Teeth Whitening

Introduction

Most people would agree that a healthy, white smile is something that everyone appreciates. It can boost self-confidence and leave a great first impression. Unfortunately because of bad habits and genetics, people’s once naturally white smiles can fade, resulting in teeth which are yellow and stained. The good news is cosmetic dentistry has evolved to offer improved teeth whitening options which can fit nearly everybody’s needs and give them the sparkly bright smile they want.

Cause of Discolored Teeth

Exposure to Elements

The structure of the tooth is an important factor in its color. Underneath the enamel, which is the glossy outer layer of the tooth, is the dentin. Dentin is yellow in color and through the years as the enamel becomes worn down through eating, chewing, and grinding, the yellow dentin can become visible and affect the appearance of your smile. In addition, to age taking its toll on your teeth’s luster, certain habits can expose your enamel to substances which promote discoloration.

Some of the habits that can affect the color of our teeth are: smoking cigarettes, chewing tobacco, eating highly-acidic fruits, and drinking certain dark liquids such as coffee, colas, tea, and red wine. This type of discoloration is referred to as extrinsic staining because it occurs in the outer layer of the tooth. Professional whitening solutions can typically reverse some or all of the discoloration associated with extrinsic stains. There is also another type of discoloration called intrinsic staining which is much harder to whiten. This is because intrinsic stains are located in the dentin and usually the result from exposure to certain medications and chemicals while the tooth was developing. For example, the antibiotic Tetracycline and the chemical fluoride are known to sometimes cause intrinsic staining. While intrinsic stains may be more difficult to remove, new developments in cosmetic dentistry can target even these deeper stains and return your smile to a more natural state.

Genetics

Our genetics also play an important role in determining tooth color and susceptibility to discoloration. For example, some people have a condition known as hypoplastic dentition which is characterized by unusually thin enamel. This condition can result in teeth that are more prone to staining and appear translucent which allows the yellow dentin to be more visible.

Another genetically driving condition is underdeveloped teeth or hypomaturation. With teeth that are underdeveloped, the enamel is very soft and more easily absorbs stains.

Osteogenesis Imperfecta is a genetic disorder in which enamel is weaker than normal and more easily succumbs to chips, cracks, and microfractures. These microfractures are where debris and other extrinsic staining materials get stuck in the enamel which ultimately leads to a yellow or discolored smile.

Professional Whitening Solutions

A whiter smile is achievable with the right treatment plan and your dentist can work with you to try and improve the color of your teeth. Whether you are seeking a subtle enhancement or a drastic change in teeth color, your dentist has treatment options that should be able to deliver noticeable results.

In-Office Whitening

If you are looking for fast results then in-office treatment may be the right choice. It delivers quick, effective results under the supervision of trained dental professionals. The procedure typically delivers results in 1 to 6 sessions that can each take up to an hour to complete. The number of sessions required depends on the type of stains, the severity of discoloration, and the desired level of whiteness.

At the onset of the treatment your cosmetic dentist protects your gums with a guard or gel and then applies the hydrogen peroxide whitening agent to your teeth in a tray that has been designed to fit your teeth. Typically, your teeth will be exposed to this whitening agent for approximately 1 hour in intervals of 15 to 30 minutes. When the whitener is removed, it is advisable to avoid substances that are known to stain teeth.

While there are changes we can make in our habits to keep our smile as bright as possible, it is important to remember that whitening is not a permanent solution and our daily activities may lead to re-staining. (See Post-whitening Tips to learn more).

Dentist Dispensed Take Home Kits

Take home whitening kits offer professionally results at a lower cost than in-office treatments. The take-home kit will be provided to you by your dentist and will include a custom-fitted tray that has been molded to fit your teeth. This tray holds a whitening gel and must be worn for the period of time recommended by your dentist.

Even though this type of whitening takes a longer time to deliver results, it is still an effective way to get an amazing smile.

