Teeth Whitening Treatments Guide

Dentist whitening is a common procedure in the lucrative field of cosmetic dentistry. For most people, our teeth are whiter and looks nicer when we are young especially our deciduous teeth (but that cannot be gotten back) compared to years later when we are working adults. As a person ages, the adult teeth gain a darker shade which is due to changes in the mineral composition of the tooth, such as loss of the enamel material or deposits of interprismatic extrinsic stains caused by diet and living habits such as coffee, vinegar, acidic fruits, red wine, tobacco etc. On the other hand, certain medications such as tetracycline antibiotics can cause unsightly intrinsic stainings of the teeth from within the tooth structure.

Despite all the arrays of tooth whitening products and treatments offered on the market today, there is only one common important element present, that is the carbamide peroxide teeth bleaching gel. This oxidizing agent can penetrate the tiny porosities in the crystalline structure of the tooth enamel layer and release oxygen to bind with the discolored deposits enlarged within the underlying dentin layer. Traditionally, tooth bleaching is done at the dental clinic with by applying a carbide peroxide based teeth gel onto each tooth. The concentration of carbide peroxide as well as other ingredients used in the tooth gel are what differentiate between the many brands and manufacturers of tooth gels available. For example, some are very high strength bleaching formula boasting 35% pf gel which claims to produce pearly white teeth in a very short time while others like Ultradent may position their opalescence 15% pf gels as gentle and does not cause any peroxide gum burns and tooth sensitivity pains. To ensure the bleaching gel performs its whitening task with improved efficiency, thin sticky stripes and teeth trays are also designed to help protect the gel from being washed away by the saliva production within our mouths. Laser light bleaching is also invented to transfer safe and cool light energy to accelerate the oxidizing process of bleaching. Due to the large and expensive medical laser equipment, such dentist whitening treatments are very expensive and cannot be performed DIY at home. No matter which type of tooth whitening product you may use, the effects of teeth bleaching generally last for several months, but if you have poor lazy oral hygiene or carry on with frequent smoking and uncontrolled diet of high pigment foods such as coffee, tea and red wine, the beneficial effects may disappear within weeks.

Internal staining of the dentin layer, such as due to tetracycline antibiotics can discolor the tooth really bad. Such internal discolorations are very difficult to whiten by the current external dental bleaching treatments. Although some dentist laser teeth whitening procedures such as BriteSmile are purported to be effective against internal teeth stains, it may take many expensive sessions and the final results may still be disappointing and unsatisfactory. In such cases, cosmetic dentists will recommend bonding and veneer for such patients, where a thin layer of ceramic or composite material is applied to the front of each tooth in order to mask the staining. However, these tend to look unnatural and being too perfect in terms of both whiteness and teeth neatness.

Many consumers choose between two general types of tooth gel bleaching - at office dentist whitening with prescription-only high concentration teeth gel, or at home DIY teeth whitening with low-concentration over the counter (OTC) products. High-concentration teeth bleaching gel require careful usage with regard to applying the gel carefully only on the teeth surface and avoiding the gums to prevent causing bleach burns on the patient. Yes, the price for brighter teeth in faster time, aside from the higher dental costs, is the increased occurrence of teeth sensitivity pains due to more breakdowns of the porous enamel layer as well as irritations on the gum skin tissues. Although potassium nitride has been found to be effective against bleaching induced tooth sensitivity, you cannot just include more tooth remineralization agents into the bleaching gel or you simply dilute the formula back to square one. The prescription teeth gels leads to more hydrogen peroxide formed on the tooth surface in order to oxidize the stain molecules on the teeth dentin. However, the maximum duration of time for this stronger bleaching and oxidization to take place must be carefully controlled or else overbleaching can occur which may cause irreversible damage to the teeth enamel and dentin structures. Since each person's teeth condition and strength is different, only a qualified dentist is capable of using high potency prescription teeth gels in a safe and correct manner. When you choose to bleach your teeth at home using non prescription teeth gels that contain the maximum ADA allowed carbamide peroxide concentration of 20% such as the opalescence PF 20% gels which are readily available online or in pharmacies, you must follow the given opalescence instructions and do not deviate from the maximum suggested bleaching time duration. Not every tooth whitening product is designed the same way. If you have used some whitening strips that recommend overnight usage whereby you put on the Crest strips before you sleep for the night and remove only the next morning, that does not mean you can do so for any other dental cosmetic products. For first time users that decided to go for DIY tooth whitening versus dentist in-office procedures due to the former being much more cost-effective, do not go for a high concentration opalescence bleaching teeth gel. Just go slow and choose a more gentle non prescription teeth whitener formulation.

