One universal desire I have noticed among my patients is to achieve a radiant, bright smile. Whiter teeth improve our self-confidence and make us feel more comfortable during social interactions. Especially with Valentine’s Day, weddings, and summer vacations just around the corner, any dental hygienist will tell you that the most common question we receive is “how can I make my teeth whiter?” While this question may seem simple, it often requires a more in depth explanation than can be done in a dental chair. This is why I have decided to devote my second blog post to increasing awareness about how we can attain that “Hollywood smile” while maintaining optimal oral health.
Oral Health – Our Primary Focus in Dental Hygiene
The first thing we consider when a patient asks about whitening is whether their oral health is at a level that cannot be compromised by tooth whitening. Studies indicate that patients with pre-existing tooth sensitivity, demineralization (rough, white spots on the enamel), or gingival inflammation are at a higher risk of tooth and gingival sensitivity following whitening procedures (Bruzell et al, 2013). Patients with existing sensitivity and demineralization are not the best candidates for whitening as the procedure has a high risk of worsening their sensitivity.
Patients with gingivitis should work with their dental hygienist to improve their periodontal (gum) health prior to proceeding with whitening for optimal results. Gingival inflammation, which is often associated with plaque and bacteria, causes your gums to become more enlarged, red, and fragile. It is important to work with your dental hygienist to professionally remove calculus deposits and to create a personalized home care regimen to reduce your plaque accumulation. This will allow you to achieve optimal gum health prior to whitening. Whitening before seeking dental hygiene treatment will not provide an aesthetically pleasing result (see below).
While whitening generally produces noticeable results, it is important to note that it will not work on all teeth. Cavities, restorations (crowns, fillings, etc.), and intrinsic (internal) stains cannot be lightened with whitening procedures. If you have any of these conditions and would like to whiten your smile, talk to your dental professional to learn more about your options!
Nutrition: You are what you Eat!
It is important to understand the effects of nutrition on your dentition and oral health. Studies have found that eating acidic foods and beverages (including carbohydrates, starches, and sugars) will lower the pH of the mouth for approximately thirty minutes. This acidic environment affects you in two ways: (1) it provides a favorable environment for the cavity and periodontal disease inducing bacteria in your mouth, and (2) it increases demineralization of your enamel. Demineralization and thriving bacteria increase your chances of tooth decay, white-spot lesions, and staining. These conditions do not provide a good foundation for optimal whitening results.
Most patients are aware of bad habits that have the ability to stain their teeth (coffee, red wine, tea, tobacco). As a fellow coffee-lover, I will never demand that my patients stop drinking coffee. However, I will provide ways for my patients to reduce its effects on their teeth.
Tips to reduce staining (for more information, see this article from RDH Magazine)
1.Use a straw when drinking dark liquids – this helps avoid direct contact of your beverage to your enamel.
2.Add milk to coffee/tea – proteins in milk have the ability to bind to staining tannins and reduce the acidity of your beverage.
3.Rinse with clear water after drinking dark liquids or foods – This will dilute the staining effects of your beverages while avoiding harm to your enamel. Note: DO NOT brush your teeth after acidic foods and beverages! Wait at least 30 minutes to let the pH in your mouth neutralize and reduce your risk of brushing away your demineralized enamel)
4.Use good oral hygiene techniques (brushing, flossing, and rinsing) and visit your hygienist on recommended intervals – this will reduce plaque and calculus that are more porous and harbor stains easily. You know I had to plug that in here somewhere!
There are foods that can improve the appearance of your teeth and your overall oral health. The American Academy of Cosmetic Dentistry (AACD) worked with a nutritionist to create a list of foods that brighten, cleanse, and fight against harmful bacteria in your mouth. They also included the scientific reasons the foods were selected and delicious recipes to utilize them. Interested? Check it out here!
How Does Whitening Work?
In a recent study performed by the California Dental Association, respondents have tried to whiten their teeth in the past twelve months using toothpaste (41%), mouthwash (17%), over-the-counter whitening strips (15%), and professional whitening (10%). See below for an overview of the options available over the counter and in the office.
Professional Teeth Whitening - Dental professionals have the ability to select a whitening technique that caters specifically to your oral health and preferences while selecting an option that has proven to be safe and effective.
- Take-Home Whitening Products – Your dental team will take an impression in order to provide you with custom mouth trays made of a flexible plastic material. This is used in combination with a highly concentrated whitening gel that is not available over the counter. These gels typically involve highly concentrated peroxide-based gels (e.g. 10-22% carbamide peroxide for overnight use or 9.5-14% hydrogen peroxide for short wear time). Peroxide-based agents dissolve stain molecules in your dentin and enamel through a process called “oxidation”. As this process continues, the enamel surface reflects more light, making the teeth appear whiter and brighter. Desired results are typically achieved over a period of 1-4 weeks. In our office, we recommend this method and offer custom whitening trays with Zoom! Whitening gels.
- In-Office Whitening – Your dentist or hygienist will apply a bleaching gel to your teeth in combination with heat or a UV light source to whiten your smile in about an hour. While this method provides faster results, it is the most expensive option for whitening.
Over-the-Counter Teeth Whitening – Since these products contain lower concentrations of bleaching agents, they do not work as quickly as professional whitening options. However, they can produce effective results in time if used as directed. When trying to decide which product to select, consult your dentist or hygienist for recommendations and search for the ADA Seal of Acceptance.
- Whitening Strips – These are clear, adhesive strips that stick to your teeth. Be sure to use them as directed. Some brands recommend thirty minute use twice daily while others recommend use overnight. Beware that since these strips are not customized for your mouth, they will require special attention when placing on the teeth in order to get full coverage and to avoid exposure to gum tissue.
- Whitening Toothpastes – These pastes typically contain abrasive particles that remove surface stains and plaque. They will not provide drastic results but are a good option for maintenance in between whitening treatments.
Sensitivity and Prevention
The main risk of teeth whitening is sensitivity. The risk of sensitivity is influenced by the concentration of gel used, exposure time, and attention to detail. Gum tissue can also become irritated with ill-fitting trays or when too much gel is used. Be sure to avoid overfilling your trays and wipe away any excess gel that touches the gum tissue to reduce your risk of gum sensitivity. According to the American Dental Hygiene Association (ADHA), it is beneficial to use a remineralizing or desensitizing agent, such as Sensodyne (Potassium Nitrate), Prevident or Fluoride Varnish (Sodium Fluoride), or MI paste (Calcium Phosphate), two weeks prior to whitening to minimize sensitivity.
For those of you searching for the best way to a healthy (and whiter) smile, I hope that you found this post helpful. As always, feel free to contact our Ellicott City office with any questions, comments, or concerns.