What They Don’t Tell You About Doing Brilliant Bright Teeth The White Way!

If you’re wondering, I’m actually talking about Whiter Teeth and Doing it the Right Way!

Dental bleaching or Tooth whitening has diversified and transformed magically over the past few years and still is a “dental hot topic”. Constant evolution in the search for Tooth whitening products which are safe and effective are constantly being tested and researched.

This can get a little Dental-ly, so I hope I can convey it as transparently as possible for you to absorb! (pun intended)

Owing to my witchiness, I do not like ‘superficial’ skimming, I am deep and translate this to my written word.

Refer below: to the introductory video about Tooth Whitening:

VIDEO MAGIC: check it out below.

“WHITER, BRIGHTER, BRILLIANT TEETH LIKE DIAMONDS IN THE SKY!”

If I had a song for every time the word ‘Diamond’ was mentioned, I’d have to dedicate this post a-literally to Rihanna’s ‘Shine Bright like a Diamond’ Top of the charts hit.

In part, it had a lot to do, influencing the way I look at aesthetic and cosmetic procedures to teeth. The topic isn’t about Billboard Hits in the past, but a definite inspirational song plus a few requests to address this topic.

Doing_Brilliantly_Bright_Teeth_The_White_Way

There just happens to be a song for every mood I’m in, and that’s my witchiness playing up! It’s also a goal I’m witch in’ to write about.

Essentially the Whitening of Teeth, and at that, Brilliant and Optically Pearlescent teeth, is going to be discussed as ‘Dental Bleaching’, because that it’s official prescription.

Doing_Brilliantly_Bright_Teeth_The_White_Way_Tooth_Whitening.

It’s a term well known in the aesthetics-oriented industries of Dermatology and Dentistry alike.

“The lightening of teeth or tooth color can be successfully be accomplished through a variety of bleaching modalities which include but are not limited to, in-office (professionally administered), at-home (professionally dispensed/sometimes self-administered) and over the counter, self-administered techniques.” (Fekrazad et al.,2017)

Various tools of the Trade are; Shade guide matching, the oh so fancy trays with activating devices, strips, paints and varnishes. You name it!

However, in deciding which Tooth Whitening products you ought to invest in, at the convenience these methods offer, come precautions and consideration of post bleaching ramifications.

Particularly, of concern with over use and high frequency dental whitening used in symphony. So what is meant by this to be exact?

Dental tooth whitening carries with it as many repercussions as it does cosmetic enhancement, therefore its timing and infrequent dental whitening is the best approach.

However, before you buy any products or book an appointment, probably even buy products at Groupon or get your teeth whitened at the nearest mall that offers it, I must ask you to reconsider this carefully.

The formulations of bleaching products today are universally compliant with FDA regulations and universal regulated standards, so the point it differs, lies in our hands and how we use it. Tools in office are the porcelain guide, as this is a standard of reference which also has a coding and algorithmic code for it’s associated software.

Your tooth shade is matched exactly under natural light to customize your tooth whitening results as naturally in harmony, with your remaining natural teeth. This is a  standard visualization assessment for those of  you who wear braces, have dentures or crowns.

Software is the new standard of customizing a desirable Tooth whitening outcome, with technology such as spectrophotometry. For this to be understood, some very basic concepts of color have to be understood.

The question of why ‘White Teeth are always associated with beautiful teeth’?

 

Doing_Brilliantly_Bright_Teeth_The_White_Way_White_perception_colour_tooth

It is just a matter of how the color white is perceived, as pure and without flaw? For a better understanding of how to use your shade guide in the kit, an understanding of the colour concepts are vital.

Ultimately, and in my belief, we are accustomed to the concept of white teeth because we don’t know any better, or can’t imagine our teeth in any color of shocking pink, neon or absolutely dark.

Most of what we consume leaves us wondering how we look, even the occasional lipstick smear can cause us to fret!

Not to mention coffee and chocolates or red wine, as major staining foods to our teeth. How much do we understand of stains and the nature of our teeth to warrant that anxiety?

This merits the discussion about staining types. ‘Intrinsic’ or internal origin stains arise from a health-related medical conditions and development of teeth.

External or ‘extrinsic’ stains are from foods, medicines or beverages etc. or drugs of misuse, such as with the examples above. More elaborate details are further in the article and for specific conditions and substances that can wreak havoc on pearly whites.

Extrinsic_stains_Doing_Brilliantly_Bright_Teeth_TheWhiteWayExtrinsic_Staining_Teeth_Sources_Red_Wine_Doing_Brilliantly_Bright_Teeth_The_White_WayHorse_Teeth_Effect_Over_Bleaching_Teeth_Stains_Doing_Brilliantly_Bright_Teeth_The_White_Way

As with any treatment, be it for skin or over doing your routines, seldom gets you the results you want! The result is post tooth whitening sensitivity.

The key is to take care with your teeth and the supporting tissues, just as you would implement your skin routine during the day. We naturally tend to treat our facial skin with tender care, hopefully, so why should our teeth be any different?

Tooth whitening is very similar, as we rely on external and chemically active compounds to cause an effect on our teeth. The concepts and practices are to take precaution with concentration and frequency from a topical or externally applied and highly active chemical compound.

Akin to casting a magic spell except on our teeth, using potions and chemicals to cause a drastic color change from what we inherited in essence!

Doing_Brilliantly_Bright_Teeth_The_White_Way

‘Dental Bleaching’ agents are chemically active compounds, capable of effecting massive structural changes to your teeth!

For this reason, the timing of your ‘Tooth Whitening’ appointments should be ‘spaced apart’.

If the appointments are too closely packed, and bleaching is requested numerous times, it is going to significantly cause changes to your enamel and the way your teeth look.

It can result in a structurally weaker tooth with loss of hydroxyapatite, the main crystal of teeth. So yeah your teeth are precious rocks like diamonds!

 

Ultimately, the result is a reversal of results or fragile teeth that break easily and which do not absorb fluoride to protect themselves against dental caries, which is a silent pandemic of our teeth.

Well don’t get scared, caries is non communicable but rather owing to lifestyle, genetics and tooth Structural factors. If one or two factors are in your control, genetics is the only factor that is modified by an evolution of good decisions.

Color changes, recall appointments and stability of results are always best ensured with constant input from your “friendly neighborhood Dentist!”

Doing_Brilliantly_Bright_Teeth_The_White_Way_Courtesy_Daniel_Frank

On the other end of the spectrum may be over zealous and enthusiasts who “bleach too much” and who have to tune it down a bit or probably a lot.

CONSEQUENCES OF OVER-BLEACHING AND FREQUENT TOOTH WHITENING:

This is applicable to in-office schedules but mostly to those who practice supplemental tooth bleaching just after they’ve had an in-office treatment the day before. It also applies to those who frequently buy Over The Counter (OTC) bleaching products at their department stores or pharmacy/drugstores (no not those stores!).

 

Changes to Enamel due to ‘Frequent Tooth Whitening’:

1. Increased Porosity of the superficial layer of your enamel.

2. Sensitivity to temperature which is reported to be very high, as much as 67% in patients, by frequency of reported problems. (Haywood, 1992). Read below for a solution to sensitive teeth, under the heading: Special considerations to Vital Tooth Bleaching.

3. Loss of crystal and mineral strength to teeth, rendering them ‘friable’ and easy to chip/fracture.

4. The attack of the bleaching agent upon the organic substance between the inorganic crystals, will also create a state of fragility of teeth, due to inadequate foundation for the crystals to rest against during functions, smiling, biting, eating, jaw movements and swallowing. The result is small micro fractures within teeth.

(Tested with a technique called ‘Trans illumination’, where a bright light is shone from the backs of your teeth, the tongue side on those teeth suspected of being compromised by fracture or tooth pulp exposures, for which  endodontic or pulp treatment is probably a requisite before any cosmetic procedures are undertaken).