To prevent saliva production within our mouths from interfering with the whitening process, teeth trays are designed to cover over our teeth and protect the bleaching gel from being washed away by saliva or accidentally licked away by our tongue subconsciously. These teeth trays are made from soft plastic molds and available from cheap generic mouth pieces to a customized set of teeth trays by your dentist or orthodontist to fit your set of teeth perfectly. Although a custom tooth tray can cost several hundred dollars to make, must wait for a few weeks and is quite expensive compared to the cheap instant one size fits all mouth pieces, they are really worth their high price because they can be reused in the future when you need to touch up on your re-stained teeth, they are made from better materials that do not bruise your gums, and they fit much better such that you get more even opalescence whitening and the peroxide teeth gels do not leak out easily and burn your gums.

The time to wear the teeth trays on depends on the teeth gel you are using, typically for about 15-45 minutes. This procedure is usually repeated daily until the desired whiter teeth shade is achieved. For in office dental whitening, you can expect the results to be visible within two to three sessions while for a gentle do it yourself treatment regime such as using the opalescence 10% PF, you may need to wear the teeth trays and repeat the bleaching for around three weeks.

At the clinic, dentists will also paint a light-cured protective layer on the gums and papilla tissues in order to reduce the risk of chemical burns to these soft delicate tissues. The dentist may also use hydrogen peroxide gels directly for faster bleaching to take place. For example, a 10% carbamide peroxide gel breaks down in the mouth to form hydrogen peroxide which is roughly equivalent to a purely 3% hydrogen peroxide formulation.

Although low-concentration at home tooth whitening may seem far less effective, it has to be so due to safety reasons. As we have described above, dental product companies know that they cannot rely on consumers to follow whitening instructions obediently and if they release 35% or 40% carbamide peroxide teeth gels on the market, they will receive a lot of complaints and negative press about their products being harmful and dangerous. There will be also a lot of unnecessary lawsuits and product returns to be handled by the customer service as well, which is very bad for their profit line.

For do it yourself whitening, you can choose to buy tooth gel that are bundled with generic mouth pieces or just the gels alone. If you do not have regularly shaped teeth, such as misaligned canines or molars etc you may have a problem trying to fit these generic mouth pieces over snugly. You may need to cut away some parts of it or bear with a tighter fit by jamming the mouth piece over your teeth but you risk bruising your gums and when the teeth gel seeps over those wounds, prepare to scream. The best solution is of course to custom make a prescription teeth tray with your orthodontist, but if you find it too expensive, there is also the cheaper do-it-yourself customized Smileplace teeth trays solution that cost only 99 pounds from United Kingdom where you are given putty to create an individualized teeth tray that suits your own teeth. With a good fitting teeth tray, you can choose to use either the gentle whitening gels available without a prescription or to buy special high strength teeth gels from your dentist. You can also choose to use the integrated whitening strips where small pieces of tag can be affixed to the front surface of your teeth to whiten them. These strips are soaked with a very sticky whitening compound such that they will not dilute or run down to your gums easily. However, they are only useful for the front surface of your tooth and you are likely to get uneven whitening because the strips may not stick well or cover all parts of your tooth. If you are uncomfortable with the idea of having the tips and gum lines of your teeth unbleached, then Crest whitestrips may not be so suitable for you. Most people use them because they are convenient and less obstructive within the mouth compared to the bulkier teeth trays.

