TEETH WHITENING- A general guide by Dr. Arvind Kittur

I am quite sure most of the readers are very familiar with the terms, “Perfect Smiles”, “Hollywood Smiles”, “Brighter and Whiter Smiles”.
Dental aesthetics play a major part in our lives. Tooth color, tooth shape and tooth size are of great importance to a vast majority of people and any change in those can have a negative impact on the quality of our lives and affect our self-confidence. I am referring here to a select few of the population who are driven by the trends and celebrities they follow on social media.
The increase in demand to have a better appearance, brighter and whiter teeth has made dental procedures like bonding, veneers and tooth whitening / tooth bleaching very popular.

Tooth whitening has become the most common option because it is a more conservative approach and can be performed in a controlled set-up under a dentist’s supervision. 3 other methods are common too, one of which is called In-office or Power bleaching. It uses a light source to activate the bleaching gel that is placed on the teeth for a stipulated amount of time. The other two are a dentist supervised home bleaching kit and Over-The-Counter (OTC) products for self-application.

● What is Tooth whitening?
Tooth whitening is one of the most requested dental treatments in many Dental practices and is a procedure carried out regularly at all branches of Apex Clinics. This procedure is growing in popularity in response to high public demand for aesthetics and it is also driven by social media to always have a brighter and whiter smile.
The procedure is carried out either at home using a home whitening kit with different whitening gel concentrations or in a dental suite using heat and light/a laser to activate the whitening gel.

● How does Tooth Whitening work?
The manner in which the teeth whiten post procedure is still sort of a mystery to most. By that I mean not completely understood to this day. The most commonly used whitening home kits contain Carbamide Peroxide as the active ingredient whilst the In-Office kits contain Hydrogen Peroxide.
From what is known, these gels when applied to the teeth enable the oxidizing agent that is present in them to penetrate the enamel and dentin to initiate a chemical reaction within the tooth. In turn affecting the tooth’s chromatic component that has caused it to be discolored, i.e. turning it from discolored to white. The treatment times and the number of applications required to achieve the desired results may vary for different patients due to the different concentrations of the chromatic component present in individual patients’ teeth.

● What makes a good candidate for Tooth Whitening?
Tooth discolorations or stains can be divided into two categories:

a) Extrinsic staining – as the word suggests, it is when stains that have accumulated on the tooth surface due to consumables that stain, like cigarettes, tea, coffee, red wine, etc.

b) Intrinsic staining – these are stains within the structures of the teeth (enamel and dentin). The most common intrinsic staining is caused due to Aging.
Yellow, light brown and orange-stained teeth are likely to have a higher success rate when whitened and often have a lasting result, although, they require lengthier treatments depending on the severity of course, usually spanning 3-4 weeks. The brown, orange and white spots seen in teeth which have been affected by Fluorosis, Tetracycline and Nicotine are slightly slower to respond to tooth whitening gels. They require longer treatment times to obtain the desired result. The brown-orange bands seen in severe cases of Fluorosis and Tetracycline-stained teeth would require further treatment like Composite or Ceramic Veneers.
Patients should be made aware that the results may vary with each individual case. Depending on the severity of the discoloration the treatment time could range from 1-3 months and the outcome would be person dependent.
Patients who have suffered accidental trauma to a single tooth from a sports injury or a fall and have undergone a root canal treatment for that particular tooth might notice it darken. These teeth can also be treated by using a technique called ‘Walking Bleach’. In this technique the treating Dentist will place the bleaching gel into a carefully prepared cavity in the tooth and allow the tooth to whiten internally.

● “Do it yourself kits”
As I mentioned earlier, tooth whitening has become a very popular Dental procedure, the demand fueled by social media and everyone wanting those perfect bright and white smile.
The whitening methods that I described earlier; the Home whitening kits or the In-office tooth whitening procedure can be heavy on the patient’s pocket, as most aesthetic procedures are not covered under dental insurance plans.
Enter “OTC”. Due to the increase in demand for these procedures, a significant rise has been seen on an array of products that have cropped up on the online and retail market. Over The Counter (OTC) ‘Do it yourself’ kits have made tooth whitening easily accessible to patients. These products are presented to the user in the form of “mouth-wash”, “tooth-paste”, “chewing- gum”, “dental-floss”, “paint-on-brushes”, “whitening-strips”. The concentration of the bleaching gel in these products is low as these procedures are carried out without professional supervision, the results and duration could. But their low cost and accessibility is their selling point.

● Concerns
The most common questions that I have been asked in my 30 years of practice:
a) Will tooth whitening weaken my Enamel?
b) Will my tooth have sensitivity, and will this sensitivity be permanent?
c) Will my gums become sensitive?
d) Will the gel produce precancerous or cancerous lesions in my mouth?
e) Is it safe to use it during pregnancy?
f) Will my old composite fillings become loose after tooth whitening?

Tooth whitening treatments do not cause weakness or reduction of the microhardness of enamel. Patients do experience tooth sensitivity during the treatment phase and maybe after the treatment is complete. These sensitivity concerns need to be addressed before the tooth whitening procedure. Patients with open exposed dentine, fractured or separated fillings, generalized weakened or lost enamel due to abrasion will need to undergo a thorough oral examination prior to starting the whitening procedure.
Sensitivity can be reduced by either reducing the concentration of the gel, reducing the time the procedure is performed, alternating the days procedure is performed (applicable for home whitening kits or OTC products), using desensitizing gels prescribed by the dentist. There is no study that shows these whitening gels cause cancerous or precancerous lesions in the oral cavity. There is no evidence that these gels could harm the fetus or infants, but it is not recommended for pregnant and lactating women to use tooth whitening procedures. Tooth whitening procedures will not weaken the bond in old fillings, but it’s recommended that any new bonding procedure be delayed 2-3 weeks after tooth whitening has been performed.

So, in general all the whitening products available in the market or at your dentist’s office are safe, the results and complications vary between individuals. Personally, I am a strong advocate of patients getting quality in their smiles rather than just having their teeth appear whiter. A healthier smile is one where the teeth are well aligned and the first thing that should be noticed in general is alignment, not just the whiteness of the teeth. My goals as a cosmetic dentist are that I firstly advise all my patients to strive to have a healthy oral status and then proceed to working towards enhancing their smiles, be it with tooth whitening procedures or using Veneers.
“Beauty is in the eye of the beholder”
The extent to which the whiteness of your teeth is beautiful is a personal preference. I am available, here at Apex Clinics Group to advise our patients to make correct informed decisions.

To healthier and happier smiles