Teeth bleaching is the most inexpensive way to cosmetically improve one’s smile. There are two methods of bleaching — in-office or at-home. The in-office bleaching is quicker, only needing a couple of one-hour appointments, however, the final result is not as good nor the satisfaction percentage, it can cause sensitivity, and it still needs to be refreshed or supplemented at home. The at-home bleaching method is much kinder and gentler. It can take from six weeks, however, the satisfaction rate is twice as high as the in-office procedure. And the tray is available to refresh the bleaching job after a few months to keep those pearly whites continue to sparkle.
At Gangwisch Dental Group, we recommend teeth bleaching with the at-home method. With that technique, we make molds of your teeth and make a custom tray that is made just for you. You will place a small amount of bleaching gel in an extremely thin, clear mouthpiece called a tray. This is placed on your teeth at bedtime and is worn while you sleep. The gel that we use is slightly sticky so it gently clings to the teeth while you doze. The active ingredient is carbamide peroxide which breaks down into hydrogen peroxide once it comes in contact with saliva. The hydrogen peroxide will break down further into harmless water and oxygen. It is the oxygen that will essentially oxidize the stains in your teeth and this lightens them considerably. Since the concentrations in the at-home method are significantly smaller than the in-office way, the incidence of tooth sensitivity is much less. It does take a number of weeks, but once you get to your ideal brightness, it will usually stay relatively stable for a number of months. The usual rule of thumb is to refresh the bleach for two or three nights after each teeth cleaning, which happens (or should happen) every six months.
We do offer the in-office teeth bleaching for those patients who need their teeth whitened fast, such as for an upcoming wedding. At Gangwisch Dental Group, we do not try to put on a fake show with a fancy light. Studies have shown that it’s the hydrogen peroxide that does the teeth bleaching, not the hot light. The heat will greatly raise the amount and intensity of teeth sensitivity. We apply a light-cured paint on a rubber dam to protect your gums. Them we let the bleaching liquid soak into the tooth enamel for three – fifteen minute intervals. We then apply a desensitizer to help minimize any discomfort.
Teeth bleaching can be very rewarding in that it will increase your confidence to smile widely and to show off those pearly whites.
In my last blog, I discussed in-office bleaching. The other method for lightening teeth is done at home. There are over the counter products and ones that are professionally available at your dentist’s office. The over the counter products seem to work OK for teenagers and young adults, however, with older adults, the professional variety works much better. My speculation is that the stains have been there much longer and are more resistant to the bleaching process.
In our office, we make a custom tray, essentially an ultra-thin, clear mouthpiece to hold the bleach in the mouth. The bleach that we use is slightly viscous and sticky so it doesn’t run all over the mouth during use. I instruct my patients to sleep with the mouthpiece in all night. The process can take anywhere from 2-6 weeks, but the bleaching solution is not near as harsh as the in-office variety and is much kinder and gentler. This greatly reduces the incidence of sensitivity. Studies have shown that after six months, the results between in-office and at-home bleaching is exactly the same. And other studies have shown that patient satisfaction hovers around 96% positive for at home and less than 50% for in-office.
There are two main methods for bleaching teeth: in office or at-home. In an office setting, a rubber-like substance is painted on the gums and then light cured. An extremely strong solution of hydrogen peroxide, usually 35%, is applied to the front teeth surfaces. The solution is left on the teeth for long enough to leach into the enamel and oxidizing the stains. This usually takes about 15 minutes. Some dentists employ the use of lights to accelerate the process. The lights can cause overheating of the dental pulp which contains the nerve and can greatly increase the sensitivity to temperatures. Studies have shown that the use of lights or “lasers” makes no difference in the final results. If there is an increased lightening right after the appointment with the use of lights, it has been shown that that is due to dehydration of the tooth surface and the color will return once the teeth have rehydrated. There are some desensitizing that the dentist can apply afterwards. These contain potassium nitrate. There are also toothpastes that are specially made for sensitive teeth that can help make an in-office bleaching procedure much easier to tolerate.
