Discover how Dr. Bassett approaches smile design, starting with patient consultations about tooth color and moving through to advanced cosmetic procedures. Learn about the latest innovations in whitening, including the Philips Sonicare Teeth Whitening Kits, and how they fit into her practice.

Gain valuable insights into the benefits of using trusted products from the Philips whitening portfolio, including the following:

• Philips Sonicare Teeth Whitening Kits
  • Latest Innovation: New offering exclusively for dental professionals, providing a safe and effective way for patients to achieve brighter smiles at home.
  • Convenience and Efficacy: Dentist-developed, enamel-safe whitening gel proven to whiten up to five shades after nine uses (Advanced, HP 9.5%), with minimal tooth sensitivity.

• Philips Zoom! Take-Home Whitening
  • The Power of 3: Specially formulated gels protect enamel, reduce sensitivity, and help improve tooth luster through a mix of Amorphous Calcium Phosphate (ACP), Potassium Nitrate (KNO3), and Fluoride.

• Fully customizable: Six options to receive optimal treatment for your patient’s teeth and sensitivity.
  • Philips Zoom! DayWhite, made with hydrogen peroxide:
    • DayWhite 14% HP (30 min/day)
    • DayWhite 9.5% HP (30-60 min/day)
    • DayWhite 6% HP (60-90 min/day)
  • Philips Zoom! NiteWhite, made with carbamide peroxide:
    • NiteWhite 22% CP (2-4hrs/overnight)
    • NiteWhite 16% CP (2-4hrs/overnight)
    • NiteWhite 10% CP (2-4hrs/overnight)

• Philips Zoom! WhiteSpeed
  • Fast Whitening: Clinically proven to whiten teeth up to eight shades in just 45 minutes with light-accelerated technology.
  • Superior Results: Known as the No.1 patient-requested professional whitening brand in the U.S., delivering dramatic, clinically superior results in one office visit.

Don’t miss this opportunity to learn from one of the best in the field. Whether you’re a dental professional looking to expand your whitening offerings or a patient curious about the latest in smile design, this interview is packed with valuable information and tips.

Levels of efficacy and patient tolerability among different products can oftentimes be confusing but enable a conversation and professional recommendation to your patients across a spectrum of in-office whitening procedures to at-home options. Understanding tooth color etiology, the relative strengths and limitations of treatment options, costs, and your patient’s goals is important for effective professional guidance.

Now, let’s get into the science!

Hydrogen Peroxide (H₂O₂) is the most researched whitening ingredient. While the H₂O₂ molecule is the same, differences in concentration and carrier impact its efficacy. It is recognized as a safe ingredient as the body naturally creates it as part of our protection against pathogens and can break it down^1,2. Also, whitening does not affect the strength of hard tissues, the integrity of restorations, or restorative bonding^3-5.

Carbamide peroxide (CH₆N₂O₃) breaks down to Hydrogen Peroxide and urea in a 3:1 ratio, so 10% carbamide peroxide is equivalent to about 3% H₂O_2.

The efficacy and tolerability of bleaching products is contingent upon the agent’s concentration, dose, and contact time. At higher concentrations or dose, results may be faster; however, tolerability may be reduced (either sensitivity or gingival irritation). At low concentrations, the benefit may not be big enough to be worth the treatment time.

Retention is imperative for effectiveness and varies by delivery system. Don’t be confused by shade claims (e.g.: “5 shades whiter in three days”). It is well established that individual baseline color of the patients’ tooth impacts the speed of benefit. In other words, a young patient with yellow coloring will whiten faster than an older patient with gray or brown hues.

Most whitening compositions consist of hydrogen peroxide, water, a carrier such as glycerin, a thickening agent, and a pH adjusting agent to keep pH in the safe 5-7 range. These structured gels are based on hydrogen bonding to establish structure and give the gel adhesiveness and viscosity. The gels work well, however, the availability of the peroxide is limited because peroxide is part of the gel structure.

Also, the gels are not completely hydrated so they pull water out of the teeth during the whitening process, resulting in a temporary, non-harmful dehydration of the teeth, which can cause bleaching-related hypersensitivity and a transient whiter appearance that will regress once rehydrated⁸.

