Wednesday, January 6, 2010

So What's the Story on Tooth Whitening?

Too Many Choices?

When you decide that you're interested in whitening your teeth, you soon find out that there are a ton of different options to choose from, many of which make the same promises but carry widely different fees or treatment times. By the time you're done digesting all the options, you probably aren't sure whether to bleach at home, at a kiosk, in a doctor's office, overnight, or during the day. Do you use a pen, strip, tray, or maybe a liquid? Do you need to be supervised by a dentist? Do you need a laser or a light? It can be confusing even for your dentist, as some companies may market one product to doctors while recommending another directly to consumers for use at home. There are many ways to bleach your teeth. The truth is that the before and after pictures you see may not tell the whole story. Think about when you see an ad for a product claiming to give you six pack abs or that promises quick weight loss. The examples they show are almost always the very best results. You can be sure that many other people  improved somewhat but fell short of what the pictures show. In fact, attaining a six pack or losing weight can be a great analogy for tooth whitening: everyone responds a little differently, so attaining the goal (in our case, white teeth) involves tailoring a regimen that works for your individual situation. In this post we'll sift though some of the more common options available to you and your doctor. Keep in mind that just like that friend who seems to be able to lose weight by barely exercising, there are people that can get great results with a minimum of bleaching. Then there are others that may need to bleach for 4-6 months or more to achieve the results they're looking for. When you go in prepared for a long treatment time, you won't be disappointed if bleaching takes awhile. Getting quicker results will be a welcome surprise.

Over the Counter

Over the counter options include strips, gels, pens, and liquids, and represent the lowest concentration of peroxide (the two main types used for whitening are hydrogen peroxide and carbamide peroxide, both of which are safe but whose active ingredients are used up over different periods of time). The benefit is that these are easy-to-use and you generally don't need to be supervised while using the product because the concentrations are low enough that side effects like sensitivity are less common. That same benefit can be a drawback, however, because unless you fall into that group that bleaches very easily, you may be disappointed by the results of one package of whatever product you're using. I'll often tell my patients to try no more than one or two packages and if they're disappointed with the results we'll discount our bleaching fee by that amount so they're not losing out by trying an OTC product first. If you've never bleached before, trying an OTC product may be worth a short trial run. The number of people I've met that can get the results they're looking for with this option is small but it is possible. For the majority of us, the best results are usually obtained by the next step up: dentist-supervised tray bleaching.

Custom Tray Bleaching

There are many advantages of custom-fitted take-home trays made by your dentist. First, a higher concentration of peroxide can be used because the active material is held in place by your tray. Also, since you can expect a professional strength product to have a higher chance of side effects the dentist supervision you receive will help minimize you chance of problems. Your dentist's exam before bleaching will allow him/her to identify conditions that make bleaching more difficult (like particular types of internal stains) and areas like recession that might cause sensitivity issues. Your dentist can adjust your treatment accordingly to make your experience more comfortable and help you achieve your goals. While you'll usually start to see results in two to four weeks, most people will get the best results with eight to twelve weeks of daily tray use. In extreme cases it can take up to six months to whiten. Just like dieting and exercise, you get out of it what you put into it. I recommend bleaching just one arch (either the top or the bottom) first so you can really see it working. After that it is easier to 'catch up' with the rest of the teeth. You can expect to invest more than with a single package of OTC whitener (probably about the same as five to six packages) but in many cases this is the best way to get the maximum results. It is also less of an investment than the final option: in office whitening.

Same Day In-Office Whitening

This is what you began to see a few years ago on makeover shows, and with claims of fast, easy whitening it generated a lot of interest as an alternative to wearing trays. You might compare this option to liposuction: it can be the easeist way to get results fast but you'll pay more, you'll still need to do some work on your own afterward, and not everyone is a candidate. The idea is that in a supervised way your teeth are exposed to a very high concentration of peroxide for about an hour. Some brands use a light to activate the bleach and others are designed to work just fine without it.  Your dentist has to place some protective coverings over your gums and lips to prevent injury to them. The good news: when it works it can be a great way to have instantly whiter teeth. The reason this hasn't fully replaced everything else: we know that only about 25% of people get an outstanding result with in-office treatment alone. Some of the whiteness that you see after the in-office treatment is due to the teeth dehydrating over the hour of being deprived of saliva and exposed to the air. Within a couple of hours they rehydrate and lose some of this initial brightness. Most people get a nice 'jump-start' but need to continue bleaching with trays at home for several weeks to reach their brightest levels.  Some dentists will include trays and take-home bleach in their fee for the in-office treatment, and starting with the in-office session may be a great way to shorten your overall treatment time. While sensitivity tends to be more of an issue, it will usually last only a day or two and can often be controlled with over-the-counter pain medication. 

Whether you plan to try OTC products or are interested in a treatment offered by your dentist, it can be very helpful to bring this up to your dentist so he/she can steer you in the right direction. Bleaching your teeth can improve your confidence and give you a radiant smile, and your dentist should be happy to help you achieve your goals in a safe and effective way. Feel free to ask any of your bleaching questions here and I'll be happy to answer them for you.