The marketing specialist in our clinic has made an interview with me about teeth whitening to be presented for our clinic patients,

here it is

how teeth whitening works??

Bleaching or whitening is generally an oxidation process. When this peroxide teeth whitener gel activated a free oxygen is released and penetrates the tooth enamel to react with the large molecules of dental stains. This reaction produce a smaller lighter molecules which cause the teeth to become whiter than before.

This will make me ask ,what is the causes of dental stains??

Usually teeth are white when they erupt but prolonged contact with staining food and drinks (coffee, tea, smoking and wine) without regular brushing will give the opportunity of the stains to accumulate deep inside the teeth and become harder to remove.  Also some drugs , plaque accumulation, general medical conditions, large amalgam fillings and dental caries can produce very deep staining.

Ok now we know that teeth whitening is an oxidation process. This will lead to a very common question about the harm or effect of teeth whiteners  on human enamel? or in other word is dental bleaching is considered safe from a scientific view?

A very good question that i have to answer daily in my clinic. We have to say that the effect of teeth whitening on enamel was one of the most discussed issues between researchers in this field and we won’t be able to mention every opinion said about this here but i will try to summarize the results after carefully reading most of the researches published about the safety of teeth whitening.

• Teeth whitening has little effect on teeth enamel surface roughness and chemical composition. The effect is not extreme or even un noticed clinically and has a very little clinical actual significance. To ease it we will say that the effect is usually equivalent to keeping carbonated beverage in you mouth for minutes.
• Even this little effect is auto repaired by the natural calcium ions presented in saliva in a matter of days.
• If you still afraid of this issue you can ask your dentist to prescribe you any re-mineralizing gel  that contains fluoride or amorphous calcium phosphate (acp) and be sure that your teeth will be even better than before.

Great, But i think that we missed a very important question. Is teeth whitening really works? Will i see actual results?

Yes for sure in most of the cases it works well, all you need is to choose a good product and used it as instructed. We have to say that Some cases are resistant  and won’t respond to teeth whitening but it still a very low ratio.

so you are saying that some cases won’t respond to bleaching, Is this means that the results will vary from a case to another?

yes but in most cases you will have an acceptable to wow results. But this leads to a very important point for both dentist and patient , Keep the expectations realistic and low as possible as the high expectations in teeth whitening will lead to disappointment. We should remember that the human teeth shouldn’t be chalky white this is un natural and will look artificial, Only we want the adult teeth to be as white as a child teeth and this will be great, natural and good looking.

Are home teeth whitening as good as over the counter or home teeth bleaching alternatives??

This is one of the most popular questions regarding teeth whitening. I will compare between the two techniques here briefly but in both cases i recommend that you consult you dentist before starting any type of teeth whitening even the home bleaching so he can choose the best solution for your case and inform you if there is any contraindication of the treatment.

I remembered now i wrote a great article about this comparison between home and dentist teeth whitening you can read it from here.

At home vs dentist teeth whitening

but i will summarize it here as much as i can:

1-Comfort: dentist whitening is more comfortable as it takes much shorter time and the gum is isolated so the gum burning is minimal. With at home teeth whitening the patient have to wear the tray over night for 4-7 nights which can be very annoying

2-Cost: sure at home teeth whitening is much more cheaper.

3-Color change: my personal opinion is that dentist whitening is more effective that at home whitening although some researchers state that a similar results can be achieved with the home bleaching but after a repeated use.

ok  lets say that i want to save some money and use home or what you call  over the counter teeth whitening product, There is many forms and types of these products can we review them quickly?

home teeth whitening tray based systems: This is the original ,oldest and the most trusted  home teeth bleaching system introduced in the markets. Personally it is the first solution i recommend for my patients as i feel that this type investigated widely and we can say that the results are expected some how. The disadvantage of this system that the patient have to wear the tray for hours over night which may be uncomfortable to some patients also it coast a little bit more than the other systems.

