The most common ingredients used in bleaching are carbamide peroxide and hydrogen peroxide, which are used at different concentrations depending on the products or regimens used. The bleaching action in chemically induced whitening is due primarily to the effects of carbamide peroxide, which releases about one-third of its content as hydrogen peroxide, a strong oxidizing agent.

The extent of whitening attained through bleaching may be influenced by the type of intrinsic stain being addressed. For example, brown stains due to fluorosis or tetracycline 28, 29 may be more responsive to bleaching than white stains associated with fluorosis or orthodontic treatment, which may appear less noticeable as the background of the tooth lightens.

For example, although stains due to tetracycline may be diminished, treatment can require three to four months of nightly treatment on average. Tooth whitening is a common elective procedure and a popular, less-invasive aesthetic treatment for patients seeking to enhance their smile and appearance.

Patients who have tooth-colored restorations including crowns or implants should be aware that only natural teeth will be affected by the bleaching agent and treatment could result in differences between natural teeth and restorations, which will not change color.

Bleaching compounds in over-the-counter whitening products are peroxide-based and typically contain carbamide peroxide or hydrogen peroxide at lower concentrations than in-office or dentist-prescribed, at-home bleaching techniques.

A variety of OTC options are available with products that include toothpastes, whitening strips, and gels painted directly on teeth or delivered in trays. Products that bear the ADA Seal of Acceptance a voluntary program for OTC oral care products , indicating that the company has demonstrated that the product meets ADA Seal Program requirements for safety and effectiveness when used as directed, include toothpastes and whitening strips.

Whitening toothpastes primarily rely on abrasives for mechanical removal of extrinsic surface stains, though some contain low levels of peroxide to help lighten tooth color. Examples of products available through dentists include gels delivered in custom-made trays, either intended for at-home use or applied as an in-office treatment.

In-office whitening treatment may involve application of a peroxide-containing gel, used with or without a light intended to accelerate and enhance the bleaching process known as a light-activated system.

At-home whitening with custom trays involves whitening gel placed in trays by the patient at home. found daily treatment times ranging from 2 to 10 hours for periods of 6 to 28 days.

Other in-office techniques for removing extrinsic stains include rubber-cup prophylaxis and enamel microabrasion, which may be completed before the provision of other in-office bleaching treatments that use gels with high peroxide concentrations or light-activated bleaching systems.

This procedure is typically limited to treatment of extrinsic stains or defects that do not extend beyond the enamel. Whitening of non-vital discolored teeth may be performed through intracoronal internal bleaching, a procedure that uses carbamide peroxide, hydrogen peroxide, or sodium perborate to provide adequate internal bleaching of non-vital teeth.

Examples of whitening treatment considerations may include the patient lifestyle, socioeconomic status, and present oral health.

Restorations can also be a cause of tooth discoloration: metallic and other restorative materials on the lingual or occlusal surface of the teeth may influence tooth color significantly.

Patient expectations may not be met or may be unrealistic without addressing cosmetic issues with existing restorations. While OTC whitening products tend to be less expensive than at-home or in-office approaches, there is often a time trade-off in that OTC products may take significantly longer than either of the other options to achieve similar levels of whitening.

Auschill et al. found that an OTC bleaching technique took 16 days to achieve the whitening level of a seven-day, at-home tray system and a one-day, in-office procedure. One common adverse effect of OTC or dentist-dispensed, tray-based whitening is tooth sensitivity, which can be more prevalent with higher concentrations of active agents but is typically mild and transient.

Regarding dental hard tissues, transient mild to moderate tooth sensitivity can occur in up to two-thirds of users during early stages of bleaching treatment.

Factors that may influence the development or extent of tooth sensitivity associated with bleaching include concentration of carbamide or hydrogen peroxide, the presence of adhesive restorations 53 or the contact time and intensity and duration of light use.

Gingival irritation can result from contact with peroxide-based gels when whitening strips or any gel-based product is used for whitening. It is typically due to poor-fitting trays or improper application of the protective barrier or gel.

A Cochrane review on the use of home-based whitening products found that tooth sensitivity and oral irritation were the most common adverse effects, which were more prevalent at higher concentrations but also considered mild and transient. In contrast to well-researched professional and OTC approaches to tooth whitening, do-it-yourself DIY methods using fruits or other household items e.

