Teeth Whitening: Frequently Asked Questions

Overview

Teeth whitening is one of the easiest ways to improve your appearance. Whiter teeth can boost your self-esteem and confidence. Years of drinking coffee, tea, cola, red wine, and smoking eventually takes their toll on teeth. The results are dull, yellowish-colored teeth. Some teeth may have darker gray-colored stains due to antibiotics. Most teeth will benefit from tooth whitening. Teeth whitening is a proven safe and effective way to brighten stained, discolored teeth.

Your dentist has a variety of methods for restoring a bright white smile including porcelain veneers, composite bonding, implants and whitening, also known as bleaching. However, of all the advances made in dentistry to enhance the appearance of the teeth, whitening is the easiest and least invasive, and effective for 3 out of 4 cases. The procedure is safe, simple, and more affordable than ever before. Because of these reasons and more, whitening has become very popular.

Should I consult a dentist about teeth whitening?

You may want to start by speaking with your dentist. They can tell you whether whitening procedures would be effective for you. Whiteners may not correct all types of discoloration. For example, yellowish hued teeth will probably bleach well, brownish-colored teeth may not bleach as well, and grayish-hued teeth may not bleach well at all.

Bleaching may not enhance your smile in the event you have had bonding or tooth-colored fillings placed in your front teeth. The whitener will not affect the color of these materials and they will stand out in your newly whitened smile. You may want to investigate other options in this case such as porcelain veneers or dental bonding.

What teeth whitening methods are available to me?

All whitening products contain peroxide either as carbamide peroxide (CP) or hydrogen peroxide (HP). Peroxide dissolves the organic stains in the tooth to change the color and produce a whitened effect.

There are four types of peroxide-containing tooth whitening products available:

* In-practice products are applied by a dental professional. These products contain a high percentage of CP or HP and are applied directly to the teeth. Some activated by heat, light, or laser. This may be the product for you if you're in a hurry for whiter teeth and you don't have tooth sensitivity. For very dark-colored teeth, the whitening process can be sped up in two to three hours followed by a take-home product until the desired whiteness is achieved.

* A take-home product supervised by a dentist is the most popular whitening method. These products contain a lesser percentage of CP or HP than in-practice products and are worn in a tray overnight or during the day at home. A custom-fitted tray is made to hold the whitening product directly against the teeth while lessening its contact with the gums. Some products have fluoride added to help prevent or treat mild tooth sensitivities. The typical stains of ageing will whiten in seven to fourteen days when the tray is worn overnight.

* Over-the-counter (OTC) whitening products contain a small percentage of HP or CP. Caution should be used with these products as many contain an acidic solution that can wear away tooth enamel. OTC products use a bulky, one-size-fits-all tray to hold the product. Usually more product is swallowed than stays in the tray because of the trays poor fit against the teeth. It can take up to six months and the purchase of several kits to get whiter teeth. Flexible strips coated with whitening gel have recently been introduced as an OTC at-home tooth whitening method. The strips are worn on the front teeth and folded over to keep them in place. Results are reported to be noticeable after fourteen days and effective for 6 months.

* Over-the-counter whitening toothpastes contain a small percentage of HP, CP, or polishing ingredient. The toothpastes are effective in keeping teeth cleaner and whiter looking but some may be very abrasive. The harsh abrasive will wear away the enamel with repeated use gradually making the teeth look yellow. Whitening toothpastes remove surface stains and prevent new stains from building up. Whitening toothpastes however aren't in contact with the teeth long enough to remove internal stains. Ask your dentist about the safety and cavity protection of specific toothpastes before you buy.

How should I choose a teeth whitening method?

It is highly advisable to inform your dentist about your goals regarding teeth whitening. They can advise you about the most suitable method and also outline the procedure, likely results, side effects and address any questions you may have.

How does teeth whitening achieve results?

