BLEACHING:

Whitening of a tooth through the application of

chemical agents to oxidize / reduce the organic
pigmentation in the tooth.

BLEACHING OF DISCOLORED TEETH:

Causes:
1. Decomposition of pulp tissue.
2. Excessive hemorrhage following pulp
removal.
3. Trauma.
4. Medicaments.
5. Filling Materials.

May be due to systemic conditions like

Red or Purple

Congenital porphyria

Violaceous

hereditary opalescent dentin

Mottled brown

Endemic fluorosis

Grayish brown

Erythroblastosis foetalis

Brown -

Jaundice.

Yellow brown Gray Tetracycline

group of Antibiotics

Classifications:
Extrinsic Discoloration
Intrinsic Discoloration

Extrinsic Discoloration:
Found on the outer surface of the teeth and are usually of
local origin.
Tobacco Stains
Tea Stains
Nasmyths membrane in children
Silver nitrate
Rx
Oral prophylaxis

Intrinsic Discoloration:
Stains within the enamel and dentin caused by deposition or
incorporation of substances within these structures.
Eg: Tetracycline stains

Fluorosis Stains

Dentinogenesis Imperfecta Systemic conditions

Pulp necrosis

Iatrogenic.

Pulp Succumbs to trauma

Hemoglobin
Breaks down
Hemin
Hematin
Hematoidin
Hematoporphyrin
Hemosiderin
Hydrogen sulfide (Bacteria)
Darkens The Tooth

Bleaching Agents:
Superoxol

30% solution of hydrogen peroxide by

weight and 100% volume in pure distilled

water.

stored in

It is clear, colorless, odorless liquid

light-proof amber bottles.

It is unstable and should be kept away from heat

Care to be taken during

handling as it has

its

chemical effect on skin and mucous membrane

Superoxol can be used alone or mixed with Na

Perborate into a paste for use in walking bleach.

Sodium Perborate:
It is a stable, white powder supplied in a granular form. It is
water soluble and decomposes into Na metaborate and
hydrogen peroxide releasing O2
Na P + H2O2

H2O + Na. M + O2

When sealed into pulp chamber it oxidizes and discolors

the stain slowly continuing its activity over a longer period
of time Walking bleach

Indications:
Discolored Teeth
Contra Indications:
1. Too much sensitivity because of erosion of enamel,
extremely large pulp, exposed root surface etc.
2. Teeth with white or opaque spots.
3. Extremely dark stains especially those with banding
or with uneven distribution.
Eg: dark tetracycline stains.

Teeth that have been bonded, laminated or have

extensive restorations.
5

Patients who are perfectionists or who do not have

a good understanding of what bleaching can and

cannot do for them.

Techniques for Bleaching:

The goal of bleaching procedures is to restore the
normal color to a tooth by decolorizing the stain with
powerful oxidizing or reducing agent.

The oxidizing agents used are superoxol [30% H2O2]

and sodium perborate.

The technique differs in the method used to activate

the superoxol to liberate O2

Whereas walking bleach uses reaction of Na

Perborate

with superoxol

The other technique uses heat and light.

Different bleaching techniques :

For non vital tooth In office bleach (Thermo catalytic)
Walking bleach
For vital tooth Mc Innes
Modified Mc Innes
Micro abrasion
Thermo catalytic
Photo flood lamp (bleach light)
Night guard / Matrix bleaching
White strips

TECHNIQUE FOR BLEACHING

PULPLESS TEETH

WALKING BLEACH OR

NON VITAL BLEACHING

Steps:
1. Prepare the tooth polishing, remove surface debris
2. Apply petroleum jelly to gingival tissues
3. Adapt the rubber dam
4. Re-establish the access cavity
5. Remove any GP that extends into the pulp chamber to
the level of alveolar bone.

6.

Seal the orifice of the root canal with at least 1mm

glass

ionomer cement to prevent percolation of the

bleaching agent into the apical area.

7.

Remove the smear layer with 30% orthophosphoric

acid

8.