The list of DIY or natural whitening techniques includes use of acid-containing fruits, vinegar or products containing charcoal and the practice of swishing coconut oil in the mouth known as oil pulling.

The limited studies to date on DIY or natural whitening interventions raise questions regarding the efficacy and safety of these approaches. Kwon et al. reported that a mixture of charcoal and table salt was abrasive and ineffective the teeth had a yellow cast, which the authors attributed to removal of the enamel during the brushing, revealing the dentin underneath.

Several activated charcoal product types e. Fabrication of Oral Appliances Used With Tooth Whitening Products Trans. Resolved, that only licensed dentists or their supervised dental auxiliaries, in compliance with applicable state law, be permitted to make impressions for the fabrication of appliances used with tooth whitening products, and be it further.

Resolved, that this information be communicated to all organizations e. Content on the Oral Health Topics section of ADA. org is for informational purposes only. Content is neither intended to nor does it establish a standard of care or the official policy or position of the ADA; and is not a substitute for professional judgment, advice, diagnosis, or treatment.

ADA is not responsible for information on external websites linked to this website. Key Points Whitening treatments can be effective on both extrinsic and intrinsic staining.

Only natural teeth can be whitened, not tooth-colored restorations. Whitening treatments include in-office bleaching procedures, dentist-supplied products for use at home, and over-the-counter OTC whiteners.

Carbamide peroxide and hydrogen peroxide are commonly used in whitening interventions and can readily permeate dental hard tissues. Temporary tooth sensitivity and gingival inflammation are the most common adverse effects of vital tooth whitening.

Intrinsic Stains Tooth and dental discoloration are terms used to describe any change in the color or translucency of a tooth, 1 as well as discoloration in multiple teeth or the entire dentition.

OTC and Dentist-Supervised At-Home and In-Office Options. Products Directly Available to Consumers Bleaching compounds in over-the-counter whitening products are peroxide-based and typically contain carbamide peroxide or hydrogen peroxide at lower concentrations than in-office or dentist-prescribed, at-home bleaching techniques.

Adverse Effects. Sensitivity One common adverse effect of OTC or dentist-dispensed, tray-based whitening is tooth sensitivity, which can be more prevalent with higher concentrations of active agents but is typically mild and transient.

Gingival Irritation Gingival irritation can result from contact with peroxide-based gels when whitening strips or any gel-based product is used for whitening. Anecdotal Claims and Do-It-Yourself Whitening.

ADA Policies on Whitening. ADA Policy on Tooth Whitening Administered by Non-Dentists Trans. American Dental Association Adopted Fabrication of Oral Appliances Used With Tooth Whitening Products Trans.

American Dental Association Adopted ; Reviewed and Retained Eachempati P, Kumbargere Nagraj S, Kiran Kumar Krishanappa S, Gupta P, Yaylali IE. Home-based chemically-induced whitening bleaching of teeth in adults.

Cochrane Database Syst Rev ;12 12 :Cd American Academy of Cosmetic Dentistry. Cosmetic dentistry-state of the industry survey, pdf ". Accessed July 26, Kothari S, Jum'ah AA, Gray AR, et al.

A randomized clinical trial investigating three vital tooth bleaching protocols and associated efficacy, effectiveness and participants' satisfaction. J Dent ; Naidu AS, Bennani V, Brunton J, Brunton P. Over-the-counter tooth whitening agents: A review of literature.

Braz Dent J ;31 3 Plotino G, Buono L, Grande NM, Pameijer CH, Somma F. Nonvital tooth bleaching: A review of the literature and clinical procedures. J Endod ;34 4 Majeed A, Farooq I, Grobler SR, Rossouw RJ. Tooth-bleaching: A review of the efficacy and adverse effects of various tooth whitening products.

J Coll Physicians Surg Pak ;25 12 Carey CM. Tooth whitening: What we now know. J Evid Based Dent Pract ;14 Suppl Côrtes G, Pini NP, Lima DA, et al.

Influence of coffee and red wine on tooth color during and after bleaching. Acta Odontol Scand ;71 6 Chen YH, Yang S, Hong DW, Attin T, Yu H. Short-term effects of stain-causing beverages on tooth bleaching: A randomized controlled clinical trial.