Teeth whitening stripes: This is the second recommendation and this option is gaining popularity and trust these days specially after some researches that state that it is as effective as the tray based  systems. here is link of one of these researches

http://www.the-o-zone.cc/HTMLOzoneF/abstracts/ab197.pdf

Teeth whitening pen or brush on systems: some researches also recommend this solution although clinical results of this systems appear to be inferior to tray systems and strips. But we have to say that teeth whitening pen systems offer the most comfortable, easy to use and cheap solution.

OK this will lead to another question,  The markets are full with hundreds of teeth whitening products and many brand names which brand name you recommend??

First thing be aware of the scams. i have to say that most of the products available are ineffective or even harmful to your teeth so you have to search for the products that has FDA and  ADA approval and quality seal.

Also stick to the famous companies that has a good reputation in dental products as these company has a reputation to conserve and expose their new products to extensive testing so you can be sure that the product is safe and effective.

Last thing avoid collecting customer reviews for teeth whitening products from the internet as the marketing teams of the scams are very active and filling the web with thousands of pages of fake reviews.

And again ask your dentist about the best type.

Doctor you are giving me a very diplomatic answer, If you recommend a product to your patient what will it be?

ok i prefer to describe for my patients the home products of the world leader companies in the field of professional teeth whitening that we use in our clinics. For example Discus Dental, Ultradent and Ivoclar Vivadent are a pioneers in the field of professional teeth whitening and has a very good home teeth whitening products so i recommend the home systems of these companies.

Another option will be the products of dental care products pioneers like Oral-B, Crest, Colgate, Rembrandt and the similar companies.

So after teeth whitening what should i make to conserve the results for a longer period?

just the routine oral hygiene procedures and regular brushing, avoiding staining food like tobacco and coffee, regular tartar removal and polishing at your dentist clinic also if you will eat or drink something that will stain your teeth you have to brush just after eating not to give the stains the chance to penetrate deep in your teeth.

sometimes it will be good to have a touchup visit every 6-8 months to keep the results.

Usually how much the effect of teeth whitening remain ??

we can say from 1-4 years. But the patient has to follow the normal oral hygiene procedures like regular brushing and calculus removal and polishing every 6 months. We have to say also that even after the teeth shade rebound it usually gets back to a lighter color than before.

thanks a lot doc and have a great day.

Teeth whitening popularity is rising rapidly these days as every one wants a pearl white teeth.  The concept of teeth whitening is based on the oxidization effect of free oxygen on stain particles. The teeth whitener or the teeth whitening agent releases free oxygen that penetrates the tooth to reach the deep layers where internal stains present.

When the free oxygen attacks the large molecules of dental stains it breaks it to a smaller particles that is lighter in color.

There is many forms of teeth whitening  available but generally we can categories it to.

• Dentist applied (which called dentist or professional teeth whitening)
• Dentist prescribed (which called at home teeth whitening).

The home teeth whitening method start by your visit to you dentist to examine your teeth and to be sure that there is no contraindications for teeth whitening treatment  like caries or gum recession , So please don’t start applying any of the products available in the market without dentist prescription as this may be dangerous and many of these products lakes the proper testing and evaluation, So your dentist is the best one who can choose you what to use and how to use it AND sometimes you are contraindicated to use teeth bleaching at all.

Dentist or professional teeth whitening products are based usually on hydrogen peroxide as an active ingredient . Some times carbamide peroxide is used but it release half of the oxygen released by the same concentration hydrogen peroxide so many dentists prefer the hydrogen peroxide based whiteners.

The procedures of teeth whitener application is depending to the system but generally we can summarize it as follow:

1-Careful examination

2- Calculus removal and teeth polishing: This is a very important step and i think it is the cause of the failure that happens with over the counter teeth whiteners. When teeth scaling is neglected the free oxygen released by the whitening gel react with tartar, plaque and superficial stains and after this reaction there will be no oxygen left to react with the deep dark stains that cause the dark color of the teeth  which will lead to failure of the treatment.

