Teeth Whitening 101

Teeth whitening has become the most in demand elective dental procedure in recent years.  In fact, with the proliferation of over the counter products that claim to whiten teeth, it has become a multi billion dollar industry world wide.  With all the options out there including a host of “do it yourself” products, professionally administered programs, and tooth whitening retail centers, how do you choose what is right for you?

It may help to start with what “whitening” really means.   Since over the counter products are not regulated by the FDA and are, therefore, not subject to any specific standards, the term “whitening” is being used to market any product that contains cleaning or bleaching chemicals often without regard to actual effectiveness.  Some products even use coatings that you essentially paint on your teeth.  For our purposes we will define teeth whitening as the process of actually lightening the intrinsic color of the teeth by reducing the saturation of organic pigments, both natural and acquired, within the tooth enamel resulting in a whiter, brighter color through the chemical process of oxidation/reduction or, as some say, bleaching.   Many “whitening toothpastes” make their whitening claims based on their ability to remove stains due to their abrasive properties and may, in fact, result in whiter appearing teeth, but they would not fit our definition of changing the actual color of teeth.

All effective tooth whitening systems need to do two things.  First, they must contain an effective whitening agent.  In most cases this is a form of hydrogen peroxide or a chemical that releases hydrogen peroxide through a chemical reaction.  These are essentially bleaching agents and can occur in a variety of concentrations which can effect the rate and effectiveness of whitening.   Second, a whitening system must provide a vehicle for applying the chemicals to the teeth and holding them in contact with the surfaces of the teeth for a long enough period of time for the chemical reaction to occur.  Depending on the strength and the chemistry involved this may take anywhere from twenty minutes to several hours.  This vehicle can be in the form of a gel that can be applied to strips (Crest White Strip) or placed in preformed or custom molded trays or retainers.  They can also be viscous solutions that are applied to the teeth with an applicator by a dental professional (ZOOM).  The combination of whitening agent and delivery system will determine how much teeth will whiten, how fast teeth will whiten, and weather the system can be purchase over the counter or professionally administered.

Over the counter systems vs professionally administered:   The benefits of over the counter systems such as Crest White strips are convenience and cost.  These systems usually use an adhesive strip or sometimes a foam tray to deliver the bleaching agent to the surfaces of the teeth and hold it there long enough for a reaction to occur.  The usual protocol is to apply the product a couple if times a day for about 20 minutes a time for about two weeks.  These systems can give a good result if you are diligent about how you apply the materials to the teeth and are compliant with the protocol.  For some people with less than perfectly straight teeth it can be a challenge to fit the strips or trays in a way that gives an even, consistent result.  Improper placement of a strip can result in a stripped or banding effect.  Also, some people with very broad smiles may find that the strip doesn’t reach far enough back to lighten the molars which may show in the smile.  Another potential disadvantage of over the counter products are that they are often used in cases where a person may not be a good candidate for bleaching.  People with existing restorative work on their teeth or with certain developmental conditions such a mottling or tetracycline discolorations may find that bleaching may make their teeth look worse.  Ideally, you should consult with your dentist or hygienist prior to starting any teeth whitening program.

Professionally administered systems either use custom trays and bleaching agents of varying strengths or in office “one hour” systems such as “Zoom Advanced Whitening”.  With these systems you get a professional assessment and the most effective whitening concentrations available.  You also get professional monitoring during the process to assure that your teeth are responding as expected and to make necessary adjustments if not.  The most common professionally administered system is the custom tray systems such as “Night White” or “Day White” by Discus Dental.  The use of a custom tray insures a perfect adaptation of the tray to the teeth resulting in an even and complete coverage of bleaching agent to the teeth surfaces.  The bleach lined trays are worn either at night during sleep or for 15 – 30 minute sessions during the day depending upon the bleaching agent used.  Typical treatment time is about two weeks.  For those who want immediate results (“I’m going to be in a wedding this weekend”) or who don’t want to deal with the at home protocol there is the in office “one hour” whitening systems (i.e. Zoom).  These systems use a powerful, fast acting bleaching agent that is applied directly to the teeth by a dental professional.  Often a special light is used to accedlerate the reaction.  Great results can usually be achieved in about one to one and half hours.  Some of the shopping mall centers employ this technique but without the oversight of a dental professional.  These professional systems tend too be more expensive ($200-$400 for tray systems and $400-$600 for in office systems) but give the advantage of optimal effectiveness and professional oversight.

Whatever system you use expect a certain amount of ongoing maintenance to keep your smile bright.  Usually a day or two of tray or strip use every few months is sufficient but individual needs will vary depending upon dietary factors and individual characteristics of teeth.

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