Teeth Whitening, Strips, Gels, Bleaching

Dr. Sargon provides many types of cosmetic dentistry at his office. One that is a commonly provided is teeth whiting. Dr Sargon offers patients at home teeth whitening kits. This is more convenient for the patient because they can whiten their teeth at their leisure and as often as they would like.

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Professionally Dispensed Take-Home Whitening Kits

Many dentists are of the opinion that professionally dispensed take-home whitening kits can produce the best results over the long haul. Take-home kits incorporate an easy-to-use lower-concentration peroxide gel that remains on the teeth for an hour or longer (sometimes overnight). The lower the peroxide percentage, the longer it may safely remain on the teeth. The gel is applied to the teeth using custom-made bleaching trays that resemble mouth guards.

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Examining Enamel

Most of us start out with sparkling white teeth, thanks to their porcelain-like enamel surface. Composed of microscopic crystalline rods, tooth enamel is designed to protect the teeth from the effects of chewing, gnashing, trauma and acid attacks caused by sugar. But over the years enamel is worn down, becoming more transparent and permitting the yellow color of dentin – the tooth's core material – to show through.

During routine chewing, dentin remains intact while millions of micro-cracks occur in the enamel. It is these cracks, as well as the spaces between the crystalline enamel rods, that gradually fill up with stains and debris. As a result, the teeth eventually develop a dull, lackluster appearance.

Teeth whitening will remove the stains and debris, leaving the enamel cracks open and exposed. Some of the cracks are quickly re-mineralized by saliva, while others are filled up again with organic debris.

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Bleaching vs. Whitening

According to the FDA, the term "bleaching" is permitted to be used only when the teeth can be whitened beyond their natural color. This applies strictly to products that contain bleach – typically hydrogen peroxide or Carbamide peroxide.

The term "whitening," on the other hand, refers to restoring a tooth's surface color by removing dirt and debris. So any product that cleans (like toothpaste) is considered a whitener. Of course, the term whitening sounds better than bleaching, so it is more frequently used – even when describing products that contain bleach.

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Tooth Discoloration: The Two Types of Tooth Stains

There are two categories of staining as it relates to the teeth: extrinsic staining and intrinsic staining.

• Extrinsic stains are those that appear on the surface of the teeth as a result of exposure to dark-colored beverages, foods and tobacco, and routine wear and tear. Superficial extrinsic stains are minor and can be removed with brushing and prophylactic dental cleaning. Stubborn extrinsic stains can be removed with more involved efforts, like teeth bleaching. Persistent extrinsic stains can penetrate into the dentin and become ingrained if they are not dealt with early.
• Intrinsic stains are those that form on the interior of teeth. Intrinsic stains result from trauma, aging, exposure to minerals (like tetracycline) during tooth formation and/or excessive ingestion of fluoride. In the past, it was thought that intrinsic stains were too resistant to be corrected by bleaching. Today, cosmetic dentistry experts believe that even deep-set intrinsic stains can be removed with supervised take-home teeth whitening that are maintained over a matter of months or even a year.

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What Causes Tooth Staining?

• Age: There is a direct correlation between tooth color and age. Over the years, teeth darken as a result of wear and tear and stain accumulation. Teenagers will likely experience immediate, dramatic results from whitening. In the twenties, as the teeth begin to show a yellow cast, teeth-whitening may require a little more effort. By the forties, the yellow gives way to brown and more maintenance may be called for. By the fifties, the teeth have absorbed a host of stubborn stains which can prove difficult (but not impossible) to remove.
• Starting color: We are all equipped with an inborn tooth color that ranges from yellow-brownish to greenish-grey, and intensifies over time. Yellow-brown is generally more responsive to bleaching than green-grey.
• Translucency and thinness: These are also genetic traits that become more pronounced with age. While all teeth show some translucency, those that are opaque and thick have an advantage: they appear lighter in color, show more sparkle and are responsive to bleaching. Teeth that are thinner and more transparent – most notably the front teeth – have less of the pigment that is necessary for bleaching. According to cosmetic dentists, transparency is the only condition that cannot be corrected by any form of teeth whitening.
• Eating habits: The habitual consumption of red wine, coffee, tea, cola, carrots, oranges and other deeply-colored beverages and foods causes considerable staining over the years. In addition, acidic foods such as citrus fruits and vinegar contribute to enamel erosion. As a result, the surface becomes more transparent and more of the yellow-colored dentin shows through.
• Smoking habits: Nicotine leaves brownish deposits which slowly soak into the tooth structure and cause intrinsic discoloration.
• Drugs / chemicals: Tetracycline usage during tooth formation produces dark grey or brown ribbon stains which are very difficult to remove. Excessive consumption of fluoride causes fluorosis and associated areas of white mottling.
• Grinding: Most frequently caused by stress, teeth grinding (gnashing, bruxing, etc.) can add to micro-cracking in the teeth and can cause the biting edges to darken.
• Trauma: Falls and other injuries can produce sizable cracks in the teeth, which collect large amounts of stains and debris.

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Teeth Whitening Risks­ ­

Teeth whitening treatments are considered to be safe when procedures are followed as directed. However, there are certain risks associated with bleaching that you should be aware of:

• Sensitivity: Bleaching can cause a temporary increase in sensitivity to temperature, pressure and touch. This is likeliest to occur during in-office whitening, where higher-concentration bleach is used. Some individuals experience spontaneous shooting pains ("zingers") down the middle of their front teeth. Individuals at greatest risk for whitening sensitivity are those with gum recession, significant cracks in their teeth or leakage resulting from faulty restorations. It has also been reported that redheads, including those with no other risk factors, are at particular risk for tooth sensitivity and zingers. Whitening sensitivity lasts no longer than a day or two, but in some cases may persist up to a month. Some dentists recommend a toothpaste containing potassium nitrate for sensitive teeth.
• Gum irritation: Over half of those who use peroxide whiteners experience some degree of gum irritation resulting from the bleach concentration or from contact with the whitening trays. Such irritation typically lasts up to several days, dissipating after bleaching has stopped or the peroxide concentration lowered.
• Technicolor teeth: Restorations such as bonding, dental crowns or porcelain veneers are not affected by bleach and therefore maintain their default color while the surrounding teeth are whitened. This results in what is frequently called "Technicolor teeth."

• Whitening results: are not fully seen until approximately two weeks after bleaching. This is an important consideration if you are about to have ceramic restorations and want to be sure the color matches that of your newly bleached teeth.
• Ifcosmetic bonding, porcelain veneers or other restorations are part of your treatment plan, they should not be placed until a minimum of two weeks following bleaching to ensure proper adhesive bonding, function and shade matching.

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