there is much more infor- Wmation about how to do the thing right with bleaching, these points provide a starting point for good quality patient care. ) 'U+D\ZRRGLVD professor in the Depart- PHQWRI2UDO5HKDELOLWD- WLRQ'HQWDO&ROOHJHRI *HRUJLDDW$XJXVWD8QLYHUVLW\LQ $XJXVWD*HRUJLD,QKHFR DXWKRUHGWKH¿UVWSXEOLFDWLRQLQWKHZRUOG RQQLJKWJXDUGYLWDOEOHDFKLQJ DWKRPH RUWUD\EOHDFKLQJ ZLWK'U+DUDOG +H\PDQQDQGLQKHFRDXWKRUHG WKH¿UVWDUWLFOHRQH[WHQGHGWUHDWPHQWRI WHWUDF\FOLQHVWDLQHGWHHWKXVLQJWKLV WHFKQLTXH+HKDVFRPSOHWHGIXUWKHU UHVHDUFKDQGRYHUSXEOLFDWLRQVRQ WKHWUD\EOHDFKLQJWHFKQLTXHDQGWKH WRSLFRIEOHDFKLQJDQGHVWKHWLFV LQFOXGLQJ¿UVWSDSHUVRQWUHDWLQJ EOHDFKLQJVHQVLWLYLW\ZLWKSRWDVVLXP QLWUDWHGLUHFWWKHUPRSODVWLFWUD\ IDEULFDWLRQEOHDFKLQJSULPDU\WHHWKDQG FDULHVFRQWUROZLWKEOHDFKLQJPDWHULDOV +HKDVOHFWXUHGLQRYHUFRXQWULHVDQG VWDWHV+LVERRNWLWOHG³7RRWK :KLWHQLQJ,QGLFDWLRQVDQG2XWFRPHVRI 1LJKWJXDUG9LWDO%OHDFKLQJ´ZDV SXEOLVKHGLQDQGLVDYDLODEOHRQOLQH IURPL%RRNVRURQKLVSHUVRQDOZHEVLWH ZZZYDQKD\ZRRGFRP 6HH0$5.(7%8==SDJH DentalPracticeSuccess SPRING 2016 Originally published in: Haywood V. Tooth whitening is not always tooth bleaching. Inside Dentistry. 2018;14(2):80. Perspective Copyright © 2018 to AEGIS Publications, LLC. All rights reserved. Used with permission of the publisher. Patient education helps eliminate confusion regarding treatment options Tooth Whitening Is Not Always Tooth Bleaching hroughout history, dentists have provided many ser- approved the first “whitening toothpaste” in 1999, the company had vices that change the color of their patients’ teeth. The to state on the package what the toothpaste was capable of doing. The oldest bleaching techniques date back to the 1800s label on this whitening toothpaste stated that it “polishes away stains,” and were performed in the dental office. Today, the but also noted that it “is not bleaching.” Today, many toothpastes are most popular bleaching technique involves the use of being sold as “whitening” toothpastes. A close look at the product bro- trays made in the dental office for at-home wear. When chure of one of the popular whitening toothpastes reveals that the the first article on this tray technique was written in toothpaste “does not change the color of the teeth, but removes surface 1989, the technique was called “Nightguard Vital Bleaching.” As this stains.” However, this does not appear until the second page. Because Ttechnique gained popularity in the profession and around the country, manufacturers have deemphasized this fact, some consumers may dentists became concerned that when discussing “bleaching,” a tech- believe that whitening toothpaste is an equally effective alternative nique that relied on the patient applying a material in the tray at home, to bleaching treatments.
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