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)AIN ! 0RETTY
2OGER 0 %LLWOOD 0AUL ! "RUNTON AND !MIN !MINIAN
6ITAL 4OOTH "LEACHING IN $ENTAL
0RACTICE 0ROFESSIONAL "LEACHING
!BSTRACT !S DENTAL HEALTH IMPROVES WITH THE CONCURRENT DROP IN THE PROVISION OF BASIC RESTORATIVE CARE PATIENTS ARE NOW ASKING THEIR
DENTISTS TO PROVIDE AESTHETIC TREATMENTS RATHER THAN THE TREATMENT OF DISEASE 4OOTH BLEACHING IS ONE SUCH TREATMENT THAT IS FREQUENTLY
DESCRIBED IN CONSUMER MAGAZINES AND TELEVISION SHOWS DRIVING CONSUMER INTEREST IN THIS APPARENTLY BENIGN THERAPY 4HIS THREE
PART SERIES
DEMONSTRATES THE TECHNIQUES THAT CAN BE EMPLOYED WITHIN THE DENTAL PRACTICE OR UNDER THE SUPERVISION OF A CLINICIAN THOSE SYSTEMS THAT
CAN BE BOUGHT BY PATIENTS OVER THE COUNTER AND FINALLY A DISCUSSION OF THE BIOLOGICAL EFFECTS OF PEROXIDE
CONTAINING SOLUTIONS AND THE LEGAL
POSITION ON SUCH PRODUCTS IN THE 5+
)N THIS SECTION WE WILL DESCRIBE THE COMMON METHODS BY WHICH TEETH CAN BE BLEACHED EITHER BY THE CLINICIAN DIRECTLY OR UNDER
HISHER SUPERVISION BY THE USE OF @AT HOME KITS %FFICACY AND SAFETY ISSUES WILL BE DESCRIBED
#LINICAL 2ELEVANCE #LINICIANS SHOULD BE ABLE TO DISCUSS THE MERITS RISKS AND LIKELY SUCCESS OF A VARIETY OF BLEACHING TREATMENTS WITH THEIR
PATIENTS AND IN DOING SO ASSIST IN THE PROCESS OF OBTAINING INFORMED CONSENT
$ENT 5PDATE
4HE NATIONS DENTAL HEALTH IS CHANGING AND
THERE IS A SHIFT IN THE 5+ DENTAL PARADIGM
FROM THE TREATMENT SOLELY OF DISEASE NOW TO
INCLUDE THE PROVISION OF AESTHETIC SERVICES
3UCH SERVICES ARE INCREASINGLY DEMANDED BY
OUR PATIENTS AND RANGE FROM THE PROVISION
OF TOOTH
COLOURED RESTORATIVE MATERIALS
VENEERS CERAMIC CROWNS ORTHODONTICS AND
OF COURSE TOOTH WHITENING
$ENTAL5PDATE
#AUSES OF TOOTH DISCOLORATION
4HERE IS A PLETHORA OF CAUSES OF
TOOTH DISCOLORATION AND COMMONLY STAINS
OR DISCOLORATIONS ARE DIVIDED INTO THOSE OF
EXTRINSIC OR INTRINSIC ORIGIN !LSO A FURTHER
CLASSIFICATION OF INTERNALIZED STAIN HAS BEEN
SUGGESTED !NY GIVEN TOOTH CAN EXHIBIT
EITHER ONE OR A COMBINATION OF THESE )T
IS IMPORTANT TO IDENTIFY THE CAUSE OF TOOTH
DISCOLORATION PRIOR TO COMMENCEMENT OF
TREATMENT AS THE SUCCESS OR OTHERWISE OF
SUCH PROCEDURES IS HEAVILY DEPENDENT ON
CORRECT DIAGNOSIS )T IS ALSO IMPORTANT TO
NOTE THAT IN THE AUTHORS EXPERIENCE MANY
PATIENTS WILL PRESENT FOR TOOTH WHITENING
WHEN THERE IS NO OBVIOUS DISCOLORATION
THE PATIENT MERELY WISHING TO HAVE @WHITER
TEETH
#OMMON CAUSES FOR TOOTH
DISCOLORATION ARE SHOWN IN 4ABLE WITH
EXAMPLES IN &IGURES AND $ISCUSSION WITH
THE PATIENT A THOROUGH HISTORY INCLUDING
A DIET AND SOCIAL HISTORY CAN HELP IN THE
DETERMINATION OF THE CAUSE OF EXTRINSIC
STAINING &OR EXAMPLE HEAVY TEACOFFEEWINE
DRINKERS ARE ESPECIALLY PRONE TO EXTRINSIC
STAINING AS ARE THOSE WHO SMOKE CIGARETTES
0ATIENT EDUCATION WITH REGARD TO THE CAUSE
OF THEIR TOOTH STAINING IS LIKELY TO INCREASE
THE SUCCESS OF THE TREATMENT ESPECIALLY IF
SUCH HABITS ARE REDUCED POST
OPERATIVELY
4HE PROVISION OF A WHITER BRIGHTER SMILE AND
THE DESIRE TO KEEP IT THAT WAY CAN PROVE TO
BE A POWERFUL MOTIVATOR
)NTRINSIC DISCOLORATION IS
THE RESULT OF A CHANGE TO THE STRUCTURAL
FORM OR COMPOSITION OF THE DENTAL HARD
TISSUES 4HERE ARE A NUMBER OF METABOLIC
DISEASES AND SYSTEMIC FACTORS AS WELL
AS PHARMACEUTICAL PRODUCTS WHICH CAN
AFFECT THE DEVELOPING DENTITION %XTRINSIC
DISCOLORATION IS PRESENT ON THE SURFACE
OF THE ENAMEL OR ACQUIRED PELLICLE AND IS
GENERALLY SEPARATED INTO A METALLIC OR NON
METALLIC ORIGIN )NTERNALIZED STAINS ARE THOSE
INTRINSIC STAINS THAT OCCUR SUBSEQUENT TO
DENTAL DEVELOPMENT ENTERING THE DENTAL
HARD TISSUES THROUGH ENAMEL DEFECTS OR
THE NATURALLY POROUS SURFACE OF EXPOSED
DENTINE 3UCH DEFECTS CAN BE DEVELOPMENTAL
OR ACQUIRED
)T IS IMPORTANT TO DETERMINE
*UNE
2ESTORATIVE$ENTISTRY
)NTRINSIC
!MENABLE TO BLEACHING TREATMENT 9OR8