Recent times have witnessed a flurry of innovations in the area of technologies impacting professional oral healthcare and the OTC products catering to the same segment. There are many ways in which discoloration can become evident and based on the cause of discoloration, approach to treatment as well as outcome can significantly vary too.
Although tooth whitening is not a new invention and the practice can be traced back to several centuries, recent years witnessed an enhanced interest from men and particularly women helping the practice to resurface albeit in a big way across most Western nations. To some extent teeth whitening has also dented the market for crowns and veneers which were the options available before teeth whitening became popular in recent years.
Historically, teeth whitening were performed in dental offices with the help of hydrogen peroxide and isolating soft tissues around the tooth so as to keep them safe from the whitening agent. This practice did prove effective but came with attendant concerns like cost, chairtime, and sensitivity risk. Carbamide peroxide was introduced around 1989 to address these risks, pegging the costs as well as risks down. This development also brought along the DIY kits enabling patients to carry out the teeth whitening procedures at home.
With the oral health care sector realizing that there was an opportunity to attract consumers directly through whitening products dispensed over the counter, the DIY teeth whitening products came into existence. Among these was a clear strip (tape) containing hydrogen peroxide that could be applied straight on the teeth. However, the OTC products lacked the expertise of professionals to determine the root cause of discoloration and therefore came with certain disadvantages in terms of safety and efficacy of the treatment.
While the ordinary teeth whitening toothpastes relied chiefly on the efficacy of their product in removing extrinsic stains on the tooth, a series of “advanced whitening” products were introduced claiming that they could remove intrinsic stains too. Adding to the confusion of consumers is the diverse methods of teeth whitening. That also brings into focus the distinction between intrinsic and extrinsic discoloration so that patients as well as professionals can take appropriate decisions.
Active Smile Teeth Whitening Kits come from an Active Smile Australia helps you get the glow back on your smile.
Tooth Colour and Discoloration
The reflectance of your dentin, modified by absorption, thickness and scattering of enamel determines the tooth colour. The colour varies from one individual to the other, teeth of the same person and even within a singular tooth. Further, teeth colour does not remain identical across a life time and can undergo changes for varying reasons.
As we mentioned earlier, the broad classification of discoloration is intrinsic or extrinsic based on how the stain originated. Researchers have also found the extrinsic stains of a long-standing nature can turn internalized making it more challenging to remove. The colour of extrinsic stains can vary like those resulting from tea, coffee, coloured food, tobacco, red wine etc and coming from superficial residue accumulation on the surface of the tooth enamel. This can also be enhanced by irregularities or pitting of enamel, salivary flow, salivary composition, or issues with general oral hygiene.
Intrinsic discoloration generally comes along the formative stage of tooth post eruption and can be attributed to stain molecules in the dentin and enamel. Dental fluorosis can cause pre-eruptive stains, hematologic disorders, inherited defects of dentin or enamel development.
Although tooth enamel has an inert character with no capacity of remodelling, it goes through dynamic and continuous ion exchange on the oral biofilm having calcium phosphate moving both ways so that mineral balance is maintained properly.
Tooth Whitening Chemistry
Traditionally extrinsic stains were addressed through prophylaxis or brushing relying on the abrasive action. Intrinsic stains on the other hand needed dental professionals and oxidising agents like carbamide peroxide or hydrogen peroxide. But, in modern times, two major events caused a paradigm shift. The first was introduction of oxidizing agents in OTC whitening products and dentifrices. Another development is the emerging evidence of extrinsic stains having the potential to be internalized making a significant distinction between intrinsic and extrinsic discoloration becoming more difficult to pinpoint. This has given rise to the argument that all types of discoloration can be eventually treated through self applied procedures on an everyday basis.
Most whitening products basically contain functional ingredients identical to ordinary toothpastes and include:-
- Calcium carbonate, hydrated silica, phosphate dehydrate, alumina, sodium bicarbonate, and pyrophosphate which represent solid abrasive cleansing materials aiding physical removal of stains.
- Thickening agents
- Active agents like fluoride to aid anticarciogenic health benefits
- Colouring agents
- Preserving and buffering agents for stability
Apart from the basic ingredients listed above, whitening products may also contain enzymes, peroxide, pyrophosphates, citrate etc to augment cleaning and/or keep stains away. While the addition of chemicals can be seemingly easy to achieve, the process is complex on account of potential reaction with the new chemicals that could trigger adverse effect from pre-existing characteristics like efficacy, consistency and stability.
Another attribute of the teeth whitening products is their ability to polish leading to improved aesthetics and lustre while also making the surface less prone to further staining.
Myriad websites also promote DIY whitening products with information on whitening remedies at-home including rubbing activated charcoal, crushed strawberries, or apples on the teeth. Anecdotal perception supports use of these fruits sailing on the rational that they come with malic acid. However, in the case of charcoal, the abrasiveness is considered helpful in stain removal.
Tooth whitening represents a dynamic process initiated by moving active ingredients through the structure of the tooth. When these ingredients interact with molecules of stain, it induces micromorphologic alterations on the surface of the tooth or within a selected tooth to impact the optical properties. What we see today in the market with regard to whitening processes and materials have resulted from continuous advances made by the industry and dental profession to preserve your tooth structure and enhance the aesthetics.