Teeth Whitening: Facts, Types, and Products That Work

Who doesn't love a dazzling, white smile? Tooth whitening is one of the most requested dental procedures done every year, with Americans spending nearly $2 billion annually to keep their smiles looking bright.

Over time, drinking coffee, red wine, smoking cigarettes, and simply aging can stain our teeth, as can certain medications such as tetracycline.

If you're looking to spruce up your smile there are many options available. The following slides provide some tips to help you choose the best tooth whitener for you!

Tooth "whitening" is defined as any process that will make teeth appear whiter. There are two ways this is commonly done: bleaching and non-bleaching whitening products. Often the terms "bleaching" and "whitening" are used interchangeably, but the U.S. Food and Drug Administration (FDA) states the term "bleaching" can only be used when a product contains bleach. A product is considered simply "whitening" when it removes food or debris from the teeth without bleach.

Bleaching products contain peroxide (hydrogen peroxide or carbamide peroxide) and these products remove both surface and deep stains on teeth and can cause teeth to become even lighter than their natural shade.

The active ingredient in tooth whiteners available from dentists or drugstores is peroxide (hydrogen or carbamide). Hydrogen peroxide is the actual bleaching agent, while carbamide peroxide breaks down into hydrogen peroxide.

The bleaching products you can get from a dentist are much stronger than those purchased over-the-counter. Whiteners used by dentists may have as much as 35% to 45% peroxide while the store-bought whitening kits such as whitening strips or trays usually have just 7% peroxide. Other ingredients in both dentist-dispensed and OTC whiteners include glycerin, carbopol, sodium hydroxide, and flavorings.

The American Dental Association (ADA) recommends if you choose to bleach your teeth you consult a dentist first. A dentist can come up with the best whitening options for you and supervise a treatment plan to avoid complications.

Professional whitening can be done in a dentist's office in about an hour. The procedure involves application of a tooth whitening gel containing between 25% to 40% hydrogen peroxide, and then aiming a special heating lamp at your teeth for three 20-minute intervals, with reapplication of the gel between intervals. Some dentists may also use a laser, which is reported to accelerate or activate the whitening process. A protective barrier is used during the whitening procedure to keep your lips, gums, and tongue away from the whitening gel so it stays in place on your teeth. For optimal results, the dentist will usually give you whitening trays molded for your teeth so you can follow-up at home with bleaching solutions.

A tooth whitening treatment at a dentist's office can cost about $500 for the light treatment, or $300 to $400 for the custom-made trays alone.

Over-the-counter teeth whitening kits have become popular since they are inexpensive and easy to use. They contain lower amounts of peroxide than the whitening products used by dentists, but some people can have good results though it will take more time. OTC whitening kits and products include whitening trays, strips, rinses, and toothpastes. Prices range from $25 to $100.

The American Dental Association still recommends dentist-supervised whitening as being the safest for your tooth enamel. The products used by dentists are also more effective at getting rid of deep stains. If you do choose to purchase whitening products at the drugstore, look for the American Dental Academy seal of approval. The ADA seal means products are held to a higher standard than required by law, and they have been evaluated and are found to be safe and effective.

Tooth whitening trays are one method of whitening your teeth at home. Dentists recommend dentist-dispensed take-home whitening kits because they contain a higher percentage of bleach for better results.

The dentist will take custom molds of your teeth and create fitted application trays made of flexible plastic. Fitted trays ensure bleach stays in close contact with the teeth for best results, they prevent saliva from diluting the bleach, and they minimize the amount of bleach that can leak out and possibly irritate the gums. Over-the-counter trays do not fit the teeth precisely, leading to leakage of bleach and sensitive gums.

Tooth bleaching products are either stored in syringes and added to trays before use, or pre-loaded into the trays. A dentist can also adjust the bleach concentration and give you a desensitizing agent to use before or after application. Kits often provide enough gel for one two-week treatment per year, plus enough for a few touch-ups in between.

One of the most popular ways to whiten teeth is with teeth whitening strips. These are made from a thin, flexible plastic and coated with a low concentration of bleaching product. The strips are pre-packaged and placed on the teeth, easily conforming to the shape of the teeth. They can be worn while doing other activities, and when the application time is up (usually about 30 minutes) they are discarded. Most are used twice daily for two weeks.

