9 Important Steps to Remember Before Vital Tooth Bleaching

9 Important Steps to Remember Before Vital Tooth Bleaching

Step 1:

(i) Teeth must be cleaned of all surface stains and plaque. Isolate and protect the teeth and mouth.

(ii) Soft tissues can be protected by applying Vaseline or Oraseal (ultradent).

Step 2:

(i) Teeth to be bleached should be isolated with rubber dam. If floss is to be used as ligature around the teeth, waxed floss is preferred as unwaxed floss may absorb the hydrogen peroxide and burn the tissue.

(ii) Prepare the tooth by cleaning with pumice.

Step 3:

Some clinicians prefer to etch the severely stained tooth with 35 percent of phosphoric acid for 5-7 seconds as it enhances the penetrability of bleaching solution and greatest amount of immediate stain reduction can be made possible.

Step 4:

Dry the teeth thoroughly and apply the 35 percent of hydrogen peroxide bleaching solution such as superoxol with help of gauze piece.

Step 5:

(i) Bleaching can be done with heat, without heat or by dual application.

(ii) In case of with heat, place the bleaching light at a distance of approximately 30cm from the teeth to be bleached. Direct the light to the labial surface of teeth.

(iii) Gradually increase the temperature by adjusting rheostat from 46°C (115°F) as long as patient feels no sensitivity.

(iv) Temperature recommended for vital teeth bleaching varies from 46°C to 60°C.

Care must be taken to prevent the irreversible thermal damage to the teeth. Patient’s comfort is used as a guide for adjusting the temperature.

The thumb rule is adjusting temperature at least 10 degree below the temperature at which patient feels discomfort.

Step 6:

Keep the teeth saturated with bleaching solution for 20 to 30 minutes.

Step 7:

Flush the teeth with copious amount of warm water before removing the dam.

Step 8:

In case of uneven discoloration, apply 35 percent hydrogen peroxide to the severely stained areas of tooth and allow it to remain on tooth for 5-10 minutes.

Enamel surface can be disked with abrasive in case of severe staining.

Step 9:

Polish the bleached teeth using the aluminum oxide abrasive disks and wheels (3M soflex system, Shofu cosmetic contouring kit). If patient feels sensitivity than 1.1 percent neutral sodium fluoride or desensitizing paste can be applied in between the appointments.