Whitening your teeth reliably, safely, and without blowing your budget

One of the most “bang-for-your-buck" cosmetic procedures you can purchase for yourself is tooth whitening. Let me share with you all I understand as a dentist about the process, the long term effects, and the risks. I'll keep this short and sweet, (which is hard for me 😀).

The most reliable, longest lasting method I’ve found for lightening the color of your natural tooth structure remains custom built whitening trays and gel containing some variant of Carbamide Peroxide. This material not only bleaches stains off surfaces, it changes the intrinsic color of your tooth structure at some depth. I specified natural tooth structure because it does not change the color of any other materials your dentist has placed to restore your teeth. Crowns, bridges, fillings... you can affect surface stains but not the actual color of these dental materials that were color matched at the time of placement. This isn’t as big a deal if you have dental work on back teeth, but if one of your front teeth has any replacement structure showing, those restorations will not change color with any whitening material. Your plan has to provide for the possibility of removal and replacement AFTER you have whitened your natural teeth and settled into a new shade. It depends on how badly you want to hide the dental work in front.

Thirty years ago, when tooth whitening first became a thing, we would tell a patient to use our trays for 10-14 days, but to not use it on day 15. No one knew what long term use might do to vital, healthy teeth. Dentists were concerned about preserving healthy nerves and root structure, and no one had done long-term studies. Obsessive, rule-scoffing patients have long since answered that question for us. Dentists have had patients “bleaching their teeth” for months at a time without any perceived detriment to their oral health. Our caution, with the materials we dispense, proved unnecessary. I’m sure that someone out there could find a way to abuse just about anything, but dental professionals have grown quite comfortable with the materials and methods we recommend. Let me mention a couple methods and materials with which we are less enthused.

I once met a man who had obliterated his outer shell of tooth structure by using Comet cleanser to brush his teeth. “No dentist was going to take [his] money”, when he had a solution under his kitchen sink! What was left of his teeth was plenty white, I’ll give him that. There are products outside the dental office that do work to a degree. Crest White Strips and some very similar products have worked surprisingly well for some patients, although the results seem to vary between dramatic and barely noticeable. I don’t know the reason for the variation. The strips are relatively flat, and our teeth are not. Since they only affect surfaces they touch, it is difficult to get the strip to wrap in between teeth or around a curve. Activated charcoal is the latest internet homeopathic craze. I’m reluctant to trash the material, but I worry about this material yielding results similar to our friend who used Comet. Activated charcoal is very abrasive and is chemically active, interacting with tooth structure in ways we do not understand. I suspect, dealing with teeth everyday, that this method will ultimately prove itself detrimental. But you can do this without your dentist, if that’s your goal. I wouldn't allow my kids to use it. Using Laser energy or Zoom Whitening seems to provide a more instant, but shorter lasting effect. Their instant result seems largely the result of tooth dehydration, so as soon as your tooth structure rehydrates, the effect is lessened. Patients rave about their result for the first few days, then become less enthused as the effect largely wears off. Spring Valley Dental hasn't found a reason to invest in laser whitening or a Zoom apparatus. Both were great for marketing a dental office by showing off expensive and impressive looking equipment, but they are not shown to provide the longevity that trays and gel provides.

So that’s the scoop. Any materials I've found to be effective, including ours, cause teeth to be achy and cold sensitive while being used. However, within days of discontinuing use, the sensitivity normalizes. There may be techniques and materials I don't yet know about, but I've shared with you the best information I have. No secrets! My partners and I still use gel in take-home trays because it is safe, effective, long lasting and economical. I believe it’s worth your time and effort to brighten your smile safely and in a way that stands the test of time.

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If you’d like to read more on this topic, please review the American Dental Associations online pamphlet on tooth whitening and on the safety and effectiveness of whitening products.

Dr. Martin is a dentist practicing at Spring Valley Dental Group in O'Fallon, IL. #dentistnearme