Teeth Whitening



What Is It?
What It's Used For
How It's Done
Non-Vital Whitening
Vital Whitening



What Is It?
Tooth whitening is a procedure that lightens teeth and helps to remove stains and discoloration. Whitening is among the most popular cosmetic dental procedures because it can significantly improve the appearance of your teeth at much less cost and inconvenience than other techniques. The majority of dentists perform tooth whitening.

Every day, a thin coating forms on your teeth and it picks up stains. Also, the outer layer of each tooth, called the enamel, contains pores that can hold stains. Whitening is not a one-time solution. It will need to be repeated periodically if you want to maintain the brighter color.

What It's Used For
The most common reasons for yellowing or stained teeth are aging, tobacco, tea and coffee, which can stain the surface of the teeth.

It is also possible to have stains that are inside the tooth. These are called intrinsic stains. For example, intrinsic stains can be caused by exposure to too much fluoride as a child while teeth are developing. Other causes include tetracycline antibiotics taken during the second half of pregnancy or given to children 8 years old or younger when the teeth are still developing.

Tooth whitening is most effective on surface stains caused by age, foods or drinks.

Cavities need to be treated before teeth are whitened because the whitening solution can penetrate decay and reach inner areas of the tooth, which can cause sensitivity. Also, whitening will not work on exposed tooth roots, because roots do not have an enamel layer. Receding gums can cause roots to become exposed. Whitening also does not work on crowns or veneers.

Whitening can be done in the dental office or at home. For in-office whitening, your dentist probably will photograph your teeth, which will help him or her to monitor how the treatment is progressing. Whitening in the office may involve two to six visits of approximately 45 minutes each. He or she also will examine your teeth and ask you questions to determine the type and severity of staining.

When the examination is complete, the dentist or a dental hygienist will clean your teeth. Once this is completed, the whitening procedure begins.

For whitening at home, your dentist will direct you to use custom trays that are made in the dental office and fit your teeth precisely. Home whitening usually takes two to three weeks. Over-the-counter kits also are widely available for home use. You should talk to your dentist about using these products, and use them according to directions to avoid overuse and possible damage to your teeth and mouth.

How It's Done
There are two main types of whitening procedures. When whitening is done on a tooth that has had root-canal treatment and no longer has a live nerve, the process is called non-vital whitening. Vital whitening means that the procedure is being done on teeth that have live nerves.

Non-Vital Whitening
Vital whitening may not improve the appearance of a tooth that has had root-canal treatment. If this is the case, your dentist will use a different procedure that whitens the tooth from the inside. He or she will place a whitening agent inside the tooth and will place a temporary filling. It will be left this way for several days. You may need this done only once, or it can be repeated until the tooth reaches the desired shade.

Vital Whitening
The most common type of vital tooth whitening involves placing a gel-like whitening solution, which usually contains hydrogen peroxides, in a tray that resembles a night guard or mouth guard. The tray is then placed over the teeth for a certain period of time — anywhere from an hour or two to overnight.

Tooth whitening can be done in the dentist's office or at home. In-office whitening (also called chairside whitening) has the advantage of allowing your dentist to supervise the process — and your progress — more closely.

In-office whitening usually takes between 30 and 90 minutes and can require up to three appointments with your dentist. The number of visits required will depend on the type of discoloration and how white you want your teeth to be.

Your dentist will start by asking about your medical history to learn how your teeth became discolored. Different types of stains will respond differently to the treatment.

Your dentist will apply a special gel to the gums to protect them from the whitening agent. Then the whitening agent is applied. The most common substance used for chairside whitening is hydrogen peroxide.

Some whitening agents are activated by special lights or by heat. After the whitening agent is applied, the dentist will shine the light on your teeth for a short time. Some dentists have started to use lasers as a high-speed alternative to conventional whitening procedures. Consumers like the high-tech aspects of laser treatments, but the technology is still too new — and too expensive — to justify its general use. The American Dental Association states that while the technique may be safe, it has not seen published data on the safety or effectiveness of using lasers for tooth whitening.

If your teeth are badly discolored, you may need more extensive whitening than can be done in the office. Or you may decide you would prefer to whiten your teeth at home.

