Intro:

Your teeth can discolor by the diverse causes, what supposes an important esthetic commitment when it is a question of previous teeth, and implies the need to be able to offer to the patient satisfactory therapeutic alternatives in these cases. The tooth whitening done in consultation with splints and a high concentration of whitening agents quimioactivados is a useful, relatively simple and somewhat aggressive, when performed in a controlled manner and under the direct supervision of the dentist gets immediate good clinical results. For this purpose, we can use two types of splints: the usual whitening home with reservoirs of a millimeter and splints specifically designed for this mode of bleaching, with pools of three or four millimeters more capacity with regard to the former.

The purpose of this therapeutic modality is the whitening optimize and facilitate the implementation of the intense action of agents used in bleaching techniques that are made in consultation and reduce the risks associated with the use of them caused by contact between these agents whitening and oral tissues of the patient.

Procedure:

Figure 1. Illumina system dental whitening powder / liquid dual syringe quimioactivable.

Whitening agent:
The bleach product used in this case (Fig. 1) is the Dentsply, which is in the form of powder and liquid contents of two syringes: the first or syringe A, is hydrogen peroxide 30% in liquid form and in the second or syringe B powder (poli-metil-vinil-eter maleic salts of sodium and calcium, and titanium dioxide), once all components become mixed consistency of gel, with a concentration of hydrogen peroxide of 15%.

Clinical technique:

This is a patient of 23 years who came to the consultation by submitting a dental discoloration tetracycline intake in children, severe and moderate periodontal disease (maxillary arch) / severe (mandibular arch) controlled (fig. 2). We performed clinical and radiological diagnosis and taking the color of teeth to whiten teeth by the use of dental colorimeter Shade EX (Shofu). On this occasion, and after assessing the type and degree of discoloration as well as periodontal problems afflicting the patient is scheduled with the home whitening splints of the maxillary arch and bleaching in the consultation with splints of the mandibular arch to avoid prolonged contact between the bleaching agents and areas exposed roots of the teeth of the mandibular arch where the problem was more advanced periodontal. We informed the patient of the risks associated with this type of therapy and the plan of treatment and confirmed in writing their acceptance of them by signing an informed consent.

Figure 2. Pre-bleaching event of tetracycline discoloration by a severe and moderate periodontal disease

Figure 3. Whitening splint and the working model on which it was made with 3 mm separator covering teeth

Alginate impressions were taken for the manufacture of bleaching splints, splint for use at home with pool, 1 mm for the maxillary arch and a splint for use in consultation with the reservoir 3 mm for the mandibular arch (Fig. 3 ); splints that in both cases must meet the quality criteria of splinting teeth (adjusted, festoons, retentive, stable and non-iatrogenic).

After photographic records and the isolation of the initial operative field, led to the initial preparation of the teeth to facilitate the action of the whitening product, therefore removing the plaque and discolor the extrinsic surface of the teeth with a brush mounted on a contra?ngulo and pumice, washed with ethanol surfaces of teeth to increase its permeability to bleaching agent and found the effectiveness of the isolation felt by asking the patient if the taste of alcohol. Then it proceeded with the application of a bleaching product on the teeth of the patient (Fig. 4) using the splint for use in the consultation for 45 minutes. After the treatment session the splint was removed with bleach and the product is completely removed from the remains of the tooth surface is removed and the rubber dam was the color of teeth. Fig. 5 shows the final result after the bleaching of the mandibular arch one weeks after the meeting accomplished.

Figure 4. Application of a bleaching product on the teeth of the patient

Figure 5. Week after completing therapy with Illumina.

Discussion:

Vital tooth bleaching in the consultation highlighted by a procedure that is performed under the direct supervision of professional, not dependent on the proper performance of the implementing rules by the patient outside the clinic, in addition to the need for reduced treatment time to achieve results similar to those achieved using the techniques home. The mode of tooth whitening quimioactivado presents also the advantage of not requiring external activation, while avoiding risks that may be associated with such procedures when they are not implemented in a rigorous and correct (5-7). In the case of the product that we used, Illumina E, add gummy consistency of it, which allows a convenient application and immobility once placed on the teeth to be bleached, which lowers the risk of contact between the patient’s oral tissues and whitening product in comparison to other whitening products used in these techniques and more fluid consistency. Like the rest of techniques carried out in the consultation, where indicated, it can complement the home bleaching treatment procedures in order to obtain more successful outcomes and perpetuates the temporal performance through this kind of therapy.

The color of the dental records should be made final a week after finishing the last bleaching session, at which time the color can be considered stable. The color was recorded using a colorimeter because it is a procedure for objective quantification of the change of color in comparison with techniques using subjective valuation guides for dental use color.

