Tooth whitening has become one of the most frequently requested dental procedures by the public. The public has come to demand whiter, more perfect smiles and in response many choices for
tooth whitening have been made available. These include home-based products such as toothpastes, gels, and films, as well as in-office based systems where products containing highly concentrated bleaching agents are applied under professional supervision. The profession and public have been aware of certain risks related to
tooth whitening such as increased tooth sensitivity and gingival irritation. New research has shown that there are other risks such as tooth surface roughening and softening, increased potential for demineralization, degradation of dental restorations, and unacceptable color change of dental restorations. The new research is also focused on optimizing whitening procedures to reduce tooth sensitivity and to increase the persistence of the whitening.
In most cases, the natural colour of teeth is within a range of light greyish-yellowshades. Teeth naturally darken with age and their appearance can be affected by theaccumulation of surface stains acquired from the use of tobacco products and theconsumption of certain foods or drinks.In addition, the perception of the colour of teeth is severely affected by skin tone andmake-up. Independent of the real colour of their teeth, people with darker skin or whouse dark makeup will look like they have brighter teeth.Although teeth are not naturally meant to be completely white, many people want abrighter smile. Responding to this desire, a wide range of “whitening” options hasbecome available to consumers. These products fall into two main categories: surfacewhiteners and bleaches.
Three fundamental bleaching approaches exist: dentist-supervised nightguard bleaching, in-office bleaching, and OTC bleaching. The most popular dentist-administered technique clearly has been nightguard vital bleaching. This approach typically uses a relatively low concentration of whitening agent delivered in a custom fabricated tray. In-office bleaching, by contrast, generally involves the use of 25–35% hydrogen peroxide, but requires only short treatment times. It is important to note that in-office tooth whitening usually requires multiple treatment appointments. It is a rare for one in-office treatment to result in maximum whitening. OTC whitening is less costly than either of the two dentist-supervised bleaching approaches, but can be equally effective if products from reputable manufacturers are used.
Surface Whiteners
These products use special abrasives to improve the product’s ability to remove surfacestains. Most products in this category are either toothpastes or chewing gums. Becausethe special abrasives in these whitening products are often only finer versions of what isused in regular toothpastes, they are unlikely to cause excessive tooth wear. However, the effectiveness of these products is limited to surface stains and should not be used asa substitute for professional cleaning.
Bleaches
Most bleaching products are peroxide-based and are actually capable of altering thecolours of the tooth itself. However, not all tooth discolourations respond to tooth-bleaching treatments. Individuals contemplating tooth-bleaching should consult with adentist to determine the cause of the tooth discolouration and to determine whether ableaching treatment will have the desired result. This step is especially important for
patients with fillings, root canal treatments, crowns and/or with extremely dark stains on the anterior teeth. A number of different bleaching techniques and products are available to patients. Yourdentist will use one of these two methods to whiten your teeth:
Vital bleaching is done on “living” teeth and can be used to whiten your teeth if theyhave become stained by food or tobacco, or if they have become dark with age. One reason bleaching has been less popular in Europe, in my opinion, is because of lingering concerns about safety. Literally hundreds of millions of teeth in the US have been bleached over the past 15-20 years without one credible account of any significant untoward effect appearing in the literature. Dozens upon dozens of clinical trials over this same time period also have affirmed the safety of vital tooth whitening when used in a short-term treatment duration according to manufacturer’s instructions. There have even been long-term clinical trials by Dr. Van B. Haywood and others that have evaluated the safety and efficacy of bleaching. One such study involved daily bleaching in patients in whom tetracycline-stained teeth were treated for a period of approximately six months. No clinically significant problems were noted even when long-term results were reported after 7½ years Although this study involved a fairly small sample size, it nonetheless is one of the first to document long-term safety of tooth whitening even after daily use of a 10% carbamide peroxide material for a period of six months.
That being said, valid concerns still exist regarding individuals who may ignore manufacturer or dentist instructions, and overuse whiteners for months or years. Long-term adverse effects on soft tissues or hard tissues cannot be totally ruled out when these products are badly abused or overused. However, as noted above, clinical experience and a very large number of clinical trials conducted over the past 20 years have demonstrated that these products are indeed quite safe and effective when used properly. In my opinion, vital tooth bleaching, when administered correctly, is one of the safest, most effective conservative aesthetic procedures available to patients today.
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