What are the different types of teeth whitening available?
Most dental practices offer two types of whitening:
- Laser / in-surgery Teeth Whitening
- Professional home whitening kits
Both procedures are based on a bleaching process that uses a peroxide-based bleaching gel of varying strength (3%-30% peroxide). The higher the concentration of peroxide in the gel, the more powerful it is. While a higher concentration gel is more effective at whitening the teeth, it also has greater potential to cause side effects such as sensitivity and damage to the surrounding gum tissue and your lips.
Laser Tooth Whitening
Laser tooth whitening or in-surgery whitening is a procedure that takes place at the dental practice and uses a light-activated bleaching gel to whiten your teeth. The procedure usually takes approx 1 -2 hours and produces instant whitening results. Many dentists recommend that laser whitening should be followed up by professional home whitening.
The Laser Tooth Whitening procedure
Prior to carrying out the procedure you would have a consultation with your dentist to make sure that you are suitable for teeth whitening and to explain possible risks and side effects of the procedure. Most dental practices will ask you to sign a teeth whitening consent form to confirm that you have fully understood the procedure and all risks. Before the teeth whitening process is started a dentist or a hygienist will thoroughly clean the teeth, removing any surface stains and tartar. This procedure is commonly referred to as a scale and polish. The next step will be for the dentist to make a record of the shade/colour of the teeth before the procedure. This is either recorded using a tooth coloured shade guide/chart or by taking a digital photograph of your teeth. The area is then prepared for the procedure. The bleaching compound usually contains a high concentration of peroxide (15-30%) and so the dentist will usually place some form of protection around the gums so that only the teeth are exposed to the compound. This involves covering the gums with rolls of cotton and a protective gel material that hardens once applied to the gums. A cheek retractor is used to keep the lips and cheeks away from the teeth. It is very important that your dentist isolates your gums and lips with a protective material in order to avoid any potential damage or burning. Home whitening kits usually have a low concentration of peroxide so that there is less chance of any damage occurring. Recently, high-strength home whitening kits purchased online and from certain stores have attracted media attention with horror stories of people with badly burnt lips and gums. It's for this reason that teeth whitening should always be carried out under the supervision of a dentist. Eye protection (goggles) is also provided to prevent any damage to the eyes from the laser used or any accidental splashes of the peroxide. Many cosmetic practices now offer "DVD glasses" so that the patient can watch a movie during their treatment! The whitening gel is then applied to the surface of the teeth and exposed to a light or laser, which activates it. Some systems do not use an activating laser and many dentists argue that the laser doesn’t make any difference to the end result. During this process if you feel that your lips or gums start to burn then you should let your dentist know immediately. After approximately 15 minutes the gel is removed and the process repeated another 2 times. During the procedure some people may feel sensitivity in their teeth, which are described as short-lived shooting pains. The dentist will finally wash off the whitening gel and remove any gum protection before evaluating the final result by taking a photograph or using a shade chart. The results are usually quite dramatic and can often be up to 10 shades lighter. A kit for home whitening may also be provided with custom trays and professional whitening gel. Many patients’ teeth are quite sensitive immediately following this procedure and it is advised to try and avoid hot or cold drinks for a while. Some dentists offer fluoride treatment following teeth whitening to reduce this effect on sensitivity. Your home whitening kit usually contains a solution to reduce tooth sensitivity. Sensitivity rarely lasts more than 48 hours, if symptoms persist for longer than this then contact your dentist. Once your treatment is complete your dentist will remove the gel and a shade guide will then be used to measure how much whiter your teeth have become during the procedure. The results are instant and can often be up to 10 shades lighter. Professional home whitening kits provide more permanent results over a longer time scale, whereas laser tooth whitening offers immediate results. A combination of the two provides the perfect solution to both immediate and long-term whitening needs.
Professional home whitening kits
To make a professional home whitening kit, your dentist will take a impression (mould) of your teeth using a special dental putty. Your dentist’s technician will then use this to cast a model of your teeth from plaster and make your custom teeth whitening trays from this. Once these trays have been made (usually takes 5-10 days) you use them in combination with professional whitening gel (provided by your dentist) until you are happy with the results. Depending on the teeth whitening system, some trays need to be worn overnight while others for only 1-2 hours a day.
Suitability for whitening
Many people are not suitable for teeth whitening and a dentist will assess your suitability during a consultation. If you have gum disease or other dental health problems, you may not be suitable. The teeth whitening process does not change the colour of crowns, veneers or fillings so it is important to understand that you may need to change these to match the colour of your whitened teeth.
