BLEACHING

Bleaching can be defined as the whitening of a tooth through the application

of chemical agent to oxidise or reduce the organic pigmentation in the tooth.
Advantage:
• Safe procedure
• painless to adults
• No tooth reduction required
• No anaesthesia necessary
• Less expensive
Disadvantage
• Unpredictable results
• Extended treatment time may be necessary
• Post operative hypersensitivity
 INDICATIONS

• Discolored teeth due to either extrinsic or intrinsic stains.

CONTRA-INDICATIONS

• Patient selection - Patients with emotional or psychologic problem or those with unrealistic goals do not
make good candidates for bleaching. YOUNG PATIENTS – owing to their large pulp chamber

• Dentinal hypersensitivity – Cases of attrition, erosion, abrasion or abfraction.

• Generalized dental caries and leaking restoration

• Heavily restored teeth - composite restorations do not lighten and become more evident after bleaching.

• Teeth with opaque white spots

• Teeth slated for bonded restorations or orthodontic bracketing - Oxygen produced during bleaching
remains in the enamel or dentin ------ interferes with the bonding agent.
 CHEMISTRY OF BLEACHING

Bleaching is a chemical process, which occurs mostly by the oxidation during which
the organic materials are eventually converted into carbon dioxide and water.

In the bleaching process, the oxidizing agent i.e. the bleaching agent has free
radicals with unpaired electrons which it gives up and becomes oxidized, whereas
the reducing agent i.e., the substance being bleached accepts the electrons and
becomes reduced.
• Discolorations arise due to the formation of chemically stable,
chromogenic products. Pigments consist of long-chain organic
molecules.

• In bleaching, these compounds which are oxidized: they are

split into smaller molecules which are usually lighter as they
reflect less light.
 Bleaching Materials:
Commonly used bleaching agents in dentistry are:

Hydrogen peroxide
Sodium perborate
Carbamide peroxide

Hydrogen Peroxide:
• It is a clear, colorless and odorless liquid.
• Higher concentrations thermodynamically unstable and may explode
unless refrigerated and kept in a dark container.
• Can be used for both intra and extra-coronal bleaching.
Adverse effects:
• Gingival irritation: As there is no barrier to restrict these gels.
• Sensitivity
• Because of its effect on skin and mucous membrane it
resembles a chemical burn.
 SODIUM PERBORATE:
• It is a stable white powder. When fresh, it contains about 95%
perborate corresponding to 9.9% of available O2
• Oxidizing agent
• Is stable when dry,but in the presence of acid,warm air,or water it
decomposes to form sodium metaborate,hydrogen peroxide and
nascent oxygen. CARBAMIDE PEROXIDE
• Also known as carbamyl peroxide, perhydrol urea, carbamide
urea, urea H2O2 and H2O2 carbamide.

• 10% carbamide peroxide breaks down into urea, ammonia,

carbondioxide and 3.5% hydrogen peroxide.

• It is a clear, colorless odorless liquid. When used as a

bleaching agent it breakdowns to hydrogen peroxide.
 BLEACHING TECHNIQUES
Non-vital bleaching:
These procedures are carried out for endodontically / pulpless treated teeth

Indications
• Discolouration of pulp chamber
• Dentin discolouration
• Not amenable to extracoronal bleaching

Contraindications
• Superficial enamel discolorations
• Defective enamel formation
• Severe dentin loss
• Presence of caries
• Discolored composites
• Extensive restorations
 In non-vital bleaching techniques, these steps are common :
• Radiographic assessment of the status of the periapical tissues
and the quality of endodontic obturation. If the obturation is
inadequate - Retreatment

• Any leaking or discolored restorations, they have to be replaced.

• Orabase or Petroleum jelly should be applied to the gingival

tissues, followed by isolation with rubber dam. Liquid dam can be
used in difficult cases.

• Advisable to restore carious lesions or replace deficient fillings

with temporary materials before treatment or to replace
restorations after completion of bleaching.

(Gianluca Plotino et al 2008)

Placement of barrier:

• Many studies have suggested using the labial CEJ as a guide for
barrier placement.

• 2mm of gutta-percha is removed from the coronal orifice and sealed

with glass ionomer cement

• Placement of a flat barrier leaves the proximal dentinal tubules

unprotected; this is the site where cervical resorption begins.
(Brigitte Zimmerli et al 2010)
 WALKING BLEACH:

•Mixture of sodium perborate and inert liquid such as water, saline or

anesthetic solution or even H2O2 can be used but preferably lower
concentrations are placed in the pulp chamber.

•35% hydrogen peroxide is called Superoxol which is also used in

walking bleach technique.

• Patient should be informed that bleaching agents work slowly and

significant lightening may not be evident for several days.

