Tooth Whitening
There have been many developments in the UK over recent times about tooth whitening. This subject even confuses many dental professionals as to what is and what isn't acceptable. Here I will direct you through some of the commonly asked questions I come across so that you can make informed choices if you are thinking about having tooth whitening. You'll know all the ins and outs, the risks and the benefits so you can decide if it is right for you.
Tooth Whitening History and Safety
Modern-day professional tooth whitening is typically carried out using Carbamide Peroxide or Hydrogen Peroxide. The effectiveness of these agents was discovered quite by accident. Dentists were using Carbamide Peroxide to aid with gum healing following surgery and found that the teeth were being made whiter. Many other agents have been used but Carbamide Peroxide and Hydrogen Peroxide give the best long term results and most importantly are safe to the teeth.
So is tooth whitening safe? It can be, but it isn't always.
It is advisable that a suitably trained dentist/dental professional carries out tooth whitening. The General Dental Council agree and they have taken illegal tooth whiteners through the legal system.
Firstly a diagnosis and appropriate treatment plan need to be made. They also need to be aware of the pros and cons of the system is recommended. Only someone with a thorough understanding of the anatomy and physiology of teeth and the soft tissues etc. can make this judgment.
The choice of tooth whitening product is important. It has to be safe, effective and give good results. Hydrogen Peroxide and Carbamide Peroxide have the best track record (in both safety and effectiveness), however, if the concentration is too low it will not be effective. The only people who are allowed to prescribe it ineffective concentrations are dentists.
Warning
Some of the systems used by non-dentists supply immediate spectacular results. Chlorine Dioxide, for example, makes teeth very white, however, it is very acidic and strips the enamel from the teeth. it's NOT reversible. It damages the surface of the teeth such that they pick up staining very rapidly, and this is very difficult to remedy. They are left rough and often permanently sensitive.
I know several dentists who have asked at tooth whitening booths in shopping centers what they use and have never had an answer. Some have even been escorted out by security! It considerations us greatly as a profession that individuals are allowing unknown chemicals to be applied to their teeth, by non-dental professionals.
Tooth Whitening Myths and facts
• Not all discoloration problems are due to the same cause, and so they need to be addressed in different ways. One size does not fit all!
• Others will judge us based on our appearance. We all know that a major part of the first impression we make is from our smile and state of our teeth.
• We don't want to make everyone's teeth look like white tombstones. We want to help people to have natural smiles which gives them confidence.
• Whitening toothpaste does not often whiten the shade of teeth effectively; they reduce staining or reduce the amount of stain that collects.
• A lot of darker teeth can be improved by stain removal.
• A lot of over-the-counter whitening kits are ineffective and some (especially ones that do not come from the UK) can be harmful.
• 'In Surgery' whitening systems leave the teeth dehydrated, which means they look a lot whiter than they are. The 'wow factor' quickly wears off.
• If your teeth get too white with 'In Surgery' systems there's nothing that can be done to reverse this quickly.
• The bright blue lights used as part of these systems offer little or no proven benefit. The benefit is predominately by warming the gel and speeding things up. There's a lot of hype and marketing that goes into them!
• 'At Home' systems tend to offer longer-lasting results, with easier options for top-ups at later dates.
• Non-dental professions who offer tooth whitening often use unidentified chemicals, the effects of which are not known.
• Many non-dental professionals who carry out tooth whitening are breaking the law.
Why do teeth get dark
There are five main causes of teeth darkening/discoloration.
• Staining: The staining is normally on the surface of the teeth, or in small imperfections within the tooth surface. These rough areas also include deposits of calculus or tartar which accumulate over time.
Many foods and drinks cause staining. The main culprits are red wine, curry (especially those with turmeric), tea and coffee. There are lots of other foods can cause staining/darkening of teeth.
Of course, Smoking also causes staining.
Certain mouthwashes (e.g. many of the ones containing Chlorhexidine Digluconate) can increase the amount of staining on teeth.
