STORY BYIf first impressions are everything, then today’s smile had better be blinding. With celebrities sporting whiter-than-white smiles, it's no wonder that so many of us believe that brighter is better.
"The esthetics of ‘white beyond nature’ is in the eye of the beholder. With regard to safety, tooth whitening, if properly administered, does not include any huge safety concern,” says Rade D. Paravina, DDS, PhD, assistant professor in the Department of Restorative Dentistry and Biomaterials at The University of Texas Dental Branch at Houston.
According to a survey done by the American Academy of Cosmetic Dentistry, 99.7 percent of people surveyed believe that whitening is important to their social lives. Seventy-five percent even believe that a smile can affect your professional success. “Regardless of what it means to people, it is one of the least invasive procedures in esthetic dentistry. No one is cutting any holes or bonding,” Paravina says.
A.K.A., ZOOM, LASER Bleaching: One or more sessions in the dental office where your dentist will apply the bleach to your teeth. Usually the fastest way to a bright smile. Sometimes accompanied by a light that is used to speed up the process. Major stain lifting. Average price: $200 to $500 per arch, or $500 to $1,000 for the wholemouth.
Customized, wax-like trays that are created to match the shape of your teeth, protecting your gum line from bleaching irritants. Typically provides same results as power bleaching, over time. Now being offered in numerous brands, some of which offer a variety of flavors. You apply the bleaching gel to your trays and wear them as directed by your dentist. Major stain lifting. Average price: $175 to $400.
Naturally more abrasive than regular toothpastes. Used to maintain your white smile and lift mild surface staining. Some brands offer peroxide or additional chemicals for minor stain lifting in the pastes. Average price: less than $5.
Clear, peroxide-based gels applied with a small brush directly to the surface of your teeth. Instructions generally call for applications twice daily. Average price: $15.
Thin, virtually invisible strips that are coated with peroxide-based whitening gel. These are of the most common choice for OTC bleaching products. Whitening strips generally require 1-2 weeks for results. Average price: $10 to $55.
Much like the whitening trays you get from your dentist, you apply gel to the trays and wear them. However, the main difference is the lower intensity bleaching solution in the OTC product. Average price: $10 to $55.
For Rachel Jordan, 31, it meant enough to try over-the-counter (OTC) products, no matter how ridiculous some seemed. “I’ve tried the strips. I’ve tried a brush-on whitener. I sadly have also tried the light infused trays, as seen on TV,” says Jordan. “I wanted to get my teeth whiter.”
With the rocketing popularity of whiteners, the dental industry has had to come up with new products, new methods and even a new tooth shade guide, developed by Paravina to assist dentists in more accurate color matching.
“This is very welcomed since we keep getting lighter and brighter. We can monitor tooth whitening more accurately and increase the quality for the patients,” Paravina explains. The current gold standard for shade guides was created in 1956 and does not reflect the new bleached tooth colors, says Paravina.
Patients have two basic options: professional whitening or over-the-counter. “Regardless of whether you’re bleaching your teeth at home or going to the dentist’s office, everyone should have a professional dental exam prior to bleaching to determine the cause of staining and to rule out decay, dying teeth or other oral health issues,” says Joe C. Ontiveros, DDS, MS, director of Esthetic Dentistry at the UT Dental Branch.
If you are a candidate for bleaching, your dentist may suggest in-office bleaching. Sometimes this procedure is referred to as “laser, zoom, or power” bleaching. It can involve one or more 30-minute, in-office bleaching sessions, depending on the product being used. Though slightly costlier than other products, it is more time efficient. The results can last up to one year, and in some cases longer.
Any one of several different bleaching solutions can be sent home with a patient. Your dentist can design customized “trays” (a clear apparatus that fits over your teeth and holds the bleaching solution in place) and instruct you on how to apply the bleaching gel at home.
These professional trays, in comparison to OTC products, generally have a higher concentration of bleaching agent, which is why it is important to follow the recommendations of your dentist.
“I preferred to whiten on my own time with a customized tray from my dentist,” says Heather Robertson, 31. “From a consumer standpoint, I felt the professional option was best. I rotate between three types of toothpastes to maintain my color,” says Robertson. “I use a regular paste, a whitening one and one for sensitivity.”
Ontiveros says both in-office power bleaching and professional take-home trays will have the same effect on your teeth, as long as the instructions are followed.
Thousands of over-the-counter (OTC) bleaching products, ranging from whitening strips to toothpastes, dazzle and often confuse consumers.
“Whitening strips are probably the most common type of OTC product used, however, those with sensitive gum lines should be careful since they are not tailor-made to cover only your teeth. Some of the bleaching gel can rub onto your gums,” says Ontiveros, causing painful but temporary sensitivity to the gum line.