Flush Naocl and water to remove acid.

also EDTA and Naocl may be used

9.

Protect the patients face.

10.

Mix sodium per borate and superoxol and carry the

thick paste into pulp chamber and cover the facial
surface of the pulp chamber with paste.

11.

Place a cotton pledget over the bleaching paste.

12.

Seal the cavity with IRM.

Maximum bleaching effect is attained after 24 hrs

To be recalled with in 3 7 days for evaluation

If the shade is not proper it has to be repeated

Generally 2 sittings have to be performed to

restore the normal color.

Heat and light bleaching:

Tooth preparation is the same.

Later, a loose material of cotton is placed on labial

surface and another is placed in the pulp chamber of

the tooth and the cotton is saturated with superoxol.

This solution is activated by exposing it to light and

heat from a powerful light
i.e Heat and light from photo flood lamp is aimed

directly on the tooth from a distance of 2ft

temperature ranges from 115-140F.

and

Superoxol is added to the cotton every 5 min.

The tooth is subject to several six,5 min exposures.

On completion, a cotton pellet moistened with

superoxol or superoxol + Na Perborate is sealed in
the pulp chamber until the next appointment.

Walking bleach is preferred to Heat and light method

as it is -

Easy to perform.

- Consumes less time

- Requires no special equipment.

Thermocatalytic Method:
An alternative method, to activate superoxol is
the application of a thermostatically controlled electric
heating instrument or a stainless steel instrument such as
woodson No.2, heated over a flame.
When heat is used the temperature is 46-60C.

Vital Teeth Bleaching:

Mc Innes Method:
Solution consists of 1 part anesthetic ether - 0.2ml
5 Parts 36% HCl

- 1ml

5 parts 30% H2O2

- 1ml

Ether removes surface debris

HCl etches the enamel

H2O2- bleaching agent

Technique:

Polish the crown.

Apply petroleum jelly onto the gingiva.

Isolate teeth with rubber dam.

Always solution is freshly mixed and applied to the

enamel surface for 5mins at 1 min intervals.

On completion, the solution is neutralized with NaOCl

irrigation and water.

Again the bleached surface is polished.

This is repeated 2-3 times until the shade is obtained.

Disadvantages of old McInnes

solution
1) Loss of contour
2) Sensitivity
3) Irritation to gingiva

Modified Mc Innes solution:

HCl Acid is replaced by 20% NaOH

In this technique, the teeth are etched with HCl and

then bleaching procedure is continued

Night Guard / Matrix Bleaching:

This uses a vacuum formed soft mouth guard and10%
carbamide peroxide to bleach the teeth
There are 2 basic regimens for application of this solution
a)

Over night use of night guard filled with bleaching

material .

b)

Use of loaded night guard during the day

- Solution is changed every 1 - 2 hrs
- Rx time is usually 4-6 wks for night time bleaching
1-3 wks for day time with
multiple application.

Make primary impression and pour a cast.

Make reservoirs on the cast on the labial aspect.

Prepare the poly resin tray with the help of vacuum

form machine.

The tray is trimmed and extended 1mm short of the

gingival margin on the labial aspect to avoid

irritation of

gingiva by the bleaching material.

for fit.

Tray is then tried on the patients mouth to check

Disadvantages
1. The solution may initially cause tissue irritation on gingival

papilla in 1st week of Rx

2. Some teeth may become more sensitive to temperature

change.
-

More lab procedures

Patient complains of gag reflex while using tray

White strips:
Which is a thin flexible polyethylene strips
which contains 5.3% hydrogen peroxide in gel
form. The strips are used for 30 minutes twice
daily for 14 days.

Prevention of tooth discoloration:

-

Proper access cavity preparation that permit complete

removal of pulp tissue including pulp horm.

All traces of blood should be removed by through

irrigation.

Any defective restoration should be removed.

Non staining medicaments and materials to be used

During bleaching procedure root canal sealer and

obturating material should be removed from pulp chamber

beyond a level of 1margin.

3mm apical to free

gingival