In my opinion, the best thing dentistry has come up with in the last 20 years in teeth bleaching. I love a beautiful healthy smile on everyone, and clean white teeth are a big part of that. The act of smiling can actually reduce stress, and make you feel better! And when you’re confident about your smile, that’s even better. So, let’s talk about tooth bleaching. I’ll demystify it- how it works, why it works, how to overcome sensitive teeth, how to bleach older teeth and what outcomes to expect. Then, let’s make your smile the beautiful smile you dream of having!
The question I get asked the most: is bleaching your teeth safe? The short answer is YES!
Now the longer answer and a little tooth anatomy background 😉 Teeth are made up of enamel on the outside and dentin on the inside. Within the enamel are bundles of microscopic enamel rods.
As we age, our teeth absorb microscopic junk, gunk, and stain within and between these enamel rods. Stain comes from our food and drink, and seeps within the tooth, going from what we call extrinsic stain to becoming intrinsic stain. This crud gets packed within the rods. As we age more and more junk gets packed deeper and deeper. The stain molecules between the enamel rods combines with other stain and pigment molecules and becomes larger and larger. This causes the tooth to look darker. The older we get, the more and more tightly packed this stain becomes. The goal of bleaching is to break down these long stain molecules into small chain molecules, which reflect light differently and look whiter.
stain molecules become small molecules after bleaching
Carbamide peroxide and hydrogen peroxide are the two bleaches we use in dentistry. For the rest of this article I will just call them bleach. The bleaching process removes the stain, junk and gunk from around the micro-tooth structure rods. Think of bleach as scrubbing bubbles cleaning out the tightly packed crud. Once these micro-structures are cleaned out, the tooth enamel can now be remineralized with fluoride, calcium and phosphate, and increase the micro-hardness of the tooth. This will restore tooth luster. The harder the tooth, the more resistant the tooth will be to future staining!
**This is important**
For teeth bleaching to be successful, we must have the bleach on the teeth, breaking down this tightly packed junk around the enamel rods for long periods of time (6 to 8 hours per day), and at the proper concentration (which will depend on what you and your dentist decide). The 15 minutes to 60 minutes of bleaching most often prescribed for daily bleaching will not be a long enough time period to break down the microscopic crud pile-up that blocks the bleach from getting inside and around the tubules. Average length of time to achieve bleaching is between one to four weeks. The younger you are, the faster it works– less microscopic tooth crud. Older teeth, tetracycline stained teeth, or teeth with dental fluorosis (too much fluoride in the teeth) are much harder to bleach because of all the extra tightly packed rods. They can eventually be bleached but it may take much
longer than the average time period. For teeth that seem to be resistant to bleach, I’d recommend the Kor system
What color can you expect to get to when you bleach? It all depends on where you start, what kind of stain you have and how persistent you are in bleaching. There are no guarantees. The longer you bleach, the whiter they’ll become. Dentistry has extended our shade guide to include bleach shades. I rather prefer the bleach white as opposed to “regular “shades, don’t you?
There are three ways to administer bleaching products to the teeth:
- professional application in the dental office
- custom made bleach trays that you take home, put bleach in the tray and wear daily
- bleach white strips- available over the counter or at your dental office with professional strength
Bleaching problems and other questions:
Tooth sensitivity and tooth pain are the number one issue when people bleach. Why does that happen? How do we over come that?
There are two types of tooth sensitivity:
#1. Typical dentinal hypersensitivity – your pulp (the nerve center of the tooth) overreacts to stimuli such as cold.
Dentinal hypersensitivity occurs when the dentinal rods become unplugged. Usually there is what’s called the “smear” layer covering them. Bleach opens up these tubules
to break down stains. An acidic diet (coffee, wine, fruit, sour candy etc), will enlarge these tubule openings and make them harder to plug up again. The fluid within the tubules have contact with the nerve, and stimulants zip up and down these tubules, causing discomfort or pain. The obvious answer is to re-plug the tubules. Now-a-days, many bleaches have remineralizing products within the bleaching solution to do just that. ** I recommend folks start desensitizing and supercharge the tooth plugs before they start bleaching. Fluoride gel and remineralizing gels like MI Paste Plus with calcium and phosphate will help desensitize teeth. Once started bleaching, wear the bleach trays for an hour or so a day with a desensitizing tooth paste or remineralizing gel, then
bleach and then after bleaching immediately remineralize again for at least 30 minutes. People with hypersensitive teeth and/or recession may not be comfortable bleaching.
