Teeth Whitening

Excerpted from Tick Tock, Stop the Clock ~ Getting Pretty on Your Lunch Hour
Chapter 5
Dr. Marty Zase

Tooth Whitening or Bleaching - Tooth whitening is often called bleaching. Although most dentists use these terms interchangeably, it is important to understand that no bleach is ever used. A variety of chemicals, usually peroxides, are applied to the teeth in such a manner that the color of the teeth gets lighter. This is not just a matter of cleaning the teeth; it is also a process that changes the inherent color of the outside layer of the teeth: the enamel. Tooth whitening is usually divided into three primary categories: in-office, take home and over the counter. Let’s look at each.

  • In-Office Whitening is often called Power Bleaching or sometimes “Laser Bleaching”, although strangely lasers are seldom used for this procedure. A dental professional applies a very strong whitening solution (usually a high concentration peroxide product) directly to the teeth, usually remaining in contact for from ten to thirty minutes per application, with up to three or four applications per sitting. The process may be repeated days, weeks or months later

    There are many different products used as the active ingredients for in-office whitening. Some work by themselves; some work best with a specifically recommended light source. If a light source is used, it might be a powerful dental light or even a laser. Although the usefulness of the light is controversial in some eyes, there is now enough research out there to say that a light helps in some systems.

    At the same time, it is also fair to say that excellent results can also be achieved with systems that do not use a light. Whitening results vary just like humans vary in every other aspect of their lives, for human teeth also have many variations. Some bleach better than others; thus the need for dental professional oversight.

    Because the results from power bleaching often fade somewhat, most dental offices follow in-office procedures with take-home tray bleaching.

  • Take-Home Tray Bleaching is another form of dentist supervised tooth whitening. It is usually done as a stand-alone procedure, but it can also be used as a follow-up to in-office power bleaching. Typically custom fit trays are constructed from molds (plaster models) of the patient’s teeth. These trays fit the teeth like gloves fit over a hand. Tooth whitening materials are placed in the trays which are then inserted over the teeth. The whitening solutions are allowed to work anywhere from a few minutes to overnight depending on the techniques and the chemicals that are being used. In addition to the peroxide that is in the solutions, other products are often added to help strengthen or remineralize teeth or to reduce sensitivity. Some systems also use pre-whiteners or activators prior to the bleaching solutions to improve the overall results.

    Typical take home whitening systems take about two to three weeks to gain maximum results. Then the question always arises: “How long will this last?”

    Touch-ups are highly recommended. Most patients find that touch-ups once or twice a year are sufficient to maintain the new whiter shades indefinitely. A common suggestion is to do a two or three day touch-up with tray bleaching immediately after either every other or every hygiene recare visit (cleaning).

    Remember, if you find that your teeth are getting sensitive when you do a whitening procedure, talk to your dentist. Most dentists have treatment methods to help reduce or eliminate that sensitivity – but only if they know about it. It is the patient’s job to communicate their symptoms to the dentist.

    Another common question is, “How white should I lighten my teeth?” Like all beauty questions, this one is somewhat subjective. Most beauty experts will tell you that body parts that blend well provide the basis for the most natural looking beauty. That goes for teeth as well. If your teeth are as white as a bathroom sink, you might look a little ridiculous. If your teeth are bright, but don’t overpower the rest of your face, you present your most attractive image. Therefore, the standard answer is that you might want to whiten your teeth until they are about the same color as the whites of your eyes (on a day after you have had a good night’s sleep). Thus your eyes and your teeth present a reasonably uniform color and you spread the attention that your face draws to its most emotionally expressive parts: your eyes and your smile.

    How White Is White Enough?

    The ideal shade for teeth is about
    the same color as the
    whites of your eyes…

    Over the counter products have advantages and disadvantages. Their primary plus is they are less expensive than dentist supervised products. Their main negative is that there is no dental professional to supervise the treatments or to answer your questions if problems occur. Most of these products are quite safe. Their effectiveness varies greatly depending on the method of delivery and patient compliance (i.e. patient’s ability to follow the directions accurately and use the products for the correct amount of time). Unfortunately, there are many products that claim huge shade changes but that do not measure up to their advertising claims. Buyer beware.

    Whitening toothpastes, flosses and rinses that meet their claims often do so by helping to clean the teeth by removing stains. You don’t have to be a rocket scientist to figure out that cleaner teeth will look whiter than dirty teeth. These products may cosmetically use the word whitener, but they really do not change the inherent shade of the teeth. A good cleaning at a dental office will often have the same effect.