Conclusion:

Depending on the results we can say that money queamiento in consultation with dental splints and high concentration of whitening agents quimioactivables is an effective technique with which, after a single session can be successful with a discoloration as presented .

How did people whiten teeth before? They had to apply to the dentist for it. Only this way they could have their teeth bleached. But all the measures taken in this direction happened to be too damaging. Nowadays the situation is much better and the variety of options is bigger, but still some means can be very harmful for your sensitive tissues because they are subjected to the exposure of destructive chemicals. But you can stay away from such destruction, giving preference to natural teeth whitening. Here are some guidelines for you:

1. Do not forget to make the appointments with your dentist to clean your teeth. Do not skip this point and make it important in the list of your duties. Some dentists call to remind, that time has come for the next in turn visit. If you visit your doctor every 6 or 12 months, then you should not be concerned over your teeth whiteness, especially in case you smoke.

2. Brush your teeth in the morning and in the evening, use dental floss the remove food particles after meals, use non-expensive gum-massager. You will avoid plaque formation if you are concentrated on your teeth care.

Dental floss is a portable thing, it doesn’t take much space and you can keep it in the pocket. Use it after meals in the cafes or restaurants. Floss your teeth before going to bed because the period of your sleep is too long – the whole 7-9 hours destructive bacteria will ruin your enamel. Rinse mouth with water thoroughly after meals.

3. It was discovered that such substance as fluoride is harmful for bright white smiles. For this reason you should avoid using toothpaste, which contain fluoride. Keep away from the drinking water with it. The water with this ingredient is not allowed is some countries as it leads to some illnesses. No natural teeth whitening remedy will be effective if you consume anything containing fluoride.

4. Try to smoke less, if you continue then you can forget about the perfect smile, so choose what is more valuable for you. It is better to stop smoking otherwise great smile will become “mission: impossible” for you.

5. Such drinks as cola, tea, coffee, wine are very bad for your teeth, that is why rinse your mouth with water after you had a cup of nice coffee or some other drink.

6. Some kind of fruits can be perfect means of natural teeth whitening, for example, strawberry or inside part of orange peel. Rub your teeth with fruit paste, leave the pulp for about 5 minutes on your teeth and then you should water your mouth well. Polish your teeth with orange peel (its white part) to make them look stunning. A number of people use also lemon juice, combining it with salt. But remember that this is acid and long subjection to it can be very harmful.

7. The most common means for whitening teeth is baking soda. It is not for nothing that it is common ingredient in many types of toothpaste. It is an ideal remedy of natural teeth whitening! The combination of its price and efficiency make it just perfect. You can create your own teeth-cleaner, mixing soda and salt.

8. Keep away from mouthwashes. There can have alcohol bad for your teeth color. Besides, they can be damaging for some sensitive areas of your mouth, especially under the tongue. Some tissues can imbibe chemicals poisonous for your body.

9. Drinking water in big amounts will help to wash your teeth after meals and will remove small particles left between teeth.

10. Eat more raw fruits and vegеtables, choose salads to processed meals and do not consume of low quality preparation. Healthy eating habits will make your teeth look better and will prevent tooth decay.

Natural teeth whitening has a big advantage: you will not ruin your teeth with damaging chemicals. Besides, it is not expensive and you will get a good result, healthy teeth and good enamel.

You dreamt about a luminous smile, underlined by an enamel in whiteness pronounced? Methods and current products do not cease advancing while respecting your teeth. Care in professional office in the kit of teeth whitening at home.

True promise of seduction and of health, to have a pretty smile passes inevitably by a dentition white and well lined up. And yet different factors with hereditary character (natural colouring or ageing of the tooth), pathological (taken by t?tracycline during the period of training of the tooth) or else coming from way of life (consumption of coffee, tea, tobacco, wine, antidepressants) sometimes return descaling and ineffectual d?tachage. Natural teeth whitening becomes then perfectly answerable.

Whitening in questions

Teeth whitening dentist. This simple technique of aesthetic dentistry serves for clarifying the colouring of the enamel and of dentine thanks to the use of a frost based on peroxide of hydrogen (hydrogen peroxide). That any whitening treatment belongs in office or at home, is necessary be performed without having beforehand performed a bucco-dental balance sheet deepened by a dental surgeon to prove the absence of contraindications (not well-manicured decays, teeth done root canal work, weakness of the enamel, gingival annoyance) as well as an efficient descaling. This type of treatment is recommended only when teeth are strongly turned yellow). “It is possible to earn half a tone or even a tone, but the important rest to preserve at the farthest the natural shade of the tooth so that she is in adequacy with the whole face”, underlines the surgeon dentist Olivier Hue.

