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May 27, 2018
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Turn a light on teeth whitening

By: George Malkemus
March 23, 2018

Teeth whitening is a popular cosmetic trend. A bright white smile makes people feel more confident and look younger. Dental whitening is an easy and rather low cost way to a radiant smile. But there is much confusion with many different methods of dental whitening. I receive many questions from my patients regarding teeth whitening. What is it? Is it safe? Will it damage my teeth? Will it make my teeth or gums sensitive or hurt? How white can my teeth become? How long does it take? How long will it last? In this article I hope to take the mystery out of teeth whitening.

What is it?

Whitening lightens teeth and helps to remove stains and discoloration. Whitening is among the most popular cosmetic dental procedures because it can greatly improve how teeth look, rather cheaply, easily and quickly.

Whitening can either be done with numerous, over-the-counter systems or professional whitening from a dental office. Over-the counter systems are less costly, but also less effective and involve much longer treatment due to much lower concentrations of active ingredients. Professional teeth whitening can either be done with a custom take home system or a quick in-office ‘laser’ whitening. 

How does teeth whitening work?                                                           

Enamel is an extremely hard crystalline structure. On the microscopic level, there are little holes that fill in with stain over time from food and drink, such as coffee, tea and tomato sauces. Tobacco is particularly staining. Basically whitening sucks out all the years of deep surface staining and returns the teeth to the shade that they were when the individual was a child. If the teeth were dark when one was young, then whitening can only do so much. But just removing the many years of constant stain will lighten the teeth to the original look. Most people have fairly light white teeth when young. For individual’s teeth that were always dark, more involved cosmetic procedures are necessary, like porcelain veneers or crowns.

Is whitening safe?

Whitening is safe and does not damage the teeth. Whitening just returns the teeth to their original shade when the person was a child. However, whitening can cause sensitivity if not done correctly.  

The root surface of a tooth can become sensitive if exposed to whitening solution, so care must be taken if an individual has gum recession. Also if one has decay, extreme sensitivity can occur. So dental examination, cleaning and all decay removal is necessary before a whitening procedure. 

Will it last?

After whitening, the teeth will darken again over time as they re-stain from food and drink.  But it will take many years to become as dark as they were before whitening.   So whitening is not a one-time procedure. It will need to be repeated from time to time to maintain the brightest white shade with a quick touch-up procedure. 

Over-the-counter systems

There are many whitening systems that can be bought at drug stores for home use. They are cheaper but take much more time and effort than professional whitening in a dental office. The systems are less effective due to low concentrations of whitening solution and poorer fitting of the systems. But over-the-counter systems can work for the right individual who perseveres and dedicates time to keep up daily treatments. 

Over-the counter systems include whitening toothpastes, whitening strips and homemade trays with gels. Whitening toothpastes rely on mild abrasion to remove surface stains and have special chemical or polishing agents that provide additional stain removal. A professional dental polish also uses slight abrasion to remove external staining.                                                                                                                                          Whitening strips stick to the teeth and release low concentrations of whitening solution. They are somewhat effective when the teeth are straight, already fairly white and used often.  

Homemade trays are made using a boil and bite method of soft acrylic and then filling a gel in the tray and placing over the teeth. Due to the low concentration of active ingredients in the gel and the thin amount of gel on the tooth surface held by the tray, many applications are necessary to get any improvement. 

Dental take home teeth whitening 

Whitening can be done in the dental office or at home. The first step is to have an exam, x-rays, check the shade of the existing teeth, take photos of the smile and determine the reason for the darkening of the teeth. The second step involves removing decay and getting the gums in good shape with periodontal treatment or a basic cleaning and polishing of the teeth. Once this is done, the whitening procedure can begin.

For whitening at home, trays are made from precise impression of the patient’s teeth.  Accurate models are made from the impressions. Trays are fabricated with small wells made on the fronts of the teeth that are to be whitened to hold the gel where it is needed.  [One of the problems with over the counter trays is the gel solution is squeezed out of the tray.] The patient is shown how to place the home whitening gel in the tray, so little gel is wasted and washed into the mouth. Different concentrations of gel can be given, depending on the patient’s sensitivity level.  

The trays should be worn for at least an hour or two. Longer than two hours and the gel does not have much effect. [Many manufactures recommend wearing trays over night while sleeping, implying that the gel keeps working all night long, not so.] The trays need to be worn for 10 to 20 times to be effective. Great results happen with constant use. The biggest problem with home systems is patient compliance. Many patients have good intentions, but it often becomes one more thing that time does not allow. I recommend finding a time for an hour or two to wear each day, like watching TV or reading in the evening after brushing and flossing.

Dental in-office whitening 

In-office whitening is quick and very effective. There are many systems that use a concentrated light activated gel placed on the teeth, a protective coating placed on the gums and an intense light source. In my office, two one-hour visits are set up with Phillips Zoom whitening system, which delivers maximum results, using advanced LED light-activated computer technology. Zoom has variable intensity settings to allow for adjustments to individual sensitivities. Patients have been having great results, up to eight to ten shade changes, with the system.

The LED light is attached to a fitted mouth attachment that isolates the teeth. Coating paste is placed on the gums for protection from the concentrated gel and intense light.  The patient sits for 30 minutes each section while the treatment occurs usually listening to music with headphones. The light intensity is adjusted as needed. Accurate trays are given to the patient to wear at the end of the procedure with a fluoride gel to seal off the enamel and prevent sensitivity. Also the trays can be used with touch up home whitening in the future. I have a few patients who have the in-office whitening every year or two.  They like to stay super white and don’t like the hassle of wearing trays. They liken the procedure to having their hair done.

Note that fluoride gel or toothpaste should always be used after any whitening system to seal off the enamel. The teeth are easily stained after whitening, while the enamel porosities are still open, Fluoride seals off the openings and makes a protective coating over the enamel. Also the teeth should be brushed without a fluoride toothpaste before any whitening procedure, so the whitening gel can be more effective by penetrating the enamel.

I hope that I have shed some ‘light’ on teeth whitening. A bright radiant smile helps make a wonder first impression.

Enjoy Life and Keep Smiling!

George Malkemus has a Family and Cosmetic Dental Practice in Rohnert Park at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com.  Visit Dr. Malkemus’ Web site at http://www.malkemusdds.com