Motivational characteristics of the topic: the demand for various bleaching agents, the number of medical procedures for teeth whitening are increasing all over the world. According to experts, teeth whitening is one of the fastest growing and promising procedures in modern dentistry. This is due to the desire of patients to improve the aesthetics of a smile.
The modern dental industry offers a large number of products for effective teeth whitening. This is due to the fact that the number of patients who are dissatisfied with the color of their teeth and wanting them to be whiter is increasing. And their desire does not depend on the real state of the teeth. Today, most people understand the role of the white-toothed smile in our lives.
Beautiful, white teeth is not only a sign of good health, but also an element of culture, a symbol of well-being and prosperity. After all, the appearance is of great importance for a sense of confidence, communication with other people, the position in society, the created impression of yourself.
A bright, attractive smile has become a professional necessity for many, whose work is connected with communication or public speaking. That is why there is so much interest in changing the color of teeth towards clarification with the help of chemicals. The desire of patients to improve aesthetics has caused the active development of a promising direction in dentistry — tooth whitening.
The aim of the research: integrate knowledge about the causes of discoloration of the teeth, and the possibilities of their warnings, the peculiarities of clinical manifestations, indications and contraindications to bleaching, bleaching techniques.
- Scheme of clinical examination and planning of patient treatment.
- Additional examination methods for caries and non-carious lesions of hard tooth tissues.
Control questions on related disciplines:
- Anatomical structure of the teeth.
- Histological structure of enamel, dentin and cement.
- Clinical picture of caries and non-carious lesions of teeth. 4. Principles of prevention and treatment of major dental diseases.
History of teeth whitening
The modern history of bleaching is more than 100 years old. Hydrochloric acid and hydrogen peroxide are the two main chemical agents used to treat many types of internal and external staining of live and depulled teeth. These two substances were used together or separately, sometimes with other chemicals, thus providing a variety of treatment options, benefiting from their synergistic effect.
The first proposals of bleaching were reduced to the local use of acids. In 1850 there were reports of clinical experience of teeth whitening with oxalic acid. The method of external teeth whitening, which was the prototype of the modern approach to professional vital bleaching, was first described by Chapple in 1877. He suggested using solutions based on oxalic acid in the treatment of certain types of dental stains. The use of chlorine-containing compounds for teeth whitening was first described in 1877 by Taft. He proposed the use of a chlorinated solution (Labarrac's solution).
The use of hydrogen peroxide for teeth whitening was first described by Harlan in 1884. The following attempts involve the use of a combination of exposure to chlorine and ultraviolet. In 1985, Westlake first used pyrosone (a mixture of hydrogen peroxide and ether). To make the treatment more effective, the solution was activated by electric current, and satisfactory results were obtained. Only in 1918 Abbot introduced an effective technique using 37 % hydrogen peroxide activated by heat and light, which became the basis for modern techniques.
Many improvements have been made to Cape's technique, including the modification of McInnes (1966). He introduced a new solution, named for him and made from a fresh mixture of 5 ml of 36 % hydrochloric acid, 5 ml of 30 % hydrogen peroxide and 30 % ether. This solution was applied to the surface of the stained tooth with a cotton swab for 16–20 minutes, then the teeth were washed with water and neutralized with a sodium bicarbonate paste. Even then, he emphasized the need for polishing teeth after treatment. MsCoskeu (1984) recommended using only a dilute (18 %) solution of hydrochloric acid, which he rubbed into the enamel with a cotton ball, similar to McInnes. Croll and Cavanaugh (1986) proposed to combine 18 % hydrochloric acid with pumice and rub this paste with a wooden stick for 5 seconds.
In 1990, the work of Croll and Cavanaugh led to the appearance of a new product called «Prema» (Premier), consisting of a ready-to-use mixture of 10 % hydrochloric acid and pumice. Miara et al. (1991), having tested lemon, hydrochloric, phosphoric, nitric and other acids, as well as a number of mixtures based on hydrochloric acid and hydrogen peroxide in various concentrations, introduced a micro-abrasive system Micro Clean (Cedia).