Treatments at the dentist

There is two there : whitening “in the chair” and that says “ambulant”.

The first comes true completely to the office in one or two sessions. The dentist accomplishes, from a dental footprint of arcades, a flexible plastic gutter made to order which receives later the frost of very concentrated laundering, and it during a time of pose that can vary from 20 till 90 minutes according to the initial state of the tooth. In certain cases, the dentist can judge useful to call a lamp of high energy or laser to speed up the process of elucidation. It is necessary to note that the accomplished treatments are painless.

As for the ambulant treatment, it is first implemented to the office with the ready-to-wear clothes of these same gutters and followed in the domicile with the aid of a frost of peroxide of hydrogen more slightly dosed. The harbour of gutters is made preferably in the course of the day and its length can wobble between 15 minutes and one hour / day, according to the prescript of the dentist. It is also possible, in extreme cases to perform a session of laundering in the chair followed by a classical ambulant treatment. In principle, results really appear at the end of 15 days and are visible on average 4 years, according to the way of life of the patient (high consumption of coffee, tobacco or not). In case of sensitivity, it is imperative to stop the treatment and to consult a dentist to avoid harming the nerve of the tooth.

Only snag, expensive price : between 390 and 1 200 ? according to number of sessions and to used method.

Teeth whitening at home or natural methods of teeth whitening

More and more marks of bucco-dental hygiene perfect kits ready for job, usable with a convincing quality, and it at much more accessible price (between 15 and 60 ?).

Available in chemist’s shops and parapharmacies, these kits of laundering have a frost as based on peroxide of hydrogen but distinctly less concentrated there than in office. Among novelties, three types of products :
- The self-adhesive transparent bands : very practical and covered in 6 % of frost, they marry perfectly the form of teeth for a store of uniform frost ;
- Frost with brush : he allows a very definite application of the product, for a selective use on some teeth or left teeth for a more located colouring ;
- The disposable gutters : hygienic and in unique usage, they are ready for job and do not require prior adaptation. They are mostly given with individual ingenious and easily transportable doses of frost.

Different factors intervene in the colouring of teeth. They can be of hereditary origin (natural colouring or ageing of the tooth), pathological (taken by tetracycline during the period of training of the tooth) or else attributable to way of life (consumption of coffee, tea, tobacco, wine, antidepressants). These cases which are sometimes productive descaling is good indications for a natural teeth whitening.

In aesthetic dentistry, laundering allows to clarify the colouring of the enamel and of dentine by means of a frost based on peroxide of hydrogen (hydrogen peroxide). No whitening treatment should however be performed without a prior bucco-dental balance sheet, in the course of who your doctor-dentist makes sure of the absence of contraindications (not well-manicured decays, teeth done root canal work, weakness of the enamel, gingival annoyance).

Tooth whitening can be performed “in the chair”, by your dentist, or in a said “ambulant ” way, at home.

The first takes place to the office in one or two sessions from 20 till about 90 minutes. It is possible also to speed up the process of elucidation by means of a lamp with high energy or of a laser. These treatments are completely painless.

The ambulant treatment starts to the office with the ready-to-wear clothes of gutters accomplished from a footprint of dental arch and continues in the domicile with the aid of a frost of peroxide of hydrogen more slightly dosed than that used in office. Your dentist will prescribe you the length of the treatment according to your particular situation. In case of pain or of sensitivity, it is imperative to stop the treatment and to consult your dentist to avoid harming the nerve of the tooth.

The products of whitening teeth sold in trade would erode the dental enamel, according to a study of american dental institute. They speak however about erosion in the order of the nanometre. That because natural tooth whitening is the best teeth whitening method.

Study concerned five products blanchissants of bandages or of frost applied with the aid of gutters. Fifty samples of teeth were treated during a period from ten days to three weeks, according to the used product. Study showed that all bleaching products reduced the enamel of teeth from 1,2 to 2 nanometres. On the other hand, the teeth which did not accept whitening treatment had earned 0,4 nanometre of enamel during the same period.

«There is no cause for becoming alarmed, asserts the Dr Serge Langlois, president of the Association of the dental surgeons of the Quebec. A loss of enamel of this microscopic order is not harmful and attains in no way hardness or resistance of teeth.» Besides, the enamel of teeth regenerates naturally in some weeks or some months, he adds.

Study also showed that, according to the type of treatment, teeth lost from 6 % to 19 % of their elasticity. Although they are rigid, teeth have some elasticity to resist shocks. The loss of enamel and of elasticity of teeth was the same, it doesn’t much matter the concentration of the agent of laundering. The tested products contained or 9 %, 10 % or 14 % of peroxide of hydrogen or 22 % of peroxide of carbamide.

