02‐Sep‐20

Bleaching Materials
By: Dr. Muhammad Hassan
PhD. (UK), MFGDP (UK), MSc. (UK), BDS (PAK)
Head of Department
Science of Dental Materials
University College of Dentistry, UOL

“The lightening of the color of a tooth

through the application of a chemical agent to
oxidize the organic pigmentation in the tooth
is referred to as bleaching.”

Causes of tooth discoloration

• Extrinsic – present on the outer surface of teeth

• Intrinsic – present with in the tooth structure

• Strain Internalization – extrinsic stain enters the tooth through

defects in the tooth structure

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• Metabolic
• Inherited
Intrinsic • Iatrogenic
Discoloration • Traumatic
• Idiopathic
• Ageing

• Diet related stains

• Bacterial stains
Tooth Extrinsic • Gingival Hemorrhage
Discoloration • Chlorhexidine
Discoloration • Marijuana and Tobacco
• Polyvalent metal salts

• Tooth wear
Strain • Gingival recession
Internalization • Caries
• Restorative materials

Management of Discolored Teeth

Treatment options:
1. No treatment
2. Removal of surface stains
3. Bleaching techniques
4. Operative techniques to mask underlying discoloration
• Veneers
• Crowns

Indication

• Mild discoloration on surface

• Evenly distributed discolorations without bands or white spots

• Teeth discolored as their innate colors or ageing

• Hemorrhagic discoloration

• Discoloration of anterior teeth after RCT

• Medication discoloration

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Contraindication
• Sensitive teeth i.e. severe cases of attrition, abrasion, erosion or
abfraction.
• Cracks, hypoplastic or severely undermined enamel.
• Extensive restorations.
• Discolorations in the gray, blue gray or black range .
• Discolouration by metallic salts, particularly silver amalgam,
• Enlargement of the pulp or other disease that makes the tooth sensitive
to bleaching solutions

Contraindication….

• Generalized dental caries

• Lack of compliance

• Pregnancy and nursing

• Peroxide allergy: A carefully applied rubber dam can help prevent

reactions.

Bleaching
Techniques

Vital Non‐vital

In Office At Home In Office At Home

Power
Night Guard Thermocatalytic Walking Bleach
Bleaching

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Bleaching Materials

• Hydrogen peroxide

• Sodium perborate

• Carbamide peroxide

Hydrogen Peroxide
• Various concentrations of this agent are available, but 30 to 35%
stabilized aqueous solutions (Superoxol) are the most common.
• Clear, colorless, odorless liquid, stored in lightproof amber
bottles.
• Unstable and should be kept away from heat, which could cause it
to explode.
• Can alone be used or mixed with sodium perborate into a paste for
use in the ‘Walking bleach’.
• Caustic and burns tissues on contact.
• Delivery in an alkaline medium improves its oxidizing
efficiency.

Sodium perborate
• Oxidizing agent is available in a powdered form or as various commercial preparations.
• When fresh, it contains about 95% perborate, corresponding to 9.9% of the available
oxygen.
• Sodium perborate is stable when dry
S.P + H2O  S.M.Borate + H2O2

S.P + H2O2 S.M.Borate + H20 + O2

• Three types of sodium perborate preparations are available:
• Monohydrate
• Trihydrate
• Tetrahydrate

• They differ in oxygen content, which determines their bleaching efficacy

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Carbamide peroxide

• Also known as urea hydrogen peroxide,

• Is a bi‐functional derivative of carbonic acid

• Available in the concentration range of 3 to 45%.

• Popular commercial preparations contain about 10% carbamide

peroxide,

• Mean pH of 5 to 6.5.

C.P  3% H2O2 + 7% Urea

H2O2  H2O + 2(O) and Urea NH3 + CO2

• H2O2 is the active ingredient whereas urea raises the pH of the

solution

• Bleaching preparations containing carbamide peroxide usually also

include Carbopol, urea, glycerin, preservatives and flavoring agents.

Carbopol
• A water‐soluble polyacrylic acid polymer
• Thickening agent, resulting in better
retention in the night guard
• Increase in length of bleaching‐solution
strength for carbamide peroxide
• Slows rate of oxygen release extending
duration of bleaching action.
Increase in length of bleaching‐solution strength for
• Improves shelf life. carbamide peroxide bleaching preparations with carbopol vs
those without carbopol.

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Chemistry
• The bleaching process is based on the oxidation of the bleaching agent
• Oxidation is the chemical process by which organic materials are converted
into carbon dioxide and water
• The oxidation‐reduction reaction that takes place in the bleaching process is
called the REDOX REACTION
• Before the bleaching process, tooth is the reducing agent and bleaching
material is the oxidizing agent
• After bleaching, tooth is oxidized i.e. organic pigment of tooth is oxidized
and the bleaching material is reduced

The free radicals produced by the peroxides are perhydroxyl and nascent oxygen. Of these, the
perhydroxyl is a more potent free radical, which is responsible for a better bleaching action

Low pH

High pH

The buffering of peroxide to a pH range of 9.5 to 10.8 provides a greater amount of perhydroxyl
free radicals.

Mechanism
High molecular weight
Complex organic
molecules
(chromogens)‐
unsaturated double
carbon bonds

Bleaching agent

Low molecular weight

organic molecules
(relatively colorless)‐
saturated carbon bonds

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Mechanism Of Action

• Thought to be due to the ingress of oxidizers and oxygenating

molecules through enamel micropores

• Break/cleave pigment bonds and allow molecules to diffuse through the

tooth

• &/or become smaller and absorb less light and hence appear lighter

Mechanism of Action ….
• When bleach is applied to the tooth it passes from
the incisal edge to the apex of the tooth through H2O
the enamel, dentin & pulp chamber within 5‐ 15
H2O2
minutes
O2
• Hydrogen Peroxide breaks down very rapidly to
water, an oxygen ion and oxygen free radicals.
The 3 or 4 most active free radical species are OH‐
95%, OOH‐ 2.3% & O‐ 2.3%

Mechanism of Action ….
• The oxygen molecules then attach to the double
carbon bonds (color stain molecules) and break
them down into single carbon bonds, thus
disfiguring their internal colors
• The Single carbon bonds reflect light and
therefore make teeth appear brighter and
whiter. The changed molecules are now
translucent
• The molecules may also now diffuse through
the pores more readily because of their reduced
size

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Bleaching effects on
• Soft tissues
• Cervical resorption
• Pulp
• Hardness of teeth
• Tooth colored restorations
• Adhesive bond strength
• changes composition of enamel and dentine, therefore defer definitive adhesive
restorations until 2 weeks (at least 10 days) after bleaching completed

Ethical Considerations
• The end point is fixed for all teeth and this must be explained fully to the
patient.

• The Professional should explain the various treatment options, including

bleaching alternatives such as toothpastes, OTC, at home tray and in‐office
so that an informed decision can be made.

• You must not lead a patient to believe that in‐office bleaching will yield
better results than home bleaching.