By: Dr. Marc Lazare, DDS
Americans have become increasingly more preoccupied with health and fitness. As they diet and exercise their way to a more youthful appearance, they are realizing more and more that one of the hallmarks of appearing youthful is having a bright, beautiful smile. Psychological studies repeatedly confirm that oral and dental beauty is very important to the perception of an individual’s confidence and well-being. Smile whitening is no longer a luxury reserved only for the rich and famous. These days, “whiter teeth” is the most popular esthetic request from dental patients, and tooth whitening is a well-tolerated, non-invasive approach to achieving this goal.
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Over-the-counter whitening products such as whitening toothpaste, whitening floss, and whitening chewing gum are relatively ineffective at best. Some of these whitening pastes are very abrasive and actually cause damage to the enamel. Brushing with toothpaste removes the extrinsic stains by mechanical means; little to no change in color actually takes place.
As for the do-it-yourself bleaching kits, they often cause one to have ill-fitting trays, unnecessary sensitivity, and results that do not meet one’s expectations. One over-the counter product worth mentioning is the Crest whitening strips, a new whitening technology that has recently entered the market.
It uses a 5.3% hydrogen peroxide-impregnated polyethylene strip that is to be placed twice daily for thirty minutes. While these strips are in my estimation to be a step above the do-it-yourself whitening systems, they do not replace the custom-fabricated tray-whitening systems that your dentist can provide for you. They are simply an alternative for patients unable to tolerate trays or who can’t afford the expense or time commitment of tray whitening.
It is imperative that one’s dentist performs a proper examination and diagnosis, in order to identify abscessed teeth, existing cavities, internal or external resorption, and other pathological problems before bleaching. Your dentist can help you to prevent the “corn-on-the-cob” effect (yellow tooth, white tooth, yellow tooth, etc.), by pointing out which of your teeth have restorations that will not whiten. A prophylaxis may be indicated to remove extrinsic stains, and a full series of x-rays and a detailed dental history should help to determine if someone is more prone to having sensitive teeth. Some patients may experience sensitivity throughout the treatment; others may not experience any sensitivity at all. Usually any sensitivity one may experience ceases upon the termination of treatment.
There are two basic options for home bleaching: daytime and nighttime intervals. Home bleaching is achieved by wearing a simple appliance, known as a nightguard, which functions as a reservoir for the whitening gel. Patient compliance is usually better at night, although some people may not be able to tolerate going to sleep with the nightguard in their mouth. Night use affords the individual maximum benefit from each application because of the longer exposure time and diminished salivary flow.
However, occasionally people may need to reduce the duration of their treatment as a result of sensitivity or personal preference. For these individuals, daytime wear is recommended for 1-2 hour intervals of treatment. It is imperative that your dentist professionally supervises this procedure, and that the mouth guard be custom made to ensure a perfect fit.
The importance of a custom-fitted tray cannot be over-emphasized; it allows for maximum patient comfort, reduces side effects, and maximizes efficacy. It should be noted that composite (tooth color) fillings, veneers and crowns might need to be replaced after bleaching, as these restorative materials will not change color. Whitening treatment is considered complete when the patient has reached their desired shade.
With good oral care the procedure’s results may last over two years, and recent studies have shown that most patients experience only a one-shade regression after 6 months. Of course, those patients who smoke, drink dark teas and coffee, indulge in red wine and other readily staining foods and beverages, are more likely to relapse sooner and require additional whitening sessions. Nightguard whitening usually tends to revert less than in-office techniques, but it takes longer to achieve desired results.
In office whitening (ie. power whitening or laser whitening) is a faster alternative for achieving that bright smile. People are interested in a tooth whitening system that is quick, safe and easy to do. In-office procedures can offer a high degree of predictability and an assurance of great results. This method has been very popular, not just among the actors and models that I treat, but with anyone whose free time is limited or who just wants instant results. In-office whitening procedures allow the dentist to whiten their patient’s teeth up to 15 shades in about an hour (the average shade change being 8 shades).
The primary ingredient is peroxide in various concentrations (those of a higher concentration may cause a greater degree of temporary sensitivity). Although some patients may experience tooth sensitivity and gum irritation, these symptoms are usually mild and disappear by the end of treatment. For some individuals, this method is popular because they don’t have to wear a tray that could trigger a gag reflex; in others a tray is contraindicated because of grinding or clenching habits.
According to an article in the June 2000 issue of Compendium, Laser whitening has not been shown to be any more effective than conventional in-office whitening. Lasers don’t actually bleach the teeth, but rather are used to activate the bleaching chemicals, just like any other light source. It doesn’t matter which light source you use, the energy (wavelength) of the light source (whether it be from argon lasers, curing lights, ion plasma lamps, etc.) must match the energy required to activate the peroxide into a higher energy state. If this is not achieved, the light will simply be converted to heat. With laser treatments, you will be paying a lot more money for similar results.
Will tooth whitening work well for you? If your teeth are discolored by the natural process of aging, the prognosis for a beautiful, youthful smile is excellent. You can expect fantastic results in one to six weeks of treatment. The in-office bleaching technique may be used in conjunction with the dentist-prescribed home whitening for a more efficient technique or for stubborn discolorations.
If your teeth are discolored as a result of smoking, coffee or other staining materials, you can expect great results anywhere from two weeks to three months. Naturally, I wouldn’t recommend smoking while bleaching, as the results will take longer to recognize.
Teeth with stains that develop as a result of ingesting the antibiotic tetracycline usually have a favorable outcome within two to six months. Single dark teeth will generally lighten over time, and a special night guard for a single tooth can be made. Brown stains due to excessive amounts of fluoride are usually removable in 80% of affected teeth, although some stains may recur.
White spots are not removed with bleaching, although they may become less noticeable. If your teeth were dark to begin with, then bleaching may decrease the relative contrast of the white spots on your teeth. Finally, it is important to note that teeth that are more yellow in color usually respond more favorably to tooth whitening than teeth that are grayer in appearance.
Tooth bleaching has proven to be a safe and effective way of achieving a more youthful and healthy-looking smile. In fact, the American Dental Association (ADA) has lent its support and approval for enhancing the esthetics of one’s smile via in-office and home bleaching, and has given its Seal of Approval to a number of whitening systems. The safety and effectiveness of this procedure is directly related to the dosage given, the frequency and duration of treatment, the concentration and type of the material used, and the type of tray or system utilized. The important thing is to choose the method that is best for you.