What are my Options for Whitening my Teeth?

Teeth whitening is one of the most common cosmetic procedures requested by patients in the dental office.  To achieve the desired outcome (how white) most economically and effectively, it is important to determine why the teeth are dark to begin with.

 There are many reasons why teeth may appear dark.  Darkening of all the teeth is often a result of what we put in our mouth.  For example, the dark colored foods we consume like tea, coffee, red wine, cigarettes and tobacco products, as well as antibiotics taken as a child, can discolor teeth. Genetics can also contribute.  If one or two teeth are dark it may be due to trauma, root canal treatment, inadequate hygiene due to crowding, or an old restoration. Once your dentist has determined why the teeth are discolored and the patient expresses how light they want their teeth to be, a treatment plan can be devised. There are several options for whitening teeth. 

If a patient would like their teeth a few shades lighter than their current teeth shade, whitening may be a great option. Mildly discolored root canal teeth may be lightened with external whitening or with internal whitening performed in a dental office.   If the desired outcome is to be significantly lighter than the current shade, whitening may not achieve the desired result.  This is especially true with tetracycline and genetically dark teeth.  To correct more intense staining, restorative options should be considered.  Restorative options may include veneers or crowns.  A complete list and explanation of whitening treatment options are:

Internal whitening.  This option may be used with root canal teeth that have discolored. It is performed in the dental office and may done in combination with external whitening.  The dental team will discuss the expected outcomes and monitor your progress.

Supervised in-office teeth whitening.  This option achieves whitening the fastest.  A very high concentration whitening gel is applied while in the dental office.  This works best when combined with at-home whitening.  The dental team will discuss expected outcomes and monitor your progress.

Supervised at-home whitening.  This may be accomplished in two different ways.  One option is your dentist makes custom fitted mouth trays for you and dispenses whitening gel for you to use at home.  The other option is dispensing disposable whitening trays, also to be used at home.  Whitening materials vary in concentration and how long they need to be worn.  For light staining the desired whitening may be achieved in as little as a few days but most often 10-14 days.  More intense staining will take longer.  The dental team will discuss these options and expected outcomes and monitor your progress.

 Over-the-counter whitening.  These products are sold in drug stores and over the internet for at-home use.  Drug store recognized brand name versions tend to be reliable but do not contain desensitizers which protects the teeth from becoming sore.  Internet versions can be effective however there is a large black market of copycat materials which may not be effective.

 Whitening toothpaste.  There are many toothpastes on the market today claiming to be whitening.  Most have abrasives to remove external stains, these are harmful to the teeth.  Some have also added hydrogen peroxide as a whitening agent.  Hydrogen peroxide works as a whitening agent only when it is in direct contact with the teeth for enough time.  The short time of brushing is insufficient to create any significant whitening.

Restoration[RGD1] .  For teeth that are intensely discolored or not responding to whitening, another option is restoring the tooth or teeth with veneers or crowns.

 A common side effect of whitening is sensitive gums and/or teeth.  Sensitive gums are due to the whitening gel getting on the gums.  Careful use of trays and gel is important to minimize gum sensitivity.  If gum sensitivity does occur, applying Vitamin E gel can help.  Tooth sensitivity may occur when using an over-the-counter whitening product because these products do not contain tooth desensitizers.  Dentist dispensed whitening gels usually contain tooth desensitizers.  Even with desensitizers, teeth may become sensitive.  If this happens, stop whitening and contact the dental office for advice.  People with very sensitive teeth may chose not to whiten.

It’s also important to know that existing restorations will not whiten.  If you have fillings, crowns or veneers whitening agents will not work.  If your teeth match your current restorations, whitening will make your teeth lighter than the restorations.  Knowing this in advance you may plan on replacing the old restorations after whitening.

The last precaution is all these products are not approved for use during pregnancy. Otherwise, teeth whitening procedures are very safe and successful for most people.  Whitening is an inexpensive means to get a nice cosmetic enhancement for the smile in a short amount of time.

Dr. Robert A. Gallegos is a Fellow in the Academy of General Dentistry, visiting faculty at Spear Education, alumnus of Pankey Institute, a member the American Academy of Cosmetic Dentistry, the American Academy of Dental Sleep Medicine and the American Dental Association.  Dr. Gallegos practices dentistry in Middleburg, VA.  www.MiddleburgSmiles.com.


Dr. Gallegos