• Pulp shrinkage: Over time as the teeth are used, they wear down slightly. The nerve inside the tooth shrinks away by creating extra dentine in the depths of the tooth. This means that over time there is less enamel (which is white) and more dentine (which is yellow), so teeth darken. This is a natural process, but there are safe ways to renew the appearance.
• Recession: Gum recession exposes the root of the tooth which is not covered with white enamel, so the necks of teeth always look darker.
• Restorations: Restorations can make teeth look darker. Amalgam fillings are silver/grey and so can create a grey appearance to the tooth they are in. White composite fillings can make the tooth look discolored, particularly if they are leaking and allow staining to seep in around the edges.
• Rarer causes: There are a number of rarer causes including Tetracycline staining, liver disease, blood disease, fluorosis, hypoplasia, trauma, tooth death, decay, heavy metal discoloration. If we explained each of them it would make the report very long, and it's really your dentist's role to make the diagnosis and suggest a suitable treatment for it. The images show examples of Tetracycline staining, fluorosis, tooth/pulp death.
Not all discoloration problems are due to the same cause, and so they need to be addressed in different ways. One size does not fit all!
Why should I whiten my teeth?
Why should I care about the color of my teeth? Some people are not really too bothered by the appearance of their teeth, but most of us are. Studies show that other people's perception of us is influenced by our teeth and our smile. Brighter teeth give a more youthful appearance, and we all want to try and stay young! Sometimes nature needs a helping hand.
Others will judge us based on our appearance. We all know that a major part of the first impression we make is from our smile and state of our teeth. So if you want to have a smile you are proud of then tooth whitening is a proven method that may be suitable for you.
Tooth Whitening Options
1: 'At Home' Systems
1: 'At Home' Systems
These fall into 2 broad categories. They have the longest track record and are considered by many to be the most reliable and predictable way to whiten teeth.
1) Tray-less
The tray-less systems are similar to 'In Surgery' systems, except you do the whitening at home. The main advantages over the 'In Surgery' system are:
• More controllability. As this system takes effect gradually over a few days, you can stop when you want.
• Lasts longer. The effects of whitening last longer if they take longer to achieve.
• Easier and less costly to do a top-up later on.
• You can use your own judgment. If there is one tooth that is darker then this can be given some extra go to allow it to catch up.
• Some have a light which warms the gel
• Low sensitivity
The main disadvantages are:
• You have to do a lot of the treatment on your own and need to consistently allow time during your day for predictable results. We all lead busy lives and this does not suit everybody.
• It is harder to get the necks of the teeth whiter when compared with tray systems (e.g. where there has been recession)
2) Systems with trays
These have the controllability, a proven track record for decades and longer-lasting effects. They tend to be a little better than tray-less systems at improving the shade of the necks of teeth. Some systems ensure such predictable results due to their excellent track record that they even offer a money-back guarantee!
The main disadvantages:
• Sensitivity. The trays hold the gel close to the teeth for a while and this can cause sensitivity, albeit fleeting after a short period.
• Nightwear. Often the most predictable way to use these trays is by wearing them in your mouth overnight. This does not suit everybody.
• Whilst you can use the trays again for a top-up in the future, they may not fit so well a few years down the line, especially if you have had any treatment in the interim. If this is the case then new trays need to be made.
Tooth Whitening Options 2: (Surgery and Over The Counter systems)
In-Surgery whitening.
This has many names (laser whitening/power whitening/Zoom), but the principle is the same. The dentist/hygienist isolates your gums and lips to protect them. A strong gel is painted on the teeth which whitens them.
There are 3 main disadvantages
1) Dehydration: If we were to isolate your teeth in the same way for 30-40 minutes and do nothing else, they would look a lot whiter as they get dehydrated. This means that these systems look great initially, but as the teeth rehydrate the impact quickly disappears. Most 'In Surgery' systems are followed up with a period of home whitening due to this.
