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Tooth Whitening and Tooth Bleaching

 

 

Dr Ramzi Matar (Winter Park Dentistry):

Hello, and welcome to this episode of this podcast. Today we’re here talking about a very popular subject, which is tooth whitening. I’m going to start off by making a little delineation, which is important, but I think most people wouldn’t know, because it’s sort of internal verbage. I’m going to be talking about vital tooth bleaching, which is what commonly people know as whitening their teeth. The reason I say that is because there is non-vital tooth whitening, which is when a tooth is necrotic, or when it’s dead. I nickname that “zombie teeth”. If you’ve ever seen anybody, or seen pictures, of a front tooth that was very dark, actually looking back I’ve seen pictures of Tiger Woods who I believe had a tooth like that, a very dark toot that looks out of place, that can be a result primarily of a trauma to the tooth, a lot of athletes or anybody growing up, anybody has gotten hit in the mouth. So within a trauma of the tooth, the tooth can actually die, the nerve can go necrotic, and overtime that darkens the tooth, and it becomes usually a brown or grey colored tooth, and that’s a non-vital tooth. That’s a tooth that actually needs treatment, such as a root canal, and we can whiten those teeth, but it’s non-vital bleaching, and that’s done from inside the tooth, you go inside the tooth and bleach it from the inside-out. That’s a completely different story for 99% of the population who want to know about how to generally whiten their teeth.

I’ll start by saying age limits. I typically like the age of 16 being the cut-off. I have not read any studies or directories as to why children under 16 cannot do it, but that’s kind of in my guideline, because I think that’s when socially kids start to want to whiten their teeth, that’s when boys start to want a girl, or a girl with a boy, or whatever combination… That’s when socially, whitening teeth becomes more popular. I think that sounds, to me, like an age when it’s appropriate to whiten your teeth. Have I had children younger whiten their teeth? I’m sure they’ve gotten white strips over the counter and their parents give it to them. But I’ve never had any problems with that.

Some things to caution people that are out there whitening their teeth. Crowns and fillings and bondings typically will not whiten. These non-vital teeth, these zombie teeth, will not whiten at all, these teeth are dark because of trauma. So be a little careful. If you’re anticipating having filling or bonding done at your dentist, specifically on a front tooth, it’s important to not whiten for at least two weeks prior to that, because whitening actually inhibits the bond strength of bonding on front teeth, or all teeth. But specifically front teeth are the ones we're worried about and typically the over the counter products are on front teeth, so if you’re a patient out there, anticipating getting bondings done on front teeth, or any kind of white filling, don’t go use white strips up until you go see your dentist, because it will go lower the bonds’ strengths and they’re more likely to fall off, so you want to have a 2 week break before that. The other reason for that is that usually when you whiten, you have a little bit of a die back. So if you whiten, let’s say four shades, or let’s just arbitrarily say you go from shade zero, when you go to bleach number three. So what happens is after you’re done whitening your bleach number three, will often times dye back to bleach number two, that’s just the nature of the teeth, it kind of rebalances, so it’s important to let that happen, and that often takes about two weeks or so, before you go to your dentist. When they match your tooth, it will stay that way.

Sensitivity. Biggest issue I have is people asking about “will my teeth get sensitive?” and everybody’s a little different, I have people that can whiten every day, and they never get sensitive, and I have people that barely come near the whitening, and they get very sensitive… What’s important to know is that if your teeth do get sensitive, stop, don’t keep doing it. There is no long term damage done for whitening, as long as you do it in moderation, like anything else. What I’ll typically tell people, as an example, it’s like cutting your nails. If you cut your nails every day, you’re eventually going to get to the base of the nail, and now you’re going to cut your fingers off, and that’s going to be damage. If you cut your nails, and wait for them to grow back, and then cut them again, it’s not going to be a problem, or cutting your hair, or anything like that. So that’s sort of a loose description that I give people when they ask me about “can I whiten? How long? Can the whiten damage my teeth?”

There is some demineralization to the teeth that happens with the whitening, but once you stop whitening, they just remineralize and your teeth are left a little bit whiter. So let’s talk about the major ways of whitening. The most common is over the counter… The dominant brand is the Crest Whitestrips, and I have a lot of patients, again, probably 70% of my patients have used those, there’s a new Crest 3D, there’s also another one that another patient told me about where you actually can scratch it over your teeth. I’ve had a patient recently really raving about those, saying that they fit great. The greatest issue with whitestrips is that they’re sort of a “one size fits all”, so I’ll tell people it’s kind of like if I bought a pair pants, and I wanted everybody to wear them. Some people would fit very well, some people  are not going to fit, it might be too loose on me, too tight on somebody else, too short on me. You get the picture. So whitestrips have sort of a cookie-cutter shape, for the majority of people’s teeth, and so if you don’t fit in that majority, if your teeth are bigger, or smaller, or crooked, or whatever, they’re not going to fit very well, so this latest rendition of whitestrips is something where it stretches really well, and apparently it molds very very well.

