Treatments Tooth Whitening

Dental Bleaching or Teeth Whitening is a common procedure in the field of Cosmetic Dentistry. A childs milk teeth are generally whiter than the adult teeth that follow. As a person ages, the adult teeth often become darker due to changes in the mineral structure of the tooth, as the enamel becomes less porous. Teeth can also become stained by bacterial pigments, foodstuffs and tobacco. Certain antibiotic medications like tetracycline can also cause teeth stains or a reduction in the brilliance of the enamel. However, most teeth can be whitened with professional whitening treatments. If you are self-conscious about the color of your teeth, tooth whitening is a great option for you to consider. Teeth Whitening can brighten your Smile

In-office whitening is one of the quickest and safest ways to whiten the teeth. The process typically involved placement of a tooth whitening agent over the tooth surface by the dentist. Depending on the whitening method, a laser or special light can be used to speed up the Bleaching process. In-office whitening can give you dazzlingly white teeth in less than an hour.

Take home whitening involves use of custom made trays loaded with whitening agent that is used for a specified number of days at home. Tray whitening is a popular and very successful method of whitening and brightening your teeth at home

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There are a number of different ways to whiten teeth. There are two main choices. One is professional Bleaching which requires visiting a dentist and the second is over the counter whitening i.e. buying it from a retail store or through the internet.

Chair-side Bleaching, which involves getting your teeth bleached in several visits or instantly in a single dental visit to a much publicized whitening center like Zoom and Zoom 2 etc.

  • From moulds of your teeth a custom-made Bleaching trays is fabricated by a dental lab, which you use at home with a Bleaching agent.
  • A boil and bite tray is made by you in minutes and used with Bleaching gel

Tray-less Whitening using Crest Whitening Strips or a paint on gel like Colgate Simply White (Rarely available in India) Chair-side Bleaching can be done in two ways. The dentist uses a very strong Bleaching agent alone or in combination with a light/laser. With both, the dentist cleans your teeth with a sandy, pumice-like material to remove plaque and cleans the surface of the tooth. Then a Peroxide-based gel is applied after which a light may be applied to assist the whitening process. Most gels are self-activating and others are activated by the use of a light. The laser does NOT whiten teeth. It merely activates the Bleaching gel and initiates the chemical reaction that produces the whitening effect (the laser does not actually penetrate the teeth). The procedure takes about an hour and a half and offers immediate results, although it may take more than one session to achieve the desired level of Bleaching.

  • Colgate Platinum
  • Colgate Visible White
  • Opalescence
  • D-Tech
  • Pola
  • Zoom
  • Brite Smile
  • Nite Brite
  • Opalescence Extra Boost
  • Rembrandt Sapphire System
  • LumaArch
  • Lasersmile

The at-home Bleaching tray methods require a fitted mouth tray (Bleaching tray) to hold the Bleaching gel against the tooth either overnight or hourly depending on the strength of the bleach dispensed. In the past, this Bleaching tray was fabricated only by a dentist. Today, these custom trays can also be ordered via the internet. We recommend that you visit your dentist before whitening to make sure that you don not have any cavities or any other limitations that would compromise your tooth whitening results. There is also tray-less over-the-counter options available for tooth whitening. These are the Crest Tooth Whitening Strips, Colgate Simply White, Brite Smile whitening pen etc. Crest whitening strips maybe a better option for those who don't want to wear a tray. These strips are more difficult to keep in place especially on the lower teeth while the paint on whitening needs be kept dry to adhere and prevent wash-out. No matter which method you choose, how white your teeth will get depends on what color they are to begin with and the source of the discoloration. Brown or yellow teeth (often the result of superficial staining caused by smoking, coffee, and tea) will usually get whiter. Gray teeth (caused not by stains but by pigment deep inside the tooth) will lighten less, sometimes not at all. Results cannot be guaranteed. To determine the initial color of your teeth, compare them to a sheet of bright white computer paper held up to your mouth. Chairside Bleaching is the fastest and usually requires more than one session for maximum results. Take-home Bleaching kits can be used with your own schedule. The most common side effect of any of these procedures is sensitivity to hot and cold, but that lasts only while you are using the bleach and tends to persist for 1-2 days afterwards. If there is little chance that you will remember to pop in a mouth tray every night, or if you are impatient to see results, chair side Bleaching may be a better option for you. This method also allows the dentist to treat teeth individually, which is ideal if you have veneers or teeth that vary in shade. With proper aftercare, whitened teeth can stay bright for a few years.

