This informational article is provided to educate our clients and the general public on the dental process of teeth whitening & bleaching. The teeth whitening & bleaching process is often poorly explained to patients prior to it being performed. This results in the process causing unnecessary teeth discomfort and has been found to lower the process effectiveness due to misuse. It is hoped this article will help educate and create a well informed patient who understands how to make their teeth bleaching process as painless and effective in obtaining that perfect smile as possible.

Teeth Whitening & Bleaching – The Basics*

Teeth whitening has become the finishing touch in the art of building the perfect smile. Along with various tooth aesthetics enhancement procedures. teeth whitening has been proven to be a critical element in the overall improvement of a younger appearance. However, the process of teeth whitening is being sold to many an unsuspecting client as a simple “do it now and you’ll look better practice.” In reality, it is far from that simple a process. Preparing for a proper tooth whitening is as critical, if not more critical than the process itself. Failure to properly plan out your teeth whitening can result in severe damage to your teeth and pain that will make you long to “undo the undoable.” As always, knowledge and planning is the key. This article will help you to understand the process and the do’s and don’ts.

Long before you stick some chemical in your mouth to make yourself have that movie star smile, you need to understand the overall health of your teeth and gums. It is pointless to waste money on an expensive teeth whitening when all you are whitening is a mouth full of unhealthy and plaque covered teeth. To start the process, a trip to your dentist is always step one. A complete dental examination and cleaning is critical before the whitening process is begun. Your teeth must be inspected to fill cavities, eliminate disease conditions and remove plaque and tarter. Think of it like painting your car prior to washing it. It’s always the other way around. After assuring your teeth and gums are in good physical condition and clean, step two begins; preparing the tooth surface for a bleaching. This involves conditioning your teeth with a professional fluoride treatment to protect the tooth surface and lower the possibility of post bleaching tooth pain. After this process, you are ready for step three; the actual whitening. Before we dive into a bleaching tray, lets talk for a minute about what got you here to needing that bleaching in the first place.

How did my teeth get to look like Captain Jack the Pirate?!*

Each of our teeth consist of a soft inner layer, called the dentin, which is covered by a hard outermost layer, called the enamel. As strong as our enamel is, this layer is quite porous by nature, which will allow various staining agents (food, drinks, tobacco, etc) to work their way into the tooth. When we consume food and beverages, especially those that have a darker pigment such as oranges, carrots, red wine, coffee, cola etc. a layer of acids and pigments in those foods/drinks, form over the enamel. The longer this layer sits on the tooth the deeper the stain may become. This is why it is important to adopt proper oral hygiene habits. You know mom’s old saying; “brush after meals young man!” Remember, Mom is always right.

A tooth stain is a tooth stain, right?….Wrong!*

All stains are not created equal. Let’s learn the difference. The result you get from teeth whitening will be impacted by the type of stain your teeth have. In some cases, the bleaching might not even work! So, knowing your teeth’s stain type is critical. There are two major types of dental stains, extrinsic and intrinsic. An “extrinsic stain” is caused from exposure to foods and beverages containing dark pigments such as red wines, coffee, teas, carrots, and other foods. These stains can easily be removed with regular brushing and prophylaxis, which is a procedure used by dentists to eliminate plaque and tartar from your teeth. Extrinsic stains must be dealt with early on so that they won’t become impregnated into the dentin (the softer inner layer of teeth). The “intrinsic stain” however, happens from within a tooth outward. Exposure to certain minerals in our diets, large amounts of fluoride consumption and certain antibiotics such as tetracycline, can cause this type of discoloration due to the interaction with the calcium hydroxyapatite crystals, a main component of the enamel. Trauma to teeth or a specific tooth may also cause intrinsic staining. If the dental pulp at the center of the tooth hemorrhages, the resulting blood will enter the dentin’s dentinal tubules, which can result in a darker color of the dentin. Lastly and regrettably, simple old age can cause notable discoloration. Only your dentist will know what kind of stain you have. Knowing the stain type will drive the type of bleaching process you need to use.