For in-home whitening, your dentist will take impressions of your teeth and will make one or two custom mouthpieces to fit you, depending on if you are having both upper and lower teeth whitened. It is important that the mouthpiece fit well so that the whitening agent remains in contact with your teeth and doesn't irritate your gums. Over-the-counter mouthpieces are unlikely to fit correctly and can cause gum irritation if the whitening agent seeps out.

At home, you will fill each mouthpiece with a whitening gel your dentist provides, and wear the mouthpiece for several hours every day. Many people achieve the amount of whitening they want within a week or two, but you may need to wear the mouthpiece for four weeks or longer.

Your dentist may want to see you a few days after in-office whitening to check your gums. If your gums were exposed to the whitening agent, they can become irritated. If you are whitening your teeth at home, your dentist will want to check to make sure the process is working properly, usually after a week.

Whitening is not a permanent solution. The stains will come back. People who expose their teeth to a lot of staining may see the whiteness start to fade in as little as one month. Those who avoid staining foods and drinks may be able to wait six to 12 months before another whitening treatment is needed.

Re-whitening can be done in the dentist's office or at home. If you have a custom-made mouthpiece and whitening agent at home, you can whiten your teeth as frequently as you want to. You should discuss your whitening schedule with your dentist, and talk about what whitening products would work best for you.

Whitening is unlikely to cause serious side effects, although some people;'s teeth may become more sensitive temporarily. There may be mild gum irritation as well. Whitening procedures should not be done while a woman is pregnant because the effect of the whitening materials on the development of the fetus is not known. Since the procedure is cosmetic and option, it should be postponed until after delivery.


You don't have to be born with perfect teeth to have a bright smile. With a process called tooth whitening, or bleaching, it's possible to erase the stains and discoloration that occur naturally over time.


Q. Can all stains be removed?
A. Most of the time, yes, but not always. "Extrinsic" stains can be removed easily in the dental office or at home by applying a bleaching agent. This kind of discoloration occurs when the outer layer of the tooth is stained by such things as drinking coffee, tea, smoking or even eating a lot of spaghetti sauce or other staining foods.

When the inner structure of the tooth becomes darker or yellowed ("intrinsic" stain), the stain is more difficult to remove or, depending on its cause, may not be able to be removed at all. For example, tetracycline (an antibiotic) causes intrinsic staining, when used by children under age 8 or women in the last half of their pregnancy. These stains cannot be removed by bleaching.

Fluorosis, a cosmetic dental condition that results from overexposure to fluoride during tooth development, also is not always successfully removed by bleaching. Mild to moderate fluorosis, characterized by white lines, streaks or spots, can be made less obvious by using whitening products or methods. However, in more severe cases of fluorosis, when the teeth can become pitted and have brown, gray or black spots, bleaching will not work.

If stains are caused by nerve or blood vessel damage, root canal therapy may be necessary to prevent permanent staining. Even so, the tooth may darken despite the treatment. If bleaching externally does not remove the stain, a bleaching agent can be applied to the inside of the tooth, or veneers can be used to cover the outer tooth surface.

A third type of stain is called "age-related." It's a combination of intrinsic and extrinsic factors. As we age, the dentin (the inner portion of the tooth) gets slightly yellow. This can become visible through the outer enamel as it gradually becomes thinner over time.

Yellow stains are the easiest to remove with bleaching. Gray or black stains tend to be more difficult. Generally, stains that have just formed are easier to remove than stains that have been on your teeth a while.

Q. How white will my teeth get?
A. Well, that depends. If you have your teeth whitened professionally in-office or at home, you can choose to make your teeth up to seven shades whiter. Your dentist will show you "shade cards" that are similar to those used for choosing paint, so you can make a decision on which is best for you.

If you use an over-the-counter product (OTC), choose carefully to ensure it is safe, effective and reliable, and follow the directions carefully. OTC products will not produce the dramatic improvements that are available through a professional. Excess exposure to OTC bleaching products can damage your teeth.

There's been a trend in recent years toward whiter, brighter teeth. The shades that were popular a few years ago seem somewhat dingy compared with the effervescent whites that many people are choosing today.

When making a decision to have your teeth whitened, it is important to think about which shade most flatters you and not how white your teeth can get. Keep in mind that your habits also dictate how white your teeth will be. Nonsmokers and people who don't drink coffee or tea will retain their whitening results much better than smokers or regular coffee or tea drinkers. Occasional touch-ups may be needed to maintain the shade you want. This must be done with professional direction.