For most people that have stained and discolored teeth that appear over the years, these yellowish stains are mostly due to acidic foods such as fruits, vinegar, soft drinks and cigarette smoke eroding the porous surface of the teeth enamel thus letting pigment molecules from dark colored foods such as coffee, wine, chocolate getting into the teeth dentin. Bleaching is an effective way to remove such stains and thus if a typical course of bleaching is correctly applied to such extrinsically stained teeth, most people will see visible improvements in the cosmetic appearance of their stained teeth by several shade given sufficient time for the bleaching to work. By the way, if you know you are born with greyish teeth, do not expect to get pearly white teeth after bleaching as it works only to remove stains and not color your teeth white! Moreover, there are also the intrinsic stains that do not respond well to bleaching. Tetracycline induced teeth stains may require persistent bleaching in order to show results, as it takes longer for the bleach to oxidize stains within the dentin material internally. Such stains commonly appear as greyish, greenish or bluish. A common side effect of bleaching is that white spot decalcifications may become more pronounced after bleaching, which actually worsen the patient's cosmetic outlooks. Bleaching is thus not recommended for patients with white spots on their teeth, or those having infected and decayed gums problems such as gingivitis or personifies or TMJ. Bleaching is most effective with yellow discolored tooth.

Laser teeth bleaching, also known as laser teeth whitening, Brightside teeth salon, Zoom teeth whitening etc utilizes laser light equipment to provide energy for accelerating the chemical oxidization process. Due to the expensive equipment and complex handling instructions, laser tooth cosmetic procedures can only be performed at authorized dental clinics. The equipment used is a safe medical laser that shines a cool beam of light to excite the hydrogen peroxide molecules to react and bind with the pigment stain molecules without overheating and causing tissue damage and inflammations to the tooth and gums. Nowadays, an argon laser is used to safely and quickly speed up the bleaching/oxidization process such that it can be completed within 45 minutes and visible improvements in tooth brightness can be easily seen. This argon laser does not radiate heat or UV emissions unlike the older method of using an arc lamp or infra-red laser. Chemical burns that can be caused by the peroxide contents within the teeth gel are not made worse by the argon laser.

The most common problems and side effects of bleaching your tooth (aside from not being happy with the improvements in color shades) are chemical burns on the gums, teeth and gum becoming sensitive to heat, cold or even air passing through, over bleaching and aggravation of existing gum diseases. Such cases happen more often with the misuse of high-concentration bleaching gels, with individual that have existing sensitive teeth or peronditis and bleeding gums, exceeding the bleaching gel usage time limit, etc. Tooth sensitivity due to weakening of the tooth enamel tends to be felt immediately within the first few teeth bleaching sessions. When this happens, the patient can choose to use remineralization toothpastes to help repair the enamel material in order to alleviate the pain. The regular bleaching sessions can also be reduced from daily to once every three days. Some people find that switching to a lower concentration teeth gel helps also in handling the onset of teeth sensitivity while still improving the whiteness of their teeth. Gum tissue irritation are mostly due to bruises caused by forcefully fitting an ill-fitting mouthpiece tray over the teeth although it is common to be a combination of that as well as chemically burnt since the carbide peroxide is well known as a skin irritant. Both of these conditions usually are temporary and minor cases recover within a week of withholding all tooth bleaching. The more minor cases include discolored mucous membranes which looked pale, as if they were bleached, which are probably due to the bleaching gel flowing onto the gums from the teeth. If you apply too much teeth gel liberally or you use a too loose fitting pair of teeth trays, they can happen to you too. Hyperodonto-oxidation, or "overly white teeth" which are obviously unnatural to onlookers who see such a person's smile can also occur when individuals aim for the perfect white shade and goes repeatedly for high concentration bleaching or even laser teeth whitening.

