Whitening and oral care – Deborah Lyle

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  Posted by: The Probe      2nd August 2018

The appearance and colour of teeth are common concerns for patients and consequently, there is a high demand for treatments and products that improve dental aesthetics, including tooth whitening. Recommending effective and evidence-based whitening products can have huge advantages for practices. While whiter teeth can also have the added benefit of helping to improve a patient’s oral hygiene habits, keeping teeth and gingiva cleaner and healthier.

We perceive colour as something physical, however it is much more than this, it is a sensation. The three key components are sources of light, objects illuminated by them and the vision system. A light source can be characterised by its energy distribution at different wavelengths in the spectrum. When light falls on an object, depending on the physical properties of the object, the light is modified by reflection, scattering, absorption and transmission. The colour of an object is strongly dependent on its spectral reflection – the amount of incident light that is reflected from the surface for different wavelengths. When light reaches the eye, its energy is absorbed by the photoreceptors in the retina and converted into a signal that is interpreted by the brain.[1]

The colour white is a symbol of purity, freshness and cleanness. Sometimes described as an achromatic colour, it is considered a combination of all the colours of the visible light spectrum. The best way to classify whiteness is in the degree of departure from a ‘perfect’ white. Tooth shade has been cited as one of the most important variables in predicting smile attractiveness. Psychophysical studies have also shown that whitened teeth lead to judgements that are more positive on personality traits, such as social competence and appeal, intellectual ability and relationship satisfaction.1


The colour of the teeth is influenced by a combination of their intrinsic colour and the presence of any extrinsic stains that may form on the tooth surface.[2]Intrinsic discolouration is determined by how much light is scattered and absorbed at the surface and within the structures of the tooth. The enamel is a translucent scattering material and illuminating light can follow highly irregular paths through the tooth before it emerges at the surface of incidence and reaches the eye of the observer. Enamel does not fully obscure the colour of the underlying dentine, therefore dentine can have a significant role in determining the overall tooth colour. Intrinsic colour changes are typically caused by deeper internal stains or enamel defects, including ingestion of chromatogenic food and drink, ageing, enamel microcracks, excessive fluoride ingestion, dental caries and thinning of the enamel layer.[3],[4]

Extrinsic stains usually result from the accumulation on the tooth surface of chromatogenic substances from sources such as poor oral hygiene, bacterial by-products, tobacco, food pigments and dark drinks, for example coffee, tea and red wine. These stains are localised mainly on the surface and are either generated by the reaction between sugars and amino acids or acquired from the retention of exogenous chromophores in the pellicle.3,[5]

As teeth become darker in appearance, losing their natural whiteness due to changes in enamel and dentin properties, many patients become unhappy with their colour. Tooth whitening products can help to improve the overall whiteness of teeth, either by changing their intrinsic colour or by removing and controlling the formation of extrinsic stains. Following treatment, patients may also engage more proactively in their oral healthcare routine.

Personal oral hygiene through mechanical disruption and removal is the primary method of plaque control. Plaque is the primary aetiological factor in gingivitis and periodontal disease, which can be largely prevented through microbial control. However, though toothbrushing and flossing are relatively simple and effective, many patients lack the daily motivation required.[6]Research has shown that an individual’s dexterity and thoroughness are more critical than technique or design in determining efficacy.6Furthermore many periodontal diseases originate interproximally, including gingivitis, which is most frequent and severe at these sites.6

Water flossing has been shown to be the most effective means for removing interdental plaque[7]and reducing interdental and gingival bleeding.[8]It works by providing a unique combination of water pressure and pulsations to clean deep between teeth and below the gumline, removing harmful bacteria and debris that traditional brushing and flossing cannot reach. The pulsation action of the device results in an impact and flushing zone, which produces a compression and decompression phase and allows clearing of bacteria from periodontal pockets. Now, patients can benefit from both water flossing and whitening with the brand new Waterpik®Whitening Water Flosser. Providing all the advantages of a water flosser, the new model gives patients brighter, whiter teeth with just one minute’s use a day.

Providing quality teeth whitening products can help patients achieve that elusive white smile safely and effectively. Successful whitening can also encourage them to look after their oral hygiene along with the long-term benefits of reducing the build-up of harmful bacteria and plaque to improve gum health and prevent future tooth decay.


For more information on Water Pik, Inc. a subsidiary of Church & Dwight Co., Inc. please visit www.waterpik.co.uk. Waterpik®products are available from Amazon, Costco UK, Boots.com and Superdrug stores across the UK and Ireland.


[1]Joiner A, Luo W. Tooth colour and whiteness: a review. Journal of Dentistry 2017 67:3-10.

https://www.ncbi.nlm.nih.gov/pubmed/?term=Joiner+A%2C+Luo+W.+Tooth+colour+and+whiteness%3A+a+review.+Journal+of+Dentistry+2017+67%3A3-10. [Accessed 6thMarch 2018]

[2]Satheesh Haralur, Ahmed Mohammed Dibas, Nabil Abdullah Almelhi & Dhafer Ali Al-Qahtani. The Tooth and Skin Colour Interrelationship across the Different Ethnic Groups. Int J Dent. 2014; 146028. doi:  10.1155/2014/146028. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4102016/[Accessed 6thMarch 2018]

[3]Alqahtani MQ. Tooth-bleaching procedures and their controversial effects: a literature review. The Saudi Dental Journal2014;26:33-46. https://www.sciencedirect.com/science/article/pii/S1013905214000182[Accessed 6th March 2018]

[4]Takesh T, Sargsyan A, Anbarani A, Ho J, Wilder-Smith P. Effects of a novel whitening formulation on dental enamel. Dentistry 2017;7(4):424. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5505690/[Accessed 6thMarch 2018]

[5]Visco D, Gaffar A, Fakhry-Smith, Xu T. Present and future technologies of tooth whitening. Compend Contin Educ Dent Suppl. 2000;(28):S36-43; quiz S49. https://www.ncbi.nlm.nih.gov/pubmed/11908346[Accessed 6th March 2018]

[6]Choo A, Delac DM, Messer LB. Oral hygiene measures and promotion: review and considerations. Australian Dental Journal 2001;46(3):166-173. https://www.ncbi.nlm.nih.gov/pubmed/11695154[Accessed 6th March 2018]

[7]Lyle DM, Goyal JG. Qaqish JG, Schuller R. Comparison of water flosser and interdental brush on plaque removal: a single-use pilot study. J Clin Dent 2016;27:23-26. https://www.ncbi.nlm.nih.gov/pubmed/28390213[Accessed 6th March 2018]

[8]Goyal CR, Lyle DM, Qaqish, JG, Schuller R. Comparison of water flosser and interdental brush on reduction of gingival bleeding and plaque: a randomized controlled pilot study. J Clin Dent 2016; 27:61-65. https://www.ncbi.nlm.nih.gov/pubmed/28390208[Accessed 6th March 2018]

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