Essay on Achieve the Perfect Smile: Exploring Tooth Whitening Methods

Introduction

The perfect white smile portrayed by the media continues to raise the public's self-awareness of discolored teeth. Consequently, tooth whitening has become the most requested dental procedure as more people desire to achieve this perfect smile. In response to this, numerous choices for tooth whitening have been availed. There are various tooth whitening methods cited in the literature, each with their unique mechanism of action dependent on the particular tooth discoloration. They have different forms of substances like hydrogen and carbamide peroxide and in different concentrations. In addition to these substances, dentists use light sources, for example allogeneic, ultraviolet, laser and LED to potentiate the bleaching action1. Home-based methods use products like toothpaste, rinse, films, and gels while in-office based techniques utilize products containing highly concentrated bleaching agents, which are applied under professional supervision.

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Tooth whitening is the initial stage in the analysis and reproduction of the perfect white smile. However, this process is associated with adverse effects such as soft-tissue burns, gingival irritation, and tooth sensitivity. New research has identified other risks like the increased potential for demineralization, tooth surface roughening and softening, and degradation of dental restorations1. However, when the manufacturer's instructions are followed, these substances can be safe and effective. Therefore, dentists must know how to diagnose the causes of tooth discoloration and to indicate the best tooth whitening technique. Additionally, dentists should inform patients about the risks associated with each method and instruct them on the identification of adverse effects so that they may seek professional help as required. Moreover, with the technological advancement, tooth-whitening techniques that facilitate use and improve safety, comfort and time reduction have emerged2. Hence, the purpose of this paper is to review current research to compare and contrast in office and at-home tooth whitening techniques.

Mechanisms of Tooth Whitening

Various tooth whitening methods have been reported since the introduction of the whitening process in 1889. Two of the most used approaches are in-office or power bleaching and at-home or dentist-supervised bleaching. In-office whitening uses a high concentration of tooth-whitening agents (25-40% hydrogen peroxide) 1. The dentist has complete control throughout the procedure and can stop it when the desired effect is attained. In this procedure, the whitening gel is applied to the teeth after the protection of the soft tissues, and the peroxide is further activated by heat or light for approximately one hour in the dental office. Conversely, at-home whitening normally involves the use of a low concentration of whitening agent (10-20% carbamide peroxide or 3.5-6.5% hydrogen peroxide) 1. Patients conduct this treatment by themselves although dentists should supervise it during recall visits. The whitening product is applied to the teeth through a custom-made mouthguard worn at night for at least two weeks.

Certainly, the efficacy of in-office tooth whitening methods may vary from at-home bleaching. Jala et al.1 conducted a comparative evaluation of the two techniques on a sample of 80 freshly extracted human incisor teeth. They concluded that although the carbamide peroxide (15%) used in the at-home method is as effective as 37.5% hydrogen peroxide, the in-office bleaching treatment showed comparatively better results immediately and post one day after the whitening process. This can be attributed to the activation with heat or light, which fastens the whitening process. Nevertheless, at-home whitening with a higher concentration of carbamide peroxide resulted in a better shade change.

In another study conducted by Nie et al.2, the color changes were clinically distinguishable between in-office and at-home technique. However, unlike in the study by Jala et al.1, here at-home whitening was found to more effective than in-office in Chinese patients. Hence, although the patients were satisfied with both whitening treatments, satisfaction scores were higher for at-home techniques than in-office procedures.

In addition to efficacy, the effects of in-office whitening techniques on patients vary from at-home methods. According to a study by Silveira et al.3, dental sensitivity was significantly different between the two bleaching approaches. Highest sensitivity rates were observed during in-office whitening sessions, possibly because of the use of a bleaching agent with a high concentration of hydrogen peroxide. Hydrogen peroxide can increase enamel and dentil permeability and the chances of sensitization of nervous terminations in the dentin structure, leading to discomfort in patients. These results were in agreement with those of Nie et al.2, who established that at-home techniques were associated with a lower frequency of tooth sensitivity compared with in-office methods. However, Silveira et al.3 attributed the absence of severe discomfort during either method to the presence of desensitizing agents like potassium nitrate and 0.5%-0.115 fluoride ions in the at-home bleaching gel. These agents reduce dental sensitivity significantly after whitening procedures.

However, a systematic review by De Geus et al.4 did not detect any differences either concerning intensity of tooth sensitivity or the effectiveness of at-home and in-office whitening. Mostly, this arose from the delivery of in-office bleaching products at low pH in most of the analyzed studies. As previously noted in the study by Silveira et al.3, low pH agents reduce dental sensitivity significantly after whitening procedures. Therefore, they recommended further clinical trials comparing both techniques to allow a more comprehensive evaluation of the variants of the whitening techniques. Rodrigues et al.5 made similar conclusions after unearthing that there was no difference between the evaluated bleaching procedures. In particular, both procedures achieved similar tooth color. Additionally, for both whitening techniques evaluated, there was some degree of pulp inflammation. Nevertheless, considering that a reduction in the inflammatory process is time- and pH-dependent a lower degree of inflammation could be expected in at-home procedures. Hence, the presence of a more inflamed pulp in in-office techniques could favor at-home methods even at lower concentrations of the bleaching agent containing carbamide peroxide.

Conclusion

In summary, the rising demand for tooth whitening has driven manufacturers to develop whitening products to be used either in the dental office or at home. Nevertheless, as with any dental procedure, these methods involve risks such as soft-tissue burns, gingival irritation, tooth sensitivity, the potential for demineralization, tooth surface roughening and softening, and degradation of dental restorations. For that reason, this review article has analyzed previous research comparing in-office and at-home tooth whitening methods to make a conclusion on which one is safer. Certainly, in-office procedures are associated with more adverse reactions than at-home methods mainly because of the high concentration of hydrogen peroxide used. However, better results are evident in in-office techniques. However, researchers need to conduct further clinical trials comparing both techniques to allow a more comprehensive evaluation of the variants of the whitening techniques. Notwithstanding, dentists should inform their patients about the reactions that may occur during and after a bleaching procedure.

References

Jala S, Ahuja R, Singh A, Abraham D. Comparative Evaluation of the Efficacy of In-Office Bleaching (37.5% Hydrogen Peroxide) and At-Home Bleaching (15% Carbamide Peroxide) Using Different Activation Systems. International Journal of Medical Science and Clinical invention. 2017; 4(5). doi:10.18535/ijmsci/v4i5.12

Silveira M L, Bruniera AR, dos Santos P H, et al. Clinical Comparison of At-Home and In-Office Dental Bleaching Procedures: A Randomized Trial of a Split-Mouth Design. International Journal of Periodontics & Restorative Dentistry. 2016; 36(2). http://www.quintpub.com/userhome/prd/prd_36_2_Machado_p250.pdf

Nie J, Tian FC, Wang Z H, Yap AU, Wang XY. Comparison of efficacy and outcome satisfaction between in-office and home teeth bleaching in Chinese patients. Journal of oral science. 2017; 59(4): 527-532. https://www.jstage.jst.go.jp/article/josnusd/59/4/59_16-0636/_pdf

De Geus JL, Wambier LM, Kossatz S, Loguercio AD, Reis A. At-home vs in-office bleaching: a systematic review and meta-analysis. Operative dentistry. 2016; 41(4): 341-356. doi: 10.2341/15-287-LIT

Rodrigues JL, Rocha PS, Pardim SL, Machado AC, Faria-e-Silva AL, Seraidarian PI. Association between in-office and at-home tooth bleaching: A single blind randomized clinical trial. Brazilian dental journal. 2018; 29(2): 133-139. http://dx.doi.org/10.1590/0103-6440201801726