Tooth Whitening during Orthodontic Treatment: a Six-Month in vitro Assessment of Effectiveness and Stability

Not only are today's orthodontic patients concerned about the alignment and shape of teeth but also the color; many wish to have their teeth whitened before the end of orthodontic treatment. Common questions that orthodontists face from patients are, “When can I whiten my teeth? Can I whiten my teeth with braces?” The answer often given is based on the assumption that ideally tooth whitening should be done after the debonding of brackets at the completion of orthodontic treatment. Currently, no evidence-based protocol exists for the optimal time to whiten teeth for patients undergoing orthodontic treatment. A recent nationwide survey of whitening protocols conducted among 3,601 active AAO members in the United States [1] showed that almost all orthodontists encounter patients seeking tooth whitening during active orthodontic treatment. Also, only about a third of those patients receive whitening treatment in the orthodontist's office while most patients are referred to another dental practitioner for the tooth whitening procedure. Jadad et al. [2] assessed the effectiveness of 8% hydrogen peroxide-based whitening agent in patients wearing fixed orthodontic appliances. The conclusion drawn by Jadad et al. was that Treswhite Ortho (Opalescence®) is an effective whitening agent for teeth with or without brackets. However, there are no other studies on dental whitening in patients wearing braces to compare and validate the findings of this study and the percentage concentration of hydrogen peroxide used was low compared to other dental whitening products that have been widely studied. The lack of information makes it difficult for the practitioner to determine the right time to provide tooth whitening procedures for their patients [1,3]. Therefore, further research is needed on the effectiveness of the whitening procedure during wearing braces and how it affects the color of the tooth enamel.