Tooth Whitening: What's real and what's hype?

Over the last 20 years, we see more and more people asking about tooth whitening. They have questions like:

"Does bleaching your teeth hurt them in any way?" 

"Does it actually work and is it worth the money?"

"What about Crest White Strips? Is there any downside?"

source: e2ua

source: e2ua

Brighter teeth, a whiter smile does sound good to most people, but all the hype and marketing can leave us paralyzed. 

In today's Fiddlehead Dental blog article, I'll try to fill you in so you know whether its right for you. First, let's hit the most common questions we get...

SAFETY?  I've never seen a shred of evidence or even read about a single episode of trouble involving the kind of tooth whitening that we recommend in our office, or the whitening strips. Both are essentially harmless ways to remove staining molecules stuck to your teeth. 

I have heard bad stories from people who have visited one of those "Tooth Whitening Salons" in the mall, but other than that, gradual tooth whitening, done over a couple of weeks, may be the greatest, safest thing to hit dentistry in 100 years. (Novocaine was the previous "greatest thing"! ha)

DOES IT HURT YOUR TEETH? The peroxide used in tooth whitening preparations simply breaks down and eliminates the large molecules of staining chemicals that are stuck in microscopic pores on your teeth. It does not change the enamel in any way. However, some people do notice an increase in tooth sensitivity during the whitening process. For those people, we recommend alternating nights with the use of a Fluoride preparation to help decrease any sensitivity that may occur. 

IS IT RIGHT FOR YOU? Firstly, you have to know why your teeth are not white. You can't fix this in an affordable or permanent way unless you understand the source of the staining.

There are three types of staining:

  1. External Staining -  comes from things like coffee, caramel colored sodas, red wine, well water, or tobacco. It can also be from old plastic fillings that are not in good shape. These are the easiest types of staining to bleach.
  2. Internal Discoloration -  is due to genetics, serious childhood illness or exposure to medicines like tetracycline before the age of 12.  Usually, this type of staining gives the teeth a core brown or grayish tone that comes from deep inside the tooth. Simple tooth whitening will not be the answer. 
  3. Failing Dental Restorations - Old fillings and crowns can pick up stain at the end of their useful lives, or the gums can recede back from the dental work and reveal dark roots. Those problems would not be solved by tooth whitening gels. Sometimes it good to visit a dentist for a "smile update". Good dental work has a long life but eventually needs replacing.

Have you given any thought to the source of your stained teeth? If the stain is from foods, beverages or nicotine, basic tooth whitening will work very well. Otherwise, you might want to explore Porcelain Veneers. (See our website's info "cosmetic dentistry".) 

In any case, we see patients who come from very far away to have us up-date their smiles, and whitening is always a part of the plan.

Which whitening method is best for you?

There are four basic methods for whitening teeth:

  1. Over-the-Counter Whitening Strips or Gel.
  2. Take-Home Whitening Gels with Custom Trays made by a dentist.
  3. Cosmetic Bonding or  Porcelain Veneers.
  4. There is a 4th method of whitening that you might want to stay away from. These are the methods that use bright lights and one long visit to the dentist, or to a "tooth whitening salon". 

1. Over-the-Counter Whitening Strips or Gels: These products - much like Crest White Strips -  can be purchased at any drug store. Our patients who have tried them get variable results. About half say that they they've seen some real improvements in the shade of their teeth. Many feel that they would like better results. 

Crest White strips®are an example of this type of method. We have noticed that they work best for college age people with otherwise perfect teeth: no front fillings and very few staining habits. If you fall into those categories, whitening strips might be perfect for you. These products treat your teeth with a concentration of 1-3% hydrogen peroxide. This is a rather low concentration that is further diluted with your saliva. The chemistry is not strong enough to remove deep stains. 

This can also get expensive and it is VERY labor intensive given the trouble that you have to go to for weeks and weeks, and this is often repeatedly necessary several times each year. 

