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Patient Teaching: Tooth Whitening
Everybody loves a bright white smile, and there are a variety of products and procedures available to help you improve the look of yours. Many people are satisfied with the sparkle they get from brushing twice daily with a fluoride-containing toothpaste, cleaning between their teeth once a day and the regular cleanings at your dentist's office. If you decide you would like to go beyond this to make your smile look brighter, you should investigate all of your options.
You can take several approaches to whiten your smile: In-office bleaching
Talk to Your Dentist
You may want to start by speaking with your dentist. He or she can tell you whether whitening procedures would be effective for you. Whiteners may not correct all types of discoloration. For example, yellowish-hued teeth will probably bleach well, brownish-colored teeth may bleach less well, and grayish-hued teeth may not bleach well at all. Likewise, bleaching may not enhance your smile if you have had bonding or tooth-colored fillings placed in your front teeth. The whitener will not effect the color of these materials, and they will stand out in your newly whitened smile. In these cases, you may want to investigate other options, like porcelain veneers or dental bonding.
You also may want to speak with your dentist should any side effects become bothersome. For example, teeth can become sensitive during the period when you are using the bleaching solution. In many cases, this sensitivity is temporary and should lessen once the treatment is finished. Some people also experience soft tissue irritationeither from a tray that doesn't fit properly or from solution that may come in contact with the tissues. If you have concerns about such side effects, you may want to discuss them with your dentist.
Dental Office Bleaching
There are two effective bleaching methods commonly used by dentists in the dental officethe in-office "power" bleaching and laser bleaching.
Dentist In-Office Power Bleaching
The in-office "power" bleaching is one of the quickest and most effective ways to whiten teeth but requires a session at the dentist's office. The dentist isolates and protects your lips, gums, and inside lining of your mouth. Next, a powerful bleaching agent is applied to the teeth. Finally, a powerful light source is applied which completes the procedure by activating the bleaching agent.
While this provides one of the best results of any bleaching methods, it is moderately expensive, ranging from $300-$600 per arch or $600-$1200 for all of your teeth. (In dental terms an arch is either the upper set or lower set of teeth).
Laser bleaching is a relatively new procedure only recently receiving FDA approval. Despite its high tech sounding name, laser bleaching is simply a variation of the above in-office power bleaching method.
The procedure is much the same. Gums and lips are protected and a bleaching agent is applied. The only difference is that an argon laser is used to activate the bleaching agent instead of the usual light source.
Inventors of the procedure claim that this produces a better whitening result than the conventional in-office power bleaching. We must say that the jury is still out. This is a case where clinical studies need to be performed to substantiate these claims. Laser bleaching does cost more than the typical in-office power bleaching, ranging between $750 to $2000 for a complete set of teeth.
Basics of the In-Office Bleaching
There are a number of bleaching procedures that your dentist can perform in the dental office: For your upper arch only, the dentist can make a custom mouth piece, use a relatively high concentration of bleaching material (often called Power Bleach), and have you wear it in the office.
A single tooth or set of teeth can be bleached using very high concentrations of the bleaching material. Your soft tissue is protected during these procedures.
This procedure, combined with take-home dentist-dispensed bleaching is effective in the treatment of severe staining due to trauma and exposure to certain drugs such as tetracycline.
The inside of a tooth can be bleached after a root canal procedure to lighten it to match the surrounding teeth.
Pros. Fast dramatic results can be achieved. You can have immediate results for a special event. Specific problem teeth can be lightened to match the rest of your smile. You are working with a professional who knows how to handle such ingredients and procedures and can integrate bleaching into your overall oral health care plan.
Cons. The cost is higher than over-the-counter products. Minor and transient tooth sensitivity can occur for some patients.
ADA News Release
A report by Dr. David Garber, a private care dentist and a clinical professor at the Medical College of Georgia School of Dentistry, suggests that combining in-office power bleaching with dentist-dispensed at home whitening trays may provide both immediate tooth shade lightening and longer-lasting effects. He also points out that the new cosmetic laser bleaching may provide a quick and longer-lasting solution for some.
The combination of power bleaching and dentist-dispensed bleaching is accomplished by treating the teeth for 30 minutes with a concentrated formula of hydrogen peroxide and then providing two weeks of treatment for 30 minutes each day at home. In-office power bleaching is characterized by rapid lightening using a high concentration of hydrogen peroxide (usually 30-35 percent) that is activated by heat and light. Patients wear a rubber dam to protect their soft tissues from the high concentration of hydrogen peroxide.
"While in-office power bleaching alone can be quick and dramatic, the patient often must come back for multiple treatments because the original stains or shade may return," said Dr. Garber. The combination of power bleaching with a 30-minute per day, every-other-day at-home bleaching schedule can achieve the most rapid and predictable results, he contends.
New laser bleaching may also be an option for some patients who want dramatic whitening effects quickly, Dr. Garber reports. Recently approved by the Food and Drug Administration for marketing as a light source, lasers have garnered a great deal of attention in the consumer press. The ADA's Council on Scientific Affairs at its January 2000 meeting issued a call to manufacturers for clinical data proving that laser bleaching is safe and effective.
Dr. Garber points out that lasers used for lightening teeth do not bleach teeth, they merely create a reaction when the hydrogen peroxide comes in contact with the laser's beam. It is this reaction that begins to lighten teeth.
"At this stage, there is little research that proves that any of these approaches are more effective than traditional bleaching methods," he reports.
Dr. Garber presented his findings at "The International Symposium on the Non-Restorative Treatment of Discolored Teeth," held last fall at the School of Dentistry of the University of North Carolina at Chapel Hill and supported by Colgate Oral Pharmaceuticals.
Source: The Journal of the American Dental Association (JADA). Dentist-Supervised Take Home Bleaching Systems
These systems are becoming increasingly popular. With these systems the dentist makes a mold of your teeth. This mold is then used to create custom mouthpiece trays which snugly fit your teeth.
The patient takes the trays and bleaching agent home. Each night for three to four weeks the patient places bleaching agent on the trays and places the trays in his or her mouth. A brief visit or two to the dentist ensures that you are doing the home treatments correctly and allows the dentist to inspect your gums for irritation.
What we like about these systems is that the mouthpiece trays are custom made to fit each individual's mouth. This means that bleaching agent is less likely to be swallowed or less likely to seep onto and irritate gum tissue.
Second, when using these systems the patient visits the dentist office to ensure that the procedure is proceeding smoothly. This allows the dentist to make sure the custom trays are fitting properly. More importantly, it allows the dentist to check for gum irritation / damage and allows the dentist to check for tooth sensitivity. These are the most common side effects of the bleaching procedure.
These systems can cost between $250-$300 per arch ($500-$600 for all of your teeth).
For extremely yellow teeth, an in-office power bleaching is performed followed by treatment with a dentist-supervised take home system. This usually provides good results.
Home bleaching is a process in which patients apply peroxide-based gels to their discolored teeth for the purpose of lightening (i.e., whitening) them. Although there are many bleaching products, this discussion will cover only those prescribed or dispensed by the dentist and having carbamide peroxide as their active ingredient. Home bleaching first began in 1968 when an orthodontist in Ft Smith, Arkansas noticed that patients who had been wearing orthodontic positioners filled with the oral antiseptic Gly-Oxide had their teeth whitened. Later, a pedodontist in the same city substituted Proxigel (Reed & Carnrick) for Gly-Oxide in his patients positioners. He did so because Proxigel (a mixture of 10% carbamide peroxide, water, glycerine, and carbopol) was thicker and, therefore, remained in the positioners longer. Clinical trials of the Proxigel technique in 1988 at the University