Whiteness HP is a 35% hydrogen peroxide-based dental whitening system.
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Description

Whiteness HP is a 35% hydrogen peroxide-based dental whitening system in-office use, indicated for vital and non-vital teeth. A pioneer among other in-office whiteners in Brazil, it has high whitening power to be used both with accelerating sources (curing light, laser, plasma lamps, etc.) and without an external auxiliary source.

Presentation

• 1 bottle with 10g of concentrated hydrogen peroxide
• 1 bottle with 5g of thickener
• 1 bottle with 2g of neutralizing solution for peroxide (Neutralize – FGM)
• 1 spatula and 1 plate to prepare the gel
• 1 light-curing gingival protector (Top dam – FGM) with 2g and 6 applicator tips
• Instructions for Use

• 1 bottle with 10g of concentrated hydrogen peroxide
• 1 bottle with 5g of thickener
• 1 bottle with 2g of neutralizing solution for peroxide (Neutralize – FGM)
• 1 spatula and 1 plate to prepare the gel
• Instructions for Use

• 1 bottle with 4g of concentrated hydrogen peroxide
• 1 bottle with 2g of thickener
• 1 bottle with 2g of neutralizing solution for peroxide (Neutralize – FGM)
• 1 spatula and 1 plate to prepare the gel
• Instructions for Use

Characteristics and Advantages

• High whitening power to be used both with accelerating sources (curing light, laser, plasma lamps, etc.) and without an external auxiliary source.

• Excellent viscosity.
• Great results on vital and non-vital teeth.
• Can be used on individual teeth or whole arches.
• Presentation in two phases, peroxide and thickener, which allows the product to be compounded in only the quantity necessary, preventing waste (whitening of only one tooth or a range of the tooth, whitening touchups).
• Versatility in combination with the take-home technique.
• Comes with Neutralize: to eliminate the actions of the peroxide in case of contact with soft tissues.
• Drop by drop mixing system: enables the dentist to use only the amount required.
• Long-lasting: the complete kit lasts an average of 18 applications.
• Excellent viscosity: does not run from the tooth surface.

Indications

• For whitening of vital and non-vital teeth exclusively in office.
• Can be used with or without light energy source.

Step by Step

Step 1

Prepare the patient according to the case for whitening (see instructions and follow step-by-step for vital and non-vital teeth).

Step 2

Remove the whitening system from the packaging, following the safety recommendations.

Step 3

Hold the bottle of peroxide vertically and open the lid carefully.

Step 4

Prepare the container and the spatula for mixing the product.

Step 5

Shake the bottle of thickener vigorously to homogenize its content. Failure in homogenization of the thickener can result in a low viscosity gel (insufficient viscosity).

Note

If the whitening system is refrigerated in storage, remove it at least 30 minutes before starting treatment, so that its temperature matches the environment.

Whitening of vital teeth

Carry out a good assessment of the oral cavity of the patient: the presence of caries, deficient restorations, fissures in the enamel, gingival recessions, gingivitis and other characteristics considered important should be checked and treated before the procedure. Ensure your protection and that of the patient.

Step 1

Select and take the color of the teeth of the patient by using a shade guide and/or photo before starting the whitening.

Step 2

Do prophylaxis with pumice stone and water, in order to remove extrinsic stains and bacterial plaque.

Step 3

Perform relative isolation with light-curing gingival protector (Top dam – FGM) covering the edges of the gums and the papillas with a layer 3 to 5 mm wide and a maximum of 1 mm thick. The barrier should cover approximately 0.5 to 1 mm of the tooth surface. Use a clinical mirror looking from incisal to cervical and note if there is uncovered gingival tissue. If there is, correct it. This step is crucial in order to prevent contact of the peroxide with the gums. Use a lip retractor (Arcflex – FGM) to facilitate the application of the barrier and also the whitener.

Step 4

Cure Top dam by using 20 to 30 seconds of light curing for each group of 3 teeth. The gingival protector that forms is rigid and insoluble, preventing any irritation by aggressive products.

