Tooth whitening is still one of the most popular treatments to improve one’s smile. It has been around since early Roman times, when urine was used to whiten teeth! Tooth whitening does not remove any tooth tissue so does not damage it. It is the procedure that is performed to whiten your teeth to shades whiter than their natural colour.
Teeth whitening should ONLY be performed by a registered dental health professional.
The ‘active ingredient’ in the whitening product is hydrogen peroxide. It can come packaged either as hydrogen peroxide or carbamide peroxide. For carbamide peroxide to work it must be broken down into hydrogen peroxide and urea. The gel penetrates your enamel to get to discolored molecules. Oxygen molecules from the whitening agents react with the discolored molecules in your teeth, breaking the bonds that hold them together. The oxygen molecules spread, whitening the tooth.
You will need to be assessed by the dentist to see whether you are a suitable candidate for tooth whitening.
You should be informed of all available tooth whitening procedures and alternative options to change the colour of your teeth. Once decided on the best treatment for you, a dental examination (+/- radiographs) will be performed to ensure your mouth is healthy, and that there are no risk factors or oral pathology present.
Photographs will be taken with shade tabs next to your teeth and their colour recorded. (This is to demonstrate tooth whitening has been successful). Your dentist should be able to give you an idea of how successful the treatment will be.
What methods are available?
The most common type of whitening is called ‘Home whitening’ (supervised by the dentist). Impressions will be taken to construct custom tooth whitening trays, which will fit only your teeth. They will appear like snug thin gum-shields. The whitening gel is then put in the trays in the surgery at the day of fitting the trays, and you will be given a routine to follow at home.
Another option is called ‘chair-side whitening’, or ‘in house whitening’. You will be told if you are suitable for the treatment, and your dentist will supervise it. First the dentist, hygienist or therapist will put a rubber shield or a gel on your gums to protect them. They will then apply the whitening product to your teeth, again using a specially made tray. This is less common, as a higher concentration of gel is used which is now illegal. If you are having this treatment you must be informed of the legalities, risks and alternatives to consent to it. There is also chair-side ‘power whitening’, often called ‘laser whitening’. A warm bright light is used, not a laser. Gel is painted onto your teeth and your gums are covered with a protective layer. A light is shone onto the gel to speed up the whitening reaction. With this procedure you often have to perform the ‘at home tooth whitening treatment’ to ‘stabilize’ the whitening performed using the light. It can often be more painful due to an element of dehydration of the teeth.
How long Does Home Whitening Take?
The total length of the home bleaching treatment can vary depending on how discoloured your teeth are and the shade you want to get to. On average it takes 2-4 weeks. Each manufacturer is different. You may wear the trays anywhere between 30 minutes up to 8 hours a day depending on which product is used. The final outcome is generally similar irrespective of which manufacturer you use. If a Carbamide peroxide gel is used this will need to be worn for up to 8 hours, as this gel needs to be broken down into urea and hydrogen peroxide (the active ingredient) to work. Hydrogen peroxide gel is used this can be worn for as little as 30 minutes, up to an hour, as this is the active ingredient. The dentist will discuss with you exactly how long you should keep the tray in your mouth. It is important to follow the instructions that you are given to get the best result.
Not everyone is suitable for tooth whitening:
Teeth that have restorations; such as crowns, bridges, veneers, dentures or teeth that have been filled with white or grey fillings, cannot be whitened with tooth whitening products. To whiten these restorations, they have to be removed and replaced with lighter ones.
Teeth that appear brown or grey in colour are very difficult to whiten effectively. These teeth can take several months to whiten just a few shades. Pregnant or breast feeding mothers should avoid whitening their teeth as there is not enough research to determine the safety of tooth whitening products during pregnancy or lactation.
Teeth that are internally stained from developmental conditions or from being root filled will not respond well to regular tooth whitening. Often root filled teeth have to be whitened internally and externally. If your teeth are stained from taking Tetracyline the treatment will take several months and the final outcome may not be your desired outcome. These teeth will not react as well to tooth whitening. If your teeth are naturally very sensitive tooth whitening may make them even more sensitive. Usually this is not permanent. Yellow teeth generally respond well to tooth whitening treatment.
Maintenance is required as this is not a one-time procedure. It will need to be repeated from time to time if you want to maintain the color and remove stains. Each tooth whitening procedure will have its own guidelines. Often it is recommended to repeat tooth whitening every four months for one to two days in the first 12 months and then every six months for one to two days to maintain the shade. However the colour change should last up to 2 years after whitening. This will vary from person to person. The effect is less likely to last as long if you smoke, or eat or drink products that can stain your teeth. Ask your dentist for their opinion before you start the treatment.