INDICATIONS AND CONTRA-INDICATIONS FOR TOOTH WHITENING
The decision to whiten teeth or not, depends on the patient's aesthetic needs. In addition, to change the color of the tooth, in most cases possible to use alternative chemical bleaching techniques or combinations thereof, however indications for this method are always relative. Most often teeth whitening is resorted to by those who have a tooth surface that has a stubborn, unnatural color. Using modern methods of whitening can significantly change the color of the teeth. Measures to improve the color of the teeth can be directed both against external and against internal staining, as well as to improve the natural color of the teeth. The effectiveness of whitening is largely dependent on the cause that caused the color disturbance. They respond well to whitening teeth discoloration, associated with surface staining (pigment raids, dental plaque), age-related changes, staining the dentine from the pulp chamber. Among the clinical situations worse amenable to bleaching include inborn errors of tooth-colored fabrics, high transparency of fabrics, dyeing the exposed dentin from the oral cavity.
The procedure of chemical teeth whitening is referred to the section of aesthetic dentistry. It is not aimed at restoring the masticatory function of the tooth or dentition as a whole, does not contribute to primary, secondary or tertiary prevention of dental diseases.
At the same time, bleaching techniques in some cases are able to eliminate the aesthetic disadvantage, thereby increasing the level of social adaptation and the quality of life of a person. As mentioned above, the indications for teeth whitening are relative. In some cases, the patient may need to clarify uncolored teeth. Most Europeans have teeth that are «A« tones and have A3-A3.5 intensity, depending on the group affiliation and jaw, however, patients who have such teeth or even lighter teeth may require bleaching. Usually this need arises because of professional or social reasons. For example, the most light teeth may be necessary for the entertainer or in a social group with high incomes it is customary to have a «white tooth» smile. Along with this increase in the use of chemical bleaching of unpainted teeth can contribute to the promotion of this technique by private dentists among their patients.
Thus, chemical teeth whitening can be performed in the following cases:
- The color of one tooth of the patient differs from neighboring teeth.
- There is a staining of all or a group of teeth.
- There is no dyeing of the teeth, the patient wants to have lighter teeth. However, it should be noted that the procedure for whitening teeth is not suitable for everyone.
CLASSIFICATION OF BLEACHING METHODS
At present, the following methods for changing the color of natural teeth are used in dental practice:
– chemical bleaching.
– direct composite restoration.
– Indirect restoration:
– veneers (ceramic, composite).
– crowns (metal-ceramic, metal-composite, all-ceramic, composite, plastic).
The choice of methodology depends on several parameters:
– intensity of dyeing of teeth.
– the prevalence of staining.
– Depth of staining.
– the cause of staining.
– level of the patient's need to change the color of the teeth.
– cost of treatment.
Often, for a significant change in the color of the teeth, the patient must consistently apply two or more of the listed techniques (for example, microabrasion, chemical whitening, the manufacture of veneers). Modern methods of chemical teeth whitening are classified as follows:
– professional whitening:
– external (on the vital teeth.(
– internal (devital teeth(.
– home whitening.
– Mixed bleaching.
Bleaching substances differ from each other in different consistency and concentration of the agent, the time of its exposure to the teeth, and the use of an additional physical factor that activates the whitening component (laser, UV rays, halogen light, heat). The essence of all modern techniques is reduced to one: substances that decompose oxygen, penetrate into the hard tissues of the tooth (dentin and enamel) and oxidize the organic substances that stain the tooth, and denature the proteins entering the pigments, making the tooth tissues less transparent and optically More light. This process is fundamentally different from the action of acids, demineralizing dental tissues.
Among home whitening systems, two main groups can be distinguished: bleaching pastes and home bleaching systems. Whitening toothpastes, for the most part, have a very high abrasiveness and make the teeth lighter due to the effective removal of dyed plaque. However, with good oral hygiene, such pastes are ineffective, because there is no plaque, and they cannot change the color of the enamel itself. Moreover, prolonged use of whitening toothpastes can lead to increased sensitivity and abrasion of the enamel. This is explained by the traumatic effect of highly abrasive substances on the enamel of the tooth, as a result of which it gradually thinens, which consequently leads to an increase in sensitivity, a decrease in the quality of oral hygiene and, consequently, an increased risk of caries and periodontal disease. These funds are designed for a long period of validity and not are intended for clarification of a teeth with the painted internal layers of enamel.
Homemade whitening takes a long time. The reason lies in very low concentrations of active substances. If the concentration is increased, the enamel will become lighter in a short time, but soft tissue burns cannot be excluded, which it is impossible to isolate at home. In addition, even minor violations of the technology of the bleaching process can lead to increased sensitivity of the teeth and even toothache. This technique is very common and popular in the world. It involves the use of kappas and whitening gels based on carbamide peroxide or hydrogen. It is used to brighten living teeth, if the change in color is not excessive. The technique allows you to remove stains and darkening caused by the effects of food colors, tobacco, etc., as well as clarify the individual color of the teeth. You can expect a color change of 2–3 tones. The final result depends on the structure of the teeth and the type of discolorite.
