Writing about dental bleaching for dentists is, at least, risky. I say this because, despite being an old technique, even today, it is a very controversial topic!
I’d like to make it clear that I love a good debate! I'm not on of those who think that football, politics and religion are not subject of discussion. I think that absolutely everything can be resolved. And it is through frank and sober talk that understanding occurs. This is what makes it very nice to write to the Opalini Blog! It is a writing that happens without ceremony, that straight talk, that delicious talk we have with our friends when we loosen the tie and take the shoes off!
Well, now the subject is dental bleaching!
I will be quite objective! I will say what I do on my day to day, how I see dental bleaching in my clinical practice. This does not disqualifies this talk, because talking about this subject is very pleasing to me. It was my Masters Theme and resulted in three scientific articles: A Thermal Investigation of Dental Bleaching In Vitro (Kabbach et al., 2008), The effect of power bleaching activated by several light sources on enamel microhardness (Kabbach et al., 2010) e An in vitro thermal analysis during different light-activated hydrogen peroxide bleaching (Kabbach et al., 2010), which consumed precious hours of sleep!
I do a lot of dental bleaching in my clinical practice, so I have experienced almost every technic, different bleaching products combined with halogen light, LED, low intensity laser (LILT), high intensity laser (HILT) and without activation, home-applied bleaching, in office bleaching, walking bleaching, among others.
Do you know which one works? All of them... that's right! Since they contain hydrogen peroxide they will work! I learned this from my great teacher Marcelo Ferrarezi (Faculty of Dentistry |UNESP - Campus of Araraquara-SP) that used to say in class, "pen and paper, let’s write: the active ingredient in tooth whitening is hydrogen peroxide". The honest truth! If you have hydrogen peroxide bleaching is possible. You may be thinking, but the product you use is carbamide peroxide! What's up? No problem! Because it dissociates into urea (7% to 10%) and hydrogen peroxide (3% to 5%).
But what about the use of light sources to accelerate the reaction, should I use it or not? This is where it catches fire, because literature has results for everyone, a lot of articles saying that light makes no difference, some saying that it helps and many others indicating that hinders! About this, it is important to know that some sources of light (halogen, high power LED or laser) can heat the pulp-dentin complex as to cause irreversible damage. And to top it off the controversy of the light source, a renowned group of researchers was able to demonstrate in vivo that lower incisors human suffering irreversible pulp damage when bleached with hydrogen peroxide at 35% for 45 minutes, even without light source! Now what?
No reason to panic! This information was important and decisive for me to establish my clinical protocol for tooth whitening, which I share with you: use carbamide peroxide at low concentrations, 10 % and 16% of BM4 for home-applied bleaching with a custom tray. The patient starts the treatment with daily use of the gel for 30 minutes up to a maximum of 2 hours, 4 to 5 weeks. No, the patient does not sleep with the plaque! That way I avoid the sensitivity, as the low concentration of hydrogen peroxide is safe. In the case sensitivity, I instruct the patient to reduce the time of application.
In some cases, when the patient calls for whiter teeth in the same session, I begin the treatment with office bleaching. And the use of carbamide peroxide, now at higher concentration, 37% of BM4 without using any light source. And I have great results! If it is necessary, the patient continues with home-applied bleaching.
I am sure that the most important for us, dentists, is to consider primarily the health of our patients. The scientific literature has many articles on the subject and sometimes they show contradictory results. However, I believe it is in the simplification of procedures that we find the real gains. And simplify does not mean neglect! I follow an evidence- based protocol! A simple technique, with low concentrations of hydrogen peroxide may not be the fastest, or the most expensive technique; but leaves me with a clear conscience, because it is a safe technique! And my patients do not complain of sensitive teeth after tooth whitening!
My purpose is to help you gain autonomy through knowledge, facilitating the dentistry and communication. AND how do I do this?
I put myself in your shoed, I identify what is preventing you from being happy with your results and untie the knots by means of a simple and accessible language! I graduated from UNESP | Araçatuba; did my Master and PhD in Operative Dentistry at UNESP Araraquara | I am a Professor of Operative Dentistry at the Federal University of Pelotas | RS.
Jul, 27th 2015