The Current Sizzle in Dentistry

One of the most wanted procedures by individuals nowadays is tooth whitening or bleaching as called by the dentist. Our teeth become darker as we age, as the enamel becomes less porous and due to changes in the mineral structure of the teeth. Bacterial pigments, smoking, paan (betel leaf with areca nut) chewing, trauma to the tooth and even some antibiotics cause staining or dulling of the enamel causing yellower or discolored teeth. Thus bleaching is certainly an answer to prayers for reformed smokers and paan chewers though not a permanent procedure.

Bleaching can be done in the dental office or at home. Commonly used agents used are carbamide peroxide, hydrogen peroxide, and sodium perborate. These are oxidizing agents which penetrate the enamel porosities and oxidize them creating a lighter shade than before. With repeated bleaching, the darker dentinal layer beneath enamel can also be bleached.

Bleaching at home is a comparatively easy procedure and considered to be more cost effective than the bleaching performed in office. Carbamide peroxide 10 to 15% can be obtained from dental stores. They are available in the form of gel which can be confined over the teeth with a mouth guard or trays constructed in the dental office for this purpose. Since the concentration of the gel used at home is preferably low, the tray may be kept in place for about 3-4 hours with the gel replaced every 2 hours.

Dental office bleaching is usually done in a higher concentration of about 35% peroxide but the application may last for shorter periods of time. This is said to be more effective than home bleaching. Light energy can be used to accelerate the process of bleaching in a dental office. Halogen, plasma arc or LED may be used.

In case of non vital bleaching which is done in the case of discolored teeth that have had root canal treatment, internal bleaching/ walking bleach is done, where an aqueous paste of sodium perborate is placed in the pulp chamber and sealed with a temporary filling. The patient is allowed to go home and reevaluated after two weeks; if the shade obtained is insufficient then a drop of 35% hydrogen peroxide is added to the perborate paste and sealed again and reevaluation done after 2 weeks.

Side effects of bleaching include:

• irritation of the unprotected gingival tissues

• sensitive teeth (temporarily)

• Hyperodonto oxidation/ over white teeth due to over bleaching.

• Prolonged exposure to bleaching agents may damage the tooth enamel.

• Bleaching is not recommended in children under 16 years of age and also contraindicated in pregnant and lactating women.

In some cases, such as tetracycline staining or heavy staining where whitening is ineffective, other methods may have to be used such as veneers where a thin layer of a filling material can be bonded to the tooth to obtain the natural shade.

Now you know that the pearly white teeth that you have most often envied on television are not that difficult to attain as you would have thought.