•Patient should be evaluated after 2 weeks and the procedure should be

repeated if necessary.
 THERMOCATALYTIC TECHNIQUE

• This technique involves placement of the oxidizing

agent in the pulp chamber followed by heat application
either by electric heating devices or specially designed
photoflood lamps for 5min.

• Should not be repeated for more than 5-6 times.

Care should be taken that the temperature of the
heating device does not exceed 114F.

• Lamp unit should be 13 inches away from patient.

 Photo-oxidation
TECHNIQUE
• In this technique, 30% to 35% of H2O2 solution
is placed in the pulp chamber on a cotton pellet
followed by exposure to the curing light for 20-
30 sec.

• For plasma arc or laser 3-5 seconds of

exposure time is sufficient.

• If the bleaching gels are used they have to be

expressed into the access cavity and onto the
labial surface of the tooth and should be
exposed to the curing light from both the sides.
Adverse effects:
• External cervical root resorption
• Chemical burns:-
35% H2O2 is caustic and may cause chemical
burns and sloughing of the gingiva.
• Coronal fracture:-
Increased brittleness of the coronal tooth structure,
particularly when heat is applied
Due to dessication of the dentin and enamel.

Post Bleaching Tooth Restoration:

• A composite restoration is placed 1 or 2 weeks after complete removal of the bleaching materials.
This time period is for the elimination of residual peroxides.

• In case of thermocatalytic or photooxiation bleaching, it has been advised to pack Ca(OH)2

paste in the pulp chamber for a few weeks to counteract acidity caused by bleaching agents and to
prevent root resorption.
 Vital bleaching techniques
❑ In-office
or Power
❑ Mouth guard or Night guard or At-home
❑ Over-the counter
 IN OFFICE TECHNIQUE
Indications:
• Light enamel discoloration
• Mild tetracycline discoloration
• Endemic fluorosis discoloration
• Age related discoloration

Contraindications:
• Severe dark discolorations
• Severe enamel loss
• Proximity of pulp horns
• Hypersensitive teeth
• Presence of caries
• Large/ poor coronal restorations

30 to 35% H2O2 solution on a
small cotton pellet or a gauze.
Light sources used are:
Tungsten-Halogen curing light, Argon laser: Carbon dioxide laser,
xenon plasma arc and diode laser
Clean the surface with pumice and water.
Apply heat with a heating device
or light source at a temperature
between 125F and 140F (52C
to 60C).
darkest stains acid etch for 5
to 10 seconds and rinse for 60
seconds.
Polish bleached surface 1.1%
neutral sodium fluoride gel
for 3 to 5 min.
Recall the patient after 2 weeks and
evaluate the effectiveness
of bleaching
Adverse effects
1. Post operative pain

2. Pulpal damage

3. Dental hard tissue damage

4. Mucosal damage
 Night guard vital bleaching
Indications:-
• Superficial enamel discolorations
• Mild yellow discolorations
• Brown fluorosis discolorations
• Age-related discolorations

Contraindications:-
• Severe enamel loss
• Hypersensitive teeth
• Presence of caries
• Defective coronal restorations
• Allergy to bleaching gels
• Bruxism
• Pregnant and lactating
• Smoking
• 10 to 15% carbamide peroxide, is the most commonly used as home bleaching agents.
• The patient can have thermal sensitivity and minor irritation of soft tissues
• Treatment may be carried out for 4 to 24 weeks.
• Recall the patient every 2 weeks to monitor stain lightening.
 Over-the-counter Products

These systems include

• Tooth pastes – AP-24, Rembrandt

• Mouth rinses – Crest
• Tooth brushes – Spine brush pro whitening
• Dental floss – Super smile
• Teeth whitening strips – Crest
• Chewing gums – Brits smile, Happy dent
• Paint on varnish – Vivastyle
• Brite smile stick or pen
 MicroAbrasion
McInne’s technique
• This technique uses a combination of 5 parts of 30% H2O2, 5 parts of 36%
HCl and 1 part of diethyl ether.
• The solution is applied directly to the stained areas for 1 to 2 minutes with cotton
applicators.
• While the surface is wet, a fine cuttle disc is run over the stained surfaces for 15
seconds.
• This process is repeated until the desirable results are achieved, during
subsequent appointments.
Disadvantages of HCl
Uncontrolled removal of enamel
Loss of contour
Irritation to gingiva
Sensitivity
 Macro Abrasion
This technique can be combined with night guard vital
bleaching to achieve better results.

In this technique the severely dark stains are removed with

diamond points

Finishing with carbide burs( 30 fluted ) and polishing by

using the composite polishing disc.

Further lightening is achieved by night guard bleaching.