Interest in bleaching teeth has grown exponentially in the last few years and is set to increase dramatically again in the future as new markets become available and stimulate further product development. This guide is written to help the busy restorative dentist who needs to keep up to date with the types of product available, the techniques to use them effectively and safely, and how to use them in combination with restorative dentistry in treating patients.
Since the last issue on temporomandibular (TMD) disorders and orofacial
pain presented in the Dental Clinics of North America (April 1997), there
has been an explosion of scientific, technologic, and procedural advances in
this complex field. The amalgamation of the science with the art of dentistry
has resulted from an enhanced appreciation for and the ability to provide
evidence-based diagnosis and care.
Pain and compromised function are the most common reasons for which
people seek health care.
At a recent meeting of the American Academy of Esthetic
Dentistry a survey questioned whether aesthetic treatment
methods were ethical. The situation typical for that time
was used as basis for the survey: "Let's assume that the
patient is completely healthy and there are no biological or
physical reasons for a therapeutic intervention.
Believing that sufficient and well-deserved prominence was not being given to the use of tin foil and its
combinations, the author decided to present a brief historical résumé of the subject, together with such
practical information as he possesses, before the profession in order that it may have the satisfaction of saving
more teeth, since that is the pre-eminent function of the modern dentist.
Stains caused by dental materials are not uncommon (Figure 7-6).Among the discolorants found in dental materials, metallic ions are
considered to be the most difficult to bleach.The metallic corrosion products may lead to a dark gray or black appearance that will
be visible through the remaining tooth structure, including the root structure (Figures 7-12 and 7-13).The severity of discoloration
and the success of bleaching depend upon the amount of metallic ions penetrating the dentinal tubules.
Since not all the dental discolorations can be bleached effectively, it is important to recognize the etiology of discoloration and to
communicate the information to the patient, along with the available treatment options, alternative treatment, and their potential
outcomes. Nonvital bleaching is indicated when the discoloration is due to pulpal necrosis, pulpal hemorrhage, endodontic filling
materials, or mild to moderate tetracycline staining.The most important prerequisite for internal bleaching of a tooth is the quality
of the endodontic therapy.