The dental climate on whitening has been like a storm of the century. For over 20 years, young and old alike have become increasingly aware of the appearance of their teeth. Bleaching has allowed a more affordable and less invasive option to whiter teeth and brighter smiles. As we prepare for holiday parties and gatherings with friends and family, this is the perfect time of year to have a more youthful smile and add a little sparkle to our holiday greetings.
Forecasting Tooth Color
Yellow, gray and brown are generally the three main color hues associated with natural tooth color. Yellow tones in the enamel are most common and are partially a result of the underlying tooth layer, called dentin, reflecting through the enamel surface, giving the tooth a less than white appearance. Some have a yellower dentinal layer causing more intense shading, while others have much lighter color, resulting in a mild tinting. Genetics and enamel thickness play a large role in tooth color. Newly erupted permanent teeth can have a pellicle (thickened film) on the enamel, further enhancing a yellower color. Baby teeth are naturally whiter than permanent teeth; hence they are often referred to as “milk teeth”, giving way to even sharper discrepancy in color when comparing them to the newly erupted permanent teeth. In addition, as we age, the enamel becomes thinner (well, at least that’s one thing on me going thinner) allowing more of the yellow hue to be exposed. Furthermore, long term exposure to stain offenders such as tobacco, coffee, tea, red wine and dark juices also provide the buttery back drop in our smiles that we all want to avoid! The ADA uses the rule that whatever will stain a white shirt can also stain our enamel.
Environmental factors like exposure to antibiotic therapy in the womb or during tooth formation will have an impact on the appearance and color of teeth. The vitality of a tooth will also determine color, both resulting in the bluish-gray and/or brown color palettes. Though there are internal bleaching treatments available, this blog will not be addressing these protocols just now. Please inquire with your dental professionals for promising bleaching methods of this type. The purpose of this blog is to help decipher between different less invasive bleaching options available today.
There are three main types of bleaching alternatives available today: Zoom (or other light enhanced bleaching treatments), Take- home trays and over- the- counter (OTC) bleaching strips. Hydrogen peroxide is the active agent in all true bleaching products and the higher the concentration, the whiter the results. Professionally applied bleach can have concentrations ranging 25%-40%, while OTC products average around 10%.
High intensity, immediate impact whitening results are best achieved using in-office light enhanced bleaching treatments. Zoom is a controlled bleaching treatment that uses a higher concentration of carbamide peroxide, which converts to hydrogen peroxide (25%) and an ultra violet light to produce same-day teeth whitening. The average costs of this type of bleaching therapy ranges from $400-$1000 and can produce up to 6-8 shades of whitening power, depending on the starting shade. A touch up kit with custom trays is provided as well, giving the patient opportunity for continued at- home enhancement when they desire. While in the office, the gums and teeth are professionally prepared and the bleaching agent is placed on the surfaces of the enamel. The Zoom lamp, offering a 33% increase in bleaching effectiveness, is positioned over the teeth in 15-20 minute intervals for approximately three to four sessions. Side effects of Zoom may include an increase in sensitivity for 1-3 days following the procedure, while “zingers” (a more intense second of discomfort) may occur in the first 24 hours.
As with all bleaching options, existing crowns, veneers and white fillings will not change or lighten with the bleaching procedure. Therefore, a consultation with a dental team member is necessary BEFORE the bleaching begins to help identify any areas that fall into this category and to make plans to replace darker restorations if desired by the patient. Zoom and other in-office bleaching options provide a maximum whitening finish that requires little compliance and offers instant results.
A Snow Fall
Take-home trays are like a beautiful snowfall that slowly builds an accumulation of brightness and whiteness beholden by whoever sees it. This is a fantastic bleaching option for those suffering from sensitivity and for those with more time and patience to achieve whitening results. Upper and lower custom trays are fabricated and delivered with a bleaching agent 10%-22% carbamide peroxide gel (an average of 3.5% -7% hydrogen peroxide). The trays are worn on 45-60 minutes a day for approximately 7 to 14 days, depending on the degree of bleaching needed to achieve the desired results. This is a controlled bleaching option, as the dental team will help monitor results and, if necessary, help to manage sensitivity as well. Take home trays offer convenience of bleaching at home and controlling the degree of sensitivity if applicable. Higher concentrations of fluoride gels and pastes are available to help pretreat areas of concern for sensitivity and can be applied between bleaching sessions to help defray discomfort while using this method. For example, if sensitivity occurs during any of the days of which a patient is bleaching, the procedure can be delayed or stopped for a day or two, allowing the pores of the enamel to re-mineralize and the nerve to settle, after which time, bleaching can resume again until the one to two week bleaching time is reached. Average costs for take-home trays are $200-$400. This includes the bleaching gel for the first full treatment. Supplemental touch-up treatments would incur costs for the bleach only. A side effect with this type of bleaching option is the possibility of a slight burning of the gums if the bleaching agent is not completely removed from the tissues while wearing the trays. It is important to avoid over filling the trays and to wipe the gum tissue of any excess bleaching gel that may escape from the tray during placement.
To achieve a quick and easy brighter smile with the reduction of surface staining, take –home whitening strips are a great option. For those with a mild discoloration or yellowing and for late teens, over –the-counter whitening strips are available nearly everywhere toothpaste is sold. These strips provide a low concentration of bleaching agent (10% carbamide peroxide or approx. 3.5% hydrogen peroxide active agent) which offers lower risks for quick onset sensitivity. Because the concentration is low, it could take three days to several weeks to see results. The costs average $10 -$55 and can last as long as in office treatments (one year stated by Crest White Strips). White strips are designed to be worn daily for 5 to 30 minutes a day. As with all bleaching options, it is important not to over bleach teeth as this could weaken the enamel if professionally unsupervised. Whitening strips can provide notable results but patience is the key.
A brighter smile is like a new spring day. It brings rejuvenation of life after a long dark winter. Energy and enthusiasm are both results of confidence and positive self-esteem. I’ve seen patients so excited about reaching this lifelong dream and have witnessed the impact of possessing a smile you can have confidence in and more importantly not feel self-conscience of. Having a smile you always wanted and can feel proud of is only a few steps away. Gone are the disappointments of the photos you’ve critiqued. Gone are the smiles with your lips closed or your hand strategically placed. Enjoy a white Christmas today and then let your concerns melt away!
– By Julia Guerra, RDH, BA