5. Weakened or completely lost organic matrix leading to weaker teeth and teeth susceptible to exaggerated staining.

6. The next stage: The Calcium and Phosphate of teeth are ‘eaten away’ and are reduced, therefore an altered mineral Calcium: Phosphate Ratio will further weaken teeth.

(Abouassi et al., 2011; Azrak et al., 2010; Ben-Amar et al., 1995; Bitter, 1992, 1998)

These changes are attributed to the easy flow of Hydrogen peroxide past the enamel and into the dentin. The good news is there is no damage initially, but with frequent use the above are most definitely signs to be alert about.

To minimize or almost negate the above effects from ever occurring, possibly it may be unadvisable to purchase or use OTC products or fancy department store products and to infrequently book ‘Tooth Whitening’ appointments.

I want what is best for your teeth and to effect good dental health and education to all who read this article. Possibly, a rehabilitation procedure after each appointment that is advised at least 2 weeks apart is best ‘Dental Bleaching’ practice.

This is definitely vastly different from scheduling your regular oral hygiene appointments, both are at opposite ends of the necessity and justification spectra.

 

Doing_Brilliantly_Bright_Teeth_The_White_Way_Tooth_Bleaching_Frequency

 

 

This merits the outstanding question of the topic, “What Tooth Whitening Product is the best currently?”

“Virtually all the whitening products of today work, and the main component is a bleaching action, upon pigments and chromogens of teeth”.

(Heymann O, 2005)

 

What are the Active Dental Bleaching Agents Employed Currently?

The following are widely employed ‘Active Dental Bleaching Agents’ which are present in both in-office and OTC home used or retail tooth whitening products:

1. Hydrogen Peroxide(H2O2) based

2. Carbamide Peroxide containing

3. Sodium Perborate solutions

4. Or Calcium peroxide pastes.

(ref: sourced from various journals and studies)

 

The Mechanism of Its’ action lies in the solution:

1.Carbamide Peroxide is usually the ‘stored’ potential form, pre-cursor of Hydrogen peroxide in solution.


2. Hydrogen Peroxide is the active form and peroxide is a storage form. Some solutions are delivered as either activated Hydrogen peroxide or inactive carbamide peroxide.


3. When Peroxide comes in contact with aqueous solution/saliva, or if it requires an activator which is aqueous, carbamide peroxide, that will disintegrate (break down) into free hydrogen peroxide radicals. These ions act ‘specifically’ at the Enamel Pellicle layer, resulting in the release of ions listed in point 5 and nascent oxygen as a by product. It’s these supercharged ions that result in Tooth Whitening.


4. A 10% solution concentration of Carbamide peroxide will yield a net result of 3.5 % Hydrogen peroxide approximately. (A break down free radical product)


5. Other free radicals released are:

 a.Hydroxyl Radicals (HO°)

b.Per-hydroxyl Radicals/Anions (negatively charged free radical ions), (HOO°) ¯

c.Super Oxide Anions (OO°) ¯

“These free radicals are highly reactive and highly unstable chasing ‘chromogenic’-pigment containing ions within the organic matrix of teeth, interspersed between the crystalline tooth structure.” (Al Qahtani MQ, 2014)

These products release nascent oxygen, from your days in chemistry lab!

Nascent oxygen has a bleaching effect as it effervesces in contact with a aqueous medium, such as that which exists within your mouth and saliva which bathes your teeth, the layer of the Enamel Pellicle. Bleaching products are most potent and effective at this interface.

(video ref: Opalescence Tooth Whitening product  video from YouTube)

Products released by Breakdown of tooth bleaching ingredients (Courtesy: YouTube professional videos). This video is not specifically based on opalescence but describes the ionic actions of all Tooth whitening products, both professional and available over the counter(OTC).

The home use products have gained wide acclaimed popularity, and are in close competition with prescription products.

Carbamide Peroxide the ‘Inactive’ form, that can also be a product constituent itself. It’s efficacy as an agent in tray, has always been compared alongside it’s activated (in solution/or saliva) form, Hydrogen Peroxide.

 

A study conducted by Martinez and associates, September 2016 in the journals of clinical oral investigation, have revealed that indeed the two forms, Hydrogen Peroxide and Carbamide peroxide, can be marketed separately, and its effects studied separately also.

The study was aimed at observing color changes, which are compared to porcelain shade guides. This is the usual in-office way to determine results which are then entered as data on ‘Dental Software’.

Results revealed that tray delivered forms of ‘inactive’ stored form, Carbamide peroxide, were preferred over Hydrogen Peroxide ‘active’ form. This impacts the packaging and product concentration of both in-office and subsequently, OTC prepared tray whitening products.

This was due to the improved bleaching (tooth whitening product efficient) action of Carbamide Peroxide, which occurred faster than hydrogen peroxide, but with mixed bag results nonetheless, as the degree of difference was negligible. However it important to stress that professional grade Carbamide Peroxide will always be a Gold standard in Tooth Whitening products. For this a prescription and appointment are the requisites.

Both tray forms of Carbamide Peroxide and Hydrogen peroxide, actually displayed similar degrees on the tooth shade guide improvements and changes also the level of gum irritability and untoward effects.

Laser tooth Whitening is the other professional Tooth Whitening service provided at your Dentist’s office and will be dedicated in a different article to follow. This article lays down the groundwork of understanding the way you view and select Tooth Whitening Products seriously.

 

Essentially, bleaching occurs nonetheless, but the most important factors for bleaching to reveal successful results are:


1. Concentration of the Tooth Whitening Product.

2. Time of contact, ‘Contact Time’ of the product and it’s duration of Tooth whitening action upon teeth.

3. Frequency of use: as described earlier it’s pivotal role in your beautiful smiles.

4. Tooth Structure and status.

 

Contact time is specified according to dentist instructions, so essentially it is a supervised whitening technique for ‘vital teeth’. The delivery system is not an important factor in ensuring whiter and brighter teeth.

There are many considerations to ensuring success of Dental Bleaching and these may be so diverse as lifestyle choices and treating crooked or misaligned smiles and bites.

That is where Orthodontic treatment usually follows or precedes Dental Bleaching and requires its own precautions.

Often times, those with braces and brackets, i.e.-orthodontic fixed treatment are advised a specific schedule for other dental cosmetic procedures, esp. dental bleaching. Why is timing so critical with those of you who wear braces, retainers or removable dentures, also fixed metallic based prostheses-Read tooth replacements.

Tooth_Whitening_Considerations_Prosthetic_Orthodontic patients_Doing_Brilliantly_Bright_Teeth_The_White_Way
special considerations of tooth whitening with patients wearing either Braces or Tooth Replacement prosthesis.

Perhaps more complex treatments have been rendered to you, in the past and timing of ‘dental bleaching’ appointments is of essence.

The peroxide may result in weakening and strength impact of your braces, orthodontic wiring, base plates and have adverse chemical reactions of tooth replacement restorations, this may include in-tooth cast metal restorations which are fabricated in a dental laboratory for you.

That can interfere and become a very costly venture into over use of Tooth whitening products, however  today’s tooth whitening products have evolved to take this into consideration.

The best smiles rely on a complex dynamics and interplay of so many associated individual factors that ‘Tooth Whitening’ is highly personable.

 

“At home dispensed concentrations of Hydrogen peroxide-based products with its varying concentrations, have become the ‘Gold-Standard’ against which other techniques and products in the market place are compared to.” (Haywood, 1992)

It’s a means of comparison, which doesn’t rule out that newer products are constantly emerging and catching up with already present delivery systems, in the Tooth Whitening aisles.