Do-It-Yourself Whitening

Over-the-Counter Treatments

Many people opt to whiten their teeth with products such as whitening strips or trays that you can purchase at most drug stores without professional guidance. These over-the-counter solutions are a cheaper, more convenient way to whiten your teeth. Whether you choose strips or trays, you are generally instructed to wear the whitening product for 10-20 minutes daily until you see the desired results. Over-the-counter whitening may take longer to deliver the results you want because the active whitening agent is weaker in comparison to professional solutions. Unlike professionally dispensed take-home kits, do-it-yourself whitening solutions are not custom-fitted to your mouth and accordingly they are more likely to cause some irritation (See Possible Risks and Side Effects of Whitening).

Toothpastes

Toothpastes can help keep your teeth looking bright and clean after whitening, but are usually not very effective at removing stains.

Whitening toothpastes may include abrasive chemicals that can cause more harm than good Therefore, if you do choose to use a whitening toothpaste, make sure to ask your dentist which toothpastes do not contain harmful ingredients.

Things to Consider about Whitening

Pre-whitening Tips

Before getting your teeth whitened it is a good idea to get a check-up, have your teeth cleaned, and fill all cavities. Also, it is important to understand that whitening does not work on certain dental fixtures. Crowns, veneers, and fillings are often made with material that is resistant to whitening chemicals which can result in uneven whitening or multicolored teeth.

Post-whitening Tips

Once you have whitened your teeth there are many ways to keep your smile looking beautiful for as long as possible. Modifications in your habits are an extremely effective way to preserve your smile. By reducing the consumption of certain dark liquids such as coffee, colas, red wine, and tea you can proactively limit the re-staining of your teeth. If you do choose to drink dark beverages, try to use a straw to decrease the exposure of your teeth to these elements. Also, you should strongly consider quitting smoking cigarettes and chewing tobacco to maintain the health of your teeth and body. Practicing good oral hygiene as well as seeing your dentist on a regular basis for cleanings and check-ups should help keep your teeth looking whiter. Because whitening is not permanent, it is highly recommended that you practice these tips to limit future discoloration and maintain the visual appeal of your teeth.

Possible Risk and Side Effects of Whitening

The complications and side effects most commonly associated with teeth whitening include tooth sensitivity, gum irritation, and multicolored teeth. Exposure to whitening agents causes both a temporary increase in sensitivity and gum irritation. While the sensitivity is associated with specific stimuli (cold, hot, contact, or pressure), many people also report spontaneous shooting pain coming from their teeth (a.k.a. zingers).

Gum irritation can be the result of do-it-yourself whitening trays whose generic design may not fit every patient properly. The whitening gel can escape from an improperly fitting tray and cause gum irritation, irregular whitening, and a poor treatment outcome.

Both the tooth sensitivity and gum irritation associated with whitening treatments typically go away after several days. The heightened sensitivity, however, can last for up to a month. If these side-effects persist you should discuss the symptoms with your dentist.

Before undergoing treatment you need to be aware that whitening does not work on certain dental materials. For example, whitening will not affect the color of bonding, crowns, tooth-colored fillings, and veneers which will retain their color while the surround enamel and teeth become brighter. Accordingly, whitening teeth which have been restored with these materials can result in what is commonly called multicolored or “technicolored” teeth.

It is important to note that we do not know the effects of whitening materials on fetuses or babies and therefore pregnant or nursing women should avoiding teeth whitening until a more appropriate time.

A Summary of Whitening Treatments

Treatment Approx. Time Avg. Cost Effectiveness/Results
Treatment Approx. Time Avg. Cost Effectiveness/Results
Professional In-Office Whitening
  • 1 to 6 visits
  • visits can last up to one hour
  • $500 - $1000
  • quick, powerful results
  • generally, a noticeable change in color
  • Professionally Dispensed Take-Home Kits
  • 2 to 6 weeks
  • treatment time ranges from 15 min to overnight
  • $100 - $500
  • great results
  • gradual change over time
  • Over-the-Counter Whitening Trays
  • may take several weeks
  • usually worn up to an hour
  • $20 - $80
  • results vary depending on product and type of stains
  • results may be very slow
  • Over-the-Counter Whitening Strips
  • up to several weeks
  • worn between 10 min to 1 hour
  • $20 - $50
  • results vary depending on product and type of stains
  • if effective, change is slow
  • Whitening Toothpaste
  • 2 to 5 min while brushing teeth
  • $5 - $20
  • typically not effective at whitening teeth