Tooth Whitening 101: Why Slow and Steady Wins the Race

Author: Chris von Tersch, D.D.S.

What types of teeth whitening are available?  What works the fastest?  Is teeth whitening bad for my teeth? What is the best teeth whitening procedure for me?  I answer questions like this all the time.  Over the years, ideas have changed regarding teeth whitening and it is worth while to delve into the subject.

Teeth whitening, or "bleaching" has been around for decades and remains the most requested cosmetic dental procedure performed by dentists across the country.  Teeth whitening usually involves the topical use of either hydrogen peroxide or carbamide peroxide (which breaks down into hydrogen peroxide) on the teeth. The enamel has microscopic pores which build up stain over the years from pigmented foods and beverages. (ie: spaghetti sauce, berries, coffee, tea, red wine, etc)  The hydrogen peroxide enters the pores of the tooth and bubbles out the stain with the end products being oxygen and water.  This process can cause short-term sensitivity in some individuals which may determine how long he or she elects to whiten per session.  Other whitening techniques involve the mechanical removal of surface stains but if harsh abrasives are used, the enamel could be damaged.  For the sake of this article I will refer to three categories of teeth whitening: home remedies, over-the-counter solutions, and services provided by dental professionals.

Home Remedies:  I am not going to comment on the safety/effectiveness of the various home remedies. They usually range from harmless and ineffective to downright destructive.  Most of these techniques have not been adequately tested and could cause damage to ones teeth and gums.  I would exercise extreme caution in considering any "experimental" or  "home" teeth whitening techniques.

Over-the-Counter Solutions:  There are several products that can be purchased over-the-counter that claim to give their users "whiter, brighter smiles".  Some are quite effective and some can be damaging. 

Tooth whitening toothpastes are very common but by themselves are minimally effective at whitening teeth. They are good at removing surface stains and can lighten teeth slightly.  They either use a mild abrasive or hydrogen peroxide or both.  Use caution as some of these toothpastes are too harsh and can remove or damage enamel.  If one is serious about whitening his or her teeth, a gentle whitening toothpaste is a nice maintenance adjunct after achieving your goal shade with a more effective technique.  

"Whitening pens" and other paint on whitening products have become increasingly popular.  They seem to vary in effectiveness so I would read reviews online prior to making a purchase.  Most of them use a concentrated amount of hydrogen peroxide to achieve their effect.  They are nice because they are portable and good if one is interested in "whitening on the go".  Caution should be taken when products claim that they can "whiten veneers and crowns". Surface stains can be removed from porcelain but the color of the porcelain itself cannot be lightened.   

"Whitening strips" are still the most popular over-the-counter technique.  Strips have been around for more than ten years and were made popular by the Crest company.  The strips have a gentler solution of carbmide peroxide or hydrogen peroxide embedded into the plastic strip that the user molds over his/her teeth and leaves in for 30 minutes to an hour.  Some advantages to the strips is the fact that they are reasonably inexpensive (approx $25-$55 per box) and they are effective.  Some disadvantages are that it can take several boxes to attain one's goal shade and also the strips are a fixed size so individuals with larger teeth will not whiten evenly because the back teeth are not covered. I have heard patients complain about their fingers turning white with the product and not liking how the strips can slide around on their teeth.

Spas, medi spas, kiosks at the mall, and so many other "over-the-counter" sources exist which sell bleaching solution that goes into some type of tray and is placed over the teeth.  Some of these trays are to be boiled in water by the consumer and then formed to his or her own teeth. This system produces an ill fitting tray which allows the whitening solution to ooze onto and irritate the gum tissue.  Some vendors actually take impressions of customers teeth in order to make better fitting, custom whitening trays.  This system is the most similar to what a dentist may do, however there is no dental professional to assess if the customer is in fact a good candidate for bleaching.  (Are cavities present?  Is there gum recession or erosion of the roots at the gumline?  Are older fillings present that may be breaking down, allowing for bleaching solution to reach the deeper areas of the the teeth?)  Also there is no dental professional available for follow up or to help personalize the treatment for the individual.

Dental Office Provided Whitening Services:

Years ago, there were many "Extreme Makeover" types of television shows where every participant received either some sort of "Turbo Bleaching" or a mouth full of "Davinci Veneers".  Fast bleaching became popular, whether it was called "laser bleaching", "power bleaching" or went by one of the brand names.  The procedure would happen in the dental office and a dental professional would place a more concentrated solution of either hydrogen peroxide or carbamide peroxide and expose the teeth to a very bright light or laser to "activate" the whitening material.  The patient's smile would be considerably whiter after only one or two sessions.  Now if the procedure was completed with no whitening solution, the result would be virtually identical because a great majority of the whitening effect from this technique is from the light dehydrating the teeth.  If no further whitening techniques are utilized, the teeth will return to the original color once they rehydrate.  Studies have shown that the light has zero effect on the whitening of the teeth and because the light does warm the teeth, it could damage the nerves of the teeth.  

This brings us to what many consider to be the gold standard in teeth whitening which is well fitting, professionally made bleaching trays and a carbamide peroxide or hydrogen peroxide solution that is tailored to the needs/whitening goals of the patient. The patient takes them home and uses them at his or her convenience.  Some people will elect to wear their trays more often or for longer periods, if comfortable, in order to achieve their whitening goals.  Some people will need to take breaks of one or more days between the days they bleach if they experience sensitivity.  During the active phase of teeth whitening, the patient comes in for regular "bleaching checks" at the dental office.  These "check" appointments are critical, allowing the dental team to monitor the patient's progress and if necessary, modify the patient's at-home instructions as to help him or her receive maximum benefits.

Most individuals would like his or her smiles to feel great and appear healthy, clean and bright.  In addition to good oral hygiene, professional dental cleanings, and the care of one's dentist, many patients can benefit from teeth whitening.  As discussed, whitening options abound, but the safest, most effective, longest lasting technique is a lower concentration solution used over a greater amount of time under the supervision of a dentist.  So as far as teeth whitening goes, slow and steady does win the race!

Keep Smiling!
Chris von Tersch, D.D.S.