No matter which treatment you use tooth whitening can cause a temporary increase in sensitivity to temperature, pressure and touch to the teeth. Some individuals can experience spontaneous shooting pains inside their teeth. Individuals at greatest risk of tooth whitening sensitivity are those with gum recession, significant cracks in their teeth or leakage resulting from faulty restorations. It has also been reported that redheads, including those with no other risk factors, are at particular risk for tooth sensitivity. Tooth whitening sensitivity is only temporary and normally lasts only a few days during and after treatment. However some cases have been reported to last up to a month or longer. Your dentist will recommend a special toothpaste or gel to help reduce the sensitivity. There is also a chance of irritation/burns to the gums. Often this results from the tooth whitening gel contacting the gums. Alternatively ill-fitting trays can irritate the gums. This discomfort normally dissipates several days after stopping the tooth whitening treatment.
No matter which treatment you use tooth whitening can cause a temporary increase in sensitivity to temperature, pressure and touch to the teeth. Some individuals can experience spontaneous shooting pains inside their teeth. Individuals at greatest risk of tooth whitening sensitivity are those with gum recession, significant cracks in their teeth or leakage resulting from faulty restorations. It has also been reported that redheads, including those with no other risk factors, are at particular risk for tooth sensitivity.
Tooth whitening sensitivity is only temporary and normally lasts only a few days during and after treatment. However some cases have been reported to last up to a month or longer. Your dentist will recommend a special toothpaste or gel to help reduce the sensitivity. There is also a chance of irritation/burns to the gums. Often this results from the tooth whitening gel contacting the gums. Alternatively ill-fitting trays can irritate the gums. This discomfort normally dissipates several days after stopping the tooth whitening treatment.
Tooth whitening is designed to improve the aesthetic appearance of teeth and amounts to the practice of dentistry. So too does the giving of clinical advice about such procedures.
Therefore all tooth whitening procedures, including bleach and laser treatment, are seen as the practice of dentistry by the General Dental Council (GDC). The practice of dentistry is limited to GDC registrants such as dentists, or dental therapists and dental hygienists on the prescription of a dentist. Anyone performing tooth whitening, who is NOT registered with the GDC is breaking the law.
Regulations also state that the tooth whitening products can only be sold to dental practitioners. Beauty therapists who are providing tooth whitening using concentrations of hydrogen peroxide above 0.1% are breaching the Regulations. The Regulations are enforced by Trading Standards Officers. The implementation of the new Regulations will give greater clarity so that Trading Standards Officers will prevent non-registrants providing tooth whitening. Tooth whitening must be performed in a healthy mouth.
Tooth whitening, can only be performed by registered dental professionals. Anyone else providing these treatments is doing so ILLEGALLY! And can cause a risk to your health.
Home kits carry risks.
What are the risks of home kits and salon teeth whitening?
Generally home kits do not contain a high enough strength of tooth whitening peroxide to be effective The tooth whitening trays will not fit accurately which can lead to unwanted and painful side effects. Also this will reduce the efficacy of the treatment. Some home kits and tooth whitening performed in beauty salons do not contain the correct gel. Teeth may appear whiter initially but this may be due to the fact that the gel has etched the tooth enamel. With time the teeth will actually stain more. The gel used has irreversibly damaged the tooth tissue. It can be very difficult to correct without removing more tooth tissue and providing a restoration that covers the tooth such as a crown or veneer.
What about whitening toothpastes?
There are several whitening toothpastes on the market. They generally contain 0.1% hydrogen peroxide, which is not strong enough to whiten your teeth like a tooth whitening treatment would. Although they do not affect the natural colour of your teeth they may be effective at removing staining, helping to restore the natural colour of your teeth. Therefore, they may improve the overall appearance of your teeth. Other considerations In addition to the aforementioned risk factors, a number of caveats should be considered before undergoing teeth whitening: Some teeth will just not whiten no matter how much whitening is carried out. Once you have reached your desired colour you must leave it several weeks to allow the shade to settle before having any restorations placed. If you have restorations placed to early they may not appear the same shade as the whitened teeth a few weeks later, as there is a degree of fade back with the whitened teeth. Where there are areas of gum recession the root surfaces may appear darker/more yellow as this area can be difficult to whiten
If the treatment is provided by a registered dental professional; the correct guidelines are followed and only the legal strength of tooth whitening gel provided; then it is a safe procedure. For the initial course of treatment the trays must be custom made and fitted by the registered dental professional. The gel must be placed in the trays in the dental surgery during this visit. You must be fully competent and confident in performing the treatment by yourself at home. No matter what treatment you use, there is a chance your gums can be sensitive to the chemicals used in teeth whitening, especially if you already have sensitive teeth. There’s also a chance of burns to gums.
