Tooth Whitening: A Cosmetic Dentistry Bonanza Part 2

By Ron Goodlin DDS, FAGD, Holly Gilchchrist CDA,Level II and Lori Place CDA Level II


Multiple exposures of hydrogen peroxide have resulted in localized effects on the gastric mucosa, decreased food consumption, reduced weight gain and blood chemistry changes in mice and rats. Studies indicate that caution is necessary to avoid swallowing bleaching materials. It is therefore recommended that bleaching procedures be closely supervised by the dentist and the utmost care and attention be paid to fabrication of bleaching trays.14


Many metals are susceptible to the effects of oxidation, causing breakdown in the molecular structure. Amalgam has been shown to be particularly susceptible to the strong oxidizing action of bleaching chemicals.15 Studies have shown that significant amounts of mercury vapour is released when exposed to carbamide peroxide however this only occurred after 40 hours of continuous exposure of the amalgam to the peroxide.16


There are reports of a 10-60 percent shade relapse within the first six to twelve months in up to 50 percent of cases following bleaching treatment. In most cases a simple short term re-treatment using a touch up kit, ranging from one to three days will boost the case to its’ original post bleaching results.

ADA, CDA, AACD and ODA have all published position statements concluding that the bleaching process is a safe and effective method of whitening teeth without any long-term deleterious side effects.17


Patient one is a 45-year-old female, businesswoman who is attempting to launch a singing career. Patient presented with dark teeth, multiple old restorations missing teeth. Wants teeth whitened. Product chosen Zoom (see photos of patient Case 1).

Patient two is a 34-year-old female, businesswoman. Wants dull teeth to look brighter. Time is a critical factor. Product chosen Zoom (see photos).


The first 24 hours following in office bleaching are a critical time to avoid any foods with any stain capacity. The first 24 hours following in office bleaching should be limited to clear foods and liquids only, no coffee, tea, coke etc.

The first day to first week, avoid berries, soy sauce, red wine, red fruit juices, tea, cigarettes and other die containing or highly staining materials. After the first week a normal diet can be resumed. Tobacco use of any form should always be avoided.

For one week following at home bleaching, the patient should avoid the above-mentioned items.

Many patients will need to boost the bleaching after eight-12 months for in office, six-nine months for DDS supervised at home bleaching and after three months for OTC bleaching products. This is usually accomplished by using an at home touch up kit generally supplied with during the original treatment.

Dr. Goodlin has a practice limited to cosmetic dentistry in Aurora, ON. He is a well-known lecturer and has been the author of many publications on cosmetic dentistry and dental photography.

Oral Health welcomes this original article.

Part One of this article appeared in the April, 2004 issue of Oral Health. Both parts can be found online at:


1.Goldstein R, Garber D, Complete Dental Bleaching Quintessence Publishing, Chicago, ISBN 0-86715-290-7, 1995

2.Haywood VB, Heymann HO, Nightguard vital bleaching. Quintessence Int 1989, 20(3): 173-6

3.Dostalova T, et al Institute of Dental Research, Prague Czech Republic, Myiagi et al Tohoku University Engineering, Sendai Japan. Comparison of tooth bleaching using three laser systems, halogen-light units and chemical action agents.

4.Christensen et al, New Generation In-Office Vital Tooth Bleaching CRA Newsletter Reports Vol 27, issue 3, March 2003.

5.Dunn J, Dunn M, Ford J, Witherow DS, Efficacy and Safety of Argon/CO2 Laser Bleaching as Compared to Night Guard Vital Bleaching Loma Linda University Biomaterials research Center Feb 1997

6.Glockner K, Hulla H, Ebeleseder K, Stadtler P, School of Dentistry Karl-Franzens University Austria Five-Year Follow up of Internal Bleaching Braz Dent J, 1999, 10 (2) pp 105-110

7.Niederman, R, Tantraphol MC, Slinin P, Hayes C, Conway S. Effectiveness of Dentist-Prescribed Home applied Tooth Whitening. JContDentPractice, Vol 1, No4, Nov 2000

8.Li Y, Tooth bleaching using peroxide containing agents: Current status of safety issues. Comp Cont Ed 1998;19: 783-794

9.Ruse ND, Smith DC, Torneck CD, Titley, KC. Preliminary surface analysis of etched bleached and normal bovine enamel. J Dent Res 9:1610-1618, 1990

10.Pinheiro Jr. CE , Fidel SRA, Cruz Filho AM, Silva RC, Pecora JD. In Vitro action of Various Carbamide Peroxide Gel Bleaching Agents on the Microhardness of Human Enamel. Braz Dent J. 1996, 7(2) 75-79.

11.Bleaching Section 3 Reality Publishing Co. Vol 15 pp 3-395-422

12.Feinman RA, Tooth whitening developments Chairside versus over the counter Pract Perio Aesthet Dent 1999 11:277

13.Donly KJ, Donly AS, Baharloo L, Rojas-Candelas E, Garcia -Godoy F, Zhou X, Gerlach R, Tooth whitening in children Compendium Vol 23 no 1A, 2002

14.Dahl JE, Pallesen U, Tooth Bleaching; A critical review of Biological Aspects. Cnt Rev Oral Biol Med, 14(4) 292-304 2003

15.Hummert TW, Osbourne JW, Norling BK, Cardenas HL. Mercury in solution following exposure of various amalgams to carbamide peroxides Am J Dent 1999, 12:227-230

16.Certosimo A, Robertello F, Dishman M, Bogacki R, Wexel M, The effect of bleaching agents on mercury release from spherical dental amalgam. J AGD, July-August 2003, p 356-359.

17.American Dental Association Position and Statements, ADA Statement on the safety and effectiveness of tooth whitening products June 2002