This might contradict the more professionally monitored dispensing of tray form Carbamide peroxide. However, such professional concentrations are often not marketed over the counter, and therefore tooth whitening at home is often by strips, paints, gels, varnishes or 

“However, it is not without demerit since active patient compliance is mandatory, and the technique suffers from high-dropout rates”.

(Leonard et al.,2003)

Typical Bleaching results with any method, last for 1-3 years only, and may require follow up appointments or maintenance in the interim to guarantee ongoing success in the Tooth Whitening department.

Differences do arise with your Tooth Status and how in-office routine tests impact you, and the approach is completely Tooth specific. So How do we classify methods of Tooth Bleaching?

 

CLASSIFICATION OF DENTAL BLEACHING METHODS AND APPROACHES:

Teeth can be responsive to thermal and or pressure tests, or confirmed of it’s response status through x ray (radiographic) assessments in office.

This is a better foundation to begin your Tooth Bleaching journey from, as you would be customizing and personalizing your results to your health and appearance expectations, more so importantly without compromising your teeth for your future.

 

Tooth status has a big voice in your decision making, and what approach is used in tooth whitening, that it would be fruitless to start without a sound foundation.

Some critical questions to ask ourselves would be:

1. Without these bytes of tests and information, would we really know what product is safe for us?

2. Which product has the maximum impact and the least side effects?

3.Or are we approaching this mildly invasive technique incorrectly?

4.Are we buying the wrong products and wasting money in the process?

 

Doing Brilliant and Brilliant the White way for ‘Vital’ Responsive Teeth:

Methods for Dental Bleaching can be further divided, as outlined as those for vital teeth and Non-vital teeth.

A few articles dedicated to this flow is definitely prescribed for! I will always strive to produce the most scientifically updated information and there might be in the horizon of Dental Bleaching.

Dental bleaching, Tooth Whitening, is always going to be a dental hot topic, because as a society we are very conscious of our appearances, and I don’t suppose it’s only that.

We are also evolving to be more health conscious individuals, who are constantly in the search of planet and animal friendly products or the impact and far reaching consequences their use may carry.

 

Night Guard Prescription is usually delivered on a tray with injected agent:

Available as: clear gels or usually white pastes. The tray needs to be washed scrupulously between uses and stored unused within its own case, provided by the dentists’ office.

 

Total time required: 1-2 weeks and you get those teeth sparkly white!

Lest I say your teeth are ravishingly radiant!

The risk lies in the frequency of attempts required to attain gorgeous results, as the criteria above are threatened. See the first part of the article, the effects of overzealous dental whitening appointments.

The Night-Guard vital bleaching method is an example of an in-office ‘prescription’ bleaching method, for ‘Vital responsive teeth’, which carries the benefits of convenience at home, it still is a professionally prescribed concentration with lower ‘Active’ ingredient, Peroxide% concentration.

This means that the above criteria enlisted early, are safely checked off and there are fewer related sensitivity issues, not to mention it’s wallet friendly!

 

It’s your night time fairy god mother of makeover mastery. The key is persistence and perseverance, not letting it slip by you. It has not been shown to work if you periodically forget to wear the tray, so the message is to always have a routine set up the night before.

Best results with absolute worth for your dollars, are best spent wearing the tray every night and following instructions to the ‘T’.

Please note the letters in bold are important factors in addition to those already mentioned, some of which are methods by themselves.

 

The Night Guard technique with its many imitations in the market today, is actually a prescribed at home, use method for whitening teeth.

The product should be injected with caution to not overflow the tray, as the product is still ‘professional grade’ at 10-15% carbamide peroxide.

The concentration of its activated compound, Hydrogen Peroxide is roughly at 3.5-6.5%.

The activated compound’s breakdown products interact intimately at the surface of your teeth, at the layer of the ‘Enamel Pellicle’.

 

“Using Invisalign trays as night guard trays, may provide more protection than Whitening trays traditionally dispensed and other Orthodontic retainer trays. However, they do not provide relief for jaw muscles or for stress on the jaw joints.

This too is a compromise to having the night guard made. We do not recommend using any kind of orthodontic retainer tray as a night guard.”

(Dr. Venin at Casa Dental.com)

It’s action with the ‘Enamel Pellicle’, is where it exerts that Tooth Whitening effect, slowly and gradually over the course of your treatments and appointments.

This mechanism also forms the basis for its careful instructions to not be over flown, and only be applied in drop wise beaded fashion, along the front facing sides of a pre-made dental laboratory tray. That which is given to you at your second appointment typically.

As no health related or cosmetic field is typically ‘isolated’, it brings to the forefront the ‘Vital’ considerations, alongside where we tick or cross our particular concerns and existing conditions.

Within this discussion, Vital teeth can be affected from within or have stains smeared externally. Ofcourse I did mention the foods causing stains, however it requires a deeper merit below.

 

TYPES OF STAINS THAT AFFECT BRIGHTER AND BRILLIANT TEETH THE WHITER WAY!

Some types of discoloration can affect the Color of your teeth, how?

Stains maybe of internal origin or external origin, intrinsic for internal and extrinsic for external discoloration respectively.

Of importance, is the relevance of supervision in those of us suffering from preexisting tooth sensitivity.

Another cause for concern is with complex and multiple dental restorations, extremely dark stains in teeth or with a single dark tooth.

(ADA Council on Scientific Affairs)

 

(Video source: American Dental Association: How Tooth Whitening Works).

 

The causes are attributed to internal systemic conditions, which give rise to ‘Intrinsic Dental Stains.’

In some cases, multiple attempts at bleaching are required or may not even yield any results in the scenario where teeth are stained, especially from internal tooth aberrations, or due to some tooth formation abnormalities.

For particular relief of tooth sensitivity scroll down to : special considerations with Tooth Whitening, where a novel but professional technique for addressing post dental bleaching will be addressed.

Mechanisms and Strategies of ‘Tooth Whitening’ By Type of Staining:

Targeted results can be tailored to the type of staining present. On this basis, as outlined in the video earlier in the article(s), staining of teeth can be broadly addressed under the following 2 types of staining patterns, usually with respect to ‘vital’ teeth.

1. Extrinsic or External mechanism of tooth staining

2. Intrinsic or Internal Tooth Staining.

(AL Qahtani MQ, 2014, Viscio et al.,2000)

With Extrinsic type of staining, an external agent called a ‘chromogen’ which is highly pigmented and usually organically bound, is responsible for the unaesthetic tooth appearance, that necessitates a drive to your dentist!

 

These substances are said to possess ‘chromogenic’ properties on the external tooth surfaces. This is usually attributed to:

1. Poor oral hygiene

2. Smoking and ‘related’ habits, such as tobacco smoke form or chew able.

3. Consumption of foods/drinks, that have these pigment-contributing properties to teeth.

The stains are ‘superficial’ relegated to the pellicle layer that is loosely bound to enamel on its external most layer.

The stains are generated by the reaction between sugars from food with amino acids of the salivary proteins or can be due to the exogenous chromophores/chromogens in the enamel pellicle.

These may permeate deeper to the organic matrices between inorganic crystalline tooth structure and lend that unsightly stain. (Al Qahtani MQ, 2014, Viscio et al.,2000)

The ‘Enamel’ Pellicle is composed of salivary proteins, saliva and the initial colonizing plaque bacteria, minerals such as calcium and phosphate.

This reaction that takes place between sugars from foods and suspended in saliva with the amino acids of salivary proteins, is called the ‘Millard Reaction’ or ‘Non-Enzymatic Browning Reaction’. It is a specific salivary-follicle interaction that occurs at the surface of enamel.

(Al Qahtani MQ, 2014).

The chemical layout is re-arranged like one would re arrange furniture in a home makeover heist, at best random and active.

The result is the presence of pigments causing stains due to food that lends such qualities to teeth, and through this study mostly aldehyde-organic ring structures were in high concentration. That would suggest a ‘Oxidative and Reactive’ pigment inducing reaction.

