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Bleaching

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History
ROMANS

Polished teeth using urea (carbamide) from Portugal

MIDDLE AGES

Barbaric bleaching

Filed teeth with an iron grater Used Aqua fortis (contains nitric acid)

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WESTLAKE (1895)

Bleached teeth with high concentrations of hydrogen peroxide (H202) mixed with ether Treatment method was first published in the American Journal of Dental Science

ABBOT (1918)
Used Superoxol (30% (H202) to bleach 7/29/12 teeth discolored by fluorosis

AMES (1937)

Bleached teeth with 30% hydrogen peroxide (H202) and ether along with a source heat Treatment lasted approximately 30 minutes and sessions were repeated up to 25 times.

ZACK AND COHEN (1965)


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to conduct a scientific evaluation

ARENS (1972)

Tried to bleach tetracycline discolorations with 35% Superoxol at 10c below the pain threshold

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History: Home Bleaching


KLUSMIER (1895)

Orthodontist from Fort Smith, Arkansas Examined the effect of Gly-Oxid (Marion) used by his young patients for removable appliances Discovered teeth became brighter and lighter tetracycline stain disappeared

WAGNER
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MUNRO (1968)

Side effect of Carbamide peroxide in a splint: Teeth became whiter

HAYWOOD (1988)

Adopted the concept

HAYWOOD AND HEYMANN (1989)


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a home bleaching technique

HAYWOOD (1990)

Bleached teeth with high concentrations of hydrogen peroxide (H202) mixed with ether Treatment method was first published in the American Journal of Dental Science

ABBOT (1918)
Used Superoxol (30% (H202) to bleach 7/29/12 teeth discolored by fluorosis

COMMERCIAL PRODUCTS INTRODUCED TO THE MARKET:

1989White & Brite by Omni

Based on Munros findings First commercial bleaching agent for vital teeth Contains 10% carbamide peroxide

1991Opalescence by Den-Mat 1992Nite White by Discus Dental by Colgate

1994Platinum 7/29/12

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Scientific Studies
HAYWOOD (1990)

Studied on extracted teeth which were bleached for 5 weeks Scanning electron microscope showed no changes Bleaching materials used did not affect the topography of the enamel

YARBOROUGH (1991)
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MURCHISON (1992)

Examined the effect of carbamide peroxide on enamel Conclusion: short term application did not cause any significant change to enamel

Generally, majority show that it is safe to bleach 7/29/12 teeth with 10% carbamide peroxide

Side Effects of Bleaching Agent


1.

CONTAINS PEROXIDES

Enhances effects of other chemicals (ex. Cigarette smoke) Tendency to change oral flora If done over a long time, C. Albicans can accumulate and hypertrophy the papilla

2.

POWER BLEACHING

Changes the hard structure of the hard tooth structures Resulted in Pulpitis (on animals)

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3.

TEMPORARY HYPERSENSITIVITY

Disappears in almost every case when bleaching is interrupted Remineralize using toothpaste with fluoride

4.

ETCHED GINGIVA

Unprotected gingiva Damage is temporary and disappears after a few days

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5.

TOOTH HYPERSENSITIVITY

Patients should not have their teeth bleached Higher risk for post-operative sensitivity

6.

ROOT RESORPTION

On non-vital teeth prepared internally Possible CROWN FRACTURE

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BONDING ABILITY

8.

NEED FOR SUPPLEMENTARY BLEACHING

Bleaching will decrease in time due and resulting to color changes (coffee, red wine, fruit juices, soda, etc) Done approximately 1 year after 1st bleaching

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Review of Bleaching Methods


BLEACHING OF VITAL TEETH

Chemicals are placed on enamel Also called External Bleaching Can only change enamel discoloraiton

BLEACHING OF NONVITAL TEETH


Chemicals Also
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placed in the pulp chamber

called Internal Bleaching dentin is changed

Coronal

IN OFFICE BLEACHING

Power Bleaching 33% H2O2 with light and heat Stronger chemicals used Enamel damage could occur For patients who want to achieve results very quickly Mostly, 3 bleaching treatments required

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HOME BLEACHING Disadvantages Advantages

Patients must collaborate actively Little time spent (dentist must have an assistant orno effect - Not worn, hygienist with necessary qualifications) Usually more affordable
- Too much, hypersensitivity Higher cost and longer treatment time (if patients prefer to have their bleaching by the Patients can bleach whenever they wish dentist) to Longer time

No rubber dam required

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