Nothing detrimental has been documented and Microscopic Research shows no changes to the tooth surface with use of 10% Bleaching solution. Most research available was initially done with a 10% concentration. There is no literature that shows any structural changes or irreversible damage to the tooth structure whatsoever.

All Bleaching gels cause some degree of tooth sensitivity. This is sensitivity to cold/hot fluids and even air can cause discomfort. This is normal and an expected side effect. Desensitizing gels or toothpaste like Sensodyne or any of the over the counter toothpastes containing potassium nitrate as the active ingredient can be used to alleviate post Bleaching sensitivity. Bleaching process causes tooth sensitivity and we recommend you to either discontinue use for a few days and the sensitivity will dissipate within 24-48 hrs. Don't be concerned as Bleaching does not need to be done consecutively. You will get to the same whitening point; it will just take a little longer.

Desensitizing gels or toothpaste like Sensodyne or any of the over the counter toothpastes containing potassium nitrate as the active ingredient can be used to alleviate post Bleaching sensitivity.

Results vary. Some teeth whiten dramatically in just a few days, while others can take a few months. The majority of people whiten within 2-3 weeks. The more yellow versus gray color you have in your teeth, the better the Bleaching. Grey enamel similar to that of Tetracycline (antibiotic) staining is more difficult to bleach and can take a few months to achieve a result.

Generally, immediately after Bleaching, the color will fade slightly and then remain stable for approx. 3 - 4 years, sometimes longer. It is recommended for maintenance to touch up your smile every 6 months with 1-2 applications.

No research has been done into Bleaching teeth while nursing or pregnant, so manufacturers for liability reasons recommend NOT Bleaching while pregnant or nursing.

All Bleaching agents used to whiten teeth will only work on natural tooth structure. This means that all dental work including but not limited to bonding, veneers, crowns (caps) and bridges will NOT bleach or whiten. All dental work would need to be replaced to match the newly whitened teeth.

There is no objective research at the present time comparing the different tooth whitening systems or the effectiveness of various Bleaching gels currently available. They all work, some Bleaching gels just gets you there quicker. They will all eventually get you to the same Bleaching plateau (maximum whitening). Results vary, some teeth whiten very well as others show minimal changes no matter what product is used. We recommend to stay with a brand or strength that has worked for you and to maybe try another brand or strength if you are unhappy with your current Bleaching results. Ultimately the choice of bleach agent is really a personal one.

Generally the shelf life of most Bleaching gel is approx. 2 yrs if refrigerated and 1 yr un-refrigerated. Un-refrigerated bleach should be stored in a dry cool environment. The wearing time is based on the strength of Bleaching gel.

10% -16% can be used for minutes to overnight if no sensitivity
20- 22% - 1 hr / application

The percentages (%'s) prefer to the concentration of Bleaching agent. It is generally accepted that the higher the % of Bleaching agent, the stronger the bleach and the more effective it is at Bleaching. There is however, no objective research to substantiate it. One of the main advantages of the higher % is reduced wearing time. 10 - 16% can be worn for a few hours to overnight, where as a 20-22% bleach should only be used for 1 hour per application.

The active ingredient is the same with most Bleaching brands. Some gels have a slightly different active ingredient, which works a little more rapidly, but in the same manner. Some feel that these products cause more tooth sensitivity. Please keep in mind that some teeth are more difficult to bleach than others no matter what Bleaching agent you use. The older you are and the grayer your teeth are, the more difficult it is to bleach. Some teeth that will achieve only minor whitening improvement no matter what product you use.

As brands of syringes vary in the amount of Bleaching gel, it is easier to quantify by using the ml's or cc's (same thing) and NOT the number of syringes. It is generally accepted that each treatment requires approx 0.5 ml's (cc's) of Bleaching gel per application. The average person with yellow teeth will therefore needs about 10-15ml's (cc's). Keep in mind that you may need to do touch-up at a later date to maintain the whitening. Grayish colored teeth are more difficult to whiten and will require additional Bleaching gel. Keep in mind that only a small droplet needs to be placed on the inside surface of the outer wall of your custom made whitening tray opposite each of the front 8 teeth. It is not necessary to whiten the teeth towards the back of your mouth as these teeth are not usually visible when you smile.