Less white teeth?
The impairment of the colour of teeth can be caused by dental decay, ageing, consumption of some food and drinks, tobacco addiction or catch of medicaments.

What best: cleaning or laundering?
The dentist Claire Deschamps, who performs treatments of laundering for more than 20 years, warns the public against infatuation for these products sold in chemist’s shop. «Stains on teeth caused by food as the coffee, or the tobacco can sometimes disappear easily with a good cleaning, she explains. A tooth shade of which is more made darker can however require a laundering with the aid of a more concentrated product which will act on the pigment of the tooth.»

The Order of the dentists of the Quebec and the Canadian dental Association recommend to consult a dentist before undertaking a treatment of laundering of teeth. «Blockings, presence of decays, displayed roots or gums in bad state can reduce the effectiveness of a treatment of laundering or procreate unpleasant side effects, as hypersensitivity of teeth», definite Claire Deschamps.

The Canadian dental Association mentions on its Internet site that the long-term effects of treatments blanchissants, that they are made at a dentist’s or at home, «are still unknown and have to make the research object, especially as the results of treatments are not permanent and what many people end up suffering periodical treatments of laundering».

Products to whiten your teeth:

- Blanchissants toothpastes
- Gels or kits of laundering
- Blanchissantes (Strips) bands

In reality these techniques have their borders and their disadvantages and very often results are not in the measure of waitings and this especially since these techniques are sometimes used ill-advisedly without medical supervision.

Fortunately, there are professional techniques allowing to clarify the shade of teeth with the aid of products more concentrated in bleaching agent based on Peroxide therefore more efficient.

- laundering to the dental office with the aid of peroxide of hydrogen
- laundering at home with the aid of a less concentrated product: peroxide of carbamide

There are 3 professional techniques of natural teeth whitening.

Teeth whitening in the chair:
The dentist, having isolated your gum undertakes three applications of frost based on peroxide of hydrogen in high concentration. Frost is then photo-speeded up by means of a specific lamp which will allow to potentialiser still the action of the product. The length of this treatment is about one o’clock. It is the quickest technology, products are the most concentrating (peroxide of hydrogen in 35 % of concentration) is used in that case of. Cheeks and gums are protected, to isolate all soft cloths of the action of the frost of laundering. Session lasts one half an hour at one o’clock; envisage two sessions spaced out by two weeks for a good result.

Teeth whitening at home:
The dentist takes footprints for the manufacture of a gutter of the precise form of your teeth. This gutter, to hit or 1:30 am during day or during all night, during about 10 - 14 days, will then be delayed to you with the frost of laundering in the concentration adapted according to your case.Le dentiste prend des empreintes pour la fabrication d’une goutti?re de la forme exacte de vos dents. Cette goutti?re, ? porter soit 1 heure 30 durant la journ?e soit durant toute la nuit, pendant environ 10 ? 14 jours, vous sera ensuite remise avec le gel de blanchiment ? la concentration appropri?e selon votre cas.

At home, gutters will be filled with a frost clarifying the night based on peroxide of carbamide during six-eight hours, according to the concentration of the product which varies from 7 % to 15 %.

The combined home teeth whitening methods and dentists chair:

During the same session, the dentist accomplishes laundering first of all in the chair, followed by the catch of footprint for the manufacture of the gutter of the precise form of your teeth.Lors de la m?me s?ance, le dentiste r?alise tout d’abord le blanchiment au fauteuil, suivi de la prise d’empreinte pour la fabrication de la goutti?re de la forme exacte de vos dents.

This one then delayed to you with a frost of laundering in a specific concentration allowing to perform at home a small treatment of maintenance, so as to support a perfect shade longer.

In what cases undertake you they a laundering?

When they point out that the presence of a colouring or a dyschromie of the teeth who can be extrinsic or intrinsic.

- The extrinsic dyschromies: it is colouring which is not linked to the structure of the enamel. These last are due to the accumulation of food pigments or to those gifts in the tobacco in the course of time. They are yellow in general for those of food origin and grey in the case of the tobacco. This type of colouring, which becomes more marked with age, is from a distance the most frequent and the one who answers laundering the best.

- The intrinsic or structural dyschromies: these are colouring of the enamel or of dentine (dental structure under the enamel) affecting structure - even of the tooth, and acquired at the time of the training of this one. They can have several origins, most known is the catch of antibiotics, such as the t?tracyclines, during the training of the final teeth (3 months - 7 years old). She can have also a genetic origin.