Moving neck-in-neck with the medical community, cosmetic enhancement has become all the rage in dentistry these days. A spin-off of the cosmetic explosion is whitening. Whitening remains one of the single most economical ways to enhance your smile. As Canadians and Americans, we can’t get enough of it, spending $1.4 billion annually on tooth whitening products. Statistics show tooth whitening procedures have increased an incredible 300 percent in recent years!
Over-the-counter systems claim to use the same ingredients and produce the same results as professional systems; yet the professional market claims to produce the only worthy results. The Food and Drug Administration (FDA) does not regulate teeth whiteners, and the Canadian and American Dental Association is siding with the professionals. So, where does this leave the consumer when they hear about somebody who just bought those strips and enjoyed great results?
The consumer is left somewhere between somewhat puzzled and downright confused. Most people hesitate or hold off completely on pursuing their whitest smile due to the uncertainty and fear of wasting time and money. To shed some light, we went on a quest to answer all the probing questions surrounding whitening — and hopefully disperse the myths and mystery behind this craze.
How does whitening actually work?
Most whiteners use a peroxide-based chemistry. Peroxide compounds have the ability to whiten teeth through an oxidation process. It has been demonstrated that peroxide has the ability to penetrate the inner aspect of the enamel within a matter of only a few minutes after application. There are complex organic molecules within the tooth that reflect a specific wavelength of light and are responsible for the color. It is believed that by releasing free radicals, peroxide has the ability to oxidize the color-producing organic compounds found within the enamel’s matrix. When these organic compounds are oxidized, the residual molecules reflect less light, or can also be described as colorless, thereby creating a reduction or elimination of the discoloration whiter teeth!
What peroxide compounds are used in a
whitening system?
Current compounds are hydrogen peroxide and carbamide peroxide. In-store or over-the-counter whitening systems use very low percentages of hydrogen peroxide. In-office whitening can utilize both carbamide peroxide and high percentage of hydrogen peroxide. Carbamide peroxide contains approximately 35 percent hydrogen peroxide.
What whitening treatment options are available?
How do they compare?
These can be classified into two categories:
In-Office
Power whitening (this is what we do at Glamorous Smile)
Power whitening can be performed with or without light technology. Light technology is referred to as photopolymerization and was first approved by the FDA for teeth whitening in 1996. There are two light techniques that can be used: blue-light or argon laser light. Both techniques require about one hour in the dental chair. Application of a high concentration hydrogen peroxide is applied to the tooth surface four times at 15-minute intervals. Both light systems work by accelerating the chemical reaction. This provides faster, more effective results.
Power whitening without light technology simply uses an in-office application of a high concentration of hydrogen peroxide to jump-start the process.
Both techniques (with or without light technology) will usually include an at-home whitening process. A whitening agent is placed on the teeth, usually once a day for half an hour.
The primary benefit of power whitening is that the process takes only one in-office visit and results can be dramatic and almost immediate.
Custom trays
Custom-fitted trays are made by first taking impressions (molds) of both upper and lower teeth. Flexible clear plastic trays are fabricated to fit precisely to your teeth. The benefit of custom trays is supported by literature that states whitening effectiveness is directly related to the percentage of peroxide and length of time it is in direct contact with the tooth surface.
With a custom tray the whitening agent is able to remain in direct contact with each tooth, allowing for more accurate and uniform whitening with less chance of seepage and gum irritation. Trays also allow for convenience of re-treating and touch-up as needed. Custom trays are typically more affordable than power whitening. However, a disadvantage in using trays is the self-placement factor, which can sometimes be a little messy and difficult to work with.
In-Store/Over-The-Counter
Strips
Whitening strips are probably the most common in-store systems used. To create a more affordable approach to whitening and simple delivery system, these strips were first introduced in 2000. There are currently three major manufacturers offering strip systems varying in concentration of hydrogen peroxide from 3 to 10 percent. The cost for whitening strip systems range from $25 to $60 and can easily be found in most grocery and drug stores. A whitening strip is a paper-thin piece of clear plastic coated with a thin layer of hydrogen peroxide on one side. The strip is peeled away from the backing, lined up with the midline of your smile and positioned over the surface of the teeth with the gel directly in contact with each tooth. Systems vary on length of time and duration of treatment. It is advised to follow the manufacturer’s directions.
