TEETH WHITENING......................

 

Home Teeth Whitening | Professional Teeth Whitening | Different Whitening Techniques

 

 

"AT Home" Teeth Whitening

 

Teeth Whitening

Age, as well as coffee, tea, tobacco and wine, can leave your teeth an undesirable shade of yellow. A lot of practices offer the most advanced teeth whitening options in Sydney, New South Wales, to dramatically whiten and brighten your yellowing teeth.

 

The Take-Home Teeth Whitening Process:

Dentists will first custom design bleaching trays that fit comfortably over your top and bottom teeth. The trays are filled with a bleaching gel and are worn for several hours at a time, typically at night. While the hydrogen peroxide active ingredient is in contact with your teeth, oxygen is allowed in, which whitens your teeth. The results of an at-home teeth whitening supervised by your dentist can boost your self-esteem, leaving you with a whiter, more beautiful smile.

 

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What are at-home tray-based teeth whitening systems?

While several systems for teeth whitening (teeth bleaching) exist, in the last decade tray-based whitening has become the most widely utilized type of at-home bleaching product. This technique utilizes a plastic tray that has been fabricated so to fit comfortably over a person's teeth. The person places bleaching gel (carbamide peroxide) into the tray and the tray is then worn for multiple hours a day (or else overnight), for some weeks, as the effects of the whitening process take place.

At home tray teeth whitening is a safe and effective way for a person to bleach their teeth but anyone utilizing this type of system needs to realize that the majority of their whitening activities will not be directly supervised by a dental professional. Because of this, anyone bleaching their teeth must be certain that the specific whitener they are using is safe, and that they know how to use this product in an appropriate manner. Failure to meet either one of these conditions could result in damage or harm.

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About at-home teeth whitening products: Know what you're buying.

There are a wide variety of tooth bleaching products available to you as a consumer, both from your dentist and also over-the-counter (i.e. drug stores). You might assume that any tooth whitener which is available has been approved by the U.S. Food and Drug Administration (the "FDA") but this is not the case. The FDA does not categorize tooth whiteners as drugs and therefore it does not regulate them.

The American Dental Association (the "ADA") has established a set of guidelines for tooth whiteners. These guidelines set standards for both safety and effectiveness. A manufacture can, at their own effort and expense, present to the ADA the results of their product's research and clinical trials. If the ADA finds that the criteria of their guidelines have been met by this data they will issue to the manufacturer, for that specific product, the ADA's "Seal of Acceptance". Since earning the ADA's seal is expensive and time consuming for a manufacturer, and of course totally optional, it clearly demonstrates the company's commitment towards creating a quality product.

In the case of at home tooth whiteners, the ADA's seal indicates that, when used as directed, a tooth whitener is not harmful to either teeth or the soft tissues of the mouth, and also that it will effectively whiten teeth. Additionally, the manufacturers of products receiving the ADA's seal are not allowed to make claims about their product which are not supported by research or else they will loose the seal. Those manufacturers who have earned the ADA's seal typically display it prominently on their product's packaging.

You may discover that the product your dentist has chosen for your use has not been granted the ADA's seal. There can be good reasons for this:
As we all know, many products are manufactured as "generic equivalents". It is very possible that your dentist has reviewed the literature detailing the properties of the product they have dispensed to you and are satisfied that it is appropriate for your use. As you might expect with a generically equivalent product, it's manufacturer might not seek the ADA's seal as a way of minimizing the expense of bringing their product to market.

The product you are using may contain more than 10% carbamide peroxide. As a result of their clinical experience and what they have read in the dental literature, your dentist may feel that a whitener with greater than 10% carbamide peroxide is indicated and appropriate for your use. In a case such as this, you should feel free to quiz your dentist so they can relate their specific thoughts and rational to you.
Facts you should know about "at home" tooth bleaching products (as of June, 2004):
The only at home tooth whiteners that have yet been able to earn the ADA's "Seal of Acceptance" are dentist dispensed products. No over-the-counter products (such as those sold in your local store) currently have earned the ADA's seal.
The active ingredient contained in all of the at home tooth whiteners that have earned the ADA's seal, and the compound which has been evaluated in the vast majority of at home bleaching studies, is carbamide peroxide at a concentration of 10%. The active ingredient found in most over-the-counter at home bleaching products is not carbamide peroxide but instead hydrogen peroxide.