(Al Qahtani MQ, 2014, Viscio et al.,2000)

This is part of it’s submicroscopic mode of Tooth whitening effect and the products such as superoxide, per hydroxyl and hydroxyl anions with a release of nascent oxygen, to reflect on the days of organic chemistry.

The mechanism by which ‘Extrinsic’ origin stains are held in place, is due to the binding retention of chromogens/chromophores within enamel follicle, occurs due to salivary proteins that are selectively attached to the surface of teeth, on the enamel through calcium bridges and channels.

The result is that a thin film called the ‘Enamel Pellicle’ forms and stays. The enamel pellicle is a fine translucent film that forms on teeth, held in place by salivary proteins, rich in a substance called ‘muco-polysaccharide’ like slime. It is the first film to form on teeth immediately after brushing teeth and serves to protect barrier invasion breaching your enamel and dentin underneath.

However, if adequate and healthy dental hygiene is not practiced, you can only imagine that this layer, is home to billions of plaque germs (bacterium) and compromises your tooth whitening results, not to mention might result in caries and bad breath ( due to the breakdown and release of volatile Sulphur products in ‘halitosis’).

For this reason, the Enamel pellicle is a tooth layer of promising and noble prospects for a new evolution in multi-benefit and all in one Tooth whitening products, such as ‘Calprox Super White’. *

The Enamel Pellicle plays a central role in trapping pigments and keeping them in place, this can be both an advantage and disadvantageous.

Advantageous, in that a bleaching product can bind and bleach the pigment, a disadvantage because the stain could have permeated deeper and becomes stubborn, necessitating a few cycles of bleaching usually in-office.

In the first and earliest stages of ‘Extrinsic Staining’, chromogens interact with the enamel pellicle via hydrogen bridges. Most extrinsic tooth stains can be removed by your dental hygienist and it is highly recommended before an official bleaching appointment is set.

Time is of essence and if you act today, you would actively prevent future tooth staining from gaining an unfair disadvantage over you.  These stains are highly responsive to bleaching by quite a few methods available both in-office and in the market place.

 

The presence of ion bridges and channels can prove prospective, in the development of advanced bleaching methods and products:

This raises an interesting phenomenon, where calcium acts as a linking bridge, for substances to cause an effect on teeth. The interface of enamel pellicle is a hot seat for revolutionizing advances in aesthetic and restorative Dentistry.

 

The Enamel Pellicle, is a film quite loosely bound to the enamel surface. It can also form an impermeable film, if restorative materials are engineered into a tooth whitening product.

This is a sector of the Dental Restorative and Aesthetic markets, that are rapidly evolving to fruition.

Although stains can be bound to surface proteins on the surface of enamel, it can also be ‘locked’ in place to be bleached by the addition of therapeutic grade (professional concentrations of) carbamide peroxide, amorphous calcium and phosphorus. This admixture has shown in several studies, to reverse to an extent, any breaches of continuity of enamel, and protect teeth with the addition of Fluoride.

This is the basis for a new and noteworthy dental bleaching product, called ‘Calprox Super Smile Extra White.

 

 

The addition of the amorphous casein phospho-peptides unless coupled with significant Peroxide concentration, or fluoride, by itself does not promote whitening of teeth, rather it’s benefits are to maintain enamel strength and continuity of surface structure.To bring in a relevant article from a different study, the New York University School Of Dentistry conducted into the ‘Cellular Mechanisms in Calcium Transport in Dental Enamel Cell Formation’. It is constantly evolving although the foundations were only recently laid down in 2015 or possibly earlier.The authors of the study, had published in the Journal Of Scientific Reports, found the main calcium influx pathway involved in the mineralization of enamel.These channels are termed CRAC, an acronym for Calcium Ion Release Activated Channels, a pivotal and specialized channel under a broader classification of Store operated ( as it is storing and transporting Calcium ions into and out of enamel cells) Entry Channels (SOCE).Why is it a promising milestone? According to this study and many to date, Enamel owes it’s diamond brilliance, structural strength and durability, to a ‘particularly high concentration of Calcium as a main mineral as well as other minerals’, according to lead researcher Rodrigo Lacruz, MSc., PhD.Calcium is bound in crystal form in Calcium Hydroxyapatite the main crystalline foundation of Enamel. The Dentin below contains comparatively less calcium and thus Enamel is a protective natural crown of teeth.The challenge lies in delivering the calcium, to the site where the enamel crystals are developing and mineralizing. “If this process is impeded, such as with the channel forming gene mutations, such as with the core of the CRAC channels the result is enamel is affected.” (Rodrigo Lacruz, MSc., PhD.)According to Lacruz,”Turning off calcium pumps in the cell organelle, the Endoplasmic Reticulum ( a sub micro-scopic structural element in all cells), the effect and contributions of the CRAC channel, in calcium uptake and signaling also more specifically, how the enamel gene function was modulated, could be specifically and accurately understood. It is indeed a new frontier in enamel biology and brings closer a reality of regenerating Enamel, whose prospects are promising for those suffering from Enamel formation disorders.”To test the modes of calcium transport and delivery to the enamel forming cells, freshly cut rodent teeth were used and the enamel cells were further studied to simulate natural processes, to gain understanding of the relationship the CRAC channels had on enamel calcium signaling, expression and transport.The study was based on earlier genome research, which has been abundant in the last few years, to establish the genes which are responsible for our strong and brilliant enamel. The maturation of enamel and other complimentary studies around the mutations of genes responsible in forming the CRAC channels, had been reported to significantly affect the strength, continuity, texture and brilliance of enamel not least it’s durability.The physiological model, to get all dental-ly, demonstrates a physiological mechanism for calcium entry (influx) into enamel cells, and gives us a clue, to it’s regulation, modulation and operation scheme.According to Lacruz, “Turning off calcium pumps in the cell organelle, the Endoplasmic Reticulum ( a sub micro-scopic structural element in all cells), the effect and contributions of the CRAC channel, in calcium uptake and signaling also more specifically, how the enamel gene function was modulated, could be specifically and accurately understood. It is indeed a new frontier in enamel biology and brings closer a reality of regenerating Enamel, whose prospects are promising for those suffering from Enamel formation disorders.”Gone are the days where all was woe, make room for radical products to regenerate and strengthen our enamel, probably even reversing signs of hypersensitivity and wear, not to mention enamel affected by dental caries ( this is still a hazy area because a certain volume and depth of enamel is still required, for action to be successful).

Quite a Novel method to take ahead, and base tooth whitening and reinforcing topically acting products upon!

Thus, its effect is two fold and strengthening teeth. The future looks toward stem cell reinforcement of teeth, by promoting enamel regenerative capacity, where previously it has always been set in stone, where enamel cannot regenerate itself.

Looking within the tooth, ‘Intrinsic Tooth Stains’ are the more stubborn variety of stains, and are rebellious in response to conventional Vital ‘Tooth Whitening’ procedures. It is also a major difficulty with non vital teeth.

Looking within the tooth, ‘Intrinsic Tooth Stains’ are the more stubborn variety of stains, and are rebellious in response to conventional Vital ‘Tooth Whitening’ procedures. It is also a major difficulty with non vital teeth.

At times, multiple rounds of bleaching may be necessary, and that is where the safety considerations should be fully pre determined and called for.

 

Intrinsic stains according to the above study, are usually the result of deeper internal stains or due to enamel defects. The cause is systemic and health related, some common causes are;

1. Aging and its accompanying changes: secondary dentin which is opaquer relative to a thinning enamel outer layer: the result is darker teeth stubborn to conventional Tooth Whitening techniques at first, and definitely requires a few repeat appointments, well spaced. The bright side are results, that are definitely promising!

