teeth whitening

Lightening the existing shade of your natural teeth is a well established popular treatment, which has a big advantage in being completely non invasive; no drilling or removal of the tooth is required. It is simple,safe and effective and can be completed at home and or in the dental chair. Teeth may discolour for many reasons, including the following most common causes:

CAUSES OF TOOTH DISCOLOURATION:
External (on top of the tooth): -Lifestyle: smoking, tea, coffee, red and white wine, certain coloured foods and drinks

  • Poor oral hygiene: soft and hard plaque (tartar/calculus)

Internal stain (from within the tooth): -Age: teeth usually change colour, often becoming darker/more yellow over time.

  • Dental disease: for example decay, old leaking or discoloured fillings.
  • Medicines: for example the antibiotic Tetracycline affects enamel formation if taken when teeth are developing.
  • Excess fluoride: if ingested in early childhood can cause mottling of enamel.
  • Trauma: A tooth damaged by trauma often turns grey.
  • Pigmentation/area of stained enamel: commonly occurs as teeth develop for various reasons.

IMPORTANT GENERAL INFORMATION

  • Bleaching is a very inexact science; there is no way to predict exactly how much any person’s teeth will lighten or how long it will take. It usually works well with great results and takes an average of 2 weeks. More complex teeth can take several months to bleach.
    • Teeth dont return to their original shade but commonly need a topup of bleach over time, on average after 1-3 years. Bringing the teeth back up to the lighter shade usually only takes a few days and is easy.
    • For everyone there is eventually a maximum plateu where no further lightening occurs no matter how much bleach is applied over time.
    • Different teeth have varying potential to bleach, eg; yellow teeth generally take up bleach better than grey shades.
    • Fillings, veneers, crowns and anything that isnt natural tooth does not take up bleach. Thus bleaching is often done prior to any other work, which is then matched to the final bleached shade of the teeth. Alternatively if bleaching is done first, fillings that then stand out in contrast may need replacement; planning is key either way.
    • Over the counter bleaches including kits and toothpastes contain abrasives and a very mild bleach (much more mild than dentists can issue). Some products also contain acid that damages enamel. Over the counter products are not generally recommended for many reasons. A custom fitting tray made by a dentist is essential to prevent most of the bleach being swallowed. Unsupervised use of over the counter products can increase the risk of side effects and research has shown they are minimally effective for whitening.

THE BLEACHING PROCESS

  1. Consultation to discuss your medical and dental histories (critical before considering any bleaching) and
  2. Diagnose the cause(s) of the discolouration.
  3. Examination of your mouth, gums and teeth including the taking of x rays if required. Any gum disease, decay and several other problems must be addressed prior to starting bleaching for success.
  4. Discuss bleaching options and choose a technique, either in chair or at home or a combination of both depending on your situation.

Option 1: At home bleaching

  • Impressions (moulds) are taken of your upper and lower teeth using special dental “putty” placed into impression trays then over the teeth.
  • The moulds are sent to the Dental Laboratory where my technician fabricates your custom made whitening trays.
  • You are given the whitening kit which contains peroxide based gel and the trays are fitted and checked then given to you
  • You place the peroxide gel into your trays and the tray is placed onto your teeth for one hour per day. The usual time it takes to achieve the desired shade is 14-21 days but this is variable. The days dont have to be consecutive.
  • After removing the trays it may be recommended to place tooth mousse or topical fluoride gel on the teeth depending on your situation.
  • Before and after wearing the trays it is advisable to clean the teeth.
  • During the bleaching period teeth are more susceptible to taking up stain; it is ideal to avoid coffee, tea and staining foods and drinks while bleaching.
  • You stop when your desired shade is reached; some people prefer to bleach the lower teeth or uppers first so they can see the change in comparison to the other arch.

Advantages of the home technique:

You control when it starts and stops. The process occurs more slowly so there is no risk of going too far and having artifically white looking teeth. -The cost is less than bleaching in the surgery. -Once you have the custom trays you can use them to top up the bleach as required over the years. -You can choose the concentration of bleach used.

Option 2: In chair bleaching in the surgery

In this procedure the whole home course of bleaching is carried out in 1-2 hours with a much more concentrated bleach.

  • Your cheeks will be held away and the gums will be covered and protected using a rubber coating.
  • A Peroxide based gel will be carefully applied to your teeth. The gel works immediately upon contact with the tooth and is left for a period of time (usually around 10min), then rinsed off then reapplied. Several rounds of gel are applied until the desired shade is achieved. Before and after photos are always taken.
  • After the final round the gel and the protective coatings are removed.

Advantage of in chair bleaching: Convenience and efficiency; potentially no need for the time and effort to wear the trays at home. Not everyone is a good candidate for bleaching. Here are examples of situations which are unsuitable for bleaching:

SITUATIONS IN WHICH WHITENING IS NOT RECOMMENDED:

  • Teeth have strong sensitivity to hot and cold food and drink
  • Defective or absent enamel on the teeth
  • Presence of gum disease –
  • Very young age with adult teeth still growing
  • Pregnant or breast feeding women

POSSIBLE COMPLICATIONS OF BLEACHING:

It is essential that you have all the information so you can weigh up the benefits and risks of treatment. Bleaching doesnt damage teeth long term. Side effects of bleaching tend to be mild and are easily prevented and managed:

  • Short term sensitivity to hot and cold or air on the teeth: This is usually prevented by using topical agents before and after bleaching and selecting the correct bleaching technique and concentration. It usually resolves as soon as you stop bleaching.
  • Short term tooth discomfort or pain: occurs extremely rarely and usually managed by pandol at the most and is usually preventable.
  • Gum/cheek irritation: usually prevented by keeping bleach off these areas.
  • Mouth ulcers/sore throat: this is usually prevented by avoiding the wearing of bleaching trays over night, which is much less well controlled than during the day.
  • Nausea from swallowing bleach; this is usually prevented by avoiding the wearing of bleaching trays over night.

The vast majority of the time things go very smoothly with none of the above occuring. The most critical thing is to choose the correct techniques and concentrations and plan things well from the beginning. Most people are very happy with their results!