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An update on discoloured teeth and bleaching part 2: mechanism of action of bleaching agents and management of discoloured teeth Raj Dubal Richard WJ Porter Dental Update 2024 45:8, 707-709.
The term ‘discoloured teeth’ describes a very broad array of clinical manifestations which can result from an equally broad list of aetiologies. The ability to assess and diagnose the cause accurately allows clinicians to prescribe and execute the appropriate treatment modality and avoid disappointing outcomes and potential overtreatment. This article aims to provide an overview of the current legislation related to dental bleaching, the mechanism of action of bleaching agents and an update regarding the techniques which are at practitioners' disposal for managing different clinical challenges. The potential risks and complications related to bleaching are presented.
CPD/Clinical Relevance: A sound understanding of the different bleaching materials and techniques available and their appropriate application are essential in helping clinicians to provide appropriate, safe and effective treatment modalities.
Article
Teeth bleaching is a commonly requested and provided treatment modality. A number of different bleaching agents have been described in the literature. The most frequently used bleaching agents are hydrogen peroxide or carbamide peroxide. Carbamide peroxide breaks down to produce urea and hydrogen peroxide and it is the latter of these products which is responsible for whitening teeth. In a split mouth trial by Mokhlis et al, the efficacy of 20% carbamide peroxide and 7.5% hydrogen peroxide were compared. There was found to be no difference in outcome, although teeth whitened with carbamide peroxide appeared lighter than the hydrogen peroxide group at 14 days. There was no difference in lightness at 12 weeks, and there was no difference with regards to gingival irritation or tooth sensitivity.1
The use of sodium perborate for internal bleaching was first described by Spasser in 1961.2 His technique of sealing sodium perborate with water within the pulp chamber was modified by Nutting and Poe in 1967, who replaced the water with hydrogen peroxide, and suggested the phrase ‘walking bleaching’.3 Both reports describe the sealing of chemicals within the pulp chamber, after which the patient was able to leave the office and return for review at a later date. Perborate-based materials are reported to release greater quantities of hydrogen peroxide than 10% carbamide peroxide, and do not have a discernibly more effective action. However, the use of sodium perborate was banned in the European Union, as of 1st December 2010. Its use in cosmetic products is prohibited in Article 15(2) of the Cosmetics Regulation 1223/2009 as a result of it being classed as carcinogenic, mutagenic or toxic for reproduction.4,5 This is also reiterated on the General Dental Council website.6
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