Tooth discolouration in childhood is significant problem in psychosocial development of children.1 It leads to cosmetic impairment in children. There is development of various non invasive treatment for tooth whitening. Most of them are used in adults with satisfactory results. These article provides information of history , various tooth whitening agents , their uses in paediatrics and their safety consideration as well as their contraindication I children and adolescence.
In 1966 Schneider et al documented use of peroxide gingival strip for healing periodontal tissue tooth whitening was seen as unintentional effect.In late 1960s Klusmier have noticed whitening effect when glyoxide is used in orthodontic positioners.
In 1989, Heyman and Heywood introduced night guard vital bleaching.
In 1989 Fischer created opalescence carbamide peroxide in gel formulation which is basis for most of night time gel use and wasfirst ADA approved system of tooth whitening.5 Very first walking bleech description by mixture of sodium perborate with distilled water was introduced by Marsh and published by Salvas.6
BLEACHING IN CHILDREN AND ADULTS
In general patients candidates for bleaching are above age of 10 but if primary teeth are causing embracement it is better to do bleaching . the only indication for bleaching in pedo patient is when there is discolouration due to trauma without any pathology.7 bleaching is rarely done in children under age of 10 years.8 under supervision bleaching is successful even in 6-10 years of age with commercial bleaching trays or strips available.9
MECHANISM OF BLEACHING AGENT:
It involves degradation of extracellular matrix and oxidation of chromophore located within enamel and dentine10. Sensitivity problem after bleaching is probably due hydrogen peroxide access to pulp space which causes transient inflammatory response 11.in addition senior author has hypothesized that sensitivity occourd due to fluid dynamics. Oxygen molecules diffuses through interstitial space and accumulates at DEJ which causes pressure on dentinal tubules is another mechanism suggested for sensitivity after bleaching.12
MATERIAL AND TECHNICQUES USED FOR PEDIATRIC PATIENT:
Whitening can be accomplished by professional or at home technique.13 In younger children due to poor compliance at home whitening is not popular. Brantley DH used night guard technique for bleaching using 10% carbamide peroxide with non scalloped non reservoir bleaching tray fabricated from thermoplastic material.14 Walkman bleach is also used successfully in children15. 10% H2O2 gel tray system and 6.5% gel H2O2 strips are also used successfully in teenagers16. Vital guard night whitening using 10% carbamide peroxide is most researched and successful method for tooth whitening in children.1
SAFETY CONSIDERATION IN CHILDREN:
Due to thinner enamel , dentine and higher pulp horns in primary and young permanent teeth sensitivity will be more compared to permanent teeth acc. To theory but due to large apex as well pulp will recover faster comparatively9.
Acute cytotoxic effects are seen with doses over 5g/Kg/day for product containing 10% carbamide peroxide.10% H2O2 polythene strips and 10% carbamide peroxide gel containing tray can be safely use in teenagers.16
ADVERSE EFFECTS OF BLEACHING:
Sensitivity and tissue irritation are two most common side effect of of bleaching vital teeth.13 Microhardness of sound enamel and both sound and demineralized dentintine is compromised due to bleaching17. Bleaching increase solubility of glass ionomer and other cements also decrease bond strength. H2O2 residues within enamel and dentin inhibit polymerization of resins and reduces its bond strength.18
- Bryan RA,WelburycRR. Treatment of aesthetic problems in pediatric dentistry. Dent Update 2003;30(6):307-13
- Schneider HG, Birkholz C, Hampel W. Clinical experience with peroxide containing gingival strip from the Leipziger Arzneimttelwerk . Dtsch Stomol 1966;16:656-67
- Goff S. Getting the white right. Dental products Report 2005:14-9
- Haywood VB, Heymann HO. Nightguard vital bleaching. Quintessence Int 1989;25:324.
- Fasanaro TS. BLEACHING TEETH: history , chemical and methodsused for common tooth discolorations. J Esthet Dent 1992;4:71-8
- Salvas CJ Perborate as a bleaching agent. J Am Dent Assoc 1938;25:324
- Brantley DH , Barnes KP, Haywood VB. Bleaching primary teeth with 10% carbamide peroxide. Pediatr Dent. 2001;23(6):514-6
- Lee SS, Zhang W, Lee HD, Li Y .Tooth whitening in children and adolescents: a literature review . pediatric dent 2005;27(5):362-8.
- Croll TP. Tooth bleaching for childrens and teens : A Protocol and examples. Quintessence. International 1994;25:811-17
- Goldberg M Grootveld M , Lynch E undesirable and adverse effect of tooth whitening products a review.clin oral Investig 2010;14(1):1-10
- Bowles WH , Ugwuneri Z. Pulp chamber penetration by hydrogen peroxide following vital bleaching procedures. J Endo 1987;13(8):362-8
- Croll TP. Bleaching sensitivity. (letter). J American Dental Association 2003;134(9):1168
- Amarican academy of pediatric dentistry. Council on clinical Affairs. Policy on dental bleaching fir child and adolescent patient. Reference manual 2204-05. Pediatr Dent 2004;26:45-7
- Brantly DH, Barnes KP, Hatwood VB, Bleeaching primary teeth with 10% carbamide peroxide. Pediatr Dent 2001;23(6):514-6.
- Sharma DS, Barjatya K, Agarwal A. intracoronal bleaching in young permanent and primary teeth with biological perspectives. J Clin Pediatr Dent 2011;35(4):349-52
- Donly KJ, Baharloo L et al. tooth whitening in children. Compend Cont Educ Dent 2002;23:22-8
- Thicket E, Martyn T, Cobourne MT. new development in tooth whitening . the current status of external bleaching in orthodontics, J Orthod 2009;36:194-201.
- Tredwin CJ, Naik S, Lewis LJ et al. hydrogen peroxide tooth whitening (bleaching) products: reviews of adverse effect and safty issues. Bri Dent J 2006;200(7):371-6.