Maslow (1908-1970) the famous American psychologist said that: of the fundamental human needs an esthetic need exist which can be fulfilled only by beauty.

1. Bleaching and its Relevance
to Esthetic Dentistry
‫ا‬.‫م‬.‫د‬.‫العميدي‬ ‫حمدي‬ ‫امير‬
Ph.D. in Esthetic and Operative Dentistry

2. The demand for esthetic dental procedures is becoming increasingly popular; a
Beautiful smile has become a kind of business card and a must-have to match the
definition of beauty portrayed in the media worldwide. Tooth bleaching is one of the
most popular modern esthetic procedures as it improves the natural appearance of the
discolored dentition.
Maslow (1908-1970) the famous American psychologist said that: of the fundamental
human needs an esthetic need exist which can be fulfilled only by beauty.

3. Most recently, much attention has been devoted to the esthetic aspects of dentistry
and the patient’s concerns regarding appearance.
As the population’s dental awareness has grown, so has its demand for a natural smile.
The one inescapable fact is that patients are very eager to have whiter and brighter
smiles.

4. Initial Attempts at Bleaching
1877- Chapple—oxalic acid
1888- Taft—calcium hypochlorite
1884- Harlan—hydrogen dioxide
1895- Electrical currents
Non-Vital Bleaching Initiated
1895- Garretson
1911- Rosenthal—ultraviolet waves
1916- Kane—18% hydrochloric acid
Modern Bleaching Techniques
1918- Abbot—Superoxol and heat
Successful Non-Vital Bleaching
1958- Pearson—intrapulpal bleach
1967- Nutting and Poe—walking bleach
1978- Superoxol heat and light
Modern Techniques
1989- Munro—outpatient tooth whitening
1990s- General use—in-office vital bleaching
1995- Yarborough—laser-assisted beaching
Tooth Whitening Timeline

5. Because tooth bleaching does not affect the structural integrity of the dentition, there is
no relationship of tooth function and discoloration. Both staining and de-staining affect
only the appearance of the surface enamel and dentin layers through the deposition or
elimination of chromogenic molecules.
These stains do not affect the interocclusal or interproximal relationships of the dentition.
Thus there need be no concern about altering these relationships during the bleaching
procedure.
RELATING FUNCTION TO ESTHETICS

6. CONSERVATION CONCEPTS
Tooth whitening or bleaching is simply the most conservative procedure that is available
to the dental profession. De-staining of the teeth is even less abrasive than routine
prophylaxis and scaling. There is no loss of tooth structure, dentin, or enamel and no
weakening of the surfaces

7. CLINICAL CONSIDERATIONS
In-office bleaching is useful in the removal of stains throughout the arch (e.g., age, diet
or tetracycline staining), for lightening a single tooth in an arch (e.g., post-
endodontically), or perhaps even for treating specific areas of a single tooth (e.g., as in
some types of fluorosis).
In order to best serve their patients, dentists should ideally be familiar with both at-
home and in-office treatment modalities.
Some manufacturers claim the use of an in-office gel bleach decreases the incidence of
tooth sensitivity by reducing the tooth desiccation commonly observed with the liquid
and the liquid-powder products. The gels typically contain 10% to 20% water, which
serves to rehydrate the teeth throughout the bleaching procedure.

8. Many terms are used to describe in-office bleaching. They can be confusing
for the professional and even more so for patients.
• In-office bleaching contrasts the professionally monitored process with patient-
administered at-home procedures.
• Chairside bleaching is just another term that reflects the in-office nature of the
procedure.
• Power bleaching is a reference to the higher concentrations of bleaching materials that
are used.
• Laser bleaching refers specifically to a laser-light–mediated treatment but in practice is
the terminology used to describe any light source that is utilized as part of a whitening
process. The light may be an argon laser, a diode laser, a curing light, or a proprietary
“activating” light.

