Teeth Whitening

About the procedure

Not everyone’s teeth are suitable for whitening. If your teeth and gums are not in a healthy condition before you whiten, the procedure may cause more damage. Even if there is nothing wrong with your teeth there may be other reasons why whitening won’t work.  

The safest way to work out if your teeth are suitable for whitening is to have a dental consultation. Dentists are able to assess your teeth and gums accurately, and offer solutions that are not available anywhere else. 

Take home teeth whitening 

Tray-based tooth whitening systems involve filling a custom-made tray with a gel whitening solution which contains a peroxide-­bleaching agent. The tray is worn for a period of time, generally from a couple of hours a day to every day during the night for up to four weeks and even longer, depending on  the degree of  discoloration  and desired level  of whitening 

In-­office whitening  

In-office bleaching provides the quickest way to whiten teeth. With in-­?office bleaching, the whitening product is applied directly to the teeth. These products can be used in combination with heat, a special light, or a laser. Results are seen in only one, 30 to 60 minute treatment. But to achieve dramatic results, several appointments are usually needed. However, with in-office bleaching, dramatic results can be seen after the first treatment. This type of whitening is also the most expensive approach.   

How long do teeth whitening effects last? 

Teeth whitening is not permanent. People who expose their teeth to foods and beverages that cause staining may see the whiteness start to fade in as little as one month. Those who avoid foods and beverages that stain may be able to wait one year or longer before another whitening treatment or touch-up is needed. 

The degree of whiteness will vary from individual to individual depending on the condition of the teeth, the level of staining, and the type of bleaching system used. 

At-­home teeth whitening vs. dentist-­supervised teeth whitening 

There are differences between whitening teeth at home and having them bleached in a dentist's office, including: 

• Strength of bleaching agent. Take home products usually contain a lower strength bleaching agent, with about a 10% to 22% carbamide peroxide content, which is equivalent to about 3% hydrogen peroxide. In-office, professionally applied tooth whitening products contain hydrogen peroxide in concentrations ranging from 15% to 43%. 

• Mouthpiece trays. With dentist-supervised at-home bleaching products, your dentist will take an impression of your teeth and make a mouthpiece tray that is customized to exactly fit your teeth. This customization allows for maximum   contact between the whitening gel, which is applied to the mouthpiece tray, and the teeth. A custom-made tray also minimizes the gel's contact with gum tissue. Ill-fitting trays can irritate the gum and soft tissue by allowing more bleaching gel to seep onto these tissues. With in-office procedures, the bleaching agent is applied directly to the teeth. 

• Additional protective measures. In the office setting, your dentist will apply either a gel to the gum tissue or use a rubber shield (which slides over the  teeth) 

• Prior to treatment to protect your gums and oral cavities from the effects of the bleaching.

• Costs. Take-home bleach is less expensive than in-office whitening

• Supervised vs. unsupervised process. Dentist-supervised at-home bleaching and in-office treatments offer additional benefits compared with over-the-counter procedures. First, your dentist can perform an oral exam and consider your complete medical history, which can be helpful in determining if bleaching is an appropriate course of treatment based on the type and extent of stains, and the number and location of restorations. Your dentist can then better match the type of stain with the best treatment, if appropriate, to lighten those stains. With dentist-­?supervised bleaching procedures, your dentist will likely want to see you a couple of times to ensure you are following directions, to make sure the customized tray is fitting properly, to inspect the gums for signs of irritation, and to generally check on how the teeth whitening process is proceeding. With over-the-counter bleaching products, you are on your own.

At your initial appointment, we will check for things like enamel thickness, receding gums, existing sensitivity, existing tooth decay, existing restorations (e.g. fillings, crowns and veneers), any other oral diseases or conditions. He will also assess the cause of discolouration, (e.g. diet, ageing etc.) and whether it is on the surface or inside the teeth.

Depending on the cause of the discolouration, results can range from impressive to disappointing so it’s important to understand what can reasonably be achieved before you go ahead with any whitening procedure. The reality is that most people will achieve a one or two shade change and it will be subtle.

At the initial consultation we will assess your teeth and colour. We will check for stains, old fillings and crowns and assess the quality of your enamel. We will take some photos and make notes on your starting shade, and take some models of your  teeth.

From these models we will fabricate your custom-made bleach trays. At your next appointment we will check the fit of these trays and issue your whitening solution. We will show you how to use it properly.