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When will at-home tray-based teeth whitening work?

At any specific point in life, the coloration of a person's teeth is influenced by a multitude of factors. Before you initiate the use of a at-home tray teeth whitening (teeth bleaching) system it is important for your dentist to determine the possible causes of your tooth discoloration. Having an idea of what has caused your discoloration will help your dentist estimate how much lightening the teeth whitening process can be expected to achieve.

Baseline tooth color.

The teeth of humans, as a race, display a wide range of shades of white. There is no one specific color that a person's teeth are supposed to be. Some person's teeth are just naturally lighter in color than others.

 

Chromogenic agents.

Beyond a person's baseline tooth shade, it seems to be a fact of life that as years pass our teeth tend to absorb discoloration and stain. The degree to which a person's teeth will darken can often be related to the amount of repeated exposure they have had to "chromogenic agents". Tea, coffee, colas, and red wine are each known to have a darkening effect on teeth. Smoking is also recognized as an activity that stains teeth.

Exposure to certain medicines.

Some persons have tooth staining because they had a systemic exposure to certain medicines. One known culprit is the antibiotic tetracycline (and its derivatives including minocycline and doxycycline). When children are given tetracycline during those years during which tooth enamel is forming their teeth can acquire a yellow-brown to blue-grey staining. For this reason tetracycline related antibiotics are seldom prescribed for children 8 years and younger or for pregnant women. The use of the minocycline even by adults has been reported to cause grey tooth staining.

Ingestion of excessive amounts of fluoride by children during their period of tooth development can cause a type of tooth staining termed "fluorosis". In its most common form fluorosis appears as chalky-white areas on a tooth. In more severe forms fluorosis can cause brown tooth staining and even result in tooth surface pitting. (Parents should be aware that a common source of fluoride ingestion can be when children swallow toothpaste. It has been suggested that children under the age of 5 swallow essentially all of the toothpaste placed on their brush.)

 

Individually darkened teeth.

There are times when a single tooth has become darker than its neighboring teeth. As an example, it is very common that a tooth that has had root canal treatment will darken as years pass.

Teeth that have a history of having been traumatized, such as being bumped in an accident, will often darken with time too. (This darkening may or may not indicate significant problems related to the health of the nerve in the tooth. Any individually darkened tooth should always be evaluated by a dentist.)

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Does tray teeth whitening always work?

How long can tray teeth whitening take?

While your dentist cannot know beforehand the precise level of whitening results you will achieve or how long it will take to realize them, they should be able to give you a general idea of what changes might be possible based on their experiences with other patients. To help you understand what types of results you might be able to obtain, some dentists will use a computer imaging system to illustrate for you the degree of whitening they think is likely.

Tray teeth whitening systems utilizing a 10% carbamide peroxide whitener can usually be expected to make at least some improvement in shade for teeth found in all of the categories discussed above, however certain types of tooth darkness will be more resistant to whitening than others. Additionally, the results a person is able to obtain, and the time it takes to achieve them, will be dependent on their degree of compliance with their dentist's instructions.

Those people who feel that they were pleased with the shade of their teeth when they were younger but now, at an older age, have found that their teeth have yellowed somewhat will most likely find the results of a tray teeth whitening system very satisfactory. This type of staining, which is often due to exposure to chromogenic agents such as tea and coffee, is commonly resolved by two to six weeks of bleaching. Fairly dark tooth staining which has been caused primarily by a person's smoking might take upwards of three months of treatment to successfully whiten.

More difficult cases to bleach will be those instances where a person does not so much feel that their teeth have stained with time but instead were always too dark, even when they were younger. While tray teeth bleaching can be expected to make a shade improvement in these cases, the degree of whitening will be less predictable. Teeth falling into this bleaching category will be those with an inherently dark baseline color and those with tetracycline or brown fluorosis staining.

The total treatment time needed in these more stubborn cases can often range between two and six months. Satisfactory results might be obtained within this time frame or else a point reached where your dentist determines that, while your teeth have responded somewhat, more whitening is not likely.

Individually darkened teeth, such as those which have been traumatized or have had root canal treatment, can be resistant to bleaching with tray-based teeth whitening systems. Total treatment time for these types of cases could range between two and six months before satisfactory results are obtained, or else your dentist determines that it is unlikely that the tooth will whiten any further.

