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Nothing but the Tooth column: The basics to whitening your teeth

Dr. Richard Greenberg
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Q: I hear so much about bleaching, pros and cons, and I wonder if once and for all you can give me and I am sure other of your readers the overall picture on whitening our teeth.
- D.S.

A: First and most important to remember is that there are no cons to bleaching or whitening your teeth. The only one I can think of is dollars spent. If we put that issue aside (I will return to it later) there are various products, a great number of promotions, as well as many different techniques. Basically, any one that appeals to you and stimulates your desire is appropriate.

Of course, some will work better than others, some techniques are more cumbersome than others but I believe that each has the potential to get a result. Whether it is the one you are looking for is not predictable. Some teeth whiten very easily and some do not at all. That (we think) has something to do with the tooth structure itself and can also be related to the technique chosen.

I would advise to first try whatever you feel is cost effective knowing full well that often you “get what you pay for.” You can be surprised. I was in active practice when bleaching teeth came to the fore. At first it was done only by dentists and their staff and once entrepreneurship rose up as it always does in our society, many other ways to whiten with less cost and purportedly easier access became popular.

As with everything, some work better than others. As time went on, I learned not to speak negatively about any technique. Honestly, whatever works is just fine.

There are a few things to remember. Bleaching materials are oxidizing agents and these can be caustic or irritating and possibly painful in the sense that your teeth and/or gums may become sensitive. The teeth could become sensitive to hot or cold, gums could be sore or could be just achy but all is reversible and will go back to normal in time. Usually just a few days. Much depends on your teeth and gums and is therefore very individual.

I would put all of the out-of-the-office, “over the counter” techniques in a similar category. Some are more involved, some are more or less expensive, but all, if directions are followed, can work. I say “can” because remember, some teeth just do not whiten. We as dental professionals do not know exactly why but assume that it is the character of the tooth structure.

When bleaching was first introduced to our profession, I decided to try it on myself as I did not want to validate or support or deliver anything that was not ethical and that I was not comfortable with. My technique consisted of making models of my teeth, then making clear flexible trays that fit my mouth very well. After that, I placed bleaching material in the trays and placed them in my mouth and over my teeth. If there was excess, I carefully wiped it off, so as not to irritate the soft tissue in my mouth and the trays were, in the early days, left overnight. That was done night after night.

We then learned that two hours a day for a week (more or less) could achieve the same result. Later on, we found that 30-45 minutes per application was fine as we learned that the material would lose effectiveness in a short time. You the patient were advised to do this until you got the result you desired, or you just got tired of it or your teeth became too sensitive.

All in all, we learned. We also learned that some patients wanted results faster with less hassle and cared little about cost so “in office” bleaching became popular. That technique bothered me academically because the bleaching agent was much stronger and with that came more danger of irritating the soft tissue around the teeth, or even the soft tissues of your mouth in general. If a great deal of care is taken on the part of the practitioner, these negatives can be avoided. It was up to the dentist as to whether to offer that technique. And of course, the dentist’s responsibility for the care needed to be taken. Because the in-office technique took much more office time, the cost was much higher.

Overall, in our society, it appears that for many, having whiter teeth is a positive thing in terms of appearance. If that is something you desire you can consult with your dentist or you can try any of the methods currently available.

If you were to ask me my preference, I would say that the original method is the most preferred. I say that because the bleaching agent is not as strong as the in-office procedure and therefore has less potential for the annoying sensitivities that can occur.

I also like that technique because the delivery system for the material (the trays) are custom fit by your dental professional and therefore less material is used and there is less cost overall. The cost is obviously more than the over-the-counter alternates but is fairly predictable in terms of outcome. Also, if you are an adult and your dentition does not change, those trays can be used for a very extended time as long as they are cared for. That way, you can “touch up” with more material for a day or so whenever you want to once again “brighten your smile” and the cost is then minimal because you only need the material. The trays should fit for a long time.

I hope my answer was clear and of course, If anything else comes up in the dental question area, do not hesitate to ask as I am sure you know that if you have the question, many others do as well.
Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at dr.richard@nothingbutthetooth.org.