    Who Should Not Bleach? If you have fillings, crowns, veneers or bridges on any of your front teeth, you probably should not bleach your teeth without a serious consultation with a dentist beforehand. None of the restorative materials just listed will lighten from the whitening products. Therefore, if you bleach, the other teeth might lighten, but the restorations (i.e. fillings, veneers and crowns) won’t.

    This is fine as long as you know in advance that this will happen and are prepared to replace the old filling with a new, whiter one if the mismatch is obvious. Depending upon the number, placement and type of restorations that need replacement, one might be faced with a serious financial consideration, so first check with your dentist, especially if you have had restorative work done on your front teeth.

    Pregnant women should not bleach. This is not because bleaching is unsafe; it is because it is untested. To err on the side of caution, just delay the procedure until after you have a happy and healthy baby. For the same reasons, if you are bleaching and find out you are pregnant, the safest decision is to discontinue the bleaching until after term. Many dentists also recommend that the breast-feeding patient refrain from bleaching. There is no scientific evidence to support any of these recommendations, but who wants to be the guinea pig to test safety for your unborn child. Most folks would rather be safe than take a chance on being sorry.

    Tooth whitening is safe but some complications can occur.
    Professionally supervised, correctly applied tooth whitening
    does no permanent damage.

    Regardless of the many rumors that have surfaced over the years, dentists have performed tooth whitening with these peroxide solutions for almost twenty years with absolutely no permanent negative effects.

    We do not see an increase in decay. We do not see teeth dying. Yes, transient temperature sensitivity (usually too cold) occurs in many patients who bleach, but it always goes away within a couple of days of discontinuation of the bleaching process. Some people whiten their teeth too much, (especially if they have no professional supervision), and the bluish translucent area near the edge of the teeth can become too obvious. Sometimes teeth get a little blotchy with white spots. Even if these things happen, they cause no lasting damage because teeth reverse these problems themselves by a process called remineralization. In fact, remineralization occurs quite quickly, usually from a few days to a few weeks. (Many dentists have products available to help speed this along.) Occasionally, the solutions used in whitening cause a burning sensation to the sensitive gum tissue near the teeth and can even make them raw for a short time. This tissue will also heal itself within a few hours to a few days once the bleaching materials are removed.

    So by using care in application and professional supervision, these products are completely safe from long-term effects. If there is no professional supervision, then the consumer must take care to stop at the first sign of any difficulty and give their body time to heal. Then, in a couple of days, you can reapply the materials in a smaller dose or for a shorter time period taking care to avoid the soft tissues. This on and off method will allow nearly everyone who wants to do so, to bleach their teeth provided there is no previous dental work as described above in the section, “Who should not bleach?”

    Bleaching Individual Teeth
    Sometimes one front tooth is much darker than the rest. Trauma is the usual cause of this problem, and often the tooth either needs or has had a root canal done in it. (See Jordan’s story later in this chapter.) There are dentist-supervised procedures that will often help correct, or at least improve this situation. By careful isolation, the dentist can bleach just the darkened tooth without affecting the others. Sometimes this is done as a type of power bleaching on the outside of the tooth. Other times, when teeth have had previous root canal treatment, the power bleaching can be done painlessly from the inside of the tooth. Those two methods are very accurate and very effective. Occasionally a dentist may choose to use the tray method and just apply the bleach to the teeth that are darker. If a patient decides to use an over the counter product, it should be one that can be painted accurately only on the darker tooth while avoiding the others.

    Why Is Tooth Whitening So In Demand?
    Those of you who have had children can probably remember noticing how white their first “baby” teeth were, but when their new “permanent” teeth filled in the spaces, you might remember that they were quite a bit darker and more yellow than the teeth they replaced. Eventually, as the children grow into adulthood, even those new teeth get more yellowed and darker with age. In fact, smoking, coffee, tea, red wine and many other adult foods continue to stain and darken the teeth throughout life. Thus, if you can whiten your teeth, it helps restore your image to earlier times. Bleaching makes us look younger. Every cosmetic dentist knows the first thing to do to help make a person look more youthful is whiten their teeth. And once the teeth are whiter, they show more and therefore attract more attention. People assume that you are smiling, and therefore happier, when more teeth are showing. So of course tooth whitening is in demand; it helps us look younger, more attractive and happier. Now that’s a combination worth keeping!

    Everyone is trying to keep up with the Joneses.
    Well, today, the Joneses have whiter teeth."

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    © 2011, 2013 by Lois W. Stern

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    Lois W. Stern is the published author of two books: Sex, Lies and Cosmetic Surgery and Tick Tock, Stop the Clock ~ Getting Pretty on Your Lunch Hour as well as numerous magazine articles. Her Professional Edition DVD is a popular aid to office staff while interacting with their patients.

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