Q. Do I have to bleach all my teeth?
A. No. It's possible for you to have one or a select number of teeth bleached to match the surrounding teeth. However, this should only be done professionally.

Q. I had a root canal and now the tooth looks dark. Can bleaching help?
A. When a tooth has been darkened because of root canal therapy, it can be bleached by applying a bleaching agent to the inside of the tooth (also known as non-vital whitening). In this situation, the middle of the tooth (the pulp chamber) is cleaned out, and a bleach-soaked cotton ball is placed into the cavity. It stays in place for about a week and then is replaced with a fresh one. Eventually the tooth will bleach from the inside out.

Q. Why should I pay more for in-office bleaching when I can do it at home?
A. For uniform results, in-office bleaching is best. Before starting a whitening program, your cosmetic dentist will determine the health of your teeth and mouth and remove any surface stains and deposits. To help maintain the results of treatment, the dentist will customize your treatment to your particular needs and advise you of any changes that are needed to your daily oral care routine.

Professional in-office whitening is also more convenient. This is because the bleaching agents are stronger than those that are used in over-the-counter products. Your teeth will get significantly whiter in 60 to 90 minutes. Two or three visits may be required in some cases, but many people can get good results in a single session. Some in-office whitening gets your teeth many shades whiter because the light used in the office activates the whitening agent, making it more efficient. In-office whitening also avoids the use of trays, so you will not ingest any of the whitening agent.

Q. Are over-the-counter products effective?
A. There are a variety of peroxide-based over-the-counter (OTC) products that can be effective at whitening your teeth. The ingredients in home kits aren't very concentrated, however, so it may take several weeks to get good results.

OTC whitening products tend to be less expensive than having your teeth whitened by a dentist, but they aren't the ideal method to choose. Some OTC whitening kits contain mouthpieces that aren't custom-fitted to your teeth, that is, they do not fit snugly around your teeth. As a result, some parts of the teeth may be covered by the bleaching agent, while some parts may not. This results in uneven covering and bleaching. The bleaching ingredient also may leak out from the badly fitting mouthpiece and cause gum and other soft tissue irritation.

If you decide to use an over-the-counter product, you should first consult with your dentist. The dentist can offer advice, and can make a mouthpiece that fits properly to ensure the best results from the OTC product.

Q. What about whitening toothpastes?
A. Whitening toothpastes can help the teeth remain cleaner and therefore look whiter. However, the stronger toothpastes rely on abrasion, which can damage the teeth. When you use an abrasive on the outer layers of the teeth, the "newer" layer looks whiter. The problem is that this process causes the teeth to lose shine and luster over time.

These toothpastes do not actually whiten or change the shade of your teeth, but help prevent stains from sticking to your teeth. Results will take some time, and the change won't be very visible. Whitening toothpastes can be used to help preserve the results of professional in-office or at-home whitening.

Before you choose whitening toothpaste, be sure to look at the product's ingredients. Some toothpastes have less abrasive materials. Ask your dentist for advice before you make a decision.

Q. How long does bleaching last?
A. If you maintain good oral hygiene, and adhere to your dentist's directions for care, you can expect the results to last one to three years. You can maintain your white teeth even longer if you don't smoke, chew tobacco, or drink a lot of coffee or tea.

Q. I've had previous dental work on my front teeth. Will that be a problem?
A. Not necessarily, although it does complicate things. The bleaching agents that are used to whiten teeth don't affect tooth-colored fillings or other restorative materials. After bleaching, these areas may appear darker than the surrounding teeth. However, sometimes the restorative work is whiter than the natural teeth. In these cases, the whitened natural teeth will blend better with the restored teeth.

If fillings or other dental work cause your tooth to appear darker than surrounding teeth, your dentist can use bonding or veneers to make your tooth the same color as the surrounding teeth.

Q. Are there any side effects?
A. It is unlikely that you will have any serious effects from a whitening procedure. However, some patients experience mild tooth sensitivity after bleaching, and minor gum irritation. The sensitivity can be reduced with a prescription fluoride gel, but most people don't need it. The sensitivity usually goes away within a few days after bleaching is complete.

Irritation of gums or other soft tissues in the mouth is more of a problem with over-the-counter bleaching kits because the bleaching agents may leak around the edges of the mouthpiece.

Women are advised to avoid tooth whitening during pregnancy because the effects of bleaching agents on fetal development are unknown.


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