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When won't the tray teeth bleaching systems work?

The tray-based at-home teeth whitening (teeth bleaching) process is not always predictable. Most definitely some tooth discolorations will be more resistant to bleaching than others. Your dentist, as part of their initial examination, will need to ascertain the most likely cause of your tooth staining. Having done so they will then be able to convey to you what type of whitening results might be expected. (Sometimes dentists utilize computer imaging systems to illustrate for you what degree of teeth whitening they think will be possible.)

 

Unnatural tooth shades.

Your dentist will not be able to unconditionally guarantee that you will be pleased with the outcome of your at-home teeth whitening efforts. This is because many people have a very unrealistic idea of what constitutes a natural shade for teeth.

Some people compare their teeth to the teeth of those persons they see featured in films, TV, and magazine advertisements. You should be aware of the fact that the shades of many models' and actors' teeth fall into the realm of "unnatural". Often these extreme shades of white have been achieved by means other than by bleaching (such as by placement of crowns, also known as "caps"), or else this extreme whiteness never existed at all but instead was created by touching up a picture. Persons trying to achieve extreme shades of white by bleaching can be guilty of whitener abuse, thus placing themselves in a realm where the safety of the product they are using has not been evaluated.

At-home tray-based teeth whitening cannot be expected to lighten existing dental work.
The at home teeth bleaching processes cannot be expected to make a color change in the dental work you have already had placed (porcelain veneers may be affected). Our "Effects of peroxide whiteners on existing dental work." page discusses some of the findings related to the affect peroxides can have on various types of dental materials (both color and structural). In most cases, a person's teeth should be whitened first and then afterwards their dental work replaced so to match the new shade of their teeth.

Before the bleaching process is begun a person should have discussed with their dentist how much post-bleaching dental work will be needed. The time and cost associated with replacing dental work can be significant.

The fact that a tray teeth whitening process will not lighten dental restorations such as a porcelain dental crown can be advantageous in some cases. There can be instances where a person's teeth have darkened during the years after a single tooth has been crowned ("capped") and now this one lone tooth, in comparison to its neighbors, appears to be too white.

The at home teeth whitening process can be used to lighten the crowned tooth's neighboring natural teeth back to a shade that more closely matches the crowned tooth's porcelain. The color match obtained by the bleaching process is not always exact, but it can be a significant improvement. (For an example of how this technique might be accomplished in real life visit our Cosmetic Dentistry section.)

At-home tray-based teeth whitening can possibly lighten teeth that have porcelain veneers.
There is an exception to the rule that existing dental work will not lighten and this exception involves teeth with porcelain veneers. Veneers are translucent shells of porcelain that have been bonded onto the front side of a person's teeth.

While the tooth bleaching agent will not change the color of the veneer itself it will be able to permeate the tooth from the backside, thus lightening the tooth structure which lies under the veneer. Because veneers are translucent, the net effect can be that the tooth, from the front side, appears whiter.

 

Teeth with gum recession.
Some persons have gum recession on one or more teeth. Usually the root surface that becomes visible as gums recede has an appearance that is somewhat darker than the rest of the tooth. This is because root surfaces are not covered by enamel but are instead composed of another naturally darker material called dentin.

Tray teeth whitening systems won't effectively lighten dentin. This means that the color of the root portion of the tooth (which shows where the gum recession has occurred) will not change noticeably as a result of your bleaching efforts.

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What steps are involved with tray teeth whitening systems?

 

The following paragraphs describe, in general, how at-home tray-based teeth whitening (teeth bleaching) systems are utilized with dentist dispensed (carbamide peroxide) whiteners.

As a part of your treatment, your dentist will need to provide you with instructions that are specific for your situation and the whitener you will be using. It is important for you to follow the instructions you are given. Not doing so might result in safety concerns or damage to your teeth.

In general, the at home teeth bleaching process is composed of the following steps:

A) The pre-bleaching dental examination.
Your dentist will need to perform a thorough dental examination prior to the initiation of the teeth whitening process, so they know that you are in good general dental health.