#2. Zingers- the sharp electric shocks that travel down the front teeth with lightening speed without any obvious cause. They usually occur in the smaller front teeth, often on the lower arch. It is theorized that hydrogen peroxide molecules enter the innermost part of the tooth (the pulp chamber) through microscopic cracks within the tooth structure. The peroxide does not damage the pulp
. It breaks down to O2 and water and because the tooth is rigid, it is incapable of expanding to accommodate this reaction, so the nerve endings in the pulp react to the pressure and cause a sharp pain.
How to stop zingers- again, supercharge the tooth with calcium, phosphate and fluoride before starting any bleaching. In our office, we also use ozone
gas and/or ozone oil, as well as applying a product called caphasol. Between the two, we are able to reduce and eliminate zingers and dentinal sensitivity. Once you stop bleaching the sensitivity does go away on its own.
The second big problem people experience with bleaching products is gum tissue irritation when using custom trays. Ideally, your custom tray is scalloped along the edge. If not, your trays may be trapping extra bleach and this will irritate your gums. Also, use only a sesame size drop of bleach in the tooth well. Remove any excess bleach that seeps out of the tray. Too strong a bleach may also cause gum pain or irritation. Stronger bleach is not necessarily the best- remember, it’s the length of time you keep it on your teeth that does the job of breaking down the long chain molecules and changing them to short chain molecules.
What to do about teeth with existing white spots? These teeth will whiten, just be aware that the white spots are more porous and will whiten even more at first, but eventually the rest of the tooth structure will catch up. Again, persistence is key here. The white spots may still be there but should blend in with rest of the tooth structure.
In-office bleaching uses a much stronger concentration of bleach for approximately one to two hours- broken down to two or three 20 minute time periods, reapplying fresh bleach each time. Isolation of the teeth takes time to achieve thus the longer appointment time. Often bleach trays and in-office are combined to get the best, fastest results.
Over the counter products: bleach white strips are so popular and considerably less expensive than the professional dental office techniques. They are an okay first step, and may do the job well enough, especially for young people. Ideally you should see your dentist first to be sure there’s no tooth decay or gum infection that may cause problems. We offer professional strength white strips. Cost-wise, and quantity wise, they are a much better bargain than OTC drugstore options.
Bleach fun facts:
1. Store your bleach in the refrigerator, not in your bathroom. Bleach is unstable, that’s what makes it so effective in your mouth, but heat degrades it more quickly. So, keep it cold.
2. Hydrogen peroxide kills the bacteria Lactobacillus
– which is one of the two main tooth decay bacteria! Read my post –K.I.S.S. Tooth Decay Goodbye
, there I discuss using bleach trays as part of a tooth decay prevention program! Really! White teeth and no cavities- that’s a win-win!
3. Hydrogen peroxide also helps kill the bacteria associated with gum disease
. A win-win-win!
4. During active bleaching, avoid staining foods and beverages. They’ll stain your teeth all over again. Anything that’ll stain your carpet stains your teeth too.
5. Once you achieve your favorite shade of white, bleach once a month, overnight, to maintain your lovely new shade. This prevents regression to your previous shade.
6. Crowns, veneers, and fillings will not whiten. Wait to have any dentistry done if you want whiter teeth, then have the new restorative work done to match your new shade of white.
7. Sometimes veneers or crowns may be needed if you want whiter or more evenly shaded teeth.
9. Real teeth can’t look unnatural, they’ll just look beautifully white! Bleach until you reach the shade you like. (The celebrity teeth that seem over-white are veneers or crowns.)
10. And then SMILE! It’s so good for you!
If you have any questions I have not addressed, please let me know. Find all my blog postings now on Pinterest under The Queen of Dental Hygiene, thanks to my daughter, who did it for me! 🙂
and now, Smile, Smile , Smile!
Til next time,