Crest Whitestrips are the #1 dentist recommended at-home whitening treatment and have delivered reliable at-home whitening for longer than two decades. The no-slip grip strips deliver an effective and safe whitening treatment without messy gels or trays. This is Crest’s fastest and most effective whitening solution.

Until now, the chemistry of the whitening procedures has been similar and has remained unchanged, except the concentration of peroxide and additive ingredients to treat the side effects of dentinal sensitivity.

Crest Whitening Emulsions is a game-changer of whitening chemistry. This new on-the-go, leave-on technology has recently been introduced, which uses a novel emulsion-based vehicle to facilitate peroxide delivery while minimizing dehydration, so patients experience virtually no sensitivity (no different than placebo).

Unlike traditional gels, which are a single-phase uniform mixture, emulsions consist of two phases — peroxide phase, which is hydrophilic (water-loving), and a carrier phase which is hydrophobic (water-hating) as petrolatum. In this emulsion, the phases remain separate because they don’t “like” each other, like oil & water.

The hydrophobic phase suspends the concentrated microdroplets (~25 microns) of the hydrogen peroxide until they come in contact with the tooth surface. The tooth surface is hydrophilic, as are the peroxide microdroplets, therefore when this whitening emulsion is applied to the tooth surface the peroxide is drawn out of suspension, offering peroxide that is uninhibited by the chemistry of thickening or gelling agents. When the peroxide is drawn out of the emulsion to the tooth surface, it creates a layer to begin the diffusion process through the enamel. As a result, the peroxide is delivered more efficiently and diffuses quickly to the stains to render them colorless and whiten the teeth.

Because the carrier phase is hydrophobic, it acts to protect the peroxide microdroplets from diluting away or being decomposed by salivary enzymes optimizing contact time. It renders the microdroplets of peroxide significantly more available and there is no inhibition of peroxide droplets to diffuse, unlike traditional delivery systems. Essentially the hydrophobic phase serves as the physical barrier during the whitening process so that no separate delivery device, like a strip or tray is needed. Even though you may not feel it, the composition remains on the teeth for 30 minutes or longer.

Tooth sensitivity experienced by some patients has remained a barrier to full utilization of vital tooth bleaching. The origins of dentinal hypersensitivity and bleaching related sensitivity are not the same. Whitening treatments produce minor, transient inflammation of pulp, which in turn elevates the response of pulp nerves.  The inflammation could be caused by the over diffusion of peroxide into the pulp, or it may be exacerbated by dehydration effects which occur from anhydrous thickening agents in the gel that delivers the bleach⁶.

There is no contraindication for treating dentinal hypersensitivity via a product whose mechanism of action is tubule occlusion, as it does not impact efficacy of the peroxide. The peroxide is still able to diffuse to the chromogen. In fact, using a product that occludes tubules or contains potassium salts may reduce the sensitivity associated with hydrodynamic pull on pulpal fluids while the pulp is inflamed.⁷

How whitening works: When peroxide encounters a stain such as porphyrin, it takes electrons from the molecules in a process called oxidation. When an electron is removed from a molecule, most often it changes its ability to filter light, rendering it colorless. For this process to occur, the peroxide must be right next to the stain.

What do we know about LED light? It is fair to say that the performance of light activated bleaching has been controversial. Some light activated in-office bleaching systems have been re-examined for patient tolerability and efficacy in improving bleaching performance.⁹ In photo-oxidation (light enhanced) molecules absorb light energy, once a stain molecule absorbs enough energy its electrons reconfigure and it becomes easier for the peroxide to remove electrons from the molecule, rendering it colorless. Therefore, for light to be effective, the intensity and wavelength must be optimized, and peroxide must be in close proximity to the stain molecule.

For this reason, it is best to protect diffusion time to the site of chromogen stain first before applying the light (i.e., apply light at the end of the treatment, after diffusion). Use the Crest LED light at the end of the treatment to break down stains even better vs. Crest Whitening Emulsions alone.