The bleaching gel is usually hydrogen or carbamide peroxide that breaks down into oxygen molecules. These molecules go into the tiny pores of the enamel and dentin and break up the stains that block out the light. More light passes through the teeth and makes them look lighter as the stains are broken into smaller and smaller pieces. Stains that are accumulated over time that are yellow to slightly brown produce the best results. Teeth that are dark brown to blue-grey are the most difficult to bleach because the stain is deeply embedded in the structure of the tooth. These types of stains are usually caused by medications taken during the development of the teeth such as tetracycline and can take a minimum of three weeks to see results and as much as six months for complete results.

Results can be seen within an hour, overnight or within three to four days depending on the bleaching gel used and the length of time it is worn. Complete results can be achieved in as little as a week or as much as several months depending on the source of the stain and the ability of the teeth or tooth to be bleached. The whitening procedure may last for up to three years and even longer in some cases depending on personal habits. A simple process of bleaching for one or two nights with a single gel syringe is usually sufficient to brighten the color again.

What takes place at the initial visit to the dentist?

You will be able to talk with your dentist about the changes you would like to make in your appearance at the first visit with your dentist. Your dentist will explain the different options available to you, the procedure itself, and its risks and limitations.

Your dentist will begin with a complete medical history and examine your teeth. They may also take photos or x-rays and give you specific instructions on how to prepare for the procedure. Any large cavities may need to be addressed before bleaching can begin. Take this opportunity to ask all the questions you have about the procedure. Learning everything you can about your options, risks and benefits is the key to making an informed decision.

How are the treatments carried out?

There are three types of bleaching procedures to choose from. Two of them are performed in the dental practice and the third is a take-home self-administered treatment.

* In-Practice whitening procedures

For laser and power bleaching, a dentist begins by applying a protective material to your gums and lips in order to isolate the teeth. A special bleaching solution usually containing hydrogen peroxide is applied to the teeth. A high intensity light or laser is directed at the teeth and activates the bleaching agent causing the gel to release the oxygen molecules. Treatments for both power and laser bleaching can take as little as 45 minutes but usually last somewhere between one and two hours.

These techniques work great for a single discolored tooth as well. The bleaching solution is placed on the outside of the tooth if the tooth has become dark due to trauma but has not had a root canal. The solution can be placed on the outside as well as the inside of the tooth if the tooth has had a root canal. Leaving a bleaching solution inside the tooth and sealing the opening is referred to as 'walking bleach'. The solution inside the tooth for a walking bleach is changed about once a week. Results can take several weeks but nothing has to be worn in the mouth.

* Take-home whitening

Take-home bleaching is performed at home under the indirect supervision of a dentist. The dentist takes impressions of the patient's teeth and then creates a perfectly fitted mouthguard at the first appointment. This mouthguard will allow the patient to apply a bleaching solution to the teeth while protecting the rest of the mouth from contact with the bleaching chemicals.

The concentration of hydrogen peroxide or carbamide peroxide in the gel is not as strong as that used in power or laser bleaching procedures. No strong light source or laser is needed to activate the bleaching agent. It is contact with the teeth that causes the gel to release oxygen. Take-home bleaching in most cases can take from one to three weeks to achieve maximum results. The dentist during this time may want to check the progress of the treatment.

Will I experience any discomfort?

The amount of discomfort experienced varies from person to person and depends on the method used. Most adults usually experience little if any discomfort. An over-the-counter anti-inflammatory may help in the case of some discomfort. Consult your dentist for more options if the discomfort lasts for more than 2 to 3 days.

Decreasing the sensitivity may be as easy as placing a gel fluoride under your dentist's instruction in your bleaching tray for an hour or so. Other materials may be used to address the sensitivity you may experience. Check with your dentist for the best options for your particular needs.

You should discuss your goals, budget, and pain tolerance with your dentist in order to help them determine the procedure, or combination of procedures, that will produce the best results for you.

What can I expect after teeth whitening?

