Tooth Bleaching (Whitening) Treatment Considerations for Patient

In the past few decades, the popularity of tooth bleaching, or tooth whitening, as
some people call the treatment has grown into one of the most popular dental
treatments.   Tooth bleaching has developed into three main categories:

  1. In-office (professionally applied)
  2. Home-use (prescribed and dispensed by
    dentist) and
  3. Over-the-counter (OTC) consumer purchased products.


The OTC marketplace has seen the evolution of gels, strips, rinses and chewing
gum. The OTC products have produced oral health concerns resulting from
undiagnosed or underlying oral health problems. Faders such as dental
restorations, extremely dark stains, tooth sensitivity, non-uniform single tooth
color difference, cavities, periodontal (gum) problems, exposed tooth root
surfaces, prior root canals, and antibiotic influenced internal colors have all
contributed to the varying success of the expended whitening results. The
incidence and varying degrees of tooth sensitivity may depend on the bleaching
material quality, operator, and applied techniques. Since consumers rarely report
adverse problems to the FDA, the American Dental Association advises patients
interested in bleaching to consult with their dentist prior to bleaching to help
determine the most appropriate method of bleaching, based on desired results
and safety.


In-office whitening (bleaching) materials are typically hydrogen peroxide based,
while some products are carbazide peroxide based. The strength of the in-office
bleaching product range typically 3-5 times more concentrated than at-home
bleaching materials. Regarding sensitivity of teeth while using the products, mild
to high tooth sensitivity can occur in up to two-thirds of users during the early
stages of treatment, with the duration of sensitivity individual. The
occurrence and severity of tooth sensitivity and gum irritation may depend on
material brand, quality, technique, duration of applications, and chemical
concentrations of products.


As in all dental and medical procedures and treatment, there have been questions
raised about the safety of tooth whitening during pregnancy. Since there are no
evidence based protocols for bleaching during pregnancy, dentists may
recommend deferring whitening procedures until the pregnancy has concluded


As a general consideration on bleaching. patients should begin with a general
dental examination that includes a health and dental history, along with
radiographs. If there is discoloration of teeth, due to favors such as trauma
and/or staining resulting from prolonged use of antibiotics, such as tetracycline,
the whitening expeditions of the patient may be unachievable without cosmetic
restorative treatment. Past history of tooth sensitivity and allergies, such as
ingredients found in the bleaching materials, are all factors to bleaching. Cracks in
tooth enamel, exposed root surfaces that resist bleaching (and may increase
sensitivity), translucency of the teeth edges, tooth anatomy and alignment, teeth
grinding/clenching habits and diets are also considerations that will influence the
whitening outcome. if dental restorations are present, the expense and risks
related to the replacement of fillings and/or crowns to match post-treatment
colors should be recognized and discussed before treatment begins. Smoking and
red wine consumption will influence the duration and outcome of the whitening
experience. Age is also a consideration, as teeth typically darker as we get older.


With tray bleaching, desired color change is normally seen in the 3 day to 6 week
range.  Although brown, beige, and light yellowed teeth may respond well to
bleaching, white discolorations and grey tooth shades may remain difficult to
change. The “background” of the white spots may be lightened to make the white
areas less noticeable. Nicotine stained teeth and tetracycline influenced grey
teeth may take months to see a color change. Tray systems available from a
dental office may have longer lasting results, safer in regard to concentrations of
materials, and more control of bleaching gels than OTC tray systems.


With in-office bleaching, proper isolations of soft tissue, such as gums and tongue,
is very important. Post-treatment sensitivity is unpredictable. There are some
studies that have suggested pulp irritation and tooth sensitivity may be higher
with the use of bleaching lights or procedures involving applying heat. Some
studies suggest heat and light application may initially increase whitening
appearance due to tooth dehydrations, which usually reverse with time. Some
studies suggest that the average number of in-office visits for whitening is three,
with the range of 1-6 treatments. A tray may be made for take home completion
of this process.


Presently, all non-internal tooth bleaching products remain unclassified by the
FDA, These products include all in-office peroxide based produds, at-home


dentist dispensed products, OTC products, as well as materials used in non dental
stores (such as retail stores). Tooth whitening products are developed and
marketed under U.S. “cosmetic” regulations.


In summary, a healthy smile is an important aspect to a positive self image along
with social interaction Tooth bleaching may be one of the most conservative and
cost-effective treatments to change a person’ s smile and image. However, tooth
bleaching is not risk free, nor a “permanent” result. Tooth bleaching is best

preformed under the supervision and care of a dentist, following