There are so many options out there today that promise to whiten your teeth - strips, toothpaste, gels, professional treatments, patients simply want to know what works. So here is everything you need to know about tooth whitening from a dentists perspective.
Whitening toothpaste is simply an ordinary toothpaste with extra abrasive added, such as silica (sand), to remove surface stains (Extrinsic Stains). I consider whitening toothpaste a good tool to maintain the brightness of your smile. An individual will bathe their teeth in coffee, tea, wine etc. daily and a whitening toothpaste can help keep those surface stains at bay. Although, over time surface stains will penetrate the tooth itself and become Intrinsic Stains. It's these internal stains that require a stronger method of whitening to remove.
A note about sensitivity and whitening toothpaste - if you already have some level of tooth sensitivity then a typical whitening toothpaste with all its extra abrasives may lead to continued or exaggerated sensitivity. We must take this into consideration when choosing a toothpaste, as well as risk of dental decay and overall periodontal (gum) health. Ask your dentist what toothpaste is right for you based on your individual condition and dental needs.
Strips, Trays, and Professional Whitening systems
Now we can move to the part everyone wants to talk about - whitening products that produce results. Before diving into all the options out there we need to talk about whitening delivery systems. Results are going to be a product of how well the whitening agent (hydrogen peroxide or a derivative in most cases) is adapted to the tooth, how strong the concentration, and how long you leave the gel on the tooth itself.
Over the Counter Whitening Strips
Add peroxide gel to a plastic strip and you get your typical over-the-counter whitening strip. These work, but they don't work best. The white strip is flawed in the sense that it can never adapt itself ideally to the size and shape of your teeth, since, well, it's just a piece of plastic. Ultimately white strips will get you results but will not give you comprehensive, consistent, and even whitening results - Enter the custom whitening tray.
Custom Whitening Trays
Custom whitening trays are precisely fitting silicone trays that adapt themselves to the unique size, shape, and morphology of your teeth. If fabricated professionally, they will include a small reservoir on the front surfaces of the tray that will hold an ideal thickness of whitening gel precisely up against your teeth. This is all achieved through a number of pretty cool steps - outlined here - first have a dental professional take an impression of your teeth, the impression is then used pour a stone model of your teeth, the stone model is trimmed, block out resin is applied to the front surfaces of the model to create a reservoir for the whitening gel, a vacuum forming machine is used to construct a silicone tray over the prepared tooth model, and finally margins of the silicone tray are trimmed to comfortably fit in your mouth. Here is a photo breakdown of the process:
- Now we have a finished set of custom silicone whitening trays, all we need to do is load them up with some whitening gel and wear them. Wear time is dependent on the particular ingredient and concentration of the whitening gel you will be using. At Kansas Dental Center we use Opalescence Whitening Gel, which contains Carbamide Peroxide, Fluoride, and Potassium Nitrate. The carbamide peroxide is the active ingredient that whitens your teeth, fluoride and potassium nitrate is added to help reduce tooth sensitivity during the whitening process. (although- some transient tooth sensitivity is normal for any tooth whitening procedure and will resolve itself after the whitening process is complete)
- 20% Carbamide Peroxide - 2-4 hours
- 35% Carbamide Peroxide - 30minutes - 1hour
- The higher concentration of carbamide peroxide will reduce daily wear time but will increase the chances of tooth sensitivity during the whitening process, particularly in patients that already have sensitive teeth.
- If sensitivity occurs, patients can skip a day of whitening.
- Teeth can be whitened a number of shades over the course of 10-14 days.
Professional In-Office Whitening Treatment
In office whitening treatments are designed to produce results in a single day. If a patient wants a visible head start on whitening, has severely discolored teeth, or has an event coming up that requires that bright smile now, in-office whitening is the best option.
In-office treatments use much higher concentrations of hydrogen peroxide than would be prescribed for an at home treatment. Notice the green resin "dam" material that is placed on the patients gums so that the high strength peroxide does not touch and burn the gingival (gum) tissues. This is a great reason to trust your dental professional with this type of whitening, in order to eliminate the chance of chemical trauma damaging your gum tissue. Whitening of a number of shades can be safely achieved in about an hour of this type of treatment.
The Final Word on Whitening
My philosophy regarding whitening treatments centers around time and results, how quickly and how many shades do you want to whiten your teeth. For a patient that would like to casually whiten their teeth over the course of two weeks, at home whitening with custom trays is the way to go. If a patient has heavily stained teeth or just wants really great results; a combination of professional in-office treatment followed with custom tray at-home whitening would be the way to go. Have a wedding or an event coming up - jump in the chair and whiten your teeth in a single day. Talk to your dentist about selecting a whitening toothpaste that contains fluoride that can help maintain your results and keep your teeth healthy at the same time. Touch-ups can be made a few times a year, like anything else, whitening in moderation is safe and effective. Constant, excessive whitening can cause unnaturally looking teeth and possibly begin to damage the pulp in your teeth. Talk to your dentist about what your goals are and what the best course of treatment is based on your dental and health history.
Anthony J. Papinsick, DMD