Everyone loves a bright smile and most people are satisfied with the sparkle they get from regular cleanings at the dentist and daily oral hygiene. However for those who want to have a smile that looks brighter, there are a variety of products and procedures available to help improve the appearance of their teeth. Some of them, like teeth whitening, are fairly inexpensive as well.

“Teeth whitening” is a very common procedure in dentistry today.  This procedure is used to lighten tooth color which has become darker due to many reasons (change in the mineral structure of the tooth, pigmentation from bacteria, foods, tobacco, medications, age, etc). Whitening material will not correct all types of discoloration and/or stains. For example, teeth with brownish or grayish undertone do not bleach as well as teeth with yellowish undertone. In addition, bonding and tooth-colored fillings in the teeth will not be affected by the whitening material and could stand out in the newly whitened smile.

Although used interchangeably by most people, there is a difference between whitening and bleaching. According to the FDA, whitening restores the natural tooth color while bleaching whitens beyond the natural color. The whitening agent used is either carbamide peroxide, which breaks down in the mouth to form hydrogen peroxide, or hydrogen peroxide itself (1% carbamide peroxide equals 0.361% Hydrogen peroxide). The whitening gel typically used and dispensed by dentists contains between 10% and 44% carbamide peroxide, which is roughly equivalent to a 3% to 16% hydrogen peroxide concentration.

There are many approved methods to whiten teeth:

– in-office whitening or bleaching, which is applied or supervised by a dentist, which generally use a  light-initiated whitening material applied on the teeth, while a different material is used to protected the gum against burn. A different method uses only a high-concentration whitening material without the light.

– at-home whitening or bleaching, which is to be used at home by the patient using custom fitted whitening trays fabricated by a dentist or dental professional; This high-concentration bleaching material is usually carbamide peroxide. Whitening is performed by carrying the whitening material to the teeth within thin plastic trays for a certain period of time, which produces quick results. The application trays ideally should be well-fitted to retain the whitening gel, ensuring even and full tooth exposure to the gel. Trays will typically stay on the teeth for about 30 minutes to one hour. Trays are then removed and the procedure is repeated in subsequent days.

-over-the-counter:  Whitening products intended for home use include whitening pens, gels, chewing gums, rinses, toothpaste. The ADA has published a list of accepted over-the-counter whitening products to help people choose appropriate whitening products. This low-concentration whitening is far less effective and results vary, depending on the method of application chosen, with some people achieving whiter teeth in a few days, and others seeing very little results or no results at all.

It is recommended that patients have teeth checked by a dentist before undergoing any whitening method.  The patient should be examined thoroughly: health and dental history, including allergies and sensitivities should be recorded; teeth and gums health, as well as conditions of existing fillings should be noted. Radiographs may be needed to determine depth of possible decays. Whitening is not recommended if teeth have decay or infected gums.

A typical course of bleaching can produce dramatic improvements in the cosmetic appearance of most teeth; however, some internal stains such as Tetracycline stains respond poorly to bleaching and may require prolonged treatment, as it takes longer for the bleach to reach the dentin layer. White-spot decalcifications may also be highlighted and become more noticeable directly following a whitening process, but usually become less noticeable, with the other parts of the teeth becoming more white with further applications.

There are, however some side effects associated with teeth whitening. Here is a list including some of the most common ones:

-Chemical burns when a high-concentration whitening gel contacts unprotected gum tissues, which may bleach or/and change color

-Risk of increased temperature (hot/cold) sensitivity.

-Pain, which may vary from discomfort to room temperature liquids to pain caused by open dentinal tubules.

-Overbleaching also known as “bleached effect”, particularly with the intensive treatments from products that provide a large change in tooth color over a very short treatment period, e.g., 1 hour

-Risk of bleachorexia which is an unhealthy obsession with whitening one’s teeth

Treatment times and recommendations are dependent on the condition of a person’s teeth at time of treatment.

Talk to your dental care professional to see if you are a candidate for teeth whitening or bleaching.