In the home bleaching method, individual dental trays are used for the bleaching gel (carbomide peroxide), whose concentration varies between 9–22 %. The home method is relatively slow and carried out for 2–6 weeks (depending on the severity of the condition and some characteristics of the tooth enamel structure). Sometimes the sensitivity of teeth changes, which is quickly restored after the procedure. Teeth, when lightened, retain the natural coloration of the entire surface, and do not change the natural appearance.
The necessary effect is not achieved in teeth with tetracycline pigmentation and other kinds of color changes in the deep tissues of the teeth. Modern bleaching gels in its composition have 20 % water, which helps to avoid hypersensitivity or reduce it, there is no drying and dehydration of the enamel.
Bleaching substances contain various flavors — neutral, banana, menthol and watermelon flavors. Systems for home bleaching are divided into physicians and uncontrolled consumer use systems (V. B. Haywood et al, 1992).
A significant proportion of patients prefer whitening in a dental office than home whitening. They are attracted by the speed of achievement and the effectiveness of the procedure. Some patients are not able to correctly perform bleaching with the use of kappas at home due to their employment, negligence, etc. The difference between professional bleaching and home is not only in the concentration of the drug (10–20 % instead of 35–40 %), but also in Duration of the procedure.
Professional bleaching is performed in the clinic with high concentrations of peroxide compounds and results in faster results. Indications for its conduct can be the following:
- if you need a quick result.
- the patient wants the bleaching to be carried out at the clinic.
- it is required to bleach individual teeth.
- there is a pronounced or difficult to eliminate staining.
- the patient has increased pharyngeal reflexes.
- the patient has bruxism or a TMJ disorder.
The success of bleaching depends on a carefully conducted diagnostic procedure with the explanation of the etiology of tooth pigmentation, individual symptoms and the definition of the correct therapeutic technique that will most effectively eliminate this defect. There are various methods of teeth whitening in a dental office. For bleaching, various drugs are used, all based on the use of a highly concentrated solution or a hydrogen peroxide gel. Some gels and solutions are activated as a result of only a chemical reaction, others — under the influence of thermal or light energy sources. In addition, existing bleaching techniques in a dental office provide different results in terms of effectiveness.
Professional methods include bleaching of depulled teeth (internal) and vital (external) bleaching. Professional bleaching is done in the dental office. For this method, gels or solutions of 30–37 % of the concentration of hydrogen peroxide with protection of the oral mucosa are more often used. At the heart of chemical bleaching are the oxidative processes that result from the action of atomic oxygen on the natural tissues of the teeth. In addition, the dentist can use a laser or special lamps to activate the whitening agent. Laser technology includes the use of argon or diode lasers, and allows a lighter shade of enamel without harm to its structure and chemical composition. You should know that the laser does not bleach teeth, it simply accelerates the oxidative action of hydrogen peroxide. Since its high concentrations are used, the oral cavity should be carefully prepared for the procedure. The course may include several sessions, although the bleaching effect in most patients is usually seen already on the first visit. This process can be applied both to the dental arch as a whole, and to a separate tooth. With external bleaching, a bleaching agent is applied to the insulated surface of the tooth row, which is then illuminated with a halogen lamp, creating a slightly palpable heating effect.
The treatment of laser teeth whitening is a treatment aimed at turning yellow and gray teeth into white teeth. Over the years, different colors accumulate on the teeth as a result of smoking, consumption of beverages containing caffeine and eating foods containing food coloring.
Laser tooth whitening is a very common treatment, and many dentists use it. Because it is a simple treatment, by which a plastic material is placed on the gums to protect it, and then oxygens high concentration on the teeth, penetrating into the tooth with the help of the laser, and the remaining bleach on the teeth a few minutes and then removed. It should be noted that treatment takes about one hour and one time.
Despite the ease of treatment and the high success rates, there are still certain disadvantages that lead to controversy in the world of medicine about its abilities and quality, one of the problems is heating the tooth layer, which leads to the disintegration of the cells in them and leads to inflammation and (necrosis).
In addition, the concentration of oxygen on the teeth is higher than the concentration used to treat normal teeth whitening, which can damage the gums. An additional critique of this treatment, addressing the fact that the treatment is relatively recent and its long-term effects, is still unknown. The only evidence obtained, over the years, has been regarding sensitivity and pain in the teeth due to this treatment.
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