It’s a great procedure to have done which we recommend every day and we have many happy patients who have brightened their smiles.  This article will serve to clarify some of the perceived issues surrounding tooth whitening.

When you as a patient ask us about whether you can have your teeth whitened we especially need to consider what it is that you don’t like about your smile and what you expect to get out of the tooth whitening process.  It is also important to be familiar with the limitations of tooth whitening procedures.  For many, tooth whitening is an ideal way to effectively create a whiter, brighter smile, while for others we can design a fantastic smile but they will only get what they desire if they also have additional dental treatment to provide an extensive smile makeover.

If you are generally happy with your smile but feel your teeth could be a bit brighter or are too yellow then tooth whitening is likely to be ideal for you.  There are some things that whitening won’t fix.  Tooth whitening is designed to whiten natural tooth structure.  Whilst it may remove some of the surface stain off artificial fillings, porcelain veneers and crowns, and acrylic teeth, it will not alter the base colour of these materials.  Some tooth defects and developmental discolourations within the tooth may also be much more difficult to whiten.   Root filled, dead teeth usually require a separate whitening procedure from inside the tooth to obtain an improvement.  Areas where the gum has receded and the yellowness of the root is showing through will not whiten.  Worn, chipped or eroded edges of teeth where the enamel is missing and the underlying dentine of the tooth is showing through will also not whiten.

There can be variation in the degree to which teeth will whiten.  Some smiles that you would expect to whiten well may only whiten a little, and conversely some smiles whiten a lot better than expected.  Also, even within a smile there may be some teeth which are naturally not as bright as others and sometimes after whitening these teeth can look whiter, but still not as bright as the others.  Whitening is still often the first step that people will take when wanting to improve their smile, whether they do any additional cosmetic treatment afterwards or not.  Once whitened, the teeth generally remain stable but can dull back after a period although usually staying whiter than what they started.  The frequency of factors likely to darken the teeth like smoking, coffee, tea, red wine, and cola can all accelerate this process.

OK, so if we’ve decided that tooth whitening works and a nice bright smile is something that you might like to have, how do we go about it?  Our first piece of advice would be to mention to your dental professional that you are considering whitening your teeth.  Not only can they provide their advice as to whether tooth whitening would be suitable for you and achieve the results you are seeking but it is also important to ensure oral health before proceeding with tooth whitening.  We always prefer our patients to have had a recent dental examination and any necessary treatment completed.  In particular any areas where the tooth whitening material may enter into the inside of the tooth or soft tissues should be properly sealed or stabilised, this would include areas of decay, broken or leaking fillings, and ensuring professional gum maintenance is current to ensure gum health.  You may choose to whiten your teeth one of the following ways:

Professional applied tooth whitening.  This procedure can be performed while you are in the dental chair.  Typically these systems use the strongest concentrations of usually hydrogen peroxide tooth whitening material available.  This gives the ability to achieve rapid immediate results.  It is important when using the stronger concentrations that it is only applied direct to the desired tooth surfaces and your dental professional will usually isolate and protect your gum and lips before applying the material.   Most systems also use an activating light to assist the reaction of the whitening material.  The advantages of tooth whitening this way are that you know you are using the most concentrated materials and you leave with a quickly achieved immediate result.  The main disadvantages are the cost of having the procedure, with most systems having a standard fee over $1000.00, and a higher degree of reported temporary sensitivity over the first day or so which is less so now with the newer formulations and can be managed, but may be more uncomfortable in people with sensitive teeth.  Also while this can give an excellent initial result we still usually recommend reinforcement of the result with some use of take home material (see below) as some studies have shown that the results can still dull back over time similar to self applied systems.  People that should consider this method – if you want and can afford the best; need white teeth in a hurry; too busy or can’t be bothered doing too much at home whitening; can’t tolerate at home whitening trays;  don’t have particularly sensitive teeth; can tolerate sitting in the dental chair for about an hour .  The system we are currently using for this procedure is the Zoom! Advance Power Whitening.

Professional assisted home tooth whitening.  At dentist tooth whitening has only really taken off in NZ in the last 5 years or so.  Before this the only available dentist vital tooth whitening was to accurately custom make thin whitening trays to safely and effectively hold the whitening gel in the correct places.  The patient is then able to use moderate concentrations of either hydrogen peroxide or carbamide peroxide in the trays at home either during the daytime or at night time usually for a couple of weeks.  Many of our patients still prefer using this method and achieve good results for approximately half the fee of professional tooth whitening in the dental chair.  The formulations have improved over the years with less patients reporting tooth sensitivity nowadays.  We use the Day White and Nite White systems for this procedure.

Tooth Whitening Pens.  A more recent and convenient way to whiten your teeth.  Originally designed as an easy way to maintain your professionally whitened smile, tooth whitening pens whilst containing a milder concentration of usually hydrogen peroxide tooth whitening material can still be very effective in whitening teeth well on their own without previous tooth whitening.  We have the Zoom! Whitening Pen available for less than a hundred dollars and this is a great way to try tooth whitening affordably and conveniently if the other options don't fall in your budget or you don't wish to go to the effort of having your dental professional whiten your teeth or make trays for you.

Other Products with Whitening.  We have not seen any patients coming in and raving about the whitening results of any other dental products they have used with additional "whitening" ability.  There are whitening toothpastes and rinses available which can improve surface appearance a little but do not have the same effect as proper tooth whitening.  The whitening toothpastes we have available can help to maintain the surface of the tooth enamel to maximise the brightness of teeth but will not whiten the teeth as such.  We do have our patients use the Sensodyne whitening toothpastes while they are whitening to reduce tooth sensitivity where required.

Whitening Brands.  There are a myriad of tooth whitening brands available worldwide.  We have always used Discus Dental products for over the last 15 years as they have given us the most consistent results since we started using the original Nite White formulation in the early 1990s.  Discus Dental was founded by Dr. Bill Dorfman way before he became the Extreme Makeover dentist and they have continued to improve and advance their products over time.

Precautions.  As mentioned before, be cautious of whitening if you already have sensitivity problems.  If doing light activated whitening there is a list of photoreactive drugs where this form of whitening is not recommended if you are taking any such medication.  With the tray whitening kits they do not recommend people who are pregnant or lactating, diabetic, or have heart disease use the material (although one Colgate kit with the same active ingredient does not have a heart disease warning).  These warnings are more to cover the manufacturers.  They can't really do any tests on pregnant and breast feeding ladies, and a well controlled diabetic or heart disease patient is probably as healthy as the rest of the population.  Whitening is not recommended for children and with caution in teenagers.  Often the tooth enamel and gum tissue is not adequately developed enough and the tooth pulp internally is much larger proportionately.  In most cases use of tooth whitening is perfectly safe but should you have any concerns you should consult your dental professional.