TEETH WHITENING

What it is teeth whitening?

Teeth-whitening is a method of lightening the colour of natural teeth. The following information relates to the use of dental whitening techniques which use Natrium-Perborate or Carbamide-peroxide with the content of up to 6% hydrogen peroxide (H2O2).
The colour of teeth varies between individuals and at different ages. Teeth can gradually darken over time. Tooth colour is influenced by a person's genetic makeup, and by any surface stains or deposits in or on the teeth. If our teeth are dark due to stains or deposits, they will need to be cleaned before teeth-whitening is undertaken.

 

Which options are available?

A gel is used to whiten the teeth and there are two main ways of doing this: 
 

1. Home whitening

The dentist takes impressions of the teeth to make individual custom made flexible whitening tray that fits around the teeth. The whitening gel is placed in the tray following the dentist's instructions. The teeth will become gradually lighter over a period of time. It is important that the tray is specially made so that the whitening gel is only applied to those teeth to be bleached. This specially constructed tray also helps to keep the gel away from gums and protected from the saliva which inactivates it.
The whitening tray is worn for several hours at a time, usually at night time or whenever it is most convenient. A course of treatment takes a variable number of weeks and results may vary depending on the initial darkness of the teeth, the concentration of gel used and the frequency of application.
 

2. Chair-Side whitening

The dentist applies a higher strength of hydrogen peroxide (H2O2) directly to the teeth in the surgery to achieve whitening results in the shortest possible time. During the procedure, the whitening gel will be applied to teeth and depend on the procedure they may be exposed to the light few sessions of 10- 15-minutes. During the entire treatment, a plastic retractor will be placed in the mouth to help keep it open and the soft tissues (i.e., lips, gums, cheeks and tongue) will be covered to ensure they are not exposed to either the gel or light. To achieve the most efficient outcome, chair-side whitening could be combined to home whitening protocol.

 

How long does it take?

Home tooth whitening normally takes about two to four weeks. The dentist will advise on how many hours a day (or night) to wear the gel-filled tray. Depending to product varies between one and six hours.

 

What are the risks involved in teeth whitening?

There is a risk that teeth whitening will not work quickly and the dentist will discuss the possible reasons why it might not work particularly well or why it might take longer than average. Not all teeth get lighter to the same extent, particularly deeply discoloured or multicoloured teeth. Some teeth whiten more effectively or more quickly than others. Teeth which are already quite white will only lighten a little further. Some teeth do not get lighter evenly. This can be a problem where the gum has receded, and the darker root surface (dentin) is exposed. Such teeth can become sensitive to bleaching. Certain types of tooth discolouration do not respond easily and may require special treatment by a dentist.
 
Fillings, veneers or crowns that match the existing teeth will not change with whitening. The costs of replacing these so that they match the new lighter colour of the natural teeth can be considerable. This needs to be discussed with the dentist before undertaking the teeth whitening.
The extensive clinical data continue to support the safety and effectiveness of this kind of tray-based tooth whitening with 6% Hydrogen peroxide and 16-18% Carbamide Peroxide. However, during teeth whitening, teeth may become sensitive for a period of time. This is usually only temporary. A fluoride gel or special toothpaste within the tray can be worn for 30 minutes before bleaching to minimize sensitivity. Temporary irritation of the soft tissues in the mouth, particularly the gums, is rare but can occur if too much gel is loaded into the trays. The dentist will advise how to help avoid this problem.

 

How long will the lighter appearance of teeth last?

The effects of home whitening may last longer than chairside in-surgery bleaching, however, it takes longer to have the desired result.
Teeth which have been bleached have a gradual tendency to return to their normal colour. This means that teeth may need to be bleached again at some time in the future. Because the gel used in the whitening process degrades fairly rapidly (six months shelf-life) it should be stored in a cool place. The new gel should be bought if repeating the treatment. The existing whitening trays can be used again for top-up treatments. The trays should be kept safely.
 

What are the alternatives?

Tooth whitening has the particular advantage that it does not involve any destruction of existing healthy tooth structure.
Tooth whitening may not be 'the right' or 'the only' aesthetic treatment. There is also the alternative of making no change to your tooth colour or the application of white (composite) filling material to disguise the colour of the teeth. The provision of crowns or veneers can be used to alter the colour of the teeth in order to make them appear lighter, but this usually involves the removal of a significant amount of sound natural tooth tissue and is destructive compared to tooth bleaching. However, a crown or veneer may be a reasonable option if a tooth is already heavily filled or root-filled.

 

Teeth whitening procedure

  1. You now have your Tooth Whitening Set containing 2 custom made trays (upper and lower) and tubes of whitening gel.    
  2. Your home whitening should be carried out for 7 days. 
  3. DAY-WHITE set: The trays should be worn at least 1 hour, 1-2 times daily.
  4. NIGHT-WHITE set: The trays should be worn at least for 4 hours overnight for two weeks.
  5. Please brush and floss your teeth prior to placing the trays. If you haven't had a hygiene session in the last 8 weeks please book one before starting the whitening procedure.
  6. Please follow your dentist's instructions on how to apply the gel on the trays. Only a small amount of gel should be used in the middle of every tooth reservoir on the tray you wish to whiten.
  7. If there is any excess gel it should be wiped off the gums with damp gauze/ tissue.
  8. Once the trays are placed in the mouth, neither food nor drink (including water) should be consumed.
  9. After removing the trays, rinse your mouth with plenty of lime-warm water and brush your teeth with Sensodyne toothpaste. Trays should be thoroughly rinsed under cold water.
  10. If any sensitivity is experienced use the trays on alternate days instead. In addition, the use of ACP- Relief gel provided and brush gently with Sensodyne toothpaste. The sensitivity is often caused by excess gel squeezed onto your gums and this may also cause their redness. If this occurs, you may choose to apply less amount of the gel in each tooth compartment.
  11. If in any doubt, please contact us by email and we will be happy to assist you.
  12. Informed consent for home whitening will be explained and signed
  13. Pre-operative Shade recording: shade guide/ Vita Classic Lumin Vacum will be undertaken
  14. Home whitening technique: Opalescence/Enlighten Carbamide peroxide 10% to 16%; will be applied 8 hours per cycle/7days/2W,
  15. Chromatic stabilization & effusion of the free oxygen radicals may take up to 3 weeks (Lim KC. 2004), hence no restoration may be allowed within 3 weeks.
  16. Post-operative shade recording: shade guide/ Vita Classic Lumin Vacum will be undertaken.


Scientific evidence

The evidence from the literature suggests that the management of discoloured endodontically treated teeth by means of combined intracoronal teeth whitening technique bleaching is a valid treatment modality in terms of safety, efficacy, time efficiency and aesthetic outcome. The result from the 16-year prospective study by Amato et al. (2006) also demonstrated the chromatic stability of nonvital discoloured teeth, when subjected to the combined intracoronary teeth whitening technique. The clinical outcome has vastly improved the poor appearance of the upper right central incisor.




Internal non-vital teeth whitening Internal non-vital teeth whitening

Please see in the links below, a number of our clinical cases performed by Dr. Nico Kamosi