REFERENCES

1. Glorieux C, Calderon PB. Catalase, a remarkable enzyme: targeting the oldest antioxidant enzyme to find a new cancer treatment approach. Biol Chem. 2017 Sep 26;398(10):1095-1108. doi: 10.1515/hsz-2017-0131. PMID: 28384098.
2. Khan, Amjad A et al. “Biochemical and pathological studies on peroxidases -an updated review.” Global journal of health science 6,5 87-98. 13 May. 2014, doi:10.5539/gjhs.v6n5p87
3. White DJ, Kozak KM, Zoladz JR, Duschner HJ, Götz H. Effects of tooth-whitening gels on enamel and dentin ultrastructure–a confocal laser scanning microscopy pilot study. Compend Contin Educ Dent Suppl. 2000;(29):S29-34; quiz S43. PMID: 11908407.
4. White DJ, Duschner H, Pioch T. Effect of bleaching treatments on microleakage of Class I restorations. J Clin Dent. 2008;19(1):33-6. PMID: 18500158
5. Effect of Bleaching on Bond Strength of Composite Resin Bonded to Dentin D.J. WHITE1 , C. DOERFER2 , H. DUSCHNER3 , K.M. KOZAK1 , and T. PIOCH2 , 1 The Procter & Gamble Company, Mason, OH, USA, 2 University of Heidelberg, Germany, 3 Johannes Gutenberg-University, Mainz, Germany Research presented at the 81ST General Session of the IADR, June 25-28, 2003
6. Vaz MM, et al. Inflammatory response of human dental pulp to at-home and in-office tooth bleaching. J Appl Oral Sci. 2016 Sep-Oct;24(5):509-517
7. Markowitz K, Pretty painful: Why does tooth bleaching hurt?, Medical Hypotheses, Volume 74, Issue 5, 2010, Pages 835-840, ISSN 0306-9877, https://doi.org/10.1016/j.mehy.2009.11.044
8. Moghadam FV, et al. The degree of color change, rebound effect and sensitivity of bleached teeth associated with at-home and power bleaching techniques: A randomized clinical trial. Eur J Dent. 2013 Oct;7(4):405-411.
9. SoutoMaior JR, de Moraes S, Lemos C, Vasconcelos BDE, Montes M, Pellizzer EP. Effectiveness of Light Sources on In-Office Dental Bleaching: A Systematic Review and Meta-Analyses. Oper Dent. 2019 May/Jun;44(3):E105-E117. doi: 10.2341/17-280-L. Epub 2018 Jun 12. PMID: 29893625.

ABOUT THE AUTHOR

Beth Jordan, RDH, MS is a graduate of Westbrook College, University of New England, Dental Hygiene, where she worked as adjunct clinical faculty for nearly 10 years and now serves on the college’s advisory committee.

She worked in private clinical practice until 2001 when she joined the Procter & Gamble Company (Crest Oral-B). Jordan is a member of ADHA and has served as a state delegate.

In 2011, she was recognized in Maine as “RDH of the Year” honored as a “catalyst for professional development.” She has contributed 2 chapters to the Darby Walsh dental hygiene textbook and has lectured to audiences of practicing dental professionals, students, and faculty. She has held several positions for the company and currently is a member of the Global Professional & Scientific Relations team where she contributes to scientific dissemination and passionately serves P&Gs commitment to oral health and prevention.

The Dental Experience, a leading dental clinic specializing in dental tourism in Costa Rica, is now providing dental vacation packages to patients across the globe.

Offering the most modern facilities in Central America exclusively for the practice of dental implantology, their dental implant services are very popular, as Costa Rican dental implant costs are known to be much lower compared to other countries, all while providing the same quality, top-rated materials, and state-of-the-art technologies.

According to The Dental Experience U.S.-trained team, a dental implant is a uniquely designed screw made of biologically compatible material that is inserted into the upper or lower jawbone to support artificial teeth. A single missing tooth, a group of missing teeth, or a whole upper or lower bridge can all be replaced with implants. Implants are not just for looks; they can improve a patient’s nutrition, chewing, communication, and overall health.