3- Soft tissue isolation : This is the reason that makes professional teeth whitening more safe and less annoying than home teeth bleaching as the dentist will isolate the gum, cheek and lips not to come in contact with the teeth whitener gel which cause the material to be more concentrated on the teeth, This can  also diminish the burning effect of oxygen on gum and lips. There is many ways to isolate the soft tissue either by using rubber dam to cover gum and lip or painting isolating resins to gum and lips before applying of the material.

4-Application of teeth whitening gel:  Teeth whitening gel may be used directly as a painting to the labial surface of the teeth or may be loaded to a custom tray that the patient wear. Also some systems like ZOOM needs light source to be activated and others may be activated chemically with no need to light. generally light systems are a little bit expensive and supposed to be more effective although some authors stated that the efficacy  is almost the same but i see that light activated systems are a little bit more effective.

The application time vary from 10 min to 45 min in some systems and also the number of application vary according to the case and the system used.

5-Rinsing the gel and removal of the insulator system.

6- Applying of desensitization gel: Dentists prefer to apply desensitizers after finishing of the whitening process as this will relive the sensitivity that happens some times and also repair the tooth surface enamel and remineralize  the lost calcium from the tooth.

After all dentist applied teeth whitening is considered the best solution to have a whiter teeth if you can afford it. It is safe,  fast and have the best results the only disadvantage is the cost as it usually coast from 500- 1000 $ which is much higher than you usually pay for home teeth whitening systems available in market so forget all the faulty information on the internet and choose it, If you can’t afford it then let your dentist describe any good at home system,  It will work too.

Bleaching techniques overview:

having a bright smile is everyone’s dream these days especially that the procedure become really popular, effective, affordable and almost harmless .Teeth whitening can be introduced in many forms that can be categorized in two main categories “dentist applied” and “home bleaching”. Dentist applied is simply when the application of the material is performed in the dental clinic using high concentrations of hydrogen or sometimes carbamide peroxides bleaching gels the process here take about one or two visits 30m-1h .

Home  teeth whitening in the form of trays (night guard), stripes or any other forms is applied by the patient after being prescribed by the dentist. Home bleaching agents usually based on carbamide peroxides solutions with varying concentration. For example tray or night guard bleaching technique the carbamide peroxide is in the form of gel that is retained on the teeth by the use of custom tray that is prepared by the dentist or a ready made tray that can be adapted easily by the patient  to the teeth . The patient wear the loaded tray every night from 3-7 days till the patient reach the satisfying color.

So after our fast overview about the dental bleaching forms available let’s talk a little about the causes of gum problems during dental bleaching procedures.

Why some patients have gums burning during and after teeth bleaching:

The bleaching process is mainly an oxidation process simply the free oxygen released from the peroxides inside the whitening gel breaks the large molecules of stains into smaller and lighter molecules. Unfortunately the contact of the oxidative peroxides with the gums can cause burning , Gum turn into dead white color as a result of oxidation  this is a temporarily harm and will be reversed in hours as we will mention afterword.

So how to prevent gums burning during teeth whitening:

First thing the patient have to be assured that minimal gums burning is normal during bleaching and can be managed easily or even prevented with a little effort.

During “dentist applied bleaching” the dentist usually isolated the gums in a way or another sometimes using some kind or resin that is painted on the gums or even rubber dam that cover the whole mouth and exposing only the anterior teeth that need to be treated.

In home bleaching technique the most important thing is to follow the manufacture instructions :

1-Using too much gel on the tray will cause the excess to ooze on the gingivae which will cause more burning so don’t overfill the tray and if any excess gel comes in contact with the gums remove it quickly to keep the burning minimal.

2-Also don’t exceed the application time advised by the manufacture or your dentist not to burn your gums also may cause teeth sensitivity.

3-last thing be calm i know that the gums looks very bad but don’t worry in a matter of hours it will retain it’s nice pink color so nothing to worry about and enjoy your nice looking smile.

last thing call your dentist if the burning last more than 24 hours.