Make no mistake: I see some great results in people who are devoted to whitening with strips, but it takes far more time than I could possibly muster for myself. I'm too impatient to use the whitening strips.

2. Take-Home Whitening Gels with Custom Trays: These are prescription strength (10% - 20%) hydrogen peroxide gels that you get from your dentist. Essentially, the dentist makes models of your teeth and makes you some custom-made trays that fit over your teeth (and your teeth only). You put the prescription strength gel in the tray every day, for 10 -14 days, wearing the gel filled trays for about 1 hour each day. In two weeks, for most people, there will be a wonderful improvement in the brightness of their smile.

These tray/gel systems get better results than the whitening strips because a higher concentration of bleach is sitting on your teeth, protected by the custom trays from your saliva. 

And here's the best part.... Even though the process costs more to start with, you only have to re-whiten once every two to three years, and because you already have the custom tray, you just have to buy a few tubes of bleaching gel from your dentists.  At $16 per tube for the prescription gel, it will cost you about $64 to re-whiten every 2 to 4 years, once you have the custom trays.  (We sell the gel separately to our patients so they can re-whiten inexpensively like this every few years, but I'm not sure all dentists do this.) 

In our office, the cost for this whitening process is around $280 initially for both upper and lower teeth. (about $180 for just the upper teeth) After that, you can continue to use your old trays indefinitely!  

Over time, this is WAY more cost effective than the whitening strips which cost anywhere from $45-$50 a box, several time each year.  

*** If your problem includes stained old fillings, that plastic will probably not whiten, so you should still plan a visit to the dentist to see about the process of up-dating that dental work.

3. Cosmetic Bonding or  Porcelain Veneers: This is the only way to whiten teeth that have the deep stain from childhood that I called "Internal Staining".

 Both methods - cosmetic bonding and porcelain veneers - basically cover the teeth with plastic or porcelain, instead of trying to change the color. Both are good choices if you have deep internal staining.

The process can be affordable with cosmetic bonding, or the Cadillac and longest lasting option is Porcelain Veneers.  

With these options, plastic or glass coverings are permanently bonded over the front surface of each of your natural teeth much like a false fingernail covers your natural nail. We can correct the color, shape and position of the teeth in the smile with both these methods too.

We recommend these to patients whose teeth have any number of imperfections that can not be improved with simple bleaching. You will see endless examples of this type of change in our "smile gallery."

4. "One Session Bleaching": This 4th method of whitening is one that you might want to stay away from. These are the methods that use bright lights and one long visit to the dentist, or to a "tooth whitening boutique". They will report that your whitening can be done in one visit of 3 or 4 hours and you will be charged $500 - $1000. 

***But very good scientific studies show this method is not effective for longer than a few weeks. The leading dental researcher in the world, Dr. Gordon Christenson, found that you will have whiter teeth when you walk out of the office because the process has temporarily dehydrated your teeth giving them a chalky white look.  

By the way: The researchers got the same change in tooth color when they had test subjects drive around for one hour with their head out the car window and their teeth exposed to the sun and breeze from the moving car. 

Word to the wise: A permanent overnight change is unlikely to be the outcome of these "one session" bleaching . One thing that is very likely is that it may make your teeth hurt excruciatingly for 3 or 4 days.   

We have some experience with this: We bought the fancy light and tried the procedure on three willing volunteers. They all said that the whitening changes were temporary (lasted only a few weeks) and their teeth were exquisitely painful for three days after the procedure. The "whitening light" went to the dumpster within a week.  

So, there is an overview of your choices.

If after you read this page, you think your problem may be more than beverage or nicotine staining, take a look at our "Smile Gallery" to see some of our patients' smile transformations.

Using custom home whitening trays is easy! Check out our hygienist Jessi and these simple instructions!

(insert video Liesl!)

Call us today to get whitening trays made so you can have a pearly white smile for your special occasion!!