Mrs. Shin brings her 9-year-old daughter, Sally, in for her examination and prophy appointment at 9 am. She tells you that she is concerned that Sally’s permanent teeth are coming in really yellow and asks if they should be bleached. You explain that it is natural for permanent teeth to appear more yellow due to the differences in deciduous and permanent teeth. Once her permanent teeth have all erupted, they will not appear so yellow since there is no longer a contrast between them and the whiter/blue hue of her primary teeth. The mother admits that the colour difference does not bother Sally, but it is something that Mrs. Shin notices.
You strongly discourage them from pursuing bleaching treatment for a mixed dentition and discuss the guidelines from both the ADA and AAPD (American Association of Pediatric Dentistry), which do not recommend tooth whitening/bleaching for children and teenagers before the age of 14.3,10 If Sally is unhappy with the colour of her teeth after her permanent dentition has fully erupted, you can revisit options, which may be very different than what exists today. Mrs. Shin should know that while Sally is under the age of 18 close supervision of the chosen procedure will be extremely important to ensure proper use and compliance, and to understand and minimise any potential adverse reactions.