Passo 5

Using the mixing plate that comes with the kit, mix the peroxide phase (phase 1) with the thickener phase (phase 2) in the proportion of 3 drops of peroxide to 1 drop of thickener. The mixture of 3 drops of peroxide to 1 drop of thickener is sufficient for application on one tooth. For the smile line (20 teeth), generally 18 drops of peroxide to 6 drops of thickener are sufficient. Shake the bottle of thickener vigorously before use.

Step 6

Let the gel remain on the tooth surface for 15 minutes after the beginning of its application. With the aid of a brush or disposable micro applicator (Cavibrush – FGM), move the gel around on the teeth three or four times to release any oxygen bubbles generated and renew the best possible contact of the gel with the tooth structure. At the end of the recommended time, remove the gel on the teeth with a suction cannula (for example, endodontic cannula) and clean them with gauze to make them ready to receive a new portion of gel. Repeat steps 5 and 6 up to two more times (at most) in the same session, if necessary, according to the evolution of the results and monitoring of the sensitivity of the patient.

Step 7

At the end of the treatment, remove the gel and wash the teeth. Remove the gum protector, detaching it with a probe.

Notes

1 – Monitor the patient throughout the whitening regarding dental sensitivity and possible points of irritation from the peroxide. In any of the cases, interrupt the process and do a check and intervention (see comments in the section on Information for the professional).
2 – If the whitening obtained does not meet expectations and if the patient does not present sensitivity or any other contraindication, the product can be reapplied for up to two more sessions. If more than one is needed, a minimum interval of 7 days should be given between the sessions.

Whitening of non-vital teeth

Before starting the whitening procedure, X-ray the tooth to be whitened to verify its conditions. The treatment should be carried out within acceptable endodontic standards.

Step 1

Select and take the color of the teeth of the patient using a shade guide and/or photo before starting the whitening.

Step 2

It is necessary to seal the cervical region of the tooth to be whitened. Using a periodontal probe, check the length of the clinical crown of the tooth. Add 3 mm to this measurement and note its value, which will be the reference for removal of the obturation material. Sealing impede the diffusion of the whitening agent to the region of cementum and periodontium.

Step 3

Make a good coronal opening by removing the restorations present carious dentin, etc. With the clean pulp chamber, deepen the entrance of the conduit, removing approximately 3 mm of obturation for preparation of the sealing of the canal. Check the measurement of the removal with a periodontal probe. It is recommended that the sealing of the canal be done with glass ionomer with a thickness of 2 mm (for better sealing).

Step 4

Carry out absolute or relative isolation with light-curing gingival protector (Top dam – FGM) and mix the phases of the Whiteness HP whitener in the proportion of 3 drops of phase 1 (peroxide) to 1 drop of phase 2 (thickener). Generally, the mixture of 3 drops of peroxide to 1 drop of thickener is sufficient for one application. Shake the bottle of thickener vigorously before use.

Step 5

Apply Whiteness HP to the vestibular face and inside the pulp chamber with the aid of a brush. A layer approximately 1 mm thick is sufficient.

Step 6

If you want to use light-curing equipment, start the light application after application of the gel. Each piece of equipment has a specific protocol for light exposure time. Follow the manufacturer’s instructions. When considering a curing light, it is recommended to apply the light for 40 seconds on the tooth for vestibular and 40 seconds for palatinal or lingual. Wait 5 minutes and apply the light again. Let the gel work for the time necessary to complete 15 minutes after the start of the application.

Step 7

Remove the gel using suction (endodontic cannula) before reapplying the product. In a single session, up to three gel applications can be done. After completion of the applications of the whitening agent, wash and dry the tooth. Provisionally restore the cavity and monitor the result of whitening for at least one week. If needed, repeat the applications up to 4 times.

Note

The provisionally restored non-vital tooth has its crown weakened by the absence of tooth structure in its interior. Instruct the patient to be careful not to fracture the crown of the weakened tooth.

Step 8

Optionally, after removal of the Whiteness HP, you can perform internal whitening with carbamide peroxide-based whitener at 37% (Whiteness Super-endo – FGM) and continue the whitening of the tooth during the interval period between the sessions with Whiteness HP (for use of the Whiteness Super-endo whitener, see its specific instructions for use).

Step 9

At the end of the whole whitening process, definitively restore the whitened tooth. It is recommended to wait a minimum of 7 days before doing the restoration (time for the stabilization of the color of the tooth and elimination of the residual oxygen).