Teeth Color – Genetics & Your Habits*

Genetics play a significant role in dental discoloration and NO, this does not mean you’re genetically inferior – so relax. We all have an inborn tooth color, which is driven by the color of your dentin. This color may range from a yellow-brown shade, which is more responsive to bleaching, to a greenish-grey shade. If your enamel has a characteristic translucency appearance, your dentin color will show through more than someone that has a genetic opaque white enamel, which appears lighter in color. The translucency of your enamel may be due to genetics. However, this translucency is also caused by erosion from acidic foods, or enamel that has been worn down through the years from improper dental care or even simply from general health issues. The most preventable tooth discoloration effect of all, results from developing smoking habits and the use of pure tobacco. As a general guideline, if you’re a heavy smoker, that teeth whitening plan should generally follow behind your quitting smoking plan.

Teeth Whitening – Picking the best Tooth Color*

When it comes to teeth whitening, you really want to know the before and after tooth color. This is critical to the natural smile appearance. Just getting the whitest teeth can make you look like you swallowed a can of gloss white paint….Woopsy -I’m in trouble! Problem is, that freshly painted appearance will not come off with paint thinner. At your cosmetic dentist, you will find they use something called a dental shade guide to measure your natural tooth shade. A shade guide has the 16 most common tooth colors, which are arranged from lightest to darkest and into four color groups that help the dentist decide the whitening approach.

Teeth Whitening – Alright, do I do it or not!?*

Of course you can get a whitening but, timing is the key! As stated earlier, there are some dental conditions that you should address before you begin any bleaching or whitening procedure. For example, if you have very sensitive teeth to heat or cold, worn enamel, cavities, exposed roots, fillings, crowns, other restorations, or dreaded periodontal disease, you have to make sure these issues get treated by your dentist FIRST. What those quick whitening studios don’t always tell you is that whitening may actually complicate serious dental problems. They just want to sell you a whitening, they don’t always know if you are ready for it or not. Further, whitening your teeth is NOT recommended if you are under the age of 16, your pregnant or are lactating after delivery of a baby. Your may also be an inadequate candidate for certain types of whitening if you have restorations such as bondings, veneers or crowns. This is due to the fact that these restorations maintain their initial intended color while the rest of your natural teeth will be whitened. This commonly results in a frequent condition called “technicolor teeth,” Teeth of varying shades. Varying shades of teeth can also occur if you happen to use whitening strips that do not cover a tooth completely.

Teeth Whitening – The Various Methods*

Choosing a teeth whitening system on your own can be a difficult task due to the variety of selections available today. The options vary from the whitening toothpastes, oral rinses, do-it-yourself dental trays, whitening strips, to the over-the-counter gels. In the dental office the cosmetic dentist has nearly a dozen professional teeth whitening systems and options tailored to specific dental conditions and those conditions can be complex. Some select in-office systems require a couple hours to perform and others can be done in a one-hour office session. Certain professional grade processes use custom made bleaching trays, which you can only obtain from your dentist. Again, knowledge is the key to choosing the best option for you and starting with your dentist is always the right choice. The most beneficial aspects of starting at the dentist is coming to understand the side effects, that are not always discussed with over-the-counter products. They simply cannot cover all the possible dental conditions.

Teeth Bleaching versus Whitening*

The term “whitening” is used when your teeth color is restored back to what its natural color should be. This means that any product that can remove stains and even just debris such as tartar from your teeth such as toothpaste, or baking soda can be called a “whitener.” The term “bleaching” is used when teeth are whitened to color shades more than what their natural color is. Only products that contain bleaching agents such as carbamide peroxide and hydrogen peroxide are permitted to use the bleaching term. However, whitening is a term often used for the public to refer to teeth bleaching. This is simply because it sounds better that bleached teeth. That term sometimes scares people. By the way, it is worth noting that the FDA does not regulate teeth whiteners since it is not a drug. So, you have to be careful with their use. Always use common sense with any dental product. Even a dental rinse can have serious health aide effects.

Teeth Whitening Agents – Hydrogen Peroxide*

In general, bleaching systems being used by dental offices contain either hydrogen peroxide or carbamide peroxide, though hydrogen peroxide is the active ingredient in both. Hydrogen peroxide, when applied to your teeth begins an oxidation process that breaks down into oxygen and water, creating the bleaching effect. Most dental offices use systems that contain hydrogen peroxide, in concentrations from 15% to 35%. This could be referred to as prescription strength. At this concentration, faster results are achieved in a shorter amount of time and the results are more pronounced. Hydrogen Peroxide could be considered slightly more powerful than carbamide peroxide, which (although being more effective) means that it may cause your teeth to be more sensitive and irritate your gums and other soft tissues of your mouth. It is recommended that if you are going to use a product containing hydrogen peroxide you do so under the supervision of a dentist.