Dental discoloration  is one of the most problems that annoying dental patients especially females. These days can be considered the era of white teeth. So before thinking about teeth whitening you should first understand why the tooth become stained from the beginning trying to avoid stains as much as possible.

Types of dental stains

A-discoloration  from inside the tooth(internal):

discoloration  that present inside the tooth can come from tooth pulp, colored materials that retained inside the tooth material during tooth development or an extrinsic stains that can penetrate inside the tooth from outside

Internal discoloration that is formed before the eruption of the tooth:

This type of dental discoloration can be caused by genetic defects that affect the tooth during tooth formation and cause the tooth to be rough and porous which make it stains very easy or even erupt stained from the beginning , increased fluoride uptake(during pregnancy or early childhood)  also  can cause severe staining, also some drugs can cause severe staining when used during pregnancy and early childhood like tetracycline antibiotic.

Also physical trauma during dental development (pregnant mom, or early childhood) can cause dental discoloration  and deformations.

last thing some diseases can cause tooth discoloration during dental development like(porphyria, infant jaundice, vitamin deficiency, phenylketonuria, haematological anaemia and many bleeding disorders disorders) because the blood pigments are retained inside tooth dentine.

Causes internal stains that is formed after the eruption of the tooth:

MINOCYCLINE antibiotic :

minocycline is an antibiotic that used to treat many infections. The use of this antibiotic especially  with the adolescent and young patient . The discoloration  is caused by the reaction of the minocycline that is circulating in the blood vessels inside the tooth pulp with the tooth dentine. This reaction causing intrinsic discoloration that cant be removed even after the treatment is stopped.

nerve death(pulp necrosis) :

This can be the result of bacterial, mechanical or chemical irritation to the pulp. Pulp death cause breaking of the blood cells and release of the iron blood iron pigments (hemoglobin) and also fermentation of the other organic materials inside the dead pulp by the bacteria all of this causing stains that penetrate the tooth dentine. To prevent this discoloration you must treat teeth with caries and  traumatized teeth  as early as possible to prevent the stains from going deep inside the tooth dentin

read more about pulp death and root canal treatment from here

Dental caries tooth discoloration:

dental caries can cause dental staining from light yellow to even deep black color. discoloration here come from the bacterial products of the bacteria causing the caries also stains from food stagnate in the cavity and penetrate the broken enamel .

Dental fillings or materials :

Amalgam is one of the most common filling materials that used to fill carious teeth. Unfortunately   amalgam is a metallic mixture that contains silver, mercury and cupper  so it simply rust in the oral conditions producing a very dark oxides that penetrate the tooth causing  a dark grey colour which can be very bad looking if used in the smile line. so you should pay a little more to change the treatment plan to be more aesthetic (using tooth colored restorations or covering the tooth with  veneers or crown will help for sure)

AGEING stains:

Thinning of enamel, dentine deposition, stains accumulation and changes in the saliva composition cause the tooth to be darker by time.

B-Extrinsic daily acquired external stains:

. They cause superficial colour changes, which are removed by prophylaxis.

Plaque

plaque and calculus on the surface of the tooth  give it a yellow appear ance this type of discoloration should be removed by the scaling and polishing periodically(6 m)·

Tobacco

Tobacco in the form of cigarettes, pipe, cigars and chewing  tobacco can cause very dark deep discoloration that can even penetrate the tooth and become very hard to remove because tobacco make the tooth become bitted and easy to be penetrated by tobacco stains· So if you are a smoker try to wash the tobacco remnants as fast of possible not to penetrate the tooth and affect it’s enamel surface, so especially brush your teeth before going to sleep .

tooth stains from food and beverages:

Consumption of food and drink such as coffee ,tea ,red wine and berries , curry, and colas results in surface discoloration .It may be that tea and coffee in the freshly prepared state cause more staining of teeth and dental restorations than ‘instant’ brands . so if you like tea or coffee it is ok but brush your teeth just after drinking tea or coffee no to give it the chance to cause  staining. also using the whitening tooth pastes can be useful but follow the instructions not to hurt your enamel.

