Introduction:

In today’s world, patients are concerned about the aesthetics of their teeth. Having white teeth has become a consideration for a large number of people. Mostly, this goal is achieved by the use of over-the-counter (OTC) dental whiteners. The patients can achieve brighter smiles without costly dental appointments or professional intervention. These are available in various forms such as strips, toothpaste, gels, and pens.

OTC dental whiteners contain bleaching agents like hydrogen peroxide or carbamide peroxide Iower concentrations. These products help remove surface stains and enhance the overall appearance of the teeth but may not deliver the same results as those of professional treatments.

Tooth whitening pens:

Tooth-whitening pens have emerged as a convenient and effective tool for individuals seeking brighter smiles. It has a gel-like substance inside that removes surface stains and whitens your teeth.

Hydrogen peroxide is the main ingredient that is present in the product. It is a strong bleaching agent that penetrates through enamel and dentin to remove the stains on the surface and whitens the tooth structure. The amount of hydrogen peroxide present is between 10 and 22%. Other ingredients include carbamide peroxide, glycerin, and carbomer. Carbamide peroxide is mixed with hydrogen peroxide to make it work better. Glycerin is a moisturizing agent that keeps the gum tissues safe. Carbomer is a thickening agent that helps keep the whitening gel on the teeth. Sometimes, sweeteners and flavorings are added to make them taste better. Wintergreen, mint, and bubblegum are some of the flavoring agents that are used.

History:

The media has influenced the public by the portrayal of perfect white smiles. Movies, electronic media, print media, and the color quality of television have raised awareness of discolored teeth. Several companies introduced home-based products and professionally applied tooth-whitening products in the US marketplace in the late 1980s. These products gained popularity among the public who demanded whiter teeth.

Intrinsic and extrinsic stains accumulate dark shades called chromogens. Chromogens fall into two sections.

• Large organic compounds having conjugated double bonds in their chemical structure

• Metal-containing compounds

Bleaching of organic compounds involves the reaction of hydrogen peroxide with the double bonds for oxidation. After the reaction, chromogen becomes a light-coloured compound.

 Advantages of tooth whitening pens:

• These products are easy to use. You can dispense the gel onto the brush tip and directly apply it to the teeth.

• These pens come with a brush tip or applicator that allows for precise application of the whitening gel. It is easy to target specific areas of staining ensuring even coverage.

• These pens are convenient to use without the need for trays or strips

• Many tooth whitening pens use lower concentrations of whitening agents that minimize tooth sensitivity.

• These products are portable and travel-friendly.

Frequency of application:

The factors affecting the usage of teeth-whitening pens include the strength of the bleach, how sensitive the person’s teeth are, and the expectations of the patients. It is best to start with once or twice a day and slowly increase the duration.

Steps to use tooth whitening pen:

• Brush or floss your teeth to remove the plaque or food debris

• Dispense the whitening gel by twisting the bottom of the pen until the gel appears at the tip.

• Apply the gel to your teeth using the applicator tip. The gel should not be applied to the gums as it can irritate.

• Leave the gel for 10-30 minutes.

• Rinse your mouth to remove any residual gel.

• Repeat the process as often as needed but do not overuse the product.

Risks associated with tooth-whitening pens:

• Increased risk of tooth sensitivity: This may occur as pain or discomfort while consuming cold or hot food items. Patients with pre-existing tooth sensitivity may be more prone to experience this side effect.

• Irritation/inflammation of gums: Contact with the gum tissues can result in soreness, mild bleeding, and redness. Avoiding excessive pressure or overapplication can minimize the irritation.

• Enamel demineralization: Improper use can cause tooth mineral degradation. This can damage the enamel causing tooth decay and sensitivity.

• Uneven whitening: It is challenging to achieve uniform whitening across the teeth, especially for individuals with restorations. This can result in an unnatural smile appearance.

• Allergic reactions: Some individuals may be allergic to hydrogen peroxide or carbamide peroxide. It can range from mild irritation to itching, swelling, or hives.

• Ineffectiveness on certain stains: Tooth-whitening pens may be less effective in removing certain stains such as those caused by tetracyclines or dental fluorosis. In such cases, professional whitening treatments, or alternative cosmetic dental procedures are preferable.

• Temporary results: The whitening effect is typically temporary. Regular application is required to maintain the results.

New studies have shown that aggressive tooth whitening can cause tooth sensitivity, changes in tooth microstructure, and restoration changes. The ingredients present can react with composite restorations, glass ionomer cements, sealants, and ceramic crowns causing a reduction in stability.

In a recent in vitro study conducted in Japan, researchers assessed the vulnerability of teeth to subsequent demineralization following a home-based bleaching regimen utilizing 10% carbamide compared to a more intense office-based regimen involving 35% hydrogen peroxide activation.

Extracted teeth of Vita shade A3 underwent the whitening procedure following the manufacturer’s instructions until the shade was changed to Vita shade A2 for all teeth. Followed by demineralization for two weeks, teeth were then evaluated for mineral density loss. The research discovered that the surface structure of teeth treated at home changed, resulting in notably more demineralization compared to teeth treated in the dental office with a stronger regimen.

The authors hypothesize that the peroxide present in the gel used in the dental office regimen reaches deeper layers of the enamel before being activated by photoirradiation.

In a randomized clinical trial, it was observed that all cases of tooth whitening using a 35% hydrogen peroxide product led to tooth sensitivity, particularly among teeth with restorations. The intensity of tooth sensitivity was significantly higher for restored teeth compared to sound teeth. The study concluded that while tooth whitening with 35% hydrogen peroxide was effective for patients with restored teeth, it was associated with a higher level of discomfort, particularly upper lateral incisors.

Conclusion:

Tooth whitening pens represent a modern and user-friendly approach to teeth whitening, providing individuals with a convenient solution for achieving a brighter smile anytime, anywhere. With their precise application and portable design, these pens offer a versatile option for incorporating teeth whitening into daily oral care routines. Overall, the discovery and development of tooth-whitening pens likely resulted from a combination of scientific research, technological innovation, and market demand for more convenient teeth-whitening options.

References:

1.     Christensen GJ. Are snow-white teeth so desirable? J Am Dent Assoc. 2005;136:933–935. [PubMed] [Google Scholar]

2.     Goldberg M, Grootveld M, Lynch E. Undesirable and adverse effects of tooth-whitening products: a review. 2010;14:1–10. [PubMed] [Google Scholar]

3.     Ogura K, Tanaka R, Shibata Y, Miyazaki T, Hisamitsu H. In vitro, demineralization of tooth enamel was subjected to two whitening regimens. J Am Dent Assoc. 2013;144:799–807. [PubMed] [Google Scholar]

(By Dr. Anjali KV)