Disadvantages of the strip system include the fact that the strips slide around easily and have the potential to produce uneven whitening. They may also cause increased gum irritation. Strips can also be messy during application and removal. One of the newest systems has a dissolving effect that can unfortunately leave a sticky residue and unpleasant taste.
Brush-on
Brush-on systems are currently found in a stylish pen. There are only a couple manufacturers offering a brush-on system. One end of the pen is a twist dial which, when turned, delivers the whitening agent to the opposite end where it is applied. A cap covers either a sponge-type or a narrow brush-type applicator that applies the whitening agent directly to the tooth. Cost is as low as $29.95 for a single pen. The primary benefits are the obvious: ease and convenience of touch-up whitening or single tooth whitening and complete control for placement on each tooth surface.
Trays
There are two types of over-the-counter tray systems. A recent manufacturer advertises its system as a tray. However, these are actually better described as pre-formed strips. These trays look and feel like strips that fit over the front of the teeth and wrap around onto the inside surface. These trays are pre-filled with a thin ribbon of a hydrogen peroxide-based gel. The cost is comparable to whitening strips. These are more secure than strips and provide more control with placement.
The other tray-type whitening is referred to as a boil and bite system. There are a few manufacturers, commonly found online, that offer this system in an attempt to create an at-home custom or semi-custom tray. These are pre-formed (arch-shaped) plastic trays designed to be softened in hot water and placed over the teeth. With biting and pressure they mold around the teeth. These are designed to be used exactly the same way as custom trays with placement of a whitening agent in the tray and fitted directly over the teeth.
What are the factors that influence the
whitening process?
A primary reason results vary significantly is because many factors influence the whitening process. Some of these factors are controllable; some are not. And they may vary from system to system and person to person. Therefore, it is difficult to make claims that will satisfy the conditions of all those wanting a whiter smile. Primary factors include:
- Color to start with – it is documented that those with more of a yellowish hue have greater response to whitening than those who have more gray or brown. Intrinsic (inside the tooth) gray discoloration is commonly seen in exposure to different types of medications. The most widely known is the antibiotic, tetracycline. Brown is often seen with excessive intake of fluoride, referred to as fluorosis. Fluorosis may also create a mottling or blotchy look to the enamel and make it equally difficult to achieve optimum results.
- Unique and inherent whitening potential – it is believed that we each have a level at which our teeth cannot whiten any more.
- Clean teeth – it is advised to have your teeth professionally cleaned to remove all deposits, as well as surface stain that may interfere with the whitening agent being in direct contact with the tooth.
- Percentage of whitening agent – meaning the higher the concentration, the faster the results. However, the higher concentration can also result in a greater risk of sensitivity. Therefore, the percentage of whitening agent should be determined based on: how sensitive your teeth are to begin with; if you have any root surfaces exposed; the delivery system you choose and over what period you want results. In-store or over-the-counter systems have a much lower whitening agent percentage, so it takes a lot longer and may require more frequent touch-up. In-office systems provide a higher percentage.
- Duration of time – the whitening agent is in direct contact with the tooth surface. This is delivery-system sensitive as well. And it is related to the ratio agent. Each system requires a different timeline and should be followed accordingly. The key is to maintain direct contact with the entire tooth to provide even and precise whitening results.
- Compliance – is easy when you choose a system based on your needs and concerns; when you use the system as directed and when you minimize risks. It is recommended to use an agent within neutral pH range. This is safer for the enamel and reduces sensitivity. Additionally, pay attention to all the factors that influence whitening and consult a dentist or your teeth whitening professional with any concerns.
- Oral habits – can play a major role in the whitening process. Before any application, it is a good idea to thoroughly brush and floss plaque, stain and food debris from the surfaces of the teeth. Maintaining good oral hygiene will keep your smile looking brighter longer.
- Avoid – foods and drinks dark in color or that are acidic (tea, coffee, sodas, wine, grape juice, chocolate, orange juice), smoking and chewing tobacco. Beware of oral home care products that contain alcohol and dyes/colors or may be high in abrasion or acidity.