Chlorhexidine mouth wash  :

using mouth wash’s containing chlorohixidine for a prolonged period can cause also teeth staining

Every body in the world now want his teeth to be lighter in color. In our dental practice we receive hundreds of questions about teeth whitening or (dental bleaching) . Most of the people asking about teeth whitening are concerned mainly about teeth whitening safety.  As a clinical expert and scientific researcher in the field of esthetic dentistry i can say that no one could answer this question by  saying yes or no.

Sure it is better not to answer this question yourself , Ask your dentist he know your case, he knows your dental history and your dental state and sure he is the only one who can say if it is safe to use home dental bleaching trays or strips etc.

what if you just want to know more before you go to you dentist keep reading and i will discuss the most important issues about home teeth whitening safety.

Home teeth whitening(teeth bleaching) effect on tooth structure:

1-Tooth surface (enamel layer):

from the  inventing of home(night guard ) teeth whitening  by van Haywood et al in the late 80s the scientists is investigating it’s effect on tooth surface properties.After a thousand research is done concerning surface roughness, tooth surface roughness and chemical composition we can list the results in easy to understand words as follow

home teeth whitening if used properly  has little or no effect (and considered safe)on the  tooth surface of the healthy, non carious, non sensitive or properly filled tooth.

which means the researches stated  that there is slight increase in surface roughness, slight decrease in hardness and slight calcium lost from the teeth enamel. But all these bad effects are in the acceptable range and so home teeth whiting considered practically harmless. Also many researches stated that most of these effects is also reversible after months by the mineralizing effect of the human saliva(as human saliva rematerializing teeth enamel  as it contains calcium naturally ).

2-Home teeth whitening effect on gums( healthy gum) :

Although the recent teeth whiteners like home dental bleaching gel,  strips, trays etc. is much more safe than the old ones. We shouldn’t forget that dental whiteners are basically oxidative materials (peroxides). SO the patient must follow the manufacture instructions not to burn the gums  or causing permanent problem to the permanent gum problems .

But we can also say that using the current whitening  products  for home whitening properly is considered safe to the healthy gums .

so when can the teeth whitening harm your teeth :

although the general safety of teeth home whiting there is cases that dental whitening can be really harmful and should be done under close supervision from a specialized dentist.

1-improper  use of teeth whitening treatment:

Again dental bleaching it is a oxidative caustic materials use it in wisdom way and as advised by the manufacture or your dentist. Don’t keep it on tooth more than instructed by the manufacture this will cause porosity and surface roughness that can make the tooth have caries easily and also stained again very easily to a darker color.

2- carious teeth :

Using the teeth home whitening strips, trays etc. on tooth even with small caries can kill the tooth nerve(pulp) the free oxygen will penetrate the tooth via the carious spot and reach the dental pulp which can cause severe sensitivity or even pulp death witch will need root canal treatment to be treated. so if you have caries treat it first and bleach later

3- gum rescission:

Using home whitening on tooth with gingival rescission can cause extreme sensitivity  because the root surface is exposed and it is really sensitive and this sensitivity increased by the application of bleaching agents (tray,strip or any other form)

4-bad filling:

using tooth whitening agents on tooth with leaked bad filling can cause severe sensitivity and even pulp harm ,

5-sensitive tooth:

A sensitive tooth need to be treated first by desensitizers before attempting to bleaching it because the free oxygen from the bleaching agent can increase sensitivity and harm the pulp.

6-Pregnant woman:

No in formations about safety yet but teeth whitening is not an emergency treatment it can wait

7-weak creaked enamel also can a contra indication for dental bleaching

also if you started the whitening  treatment  and feel any remarkable pain, sensitivity, burning or allergy stop the treatment and contact your dentist

keep smiling show your teeth

DR. A. galal

dr.agalal@speakasp.net