How to use Opalescence for customized take-home whitening
An evaluation of Opalescence, a whitening system from Ultradent Products.
Why professional supervision matters
During the initial whitening consult, dentists should complete a thorough oral examination and evaluation with pre-operative photographs. With this information the dentist can monitor the tissues (hard and soft) throughout treatment to ensure the patient responds ideally to the whitening gel and no damaging effects occur, such as tooth demineralization or gingival irritation.
After the initial assessment, determining the types of discolorations will help identify the appropriate whitening solution. With three classifications—intrinsic, extrinsic or internalized—tooth stains vary in their ease of removal. Extrinsic stains are localized on the tooth surface or within the pellicle layer by reaction between sugars and amino acids, or acquired from other external elements.8,9 Intrinsic stains, such as those from tetracycline or fluorosis, are found within the dentine, and result from systemic or pulpal origin.9 They are the most difficult type of stains to remove. Similarly, internalized stains are also located in the dentine, but result from extrinsic stains entering the dentine via tooth defects, such as cracks on the tooth surface.9
Although in-office treatment is ideal for a variety of tooth discolorations, darker stains (e.g. dark yellow and black teeth or stains from tetracycline and fluorosis) can be challenging to whiten, requiring more than one bleaching application.10 Used in conjunction with in-office treatment, at-home whitening can provide the ideal supplement to treat tougher stains.
At-home whitening is also effective as a standalone treatment and a practical alternative to in-office whitening. Effective at treating most discolorations, at-home whitening is still under dental supervision and monitoring. At-home whitening provides a cost-effective solution for those who can’t afford in-office treatment or for those who prefer the convenience of whitening at home. Dentist-dispensed at-home whitening minimizes risks involved in whitening such as uneven results, enamel damage or hypersensitivity, because the systems are supplied by dentists, who can diagnose any problems or special needs, plan the appropriate treatment and fabricate the customized tray used to apply the whitening gel.11
Challenges with at-home whitening
While ideal for patients who desire to whiten their teeth on their own schedule, complications still occur with dentist-dispensed at-home whitening. Problems with patient compliance can arise due to discomfort and inconvenience. Poorly fitted trays can inhibit proper application of the whitening gel to the tooth surface, reducing the effectiveness of the hydrogen peroxide. Patients can have difficulty applying the material, especially if the gel is too thin. During whitening, some patients report discomfort as the tray moves or gel migrates out of the tray and onto gingival tissues. The discomfort can be exacerbated if the taste of the gel is unappealing.
Patients may also complain of increased sensitivity during and after whitening treatments. This side effect may be caused by changes of fluid in the dentinal tubules. Specifically, too much fluid moves out of the teeth during whitening, causing dehydration that leads to oral pain. Some whitening gels add water to their solution to ensure proper hydration. The addition of fluoride and potassium nitrate has also been shown to reduce tooth sensitivity.12-14 The application of fluoride also makes the teeth less susceptible to caries,15 and leads to fewer hazardous effects on the enamel mineral content.16
Further, as hydrogen peroxide degrades throughout the whitening process, it can create a more acidic environment that leads to potential tooth structure damage.17 Some whitening gels have an initial acidic pH, which can further favor demineralization of tooth enamel.18 Lower pH environments can lead to increased tooth sensitivity, gingival irritation, and bacteria growth. Adding buffers to the whitening gel ensures a basic or neutral pH.
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