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Tooth whitening or tooth bleaching is the process of lightning the color of human teeth. Whitening is often desirable when teeth become yellowed over time for a number of reasons, and can be achieved by changing the intrinsic or extrinsic color of the tooth enamel. The chemical degradation of the chromogens within or on the tooth is termed as bleaching. Hydrogen peroxide ( H 2 O 2 ) is the active ingredient most commonly used in whitening products and is delivered as either hydrogen peroxide or carbamide peroxide. Hydrogen peroxide is analogous to carbamide peroxide as it is released when the stable complex is in contact with water. When it diffuses into the tooth, hydrogen peroxide acts as an oxidising agent that breaks down to produce unstable free radicals. In the spaces between the inorganic salts in tooth enamel, these unstable free radicals attach to organic pigment molecules resulting in small, less heavily pigmented components. Reflecting less light, these smaller molecules c

The perception of tooth colour is multi-factorial. Reflection and absorption of light by the tooth can be influenced by a number of factors including specular transmission of light through the tooth; specular reflection at the surface; diffuse light reflection at the surface; absorption and scattering of light within the dental tissues; enamel mineral content; enamel thickness; dentine colour, the human observer, the fatigue of the eye, the type of incident light, and the presence of extrinsic and intrinsic stains. Additionally, the perceived brightness of the tooth can change depending on the brightness and colour of the background. The combination of intrinsic colour and the presence of extrinsic stains on the tooth surface influence the colour and thus the overall appearance of teeth. The scattering of light and absorption within enamel and dentine determine the intrinsic colour of teeth and because the enamel is relatively translucent, the dentinal properties can play a major role

Tooth discolouration and staining is primarily due to two sources of stain: intrinsic and extrinsic (see Figure 2). In essence, tooth whitening primarily targets those intrinsic stains in which cannot be removed through mechanics such as a debridement (clean) or prophylaxis, in the dental office. Below explains in-depth the differences between the two sources of which contribute to such discolouration of the tooth's surface. Extrinsic staining edit Extrinsic staining, is largely due to environmental factors including smoking, pigments in beverages and foods, antibiotics, and metals such as iron or copper. Coloured compounds from these sources are adsorbed into acquired dental pellicle or directly onto the surface of the tooth causing a stain to appear. Dental plaque: Dental plaque is a clear biofilm of bacteria that naturally forms in the mouth, particularly along the gumline, and it occurs due to the normal development and defences of the immune system. Although usually virtuall

Prior to proceeding to tooth whitening alternatives, it is advised that the patient comes into the dental office to have a comprehensive oral examination that consists of a full medical, dental, and social history. This will allow the clinician to see if there is any treatment that needs to be done such as restorations to remove caries, and to assess whether or not the patient will be a good candidate to have the whitening done. The clinician would then debride (clean) the tooth surface with an ultrasonic scaler, hand instruments, and potentially a prophy paste to remove extrinsic stains as mentioned above. This will allow a clean surface for maximum benefits of whichever tooth whitening method the patient chooses. Below will discuss the various types of tooth whitening methods including both internal application of bleaching and external application through the use of bleaching agents. In-office edit Before the treatment, the clinician should examine the patient: taking a health and d

Tooth whitening may be undertaken for a variety of reasons, but whitening may also be recommended to some individuals by dental professionals. Intrinsic tooth staining Aesthetics Dental fluorosis Endodontic treatment (internal bleaching) Tetracycline staining

Some groups are advised to carry out tooth whitening with caution as they may be at higher risk of adverse effects. Patients with unrealistic expectations Allergy to peroxide Pre-existing sensitive teeth Cracks or exposed dentine Enamel development defects Acid erosion Receding gums (gingival recession) and yellow roots Sensitive gums Defective dental restorations Tooth decay. White-spot decalcification may be highlighted and become more noticeable directly following a whitening process, but with further applications the other parts of the teeth usually become more white and the spots less noticeable. Active periapical pathology Untreated periodontal disease Pregnant or lactating women Children under the age of 16. This is because the pulp chamber, or nerve of the tooth, is enlarged until this age. Tooth whitening under this condition could irritate the pulp or cause it to become sensitive. Younger people are also more susceptible to abusing bleaching. Persons with visibl

Some of the common side effects involved in teeth whitening are increased sensitivity of the teeth, gum irritation, and extrinsic teeth discolouration. Hypersensitivity edit The use of bleach with extremely low pH levels in the tooth whitening procedure may lead to hypersensitive teeth, as it causes the dentinal tubules to open. Exposure to cold, hot, or sweet stimuli may further exacerbate the intensity of the hypersensitive response. Amongst those who receive in-office whitening treatment, between 67–78% of the individuals experience sensitivity after the procedure where hydrogen peroxide and heat is utilised. Although it varies from person to person, sensitivity after whitening treatment can last up to 4–39 days. Potassium nitrate and sodium fluoride in toothpastes are used to ease discomfort following bleaching, however, there is no evidence to suggest that this is a permanent method to eradicate the issue of hypersensitivity. Irritation of mucous membranes edit Hydrogen peroxide i

Despite achieving the results of treatment, stains can return within an initial couple of months of treatment. Various methods may be employed to prolong the treatment results, such as: citation needed Brush or flush out mouth with water after eating and drinking Floss to remove plaque and biofilms between the teeth Take special care during the first 2 days – the first 24–48 hours after the whitening procedure is seen as the most crucial period in which you must protect for your teeth the most. Hence, it is vital that non-staining drinks or foods are eaten during this time as enamel is prone to adhere to stains. Drink fluids that may cause staining through a straw Depending on the method used to whiten the teeth, re-treatment every six months or after a year may be required. If an individual is a smoker or they consume beverages with the capacity to stain, regular re-treatments would be required.

Teeth whitening remedies have been present since ancient times. Despite seeming absurd, some methods were somewhat effective in their results. The Ancient Romans believed in using urine with goat milk to make their teeth look whiter. citation needed Pearly white teeth symbolized beauty and marked wealth. In the Auyrveda medicine system, oil pulling was used as an oral therapy. For this process today, swish coconut or olive oil in your mouth for up to 20 minutes each day. In the late 17th century, many people reached out to barbers, who used a file to file down the teeth before applying an acid that would, in fact, whiten the teeth. Although the procedure was successful, the teeth would become completely eroded and more prone to becoming decayed. Guy de Chauliac suggested the following to whiten the teeth: "Clean the teeth gently with a mixture of honey and burnt salt to which some vinegar has been added." In 1877, oxalic acid was proposed for whitening, followed by calcium

Teeth whitening has become the most promoted and mentioned methodology in cosmetic dentistry. In excess of 100 million Americans brighten their teeth using different methods; spending $15 billion in 2010. The US Food and Drug Administration only endorses gels that are under 6% hydrogen peroxide or 16% or less of carbamide peroxide. The Scientific Committee on Consumer Safety of the EU consider gels containing higher fixations can be dangerous. citation needed As per European Council guidelines, only a certified dental professional can lawfully give tooth whitening products utilizing 0.1–6% hydrogen peroxide, provided the patient is 18 years of age or older. In 2010, the UK General Dental Council became concerned of the "risk to patient safety from poor quality tooth whitening being carried out by untrained or poorly trained staff." A public attitudes survey, conducted by the GDC, showed that 83% of people support "policies of regulating tooth whitening to protect patien