The results of teeth whitening vary but most people are happy with the results. Patients should avoid foods that stain such as tobacco and red wine for about a week after any bleaching treatment. Keeping teeth clean with flossing and brushing can maintain whiteness. Tooth bleaching lasts on average about 1 to 3 years. Bleaching may last even longer if you are not a regular tobacco user and do not eat many foods that are known to stain teeth.

Decalcified spots are white spots that affect the calcium in the enamel. These spots appear chalky white and are difficult to treat with just bleaching. Your dentist may recommend a procedure called micro-abrasion. This procedure can be done by itself or in conjunction with bleaching. The micro-abrasion material is much like the paste used to clean and polish teeth. The paste consists of an abrasive combined with a hydrochloric acid used to "polish" out the white or brown spots. The procedure can be performed usually in one practice visit and can be done without anesthesia.

How long will the teeth whitening last?

The effects of the teeth whitening should last for 1 to 3 years. Daily brushing and flossing will assist in maintaining the whiteness. The duration of the whiteness will also depend on your personal habits. Drinking red wine, tea, coffee or smoking will shorten the life of the new whiteness. You may want to conduct a re-treatment in the future. This should not be as costly and time consuming as the original whitening procedure as you will already have the custom made trays.

Am I an ideal candidate for teeth whitening?

In general, the best candidates for teeth whitening are:

? Mature enough to fully understand the procedure
? Experiencing stained and marked teeth
? Knowledgeable about the procedure
? Wanting to improve their appearance and confidence
? Realistic in their expectations

The above is only a partial list of the criteria that your dentist will consider in determining whether or not this procedure is appropriate for you. Be sure to ask your dentist if they consider you an ideal candidate for this procedure.

Are there any alternatives?

Teeth that have dark stains may be better candidates for another whitening option such as veneers, bonding, or crowns. Your dentist can discuss the options best suited for your situation.

Patients interested in whitening their teeth should consult a dentist before taking on any form of treatment whatsoever. A consultation with a dentist will help you understand the benefits and risks associated with each of the options.

What are the risks and limitations?

Bleaching can produce side effects ranging from increased tooth sensitivity to pain and tenderness in the gums, tongue and other soft tissues. There is also a possibility of over-bleaching. The result will be a translucency that may appear grey from the shadows of the mouth. There is a very low percentage of this occurring and only if the bleaching process is over-extended. Having a dentist supervise the process can eliminate this risk.

With take-home bleaching there is a small risk of ingesting the gel administered by the dentist. The chances of this occurring are relatively small since your bleaching tray should fit almost perfectly around your teeth. However, if the gel is ingested, it may result in nausea, vomiting or burning. You should contact a doctor immediately if this occurs to you.

How do I choose an appropriate dentist?

It is very important you select a dentist adequately trained and experienced in teeth whitening. Your dentist is most likely equipped to administer teeth whitening. They will be able to assist you achieve your goals pertaining to teeth whitening.

What questions should I ask my dentist?

1. Are the desired results I described realistic?

2. Is there an alternative treatment that I should consider as well?

3. How long will the procedure take?

4. How much does it cost?

5. What is your experience in performing this procedure?

6. Have many patients had significant complications?

7. Can you give me some idea of the result I will achieve after the teeth whitening?

8. What should I expect after the procedure and what things should I avoid?

Anything else I should know?

? Tell your dentist about any allergies you have to foods, drugs, vinyl, peroxide, or environmental elements.

? Tell your dentist about all medications you are taking including prescription and non-prescription.

? Carefully follow any instructions your dentist gives you.

Dion Kramer
www.noblehealth.com.au

Dion Kramer is co-founder and managing director of NobleHealth. NobleHealth is a dental plan for the people of Brisbane, Australia. Members are entitled to 15% to 55% off their dental fees. Dion Kramer began writing about oral health to assist members of NobleHealth. Dion Kramer collaborates with NobleHealth dentists so his writings are topical and up-to-date. You can visit our website to learn more about NobleHealth and our dentists Brisbane

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