There are 2 main Bleaching ingredients - Carbamide Peroxide and Hydrogen Peroxide. Comparatively, a 7.5% Hydrogen Peroxide is equivalent to 16% Carbamide Peroxide while a 9.5% Hydrogen Peroxide is equivalent to 26% Carbamide Peroxide. Carbamide Peroxide is mostly for Night Whitening whilst Hydrogen Peroxide is for Night Whitening. Carbamide Peroxide actually breaks down into Hydrogen Peroxide. Patients must wear the gel with Carbamide Peroxide for a longer period of time so that the Carbamide can break down in to Hydrogen Peroxide, the active ingredient. The only real difference for you is the wearing time. With the demand for a more effective Bleaching agent, the 16% and 22% were launched. The 16% can also be used overnight while the 22% is used for 1 hour only. Both Day & Night Whitening will take you to the same Bleaching end point. Theoretically it would appear then that Day Whitening would be more effective but there is no research to substantiate this.

It is recommended to avoid such during whitening and for 1 week after tooth Bleaching. We recommend you not changing your lifestyle. If you feel that your teeth have yellowed over time, it is okay to do touch-up Bleaching 1-2 applications every 6 months as needed.

No�Results vary. Some teeth whiten dramatically in just a few days, while others may take weeks to months to show a difference, if any. The more yellow versus gray color you have in your teeth, the better the Bleaching result. Grey enamel similar to that of Tetracycline (antibiotic) staining is more difficult to bleach. Some normal teeth will achieve only minor whitening improvement no matter what product you use. Results cannot be guaranteed.

Make sure that the bleach covers the entire surface of the tooth and not just the bottom half. The average tooth will usually have a seamless whitening transition from whiter at the bottom of the tooth (biting surface) to less white towards the gum line. This is normal and an expected result. This is due to thinner enamel in this area allowing more show through of the tooth color. Very few cases have total uniform whiteness. With grayish teeth, the transition is occasionally somewhat more noticeable. One might see a demarcation area / line between the 2 areas. Keep in mind that whitening fades and the tooth will in most instances gradually blend. In some cases that are extremely resistant to Bleaching, one might consider bonding or veneers as an alternative treatment.

It is also normal that certain areas of the tooth such as areas of decalcification will respond more rapidly to Bleaching resulting in blotchiness at first while the rest of the tooth catches up as one continues to bleach. The blotchiness is the first to fade after stopping resulting in a more uniform appearance.

The choice when to stop Bleaching is really a personal one. Stop when you are pleased with the results. Teeth will gradually get whiter and within either a few days or 2 weeks in most cases reach a plateau where they will not get any whiter. This is the maximum amount of whitening you will reach and at that point do not bleach any further. It is normal for it to fade slightly and then stabilize after you have discontinued. We do not recommend Bleaching beyond 2-4 weeks. Most teeth whiten well within the first week of use.

Tetracycline is difficult to whiten. Results vary and results, if any are not guaranteed. If you have bleached your teeth with another Bleaching agent, the results will most likely not show much improvement with another brand. Bleaching tetracycline teeth can sometimes cause uneven whitening, horizontal tetracycline lines to become more prominent and even blotchiness. Some cases lighten evenly and customers are pleased with the results. Accepting any Bleaching product for use, is accepting all the possible risks that could arise from tooth bleaching products. With tetracycline staining you may want to consult with a dental professional for your whitening needs. Tetracycline stained teeth may need to be bleached for a few months to show results.

It is acceptable to continue Bleaching up to 6 weeks for normal teeth. Some literature suggest than one can even safely whiten for up to 6 months for those who have tetracycline-stained teeth. We feel that an 8 week regime should suffice. If you feel you reach whitening plateau and your teeth do not get any whiter that would be a safe termination point.

White spots commonly come from too much fluoride during tooth development. This condition is known as Fluorosis. Although it might look imperfect, these teeth are extremely resistant to cavities. White spots can also occur after orthodontic treatment in the area of the orthodontic brackets. This is decalcification as a result of inadequate hygiene and in these situations; these areas are more susceptible to cavities. There has been no research conducted on Bleaching and kids. There have been a few cases reported in the literature with no adverse effects besides temporary tooth sensitivity. We recommend to wait until all the teeth have FULLY erupted otherwise the un-erupted tooth portion will not be bleached. White spots will initially get whiter quicker, but becomes less prominent as the surrounding tooth structure bleaches and becomes whiter. The white spots will usually return to their normal whitish color but will be less conspicuous as the background is now whiter. Results vary and one cannot guarantee a result.