The American Dental Association has approved two dental implant protocols: the traditional two-stage implant protocol and the new one-stage immediate-loading protocol. Both varieties are available from Dr. Mario Garita, DDS, a famous Costa Rican specialist who has conducted more than 30,000 implants over the past 30 years. 

Dr. Garita’s cutting-edge San José dental clinic is a hub for dental implants abroad, providing the most advanced dental technology at an affordable price, in an ideal setting for surgery and recovery. In addition to quality dental implants, Dr. Garita offers a variety of packages, including teeth whitening, composite fillings, wisdom teeth surgery, veneers, and more.

Interested readers are invited to visit https://www.dentalimplantscr.com/ to learn more about their Costa Rica dental vacation opportunities. 

About Dr. Mario Garita

Dr. Mario Garita, DDS, is a dental implant and full mouth rehabilitation specialist. He graduated from Costa Rican Dental School in 1990 and completed his “General Practice Residency” program in 1991. He completed an implant dentistry residency at the University of Miami’s Jackson Memorial Hospital. For over 30 years, he has successfully treated thousands of dental tourism patients from all over the world as a bilingual doctor.

SOURCE: The Dental Experience, via Newswire

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Devin Booker of the NBA’s Phoenix Suns has partnered with team dentist Dr. John Badolato of Studio B Smiles to support Special Olympics Arizona and provide up to $250,000 in free dental care to local athletes in need for the next 10 years.

“Devin Booker has made so many Phoenix Suns fans smile this year,” said Badolato, who also is the team dentist for the Arizona Diamondbacks of Major League Baseball. “Now you can help him make many more local athletes in need have happier and healthier smiles too.”

When new patients who say “Book it!” while scheduling an appointment at either of Studio B Smiles’ offices in Scottsdale or Phoenix, Badolato will donate needed dental care for local Special Olympics athletes, including exams, cleanings, fillings, crowns, Invisalign, and teeth whitening.

The initiative is part of Booker’s Starting Five program, which includes a $2.5 million pledge to local charities. The first class of the program included Special Olympics Arizona as well as the Leukemia and Lymphoma Society, the Southwest Autism Research and Resource Center, UMOM New Day Centers, and Ability 360. Each received $100,000.

Last month, the program added five more groups: Arizona Autism United, Central Arizona Shelter Services, YMCA of Southern Arizona, GAP Ministries, and Elevate Phoenix. They also will receive $100,000 each.

“From the beginning of my career, it has been important for me to be involved with the Suns organization and the community here in Phoenix. The state of Arizona, and our fans, have supported me on and off the court, and I wanted to return the love,” said Booker.

“All of these organizations better the lives of the youth by giving them opportunities they need to succeed. I want to thank these organizations for allowing me the opportunity to help advance all of the work they’re doing in our community,” he said.

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Researchers at the University of Washington (UW) are preparing to launch clinical trials of a lozenge that may rebuild tooth enamel.

The lozenge includes a genetically engineered peptide, or chain of amino acids, along with phosphorous and calcium ions, which are the building blocks of tooth enamel. The peptide is derived from amelogenin, the key protein in tooth enamel formation. It also is vital to the formation of cementum, which makes up the surface of the tooth root.

Each lozenge deposits several micrometers of new enamel on the teeth via the peptide, which is engineered to bind to the damaged enamel to repair it while not affecting the mouth’s soft tissue. The new layer also integrates with dentin, the living tissue underneath the tooth’s surface.

Two lozenges a day could rebuild enamel, while one a day could maintain a healthy layer, the researchers said. The lozenge, which could be used like a mint, is expected to be safe for use by adults and children alike. The researchers have been discussing commercial applications with potential corporate partners.

The lozenge also produces new enamel that is whiter than what tooth-whitening strips or gels produce, the researchers said. Plus, conventional whitening treatments rely on hydrogen peroxide, a bleaching agent that can weaken tooth enamel after prolonged use.

Since tooth enamel doesn’t regrow spontaneously, the underlying dentin can be exposed, with results ranging from hypersensitivity to cavities or even gum disease, the researchers said. But the lozenge, on the other hand, is designed to strengthen, rebuild, and protect teeth.