Journal of Dentistry ; Joiner A. Tooth colour: A review of the literature. J Dent ;32 Suppl Addy M, Moran J, Griffiths AA, Wills-Wood NJ. Extrinsic tooth discoloration by metals and chlorhexidine. Surface protein denaturation or dietary precipitation?

Br Dent J ; 9 Alqahtani MQ. Tooth-bleaching procedures and their controversial effects: A literature review. Saudi Dent J ;26 2 daSilva EM, Maia JN, Mitraud CG, et al.

Can whitening toothpastes maintain the optical stability of enamel over time? J Appl Oral Sci ; Stain removal and whitening by baking soda dentifrice: A review of literature.

J Am Dent Assoc ; 11s :Ss Irusa K, Abd Alrahaem I, Ngoc CN, Donovan TD. Tooth whitening procedures: A narrative review. Dentistry Review Toupenay S, Fournier BP, Manière M-C, et al.

Amelogenesis imperfecta: Therapeutic strategy from primary to permanent dentition across case reports. BMC Oral Health ;18 1 Epple M, Meyer F, Enax J. A critical review of modern concepts for teeth whitening.

Dent J Basel ;7 3. Algarni AA, Ungar PS, Lippert F, et al. Trend-analysis of dental hard-tissue conditions as function of tooth age. Kugel G, Gerlach RW, Aboushala A, Ferreira S, Magnuson B. Long-term use of 6. Compend Contin Educ Dent ;32 8 Mendes L, Laxe L, Passos L. Ten-year follow-up of a fragment reattachment to an anterior tooth: A conservative approach.

Case Rep Dent ; James P, Worthington HV, Parnell C, et al. Chlorhexidine mouthrinse as an adjunctive treatment for gingival health. Cochrane Database Syst Rev ;3:Cd Safety controversies in tooth bleaching.

Dent Clin North Am ;55 2 , viii. Goldberg M, Grootveld M, Lynch E. Undesirable and adverse effects of tooth-whitening products: A review. Clin Oral Investig ;14 1 Torres CR, Crastechini E, Feitosa FA, Pucci CR, Borges AB.

Influence of pH on the effectiveness of hydrogen peroxide whitening. Oper Dent ;39 6 :E Llena C, Martínez-Galdón O, Forner L, et al. Hydrogen peroxide diffusion through enamel and dentin.

Materials Basel, Switzerland ;11 9 Cooper JS, Bokmeyer TJ, Bowles WH. Penetration of the pulp chamber by carbamide peroxide bleaching agents. J Endod ;18 7 Kwon SR, Wertz PW.

Review of the mechanism of tooth whitening. J Esthet Restor Dent ;27 5 Despite seeming absurd, some methods were somewhat effective in their results. Ancient Roman dentists believed in using urine with goat milk to make their teeth look whiter. 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. In the late s, mouthwash containing pyrozone ether peroxide was found to reduce cavities while providing a whiter appearance to the teeth.

In the late s, Dr William Klusmeier, an Orthodontist from Fort Smith, Arkansas, introduced the custom tray bleaching. However, it was not until that Haywood and Heymann published an article in support of this method.

Carbamide peroxide with a shelf life of one to two years, as opposed to hydrogen peroxide with a shelf life one to two months, was seen as a more stable agent for whitening teeth. Teeth whitening has become the most promoted and mentioned methodology in cosmetic dentistry.

The Scientific Committee on Consumer Safety of the EU consider gels containing higher fixations can be dangerous. As per European Council guidelines, only a certified dental professional can lawfully give tooth whitening products utilizing 0.

Reports can be made to the TWIG through their website with respect to any individual giving unlawful tooth whitening services, or if an individual has personally undergone treatment done by a non-dental professional.

In Brazil, all whitening items are classed as cosmetics Degree II. However, its main side-effect, tooth sensitivity , negatively affects quality of life. Contents move to sidebar hide. Article Talk. Read Edit View history. Tools Tools. What links here Related changes Upload file Special pages Permanent link Page information Cite this page Get shortened URL Download QR code Wikidata item.

Download as PDF Printable version. In other projects. Wikimedia Commons. Process to lighten the colour of teeth. Figure 3. Shade guides. VITA classical A1-D4 shade guide arranged according to value. VITA classical A1-D4 shade guide arranged according to chroma ; A: red-brown, B: red-yellow, C: grey, D: red-grey.

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