Teeth Whitening Agents – Carbamide Peroxide*

In products that contain carbamide peroxide, hydrogen is the active ingredient. The difference is that a urea molecule is added to hydrogen peroxide that results in the compound we know as carbamide. This means that it takes carbamide an extra step for the teeth whitening process to take effect. While products containing hydrogen peroxide only have to break down into oxygen and water, carbamide has to first break down into hydrogen peroxide and then into oxygen, which is what whitens your teeth. It takes about 15 minutes for the carbamide to begin to break down into hydrogen peroxide. Since there is an extra chemical step for the peroxide to go through, it takes longer to work its magic on your teeth. However, the GOOD NEWS is that this extra chemical step is gentler on your gums and will in most cases cause less sensitivity effects in the teeth. Carbamide is often found in most “over the counter” products because it is safer for consumer use. This is good, but, this means it has to be used over a longer period of time to get the results you want.

Over-the-Counter Teeth Whitening – Considerations*

When it comes to brightening your smile you always select a product that is safe for your teeth and most of all your health. Make sure the product is approved by the American Dental Association (ADA). The ADA has strict guidelines for safety and effectiveness that a product must meet in order to receive their seal of approval. It cannot be emphasized enough, it is always best to visit your dentist first. Teeth whiteners can worsen and accelerate various forms of dental disease. It should not even have to be said you must always follow the instructions to the letter. It is possible to misuse and overuse over-the-counter whiteners. The biggest concern you should be aware of right off is the potential for dental pain. A whitener can cause both gum and tooth pain. If misused or over used, the resulting pain may not go away for months! The bad news is, the dentist may not be able to make that pain go away any faster either. So BEWARE. There is a potential for allergic reactions too, so start out slow.

Dental Office Teeth Whitening – Considerations*

Out of all the cosmetic teeth whitening systems on the market, in-office bleaching/whitening gives the most dramatic results in the shortest amount of time. This is simply due to the use of prescription grade chemicals. This option is the most recommended because your cosmetic dentist will first examine and clean teeth with pumice, fill cavities, and make sure your health condition is ready for the process. Don’t panic if a dentist determines you are not a good candidate for tooth whitening. If you are not, there are almost always alternative cosmetic dental options available.

The bottom line is, teeth and gums must be in good condition if whitening is to be performed. This is simply because the peroxide may worsen any periodontal problems or other conditions present. In the dental office, the dentist will likely isolate your gums with the help of a device known as a rubber dam or a protective gel. When these protections are in place. the whitening solution will be applied directly on to your teeth where it will remain for a given interval of minutes. Some products may require heat, laser, or an infrared light to activate the release of the oxygen molecules. Keep in mind that everybody’s teeth are different and therefore respond differently to the bleaching process.

The best advantage of performing the process in the dental office is due to the dentists ability to deal with dental restorations that cannot be whitened. If you have crowns, bridges, composites, veneers and other restorations that will not lighten with the whitening process, the dentist can successfully isolate those restorations and tailor the whitening process to give a perfect uniform color and shade across all teeth. This is almost impossible in the at-home products.

Prescription Teeth Whitening*

If your dentist determines that you are a candidate for at-home prescription whitening, this can be a significant cost saver for you. This type of whitening can still help you achieve similar results to in-office whitening in a safe and effective way. You need to remember though, this process will take a longer amount of time and must be followed with high consistency. These kits use a solution with a lower concentration of hydrogen peroxide than the in-office product. Generally, they must be used once a day for a 10-60 minute period. The dentist will specify the period. Keep in mind, the lower the concentration of hydrogen peroxide the longer it may safely remain in contact with your teeth. Other kits may contain carbamide peroxide, which is more stable than hydrogen peroxide and may, if in the right concentration, be used overnight. The key aspect of both of these products is the lowered chance of tooth sensitivity. You are essentially trading time for comfort and safety.