While fluoride also can fortify tooth enamel, the researchers added, it does not actively rebuild it. Fluoride also dilutes relatively quickly, and its overall effectiveness depend largely on diligent oral hygiene. Meanwhile, the lozenge can be used in conjunction with very low concentrations of fluoride, or about 20% of what is found in most toothpastes, the researchers said.

“We have three objectives in the clinical trial,” said team leader Mehmet Sarikaya, professor in the Department of Materials Research Science and Engineering and adjunct professor in the Department of Oral Health Sciences.

“First, demonstrate efficacy. Second, documentation. Third, benchmarking, seeing how the whitening effect compares to existing commercial treatments,” said Sarikaya.

The researchers already have tested the lozenge on extracted teeth from human beings, pigs, and rats, as well as on live rats. Also, the researchers plan to develop related products for use in dental office, with this phase of trials beginning in March or April.

“Each study will take two weeks, and we expect these trials to take no more than three months,” said Sami Dogan of the School of Dentistry’s Department of Restorative Dentistry.

The researchers additionally are developing a toothpaste for over-the-counter use, but they have not fixed a timetable for its introduction.

Plus, the researchers are investigating a gel or solution with the engineered peptide to treat hypersensitive teeth, which results from weakness in the enamel that makes the underlying dentin and nerves more vulnerable to heat or cold.

Most common products currently on the market can put a layer of organic material on the tooth and numb nerve endings with potassium nitrate, but the relief is only temporary. The peptide, however, addresses the problem permanently at the source by strengthening the enamel, the researchers said.

The idea for the lozenge design began with Deniz Yucesoy, a graduate student in the university’s Genetically Engineered Materials Science and Engineering Center who received a $100,000 Amazon Catalyst grant through CoMotion, UW’s commercialization center, to support the initial project. Key contributions also came from Hanson Fong, a research scientist in the Department of Materials Science and Engineering.

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Dentistry Today’s Readers’ Choice Top 25 Aesthetic and Restorative Products, selected on the basis of lead generation, represent some of the profession’s most innovative items. They appear below in no particular order.

Parkell Predicta Bioactive Bulk Resin Composite

Tokuyama Dental America Omnichroma Universal Composite

Evolve Dental Technologies KöR Whitening Systems

Bisco Dental Products TheraCal PT Calcium Silicate

Voco Admira Fusion Direct Restorative Material

Shofu Dental Beautifil II LS Universal Composite

Septodont Biodentine Material

DMG America LuxaCrown Restorative Option

Glidewell BruxZir Zirconia Family

Ultradent Products Valo Grand Curing Light

GC America Equia Forte HT Restorative System

Clinician’s Choice Dental Products Evanesce Nano-Enhanced Universal Restorative

Kuraray America Panavia SA Cement Universal

DMP Dental Nanoceram-Bright Material

Pulpdent Activa BioActive-Restorative Material

Ivoclar Vivadent IPS e.max System

Garrison Dental Solutions 3D Fusion Ultra Adaptive Wedge

Advantage Dental Products Hemaseal & Cide Desensitizer

3M Filtek One Bulk Fill Restorative

KaVo Kerr OptiBond eXTRa Universal Solution

SDI Pola Office+ In-Office Tooth Whitening System

Coltene SoloCem Self-Adhesive Cement

Zest Dental Solutions Bulk EZ Bulk-Fill Composite

DenMat Splash Max VPS Impression Material

Align Technology SmartTrack Material

Walmart has launched its second Health Center, including oral healthcare, with a January 29 grand opening adjacent to its retail Supercenter in Calhoun, Georgia. Services include exams with x-rays, cleanings, porcelain crowns, whitening, deep cleanings, emergency treatment, fillings, and clear aligners, with transparent pricing regardless of insurance status.

“We think we can make an impactful difference in affordability, convenience, and, most importantly, accessibility for the Calhoun community,” said Sean Slovenski, senior vice president and president of Walmart US Health and Wellness.

“We have a history of launching innovative products and programs that have transformed the industry and created significant healthcare savings for customers. Now, we’re focused on a solution to provide affordable integrated care that our customers want and deserve,” said Slovenski.