How much whiter will my teeth look?
This varies from individual to individual, and also depends on the type of whitening system used. Some people respond very well to teeth whitening and have dramatically whiter teeth as a result, whereas others may notice very little difference at all. People with heavily stained yellow teeth tend to have more dramatic results than those with slightly discoloured teeth.Your dentist will be able to advise you on the likely results following a consultation.
Does it hurt? What are the side effects of teeth whitening?
Some people experience no pain or sensitivity with their teeth. However, the majority of people will experience some kind of sensitivity either during and/or after the initial treatment. This is usually described by patients as sporadic, sharp shooting pains coming from their teeth. This should settle down after approximately 48 hours though. Your dentist may give you a special gel or mousse to apply to your teeth to help with the sensitivity. It is advisable to avoid hot or cold food and drinks within the first 48 hours of your whitening treatment.
Which teeth-whitening brand or system is the best?
There are many different brands of professional teeth-whitening systems, each claiming to provide the best results. The most popular systems are Zoom!®, as featured on Extreme Makeover, Opalescence® , BriteSmile® and the latest Enlighten system. Each system has its pros and cons, and your dentist will be able to advise you on which system would be best suited for your teeth.
Many teeth whitening systems are available, including whitening toothpastes, over-the-counter gels, rinses, strips, and trays, and whitening agents obtained from a dentist.
Teeth whitening is ideal for people who have healthy, unrestored teeth (no fillings) and gums. Individuals with yellow tones to their teeth respond best. But this cosmetic procedure is not recommended for everyone.
Find out if teeth whitening is right for you.
All toothpastes help remove surface stains because they contain mild abrasives. Some whitening toothpastes contain gentle polishing or chemical agents that provide additional stain removal effectiveness. Whitening toothpastes can help remove surface stains only and do not contain bleach; over-the-counter and professional whitening products contain carbamide peroxide or hydrogen peroxide that helps lighten the color deep in the tooth. Whitening toothpastes can lighten your tooth's color by about one shade. In contrast, light-activated whitening conducted in your dentist's office can make your teeth three to eight shades lighter.
Over-the-Counter Whitening Strips and Gels
Whitening gels are clear, peroxide-based gels applied with a small brush directly to the surface of your teeth. Instructions generally call for twice a day application for 14 days. Initial results are seen in a few days and final results are sustained for about four months.
Whitening strips are very thin, virtually invisible strips that are coated with a peroxide-based whitening gel. The strips are applied twice daily for 30 minutes for 14 days. Initial results are seen in a few days and final results are sustained for about four months.
Among the newest whitening products available are whitening rinses. Like most mouthwashes, they freshen breath and help reduce dental plaque and gum disease. But these products also include ingredients, such as hydrogen peroxide, which whiten teeth. Manufacturers say it may take 12 weeks to see results. You just swish them around in your mouth for 60 seconds twice a day before brushing your teeth. However, some experts say that rinses may not be as effective as other over-the-counter whitening products. Because a whitening rinse is only in contact with the teeth for such a short time — just two minutes a day compared to 30 minutes for many strips — it may have less of an effect.
Tray-Based Tooth Whiteners
Tray-based tooth whitening systems, purchased either over-the-counter or from your dentist, involve filling a mouth guard-like tray with a gel whitening solution — which contains a peroxide-bleaching agent — and wearing the tray for a period of time, generally from a couple hours a day to every day during the night for up to four weeks and even longer (depending on the degree of discoloration and desired level of whitening).
In-office bleaching provides the quickest way to whiten teeth. With in-office bleaching, the whitening product is applied directly to the teeth. These products can be used in combination with heat, a special light, and/or a laser. Results are seen in only one, 30- to 60-minute treatment. But to achieve dramatic results, several appointments are usually needed. However, with in-office bleaching, dramatic results can be seen after the first treatment. This type of whitening is the most expensive technique.
How Long Do Teeth Whitening Effects Last?
Teeth whitening is not permanent. People who expose their teeth to foods and beverages that cause staining may see the whiteness start to fade in as little as one month. Those who avoid foods and beverages that stain may be able to wait one year or longer before another whitening treatment or touch-up is needed.
The degree of whiteness will vary from individual to individual depending on the condition of the teeth, nature of the stain, the type of bleaching system used, and for how long.
