INSTANT TEETH WHITENING

4. INSTANT TEETH WHITENING: Whitening of a tooth through the application of chemical agents to oxidize / reduce the organic pigmentation in the tooth.

5. BLEACHING OF DISCOLORED TEETH: • Causes: • Decomposition of pulp tissue. • Excessive hemorrhage following pulp removal. • Trauma. • Medicaments. • Filling Materials.

6. May be due to systemic conditions like Red or Purple – Congenital porphyria Violaceous – hereditary opalescent dentin Mottled brown – Endemic fluorosis Grayish brown – Erythroblastosis foetalis Brown - Jaundice. Yellow – brown Gray – Tetracycline group of Antibiotics

8. Classifications: Extrinsic Discoloration Intrinsic Discoloration

9. Extrinsic Discoloration: Found on the outer surface of the teeth and are usually of local origin. Tobacco Stains Tea Stains Nasmyths membrane in children Silver nitrate Rx Oral prophylaxis

10. Intrinsic Discoloration: Stains within the enamel and dentin caused by deposition or incorporation of substances within these structures. Eg: Tetracycline stains Fluorosis Stains Dentinogenesis Imperfecta Systemic conditions Pulp necrosis Iatrogenic.

11. Pulp Succumbs to trauma Hemoglobin Breaks down Hemin Hematin Hematoidin Hematoporphyrin Hemosiderin Hydrogen sulfide (Bacteria) Darkens The Tooth

12. Bleaching Agents: • Superoxol • 30% solution of hydrogen peroxide by weight and 100% volume in pure distilled water. • It is clear, colorless, odorless liquid stored in light-proof amber bottles.

13. It is unstable and should be kept away from heat Care to be taken during handling as it has its chemical effect on skin and mucous membrane • Superoxol can be used alone or mixed with Na Perborate into a paste for use in walking bleach.

14. Sodium Perborate: It is a stable, white powder supplied in a granular form. It is water soluble and decomposes into Na metaborate and hydrogen peroxide releasing O2 Na P + H2O2 H2O + Na. M + O2 When sealed into pulp chamber it oxidizes and discolors the stain slowly continuing its activity over a longer period of time –Walking bleach

15. Indications: • Discolored Teeth • Contra Indications: • 1. Too much sensitivity because of erosion of enamel, extremely large pulp, exposed root surface etc. • Teeth with white or opaque spots. • Extremely dark stains especially those with banding or with uneven distribution. • Eg: dark tetracycline stains.

16. 4 Teeth that have been bonded, laminated or have extensive restorations. 5 Patient’s who are perfectionists or who do not have a good understanding of what bleaching can and cannot do for them.

17. Techniques for Bleaching: The goal of bleaching procedures is to restore the normal color to a tooth by decolorizing the stain with powerful oxidizing or reducing agent.

18. The oxidizing agents used are superoxol [30% H2O2] and sodium perborate. • The technique differs in the method used to activate the superoxol to liberate O2 • Whereas walking bleach uses reaction of Na Perborate with superoxol • The other technique uses heat and light.

19. Different bleaching techniques : For non vital tooth – In office bleach (Thermo catalytic) Walking bleach For vital tooth –Mc Innes Modified Mc Innes Micro abrasion Thermo catalytic Photo flood lamp (bleach light) Night guard / Matrix bleaching White strips

20. TECHNIQUE FOR BLEACHING PULPLESS TEETH

21. ‘WALKING BLEACH’ OR NON VITAL BLEACHING • Steps: • Prepare the tooth – polishing, remove surface debris • Apply petroleum jelly to gingival tissues • Adapt the rubber dam • Re-establish the access cavity • Remove any GP that extends into the pulp chamber to the level of alveolar bone.

