1. Introduction to Teeth Whitening
Your smile dominates a large portion of what people see when they meet you. Others may be put off by a stained or yellowing smile when you smile, and so people will go to great lengths to obtain a whiter, brighter smile. It is a popular fact that having a whiter smile will help build a person’s confidence and enhance one’s natural beauty. Apart from having heads turn and people notice your gorgeous smile, you feel good about yourself, which lights up the room. There are numerous at-home teeth whitening products on the market, as well as teeth whitening services offered by different clinics. With so many treatments available, it is easy for the consumer to become baffled, and so we have compiled a list of different teeth whitening services as a guide.
Everyone wants to have a whiter, brighter smile, so a lot of people will go out and use the teeth whitening techniques and services that are available on the market. The services for teeth whitening have developed exponentially as well due to the fact that there is an ever-increasing demand for them. Today, one can obtain a dazzling smile both within the comfort of your own home or different clinics that specialize in teeth whitening services. The popularity of teeth whitening services has once again been brought to the fore in films, television, magazines, and in music.
1.1. Understanding the Importance of a Bright Smile
If you’re a non-smoker, alcohol-free, and brush at least twice a day, why are your teeth still yellow and discolored? The tooth’s outer layer is enamel. It comprises two essential elements: hard tissue composed of calcium phosphate like bone and dentin beneath the enamel. The dentin is dark yellow in color. The top enamel is translucent and semi-transparent, allowing the yellow dentin to show through. It’s a natural luminescence effect. Over time, the surface of the enamel is stained, making it opaque and diminishing the translucent effect. The yellower the dentin is, the more yellow your teeth will appear. Brushing often doesn’t eliminate the stains; in fact, the abrasion of dentin will make the situation worse. In most cases, the stains are chemically attached to the tooth surface and cannot be removed by brushing with toothpaste.
A bright smile conveys positivity and communicates good health while illuminating the entire face. A study published in 2018 in the American Journal of Dentistry revealed that teeth whitening enhances facial attractiveness and positively influences a first impression. Moreover, white teeth receive higher evaluations for their social standing as opposed to yellowed teeth. In the Journal of the American Dental Association, participants were asked to evaluate a photo. The lens blurrily displayed one group of teeth as a reference, which was whiter than those of the test groups. The result? Test groups judged the characters with reference teeth to be more favorable than the others. Even though in daily routines, personality and behavior will dominate the impression caused by the visible teeth in an instant, people will think differently about your competence, friendship, compassion, sensitivity, intelligence, and the capability to perform as they evaluate your smile. Moreover, white teeth can make you look thinner. The improvement in your appearance and the perception of it isn’t imaginary; it’s real.
2. Types of Teeth Discoloration
Tooth whitening can be performed with various techniques such as chemical whitening, dental laser, and at-home kits. The best option for patients is the at-home kits that include a latex mouthpiece. Hydrogen peroxide is the active ingredient in almost all tooth-whitening products as it bleaches the enamel. Once the patient has the kit with the mouthpiece, they can perform the treatment quite easily whenever they want. This also ensures the privacy desired by some patients.
There are two types of teeth discoloration: surface-level and deeper. Surface-level discoloration is a result of exposure to the darkening effects of different substances such as tobacco and food. The main causes for surface-level discoloration are poor dental hygiene: failure to brush and floss your teeth can lead to the deposits of substances on the enamel. Deeper discoloration concerns changes inside the tooth structure. These can be a result of aging, trauma, nerve degeneration, genetics, and exposure to minerals that discolor teeth during the developmental stage.
2.1. Extrinsic vs Intrinsic Discoloration
Topics covered by the dictionary include: identifying a discolored tooth and how this can affect treatment effectiveness, biomechanical changes of the internal tooth structure and how whitening agents can diffuse through these and other structures, methods for activating and deactivating agents, the effects of reactive species on tooth structures, mineralization techniques to reduce adverse whitening effects, use of chelating agents for reducing hydrogen peroxide penetration, published case studies for these agents, cavities and changes in surface appearance, adverse events caused by tooth preservatives and other methods, and even changes in coloring of implants and crowns. This timely set of topics can provide many hydroxyapatite readers with the help that they need.
Intrinsic staining, on the other hand, is much more severe. It involves a permanent change to the overall tooth color, penetrating to the dentin layer situated beneath the enamel. This internal staining can be caused by the aging process, trauma so severe it kills the tooth causing discoloration, or the use of specific medications or excessive fluoride use during tooth development. Before discussing tooth whitening or taking the next steps in order to whiten your teeth, you should discuss intrinsic stains with a professional dentist. If your discoloration is due to trauma and not possible to treat effectively at home, you must visit a dental clinic in order to explore potential treatment options that are combined with other issues that are a consequence of the initial trauma.
The two major categories of tooth discoloration are intrinsic and extrinsic staining. Understanding the type of staining you are experiencing, whether it be intrinsic or extrinsic, is crucial as they require vastly different treatments to whiten your teeth. The two prominent categories of tooth discoloration are extrinsic and intrinsic staining. Extrinsic staining occurs when the outer layer of the tooth, also known as the enamel, becomes discolored. Consuming darkly pigmented foods and drinks such as coffee, red wine, or blueberries is the most common cause of this type of staining. Forgetting to brush your teeth after eating these foods, or at least performing a rinse with water, results in the particles becoming ground into the microscopic ridges of the tooth enamel, resulting in a colored enamel appearance.