At-Home Teeth Whitening vs. Dentist-Supervised Teeth Whitening
There are differences between whitening your teeth at home and having them bleached in a dentist's office, including:
Strength of bleaching agent. Over-the-counter products and dentist-supervised at-home products usually contain a lower strength-bleaching agent from 10% carbamide peroxide, which is equivalent to about 3% hydrogen peroxide, up to 22% carbamide peroxide. In-office, professionally applied tooth whitening products contain hydrogen peroxide in concentrations ranging from 15% to 43%.
Mouthpiece trays. With dentist-supervised at-home bleaching products, your dentist will take an impression of your teeth and make a mouthpiece tray that is customized to exactly fit your teeth. This customization allows for maximum contact between the whitening gel, which is applied to the mouthpiece tray, and the teeth. A custom-made tray also minimizes the gel's contact with gum tissue. Over-the-counter whitening products also contain a mouthpiece tray, but the "one-size-fits-all" approach means that the fit will not be exact. Ill-fitting trays can irritate the gum and soft tissue by allowing more bleaching gel to seep onto these tissues. With in-office procedures, the bleaching agent is applied directly to the teeth.
Additional protective measures. In the office setting, your dentist will apply either a gel to the gum tissue or use a rubber shield (which slides over the teeth) prior to treatment to protect your gums and oral cavity from the effects of the bleaching. Over-the-counter products don't provide these extra protective measures.
Costs. Over-the-counter bleaching systems are the least expensive option, with in-office whitening being the costliest.
Supervised vs. unsupervised process. Dentist-supervised at-home bleaching and in-office treatments offer additional benefits compared with over-the-counter procedures. First, your dentist can perform an oral exam and consider your complete medical history, which can be helpful in determining how your teeth became discolored and if bleaching is an appropriate course of treatment based on your type and extent of stains and type, number and location of restorations. Your dentist can then better match the type of stain with the best treatment, if appropriate, to lighten those stains. With dentist-supervised bleaching procedures, your dentist will likely want to see you a couple of times to ensure you are following directions, to make sure the customized tray is fitting properly, to inspect your gums for signs of irritation, and to generally check on how the teeth whitening process is proceeding. With over-the-counter bleaching products, you are on your own.
Who Should Not Undergo Teeth Whitening?
Whitening is not recommended or will be less successful in the following circumstances:
Age and pregnancy issues. Bleaching is not recommended in children under the age of 16. This is because the pulp chamber, or nerve of the tooth, is enlarged until this age. Teeth whitening under this condition could irritate the pulp or cause it to become sensitive. Teeth whitening is also not recommended in pregnant or lactating women.
Sensitive teeth and allergies. Individuals with sensitive teeth and gums, receding gums, and/or defective restorations should consult with their dentist prior to using a tooth-whitening system. Anyone allergic to peroxide (the whitening agent) should not use a bleaching product.
Gum disease, worn enamel, cavities, and exposed roots. Individuals with gum disease or teeth with worn enamel are generally discouraged from undergoing a tooth-whitening procedure. Cavities need to be treated before undergoing any whitening procedure. This is because the whitening solutions penetrate into any existing decay and the inner areas of the tooth, which can cause sensitivity. Also, whitening procedures will not work on exposed tooth roots because roots do not have an enamel layer.
Fillings, crowns, and other restorations. Tooth-colored fillings and resin composite materials used in dental restorations (crowns, veneers, bonding, bridges) do not whiten. Therefore, using a whitening agent on teeth that contain restorations will results in uneven whitening — in this case, making the teeth without restorations appear lighter than those with restorations. Any whitening procedure should be done prior to the placement of restorations. Individuals with numerous restorations that would result in uneven whitening may be better off considering bonding, veneers, or crowns rather than a tooth whitening system. Ask your dentist what strategy is best for you.
Unrealistic expectations. Individuals who expect their teeth to be a new "blinding white" may be disappointed with their results. Smokers need to be aware that their results will be limited unless they refrain from continued smoking, particularly during the bleaching process. A healthy guide as to a reasonable degree of whiteness to achieve with a whitening process that would give a natural appearance to a person's teeth is a slightly whiter color than the whites of your eyes.
Darkly stained teeth. Yellowish teeth respond well to bleaching, brownish-colored teeth respond less well and grayish-hue or purple-stained teeth may not respond to bleaching at all. Blue-gray staining caused by the antibiotic tetracycline is more difficult to lighten and may require up to six months of home treatments or several in-office appointments to successfully lighten. Teeth that have dark stains may be better candidates for another lightening option, such as veneers, bonding, or crowns. Your dentist can discuss the options best suited for you.