2. Intake of highly pigment causing food, frequently and sustained contact with teeth for prolonged periods of time.

3. Eating disorders, especially Bulimia Nervosa that make teeth susceptible to pigmentation by chromogenic foods (through acid erosion causing alterations in enamel structure).

4. Tobacco especially the chew able and mouth held variety, even hookah, not to mention it’s ardent fan following can expect gum disease and subsequent tooth loosening in the years to follow. Sorry for that spook but it’s relevant and true.

5. Tooth developmental abnormalities, ‘aberrations’ as they are termed (deviations from standard).

6. Micro fractures of teeth in enamel, due to traumatic biting patterns and due to jaw movement hindrances’. It can also be the result of an incorrectly milled restoration or in this context, a faulty Night Guard Home Tray, used in ‘vital tooth bleaching.’

7. Like I mentioned in my list of considerations, here is where I introduce the concept of ‘The yester-years of antibiotic prescriptions with tetracycline’s’.

8. Fluoride and fluorosis above the toxic limits of 2 parts per million. This can alter the structural re arrangement of enamel forming cells during its development. The result is abnormal teeth and defective organic matrix of teeth. This lends to weaker teeth friable and susceptible to fracture. (AL Qahtani MQ, 2014, Dodson and Bowles, 1991).

9. Attributed to Inherited Conditions of tooth tissues, Enamel and Dentin: such as Amelogenesis Imperfecta and Dentinogenesis Imperfecta, defects of enamel and dentin layers of teeth respectively.

(AL Qahtani MQ, 2014, Nathoo,1997, Viscio et. al.,2000)

10. Blood abnormalities in formation such as jaundice and porphyria in infancy.

11. Dental caries as a no.1 culprit most often.

12. Dental Restorations such as mercury amalgam, which has ‘aged and worn well’ due to properties of creep and expansion of metal progressively in time.

13. Thinning of Enamel due to excessive wear and non-dental-caries, habits such as clenching, wear and forceful biting, nail or needle biting, biting pencil lead etc.

14. Blood penetrating the dentinal tubules and metals released from dental restorative materials also cause stains, especially old mercury fillings which have aged and ‘worn well’. This can be worsened in tooth fractures of a major extent, both horizontal and vertical.

15. Certain diseases of pulp, such as pulpal material undergoing an inflammatory or some instances, a carcinogenic change.

16.It is evidenced as abundant pulp material growing uncontrollably within a confined chamber, known as ‘pulpal hyperplasia’ causes a pink tinge or blood-tinged stain to enamel.

 

Intrinsic stains are more stubborn to removal by your hygienist, who’s going to tirelessly work at improving your results, with the correct techniques.

The above causes of intrinsic staining also are pertinent causes of non-vital teeth, which are not responsive to any dental office assessments.

The pre-conditioning of teeth by a hygienist, drastically improves results in tooth whitening and possibly a fewer rounds of bleaching may be required.

Although a procedure is employed, certain discoloration of Teeth, is more stubborn and requires repeated bleaching to yield ravishly radiant white teeth.

Promising results can be expected with ‘Dental Bleaching’ agents, which penetrate enamel and Dentin to Oxidize the chromogens, as mentioned in the mechanism of action, also outlined in the video above.

 

According to a study by Haywood and associates during 1999-2003, Intrinsic stains that are caused by aging or genetics even by chromogenic-pigment causing foods or drinks are the fastest to respond to in-office bleaching, followed by yellow stains of aging and lastly and very slowly responsive in the case of blue-grey stains of tetracycline.

With the Blue-grey stains of Tetracycline staining, the mechanism by which ‘Tooth Whitening’ occurs is by the chemical decomposition and break down of the Quinone group structures that make up the structure of Tetracycline. (AL Qahtani MQ, 2014, Leonard et al.,2003)

 

This results in few colored pigments/ chromophores in teeth. The attributed mechanisms are decomposition and degradation of the colored pigments within the organic matrix of teeth.

The depth of penetration depends on the concentration of the agent, especially for stubborn intrinsic stains.Compare this with the ‘trapping and bleaching’ action, similar in mechanism but superficially on surfaces of teeth for external staining of teeth.

There is good news however, as teeth with the brown spots of excess fluoride intake, have shown to respond well with in-office bleaching procedures.

Not much can be said about over the counter tooth bleaching methods for intrinsic stains.

Doing Bright and Brilliant Teeth for Non-Vital Teeth, the White Way!

“A Non-Communicative Tooth”, is a non-vital tooth that has been deeply restored from the Root up to the crown, and is no longer responsive to dental in-office chair side testing. It is a tooth that has a confirmed root filling through Root canal treatment or post and core type root-crown restorations.”

(Grabers’ Endodontic Textbook)

 

Quite a few techniques are available for teeth or a tooth that has been root filled, which mostly cut out the heat or accelerated torches/devices that are employed for teeth that are otherwise healthy or respond normally.

The risk in teeth that are root filled, is that it would cause gum disease and the neck of the tooth would be gradually dissolved and altered permanently.

None of those devices where LASER is employed, are suitable due to this reason.

The risk is greater than the reward of whiter teeth, and with root filled teeth, only a few shades lighter is achievable with dental bleaching techniques available for it.

Adequate protection to the filling that already exists, with precautionary measure by your dentist is taken.

Some techniques adapted specifically for your root filled or Root canal treated teeth are;

1. Walking Bleach Technique
2. Modified Walking Bleach Technique
3. Power Bleaching
4. Inside-outside (in’n’out bleaching not burgers here, but if you love burgers like I do, and it helps you remember, by all means think of it like that.)

With the first method, ‘The Walking Bleach Technique’, your dentist places a mixture of one of the earlier mentioned, ‘active bleaching’ ingredients, Sodium Perborate +water paste, into the small area called the pulp chamber.

It is protected below by a light cured resin, with a protective and anti-caries effect to properly ‘isolate’ the sodium perborate pastes into pulp.

The mechanism of action is much similar to the teeth that are otherwise ‘responsive and healthy’.

The release of all free radicals will cross channels and barriers of teeth to cause the lightening and tooth whitening effect.

You might need to go for a follow up or second round appointment but that solely depends on how light you envision your teeth to be. What do you have in mind can affect your recall appointment rates.

If the paste were to be combined with a 30% Hydrogen Peroxide, another one of the ‘active ingredients’, with the sodium perborate, it would be called a ‘Modified Walking Bleach Technique’.

However, with this method I should inform you, that activation by heat or light is usually the way it works.

Effervescent states of bleaching and temperature, are maintained for only 5 minutes roughly. That is not much to ask for and it is proven by studies to not cause harm, so why not?

Besides, you won’t be sent out so soon, the teeth will need to ‘cool’ down for five minutes, to be checked again after removing the gel, and slightly drying the tooth for a few bursts by an air pen tool.

The duration it is kept in place is approximately 1 week, after this you will be called to check the progress.

If you are satisfied you can walk out happily to return back after 2 weeks.
It’s a fortnightly schedule especially with root treated teeth.

Perhaps, you may be advised that it is safe to use OTC or not, in some instances you may be prescribed a maintenance scheduled and dispensed a product. It really is variable but to know how to prepare for it, the first appointment is definitely a necessity. I can’t stress it enough.

“The inside-outside technique for bleaching teeth, is a combination of the above techniques, ‘internal’ methods in combination with a home bleaching modality.”
(Setien et al.,2008)

 

 

Special Considerations in Vital tooth ‘Dental Bleaching’:

Some precautions merit the postponement or careful use of ‘Dental Bleaching’ products, OTC or in-office, such as with;

1. With existing restorations and complex dental work
2. Orthodontic treatment
3. Composite-Tooth colored restorations, and the impact of Dental bleaching on bond strength and curing completion (the strength of such tooth colored resin cements)
4. The propensity to aggravate hypersensitivity in your teeth, creating a vicious cycle. Your teeth are compromised, and sub microscopically are weak, with micro fractures that take up stains from foods and substances easier.

