Teeth Whitening

How can you brighten your smile?
Your wedding is coming up and you want your smile to be it’s brightest.   Or maybe you have an important speaking engagement.  Whatever the reason, tooth whitening isn’t just for the movie stars, and it isn’t just for one day.  Many people have had their teeth whitened and probably millions more are thinking about it.  The desire for a brighter smile with whiter teeth is very strong, and tooth whitening safely lightens the color of the teeth, lasting up to five years.  The most effective and safest method of tooth whitening is dentist-supervised.

Is whitening for you?
Generally, whitening is successful in at least 90 percent of patients, though it may not be an option for everyone.  Consider tooth whitening if your teeth are darkened from age, coffee, tea or smoking.  Teeth darkened with the color of yellow, brown or orange respond better to lightening. Other types of gray stains caused by fluorosis (growing up in areas with high fluoride), or tetracycline are lightened, but results are not as dramatic.  If you have very sensitive teeth, periodontal disease, or teeth with worn enamel, your dentist may discourage whitening. 

What's involved?  First, Dr. McBride or his staff will determine whether you are a candidate for tooth whitening and what type of whitening system would provide the best results. 

If you're in a hurry for whiter teeth, you may decide to have your teeth lightened immediately. Dr. McBride's staff can use either an in-office (Zoom 2) whitening system while you sit in the dental chair, or dentist-supervised at-home whitening.  In-office whitening is a newer technology.  Ideally, you can coordinate this treatment with your hygiene appointment.  It uses a stronger dose of the carbamide and hydrogen peroxide chemicals than at-home whitening systems.  This allows the whitening to occur faster, but we have found that the appearance of whiteness is delayed.  Approximately three days pass before you can determine the full difference.  At-home whitening systems, at a lower dose, must be repeatedly applied by you at home, worn at night while you sleep, and takes an average of 10-14 applications to achieve the whitest result possible.  Some whitening systems recommend whitening your teeth from two to four hours a day. Generally this type of system requires three to six weeks to complete.  

If you choose the at-home system, the hygienist or assistant will make impressions of your teeth to fabricate a mouthguard appliance for you.  The mouthguard is custom made for your mouth and is lightweight so that it can be worn comfortably while you are awake or sleeping.  The mouthguard is so thin that you should even he able to talk and work while wearing it.  Along with the mouthguard, you’ll receive the whitening materials. You'll be given instructions on how to wear the mouthguard and how to put the whitening gel into it.  It's easy! Everyone is very satisfied by this system.  It allows you to control the level of whiteness you want.  In some cases, teeth don't start out the same color to begin with, so some need extra time.  You can put the gel into the tray only in the spots that would touch these teeth to allow them to catch up with the other teeth.  This is not as easy to manage with the one-time in-office system.

With either system there is a potential for sensitive teeth to become more sensitive if unmanaged.  This can be solved in a few ways.  If you know the teeth that are sensitive already before treatment, discuss this with Dr. McBride or the hygienist.  These teeth can be desensitized.  We have a treatment of inorganic salts that can be painted on the exposed dentin (the sensitive part) which provides an insulation and desensitization of the nerve endings.  This desensitization is ideal for persons that find the sensitivity is noticeable when they attempt to drink cold beverages or touch their teeth.  Another way to manage sensitivity is to protect exposed dentin with something like petroleum jelly.  We have mini-sized cotton-tipped applicators for the application of the petroleum jelly, immediately prior to the application of the whitening system.  If you did not previously have sensitive teeth, but find that you do after the application of the whitening system, this can be caused by dehydration of the enamel's microtubules.  Replenish with lots of water consumption and swishing with water; hold off on reapplication of the whitening systems by staggering the application to every other day and on the alternate days apply a fluoride gel in the trays, wearing this at bedtime as you would have the whitening gel.  This fluoride can be prescribed over the phone and picked up at a pharmacy, or purchased at our office. 

How long does it last?
Lightness should last from one to five years, depending on your personal habits such as smoking and drinking coffee and tea.  At this point you may choose to get a touch up.  This procedure may not be as costly because you can probably still use the same mouthguard(s).  The retreatment time also is much shorter than the original treatment time.  Touch-up applications are usually one full night every one to two years. 

How does it work?
The active ingredient in most of the dentist- supervised at-home whitening agents is 10-16 percent carbamide peroxide (CH4N202) and in-office whitening systems combine 30-35 percent carbamide peroxide and 30-40 percent hydrogen peroxide.  When water contacts the white crystal of carbamide peroxide, a release of hydrogen peroxide lightens the teeth.

Is it safe? Any side effects?
Several studies, during the past five years have proven whitening to be safe and effective.  The American Dental Association has granted its seal of approval to some tooth whitening products. Some patients may experience slight gum irritation or tooth sensitivity, which will usually resolve when the treatment ends.  (See above for more information about sensitive teeth.)

What are realistic expectations? 
No one can really predict how much lighter your teeth will become.  Every case is different. Typically, there is a two-shade improvement as seen on a dentist's shade guide.  The success rate depends upon the type of stain involved and your compliance.  Whitening can only provide a shift in color from gray to a lighter shade of gray, for example.  Too white isn't attractive or natural looking, but usually your teeth won't get any whiter than their original design, but with the dentist-supervised at-home products you can have more control to continue the process until you are satisfied.  Whitening does not lighten artificial restorative filling materials such as resins, silicants or porcelain crowns.  This is important to know, as if the white fillings, crowns, etc. are similar in color as the non-filled teeth before whitening, they may need to be replaced after whitening.  Conversely, if the crowns are lighter than the teeth to be whitened, the process may allow for a better match in shade.