Risks Associated With Teeth Whitening
The two side effects that occur most often with teeth whitening are a temporary increase in tooth sensitivity and mild irritation of the soft tissues of the mouth, particularly the gums. Tooth sensitivity often occurs during early stages of the bleaching treatment. Tissue irritation most commonly results from an ill-fitting mouthpiece tray rather than the tooth-bleaching agent. Both of these conditions usually are temporary and disappear within one to three days of stopping or completing treatment.
If you do experience sensitivity, you can reduce or eliminate it by:
Wearing the tray for a shorter period of time (for example, two 30-minute sessions vs. two 60-minute sessions).
Stop whitening your teeth for two to three days to allow your teeth to adjust to the whitening process.
Ask your dentist or pharmacist for a high fluoride-containing product, which can help remineralize your teeth. Apply the fluoride product to the tray and wear for four minutes prior to and following the whitening agent.
Brush your teeth with a toothpaste made for sensitive teeth. These toothpastes contain potassium nitrate, which helps soothe your teeth's nerve endings.
Some whitening products dispensed through dentists' offices as well as professionally applied (in-office) bleaching products have received the American Dental Association (ADA) Seal of Acceptance, which indicates that the product has met ADA guidelines for safety and effectiveness. Currently, only dentist-dispensed home-use products containing 10% carbamide peroxide and office-applied products containing 35% hydrogen peroxide have received the ADA Seal of Acceptance. Over-the-counter bleaching products are not endorsed by the ADA because the organization believes that professional consultation is important to ensuring safe and effective use. No whitening products using lasers are on the ADA's list of accepted products. Several whitening toothpastes that are available over-the-counter have received the ADA Seal of Acceptance. For a list of specific toothpastes that have gained the ADA's Seal of Acceptance, visit www.ada.org.
It should be noted that not all manufacturers seek the ADA's Seal of Acceptance. This is a voluntary program that requires considerable expense and time on the part of a manufacturer. Just because a product does not have the ADA Seal of Acceptance does not necessarily mean that the product is not safe and effective. You can be assured, however, that products that do carry the seal have meet the ADA's standards for safety and effectiveness when used as directed.
Teeth whiteners are not drugs and therefore are not regulated by the FDA.
Tips to Consider When Choosing an Over-the-Counter Whitening Kit
Try to select a teeth whitening kit that allows some customization of the mouthpiece. Some kits come with a mouthpiece that can be molded to some degree. These are better than others that come with a standard mouthpiece.
Try to gain the opinion of others who may have already tried the kit you are considering.
If at any time you experience a prolonged change in the color of your gums or an increased tooth sensitivity to hot or cold foods and beverages, stop wearing the mouthpiece and see your dentist immediately.
The desire to have a bright, shiny teeth can make all of us forget that teeth whitening, like the most of the dental and cosmetic procedures, can have negative sides if not done correctly. Yes, all of us would like to be able to show off the new show-white smile, but how big is the price for that? And I don’t mean in money terms. Although teeth whitening methods are said to be totally safe and not harsh for the teeth, some people still have second thoughts. I mean, in this process really harsh bleaching chemicals are used so it’s quite logical to ask yourself what negative effect can that have and are they temporary or there are some long term side effects that nobody wants to mention. Well, yes, there are negative effects. Some of them are just a temporary inconvenience while some of them can seriously damage the teeth. All that, of course depends on how the whitening is conduced.
If a dentist performs the whitening there are no potential risks because he will do it carefully and professionally. You can, however experience some short term inconveniences like burning gum or you teeth may became a little more sensitive. The reason for that are of course the chemicals that are used in the whitening process. The dentist will make sure you teeth don’t get over bleached and he will protect the soft tissues so the burning of the gum is reduced to a minimum. The chemical dentist uses are, indeed, stronger than in over-the-counter kits but that should not be a problem if a procedure is conducted rarely and by a professional. However, going to the dentist shop for teeth whitening and then bleaching some more at home can, and probably will damage the tooth enamel and make the teeth very sensitive.
If you try to do the teeth whitening by yourself you may experience graver discomfort. Many people use over- the–counter products without consulting their dentist. What they don’t know is that bleaching agents like hydrogen and carbamide peroxide can cause severe bleeding and burning of the mouths soft tissues, and if they are ingested can also cause abdominal pains and diarrhea. The result of the home teeth bleaching can be pretty bad. The teeth can became unnaturally white while all corrections done on them remain the same colour as before and that doesn’t only look bad but demands a visit to the dentist office as soon as possible. This method can actually make you spend more money fixing the damage rather than saving money by whitening at home.