An ‘Active’ Ingredient of choice today is Proxigel, for its moderate concentration of 10% Carbamide Peroxide, which is released slowly to not corrode or cause resorption, from what can already be expected with orthodontic treatment or with certain restorations.

It has replaced a product called Gly-oxide which was previously the choice of bleaching agent in-office for patients who have been treated for complex restorations, prosthesis, resins or orthodontic treatments.

Bleaching agents used frequently in these cases, may result in breakage of the crowns, chipping or loose crowns and other fixed restorations or treatments, including orthodontic cements and brackets from teeth.

This can be a hazard in teenagers, as it may lead to swallowing metal brackets and bands, if the appliance lost its bonding or if ‘curing polymerization’ was rendered incomplete.

It has been reported by a few studies that surface changes occur, merely by the bonded brackets and bands in orthodontic patients, this results in a phenomenon of ‘enamel surface resorption’.
The acidic bonding substance apparently surface alters and etches the tooth structure.

Now imagine the action of a bleaching agent, as described will attack the organic matrix of teeth.

This results in a two-fold attack of tooth structure and in such cases, it is essential to plan bleaching appointments sparsely between or wait until treatment is completed, such as with orthodontic treatment.

 

Conclusions and Solutions to Brilliant Bright Teeth the White Way:

There is no single preferred method over the other, as most ‘active agents’ in the current market are of low to intermediate 10% and 15-20% carbamide or hydrogen peroxide concentrations, but just ‘right’ at the point, you get brilliant, Bright teeth the White way.

Choosing a product in the current market today has a lot to do with personal preference and what the customized outcomes are for you, by your dentist.
With respect to all the conditions and precautions listed throughout this series: “Doing Brilliant Bright Teeth The White Way!”

As with any medical topic, it’s not set in stone and always carries the burden of further investigation.The Subsequent Article will dive right into some Bright Teeth Solutions and Potions.

I have learnt much myself to be honest. As a Dentist and student of Dentistry, it is very easy to get immersed into the theory and foundations of Dental Bleaching, the applicability and market research for how diverse this topic is, definitely needs ongoing updates.

Natural Solutions maybe helpful for all teeth, Vital or Non-Vital: However, to treat it with prudence is a virtue.The 2 different modes of bleaching are vastly different but the end result is Brilliant Bright teeth the white way!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The Enamel pellicle plays a central role in trapping pigments and keeping them in place, this can be both an advantage and disadvantageous also.

Advantageous, in that a bleaching product can bind and bleach the pigment, a disadvantage because the stain could have permeated deeper and becomes stubborn, necessitating a few cycles of bleaching usually in-office.

In the first and earliest stages of ‘Extrinsic Staining’, chromogens interact with the enamel pellicle via hydrogen bridges.

Most extrinsic tooth stains can be removed by your dental hygienist and it is highly recommended before an official bleaching appointment is set.

Time is of essence and if you act today, you would actively prevent future tooth staining from gaining an unfair disadvantage over you.
These stains are highly responsive to bleaching by quite a few methods available both in-office and in the market place.

The presence of ion bridges and channels can prove prospective in the development of advanced bleaching methods and products:

This raises an interesting phenomenon, where calcium acts as a linking bridge, for substances to cause an effect on teeth. The interface of enamel is a hot seat for revolutionizing advances in esthetic and restorative Dentistry.

 

The result is a lustrous shine of beauty to teeth, protection against dental caries and definitely stronger teeth that do not chip!

At the bottom  of this article is the link specifically  to make it easier to get your hands on this revolutionary system and series of products by ‘Super Smile Extra White’ toothpaste or as it is known formally as, Dentifrice series. Try it and let me know if it worked for you in the comments below also .

Please note: that the products are links to Amazon, and that I may earn a tiny referral amount from placing it within my website. The link will take you to product page on Amazon.

“The addition of the amorphous casein phospho-peptides unless coupled with significant Peroxide concentration, or fluoride, by itself does not promote whitening of teeth, rather it’s benefits are to maintain enamel strength and continuity of surface structure.”

To bring in a relevant article from a different study, the New York University School Of Dentistry conducted into the ‘Cellular Mechanisms in Calcium Transport in Dental Enamel Cell Formation’.

It is constantly evolving although the foundations were only recently laid down in 2015 or possibly earlier. Authors of the study, had published in the Journal Of Scientific Reports, found the main calcium influx pathway involved in the mineralization of enamel.

These channels are termed CRAC, an acronym for Calcium Ion Release Activated Channels, a pivotal and specialized channel under a broader classification of Store operated ( as it is storing and transporting Calcium ions into and out of enamel cells) Entry Channels (SOCE).

To test the modes of calcium transport and delivery to the enamel forming cells, freshly cut rodent teeth were used and the enamel cells were further studied to simulate natural processes, to gain understanding of the relationship the CRAC channels had on enamel calcium signaling, expression and transport.

The study was based on earlier genome research, which has been abundant in the last few years, to establish the genes which are responsible for our strong and brilliant enamel. The maturation of enamel and other complimentary studies around the mutations of genes responsible in forming the CRAC channels, had been reported to significantly affect the strength, continuity, texture and brilliance of enamel not least it’s durability.

Why is it a promising milestone? According to this study and many to date, Enamel owes it’s diamond brilliance, structural strength and durability, to a ‘particularly high concentration of Calcium as a main mineral as well as other minerals’, according to lead researcher Rodrigo Lacruz, MSc., PhD.

 

Calcium is bound in crystal form in Calcium Hydroxyapatite the main crystalline foundation of Enamel. The Dentin below contains comparatively less calcium and thus Enamel is a protective natural crown of teeth.

To take it further, the knowledge that came about by this research led to more exciting prospects for regulating calcium uptake and transport into the enamel forming cells, revolutionizing the way we approach Cosmetic Dentistry and use it to our aesthetic advantage.

The physiological model, to get all dental-ly, demonstrates a physiological mechanism for calcium entry (influx) into enamel cells, and gives us a clue, to it’s regulation, modulation and operation scheme.

According to Lacruz, “Turning off calcium pumps in the cell organelle, the Endoplasmic Reticulum ( a sub micro-scopic structural element in all cells), the effect and contributions of the CRAC channel, in calcium uptake and signaling also more specifically, how the enamel gene function was modulated, could be specifically and accurately understood. It is indeed a new frontier in enamel biology and brings closer a reality of regenerating Enamel, whose prospects are promising for those suffering from Enamel formation disorders.

Gone are the days where all was woe, make room for radical products to regenerate and strengthen our enamel, probably even reversing signs of hypersensitivity and wear, not to mention enamel affected by dental caries ( this is still a hazy area because a certain volume and depth of enamel is still required, for action to be successful).

Quite a Novel method to take ahead, and base tooth whitening and reinforcing topically acting products upon!

Thus, its effect is two fold and strengthening teeth. The future looks toward stem cell reinforcement of teeth, by promoting enamel regenerative capacity, where previously it has always been set in stone, where enamel cannot regenerate itself.

At times, multiple rounds of bleaching may be necessary, and that is where the safety considerations should be in full swing. That is essentially why professional tooth whitening is advocated, so a dental professional can monitor and customize results

 

CRIMINALS  OF INTRINSIC TOOTH STAINING

Looking within the tooth, ‘Intrinsic Tooth Stains’ are the more stubborn variety of stains, and are rebellious in response to conventional ‘Tooth Whitening’ procedures

Intrinsic stains according to the above study, are usually the result of deeper internal stains or due to enamel defects. The cause is systemic and health related, some common causes are;

 

1. Aging and its accompanying changes: secondary dentin which is opaquer relative to a thinning enamel outer layer: the result is darker teeth stubborn to conventional Tooth Whitening techniques at first, and definitely requires a few rounds but the results are definitely promising after a few rounds.