When bleaching one’s teeth, it must be kept in mind that the bleaching process will not effect the color of dental restorations such as tooth-colored fillings, bonding, or porcelain laminate veneers or crowns. It will not harm porcelain, but scanning electron microscope studies have shown some some minor pitting in composite (tooth-colored) restorations. Hypocalcified and fluorosed areas have stark white splotches. When initially bleaching the teeth, these areas tend to stand out dramatically, however, as time goes on, the surrounding tooth structure will begin to lighten, thus allowing the hypocalcification to blend in better. Teeth bleaching will not remove these splotchy areas, just make them less noticeable. Many people have grey stains in their teeth. These stains can be very resistant to the bleaching process. The products that cause the grey color do not appear to oxidize as well. On the other hand, yellow stains are very amenable to bleaching and will lighten very well. The nice thing about the grey stain is that it is not as noticeable from a conversational distance as the yellow, so the teeth can still have a light, appealing appearance even with some residual grey.
Before bleaching one’s teeth, they should have a thorough dental examination by their dentist. One would not want to place bleach over cavities. The bleaching process many times will cause the teeth to be sensitive, so placing bleach into a cavity could increase the sensitivity. Bleaching is also not recommended for children under 16 because their pulp chamber in the center of the teeth where the nerves reside are very large which could make for extremely sensitive teeth. The peroxide ion has been shown to give off oxygen free radicals which have been shown to cause tissue damage. That is something I would not want to take a chance with in a growing child. Other issues include the possibility of gum irritation. The bleaching solutions, especially at the higher concentrations, can be somewhat caustic, and can injure the gums. Most of the time, it is just a temporary reddening and discomfort. This can be reduced by cutting the bleaching time or by switching to a weaker concentration of the bleaching solution. Both sensitivity and gum irritation tend to go away when the bleaching is stopped.
Vital teeth bleaching is performed by placing a peroxide based solution on the tooth surface. Even though tooth enamel is extremely hard, it is somewhat porous which allows the bleaching solution to leach into the tooth. The solution can be either hydrogen peroxide or carbamide peroxide. Carbamide peroxide will turn into hydrogen peroxide when it comes in contact with water. Once the peroxide ion has permeated into the body of the enamel and dentin, it will oxidize the stains that are residing inside the tooth structure thus, effectively lightening the tooth color. Studies have not shown any harm done to the enamel. The peroxide ion has been shown to give of oxygen free radicals which has been implicated as being possibly carcinogenic. No study has shown this to be a problem with short term use of the solutions. However, I personally feel that one should use caution when selecting a “whitening” toothpaste to make certain that they do not contain peroxides. Since toothpastes are used daily for not only years, but decades, I don’t think that it is a good idea to find out after the fact that there was some harm being done.
Bleaching of vital teeth has been a great thing for cosmetic dentistry. Teeth can be lightened considerably with out having to do any invasive drilling or bonding of tooth-colored materials onto the teeth. The cost is significantly cheaper than all other cosmetic dental procedures. Discolorations in teeth can come from many sources. Intrinsic stains (ones that are actually incorporated into the tooth structure itself), include antibiotics (especially tetracycline), fluorosis, and enamel hyperplasia. Aging will also naturally yellow the teeth. Foods such as tea, coffee, red wine, and colas and tobacco products will also discolor teeth. Extrinsic stains, stains that reside on the surface of the teeth, are caused by bacterial plaque accumulations soaking up pigmented food and drink. Extrinsic stains can be removed by a professional cleaning or by using a “whitening” toothpaste that has extra abrasives in it. Since intrinsic stains reside within the tooth enamel, they must be removed by chemicals that have the ability to soak into the tooth structure itself.
Teeth bleaching has become a very popular way of lightening one’s teeth. It is a great technique that can be done minimally invasive and for low cost. As with any dental procedure, it does come with some minor risks. The most common one is tooth hypersensitivity, in other words, that next cold drink could shoot you through the roof. We use an at-home bleaching technique which greatly lessens the sensitivity. The bleaching agent that we use has potassium nitrate in it which which significantly reduces the problems with cold food and drink. You can also use a toothpaste that is specifically made for hypersensitive teeth, such as Sensodyne.
Scanning electron microscope studies have shown no appreciable damage to the tooth enamel, however, there can be some roughening of composite resins which are used for the tooth colored fillings. It’s not significant enough to avoid bleaching altogether, although you may need to be prepared to have any large fillings in your front teeth replaced since they probably won’t match after the bleaching is done.
Contact with the gums can cause some irritation, especially with the stronger concentrations of bleaching agent. Make sure that the tray that holds the bleach has been properly contoured so as to not cover the gums and wipe any excess gel off the gums.