“The whitening made my teeth very sensitive just after a few days, particularly along the gum line. I did them myself,” says Phyllis Alexander, 48.
For some patients who only need minimal whitening or brightening, the OTC whitening products may be ideal. Though less expensive, the effect may not last as long as a professional treatment. Some drugstore products do last six months or more, however.
A common misconception is that bleaching products and teeth whitening treatments will give you that sheet-of-paper-white smile. Often, those over-the-top white smiles are not the result of teeth bleaching alone. Veneers, bonding or crowns may have created that smile.
“Every person has a different rate at which their teeth will bleach, and once their teeth reach the maximum bleach potential, they cannot get any whiter,” says Magda Eldiwany, DDS, MS, clinical associate professor in the Department of Restorative Dentistry and Biomaterials.
Due to the sensitivity that bleaching your teeth may cause, many consumers quit the process before achieving their whitest endpoint. “I had painful sensitivity to my gums during the 30 minutes I was using the strips and my teeth would also be sore for the rest of the day,” says Jordan. “I always had to recover from the first session for at least a day. My teeth would be a little bit whiter each time, but the pain kind of made it not worth my time.”
Teeth bleachers should expect to experience some degree of sensitivity, which is caused by the passing of the peroxide through the enamel, dentin and to the pulp. Its extent depends on the patient’s inherent sensitivity and pain threshold. Sensitivity usually occurs in the first few days but could happen at any time during the bleaching process.
There are many ways to reduce sensitivity. These include lower concentration of the bleaching agent, reducing the wear time, alternating days and using products containing fluoride, potassium nitrate and amorphous calcium phosphate (ACP).
“Patients should also be advised that only the natural teeth will bleach,” says Eldiwany. “If they have porcelain crowns or composite fillings, they will not change color.”
Eldiwany also stresses the importance of a dental exam before bleaching to reveal any decay, oral pathology (underlying conditions) or existing restorations.
Also, bleaching is recommended prior to any dental work done, such as crowns or fillings on the front teeth.
Patients with existing porcelain veneers should be aware that any portion of the tooth not covered by the veneer is susceptible to staining. “This could occur most often at the margin near the gum line, where the porcelain interfaces with the actual tooth in the front,” Ontiveros explains. “In this case your dentist may attempt to apply a strong in-office bleaching agent to the exposed portion of the tooth for about an hour until it matches the original color.”
Severely stained teeth should be bleached before restoring them with porcelain veneers if possible, Ontiveros says.
Even with veneers, the natural discoloration over time of the real tooth behind the veneer can change the hue of your teeth because the veneer is usually translucent. “It is possible to influence the color of a thin veneer by bleaching the back side of the tooth,” Ontiveros says, “but in the case where (thicker) veneers were made to hide dark teeth, any color change of the natural teeth will not be seen through the veneer since the porcelain is opaque.”
Children shouldn’t whiten their teeth because the nerve chamber of the tooth is enlarged at this age and may cause strong sensitivity. Teeth bleaching is not recommended for pregnant or lactating women or anyone with allergies to bleaching products, such as peroxide. Anyone with fillings, crowns or restorations is advised to proceed with caution when whitening, as only the natural teeth will respond to bleaching products. If your restorations are whiter than your natural teeth, bleaching your natural teeth may actually help your restorations match better.]
Blue-gray staining caused by tetracycline is more difficult to lighten and may require several attempts to successfully lighten. Always check with your dentist before you purchase OTC whiteners.
Last Updated: 1-09-2008 Editorial Board | Legal Disclaimer | Privacy & Security | Contact Us
©2000-2006 Office of Institutional Advancement, UT-Houston
Dr. Rade D. Paravina is an assistant professor in the Department of Restorative Dentistry and Biomaterials at the UT Dental Branch.
Dr. Joe Ontiveros is director of esthetic dentistry at the UT Dental Branch.
See Dr. Ontiveros also at:
Microwaves and 'Erupted Hot Water Phenomena'
Hot-water eruption can occur if you use a microwave oven to super-heat water in a clean cup. ("Super-heated" means the water is hot beyond boiling temperature, although it shows no signs of boiling.)
A slight disturbance or movement may cause the water to violently explode out of the cup. There have been reports of serious skin burns or scalding injuries around people's hands and faces as a result of this phenomenon.
Adding materials such as instant coffee or sugar to the water before heating greatly reduces the risk of hot-water eruption. Also, follow the precautions and recommendations found in microwave oven instruction manuals; specifically the heating time.