2. Intake of highly pigment causing food, frequently and sustained contact with teeth for prolonged periods of time.

3. Eating disorders, especially Bulimia Nervosa that make teeth susceptible to pigmentation by chromogenic foods (through acid erosion causing alterations in enamel structure).

4. Tobacco especially the chewable and mouth held variety, even hookah, not to mention it’s ardent fan following can expect gum disease and subsequent tooth loosening in the years to follow. Sorry for that spook but it’s relevant and true.

5. Tooth developmental abnormalities, ‘aberrations’ as they are termed (deviations from standard)

6. Micro fractures of teeth in enamel, due to traumatic biting patterns and due to jaw movement hindrances. It can also be the result of an incorrectly milled restoration or in this context, a faulty Night Guard Home Tray, used in ‘vital tooth bleaching.’

7. Like I mentioned in my list of considerations, here is where I introduce the concept of ‘The yesteryears of antibiotic prescriptions with Tetracycline’s’.

8. Fluoride and fluorosis above the toxic limits of 2 parts per million. This can alter the structural re arrangement of enamel forming cells during its development. The result is abnormal teeth and defective organic matrix of teeth. This lends to weaker teeth friable and susceptible to fracture. (AL Qahtani MQ, 2014, Dodson and Bowles, 1991).

9. Attributed to Inherited Conditions such as Amelogenesis Imperfecta and Dentinogenesis Imperfecta, defects of enamel and dentin layers of teeth respectively.
(AL Qahtani MQ, 2014, Nathoo,1997, Viscio et. al.,2000)

10. Blood abnormalities in formation such as jaundice and porphyria in infancy.

11. Dental caries as a no.1 culprit most often

12. Dental Restorations such as mercury amalgam, which has ‘aged and worn well’ due to properties of creep and expansion of metal progressively in time.

13. Thinning of Enamel due to excessive wear and non-dental-caries, habits such as clenching, wear and forceful biting, nail or needle biting, biting pencil lead etc.

14. Blood penetrating the dentinal tubules and metals released from dental restorative materials also cause stains, especially old mercury fillings which have aged and ‘worn well’.

15.This can be worsened in tooth fractures of a major extent, both horizontal and vertical.

16.Certain diseases of pulp, such as pulpal material undergoing an inflammatory or some instances, a carcinogenic change.

It is evidenced as abundant pulp material growing uncontrollably within a confined chamber, known as ‘pulpal hyperplasia’ causes a pink tinge or blood-tinged stain to enamel.

Intrinsic stains are more stubborn to removal by your hygienist, who’s going to tirelessly work at improving your results, with the correct techniques.

The pre-conditioning of teeth by a hygienist, drastically improves results in tooth whitening and possibly a fewer rounds of bleaching may be required.

Although a procedure is employed, certain discoloration of Teeth is more stubborn and require repeated bleaching, to yield ravishly radiant white teeth.

Promising results can be expected with ‘Dental Bleaching’ agents, which penetrate enamel and Dentin to Oxidize the chromogens, as mentioned in the mechanism of action, also outlined in the video earlier.

According to a study by Haywood and associates during 1999-2003, Intrinsic stains that are caused by aging or genetics even by chromogenic-pigment causing foods or drinks are the fastest to respond to in-office bleaching, followed by yellow stains of aging and lastly and very
slowly responsive in the case of blue-grey stains of tetracycline.

With the Blue-grey stains of Tetracycline staining, the mechanism by which ‘Tooth Whitening’ occurs is by the chemical decomposition and break down of the quinone group structures that make up the structure of Tetracyclines. (AL Qahtani MQ, 2014, Leonard et al.,2003)

This results in few colored pigments/ chromophores in teeth. The attributed mechanisms are decomposition and degradation of the colored pigments within the organic matrix of teeth.

The depth of penetration depends on the concentration of the agent, especially for stubborn intrinsic stains.  Compare this with the ‘trapping and bleaching’ action, similar in mechanism but superficially on surfaces of teeth for external staining of teeth.

There is good news however, as teeth with the brown spots of excess fluoride intake, have shown to respond well with in-office bleaching procedures.
Not much can be said about over the counter tooth bleaching methods for intrinsic stains.

Special Considerations in Vital tooth ‘Dental Bleaching’:

Some precautions merit the postponement or careful use of ‘Dental Bleaching’ products, OTC or in-office, such as with;

1. With existing restorations and complex dental work
2. Orthodontic treatment
3. Composite-Tooth colored restorations, and the impact of Dental bleaching on bond strength and curing completion (the strength of such tooth colored resin cements)
4. The propensity to aggravate hypersensitivity in your teeth, creating a vicious cycle. Your teeth are compromised, and sub microscopically are weak, with micro fractures that take up stains from foods and substances easier.

An ‘Active’ Ingredient of choice today is Proxigel, for its moderate concentration of 10% Carbamide Peroxide, which is released slowly to not corrode or cause resorption, from what can already be expected with orthodontic treatment or with certain restorations.

It has replaced a product called Gly-oxide which was previously the choice of bleaching agent in-office for patients who have been treated for complex restorations, prosthesis, resins or orthodontic treatments.

Bleaching agents used frequently in these cases, may result in breakage of the crowns, chipping or loose crowns and other fixed restorations or treatments, including orthodontic cements and brackets from teeth.

This can be a hazard in teenagers, as it may lead to swallowing metal brackets and bands, if the appliance lost its bonding or if ‘curing polymerization’ was rendered incomplete.

It has been reported by a few studies that surface changes occur, merely by the bonded brackets and bands in orthodontic patients, this results in a phenomenon of ‘enamel surface resorption’. The acidic bonding substance apparently surface alters and etches the tooth structure.

Now imagine the action of a bleaching agent, as described will attack the organic matrix of teeth.

This results in a two-fold attack of tooth structure and in such cases, it is essential to plan bleaching appointments sparsely between or wait until treatment is completed, such as with orthodontic treatment.

As with any medical topic, it’s not set in stone and always carries the burden of further investigation.

According to the Journal of the American Dental Association (JADA), a novel method to address ‘in-office’, post tooth whitening sensitivity, which employs the use of an externally applied (topical) of Dipyrone is proving a promise in terms of patient comfort.

Filters or parameters for this assessment were that individuals selected had a darker tooth shade, were classified as otherwise healthy participants and the dipyrone was randomly applied to tooth surfaces, in what is known as a ‘split mouth’ trial. No mouths were split in the undertaking of this study by the way!

Teeth and surfaces are randomly chosen with incremental and step wise assessment, and  another vital consideration is that ‘healthy’ implies vital teeth.

The tests were conducted at multiple centers with as much emphasis on reducing errors and statistical biases, through added randomness measures and through the basis of multi-center tests.

Dipyrone and a placebo were tested in this study, where the  ‘selected’ teeth were coated with the Dipyrone once before those selected were supposed to have 2 sequential and timed appointments with 35 % of the active ‘Hydrogen Peroxide’ Tooth whitening in office.

The customary practices of employing both visual and software assessment ( analog) with the use of shade guide under natural light settings and employing the fancy spectrophotometer were the base lines of assessment in the study.

Like the methods similar in studies mentioned throughout this article, once again the results are converted to numerical statistics and then the results are concluded from those numbers, with an approach the lead investigators described as ‘Intention to Treat Analysis’.

Individuals were re-assessed 2 days later ( 48 hours post procedure), especially considering a decisive factor such as one’s absolute and relative risk for suffering tooth sensitivity post Tooth whitening were the cornerstones of this multi center assessment.

