Authors: ADEPT Report.
Title: Lightening natural teeth.
Journal: Winter 1991
Date: Dec 1991
Citation: Vol.2, No.1
Category: Bleaching/Tooth Whitening
Evidence-based Ranking: 5
Purpose/Objectives: A review of all aspects of teeth whitening

Review: 1) Considerations a) Bleaching occurs by oxidation, removal of electrons, which breaks down large, organic, pigmented molecules into smaller, less pigmented constituents. b) Today’s most common bleaching agents are hydrogen peroxide and carbamide peroxide. 2) Indications a) External bleaching – teeth with mild uniform yellow discolorations b) Enamel microabrasion – superficial white, brown, and yellow spots c) Restorations – very dark or black stains, heavily restored or carious teeth d) Internal bleaching – stains from blood breakdown products, endodontics or receded pulp chambers. Tetracycline stains respond best to internal bleaching. 3) Risks a) Peroxides are mutagenic and can increase the effects of carcinogens. b) Pulpal inflammation, sensitivity, and external root resorption. 4) General Considerations a) Tetracycline stains can improve with long term external bleaching but respond best to internal bleaching. b) Using heat increases pulpal irritation. c) Acid etching the pulp chamber increases rate of internal bleaching. d) Always obtain pre and post photographs. e) Peroxides can “burn” soft tissue. f) Always seal pulp chamber before internal bleaching to prevent external resorption, glass ionomers should not be used for this because they can absorb the bleach.