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Bleaching of tetracycline-stained vital teeth

1979; Elsevier BV; Volume: 5; Issue: 5 Linguagem: Inglês

10.1016/s0099-2399(79)80026-6

1878-3554

Duane Compton,

Dental Erosion and Treatment

This paper regarding the methods and materials of bleaching vital teeth has been prepared at the request of Mrs. Elenore Baker, Executive Secretary of the AAE, in response to the tremendous number of inquiries she has received in the last few months on this subject. Mrs. Baker hopes a number of you in cities around the country will consider using this technique as part of your treatment regimen and will notify her that you will accept patients for the bleaching procedure. The bleaching of vital teeth is done mostly to children aged 10 years and older, into their 20s. It is explained to the patient that teeth stained yellow or yellow-brown bleach out better than do teeth stained gray or blue-gray. In n o instance do we get a 100% result; usualIy we do produce an improvement. The upper six anterior teeth are bleached initially. Two appointments are made; the patient is told that there will be some improvement after the first appointment, but the most dramatic change, if there is improvement, will be after the second appointment. After the second appointment, the patient is told to call back after three to five days to indicate if there has been enough improvement to proceed to the third (of a maximum of four) appointments. The period of three to five days is necessary because, immediately after the bleaching process, the teeth will appear whiter than they eventually will be as a result of the treatment. The initial whiter appearance is caused by the dehydration involved in the bleaching procedure. Parents and patient are asked to compare the upper anterior teeth with the lower incisors for change in color. If there is enough of an improvement, then a third, and possibly a fourth, appointment is made to bleach both the upper and lower six anterior teeth. There may be some reversion of the color of the teeth and rebleaching may be necessary. Prolonged exposure of the teeth to direct sunlight hastens the discoloration. The technique involves a prophylaxis of the upper six anterior teeth, and then isolation of the teeth with a leakproof rubber dam. Cotton pellets or a cotton roll cut in half longitudinally are moistened with 35% hydrogen peroxide solution and placed on the labial surface of the teeth. The foot end of the Indiana University Bleaching Instrument* is placedagainst the moist cotton until the patient indicates that he feels it, or for a count of eight seconds. The foot is then moved on to the next tooth until all the teeth have been contacted. The procedure is repeated over a 30to 45-minute period. The temperature of the machine should be placed at 130 to 145 F for the procedure, and approximately 20 to 30 minutes should be allowed for the instrument to warm up. Before and after the rubber dam is removed, the teeth are washed with water to remove the hydrogen peroxide. There may be some blanching of the gingiva if some of the bleach has leaked around the edge. This will dissipate within 24 hours. The teeth may feel sensitive for a day or two. In most offices, the technique, including the placement and removal of the rubber dam and the bleaching procedure itself, may be performed totally by the auxiliary personnel. The first two appointments, involving upper anterior teeth only, take 45 to 60 minutes each, and the third and fourth appointments, during which both upper and lower teeth are bleached, take approximately 90 minutes each. A complete discussion of the history, methods, materials, and results of the bleaching of vital teeth may be found in Arens and others (Oral Surg 34:812-817, 1972).