As a part of this examination your dentist will document the current shade of your teeth, sometimes by taking photographs, and also discuss with you the history related to your current tooth shade. This discussion will help your dentist both identify the nature of the discoloration of your teeth and determine if tray teeth whitening is an appropriate method by which to make a change. Once having determined the most likely cause of your tooth discoloration your dentist will be able to provide you with an idea of what type of improvement can be expected and how long the bleaching process might take.

During the examination you and your dentist must discuss and decide if you will whiten both your upper and lower teeth, or just one or the other. Usually a person's greatest concern is the appearance of their front upper teeth, and some people start out by just bleaching them.

There are some good reasons to approach the whitening process in this manner. One of them is related to the fact that a person's unbleached teeth can provide a source of comparison. This contrast can make it easy to visualize exactly what progress a person's whitening efforts have achieved. Sometimes this ready reference provides a source of encouragement and helps to motivate a person to continue on with their bleaching regimen.

Another good reason is related to cost. Dentists often charge for teeth whitening by the "arch". An arch is dental terminology for either the upper or lower teeth. A person's complete set of teeth is composed of two arches. If you whiten just one arch you could expect your costs to be approximately half of what you would pay to bleach both arches. After you have successfully bleached one arch you can, of course, always begin the whitening process on your other arch.

During the examination process your dentist will identify any dental work which exists on those teeth you have chosen to whiten. It is imperative for you to realize that the shade of existing dental restorations will not lighten. Restorations on whitened teeth will need to be replaced after the bleaching process has been completed. Prior to initiating the whitening process you should be aware of the time and cost associated with performing this dental work, it might be substantial.

B) Taking impressions for the bleaching trays.
An important feature of dentist dispensed tray-based teeth whitening systems that can both increases the technique's effectiveness and minimizes its side effects is the use of custom fitted bleaching trays. The first step in creating these trays is for your dentist to take impressions of your teeth. From these impressions your dentist will create plaster casts. Your bleaching trays in turn will be crafted on them. Usually, once impressions have been taken, your dentist will need at least a few days to complete the tray fabrication process.

C) Fitting the custom bleaching trays.
Your dentist will ask you to make an appointment where you return to their office so they can evaluate, and refine as necessary, the fit of your bleaching trays.

The bleaching trays themselves are usually clear, they are often made from a soft flexible plastic, and one is made for your upper teeth and a separate one is made for your lower teeth. Usually bleaching trays have been trimmed so they fully cover each tooth but come just short of lying on your gums.

D) Instructions about how to place teeth whitener in the trays.
During the dental appointment when your bleaching trays are fitted your dentist will also dispense to you an initial quantity of teeth whitener (10% carbamide peroxide). Usually this is a gel that is contained in a small syringe or plastic bottle. Your dentist will show you how and where to place the whitener in your bleaching trays. As a means of minimizing the amount of whitening gel used during each application, the whitener is usually just placed on those aspects of the tray which touch the front side of your teeth and only in those portions of the tray which cover the teeth you want to lighten.

After the whitener has been placed into the tray and the tray has been positioned over your teeth, there will usually be some excess gel that escapes from the tray up and onto your gums. As a way of minimizing any gum irritation the whitener may cause, it is best to wipe this excess away with your finger or your toothbrush.

E) How long should bleaching trays be worn each day?
Your dentist will provide you with specific recommendations regarding the amount of time your bleaching trays should be worn each day. If your dentist gives you a range of times, in general the more hours you wear your bleaching trays the more rapidly you will notice results. The whitening process is simply one of cause and effect.

One option usually given to patients is to wear their bleaching trays at night while they are sleeping. The advantages of this method are that both the total amount of whitener and the total number of individual bleaching episodes that are needed for treatment will be minimized. This is because each application of the whitener will be in the tray long enough to produce its maximum effect. Utilization of this method can be especially beneficial in those cases where the tooth staining being treated is expected to be stubborn.

Another common manner in which dentist's instruct their patients to use their bleaching trays is to wear them during the day, however some persons may find that doing so conflicts with their normal daytime activities. While both whitening gels and bleaching trays are usually clear, they can still be visualized somewhat by others. Speech can also be affected by bleaching trays, although because they are usually thin it is usually only minimally.

Daytime bleaching for less than 2 hours a day tends to waste teeth whitener and will extend the total number of days needed for treatment. Most whitening gels are effective for up to 4 hours or longer. Some dentists recommend that their patients should refresh the whitener periodically by removing the tray and adding more.