Feeling cheated or getting unsatisfactory results are also common complaints. Since tooth color improvements can be slow, the tiny bits of whitened shades may not be well noticed after every bleaching session, especially for consumers using low peroxide content gels for at home teeth bleaching. Unless they took a before treatment photo and compare after all treatments are completed, some people are not aware that they have a whiter smile now. Some other patients may have unrealistic expectations about their potential teeth whiteness and expect to have a fabulous smile like Holly Robinson Peete after a few attempts. Even more get bored and lost motivation to carry on the bleaching sessions as it can get tiring and muscle aches in the mouth while wearing the teeth trays. The tooth gels do not taste exactly pleasant either and a foreign object in the mouth often causes saliva to flow non stop and you have to keep spitting them out. When they do not observe significant results after one or two bleaching session, many gave up and complained that they have been cheated.

Some consumers also feedback that their whitened teeth tend to lose the newly gained whiteness smile very fast and returned to their previous dark and yellowish appearance or even worse than before. This rebound in teeth color shade is inevitable but still controllable and can be put off as long as your self discipline holds. Before starting to whiten your tooth, you must understand that results are not permanent; otherwise your teeth would have been always white since the moment they grew out when you are in your teens. Newly bleached teeth have lesser stain molecules on the tooth dentin, but at the expense of more opened and larger pores on the tooth enamel. Until these pores get filled up and repaired by your saliva or enhanced healing by remineralization toothpastes such as sensodyne toothpastes for sensitive teeth which contains potassium nitrate, it is very easier for stain and pigment molecules to re-enter the dentin layer through the existing holes. That is why it is very important to refrain from smoking, coffee, acidic drinks and foods etc, all the usual culprits for staining teeth during the period whereby you are undergoing teeth bleaching or at two weeks after you completed your tooth whitening and achieved your desired teeth brightness. This is the only way for you to retain the same level of brightness for a longer while and make your money and effort invested into the tooth whitening program more worthwhile. If you can keep this up, maybe you only need to redo teeth bleaching or just a minor touch up once every six months or so. And if you are wondering, the potential for teeth color rebound is the same no matter which type of teeth cosmetic treatments you undergone. For example, a recent study by Kugel has shown that at-office laser teeth bleaching patient lost 4 shades of brightness after only 30 days. One reason I can think of on why laser tooth bleaching patients tend to lose their newly gained teeth whiteness is because they paid for at least ten times more expensive dentist teeth whitening compared to the at home DIY tooth whitening group. They are more likely to refrain from food and habits that stain their teeth easily than to cough up another few hundreds to rewhiten their teeth. Since this group tends to achieve more brighter teeth after their treatments, they have a "longer" fall to drop before their teeth looks really yellow and stained.

Tooth whitening is not able to change the colour of composite resin fillings and other teeth restorative materials. It does not affect Amalgam, glass, ceramics, or gold. However, it can help restore the original color of these restorative fillings if they have become stained by smoking, foods, drinks, etc over time. Internal bleaching treatments are necessary for devitalized teeth that have undergone endodontic therapy but are discoloured due to internal staining of the tooth structure by blood and other fluids that leached in. Unlike external bleaching which brightens teeth by removing external stains on the teeth dentin layer, internal bleaching brightens each tooth from the inside out. That means it is a very manual intensive and expensive process as a hole to the pulp chamber of each tooth must first be drilled by the orthodontist. This is followed by cleaning and filling the root canal with a rubbery compound and injecting some peroxide gel inside each tooth to oxidize stains from within the dentin layer. This is often called the walking bleach treatment as the peroxide is added and sealed within each tooth for a few days and then replaced. This is repeated as needed, until the desired tooth brightness is achieved.

Besides the bleaching agent hydrogen peroxide, there are other various chemical agents that can be used to whiten our stained teeth. Even a tube of ordinary toothpaste contains small particles of silica, aluminum oxide, calcium carbonate, or calcium phosphate which act as a physical agent to polish off stains that are stuck onto the tooth surface. Whitening toothpaste will contain a higher concentration of such physical agents while it may or may not contain any bleaching agent. This is because carbide peroxide takes time to oxidize the teeth enamel layer but the maximum time you can take to brush your teeth really thoroughly is often not more then 10 minutes. That is why whitening toothpastes that contain carbide peroxide are often a marketing move to sell more features of the whitening toothpaste rather than it really having a significant bleaching effect. Note that physical tooth whitening agents are only useful for the external stains and discolorations, unlike the bleaching agents that oxidizes the tooth enamel itself and whiten its color.