2) Longevity: The gel applied gives quick results but its effects do not last as long as some of the slower methods (e.g. the 'At Home' tray system). This means that when there is a need for a top-up later it that means you have to do the whole thing again (including paying again)!
3) Gel strength: The gel used is notorious for causing extreme sensitivity in some people, due to its strength. So much so that dentists refer to these episodes as 'zingers'. How many products out there do you know that has resulted in an addition to the English language due to an adverse effect! Recent changes in legislation have meant that most of the effective 'In Surgery' systems are not allowed to be used in most parts of the UK.
Fact: in the chair whitening systems leave the teeth dehydrated, which means they look a lot whiter than they really are. The 'wow factor' quickly wears off.
Fact: If your teeth get too white with 'In Surgery' systems there's nothing that can be done about it quickly!
But wait, did I forget to mention the light? Well no. The light is predominately a marketing gimmick. There is very little evidence that the light does anything. The one benefit of the light is that it can warm the gel, and as any chemistry student knows if you warm something the reaction will occur faster.
Over The Counter systems
These can be effective but one of the major problems is that the cause of the discoloration has not been diagnosed. So in many cases, they are inappropriately used.
Professional Tooth Whitening vs. Beauty Salon
There is an increase in beauty salons/hairdressers/even temporary stands in shopping centers offering tooth whitening. This worries us greatly. Many of these non-dentists have now been prosecuted by the General Dental Council as they are not acting in patients' best interest, and they are breaking the law by carrying out the treatment.
There is a stark contrast when you compare this with the predictability of professional tooth whitening.
Tooth Whitening Considerations and Contraindications
There are many considerations when deciding on whitening. Below I have listed a few of the things to think about.
What do you want to achieve?
One of the main considerations of any tooth whitening system is what the end result will look like.
If you have any restorations (crowns, bridges, white fillings, implants, dentures) then these are unlikely to lighten in the same way that natural teeth lighten. This means that you could end up having some restorations that are too dark following treatment. A dentist will identify those that need to be considered prior to start the process. You may want to factor in the cost of replacing restorations following treatment.
What if you have a lighter restoration and want your tooth to match it?
It is possible to lighten teeth to match existing restorations which are already lighter. This means that the difference between the two becomes less noticeable (symmetry is beauty, after all!), but it is impossible to predict if an exact match will be achieved. This type of whitening is often easier with tray-less systems. It can be done with trays but is not as easy to do. 'Surgery' systems are a big no-no for this!
How much time do you have to do the treatment?
All treatment takes time, and this may be a consideration when choosing the most appropriate system for you. For example, the tray-less home systems normally take 45-60 minutes of dedicated time each day. Tray systems normally take a couple of hours, but you can go about your day-to-day activities (including sleeping) when you use them. 'Surgery' systems normally take 60-90 minutes.
Discomfort from tooth whitening
Some people do experience some problems when using tooth whitening, so here's what you can expect
1) Trays: these will feel a little strange at first, but shouldn't hurt. If you find that they rub the gum/cheek for example-then take them back to the dentist as they probably just need to be adjusted slightly.
2) Sensitivity: Many people carry out tooth whitening and get no sensitivity at all. Some people do, and your dentist will advise you on how to manage this. Typically you will notice at least a 'heightened awareness' of your teeth for a few weeks. Most people will have no sensitivity.
Many professional whitening gels have de-sensitizing components in them so this reduces the risk. Some systems include a special Tooth Serum as part of the whitening process which helps de-sensitize.
Summary
I hope you have found this article useful, and please share the link with others who may be interested.
enVisage offers tooth whitening and has a wealth of experience in different systems. Our team has carried out post-graduate training in tooth whitening to ensure we can offer care which puts your health and well-being at the core of everything we do. Being a Gold Member of the British people Dental Bleaching Society has helped me ensure that all those at my apply area unit providing treatment to high standards and treatment that the profession would consider being best apply.