Strips are more effective than whitening toothpastes, but they can cause sensitive teeth and gum irritation. Tell your dentist if you use whitening strips and experience these side effects. Strips are generally less effective than custom-fitted trays because saliva can seep under the strips and dilute the bleach. Strips may not be long enough for a wide smile, and they often slip out of place.

Most whitening strips are considered safe, as the strength of the peroxide is low. However, be careful to avoid strips that contain chlorine dioxide, which can destroy tooth enamel.

One of the newest products that claims to whiten teeth are whitening rinses. In addition to freshening breath and reducing dental plaque and gum disease, these products also include bleaching agents such as peroxide that whiten teeth. Like mouthwash, just swish them around in your mouth twice daily before brushing, and manufacturers claim you may have to wait 12 weeks to see results.

Some experts believe that the short time the mouthwash is used is not enough to actually see results.

Toothpastes contain mild abrasives such as silica, aluminum oxide, calcium carbonate, and baking soda, which help remove surface stains. Whitening toothpastes do not contain bleach like professional whitening products, but they usually contain extra polishing or chemical agents that can help remove additional surface stains. They do not help with removal of deep-set stains. Whitening toothpastes may also be more abrasive than some dentists would recommend. Most whitening toothpastes can only get your teeth about one shade lighter.

If you do choose whitening toothpaste, look for the ADA Seal to make sure the product has been tested to be safe and effective.

Tooth whitening is safe for most people and the best candidates are those who only have mild to moderate discoloration. But there are certain types of discoloration that cannot be corrected by whitening treatments, and there are certain dental or medical conditions that may reduce the chances tooth whitening will work for you. These include:

• Porcelain veneers, dental crowns, caps, fillings, or dental bonding on the front teeth. These synthetic materials do not respond well to bleaching products. You may need new crowns or veneers if you want these teeth to appear whiter.
• Yellow teeth usually bleach well, however brown teeth may not whiten as much. Teeth with gray tones, white spots, or discoloration from a "dead" tooth may not bleach at all.
• Some conditions may become worse if teeth are bleached. These include: sensitive teeth or teeth with worn enamel, and patients with bruxism (grinding or gnashing of teeth) or temporomandibular joint disorder (TMJ/TMD). In-office whitening procedures may be able to be performed in some cases with these conditions. Consult your dentist.
• Tooth whitening is not effective if tooth discoloration is caused by medications or a tooth injury.

Tooth whitening performed by a dentist in-office is the most effective way to get the best and safest results. Stronger agents are used, but the mouth and gums are protected, and the dentist can customize the concentration of the bleaching agent. Further, a dentist can manage any tooth sensitivity or other issues that may arise from treatment. Teeth may be whitened up to 10 shades in just one hour.

The second-most beneficial whitening system would be a dentist supervised at-home bleaching product, which uses custom-fitted tooth trays. The bleaching agent usually contains about 10% carbamide peroxide and is used for two weeks, for about eight hours per night.

With so many choices, how do you know which whitening product is right for you?

Your first step should be to consult your dentist, whether you are planning to get a professional whitening treatment or want to try an over-the-counter product. Your dentist will let you know if you have any conditions which will not respond well to bleaching, or which might be aggravated by it.

Determine how white you want your teeth to be. An in-office whitening procedure can make teeth 10 shades whiter, while whitening toothpaste may only lighten teeth by one shade.

Factor in your budget. In-office tooth whitening done by a dentist will give the best results in the shortest amount of time, but will run you hundreds of dollars. Meanwhile, over-the-counter products will offer a modest improvement, for about $25 to $100.

Consider how much time you are willing to commit to the process. An in-office whitening treatment takes about an hour but will cost you. Over-the-counter methods are far cheaper but require using them about twice daily for several weeks.

Finally, remember that no matter what whitening treatment you choose, the results won't last forever. Foods, drinks, smoking, and medications can re-stain your teeth. Maintenance is required, no matter what whitening product you choose.