Tooth Whitening Treatments

By Juliet Dunaway, D.M.D.

Tooth whitening has become one of the most popular esthetic dental procedures. The American Dental Association (ADA) found that in each of the last four years, approximately 25 percent of surveyed dentists reported tooth whitening to be the fastest growing aspect of their practice. Whitening is a simple, conservative and economical way to a brighter, healthier-looking smile when incorporated into a comprehensive dentist-supervised treatment plan that promotes good oral health.

"Whitening" is any process that will make the teeth appear whiter. This can be achieved through two methods:

•  A peroxide-containing whitener can bleach the tooth, which actually changes the natural tooth color by removing deep (intrinsic) stains and surface (intrinsic) stains.

•  A non-bleaching whitening toothpaste (dentifrice) containing agents to physically or chemically help remove superficial surface stains like coffee or tobacco can be used.

Start by having your teeth evaluated by a dentist. He or she can best determine which whitening method would be most effective for enhancing your smile. Natural tooth color varies between individuals, with some being more yellow than others or becoming more yellow with age. Teeth that are yellow usually respond best to bleaching. Gray or brown stains can be caused by ingesting certain medications during tooth development. Spotty or mottled-looking teeth can be an indication of too much fluoride (fluorosis).

Not all types of discoloration or defects can be improved through dental whitening. In some cases, other dental treatment options, such as porcelain veneers or dental bonding, may be recommended to achieve the beautiful smile you desire. Many factors such as existing crowns, large front (anterior) fillings, smoking and receding gums (periodontal disease) may influence whether or not you are a candidate for tooth whitening. Be aware that existing tooth-colored fillings will not change in color through the whitening process.

PEROXIDE-CONTAINING WHITENERS OR BLEACHING AGENTS

In-office (chair-side) whitening and at-home (tray) whitening both commonly contain a form of peroxide as an active ingredient. The type of peroxide (carbamide or hydrogen) and percent of concentration will vary with application. There are significant cost differences between bleaching procedures:

•  Chair-side bleaching is a common method of tooth whitening that takes place in the dental office. Your dentist will do a thorough oral exam and shade assessment before beginning the procedure, which usually lasts about one hour. A professional cleaning is also recommended to remove extrinsic stains prior to whitening. The soft tissue in and around the mouth is then isolated and protected before the hydrogen peroxide gel is applied to the teeth and activated by a specially designed light or laser. After a predetermined length of time the gel is removed and a fluoride treatment is applied to decrease post-op sensitivity. Most patients comfortably listen to music or fall asleep during the procedure. Teeth will typically become six to ten shades lighter in just over an hour. An example of this system is Zoom! This is a good choice for patients in need of dramatic results for a special occasion or busy individuals seeking rapid treatment response. The cost of in-office bleaching varies depending on where you live and which product is used, but typically is in the $500 range. The Zoom! system also includes custom mouth trays and a take-home touch-up kit to be used whenever discoloration is noticed. Maintenance whitening using the take-home kit will depend on the dietary and smoking habits of each individual, but once a year is a common interval.

•  Tray Bleaching - Night guard bleaching usually involves the use of a 10-to-12 percent carbamide peroxide gel in a custom mouthpiece fabricated by your dentist. The tray is clear, comfortable and can be worn for as little as 30 minutes a day. Normal treatment is two weeks, but difficult stains may take longer. Stain type, stain depth and tooth structure all affect length of treatment. The average cost of custom-made bleaching trays and whitening gel is $200-$300.

•  Over-the-counter - These products include boil-and-bite moldable trays, brush-on gels and whitening strips. Often they contain the same bleaching ingredient (caramide peroxide) as the professional kits at a very low concentration requiring several weeks to see results. Average results are one to two shades whiter. These products offer no professional supervision and increase the possibility of tissue contact causing gum and throat irritation. They range in price from $10 to $40.

In the past, sensitivity occurred during and after whitening procedures, especially when eating hot or cold foods. This usually lasted 24-48 hours and disappeared completely when whitening had stopped. Systems today are better buffered, creating less of a problem. If sensitivity does occur during the bleaching process there are several steps that can resolve the problem, making it important to follow directions and consult your dental professional. Additionally, the bleaching agents can temporarily irritate gums and soft tissues in the mouth. This is a more common problem with over-the-counter bleach kits due to the fact the trays are not custom fitted.

Studies over the past five to ten years have shown bleaching and other whitening methods to be both safe and effective with no adverse effects on teeth or gums. To receive the ADA Seal of Acceptance, manufacturers must demonstrate through clinical and laboratory research that their products meet specific ADA guidelines. This is your assurance that they have met ADA standards.

WHITENING TOOTHPASTES (DENTIFRICES)

All toothpastes use mild abrasion to help remove surface stains. Whitening toothpastes have a special chemical or polishing agent for additional stain removal. They are good for maintaining a level of whiteness after a more powerful whitening treatment has been performed. Again, look for the ADA Seal of Acceptance.

Individuals will respond differently to different whitening methods. The ADA advises a consultation with a licensed dentist to determine if bleaching is indicated and how it can be used within the context of a comprehensive oral healthcare treatment plan to create a whiter, brighter, healthier smile.

Dr. Juliet Dunaway obtained her undergraduate degree (a B.A. in biology) from Indiana University . She received her D.M.D. from the University of Louisville in 1997 and then completed a residency in advanced restorative and hospital dentistry at University Hospital in Louisville , KY. Dr. Dunaway is devoted to creating a comfortable, relaxed environment in which every patient receives comprehensive treatment for a healthy, beautiful smile. For more information, call 425-6021 or visit www.attractivesmile.com.