Tooth Bleaching

Tooth whitening or tooth bleaching procedures attempt to lighten a tooth's color in either of two
ways: by chemical or mechanical action. Working chemically, a bleaching agent is used to carry
out an oxidation reaction in the enamel and dentin.[48] The agents most commonly used to
intrinsically change the color of teeth are hydrogen peroxide and carbamide peroxide. Oxygen
radicals from the peroxide in the whitening agents contact the stains in the interprismatic spaces
within the enamel layer. When this occurs, stains will be bleached and the teeth now appear
lighter in color. Teeth not only appear whiter but also reflect light in increased amounts, which
makes the teeth appear brighter as well. Studies show that whitening does not produce any
ultrastructural or microhardness changes in the dental tissues.[8]

Studies show that patients who have whitened their teeth take better care of them. [49] However, a
tooth whitening product with an overall low pH can put enamel at risk for decay or destruction
by demineralization. Consequently, care should be taken and risk evaluated when choosing a
product which is very acidic. [50] Tooth whiteners in toothpastes work through a mechanical
action. They have mild abrasives which aid in the removal of stains on enamel. Although this can
be an effective method, it does not alter the intrinsic color of teeth. Microabrasion techniques
employ both methods. An acid is used first to weaken the outer 22–27 micrometers of enamel in
order to weaken it enough for the subsequent abrasive force. [51] This allows for removal of
superficial stains in the enamel. If the discoloration is deeper or in the dentin, this method of
tooth whitening will not be successful.