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Indications and contraindications. Optimization of the choice of whitening method for patients with different clinical situations
Summary:
This article discusses teeth whitening san diego techniques. Their advantages and disadvantages, as well as an individual approach to patients with various clinical situations.This article discusses methods of teeth whitening. Their advantages and disadvantages, as well as individual approach to patients with different clinical situations.
Introduction
To date, the appeal of patients for teeth whitening has increased significantly due to the aesthetic requirements of patients. Manufacturers of teeth whitening products are actively promoting their products in the dental market. According to R. Goldstein (2003), nowadays, home, professional and combined teeth whitening are widely used [1].
Goal
Optimization of the choice of whitening methods in patients with various clinical situations.
Material and methods
An analysis of medical books, manuals, articles, journals was carried out.
Results
A change in the color of teeth or discoloritis can be the result of a variety of reasons, ranging from a hereditary predisposition to non-compliance with the rules of oral hygiene.
Teeth whitening is a change in their color, under the influence of preparations containing hydrogen peroxide, the main mechanism of which is its penetration into the enamel, followed by oxidation of the molecule containing pigment [2, 12, 14].
Indications and contraindications.
Indications for whitening are relative and the result is not guaranteed. In general, the indications and contraindications for professional and home whitening are the same. About which method to choose, the doctor selects individually based on the clinical situation of the oral cavity.
Indications for whitening:
- Enamel pigmentation
- Aesthetic preferences
- “Tetracycline teeth”
- Spotted and dashed forms of fluorosis
- Age-related changes
- Post-restoration treatment
Contraindications to whitening:
- Children and adolescents
- Enlarged pulp chamber
- Disease of periodontal tissues
- The presence of orthopedic and (or) orthodontic structures
- Caries at all stages
- Hyperesthesia
- The presence of tumors, bronchial asthma, uncontrolled increase in blood pressure
- Temporary teeth
- Unsanitary oral cavity [3, 15, 20]
Do not forget about the enamel resistance to caries. For patients with a high degree of resistance, the bleaching procedure is not contraindicated, remineralizing therapy can be dispensed with, with an average value, remterapy is necessary. For patients with low and very low resistance, the procedure is contraindicated [4, 13, 21].
Teeth whitening techniques.
- Home whitening. The whitening regimen is determined by the lifestyle and preferences of the patient. If you can use mouthguards at night, use 10% carbamide peroxide for 8 hours, every other day. With the simultaneous use of mouthguards on the upper and lower jaw, the terms will take up to 2 weeks, if separately up to 4 weeks. An undesirable effect is increased salivation, which reduces the concentration of the gel, which reduces the whitening effect. Good results can be achieved with high concentrations of carbamide peroxide (15 or 20%) and (10%) for light.
- Professional whitening. A relatively expensive procedure is indicated for patients with significant discoloritis, the presence of a gag reflex, and the inconvenience of wearing mouth guards. In this technique, 35% hydrogen peroxide is used as a combination of powder and liquid until a gel is formed. The activation of the gel is carried out due to light exposure for 30 seconds for each tooth, in a course of 3 sessions of 10 minutes. It is necessary to isolate the lips, cheeks, gums from the burn.
- “Corridor” bleaching technique. Use carbamide peroxide 35%, activation is carried out by heating the syringe under hot water for 1.5-2 minutes. The gel is evenly distributed over the mouthguard, introduced into the oral cavity, the excess removed and the patient is asked to wait in the hallway. After 30-60 minutes, the patient is invited to the office, the mouthguard is removed, and the gel is washed off. For 1 session, repeat 2-3 times.
- The technique of “deep whitening.” Deep whitening includes external teeth whitening with carbamide peroxide (16%) for 14 nights, and on day 15 – 1 session of office whitening (9%) with hydrogen peroxide in the same mouthguard. Home whitening prepares the teeth, increasing their permeability, and thus the office session becomes more effective. The leading role is provided by the mouthguard tightness, up to 1 mm below the gingival margin, which allows the bleaching agent to act throughout the night.
- Ambulatory whitening directed to fill the tooth cavity with a mixture of NaBO3 and H2O for 1 week under a temporary seal. Then, repeat the procedure until the desired effect is achieved. NaBO3 is mixed with H2O2 30% until a thick paste is formed, after which the mixture is introduced into the tooth cavity for 1 week. Hydrogen peroxide mixed with sodium perborate enhances the effect and has the best whitening effect [16, 18].
- Office energy whitening. The technique is less favorable due to the high temperature and increased risk of internal resorption. Gel H2O2 30-35% is introduced into the tooth cavity and activated by light or heat. The temperature is kept at 50-60C for 5 minutes and the gel is washed off with water for 1 minute. Between visits, an outpatient whitening technique is used.
The combination of internal bleaching methods with external.
Method I variant – office use of 35% Н2О2 gel, which is introduced into the cavity and externally. Spend internal and external activation by exposure. After the procedure, the tooth is washed, dried, temporarily filled. A follow-up examination after 2 weeks, when the shade stabilizes and the tooth is ready for final restoration.
Option II – a combination of office internal whitening of the pulled teeth with home whitening. The preparation of the tooth is the same as in the method of outpatient whitening. The advantage is a low concentration of carbamide peroxide (5-20%), which reduces the risk of resorption. There is no need for a weekly change of temporary fillings in which oxygen accumulating inside the pulp chamber displaces the seal [5,6,7].
Whitening “tetracycline” teeth.
It is recommended that whitening “tetracycline teeth” be carried out using a combined technique, but it will not be rational without eliminating the cause, therefore we first get rid of the causes. Before the procedure, it is necessary to clean the teeth of plaque, dental plaque, then conduct remineralizing therapy from 20 applications per day for 20 days to restore the enamel structure. After we start whitening. With intensive staining, partial bleaching can be achieved, first in the clinic, then at home. If the procedure does not lead to the desired results, it is worth considering orthopedic structures.
Teeth whitening with fluorosis.
Teeth whitening with fluorosis is recommended only with its mild form, with severe aesthetic restoration is advisable. Before the procedure, remineralizing therapy and professional oral hygiene are necessary. Professional whitening, among other methods, is the safest. Gels based on: hydrogen peroxide, hydrochloric acid 10%, carbamide peroxide 10% are used as a bleaching agent. The gel is applied to the tooth surface, subjected to activation, and then washed off. At the end of the procedure, repeat the remtherapy and follow all the recommendations of the dentist.
Teeth whitening.
Teeth whitening can be done using several methods. With a professional, a whitening agent (35% hydrogen peroxide) is applied to the surface, and sodium perborate is injected into the tooth. At home bleaching (carbamide peroxide 10%). With the combined technique, a short course of professional whitening and home treatment lasting 7-10 days is used. The advantage is a lower risk of complications, but the duration of the procedure is superior to other methods.
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