EVERYTHING YOU NEED TO KNOW ABOUT WHITENING YOUR TEETH - Dr. Jennifer Graas - Eau Claire Park Dental
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EVERYTHING
YOU NEED TO KNOW ABOUT WHITENING YOUR TEETH
Dr. Jennifer Graas
EVERYTHING you need to know
about whitening your teeth
Dr. Jennifer Graas
When we ask our patients if there is anything they would like to change about their smile, the #1
answer we get is that they would like their teeth whiter. Social media in particular has caused an
increased awareness and desire for whiter brighter teeth, and we often hear marketing campaigns
that focus on the smile being one of our most important assets. There is no doubt that a beautiful
smile improves self-confidence, self-image and physical attractiveness.
However, there are so many different whitening options to choose from, and every system claims
it’s the best. It’s no wonder people are confused! There are in-office treatments, professional home
treatments and over-the-counter/do-it-yourself treatments.
So… what is the best option?
We thought we would put all of the latest information on tooth whitening together for our patients
so that they can be well informed and decide what is the best solution for them. As with everything
we do, we want to help you minimize risks while achieving optimal results.
How does tooth whitening work?
Did you know tooth whitening was discovered by accident in the 1980s? Dentists were using
peroxides to treat periodontal (gum) disease and noticed over time it also lightened tooth
color!
Tooth whitening is the process of removing stains from the enamel of your teeth by applying a spe-
cial bleaching material (peroxides). The bleach material penetrates the outer layer of the enamel
and takes out stains that cannot be removed otherwise. Today, hydrogen peroxide (HP) is the key
ingredient, however carbamide peroxide (CP) is also used. CP breaks down into hydrogen peroxide
and urea once it is in contact with saliva. It is important to understand that the concentration
effectiveness of CP to HP is 3:1. So, if you are comparing bleaching products, look at whether the
active ingredient is HP or CP, and then look at the concentration or percentage (10% HP is equiva-
lent to 30% CP).
The chemical process of whitening is known as oxygenation, where HP is broken down into oxygen
free radicals and water. The free radicals adhere to the surface of the stain molecules and break
them down. To get the best whitening effect, concentration and contact time must be considered
and customized for each type of stain.
Everything you need to know about whitening your teeth 01
Does whitening damage your enamel? Are there any side effects? This is a common misconception among our patients. No, whitening does not damage your enamel. However, the biggest side effects with whitening are increased tooth sensitivity and gum irritation. Both of these effects are short lasting and typically only happen while you are whitening but may last for a few days afterwards. One of the downsides of over-the-counter systems is that the trays are not custom fit to your teeth making it more likely that the bleach gel touches your gums and causes pain and irritation. All bleaching gels are not created equal… The professional gel that we give patients in our practice (Opalescence by Ultradent) contains optimum levels of fluoride, potassium nitrate, and 20% water to help minimize tooth sensitivity. It also much more viscous than other gels which prevents it from flowing onto the gum tissue and causing irritation. The over-the-counter versions are a lower concentration of HP/CP and therefore less effective and less predictable. We also find that patients have higher rates of tooth sensitivity with over-the-counter systems because they dehydrate the teeth. How white can you expect your teeth to get? Whitening is a cosmetic and elective procedure and requires your commitment. Lack of commit- ment or following instructions will affect your end result. Managing our patient’s whitening expec- tations has always been difficult because it is hard to predict the final outcome. By using a more comprehensive approach based on our patient’s individual oral health status and needs, we can be more confident in achieving optimal whitening outcomes. Everything you need to know about whitening your teeth 02
We evaluate the following aspects for all of our patients considering whitening: Type of stain on your teeth Intrinsic stains: Extrinsic stains: These stains occurred during the develop- These stains are superficial ment of your teeth and are caused by gene- and much easier to remove. tic/systemic conditions and/or medications. These stains are more difficult to remove. Starting shade and susceptibility to stains Our natural shade does darken throughout our lives. Regular annual shade monitoring is recommended and helps us determine your susceptibility to shade change as well as risk of staining over time. Your oral hygiene, and current oral health status Poor oral hygiene generally means whitening will be less effective and the result will not last as long. Your teeth whitening history History of sensitivity, compliance, and how well your teeth have whitened in the past will influence our recommendations. Your diet (Coffee, tea, red wine, berries) Diets high in these foods will mean that you can expect your teeth to stain again and more frequent whitening may be required. Commitment to a maintenance schedule is what will provide you with the best value from your whitening treatment over time. Your current dental restorations It is important to realize that your existing dental restorations (white fillings, crowns, bridges, implants) will not whiten along with your natural teeth. Sometimes dental work must be replaced if you want it to match your new lighter teeth after whitening is done. This would be something that would be discussed with you prior to commencing the treatment. Everything you need to know about whitening your teeth 03
What are the available options for tooth whitening?
What are the risks and benefits of each?
There are 3 primary methods to whiten your teeth:
1 In-office
whitening:
Tooth whitening done in a dental office involves placing a higher concen-
tration peroxide material on your teeth for a period of time, and is removed
at the end of the appointment. You will leave the office with notably whiter
teeth… Doesn’t that sound like a productive way to spend a lunch hour?!
We generally recommend that patients also use a take home kit to main-
tain and even enhance the result they get after the in-office treatment. For
best results, a “white diet” (no coffee, tea, red wine, berries) is recom-
mended during the time you are doing these post care touch-ups.
This method takes the shortest amount of time, but is the most costly.
Tooth sensitivity is a risk but it is temporary.
2
This method of tooth whitening has the most research proving its effec-
Professional tiveness time and time again.
take-home
Custom trays are fabricated at our clinic to fit the shape of your teeth
kit:
perfectly, maximizing contact with the gel to your teeth and minimizing the
risk it will touch your gums. These trays plus a supply of peroxide gel is
given to you to take home. There are a variety of concentrations available
and one will be recommended based on your needs. These trays are worn
for a period of time each day. The kit lasts 2-3 weeks and your teeth
become notably whiter over this time.
This method is less costly than the in-office bleaching, but takes several
weeks to produce the desired outcome. The effectiveness of this method
depends on your ability to comply with wearing the trays as directed. For
best results, a “white diet” (no coffee, tea, red wine, berries) is recom-
mended during this time. Patients can also experience some sensitivity
during the whitening period.
Everything you need to know about whitening your teeth 04
3 Over the
counter
whitening: eg. Crest white strips, Aquafresh white trays etc.
These kits are the least effective and least predictable in terms of whiten-
ing outcome. They have a higher risk of tooth sensitivity and gingival irrita-
tion when compared to professional methods. They are increasing in price
and some are even comparable to professional take home kits now. For
these reasons this method is not recommended.
How long do results last?
Teeth whitening procedures can be expected to last up to 2 years depending on lifestyle habits like
diet and oral hygiene. Maintenance schedules for each individual are customized to prolong the
whitening effect.
We hope this has helped to answer any questions you may have regarding tooth whitening!
Should you have any other questions, please feel free to contact us or request an appointment for
a consultation.
Dr. Jennifer Graas
Sources:
Tran, A. (2019) “Transforming teeth whitening in your practice”. Spectrum Dental Teamwork vol 12 No 2 p. 42-49.
Ajaj, R.A. Chiappelli, F, Phi, L. Giroux, A. Maida, C., Garrett, N., Polinovsky, O., (2012). “Evidence based assessment of the efficacy and
effectiveness of light/laser activation in in-office bleaching.”
The Kois Center Informed Consent Document Tooth Whitening
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