The next step is sort of a semi-custom, that’s usually an office product that’s sold at a dental office. The most recent common one is Opal-Go, made by a company called Ultradent. This has been a pretty favorite product. It’s a little bit stronger than the whitestrips, as far as the gel, and instead of having it as a strip, it’s sort of like this wax, if you will, and you sort of shape it to your teeth. It fits pretty well, I’ve tried it, I like it, I actually use it. That’s actually my product of choice, currently, because I can take it with me, use them and then you throw it away. It’s kind of messy, when you take them off, I have to say, the wax kind of gets everywhere, so you have to make sure you have a tooth brush handy when you’re using it, because when you take them off there’s wax and gel everywhere. It’s not something that you can just take out and spit out and go into work, because you’re going to have to spend some time brushing your teeth afterwards, so that’s something you have to consider, but it is a good product.

The next one, which is probably the most common one, is a custom bleaching tray, which is the one where we take molds of your teeth and we make you a very thin, usually about half a millimeter, clear plastic tray, that fits. It’s almost like wrap on your teeth, you generally don’t even know it’s there, you can for the most part talk pretty well, and you load the gel, you buy the tubes of gel, and you load it in there. And you wear it overnight, or you wear it for a few hours, depending on the strength of the gel. This is probably the most predictable of the options, meaning it works for everybody. I have not had a set of these custom trays not work, because they’re made for you, they stick under your teeth very well, and as long as you put the gel in there, which is almost foolproof, it’s going to whiten your teeth. Very predictable, as long as your teeth don’t change, you can have those trays forever. Cost-wise, you’re looking at usually moderate, 2 to 4 hundred dollars, maybe 5 hundred, somewhere in that range, but it’s a few hundred dollars, it’s not thousands of dollars.

The next one, which is probably the most the most advertised, it’s the power-bleaching, or the in-office bleaching, there’s different renditions of this. This is basically when you go to the dentist and he puts this super high-powered gel on your teeth. Sometimes there’s a light that activates it, sometimes they’re activated other ways, but point is this is something that’s done in the office. You have to put different barriers, because the gel is so powerful, it could burn your gums and your lips and all that stuff. I have used these, I’m not a big fan, mainly because of this… The results, and the side effects are not equal. Meaning, you might whiten a little bit more in that hour or in that two hours, than you would in a week of the home tray or whatever other method, but the sensitivity and the problems and the burn potential is so much higher  than the increase in the result. It’s not worth it to me. I’ve had a few occasions where I’m doing that and the patient’s just dying in pain and tearing it all off, and it’s sort of a little bit of a scary thing, because the patients can’t close, they have all these lip retractors that keep their mouth open, their lips away from the gel, and the gel has to be carefully put on and you have to put this special barrier on the gums, and man it’s tough, because you may not be in the room, patient’s in pain, and they’re trying to scream for you, and eventually someone will check up on them and see them in distress, and it’s a stressful procedure and a lot of times they have high levels of sensitivity. They can, not all of them do, and it’s just not worth the added risk, in my opinion. There’s a lot of dentists that do it all the time, and they swear by it, and I do think it gives you a quick result, so if somebody “well, I’ getting married tomorrow, I don’t have a choice”, well yeah, that’s kind of what you have to do.

Price is a lot of times 5 hundred up to a thousand. Another thing that a lot of dentists do, which I personally do too, is if you’re doing one of these, I will go ahead and make you the custom tray, so that if you have problems, and if it’s very sensitive, and you have to cut the treatment off, let’s just say instead of an hour, you can only take it for fifteen minutes, well the patient has then paid you a thousand dollars and you only gave a quarter of the treatment, I’ll send them home with a custom tray or with a kit, and say “okay, finish off what we didn’t finish in here”. But I’m pretty clear with patients that want to get into this power bleaching, that there are some risks involved, like anything else if you’re trying to do something very quickly, and take the proverbial shortcut, sometimes there are some drawbacks there. I hope this podcast helps anybody who’s considering whitening their teeth, thank you.