1. Discoloration of teethم3
Discoloration of teeth
Intrinsic discoloration
Extrinsic discoloration

2. Extrinsic stains
“located on the surface of the tooth and are most easily removed by external cleaning.”
Extrinsic color changes may be due to:
poor oral hygiene
ingestion of chromatogenic foods and drinks
tobacco use.

3. “located within the tooth and are accessible only by bleaching.”
Intrinsic stains
“located within the tooth and are accessible only by bleaching.”
Intrinsic color changes may be caused by :
aging
ingestion of chromatogenic foods and drink
tobacco usage
microcracks in the enamel
tetracycline medication
excessive fluoride ingestion
severe jaundice in infancy
dental caries
restorations

4. VITAL BLEACHING
Commonly known as, tooth whitening is a noninvasive method of lightening dark or discolored teeth.

5. Vital Bleaching Advantages
Low cost
High success rate
No tooth alteration

6. Vital Bleaching Disadvantages
Unpredictable results
Need Re-treatment
Possible side effects
Transient sensitivity

7. Dental bleaching agents
Composition
Carbamide peroxide 5% to 40%
Carbopol ( slow oxygen releasing)
Glycerin (thickening agent)
Sodium hydroxide
Flavors and fluoride

8. Mode of action
In saliva Carbamide peroxide converts to hydrogen peroxide, the active bleaching agent, and urea.
Hydrogen peroxide, typically generates short-lived oxygen intermediates, such as hydroxyl radical
It enters enamel or dentine and diffuse to areas of discoloration and breaks down some of the double bonds in discolored or stained compounds, results in whitened appearance.

9. hydroxyl radical Carbamide peroxide Hydrogen peroxide DOUBLE BONDS
UREA
Hydrogen peroxide
hydroxyl radical
DOUBLE BONDS

10. Bleaching Techniques In-office bleaching technique Laser bleaching
Dentist-prescribed, home applied bleaching
Non vital bleaching

11. In-office Bleaching (Clinical Protocol)
Clean teeth with pumice
Record pre-op shade
Isolate teeth as close to the gingival margin as possible with rubber dam

12. Mix the thickening agent with 35% hydrogen peroxide .
Place the gel material on the teeth for 30 min

13. Rinse and clean; remove rubber dam and record post-op shade

14. Laser bleaching
Lasers are also used within the clinical setting for dental bleaching.
Quick results
expensive

15. Recommended agents for bleaching
35% hydrogen peroxide for in office bleaching
10% carbamide peroxide for home bleaching

16. Contraindications of bleaching
Discoloration due to restorations
Children with large pulp horns and cracks
exposed roots and severe enamel loss

17. Non vital bleaching
 When the discoloration is from within the pulp chamber, from necrotic pulp tissue or from staining agents that are present in the pulp chamber, the bleaching treatment need to take place within the pulp chamber

18. Techniques for non vital bleaching
Thermocatalytic technique
Walking bleaching
Inside-outside bleaching

19. Recommendations Sodium perborate mixed with water OR
10% carbamide peroxide

21. Potential Results
Before
After

23. Alternatives to bleaching
Microabrasion
Veneers (Direct and Indirect)
Crowns