Teeth Whitening…What Works And What Doesn’t

White teeth have become a phenomenon in the United States. Turn on the television, open an entertainment magazine, watch a popular movie and you will see that all of the stars have brilliant and seemingly perfect white teeth. Remember Demi Moore’s teeth  in Ghost and compare to a current photo. Not only are they all crowned and veneered but her vertical has been opened. Think of old Tom Cruise before ortho and veneers reshifted his midline (still about 1/2 a tooth off to his left). These stars have the incomes to pay for a full mouth reconstruction or smile rehabilitation. We are talking about porcelain crowns and/or veneers, often at a cost of $1500-2000 per tooth. Is this an attainable goal for the average person looking to improve their appearance or chase a Hollywood smile? 

Such cosmetic dental work produces predictable and dazzling results because the patient’s smile is redesigned with porcelain. The artistry is in the hands of the dentist and ceramist, and this material will give beautiful and translucent results. However, if you have a fairly young, compliant patient who has nicely alligned and nonrestored anterior teeth, then tooth whitening also is a good way to brighten their smile.

Certainly more affordable and conservative than porcelain, tooth whitening systems do have their place in our cosmetic driven society, and people are hungry for it. Pick your patients carefully, however, and keep their expectations low because bleaching results are far less predictable as most of the control goes to the inherent biology of patients’ teeth and habits, not your skills. We are dealing with individual tooth composition, patient compliance, and occasional sensitivity concerns that all limit tooth whitening efficacy. However, almost every patient is interested in whitening their teeth, and I do believe that whitening works for certain people, so I will blog on the system that I use.

First let’s review the bleaching vs. whitening ideas. The FDA allows the word “bleaching” to be used only for products that contain hydrogen peroxide or carbamide peroxide…these two products will lighten a tooth to a shade lighter than its natural color. The word “whitening” can be used in the abscence of peroxides and when a tooth is cleaned of plaque, calculus, debris. Your hygienist’s prophy whitens teeth. Toothpastes also are advertised as tooth whiteners.

Think of the pearly whites of little kids’ teeth. As we age our teeth lose this luster because our enamel, the tooth’s outer covering, thins, cracks, and allows the dentin to poke through. Dentin is yellower and so teeth look duller. Extrinsic stain gets into our thinning enamel and discolors it even more…think colored drinks, smokes, grinding and bruxing, tartar. These types of stains are easily removed with prophys and bleaching. Intrinsic stain, however,  is more stubborn because it discolors teeth from the inside…tetracycline during tooth formation, excessive fluoride ingestion, internal resorption, trauma. Tooth bleaching systems claim to work here, but I am skeptical. I usually end up veneering or crowning such teeth.

It is also important to remember that every person has their individual tooth color make-up. This is the natural shade of their own teeth that they start out with before bleaching or any other cosmetic procedures. Some teeth are more green-grey and others are yellow-brown. Yellow-brown whitens better.

There are three whitening modalities today: over-the-counter products, in-office professional treatments, and professionally dispersed take home whitening products.

The over-the-counter whiteners are sold just as they sound…at your local store. They have a lower concentration of peroxide and contain strips, paint-on gels, or standard trays that the solution is applied into to and then placed in your mouth. Such popular products include Crest White Strips, Colgate Simply White Night, Crest Night Effects. I believe Crest White Strips are the most bang for your buck. My patients have reported the best results from this over-the-counter product. Average cost of these products range from $20-$100. 

A note on over-the-counter toothpastes that advertise to whiten teeth. They contain a negligible 1% peroxide and are applied to your teeth too briefly to take effect. They will clean your teeth but they will not whiten them, so don’t waste your money. 

In-office treatments are the second kind of whitening modality.  These bleaching lights and lasers promise a quick result with little vested time and so have great appeal in our busy society. Unfortunately current research shows that lights and lasers do not whiten teeth more, they simply dehydrate teeth and produce more sensitivity. Cost averages between $400-800 per session. Zoom, BriteSmile, LaserSmile, LumaCool, and Sapphire are such products. Patients ask for these because of the quick result, but I have found that the initial shade drop disappears just as quickly as it is achieved. The patient is out a considerable fee and two weeks later has yellow teeth again.

The third kind of whitening modality is take home products that are applied to teeth in custom fitting trays from one hour up to overnight. When made properly these trays can even be used in sensitive areas like recessed gums because they can be cut short. The patient has to be instructed on proper filling technique and amount and are then observed throughout the whitening duration (usually 2 weeks- 1 month). I have found that continued exposure to peroxide over a period of time whitens teeth most effectively, and so I like this bleaching modality the most of the three. 

In our office we use the Kor Whitening Deep Bleaching System from Evolve Technologies, a combination of two in-office treatments (up to one hour each) and one take home kit that patients sleep in. We also give out desensitizing applicators. This combination of in-office or boost treatments as I call them, coupled with take home solutions applied into carefully constructed custom trays for 2 weeks gives awesome results.  Dr. Rod Kurthy is the developer… www.korwhitening.com (866-763-7753) or  international +1-949-713-0909.  Again we are dependent on individual tooth morphology and personal habits, patients need to stay as free of tea, coffee, smokes, wine, colored sodas as their will power allows during whitening for best effects, but this system has produced the best results I have seen from a whitening system. Our fee is $570.

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