Who should not undergo teeth whitening?

Whitening is not recommended or will be less successful in the following circumstances:

• Age and pregnancy issues. Bleaching is not recommended in children under  the age of 16. Teeth whitening is also not recommended in pregnant or lactating women.

• Sensitive teeth and allergies. Individuals with sensitive teeth and gums, receding gums, and/or defective restorations will have increased sensitivity with tooth whitening. Anyone allergic to peroxide (the whitening agent) should not use a bleaching product.

• Gum disease, worn enamel, cavities, and exposed roots. Individuals with  gum disease or teeth with worn enamel are generally discouraged from undergoing a tooth-whitening procedure. Cavities need to be treated before undergoing any whitening procedure. Also, whitening procedures will not work on exposed tooth roots, because roots do not have an enamel  layer.

• Fillings, crowns, and other restorations. Tooth-colored fillings and resin composite materials used in dental restorations (crowns, veneers, bonding, bridges) do not whiten. Therefore, using a whitening agent on teeth that  contain

• Restorations will result in uneven whitening - in this case, making the teeth without restorations appear lighter than those with restorations. Any whitening procedure should be done prior to the placement of restorations.

• Unrealistic expectations. Individuals who expect their teeth to be a new "blinding white" may be disappointed with their results. Smokers need to be aware that their results will be limited unless they refrain from continued smoking, particularly during the bleaching process. A healthy guide to is to achieve a shade slightly whiter than the whites of your eyes.

• Darkly stained teeth. Yellowish teeth respond well to bleaching, brownish-colored teeth respond less well and grayish-hue or purple-stained teeth may not respond to bleaching at all. Blue-gray staining caused by the antibiotic tetracycline is more difficult to lighten and may require up to six months of home treatments or several in-office appointments to successfully lighten. Teeth that have dark stains may be better candidates for another lightening option, such as veneers, bonding, or crowns. We can discuss the options best suited for you.

Tooth whitening: complications

For many people teeth whitening poses no serious risk if done correctly. However, if you choose the wrong treatment for your teeth or that treatment is applied incorrectly (e.g. whitening products are often used too frequently or applied for too long a time) then some damage can occur.

The main problems and side-effects can be:

• Reduction in the hardness and strength of  enamel
• Damaged and inflamed gums
• Blistering
• Heightened tooth sensitivity
• Irritation and possibly bleeding in the oesophagus and stomach if some of the bleaching agent is ingested
• If you have crowns, veneers or fillings these will not change colour at all after bleaching so you could end up with multicoloured teeth

The process of teeth whitening involves oxidising agents such as hydrogen peroxide.

The two side effects that occur most often with teeth whitening are a temporary increase in tooth sensitivity and mild irritation of the soft tissues of the mouth, particularly the gums. Tooth sensitivity often occurs during early stages of the bleaching treatment. Tissue irritation most commonly results from an ill-fitting mouthpiece tray rather than the tooth-bleaching agent. Both of these conditions usually are temporary and disappear within one to three days of stopping or completing   treatment.

If you do experience sensitivity, you can reduce or eliminate it by:

• Wearing the tray for a shorter period of time (for example, two 30-­?minute sessions vs. two 60 minute sessions).
• Stop whitening your teeth for two to three days to allow teeth to adjust to the whitening process.
• We will provide you with a high fluoride-containing product, which can help remineralize your teeth. Apply the fluoride product to the tray and wear for four minutes prior to and following the whitening agent.
• Brush teeth with a toothpaste made for sensitive teeth. These toothpastes contain potassium nitrate, which helps soothe the teeth's nerve endings.

Key facts

• The safest way to work out if your teeth are suitable for whitening is to have a dental consultation. Dentists are able to assess your teeth and gums accurately, and offer solutions that are not available anywhere else. 

• Teeth whitening is not permanent. People who expose their teeth to foods and beverages that cause staining may see the whiteness start to fade in as little as one month. Those who avoid foods and beverages that stain may be able to wait one year or longer before another whitening treatment or touch-up is needed. 

Important to know

Good dental hygiene is critical in keeping infection at bay. Non-­?smokers and patients with good oral hygiene habits put themselves in a much better position for a full and fast recovery. Smokers will typically be encouraged to stop smoking beforehand to improve the odds of successful surgery. If properly constructed and cared for, most dental implants should last a lifetime