3. At-Home Teeth Whitening Options
Companies have taken notice and responded by creating custom bleaching trays in which the whitening agents are now used for only an hour a day. While it takes 7-14 days to achieve the desired results, the low but constant presence of the whitener coupled with the time-released activity means that these newer products replace themselves. As a result, while the custom tray systems still offer the best outcomes for the least amount of wear-time, these newer custom tray kits garner positive feedback from discriminating users and are certainly worth mulling over. Suggested to your dentist during teeth whitening services, initial gum shrinkage is a normal reaction to the whitening process. Taking a break and continuing the trays will allow your gums to regenerate over a 2-3 day period. Once you resume, desensitizing toothpaste will help to minimize any associated discomfort.
While there are a variety of at-home teeth whitening products, a few warrant more than a cursory glance. If you are a to-the-max type of person who wants all the gory details, please know that teeth are porous and spongy to some extent. As a result, rinsing with anything that you put in your mouth (even just water) will extract some degree of dental material. Placing a whitening agent on your teeth for about an hour will work and is safer than the once-a-day for 7-14 days that most companies recommend. Professional strength whitening strips and several new higher-end “hybrid” products utilize the pre-loaded hour-on approach with the results closely mimicking in-office external bleaching. One big thrill for manufacturers is that strategically compromising the dental material accelerates outcomes and this bursting WOW is what drives consumer satisfaction and repeat business!
3.1. Whitening Toothpaste and Mouthwash
Most toothpastes only address the surface stains on one’s teeth and contain a certain percentage of abrasives – typically 0.2%. Common abrasives include calcium carbonate or hydrated silica and are quite gentle. The amount is similar to the size of undertakings a professional hygienist or dentist performs. The risk accompanying with using toothpaste with more abrasives is more significant. More abrasive toothpastes lead to a higher likelihood of enamel wear and increased sensitivity. It is why toothpaste should always stringently follow oral instructions. If you already have sensitivities, we recommend addressing them before venturing into a higher amount of abrasion. On the flip side, mouthwash is a liquid and therefore contains no abrasives. On the other hand, the higher percentage of a topical fluoride paste application requires a prescription and is needed to desensitize if necessary.
In general, the majority of toothpaste products will remove surface staining due to their adequately abrasive nature. But if they don’t contain a form of peroxide as well, surface stains will not be bleached away. This is where whitening toothpaste comes in. Whitening toothpaste usually contains a low dose of peroxide. The actual effect can usually be seen when used over prolonged periods. The range is extensive with varying formulas offered by manufacturers but none of the components are able to penetrate the tooth to internally bleach or alter the color of it. The same goes for whitening mouthwash with similar content as whitening toothpaste. If there is peroxide in the toothpaste that is not dispensable before application, there is an overall risk for sensitivity which is why many people dislike the idea.
4. Professional Teeth Whitening Services
Once this whole process is finished, the hydrogen peroxide for teeth whitening is placed on the teeth. One of the common tools used for this purpose is the LED lamp, a light that is placed in the mouth to accelerate the function of the product. The lamp accelerates the whitening, highlighting rays of an LED light creates hydrogen peroxide to go faster. This is the so-called cold plasma. There are other lamps that surround the mouth, but the main function of the light is still the same. The teeth whitening lamp serves to illuminate the hydrogen peroxide gel, which in a period of 20-25 minutes must remain incorporated. Oral diagnosis in teeth whitening is very important because some patients have pathologies, or treatments are not recommended.
The procedure is carried out in the dental clinic, so there is no need to measure them. The session duration depends on the technology that dentists always have in the clinic. Some people use 5-mm gum protectors not to bother, and it is more common to place some protective white paste on the gums that will later harden over the remainder of the teeth away from the whitening material. With all the protective measures in place, the dentist applies a shield or a dam, which serves so that the bleach product used to bleach the teeth does not fall on the gums.
4.1. In-Office Whitening Procedures
Chairside whitening typically uses a relatively large amount of peroxide gel applied directly to the teeth. The bleaching gel is activated, or “activated,” with a special, super bright white light. Other accelerated whitening methods use powerful lasers or low-intensity heat regulations to activate the peroxide. Results from the best in-office whitening services can last between one and two years. Most dental offices can apply a super-thin protective layer of fluoride to the teeth in the aftermath of treatment to help protect tooth enamel. One huge advantage of teeth whitening treatments that can only be done at the dentist? Your dentist can use a stronger bleaching agent than OTC treatments because he can carefully monitor the treatment to ensure there isn’t too much gum exposure.