22. 6. Seal the orifice of the root canal with at least 1mm glass ionomer cement to prevent percolation of the bleaching agent into the apical area. • Remove the smear layer with 30% orthophosphoric acid • Flush Naocl and water to remove acid. • also EDTA and Naocl may be used

23. 9. Protect the patients face. 10. Mix sodium per borate and superoxol and carry the thick paste into pulp chamber and cover the facial surface of the pulp chamber with paste. 11. Place a cotton pledget over the bleaching paste. 12. Seal the cavity with IRM.

24. - Maximum bleaching effect is attained after 24 hrs • To be recalled with in 3 –7 days for evaluation • If the shade is not proper it has to be repeated • Generally 2 sittings have to be performed to restore the normal color.

25. Heat and light bleaching: • Tooth preparation is the same. • Later, a loose material of cotton is placed on labial surface and another is placed in the pulp chamber of the tooth and the cotton is saturated with superoxol. • This solution is activated by exposing it to light and heat from a powerful light i.e Heat and light from photo flood lamp is aimed directly on the tooth from a distance of 2ft and temperature ranges from 115°-140°F.

26. Superoxol is added to the cotton every 5 min. • The tooth is subject to several six,5 min exposures. • On completion, a cotton pellet moistened with superoxol or superoxol + Na Perborate is sealed in the pulp chamber until the next appointment. • Walking bleach is preferred to Heat and light method as it is - Easy to perform. • - Consumes less time • - Requires no special equipment.

28. Thermocatalytic Method: • An alternative method, to activate superoxol is the application of a thermostatically controlled electric heating instrument or a stainless steel instrument such as woodson No.2, heated over a flame. • When heat is used the temperature is 46°-60°C.

29. Vital Teeth Bleaching: • Mc Innes Method: • Solution consists of 1 part anesthetic ether - 0.2ml • 5 Parts 36% HCl - 1ml • 5 parts 30% H2O2 - 1ml • Ether removes surface debris • HCl etches the enamel • H2O2- bleaching agent

30. Technique: • Polish the crown. • Apply petroleum jelly onto the gingiva. • Isolate teeth with rubber dam. • Always solution is freshly mixed and applied to the enamel surface for 5mins at 1 min intervals. • On completion, the solution is neutralized with NaOCl irrigation and water. • Again the bleached surface is polished. • This is repeated 2-3 times until the shade is obtained.

34. Disadvantages of old McInnes solution 1)   Loss of contour 2)   Sensitivity 3)   Irritation to gingiva

35. Modified Mc Innes solution: • HCl Acid is replaced by 20% NaOH • In this technique, the teeth are etched with HCl and then bleaching procedure is continued

36. Night Guard / Matrix Bleaching: This uses a vacuum formed soft mouth guard and10% carbamide peroxide to bleach the teeth • There are 2 basic regimens for application of this solution • Over night use of night guard filled with bleaching material . • Use of loaded night guard during the day • - Solution is changed every 1½ - 2 hrs • - Rx time is usually 4-6 wks for night time bleaching 1-3 wks for day time with multiple application.

37. Make primary impression and pour a cast. • Make reservoirs on the cast on the labial aspect. • Prepare the poly resin tray with the help of vacuum form machine. • The tray is trimmed and extended 1mm short of the gingival margin on the labial aspect to avoid irritation of gingiva by the bleaching material. • Tray is then tried on the patient’s mouth to check for fit.

38. Disadvantages • The solution may initially cause tissue irritation on gingival papilla – in 1st week of Rx • Some teeth may become more sensitive to temperature change. -      More lab procedures -      Patient complains of gag reflex while using tray

39. White strips: Which is a thin flexible polyethylene strips which contains 5.3% hydrogen peroxide in gel form. The strips are used for 30 minutes twice daily for 14 days.

40. Prevention of tooth discoloration: • Proper access cavity preparation that permit complete removal of pulp tissue including pulp horm. • All traces of blood should be removed by through irrigation. • Any defective restoration should be removed. • Non staining medicaments and materials to be used • During bleaching procedure root canal sealer and obturating material should be removed from pulp chamber beyond a level of 1- 3mm apical to free gingival margin.