In-office Whitening Versus At-home Whitening

            Without fail, a beautiful smile always ranks highly on lists that seek to assess attractiveness. Aesthetics aside, our teeth have many critical functions in our everyday life, including chewing, speech, and heavily influencing our face’s shape. They undergo so much daily wear and tear (literally); however, they are often neglected. Just as our physical body requires a tune-up here and there, our teeth deserve the same. Attending the dentist regularly (though it does not rank highly on people’s list of favourite places) for cleanings and oral examinations every six months is one of the most beneficial things we can do to maintain our oral health. Our teeth should be in good order combined with our home care of brushing and flossing at least twice per day. Ensuring that our foundation is sound (gums and teeth) allows us to focus on adding some final flourishes that will make our smile even more desirous. One of those flourishes can be teeth whitening.

What is teeth whitening?

            Teeth whitening is a relatively simple cosmetic procedure in which the tooth enamel’s colour is changed using a bleaching solution or gel. Our natural tooth colour can be changed by various things, including age, some types of food and drink, tobacco, medications, or a history of trauma to the teeth. While teeth whitening is a quick and painless procedure, not everyone is a candidate to have this done. Teeth whitening is best suited for patients who have unrestored teeth. It is ill-advised in individuals with large fillings or crowns and bridges. In these cases, the chemicals used to whiten the teeth would only change their natural teeth. Still, the restorations (which may be fabricated from porcelain, ceramic or composite) would remain unchanged, causing your teeth to be different colours and a rather awkward result. It is also not advised for patients who experience extreme tooth sensitivity as it will exacerbate the problem.

            The results of these procedures may also vary depending on the type of discolouration that you have. Teeth that appear yellow respond much better to bleaching than those that are brown, and teeth with a grey appearance may not be affected at all. Extrinsic discolouration affects your teeth’ external surfaces and is commonly caused by foods, drinks, or habits such as smoking that stain your teeth. Coffee, teas, wine, and highly coloured foods are common culprits for these types of stains. Intrinsic discolouration occurs within the tooth and is commonly caused by medications, childhood illnesses, dental trauma, or ageing. Intrinsic discolouration is more difficult to remove since it occurs internally, and professional whitening is required to achieve a desirable result.

            You must have an open and honest discussion with your dentist so that you can know the results you can realistically expect if you have whitening done.

What teeth whitening options are there?

            With its ever-increasing popularity, there are many teeth whitening options available to you. Having a consultation with your dentist can help you to decide which one is best for you. In general, however, there are three (3) main categories into which these options fall:

•          teeth whitening administered by a dental professional in-office

•          teeth whitening that your dentist dispenses for at-home use

•          over-the-counter whitening solutions that may be accessed without any type of dental advice

The option you choose may be influenced by several factors such as the type of discolouration you have, the cost, your comfort with the treatment method, and your dental history (including the presence of fillings or crowns).

How do these teeth whitening options work?

In-office whitening

This is performed by trained dental professionals and generally produces safe and consistent results. Results achieved via this method tend to be better because of the higher concentrations of the bleaching gels used. Some of the popular brands used for this procedure include Zoom!, Britesmile, Opalescence, and Lumibrite. Though there may be some differences in the application mode for these products, the procedure itself is generally the same. Having undergone an oral examination and consultation to assess patient suitability, the teeth are prepared. Pre-treatment photos may be taken, and a shade guide is used to record your teeth’ pre-treatment colour to do a before and after comparison.

To begin, a cheek retractor is placed intra-orally to expose the teeth and move the cheeks and lips out of the way. Next, a liquid rubber dam or resin that hardens with UV-light will be placed at the tooth and gums’ junction. This forms a gingival barrier that protects your gums from the chemicals used to bleach the teeth. Additionally, a compound may be applied to your teeth to help safeguard against sensitivity. The actual whitening process starts with the topical application of a fifteen to thirty-five percentage (15%-35%) hydrogen peroxide gel. Hydrogen peroxide is an effective bleaching agent due to its ability to permeate your teeth’ porous external layer and break apart stain compounds via a chemical reaction known as oxidation. The hydrogen peroxide gel may be left on the teeth for fifteen (15) to thirty (30) minutes. Based on the system being used, gel application may be followed by light curing with a UV-light to activate or speed up the bleaching process. After the time has elapsed, the teeth are cleaned off and the gel is reapplied for a second fifteen (15) to thirty (30) minute period. Results are immediate though their full extent may not be seen until days after.