Chairside, which is conducted in the dental clinic, or in-office whitening, is by far the fastest way to enhance the shade of teeth. It’s especially ideal for those with a special day coming up or those who don’t have the patience for other methods. With a powerful whitening gel and a light or laser, your teeth will be several shades lighter in just one to two treatments at the dental clinic. However, the much higher cost, an increased chance of developing sensitivity, and concerns over over-exposure to the extremely high-strength peroxides used are a put-off for some. This method, based on a very concentrated gel, works especially well for brown and orange stains, as the peroxide attacks these deep and stubborn dyes.
5. Factors to Consider Before Whitening
The question is frequently asked of me by fellow dentists and also by their patients as to “what shade will my teeth eventually go?” I will say two or three shades lighter and on the other hand, that a very satisfactory result should be achieved. I will remind them that this cannot be counted on with everyone and that the most successful results are seen with dentitions of a yellow hue. They will then frequently ask about the difference that the color of one’s teeth can make. They may say that they have formed the opinion that people judge confidence, personality, age, preferred, and professional success from the way a person smiles and that the presence of white teeth accentuates that smile. With white teeth, they will have a natural gleam that portrays youth and vitality. The ensuing positive comments from friends and colleagues will further boost their ego. These comments have to be lauded as they are endorsements for the procedure. Prior to the application of the teeth whitening systems, and for the management of post-operative sensitivity, I have compiled a number of tips for the patient which are useful as a patient handout.
Evidence that you cannot whiten your teeth uniformly and to prevent any disappointment, advise your patients during the initial stages that total whitening may not be expected. This can be a problem with those few patients who are hopelessly striving for perfection. I usually inform them that my job is one of “teeth lightening” not “teeth whitening”. It cannot be stressed enough that all patients must understand that achieving a perfect color is not normally possible. The resulting color change should just be accepted as a bonus and one to be pleased with.
5.1. Dental Health and Sensitivity Issues
Any minor discomfort from teeth and gums is most often observed after bleaching. Small improvements may also occur in sensitivity. Your teeth and gums can be tested for a few days or even weeks. If it does not improve after 2 to 7 days, contact your dentist. About 10 percent of people bleached experience a sensitivity problem that delays the procedure and, of course, affects the results. Some people, however, continue to have stimulated nerves for a long time. There’s no cause for worry. Most dentists should tell you about the possibility of discomfort and pain. If not, you have the right to ask. I once read of a case where a woman was crying because her toothache was exaggerated.
These are for individuals who have a tooth or gum disease and receding gums that expose tooth nerves. Their teeth are very weak and sensitive, and these people cannot use off-the-shelf teeth whitening store kits. People who have previously had their teeth restored or filled with crowns, bridges, and porcelain veneers are also not suitable for teeth whitening. This, however, differs with a dentist consultation. Those who want to lighten their teeth to the greatest amount possible should go directly to the dentist and let him handle your teeth whitening.
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References:
Martini, E. C., et al. “Bleaching-induced tooth sensitivity with application of a desensitizing gel before and after in-office bleaching: a triple-blind randomized clinical trial.” Clinical oral investigations 24 (2020): 385-394. researchgate.net
Goettems, Marília Leão, et al. “Impact of tooth bleaching on oral health-related quality of life in adults: A triple-blind randomised clinical trial.” Journal of Dentistry 105 (2021): 103564. sciencedirect.com
Donassollo, Sandrina Henn, et al. “Triple-blinded randomized clinical trial comparing efficacy and tooth sensitivity of in-office and at-home bleaching techniques.” Journal of applied oral science 29 (2021): e20200794. scielo.br
Meireles, Sonia Saeger, et al. “Efficacy and tooth sensitivity of at-home bleaching in patients with esthetic restorations: a randomized clinical trial.” Clinical Oral Investigations 26.1 (2022): 565-573. researchgate.net
Al-Shamrani, Sultan S., et al. “Knowledge and perception of in-office and home teeth bleaching and related adverse effects in Saudi Arabia.” Annals of Dental Specialty 10.3-2022 (2022): 17-23. annalsofdentalspecialty.net.in
Meireles, Sônia Saeger, et al. “Effects of a reduced in‐office bleaching protocol with 37.5% hydrogen peroxide on effectiveness and tooth sensitivity: A double‐blind randomized clinical trial.” Journal of Esthetic and Restorative Dentistry 33.5 (2021): 824-831. [HTML]
Mazilu Moldovan, Amalia, et al. “Various Aspects Involved in the Study of Tooth Bleaching Procedure: A Questionnaire–Based Study.” International Journal of environmental research and public health 19.7 (2022): 3977. mdpi.com
Terra, R. M. O., et al. “Effect of daily usage time of 4% hydrogen peroxide on the efficacy and bleaching-induced tooth sensitivity: a single-blind randomized clinical trial.” Operative dentistry 46.4 (2021): 395-405. researchgate.net
Sutil, Elisama, et al. “Effectiveness and adverse effects of at‐home dental bleaching with 37% versus 10% carbamide peroxide: A randomized, blind clinical trial.” Journal of Esthetic and Restorative Dentistry 34.2 (2022): 313-321. [HTML]
Chemin, K., et al. “Evaluation of at-home bleaching times on effectiveness and sensitivity with 10% hydrogen peroxide: a randomized controlled double-blind clinical trial.” Operative dentistry 46.4 (2021): 385-394. [HTML]