FAQ

How does dental whitening work?

Whitening can be done due to the permeability of the teeth, which allows the molecules of the whitening gel to penetrate inside the enamel and dentin. The hydrogen peroxide in the whitening gel “breaks” the molecules of the pigments that cause stains, which are removed by diffusion.

How can I treat dental sensitivity caused by in-office whitening?

You can increase the space of time between one application and another by applying a desensitizing gel of potassium nitrate and fluoride such as Desensibilize KF 2%, in the office for 10 minutes.

During whitening, some white stains may appear. What can be done?

Dental whitening does not cause stains. In areas of hypoplasia, stains which are often imperceptible, they become visible during whitening, but they usually disappear at the end of the treatment.

If a touch-up is needed, how should it be done?

Whitening touch-ups can be done with the take-home or in-office technique. Generally this “rewhitening” is a quicker treatment.

Can patients with tetracycline staining receive dental whitening?

The best procedure is to assess the degree of staining caused by tetracycline and talk with the patient about the possible results. We have reports in the dental whitening literature of tetracycline cases with the take-home technique up to six months in duration with satisfactory results. You can also use Whiteness HP or Whiteness HP Maxx, which have the advantage that they can be used on areas where there is staining. A good option is to combine the in-office and take-home technique.

Can pregnant or breastfeeding patients do dental whitening?

We do not recommend using dental whitening during these stages. In the scientific literature, there are no reports that whitening may cause any problem to the baby, but we recommend waiting for this stage to pass and starting safely after this period.

Why is dental whitening not recommended before the age of 15?

We do not recommend whitening at ages under 15, because the pulp chamber is very wide, and hypersensitivity may occur.

Why must cervical sealing be done for whitening of non-vital teeth?

Cervical sealing must be done because it prevents diffusion of the whitening gel to the periodontium via dentinal tubules, preventing radicular resorption.

Can I combine in-office whitening with take-home whitening?

Yes. It is an excellent option in various cases of very dark teeth, difficult-to-remove pigmentations, cases of patients with tetracycline stains, etc.

What care should the patient take with food during whitening?

The patient should avoid excessive consumption of foods with colorant such as carrots, beets, coffee, tea, or red wine. Consumption of citrus- and cola-based beverages should be avoided because they can increase sensitivity.

What are the cases with the best indications for whitening?

The cases that best respond to whitening are young patients with naturally dark teeth, cases of darkening with age, yellow tones.

How long does a dental whitening last?

The longevity of a whitening is variable from one patient to another. In a study conducted by Leonard, 1998, the author describes that 63% of patients are satisfied with the retention of the color obtained 3 years after undergoing whitening, and that at least 35% of patients are satisfied 7 years after undergoing the treatment. Reference: Leonard RH Jr. Efficacy, longevity, side effects, and patient perceptions of nightguard vital bleaching. Compend Contin Educ Dent. 1998;19(8):766-70, 772, 774.

Can anyone whiten their teeth?

Yes. Anyone can have their teeth whitened, provided that they are healthy and do not have too many restorations. The dentist will conduct a thorough assessment of the patient’s dental condition. A person can whiten their teeth starting at 15 years of age.

When should I choose take-home whitening, in-office whitening, or a mixed technique?

There is no rule. We can resolve cases with the take-home technique, the in-office technique, or a mixed technique. We should assess the degree of discoloration, the patient’s lifestyle, their discipline, and the desired speed of whitening.

When is dental whitening contraindicated?

Whitening is contraindicated in cases of teeth with many extensive restorations, patients with allergies to the components of the product, pregnant women, and women in the breastfeeding stage.

How long does a syringe for take-home whitening last?

A whitening syringe lasts, on average, 6 to 7 days. It is very important to adequately guide the patient on the quantity of gel that should be applied, so that there is no waste and for the treatment to be effective.

Is it necessary to make reservoirs in the plaster models before preparing the trays?

It is not mandatory, but some authors advocate making reservoirs because they help in the full settlement of the trays, enable a greater quantity of gel, and reduce the pressure on the teeth. The reservoirs can be made with Top dam (FGM).

How long after whitening can restorations be done with composite resin?