The efficacy of this type of treatment can be greatly enhanced by the avoidance of certain highly staining foods or habits. Additionally, you may be given a whitening kit or pen to take home with you to help maintain your smile. These at-home kits consist of trays that are custom-fitted to your teeth and tubes of whitening gel (of lower concentration than that used in-office) so that the trays can be lined with the gel and worn for a few hours at a time each day for a few weeks.

The advantages of this type of treatment are that the results are produced in the shortest time, they are consistent, and steps are taken to prevent post-procedure sensitivity. However, most people do not pursue this option because of the cost compared to cheaper alternatives such as over-the-counter or take-home trays.

At-home whitening supervised by your dentist

Briefly mentioned above, this treatment wearing custom fabricated trays to which a lower strength bleaching agent (usually 10% to 22% carbamide peroxide, equivalent to about 3% hydrogen peroxide) is applied. Since these trays are custom made, they ensure maximum contact between the teeth and the whitening gel. These are worn for a period prescribed by your dentist (usually a few hours per day for a few weeks).

While this option is advantageous because it is more affordable than in-office whitening, the lower concentration of gel used (~3% hydrogen peroxide vs. 15-35%) means that the same level of whiteness cannot be expected using this method.

Over the counter whitening solutions/gels/trays

Owing to the popularity of teeth whitening, the market has been flooded with varying do-it-yourself options for those seeking an alternative to the more traditional route.  Their range of modalities and the fact that they are far more budget-friendly than traditional methods are just two (2) reasons for their appeal. These are just a few of the most popular options outlined below:

Whitening toothpaste

The removal of surface stains is common to all toothpaste because they are formulated with mild abrasives. However, whitening toothpaste often contains additional polishing or chemical agents (such as blue covarine) that boost their stain removal efficiency. Because these kinds of toothpaste do not contain bleach, they are only effective with surface stains and can only produce a tooth colour change of about one (1) shade (compare this with professional whitening that can change your teeth by at least three shades and as much as eight shades).

Whitening strips

These are thin, flexible strips that are impregnated with a bleaching gel. They are especially appealing because they are easy to use and are not cumbersome, so they can be worn while going about your daily activities. However, they are not effective in removing stains that occur between the teeth and are poorly suited for those with misaligned or crooked teeth. Additionally, though they are adhesive, it is easy for saliva to go beneath the strips and dilute the strip’s concentration and efficacy. In addition to their tendency to slip and slide, more than one (1) strip may also be needed to cover wide smiles.

Whitening rinses

These are relatively new products. In addition to helping maintain oral hygiene, the addition of hydrogen peroxide has the additional benefit of whitening teeth. It is advised that you swish them around for about sixty (60) seconds twice per day before brushing. It is said that results can be seen in twelve (12) weeks, however, their efficacy has been disputed when compared to other over-the-counter methods based on the time of contact (two minutes per day versus thirty minutes for strips).

Whitening trays

These are done as a one size fits all tray that is used with a whitening gel. Since they are not custom made, they are often ill-fitting and can cause the gums and soft tissue to become irritated. It is also important not to overuse the whitening gels as over-bleaching can cause the teeth to have a blue hue, appear chalky white, or produce uneven results

Brush on whiteners

These formulations include pens with a brush or foam tip. They are commonly touted to be used after meals as an instant fix for stains caused by food or beverages that were just consumed. These have been said to have mixed results, with some remaining unconvinced about their usefulness.

 Which method is best for me?

As stated before, many factors come into play when deciding which treatment options to pursue. There are patient-related factors such as cost and there is professional advice from your dentist based on your specific case (whether your teeth are intrinsically or extrinsically stained, how badly stained they are etc.) to consider. Armed with the facts, you will be able to make the most well-informed decision that is best for you.

As with most things in life, you get what you put in to say that you get what you pay for. Over-the-counter-treatments may be easy on the pocket and more convenient, but because the concentrations of bleaching agents used are significantly lower than those used for professional whitening, the results will not be as dramatic, and they will take a longer time to achieve. Also, without professional guidance, you may not be able to achieve the best result based on your case’s specifics.  Now, this is by no means saying that professional cleanings are a straight train to permanent success as stains will accumulate on teeth after treatment. Success with this type of treatment will depend upon your discipline level with dietary restrictions or lifestyle changes and your compliance with at-home kits and care.

Therefore, teeth whitening can be a safe and easy undertaking for anyone willing to improve their smile. By choosing the method that is best suited for your needs and following it correctly, you can be well on your way to achieving the picture-perfect smile.