Clarifications, guidelines and questions about the dental bleaching "associated" with orthodontic treatment

Abstract

With regard to the best moment for carrying out or recommending dental bleaching to orthodontic patients, some explanations and orientations are given in order to answers the following questions: 1) Why orthodontic treatment completion is considered the best opportunity for carrying out the procedure? 2) Why dental bleaching should not be performed immediately before orthodontic treatment? 3) If that would be possible at any special case, what would that be? 4) Why dental bleaching should not be performed during orthodontic treatment? 5) If that would be possible at any special case, what would that be? This article highlights why it is essential to protect both the mucosa and the cervical region, regardless of the moment when dental bleaching is performed, whether associated with orthodontic treatment or not. The "how", "why" and "if" of whether or not it is convenient to perform dental bleaching before orthodontic treatment are still a matter of clinical suggestion, as it is a procedure that is under analysis, empirical knowledge waiting for scientific proof or disproof! Although tooth enamel has adamantine fluid flowing within it, providing a specific metabolism that is peculiar to its own and which could scientifically explain and base the option of carrying out teeth whitening before and during orthodontic treatment, we must still be very careful.

In‐Office Bleaching During Orthodontic Treatment

“…Some authors consider it a contraindication to perform bleaching treatment in patients with orthodontic appliances in the following situations: (i) children or youth presenting teeth at different maturation or mineralization stages, which would result in different final colors among whitened teeth; (ii) patients with intruded tooth or teeth covered by gums at unreachable regions. According to these authors, these teeth would not be reached by the whitening agent . The acid pH of some whitening agents may oxidize the enamel's small protein content, which may result in enamel cohesive fracture during brackets removal .…”

“…It is well known that the hydrogen peroxide dissolution products are low molecular weight molecules, which easily diffuse into lamellae, grooves, fissures, and depression regions present in enamel structures. 2 The tooth enamel is the most mineralized, hence, the hardest tissue in the human body. 17 Its thickness in permanent teeth varies, with less thickness in the mesial and distal surfaces and reaching up to 2.3 gm at cusp tips.…”

Clareamento dentário durante tratamento ortodôntico

“…De acordo com Consolar et al 6 (2013), desprendimento dos braquetes, manchas brancas, perda de uniformidade na cor do dente após remoção do aparelho ortodôntico e retenção de placa bacteriana estão entre as consequências do clareamento dentário associado ao tratamento ortodôntico, uma vez que os agentes clareadores promovem a desmineralização do esmalte. Entretanto, em face da crescente popularização da prática de clareamento dentário durante o tratamento ortodôntico, há poucas evidências científicas sobre essa temática.…”

“…Assim, associar o clareamento dentário com tratamento ortodôntico requer muita cautela e conhecimento científico. Além disso, é de suma importância que profissionais e pacientes estejam cientes de seus potenciais riscos 6 . Nesse sentido, o presente trabalho objetivou revisar a literatura atualmente disponível sobre clareamento dentário realizado durante o tratamento ortodôntico.…”

Efecto del peróxido de hidrógeno al 40% sobre la fuerza de adhesión de brackets metálicos

“…Se sabe que existe una liberación prolongada de oxígeno en el esmalte aclarado y esto podría inhibir la polimerización de la resina afectando de forma negativa la resistencia al descementado de los aparatos ortodónticos (3,5,6,7).…”