F) Follow up appointments with your dentist.
Your dentist will ask you to make periodic follow up visits to their office so they can evaluate the shade change your bleaching efforts have achieved. Tray teeth whitening is usually continued until you and your dentist have become satisfied with the color change which has taken placed or until that point at which no more whitening seems to occur. After evaluating your progress your dentist will, if they feel that more whitening is possible, dispense additional whitening gel to you.

Additionally, at each follow up visit your dentist will ask you if you have experienced any side effects from the bleaching process. If you have they will make recommendations so to help you manage them. This does not mean that if you are experiencing side effects you should wait until your next follow up appointment to bring them to your dentist's attention. You should always feel free to contact your dentist regarding any problems or difficulties you have encountered.

G) Terminating the at home teeth bleaching process.
Once your bleaching efforts have achieved a pleasing tooth shade, or at that point in time when no more whitening appears to occur, your dentist will recommend to you to terminate the bleaching process. Once you have stopped there can be a period, possibly two weeks or so, where the shade of your teeth will relapse slightly before stabilizing. Once the shade of your teeth has stabilized you and your dentist can make plans to begin the process of replacing your existing dental work so to match the new shade of your teeth.

How long do the effects of tray teeth whitening last?
The effects of at-home tray-based teeth whitening can, on occasion, last fairly indefinitely but in most cases a "satisfactory" shade change is found to last for about 1 to 3 years. One study found that 42% of the persons who had under gone the bleaching process were still satisfied with the shade of their teeth 7 years later. Possibly more importantly, no one in this study, including even those who were not happy with their current tooth shade, felt that their teeth had regressed all the way back to their original pre-bleaching color.

Of course once initially whitened it is an easy matter to retreat or "touch up" your teeth with additional bleaching at that point in time when it is needed. Usually this touch up bleaching is of much shorter duration than the original whitening process.

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How long do the effects of tray teeth whitening last?

The effects of at-home tray-based teeth whitening can, on occasion, last fairly indefinitely but in most cases a "satisfactory" shade change is found to last for about 1 to 3 years. One study found that 42% of the persons who had under gone the bleaching process were still satisfied with the shade of their teeth 7 years later. Possibly more importantly, no one in this study, including even those who were not happy with their current tooth shade, felt that their teeth had regressed all the way back to their original pre-bleaching color.

Of course once initially whitened it is an easy matter to retreat or "touch up" your teeth with additional bleaching at that point in time when it is needed. Usually this touch up bleaching is of much shorter duration than the original whitening process.

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Are teeth whiteners (10% carbamide peroxide) used with tray-based teeth whitening products safe?

The first article to appear in a dental journal documenting an at-home tray-based teeth whitening (teeth bleaching) system using 10% carbamide peroxide as the whitener was published in 1989, although the technique itself can be traced back to the 1960's. During the years following this article tray-based teeth whitening technique has gained wide acceptance by the dental community. The overwhelming majority of dentists in this country do offer this procedure to their patients. The research data that has been accumulated since 1989 has supported and continues to support this method's effectiveness and safety.

 

What side effects can be expected when using 10% carbamide peroxide teeth whiteners?

Side effects can and do occur when using a 10% carbamide peroxide whitener in conjunction with an at-home tray-based teeth whitening system. The two most common side effects are the creation (or increase) of tooth thermal sensitivity (hot and cold sensitivity in a person's teeth), and irritation of a person's gums. Other, less frequently encountered, side effects that have been reported by patients are: sore throat, tooth pain, tingling of the tissues, and headaches.

While the side effects a person encounters can be significant enough that the bleaching process must be discontinued, they are usually found to be minor. One study asked participants to rate the discomfort associated with their side effects on a scale from 0 to 10, 10 being the most painful. Most respondents rated their side effects as a 1 or 2. In all cases, if you do notice any side effects during the bleaching process, you should report them to your dentist.

When just minor side effects have presented themselves a dentist will often recommend that the person just reduce the total number of hours their bleaching trays are worn each day, or recommend that the bleaching process only be performed on alternating days. Because both of these methods reduce a person's exposure to the carbamide peroxide teeth whitener, the side effects they have noticed will usually subside. In more severe cases a dentist may feel that palliative treatments, usually quite simple in nature, are indicated or else that the teeth whitening process should be stopped altogether.