How does Dipyrone work? According to this study it was demonstrated to act at inflammatory compound enzyme pathways.

However, results were shown to only minimize inflammatory processes immediately before the Tooth Whitening appointments,  with the good news that no adverse effects were recorded, which is definitely great news, but there were actually no well defined ‘statistical differences  between dipyrone and the placebo used in comparison.

The need for Dipyrone in post  tooth whitening in office, to effectively remedy tooth sensitivity, needs further investigation, for newer products that have a real impact.

It brings the question of what placebo was used? I had access to a limited scope through article abstracts. Another method which is relatively within your reach down the aisles of your nearest grocery store, is the widely acclaimed ‘Sensodyne’, where the mechanism is to form a dentine chelate, that builds up over time to form a ‘dentine plug’ against irritants from food or beverages.

 

Non- Vital Tooth Bleaching (Tooth Whitening) Methods:

Doing Bright and Brilliant Teeth for Non-Vital Teeth, the White Way!

“A Non-Communicative Tooth”, is a non-vital tooth that has been deeply restored from the Root up to the crown, and is no longer responsive to dental in-office chair side testing. It is a tooth that has a confirmed root filling through Root canal treatment or post and core type root-crown restorations.”

(Grabers’ Endodontic Textbook)

Quite a few techniques are available for teeth or a tooth that has been root filled, which mostly cut out the heat or accelerated torches/devices that are employed for teeth that are otherwise healthy or respond normally.

The risk in teeth that are root filled, is that it would cause gum disease and the neck of the tooth would be gradually dissolved and altered permanently.

None of the LASER modes of Tooth Whitening, are suitable due to this reason.

The risk is greater than the reward of whiter teeth, and with root filled teeth, only a few shades lighter is achievable with dental bleaching techniques available for it.

Adequate protection to the filling that already exists, with precautionary measure by your dentist is taken.

Some techniques adapted specifically for your root filled or Root canal treated teeth are;

1. Walking Bleach Technique
2. Modified Walking Bleach Technique
3. Power Bleaching
4. Inside-outside (in’n’out bleaching not burgers here, but if you love burgers like I do, and it helps you remember, by all means think of it like that.)

With the first method, of Tooth whitening, ‘The Walking Bleach Technique’, your dentist places a mixture of one of the earlier mentioned, ‘active bleaching’ ingredients, Sodium Perborate +water paste, into the small area called the pulp chamber.

It is protected below by a light cured resin, with a protective and anti-caries effect to properly ‘isolate’ the sodium perborate pastes into pulp.

The mechanism of action is much similar to the teeth that are otherwise ‘responsive and healthy’.

The 2 different modes of Tooth whitening, for both vital and non vital or responsive teeth, are vastly different but the end result is Brilliant Bright teeth the white way!

The release of all free radicals will cross channels and barriers of teeth to cause the lightening and tooth whitening effect.

You might need to go for a follow up or second round appointment but that solely depends on how light you envision your teeth to be. What do you have in mind can affect your recall appointment rates.

If the paste were to be combined with a 30% Hydrogen Peroxide, another one of the ‘active ingredients’, with the sodium perborate, it would be called a ‘Modified Walking Bleach Technique’.

However, with this method I should inform you, that activation by heat or light is usually the way with Modified Tooth Whitening works and is essential to it’s mode of dental bleaching.

Effervescent states of bleaching and temperature, are maintained for only 5 minutes roughly. That is not much to ask for and it is proven by studies to not cause harm, so why not?

Besides, you won’t be sent out so soon, the teeth will need to ‘cool’ down for five minutes, to be checked again after removing the gel, and slightly drying the tooth for a few bursts by an air pen tool.

The duration it is kept in place is approximately 1 week, after this you will be called to check the progress. If you are satisfied you can walk out happily to return back after 2 weeks.It’s a fortnightly schedule especially with root treated teeth. If you feel you need more customized ‘Tooth Whitening’, you can modify that within the same appointment, and still tooth status is of critical importance.

Perhaps, you may be advised that it is safe to use OTC or not, in some instances you may be prescribed a maintenance scheduled and dispensed a product. It really is variable but to know how to prepare for it, the first appointment is definitely a necessity. I can’t stress it enough.

“The inside-outside technique for bleaching teeth, is a combination of the above techniques, ‘internal’ methods in combination with a home bleaching modality.”
(Setien et al.,2008)

Conclusions and Solutions to Brilliant Bright Teeth the White Way.

There is no single preferred method over the other, as most ‘active agents’ in the current market are of low to intermediate 10% and 15-20% carbamide or hydrogen peroxide concentrations, but just ‘right’ at the point, you get brilliant, Bright teeth the White way.

Choosing a product in the current market today has a lot to do with personal preference and what the customized outcomes are for you, by your dentist.

With respect to all the conditions and precautions listed throughout this series: “Doing Brilliant Bright Teeth The White Way!”
Please find below a listed (created by self and not found elsewhere) method to organize these products, both for your reference and as a guide to discuss with your Dentist.

I have learnt much myself to be honest.
As a Dentist and student of Dentistry, it is very easy to get immersed into the theory and foundations of Dental Bleaching, the applicability and market research for how diverse this topic is, definitely needs ongoing updates.

Natural Solutions maybe helpful for all teeth, Vital or Non-Vital: However, to treat it with prudence is a virtue.

 

Here’s the Shout out to Solutions for Super Smile in your conquest for Doing Brilliantly Bright Teeth The Whitening Way!

 

 

Once Again I declare that the above link is associated to Amazon, for which I may earn affiliate referral revenue for each link and  it’s presence on my website and specifically this article.

Respectfully as always,

Dr. Shweta MG

(BDs)

10 thoughts on “What They Don’t Tell You About Doing Brilliant Bright Teeth The White Way!

  1. It looks very nice. You gave me a lot of useful information. Thank you very much for your hard work.

    Msiman

  2. Wow this is such a detailed and comprehensive article! Can see lots of work put into it. Thank you for providing all these information. I never knew that teeth whitening can have harmful effects on our teeth. My teeth whitening appointments are definitely spaced very far apart, as I’m too busy with the kids to bother about whitening my own teeth. So this may turn out to be a blessing in disguise!

    1. Thank you Joo, indeed parenthood can protect us when we least think so and I’m glad by default you were already saved by the kids! I am a mom too and the follow up article will be more geared towards the various discussions on Over the Counter Products when we just can’t make a dash to our Dentists’ office given the busy day to day schedules. I myself have only studied the topic in Depth, with respect to Endodontics and journals that substantiate this article, but like you it’s been rare at best. It’s a great booster if our toothpastes do have the potential to promote strength and protection against caries, preserve our gum health and still cause a ‘Tooth Whitening’ effectively, yet never interact with other forms of treatment.
      That is mostly why I read extensively about Super Smile Extra white, which employs a modification and strengthening plus whitening to our teeth. Of course, as stated I am in the works to be gathering it all neatly and writing a follow up article pretty soon. You inspired me to get ahead with it thank you Joo!

  3. Great article! I was actually not aware of the risks and dangers of over-whitening your teeth. The article explained everything clearly, and I was able to understand everything without issue. Keep it up with the great and in-depth information about teeth whitening.

    1. Thankyou I will always keep the amazing motivation of my readers at heart and continually maintain the depth of my articles for you all:)

  4. Thank you for all of the great information! Do you know anything about the HiSmile tooth whitening system? My husband bought it recently, but I’m a little skeptical, to be honest.

    1. Hi Christina, I will be covering the products in an article I will compose today. That’s an excellent question and just to touch upon the foundation of tooth whitening,over the counter formulations mostly are sold as carbamide peroxide, 15% these days, although for Hi Smile which is popular I will give some detail to it today:)
      I really appreciate your question Christina.

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