What is tooth whitening?
Tooth whitening is the process whereby a peroxide material (carbamide peroxide) is placed next to the teeth, by putting it into custom made whitening trays for a length of time. Carbamide peroxide has many benefits in the mouth, not just lightening the colour of your teeth, it can improve gum health and oral hygiene and help reduce root decay and tooth decay by elevating the pH in the mouth.
What causes tooth discolouration?
Extrinsic factors; Fried food, oil molecule, drinks (coffee, red wine, tea), antibiotics (tetracycline or amoxil), smoking poor oral hygiene, dairy cheese
Intrinsic factors; Liver disease, kidney disease, trauma, medication, iron staining, chlorine from swimming pools
Other; Genetic factors, chemicals, bisphenol A, dioxin in breast milk, age
How whitening works;
Peroxide gel breaks down into water, oxygen and free radicals- this oxidises the bonds of coloured molecules in the tooth that case tooth discolouration. By breaking down colour molecules, more light is able to reflect back to the human eye.
Who is suitable for tooth whitening?
Your dentist completes a process before selecting a patient for tooth whitening; this includes a medical and dental history, expectations, shade taking of existing teeth. A detailed check of the teeth and gums are done also. This is to address problems like, decay, tooth abscess, gingivitis, periodontitis, mobile teeth, bruxism or cracks on the teeth. You may need an x-ray, percussion tests and fillings, root canals treatments, periodontal treatments are carried out prior to any tooth whitening.
Fillings and crowns do not change colour with tooth whitening. The peroxide only whitens natural teeth.
Patients with good oral hygiene, no active decay and how are not pregnant or breastfeeding, should be eligible for tooth whitening subject to their dentist's approval.
Sensitivity
As sensitivity is the most common complaint for patients going through whitening, there are a number of ways to help reduce this! A soother gel/desensitising toothpaste (sensodyne or colgate prorelief) can be used for one week on teeth prior to whitening. A fluoride gel can be used in the whitening tray prior to tooth whitening. A lower concentration of carbamide peroxide can be used. Less material can be placed in the whitening tray. Whitening gels can be applied every second or third night. The treatment can be suspended if extreme sensitivity is experienced.
The Whitening Process
Impressions are taken and sent to a dental lab for the construction of your custom-made, soft acrylic whitening trays. When these are returned, they are disinfected, tried in the mouth and instructions of use are given. We advise taking 6 weeks to whitening your teeth and whitening the upper teeth first as upper teeth are less sensitive than the lower teeth. The upper teeth will take approx. 2 weeks to whiten, the lower teeth approx. 3 weeks.
We give you 6 syringes of whitening gels, 3 x 10% carbamide peroxide and 3 x 16% carbamide peroxide. Start with the 10% carbamide peroxide to acclimatize your teeth to the whitening gel. Each syringe should give you 4-7 nights worth of whitening.
Prior to treatment at home;
Try in the trays first without any whitening gel to check the fit and comfort. Ensure the whitening trays are clean and dry before applying the whitening gel. Moisture reduces the efficiency of the whitening gel and can slow down the whitening process. Recent research shows that the best result is achieved by drying the teeth with a tissue before putting the whitening trays in. Brush and floss your teeth prior to whitening them.
Instructions of use;
Unscrew the cap off your whitening gel syringe and screw on the nozzle that comes with your whitening kit. Place a small drop of gel onto each tooth in the whitening tray. Do not spread the bleach around and be careful not to overfill the tray. Less is more when it comes to whitening gel. Any excess gel placed into the tray will come out the top of the tray after insertion. Place the whitening trays firmly into the mouth. Wipe away any excess gel with your finger or tissue to prevent injury to you gums and apply less gel to the tray next time. The recommended time to keep whitening trays and gels in your mouth is minimum 2 hours and maximum 10 hours. The whitening effect, between 2-4 hours after putting in the whitening trays, is when it’s at its strongest. Some patients will sleep with their whitening trays in situ overnight, however other patients find the sensitivity too great to do this and will stick to wearing them for a couple of hours in the evening. The length of time taken to achieve the desired whitening result varies per patient. On average, the process takes between 2-6 weeks. The longer the whitening trays are worn per treatment, the quicker they will whiten, but the more sensitive they will become. Sensitivity is temporary, however can be significant. Use of a desensitising toothpaste during treatment can improve symptoms. Taking rest days can also help reduce symptoms and will not affect the overall accumulative result.
Remove the trays when finished whitening and thoroughly rinse your mouth with water and rinse all residue off of the trays. Keep the trays in the case supplied to ensure they are kept safe and allow any moisture to evaporate ready for the next use.
Patients with tetracyline staining of their teeth can take 3,6,9 months to whiten and more whitening gels will need to be purchased as a result of this.
Caring for you whitening trays and gels;
Store whitening gels long term in a cold, dark place. You can keep the whitening gel you are using at room temperature as placing very cold whitening gel next to sensitive teeth can be very unpleasant. Any unused gel can be stored in your fridge and may be used at a later date.
Clean your whitening trays with warm, soapy water. Do not use hot water on them as that can cause them to melt and distort. Whitening trays may become a cloudy colour over time. Retainer cleaners can help in keeping whitening trays clean. Whitening trays are reusable.
Possible side effects;
Sensitivity is the most common side effect of whitening. Some patients notice white flecks on their teeth immediately after whitening their teeth. This is causes by fluorosis of the teeth and the flecks fade quickly once teeth are hydrated. Fluorosis of teeth is common in Ireland as there is fluoride in our water. Whitening gel left on the gums and not wiped away can cause a chemical burn to the gingivae.
For best results;
We advise not to smoke, eat or drink when the whitening trays and gels are in the mouth. It is recommended not to smoke for 2 hours after removing the whitening trays from the mouth. During the course of the whitening treatment, it is advised to avoid foods and drinks of strong colours e.g. red wine, pasta sauce and these can stain teeth quickly.
Other information;
Many patients do not notice a result from the whitening trays the first couple of days after they start treatment. It can take several days for the whitening effect to show and this often coincides with sensitivity. The teeth can be quite dehydrated immediately after completing the whitening treatment and will go back half a shade after normal eating and drink recommences. As dentists, we do not recommend whitening teeth more than once a year. Whitening should only be carried out in a decay free, healthy mouth. The whitening gel can travel straight into the crack of a tooth, also causing sensitivity. Replacement whitening gels can be purchased in our dental practice. Whitening does not lighten fillings or crowns. There is some research showing that whitening may affect the bond of white (composite) fillings. In some cases, whitening, although lightening the colour pigment of the tooth thus internally lightening them, can actually make teeth more prone to surface staining i.e. from coffee/tea.
Precautions;
Keep whitening gels out of the reach of children
Do not use if you are pregnant or breastfeeding or going through IVF
Do not use whitening gel past their “sell by” date
Do not use if you are under 18 years of age
Patients with a history of chemical allergies are advised to have allergy testing with a specialist before carrying out whitening
Discontinue use if any unusual reactions or symptoms occur.
If you have any issues, queries or questions, please do not hesitate to call Northumberland Dental Care on (01) 6688441 or email us on info@nidm.ie
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