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What are the safety concerns associated with the use of 10% carbamide peroxide teeth whiteners?

As mentioned in our section titled "About at home teeth whitening products: Know what you are buying." , all references to teeth whiteners, bleaches, bleaching agents, bleaching gels, etc... on these pages refers to "10% carbamide peroxide" products. These products contain carbamide peroxide as their active ingredient and as non-active ingredients compounds such as glycerin and flavorings.

With the continued accumulation of data by dentists over the last 10 years, most of the safety concerns with teeth whiteners containing 10% carbamide peroxide have diminished (when these products are used as instructed).

Adverse effects associated with tray teeth bleaching technique may develop when it is used inappropriately. Inappropriate usage of the method includes "over use" of the technique and also utilizing it with inappropriate teeth whiteners.

Will 10% carbamide peroxide teeth whiteners cause cancer?
Concerns have been postulated that teeth whiteners can possibly cause cancer in the soft tissues of the mouth. These concerns are related to the fact that the peroxide contained in teeth whiteners can produce molecules called "free radicals". Free radicals are capable of causing cellular damage.

The proper use of dentist monitored at home teeth whiteners containing 10% carbamide peroxide have not been shown to produce a carcinogenic risk.
The concentration of hydrogen peroxide created by these whiteners is low, on the order of 3.5%. Studies of hydrogen peroxide at about this same concentration (actually 3.0%) have not shown a carcinogenic risk.
The actual contact of teeth whitener to a person's soft tissues ("gums") in dentist made bleaching trays is minimal.
One of the human body's major defenses against the adverse affects of peroxides is a compound found in saliva. This compound has been calculated to effectively neutralize about 30mg of peroxide in one minute. The typical single application of carbamide peroxide tooth whitener is only 3.52 mg.
Calculations have been made and on average, the daily total peroxide a person is exposed to from bleaching their teeth is less than .1% of the daily production of peroxide by their liver.

Will 10% carbamide peroxide teeth whiteners damage tooth enamel?
Studies involving 10% carbamide peroxide whiteners have found minimal or no effect on the microhardness or mineral content of tooth enamel surfaces. Scanning electron microscope studies of the enamel of teeth that have been bleached have typically not shown any damage either. In relative terms, studies have shown that exposure to soft drinks and fruit juices cause comparable or greater alteration of tooth enamel than tooth whiteners.

There has been documentation in dental literature of two clinical cases where over-the-counter teeth whiteners have adversely affected a person's tooth enamel. These cases involved whiteners which had either: a high peroxide content, an acidic pre-rinse, or the whitener itself was acidic. These whiteners were purchased and used without professional supervision.

The tooth damage caused by these whiteners was irreversible and the dental treatment needed to repair it involved significant effort and cost. If you haven't already, please read our discussion titled: "About at home teeth whitening products: Know what you are buying."

 

Will peroxide-based teeth whiteners damage my existing dental restorations?

Teeth can be whitened with the at home bleaching method utilizing a 10% carbamide peroxide whitener with little concern about significant damage to a person's existing fillings. Over ten years of clinical use of these products has not revealed any obvious problems or concerns. Some studies have suggested that some degree of interaction or change might occur with white dental fillings, amalgam dental fillings, and some types of dental cements. However the clinical significance of these effects is still considered to be inconclusive. (Our "Effects of peroxide whiteners on existing dental work." page discusses some of the findings related to the affect peroxides can have on various types of dental materials.) Your dentist can address any specific concerns you may have during your pre-whitening dental examination.

The main difficulty encountered with existing dental work is that it does not lighten during the at home teeth whitening process (the color of porcelain veneers may be affected). This means that pre-existing dental work will usually have to be replaced so to match a person's new, post bleaching, tooth shade.

Will 10% carbamide peroxide teeth whiteners damage the nerve in my tooth?
Studies conducted since the introduction of the at home teeth bleaching method in 1989 have not identified a problem related the process having a harmful effect on the health of a tooth's nerve. One study's results found that no one in their 4.5 and 7 year follow up groups reported needing root canal treatment on any whitened tooth.

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COSMETIC DENTISTRY - TEETH WHITENING