You must wait 7 to 14 days to be able to do adhesive restorations, due to a reduction in the adhesive force that occurs when restorations are done immediately after dental whitening.

Information for the Professional

Precautions and contraindications

• If using heating lamps to accelerate the whitening process, proper care must be taken to avoid excessive heating of the teeth and consequently damage the pulp (maximum tolerated is 42° C).
• The product is not recommended for people who have recently undergone periodontal surgery, have gingivitis and/or periodontitis, have active caries lesions, defective restorations and enamel hypoplasia, or have allergic reactions to components of the product.
• Use during pregnancy and lactation is not recommended.
• It is normal for tooth sensitivity to occur during or after whitening. If the patient has sensitivity during the treatment, interrupt the whitening and treat the teeth with Desensibilize KF 2% desensitizer. If the sensitivity persists and it is not possible to continue the whitening, schedule a new session with an interval of at least 7 days. Assess whether there is any anomaly in the teeth that may be corrected to eliminate this sensitivity.
• There are cases in which sensitivity appears only after the treatment (1 or 2 hours later). In these cases, if the sensitivity is high, it is recommended to prescribe an analgesic and application of Desensibilize KF 0.2% in a tray for whitening for 10 minutes. Desensibilize should not be applied more than once daily.
• The whitening treatment may reveal or highlight areas of hypocalcification due to the different (more intense) whitening of these areas. In some cases, these stains disappear due to dehydration of the enamel after the whitening is concluded. Treatment of these areas with fluoride may also assist in making them disappear;
• Exposure of the product for long periods to temperatures exceeding 40°C may result in alteration or spillage of the product.
• It may cause irritation in case of contact with skin/eyes. Ingestion of the product may cause gastric irritation.
• Keep out of reach of children.

Preservation and storage

• Store the product at temperatures between 5 and 25°C for best preservation of the product.
• Do not freeze the product.
• Protect from direct sun light.
• The validity period of Whiteness HP is 2 years from the date of manufacture.
• Do not use the product after its expiration date.

General recommendations

• The majority of dental stains can be removed with a single whitening session. However, depending on the origin and age of the stain, there are cases where more than one whitening session may be needed.
• If the whitening obtained in one session does not meet expectations and if the patient does not present sensitivity or any other contraindication, the product can be reapplied for up to two more sessions. If more than one is needed, a minimum interval of 7 days should be given between sessions.
• If the patient develops sensitivity that cannot be controlled, the whitening time may alternatively be reduced and divided into 3 sessions. In this case, it is suggested to make sure there is no anomaly in the dental structure that could be causing the sensitivity (fissures, exposure of dentin, etc.). When the sensitivity is difficult to control or, for some reason, another whitening session is not possible or not recommended, whitening can be supplemented by using take-home whiteners (carbamide peroxide-based Whiteness Perfect, or hydrogen peroxide-based White Class, for example);
• As with other whitening techniques, it is recommended to take the color of the teeth before whitening, provide clarification to the patient on the real expectations of their case (limitations in cases of tetracycline staining, grayish coloring, etc.), and warn about possible sensitivity and the need to change restorations. There are cases in which, due to particular characteristics of the teeth (characteristics of the enamel, pigmentation type, etc.), the desired level of whitening may not be possible to obtain.

Side effects

• Dental hypersensitivity may occur during or after whitening. Since this is difficult to predict in a variety of situations, it is recommended to use Desensibilize KF 0.2% (take-home use) or Desensibilize KF 2% (in-office use) as prophylactic desensitization, before the start of the whitening. If hypersensitivity persists and it is not possible to continue the whitening, schedule a new session with an interval of at least 7 days. Assess whether there is any anomaly in the teeth that may be corrected to eliminate this hypersensitivity.
• There may be cases where elevated dental hypersensitivity manifests itself after the procedure (1 to 2 hours after). In these cases, it is recommended to prescribe an analgesic and application of Desensibilize KF 0.2% in an individual tray for 10 minutes a day;
• The whitening may highlight areas of dental hypocalcification due to the more intense whitening of these areas. In the majority of cases, no additional care need to be taken, and the stains disappear as soon as the whitening is completed and the tooth regains its usual hydration. For more resistant cases, treatment with fluoride in the highlighted region may assist in making them disappear.