There are different treatment approaches for cosmetic problems caused by discoloration of teeth, especially in the front area. In addition to indirect crowns and porcelain laminate veneers, direct composite laminates are also included in these treatments. However, teeth whitening systems appear to be a less invasive method than composite or porcelain veneers and are frequently used in frontal area aesthetics. Teeth whitening systems, which have shown rapid development in the last 10 years, have a history dating back many years. The first technique described was applied to devital teeth and was published in the second half of the 19th century. Teeth whitening systems that have evolved to the present day still raise questions in our minds. We can group the questions from patients about whitening treatment into four groups.
1. Does whitening treatment cause any harm to teeth?
2. Does the whitening treatment cause any harm to other restorations in the mouth?
3. What is the toxicity of whitening treatment?
4. How long does the whitening treatment last?
The effect of whitening treatment on teeth
Looking at the studies, we can say that many teeth can be whitened successfully. Whitening treatment occurs when peroxide, broken down by the release of active oxygen, transforms the pigmented carbon atoms in the structure of the tooth into lighter colored carbon chains. The effect of whitening treatment on tooth enamel has been investigated in different studies. In a study evaluating the topographic structure of enamel exposed to 15% carbamide peroxide for 15 hours a day using an electron microscope, significant changes were detected compared to the control group. This has been attributed to calcium loss. In a clinical study conducted in 1998 (35% carbamide peroxide for 35 minutes a day for 14 days), it was not possible to repair the damage that occurred after 20 days. Thereupon, in a study conducted in 2000, when 35% carbamide peroxide was compared with 10% and 16% concentrations, a change on the enamel was determined at the 35% concentration, while no change was determined at the 10% and 16% concentrations.
The effect of whitening treatment on restorations
A study conducted in 1994 emphasized that little or no whitening agents have little or no effect on restorations. However, it has been determined that glass ionomer increases the solubility of cements and reduces the bond strength between composite fillings and tooth enamel due to oxygen release, albeit for a short time. For this reason, postponing the composite filling for one week will eliminate the problem. It has been determined that whitening agents have no effect on porcelain.
Toxicity of whitening agents
As a result of many studies, life-threatening conditions can occur during short-term whitening treatments performed in accordance with the manufacturer's instructions. There is no disturbing effect. However, if it is not used in accordance with the rules set by the manufacturer, if the dentist's precautions or warnings are ignored, toxicity and damage to hard and soft tissues are inevitable in long-term use for months or even years.
Stability of whitening treatment
Another question about whitening treatment is its stability, that is, its permanence. However, this is the most uncertain aspect of whitening treatment. Many factors must be taken into consideration to determine or estimate its permanence. These are:
- Factors that cause discoloration
- The degree of discoloration
- The patient's diet
- The patient's smoking
- We can list it as the age of the patient..
In a review conducted in 1999, in the evaluation of 23 patients 23 years after the whitening treatment, 62% had a slight change in tooth color, and the rest had a change in tooth color. No change was observed. In another study conducted in 2002, after a 6-week whitening treatment, no discoloration was found in 43% of the patients at the 10-year follow-up.
As a result, teeth whitening systems are a part of today's dentistry and are applied by many physicians. However, when deciding on a whitening treatment, the appropriate decision should be made for the patient. Whether it is available or not, its advantages and disadvantages should be evaluated. Studies on whitening products and developed techniques will increase patient satisfaction and provide better and longer-term results.
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