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


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


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 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


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


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


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


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