The Calhoun location follows the opening of Walmart’s first Health Center, which opened last September in Dallas, Georgia. Walmart Health is operated by qualified medical professionals, including physicians, nurse practitioners, dentists, behavioral health providers, and optometrists, Walmart says.

Walmart Care Hosts and Community Health Workers onsite will help customers navigate their visit, understand resources, and be a familiar presence for regular visits, Walmart says. As part of the grand opening, Walmart also will make a donation to Susan G. Komen to help meet women’s health needs through expanded access to care.

Dental exams will cost $25. Adult cleanings will start at $25, and youth exams will start at $15. Walmart expects porcelain crowns to have an average price of $675. Whitening treatment will cost $225. Deep cleanings per quad will cost $75. Emergency treatment for pain will cost $50. Fillings will range from $75 to $125. Clear aligners will cost $1,800.

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More than a quarter of adults in the United States are insecure about their oral health, according to a survey from Cigna. The poll of 1,000 adults age 18 and older also found a correlation between routine dental care and self-confidence, with 75% of people who visit the dentist at least twice a year reporting very good self-confidence.

Additionally, the survey found a generational divide, with 74% of gen Z respondents saying their oral health could be improved, compared to 50% of baby boomer and older generations. Younger generations also are more likely to associate oral health with confidence and social comfort, yet older generations visit the dentist more frequently.

Obstacles to maintaining oral care also came up in the survey. Work schedules and difficulty getting to the dentist’s office were cited as the top challenges among those who found dental visits inconvenient. Many respondents also expressed a desire for on-site dental appointments at the workplace and virtual visits, predominantly among millennials and gen Z.

Oral health impacts careers as well. More than 21% of the people surveyed said they felt less confident about job interviews because of their smile or the state of their oral health, with 12% believing that their smile or oral health held them back from getting a job or a promotion.

The majority of respondents thought they could do better, too, with 63% saying they could benefit from improvements in their oral health, and 58% saying their smile could be improved. Younger generations focused more on their appearance than their oral health, including discoloration and straightening as chief concerns.

The Cigna Dental Health Connect suite of clinical programs is designed to help employers provide meaningful dental care services tailored for their workforce. It aims to improve whole person health through convenient access to oral care and reducing the risk of complications stemming from oral health disease, including:

• Onsite care: Cigna brings in-network dental providers right to the workplace to make checkups and cleanings more convenient.
• Dental outreach program: Cigna engages employees who have a chronic health condition associated with gum disease and who have not seen a dentist in more than seven months to help them stay on top of their preventive care and avoid complications with their medical condition.
• Safe prescribing measures: Cigna works with dental providers through monitoring, coaching, and safe prescribing protocols, helping to protect employees from misuse, addiction, and overdose.
• Chronic condition support: For employees with certain chronic conditions like diabetes or heart disease, or for those who are pregnant, the Cigna Dental Oral Health Integration Program offers reimbursement for out-of-pocket costs for certain dental services to reduce the impact gum disease can have on their condition.

“Cigna Dental Health Connect wraps our customers in care through a model that provides convenient preventive dental care solutions, proactively intervenes, and ensures access to high-quality dental care,” said Dr. Cary Sun, Cigna’s chief dental officer. “Through this program, we are empowering all our customers to improve their oral health and hopefully live more confidently every day.”

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As the holidays approach, many folks indulge in more wine than usual—and that could lead to more stained teeth, according to Uchenna Akosa, DDS, head of Rutgers Health University Dental Associates, the faculty practice of the Rutgers School of Dental Medicine. But dentists can give their patients tips for preventing these stains while still enjoying their celebrations.

“When you drink red wine, you’re encountering a triple threat to your teeth’s whiteness: anthocyanins, which are the pigments in grapes that give red wine its rich color; tannins, which help bind the pigment to your teeth; and the acidity found in wine, which etches your enamel, making it more porous and easier for the stain to stick,” Akosa said. 

