60 Facts for Teeth Whitening

Jeff Davies
Nov 14, 2015
4 min read

Photo Source: Johan Figueira. PhotoShop Design, Shade Analysis. ( https://www.facebook.com/johan.figueira.1.)

Bleaching is one of the ultimate noninvasive treatments that we can offer to our patients. Teeth whitening has become somewhat of a trend lately. It seems that everywhere you look, products are claiming “whiter teeth”, “removes stains”, and even DIY at home bleach kits. Patients want whiter teeth. The examination prior to prescribing bleaching needs to be thorough to make sure the correct treatment is being offered. Here is a list of 60 facts that should be considered prior to prescribing a successful bleaching treatment in your office.

A proper pre-bleaching examination should include a radiographic component to detect possible etiologies of discolored teeth.
Anterior caries can be easily detected if no current anterior radiographs are on record.
Any single dark tooth should have a periapical radiograph taken to detect pathology or resorption.
Apical pathology can result in no pain, swelling, mobility or any other clinical symptoms, other than discoloration.
Teeth may take up to 20 yrs to show evidence of apical pathologies after trauma, while showing little or no symptoms.
Teeth can become darker with or without pulpal death after trauma.
Its preferred to bleach rather than preform endodontic therapy on a tooth with nonvital pulpal status with the absence of of clinical symptoms.
Teeth that have resorption, after trauma, may still be vital, but just discolored.
Any loss of time due to improper diagnosis of the discoloration may result in the loss of a tooth.
Periodontal surgery may be necessary to address resorption.
Orthodontic extrusion with crowning may be needed rather than bleaching.
Teeth with calcified canals may respond positively or negatively to vitality testing.
Teeth that are calcified may take longer to achieve the desired result.
Special trays are made to treat that specific tooth alone to test the maximum color change possible.
Radiographs can determine other abnormalities such as tumors, or cysts, which may affect the color of the tooth.
Clinical examination needs to be preformed to detect possible cancerous lesions, abscesses, or other pathologies.
Caries can make the tooth appear dark.
Discolored restorations can make the tooth look darker than normal.
Exposed roots don't bleach in the same manner as the anatomic crown.
Stronger discoloration at the gingiva will be less responsive to bleaching.
White spots should be noted.
White spots cannot be removed with bleaching.
When white spots exist, the goal is to match the rest of the tooth to that white spot.
Typically, short teeth and a gummy smile do not look better after bleaching.
Whiter teeth tend to accentuate the gummy smile.
Periodontal plastic surgery is preferred to treat these patients prior to bleaching.
Whiter teeth make gingival defects and cross-arch harmony more noticeable.
Patients look best when the color of their teeth match the white portion of their eyes.
Matching the white of the eyes is a better end point than a certain color of a shade guide.
Composite and ceramic do not bleach.
Replacing existing restorations may be needed if they do not match the new tooth color.
Patents should be evaluated to detect translucent incisal edges.
Teeth can become either more opaque or more translucent with bleaching.
A white gloved finger can be placed behind the translucent area to see if it discolored or translucent.
If the discoloration goes away, it is translucent, and wont respond well to bleach.
If the discoloration stays, it is discolored, which generally will respond well to bleaching.
Translucency can be from lingual erosion.
This may be associated with medical issues, additional bonding would be necessary to protect dentin from erosion.
If bruxing is an issue, bonding may not be a suitable option.
Tetracycline causes discolorations.
Tetracycline staining doesn't always happen during tooth formation.
Minocycline, a treatment for acne, causes staining in adult teeth.
Tetracycline class drugs are deposited in secondary dentin and secreted in saliva to be absorbed into the tooth much like iron stains.
There is no good substitute for minocycline.
Patients on these types of drugs need to expect a longer duration of treatment.
Patients with teeth sensitivity should use the lowest concentration of bleach in the tray.
They should brush with toothpaste that contains potassium nitrate.
Patients may also need to place desensitizing material, which contains potassium nitrate, in the tray to avoid sensitivity.
Brushing with desensitizing toothpaste for two weeks before bleaching can reduce sensitivity.
Do not initiate bleaching same day as a prophylaxis, as teeth and gingiva maybe sensitive.
The TMJ should be evaluated to see the bite relationship of the patient.
Different tray designs maybe indicated with TMJ issues.
Using a single tray will aid in minimizing occlusal insult.
In office treatment maybe indicated with more serious TMJ conditions.
A single tray will also help to minimize sensitivity.
Single trays are also more cost conscious which allows to determine the bleaching progress.
Endodontically treated teeth have different options available to them, such as bleaching from the inside out, a walking bleach technique.
Special single tooth trays are indicated to see if the tooth lighten enough to justify the complete treatment.
Material left in the pulp chamber will influence the color of the tooth.
Silver points in teeth are best left alone unless the patient is willing to retreat the canal.

The list is extensive but is worthy of consideration when offering the patient effective treatment. All of the material was taken from Dr. Van Haywood's article, that is found here, who has done extensive research on the topic. Take a look at his website. Its full of good information.