To Whiten or Not to Whiten Your teeth?

October 2019

When patients enter our practice they complete a form about their medical history and dental history. Using information from that form we interview our patients about what they would like to change about their teeth.  95% of our patients always list wanting whiter teeth. Then comes the follow up questions about which is better, take home or in office whitening? Does over the counter products work? What are the side effects of whitening? How white will my teeth get? Hopefully we can answer some of these questions for you and if you are interested in whitening, help you make a decision that is right for you. 

Staining 

There are two types of staining 

1. Extrinsic stains are stains that are only on the surface of the tooth and is a result of foods we eat or habits we may have i.e. coffee and tea or smoking and tobacco chewing. These stains can be polished off with professional cleanings. Whitening products can help but mechanical removal is most effective. 
2. Intrinsic stains. These are stains that involve the layers beneath the enamel. This staining can be a result of age (our enamel gets thinner as we get older and the second layer of tooth is more yellow in color and shows through). It can be a result of long term antibiotic use as a child during tooth development. Trauma to a tooth can damage the nerve and cause discoloration if not treated right away, and sometimes restorations (fillings) can cause discoloration especially amalgam fillings. Whitening products can be used effectively on some of these types of intrinsic staining. 

Over the counter whitening products vs Dental office whitening?

Chemically changing the internal color of teeth is called bleaching, the active ingredients are carbamide and hydrogen peroxide. It can come in the form a light activated gel, used mostly in dental offices, strips or oral trays as seen in over the counter products.

 Over the counter bleaching products vary in concentration of active ingredients and length of time of use. While effective, the lower concentrations can required longer wear time and be affected by the patient being compliant and consistent with its use. This can affect the results.

The in-office bleaching is usually a higher concentration of active ingredients and is light activated. The light accelerates and enhances the process.  The process is shorter and the results are immediate with in-office whitening and because the process is not dependent on patient compliance the results are more predictable. 

Patients always ask which one is better. It is dependent on the patient, type if staining and dental history. I have also been asked to recommend over the counter products, but because there are so many I cannot endorse one over the other but I do recommend reading the instructions and being sure your lifestyle allows you the time to use the product as directed. It is important to note, while we can predict that teeth will get whiter, we cannot predict the exact shade it will be at end of treatment with in-office or take home.

Potential side effects

The two biggest side effects are 

1. Sensitivity. Temporary sensitivity is the most common side effect of bleaching. It could be the effect of the active ingredient temporarily causing inflammation in the nerve tissue of the tooth. There is a gel that contains potassium nitrate and fluoride that your dental provide can give to help with relief. 
2. Gingival irritation. Sometimes the bleaching gel may get on the gums and cause irritation. This is usually temporary and resolves with time. 

Charcoal Whitening 

The latest craze in over the counter whitening is Charcoal activated tooth paste and products. While according to The Journal of American Dental Association in September 2017, there is no evidence that products with charcoal are safe or effective for teeth, however people have seen results. 

Charcoal is abrasive and likely good at removing surface extrinsic stains as mention above. Stains that would typically be removed by your dental professional at a cleaning. It is believed by some members of the dental community that it is too abrasive for everyday use in a toothpaste and can cause damage to enamel. While not enough research is available we will continue to learn more about this product and others with time. Consulting with your Dentist before using any whitening product is the best way to choose a product that is good for you. 

References: 

• American Dental Association.  Department of Scientific Information, ADA Science Institute August 29, 2019    www.ada.org/en/member-center/oral-health-topics/whitening
• American Dental Associaton  www.mouthhealthy.org/en/az-topics/w/natural-teeth-whitening