A New System for Tooth Whitening:Less Time—Less Sensitivity

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Since the mid 1980s, I have beenusing whitening agents to lightenmy patients’ teeth. Early power

bleaching techniques involved saturat-ing cotton gauze pads with liquid per-oxide solutions and placing them onthe teeth for an hour at a time. The tis-sue was protected with a conventionalrubber dam that was carefully ligatedwith dental tape to produce a seal. Aspecial high intensity light was fo-cused on the teeth for the hour duringtreatment in an attempt to acceleratethe peroxide and increase the whiten-ing effect. Extreme tooth sensitivityoften resulted in many patients need-ing pain medication. The amount oftooth whitening achieved with thisprocess was usually acceptable formost patients, except for those withtetracycline staining or similar intrin-sic problems.

When take-home carbamide per-oxide agents were introduced, manyof my patients elected to try thisalternative. Patients would wear thehome bleaching trays for severalhours per day for a few weeks at atime. The whitening results were sim-ilar to those from power bleaching,and tooth sensitivity still remained aproblem for many. Pain medicationswere sometimes needed and somepatients had to discontinue use forperiods of time or reduce the amountof time they used the whiteningagents to decrease this problem.

Many of my patients continuedto request an in-office alternative fortooth whitening; several new systemsthat resulted in less tooth sensitivitywere introduced for this purpose. Ifound that office treatment with per-oxide solutions combined with hometreatment with carbamide peroxidesolutions gave my patients the bestresults. I usually recommend 2 officetreatments 1 week apart and homebleaching between the 2 appoint-ments. Home bleaching trays canthen be used for touch-ups.

A New TechniqueThe process that I find works

well involves the use of an aqueouschemical cleaner in conjunction witha whitening agent. During the last 6months, my experience shows that Ican decrease the time needed for bothoffice and home processes to one-third of what was used in the past.The combination of the aqueouscleaner and the tooth whiteningagent has reduced complaints of sen-sitivity to nearly zero.

According to the manufacturerof the aqueous cleaner it containseffervescent orally safe detergentsand solvents that remove stainsthrough a process similar to the wayin which laundry pre-treaters work.The cleaner removes organic andinorganic stains and enables deep-penetrating hydration of teeth, which

Ross W. Nash, DDSFounder

Nash Institute for Dental LearningCharlotte, North Carolina

Phone: 704.364.5272Email: rosswnashdds@aol.com

Web site: www.NashInstitute.com

Board Member Contemporary Esthetics

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Figure 7—After 7 minutes, the whitening gelwas suctioned from the teeth.

Figure 8—The aqueous cleaner was againapplied.

Figure 9—More whitening gel was applied.

Figure 4—Whitening agent applied directlythrough the mixing tip.

Figure 5—The swab from the aqueous clean-er was used to agitate and spread the whiten-ing gel.

Figure 6—Whitening gel allowed to remainon the teeth for 7 minutes.

Figure 1—After the gingiva was dried, alight-cured liquid dam material was applied.

Figure 2—The liquid dam was light-cured for10 seconds.

Figure 3—Once the tissue was isolated, anaqueous chemical cleaner (Whitening StainRemover, GrinRx) was applied.

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increases the effectiveness of otheragents and reduces dentin hypersen-sitivity resulting from dehydration.

The aqueous cleaner can be usedalone to remove tough, deeply seatedstains. Should a whitening treatmentbe added to lighten tooth stains, thecleaner can be applied 30 seconds be-fore applying of the whitening agent.

The following case illustrates thetechnique I use and involves applyingthe aqueous cleaner before a perox-ide office whitening gel. It also in-

volves using the aqueous cleanerbefore placing a home tray with acarbamide peroxide solution used forthe time between the power whiten-ing appointments.

Office Whitening The patient’s lips, tongue, and

cheeks were retracted with a plasticretractor (FastTrak, Spectrum Den-tal). After the gingiva was dried, alight-cured liquid dam material wasapplied (Fast Dam, Spectrum Dental)

as seen in Figure 1. The liquid damwas light-cured for 10 seconds(Figure 2).

Once the tissue was isolated, anaqueous chemical cleaner (WhiteningStain Remover, GrinRx) was appliedas seen in Figure 3. The solution wascarried to place with a special swabdispenser that was used to scrub theteeth with the chemical for 30 sec-onds.

Without removing the liquidcleaner, a peroxide whitening agent

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(Contrasta.m., Spectrum Dental) wasapplied to the facial aspects of theteeth. The whitening agent wasapplied directly through the mixingtip as shown in Figure 4. The swabfrom the aqueous cleaner was used toagitate and spread the whitening gel(Figure 5).

The whitening gel was allowedto remain on the teeth for 7 minutes(Figure 6). Even though a lightsource can be used to activate thewhitening agent, I chose to use none.

It is my experience that the chemicalactivity of the whitening agent aloneis effective.

After 7 minutes, the whiteninggel was suctioned from the teeth(Figure 7) with a high speed evacua-tor. The aqueous cleaner was againapplied (Figure 8) and more whiten-ing gel was applied (Figure 9). Theaqueous cleaner and whitening gelwere allowed to remain in place foranother 7 minutes and the gel wasagain suctioned off. One more 7-

minute treatment was performedwith the aqueous cleaner and whiten-ing gel for a total of 21 minutes. Theteeth were then thoroughly rinsedwith an air/water syringe (Figure 10)and the liquid dam was removedwith an explorer (Figure 11).

Home BleachingOn models made from previous-

ly taken impressions, bleaching trayswere fabricated. The patient wasinstructed to place a small drop ofcarbamide peroxide bleaching gel(Contrastp.m., Spectrum Dental) foreach tooth in the tray as shown inFigure 12. The patient was instructedto apply the aqueous cleaner to thesurfaces of the teeth in a scrubbingmotion for 30 seconds before placingthe trays (Figure 13). The patient wasinstructed to place the trays with thewhitening gel in place over the teethtreated with aqueous cleaner (Figure14) and to leave the trays in place(Figure 15) for only 20 minutes perday for the next 5 days before report-ing back for 1 more office treatment.

ConclusionWith this regimen, I am achieving

results that I consider equal to or bet-ter than those I achieved with my pre-vious method in which I used similartechniques without the use of anaqueous chemical cleaner. But I amachieving them in one-third of thetime. I am finding that my patientsare experiencing very little tooth sen-sitivity and I am seeing minimalrebound in color. I have achievedgood whitening results with numer-ous products on the market, but thisnew system has proven to be veryeffective. !c

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Figures 14 and 15—The patient was instructed to place the trays with the whitening gel inplace over the teeth treated with aqueous cleaner and to leave the trays in place.

Figure 12—The patient was instructed toplace a small drop of carbamide peroxidebleaching gel (Contrastpm, Spectrum Dental)for each tooth in the tray.

Figure 13—The patient was instructed toapply the aqueous cleaner to the surfaces ofthe teeth in a scrubbing motion for 30 secondsbefore placing the trays.

Figures 10 and 11—The teeth were then thoroughly rinsed with an air/water syringe and theliquid dam was removed with an explorer.

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