Tooth Whitening
An overview of tooth whitening: tips and options
One of the most popular and simple esthetic dental treatments is tooth bleaching. This refers to any procedure that changes the shade and appearance of teeth without using restorative materials. Bleaching can either be done at the dental office or at home. There are several different systems available to a dentist for use in the office. Likewise, there are several ways that patients can bleach their teeth at home. The two main categories for at-home bleaching are via using trays with bleaching gel or via trayless systems such as Crest Whitestrips. All of these systems have been proven effective; however, the degree of whitening a certain individual will be able to achieve continues to be hard to predict since the ‘depth’ of the discoloration is difficult to predict. Tooth whitening has a better outcome if the stain or discoloration is more superficial (extrinsic) rather than deep inside the tooth (intrinsic). Tooth discolorations with the best prognosis for whitening are yellowing of teeth without any systemic or developmental cause (ex. Food stains, smoking, aging). Milder stains also have a better prognosis.
The active ingredient with at-home whitening is carbamide peroxide, a chemical similar to hydrogen peroxide. Modifications to the chemistry of carbamide peroxide has allowed the peroxide to be longer lasting. The lifespan of most carbamide peroxide gels is 8 hours. Hydrogen peroxide, however, loses more than 50% of its bleaching potential within 30 minutes. For this reason, the trayless strips using hydrogen peroxide are only to be worn for 30 minutes, whereas carbamide peroxide in trays may be used overnight.
With at-home whitening trays, the dentist first makes a custom tray for the patient, the patient takes the tray home, applies a whitening gel inside the tray, and wears the tray. Many dentists will recommend that the patient only wear the tray for an hour or two each day before progressing to wearing the tray overnight. This is because tooth sensitivity is an adverse reaction associated with tooth whitening. Sensitivity with tooth bleaching, however, is transient, with no long-term effects. If sensitivity is experienced, it is recommended to decrease the time the tray is worn and use a desensitizing toothpaste. Some bleaching products have even begun to incorporate the desensitizing agent into the whitening gel.
Most companies recommend tooth whitening for a 2 week period. For most patients, 2 weeks of wearing the tray at least 1 hour a day will provide up to 90% of the whitening effect. Research has shown that a bleaching endpoint will be reached at 6 weeks independent of the concentration and type of peroxide used. Initially, especially with higher concentrations of bleaching gels, patients may report a splotchy appearance to teeth. However, this uneven coloration of teeth being bleached disappears after the first week. Higher concentrations of carbamide peroxide bleach worn in a tray show faster initial improvements, but, as stated previously, over a 6 week period comparing 10% carbamide peroxide to higher concentrations, there is no difference in the final result.
Over-the-counter bleaching strips, such as Crest Whitestrips, have also been shown to be effective at tooth bleaching. These strips usually use hydrogen peroxide. One of the limitations of the strips is that they only cover front teeth, from canine to canine. Additionally, strips may be difficult to apply to misaligned teeth.
In-office bleaching is a great option for patients who desire whiter teeth, but cannot find time to apply trays or strips in their busy lives. In-office whitening usually consists of a 1-hour treatment with high concentration hydrogen peroxides. This hour session may be repeated. Studies comparing in-office bleaching to at-home bleaching have shown that at-home bleaching usually gives the better result. For this reason, at-home whitening is usually recommended for one week after in-office treatment.
Bleaching relapse has been reported at varying degrees over time. There are several things a patient can do to prevent bleaching relapse. These are:
- Use a whitening toothpaste with a power toothbrush vs. mechanical toothbrush
- Brush or rinse immediately after consuming stain-causing beverages or food
- Use a straw to drink beverages that stain, such as coffee, tea, colas, and red wine
- Check whether you need a touch up. Depending on the whitening method you used, you may need a touch up in 6 months or after a year or two
Strassler, Howard. “Vital Tooth Bleaching: An Update.” Maryland Dental Continuing Education Course. Fall 2006
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7 Mdental Continuing Education Course
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