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“Would you like whiter
teeth?” The other night while channel surfing, the number of infomercials
asking this question struck me, and selling products that claim to whiten
teeth. Over-the-counter bleaching products from “boil and form” mouth trays
to spray-on mists and special whitening gels are available through
television promotions. Increasingly, these products are beginning to make
their way onto pharmacy shelves. It is understandable that many consumers
will opt for a product that promises “the same results your dentist can deliver,”
and costs much less than a bleaching system dispensed by a dentist.
However, over-the-counter whiteners cannot and will not deliver the same
results as a dentist. In most instances, the use of such products will
leave consumers poorer and disappointed with the results of bleaching. In
many other instances, over-the-counter bleachers will jeopardize the oral
health of individuals who choose such systems. The excess of over-the
counter whitening systems available to the public makes bleaching an area of
cosmetic dentistry in which patient education is important to allow for
informative choices. The purpose of this up-date letter is to discuss the
differences between over-the-counter bleachers, and whitening products
offered in the dentist’s office.
Tooth whitening in the
dental office is a painless, safe procedure that does not involve
anesthetic or cutting down teeth to achieve a desired cosmetic change. Over
time teeth become discolored and stained due to physiologic changes
associated with aging. Food as well as coffee, tea or smoking also cause
teeth to become discolored. Bleaching negates the dull and lackluster
appearance of teeth, which matures the overall expression of the smile.
Whitening systems used
in the office typically involve taking an impression of the teeth, which
our laboratory then uses to fabricate a very thin tray. The tray custom
fits the patient’s arch and may be scalloped away from the gums. Thin trays
do not disrupt occlusion and can be adjusted to lighten single teeth. The
whitening gel is placed in the tray, and, depending upon the bleaching
system utilized, is worn twice a day for approximately 30 minutes or at
night while sleeping. Use of the whitening system continues until the
desired bleaching result is achieved. The color change is relatively
permanent. Any darkening, which occurs over time, is easily remedied with a
touch-up. Conversely, over the counter “boil and form” bleaching trays are
often thick, unwieldy and hold the jaw too far apart, which can lead to
temporomandibular joint problems. Furthermore, most of these bleaching
trays lap onto the gums, which increases the chances that the whitening
product will irritate the soft tissue. In addition, the bleaching material
is often runny, causing it to leak out of the tray, making whitening less
effective.
When using an
over-the-counter whitener it is important to understand that bleaching is
an invasive procedure, which is being used without any supervision by a
dentist. Tooth whitening involves the use of carbamide peroxide, which
penetrates through the enamel, into the dentin into the inside of the
tooth. The carbamide peroxide releases oxygen, which causes teeth to
lighten. Bleaching products can cause a mild burning sensation in the gums
and a temporary increase in tooth sensitivity. Without dental supervision,
monitoring of the bleaching process and treatment of any sensitivity during
bleaching is lost. Moreover, bleaching gels used in the dental office can
reduce or eliminate sensitivity as a side effect.
Another problem with
over-the-counter whitening systems is that self-diagnosis in whitening may
lead to a misdiagnosis which can have ramifications on a patient’s health.
For instance, an individual with dark or discolored teeth may decide that
they are a perfect candidate for bleaching, and not realize that their dark
or discolored teeth result from an abscess. In such instances, proceeding
with bleaching will result in the postponement of necessary dental
treatment. Similarly, most individuals cannot identify tooth discoloration
caused by conditions such as leaky filings. In addition, not everyone is a
good candidate for tooth whitening. For a small percentage of individuals,
their natural tooth pigment makes bleaching impossible. Unknowingly, these
individuals may continue to bleach over a long period of time risking
changes in occlusion or enamel surface.
Lastly, not every
over-the-counter product is safe and effective. For example, many whitening
products will remove some surface stains, but will not affect internal
tooth discoloration. Other over-the-counter bleaching products can be so
highly acidic that they eat the enamel off of teeth. Products available in
the dental office have received the American Dental Association’s Seal of Acceptance,
which means that these whitening systems have gone through rigorous studies
and clinical trials to establish their safety and efficiency. No
over-the-counter products have received the Seal of Acceptance.
Bleaching, as is the case with any invasive procedure, should be supervised
and done with materials, which provide long-term results and protect the
patient’s oral health. The end result, will be a safe and effective
cosmetic change.
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