9. Indications
The only necessary indication for tooth whitening is the patient’s desire for whiter
teeth.
Bleaching techniques are use to treat some or all of the following:
• Developmental or acquired stains
• Stains in enamel and dentin
• Yellow-brown stains
• Age-yellowed smiles
• White or brown fluorosis
• Mild to moderate tetracycline stains

10. Contraindications
1-Any patient who is allergic or sensitive to any of the bleaching components or
materials should not attempt the treatment.
2-Women who are pregnant or nursing should also not undergo tooth bleaching (there
is no evidence that such effects have ever occurred, but safe is better than sorry).
3-Vital tooth bleaching techniques, whether performed at home or in office, should be
avoided for teeth with large pulp chambers or those that have exhibited sensitivity.

11. Contraindications
4-Patients with erosions, whether chemical, abrasive, or caused by recession
(insufficient enamel to bleach), may experience more bleaching sensitivity through
and after treatment, and thus these erosions should be treated before treatment.
5-Factors that can limit the success of bleaching are the degree and quality of the
discoloration (This is particularly true with stains in the gray-blue range, which do not
respond as well to whitening as stains in the yellow-brown range ).

12. Staining and discoloration of the teeth can be caused by many factors:
Extrinsic Stains
Tobacco
Foods and beverages
Medications
Intrinsic Stains
A-Pre-Eruptively Caused Discolorations
Alkaptonuria
Amelogenesis imperfecta
Dentinogenesis imperfecta
Endemic fluorosis
Erythroblastosis fetalis
Porphyria
Sickle cell anemia
Thalassemia
Tetracycline staining
B-Post-Eruptively Caused Discolorations
Age
Dental metals
Foods, beverages, and habits such as smoking
Idiopathic pulpal recession
Non-alloy dental material
Traumatic injury

13. Amelogenesis imperfecta, hypocalcified type
Moderate form of fluoride mottling with ridges of hypoplasia
Clinical and radiographic photograph appearance
of dentinogenesis imperfecta.
(From Ibsen O, Phelan J: Oral pathology for the dental hygienist, ed 5, St Louis, 2009, Saunders)

14. Teeth stained as a result of tetracycline administration. This is an extreme example of
tetracycline staining: the entire enamel (and dentin) has become pigmented. As the staining
is built into the structure of the tooth, bleaching procedures do not usually greatly improve
the appearance of these teeth. Crowns or, more conservatively, veneers will do so. (From
Berkovitz BKB, Holland GR, Maxham BJ: Oral anatomy, histology, and embryology, ed 4, St
Louis, 2010, Mosby.)

15. Complications with Stronger Bleach Concentrations
Stronger concentrations of hydrogen peroxide, such as 35%, can cause soft tissue damage,
gingival ulcerations, and skin burns. These soft tissue irritations appear as a white lesion
surrounded by a red rim.
It is advisable to use soft tissue protection for most in-office bleaching techniques: rubber
dam or light-activated liquid resin soft tissue coverage.
Isolation and retraction Application of LED light

16. The Different Bleaching Treatments
Basic bleaching treatment patients have healthy teeth requiring no restorative dentistry.
Bleaching treatments are straightforward: either a home bleaching treatment, such as
night guard vital bleaching, or a single power whitening session. It can take up to 6 weeks
to reach shade B1.
Intermediate bleaching is a combination of treatments such as non-vital bleaching and
home bleaching, home bleaching and micro-abrasion, or home bleaching or power
bleaching followed by home bleaching. It may take 4 to 8 weeks to reach shade B1. These
patients may require some basic restorative dentistry after whitening.
Advanced bleaching could require a combination of bleaching treatments and/or
advanced restorative dentistry or advanced esthetic dentistry. These treatments can
include extensive tetracycline bleaching, which can take 6 to 52 weeks to improve the
shade to B1.

19. Evidence-Based Principles
A large body of evidence-based scientific data is
available to support both the safety and the
efficacy of bleaching.
Bleaching actually works on the basis of dissolving
long-chain stain molecules within the enamel and
the dentin.
Short-chain stain molecules enter the enamel
lattices and dentinal surfaces, where they
join with double bonds to form longer-chain
molecules, which are not easily dislodged.
Over time the buildup of long-chain stain
molecule formation within the enamel and
dentin makes the tooth appear darker.

20. Bleaching actually works

29. THANK YOU