All you need to do is place a continuous line of bleach half way up on the inner side of outer wall of the whitening tray so that it forms a rope line of Bleaching gel which will not run or slump. When you place the tray over the teeth, the teeth will displace the gel to cover the tooth surface (i.e. the teeth will spread the bleach). You can see where the bleach covers the tooth and if it appears deficient in an area, you can merely touch the tray gently on the outside to move the bleach around. The gel consistency should be thick and viscous. By creating the gel with increased viscosity allows better retention of the bleach against the tooth surface and therefore more effective even whitening. If you are refrigerating the product, allow it to sit for a few hours before using it to allow it to be more flowable.

Withdraw the plunger slightly after use to decrease the hydraulic pressure within the syringe. This will prevent it from oozing out.

Either your trays are covering the gum area or you overfilled the trays. All you need is either to place a small droplet in each tooth or a bleach line midway across the inner outer wall of the tray. The gums will return to normal in a few hrs i.e. the whiteness will disappear. Avoid any further Bleaching until healed. Avoid hot and spicy foods till then. Next time, use for 15 minutes and then increase the time on subsequent Bleaching periods.

It's not normal to have sensitive teeth and it can be diagnosed and treated appropriately. We always recommend a second opinion when it comes to ones health. We do not usually make recommendations as we cannot be responsible for returns but here are a few suggestions to help you make an informed decision. As far as tooth sensitivity goes, one can treat it symptomatically with any toothpaste containing Potassium Nitrate. Keep in mind that these toothpastes are recommended to be used for a few weeks. The recent launch of the remineralization toothpastes not only address tooth sensitivity, but have also shown to remineralize the toothpaste thereby helping to reverse small cavities. I would recommend the Vantej toothpaste as a choice for this.

Bleaching gels approx. have a pH of 6.5.

From flavor to flavor and depending on the filling process, Bleaching gel syringes can be found with no bubbles or with many small bubbles. Many of the pictures in our literature and catalog show the product with many small bubbles. These bubbles do not result from Peroxide decomposition in the syringe; they are simply inherent in a thick formulation such as this.

The dark purple coloration that may appear in the tray following Bleaching adjacent to older silver fillings / amalgams is normal and has proven inconsequential, based on years of clinical use. No adverse/detrimental effect on the amalgam restorations has been experienced. It has been theorized that the zinc in old amalgams may be the cause of the discoloration.

Whitening is a modification of the anatomy relative to the oxidation process, which eliminates the dark, disfiguring intra-dental organic dyes and stains by breaking down the conjugated double bonds of the color (selective light) absorbing offending molecules. Conjugated double bonds occur in many different molecular configured color-absorbing molecules. They are part of said molecule, which is ... C-C=C-C=C-C= ... etc. Bleaching oxidizes the internal tooth-disfiguring color molecules, changing them to alcohols, ketones and terminal carboxylic acids, etc., which eliminates the light-absorbing properties of the conjugated bonds. These are not cells or the constituents of cells; they are unwanted dye molecules within the noncellular matrix, namely dentin and enamel.

There are a few reasons for this occurrence. The simplest is that the enamel is thinner at the gingival third, so the dentin shows through more easily. The dentin can take longer to bleach than the enamel of the incisal third. The gingival third may not have caught up with the rest of the tooth yet.

Normally 7-10 days are required as a waiting period before you can actually bond or fill on to the tooth.

There is very little published on the whitening of primary dentition. Clinical experience has shown that even young people's teeth will bleach with no surprising side effects. We do recommend that in order to ensure an even level of whitening, all of the permanent dentition should have fully erupted. If the child bleaches before this has occurred, the teeth that erupt proceeding bleaching will be a darker shade than those that have previously been bleached. Another important consideration is whether the child should be capable of following the doctor's recommendations and instructions.

As per the Bleaching gels instructions, it is important to have all exposed dentin properly sealed due to possible sensitivity occurring during the whitening process. Hence, it would be recommended to leave the existing composite restoration intact during the whitening procedure. Another consideration for leaving the restoration intact is due to the fact that there is no way of predicting what shade a person's teeth will be after whitening. For this reason, it is better to replace restorations after the whitening procedure to ensure that the proper shade of composite is used. However, it is important to wait two weeks after whitening before a restoration is replaced in order to give time for the shade of the whitened teeth to stabilize. This will also allow the Peroxide to diffuse out of the teeth, which will give better bonds.

There are several reasons for a non-vital tooth to turn dark. One of the reasons is intra-coronal bleeding. Blood gets trapped in the dentinal tubules and the haemosiderin of the blood blackens.

Studies show that the Peroxide will not add to the carcinoma phenomena.

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