Recently, there are many controversial reports on in-office teeth bleaching treatments being performed by non-dentists of questionable qualifications and skills. You can commonly see these trendy teeth whitening studios or boutiques at large mall or even mobile kiosks, and the personnel wear white robes just like dentists do. Notice they do not name themselves clinics, because they are not able to do so legally since there are no qualified dentists manning the equipments or offering consultations. Instead, they try to divert attention by advertising "in-office" dental whitening which sounds vague equivalent to in-chair or in-clinic teeth whitening procedures, and many unaware consumers have signed up without realizing the difference. Most of such setups are managed by the cosmetic industry people who have vast experience in selling to the vanity needs of you and me. They can be very persuasive and are much better experts at selling tooth whitening plans compared to your family dentist. However, they are not professional dentists and are not trained in the safety usages of peroxide based bleaching products, which can cause skin irritations and even burns. Many customers have thus developed chemical burns on their gums while their teeth still remain yellow and stained. Do not be surprised if the whitening gels they use have not been approved by the American Dental Association (ADA). The bleaching gel formula may contain too high a concentration of carbide peroxide in an over zealous attempt to prove quick tooth whitening results, but the risks of development teeth sensitivity pains are very high as well. Furthermore, government regulations on teeth bleaching products tend to be more lax in North America compared to the European Union countries. Despite numerous complaints from consumer organizations and lobbying from the health professionals that high concentration teeth whitening products should only be used under supervision of a dentist, there are always loopholes to be exploited especially in the lucrative cosmetic and beauty industry.

Off-the-shelf cosmetic teeth products by large reputable brands such as Crest, Colgate, Pearly, Ultradent etc typically follow ADA's guidelines on the safety carbamide peroxide concentration which ranges around 5% to 20%. As the bleaching solutions may be applied directly to the tooth, embedded in a plastic strip that is placed on the teeth or use a gel held in place by a mouth guard. Because the concentration is typically low to avoid toxicity, whitening often takes several weeks. Whitening treatments used by dentists are much more concentrated, containing substances with more than 30% hydrogen peroxide, such as the Opalescence Treswhite Supreme and require protection of the soft tissues.

Teeth whiteners such as hydrogen peroxide often enlarge the naturally occurring pores within the teeth structure which results in patients experiencing temporary sensitivity to hot or cold food and drinks, and sometimes even air as they suck in their breaths. Unless the pores are severely damaged, this tooth sensitivity will recover by itself eventually because our saliva contains minerals which refill such pores and allow our tooth to heal and repair themselves. As dentine hypersensitivity is a very common undesirable side effect from tooth whitening, ADA researchers have identified that applying potassium nitrate onto recently bleached teeth is very effective in repairing these enlarged pores at a much faster rate compared to our natural saliva. This is why the teeth bleaching gels available on the market today have mostly been reformulated to include potassium nitrate for teeth remineralization and there has been a drop in the number of complaints of tooth aches after bleaching.


Just a gentle reminder for some special cases where teeth whitening may not be suitable. People with sensitive teeth and gums, receding gums due to Gingivitis, wearing braces and defective teeth restorations should consult with their dentist prior to using any tooth whiteners. If you know that you are allergic to carbide peroxide, hydrogen peroxide or any other ingredients used in a particular cosmetic tooth product, do not even try and you should just ask your dentist for valuable advice. As we have mentioned above, teeth bleaching is a double edged sword which removes stains but creates holes in your tooth enamel. Excessive usage may remove too much tooth enamel leaving the weak dentin exposed and vulnerable to cavities, diseases and even chipping just from knocking your exposed teeth together. Do not undergo any tooth whitening if you are currently pregnant or lactating. If you are below 16 years old, your pulp chamber and the central nerve under each tooth can be easily irritated and inflamed by the tooth bleaching gel ingredients. Anyway, it is not likely for you to need teeth whitening so soon since they are not likely to be stained this young.