“The strength of your enamel and how prone you are to plaque buildup is key to how much your teeth might stain,” said Akosa, who offered four tips that dentists can share to help their patients prevent wine-stained teeth:

• Brush before, but no immediately after, drinking. Since plaque can make it look like your teeth are stained, you should brush your teeth 30 minutes before drinking, but not right after since toothpaste can cause more etching.
• Don’t drink white wine before red wine. The extra acid in the white wine will exacerbate the staining.
• Drink water while drinking wine. Swishing your mouth with water, which is neither basic nor acidic, after drinking wine helps to reduce the wine’s acidity and stimulates saliva flow, which is critical in fighting harmful bacteria and maintaining the idea pH in your mouth. 
• Enjoy cheese with your wine. Chewing food also stimulates saliva. Cheese is ideal to pair with wine as it both stimulates saliva and reduces the acidity from the wine.
• Get regular dental cleanings to keep your enamel strong. Cleanings can help remove plaque, which is an acidic substance that damages your tooth enamel. If not cleaned, it can result in cavities.

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The Fine Points of Bleaching Intrinsic and Extrinsic Stains

I appreciate the fine article Dr. Wynn H. Okuda shared on masking techniques for extremely dark teeth in the August 2019 issue of Dentistry Today. That is a technique that may be needed in discoloration cases. However, I must take issue with the statement that “Bleaching only removes extrinsic stains,” as that is not a correct statement. 

Bleaching primarily removes intrinsic stains as well as external stains. The peroxide molecule passes through the enamel and dentin to the pulp in 5 to 15 minutes.¹ Bleaching is changing the color of dentin,² which is where the tooth color resides. Enamel is almost transparent. 

Tetracycline is an intrinsic stain. Hence, tetracycline-stained teeth can be bleached^3,4 to some level, although each analogue of tetracycline creates a different color in the dentin with a different response. Some tetracycline stains are totally removed, while others are only made lighter. 

Bleaching treatment time for tetracycline stained teeth with 10% carbamide peroxide in the nightwear of a non-scalloped, no reservoir tray can take from one to 12 months of nightly treatment, with the average being three to four months.⁵ There is no damage to the pulp or the enamel from this long-term treatment of a low concentration of carbamide peroxide.⁶ 

The technique for masking is important to know, as gray from tetracycline or amalgam is the hardest color to bleach,⁷ but the lighter the gray, the easier for the masking technique to work well.

No restorative material we as dentists can provide is better than God’s enamel, so our first choice in issues of discoloration should be how to preserve enamel and still obtain the aesthetic results desired through bleaching first, then proceed with masking if needed. 

References

1. Cooper JS, Bokmeyer TJ, Bowles WH. Penetration of the pulp chamber by carbamide peroxide bleaching agents. J Endod. 1992;18:315-317. 

2. McCaslin AJ, Haywood VB, Potter BJ, et al. Assessing dentin color changes from nightguard vital bleaching. J Am Dent Assoc. 1999;130:1485-1490.

3. Haywood VB, Leonard RH, Dickinson GL. Efficacy of six months of nightguard vital bleaching of tetracycline-stained teeth. J Esthet Dent. 1997;9:13-19. 

4. Haywood VB, Sword RJ. Tooth bleaching questions answered. Br Dent J. 2017;223:369-380.

5. Haywood VB, Sword RJ. Bleaching tetracycline-stained teeth: considerations and recommendations for treatment. Inside Dentistry. 2018;14:38-44.

6. Li Y. The safety of peroxide-containing at-home tooth whiteners. Compend Contin Educ Dent. 2003;24:384-389.

7. Haywood VB, Fortney LA. Diagnosis and prognosis for dark tooth bleaching. Decisions in Dentistry. 2019;5:10-14. 

Dr. Haywood is a professor in the Department of Restorative Sciences at the Dental College of Georgia at Augusta University. A 1974 graduate of the Medical College of Georgia School of Dentistry, he was in private practice for seven years in Augusta and taught at the University of North Carolina School of Dentistry in Chapel Hill, NC, in operative and prosthodontics for 12 years before coming to Augusta University in 1993. He can be reached at vhaywood@augusta.edu. 

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