For the prescription at-home whitening process, an impression of your upper and lower teeth is taken and sent to a dental lab where a set of custom-made dental trays will be prepared for you. In about a week or two of your impressions being taken, an appointment will be made where you will be shown how to apply the solution to the trays and place them in the mouth. As stated before, these are used for a maximum of one hour a day for about two weeks or in some cases overnight, depending on type of solution and concentration of peroxide. You should wipe any excess solution, since it may irritate/damage your gums and it is always proper to brush and floss your teeth before using any type of whitening solution. This overall whitening process is done over a period of two to four weeks.

Internal Tooth Bleaching*

Internal tooth bleaching is more commonly performed by certain general dentists or an Endodontist on a tooth that is discolored due to a root canal therapy (RCT) or trauma to the tooth. Teeth may become discolored if a root canal is not performed correctly. The blood components may enter the root, which then decompose causing the darkening of the tooth from the inside. This requires re-treatment of the root canal therapy to remove the source that is causing the discoloration of the tooth. Once the root canal is re-treated, a bleaching gel or crystal are then inserted in the cavity of the tooth for a certain period of time to whiten the root. In some instances a method called “walking bleach” may be used. In this procedure the bleach crystals are left in the tooth and the patient is to return to office in a couple of days to get the bleaching agent removed. You should note there are certain risks associated with internal bleaching. These risks can involve loosing the tooth due to a leaking root filling or damage of the crown or tooth when the tooth is opened.

Teeth whitening – Risks & Side Effects*

It should go without saying that to maintain your white teeth for as long as possible, make sure to keep practicing good oral hygiene. Translated – brushing and flossing your teeth at least two times a day. Also at-home maintenance whitening may be implemented when you start noticing discoloration. The avoidance of eating foods and beverages that are dark in color, such as coffee, cola, carrots, oranges, and such, for about one to two weeks after the whitening is advised. This is especially important within the first 24 hours after bleaching since your enamel has been compromised and will easily pick up a color from a film coating. CAUTION – in worst cases, failure to observe this first 24 hour requirement may permanently discolor your enamel! You should also avoid smoking since it causes stains that in the long term become intrinsic stains. Be aware that the consumption of certain pharmaceuticals may cause staining of the teeth as well and start the staining process all over again.

Teeth whitening – Risks & Side Effects*

The most common side effect from teeth whitening is the temporary sensitivity of the patients teeth and irritation of the gums. It is a common side effect to have sensitivity to temperature and touch with in-office bleaching. This is simply because higher concentrations of peroxide are used in this process. Other factors that may cause sensitivity are if the patient suffers from gum recession or significant cracks in their teeth that results in leakage. After cracks are repaired, the pre-treatment of teeth with a fluoride rise prior to the whitening process is shown to lower the level of tooth sensitivity. This is because the fluoride helps re-mineralize (seal) the tooth enamel surface and protect the dentin from the chemical exposure, which causes pain.

In certain patient cases, after the whitening process, they may feel a shooting pain or tingling sensation in the middle of their teeth. If a hydrogen peroxide based system was used, these effects are the result of irritations to the gums due to the concentration of the chemicals. In some cases a poor fitting whitening tray may be the cause of irritation. Is should be noted, this condition is sometimes unavoidable simply due to a unique teeth condition such as tooth mis-alignment and a number of other factors outside the dentists control. Though it is an inconvenience, the sensitivity and irritation will generally dissipate in typically seven to ten days. If the pain dose not subside, a immediate trip to the dentist is necessary.

Teeth Whitening – Reducing Risk & Pain*

As a minimum, the use of a toothpaste for sensitive teeth before, during, and after whitening is always advised. Sensitivity toothpastes generally contain potassium nitrate that eases a tooth’s nerve endings. If performing at-home prescription whitening to reduce the feeling of sensitivity, the patient may try reducing the amount of time the solution is in contact with their teeth or try skipping on one or two days of use as opposed to wearing the trays everyday. The prescribing dentist may also recommend a prescription fluoride rinse to help re-mineralize the enamel of the teeth. Certain types of fluoride gels may be prescribed as well. Applying the fluoride gel on the custom whitening trays prior to the whitening process has proven to help reduce the discomfort of the process.

* – All information contained in this article is for “informational purposes only.” It is not to be interpreted as direction towards a diagnosis/treatment recommendation. Reader must directly consult a dentist for any evaluation/specific treatment advice.

©2012 Dental Aesthetics Professionals. No portion of this article may be reused without the written permission of the author.

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