“Should I whiten my teeth or not?” is one of the most common questions hygienists and dentists get from patients.  Most patients’ questions are pretty straight forward and can be answered with a “yes” or “no”. However, the question to whiten or not is a personal choice. Nevertheless, there are some precautions that should be taken into consideration when making your decision. 

Health questions are generally those like, “Should I fix my chipped tooth?” “Should I replace my missing tooth?”  “Should I save my tooth or have an implant?” “Do I need to remove my wisdom teeth?” “If it does not hurt now can I leave it alone until it hurts?”  Although the options for dental treatment may be varied and complex, the yes or no answer is always based on what is in the best interest of that patient’s health and well-being.  Deciding to whiten your teeth can certainly have a positive mental health effect. Having a nice smile is a confidence and mood booster.  Studies have revealed that people who smile more are happier, more self-confident, healthier, less likely to be depressed and live longer.  So when patients say they do not smile because they do not like the appearance of their teeth it is important to address.  If one of the reasons people do not smile is discolored teeth then whitening is an easy, low cost, safe and non-invasive option.

There are only a few reasons to not whiten:  pregnancy, nursing, allergy to materials, translucent teeth and extreme tooth sensitivity.  Most of these reasons can be overcome with good management of the whitening process and timing.  For patients who are pregnant or nursing the solution is timing. The caution to not whiten during pregnancy or nursing exists because no studies were done on pregnant or nursing patients so the Food and Drug Administration (FDA) could not give clearance for this patient group.  The active ingredient in whitening products is hydrogen peroxide. Very few people are allergic to hydrogen peroxide but if you are one, avoid whitening.  People with translucent teeth should not use whitener because their teeth may actually get darker if “whitened.”  

The most common issue with whitening is sensitive teeth and sensitivity can be kept to a minimum with proper management of the process. There are four main ways to control sensitivity during whitening that can be used individually or together: use a whitening product that has a desensitizer incorporated into the whitening product, use a separate tooth desensitizer, use a lower concentration of peroxide and/or decrease the contact/wear times.  Dental office dispensed whitening is FDA registered which means that general safety and effectiveness regulations are adhered to and these products are International Organization for Standardization (ISO) certified which ensures every product performs exactly as it is advertised.  Dental office dispensed products have desensitizers incorporated into the whitening solution.  Online products are often inconsistent in ingredients and effectiveness.  Additional products may be helpful, like desensitizing gels and toothpastes.  Also, lower concentration peroxide is less sensitive.  Some products are fast acting and can lower sensitivity by shortening the contact/wear time with the teeth.

Whitening works best when stored and used according to the instructions.  If stored or used improperly the products may be ineffective.  Patients with either extreme tooth discoloration, dark spots or white spots can still get good results but may not get bright white and will take longer.  People with red hair have pigments in their teeth that effect how white the teeth may get.  If the ultimate goal is whiter teeth, it is best to consult with your dentist about the options and expected outcomes.  If whitening cannot get the fully desired results speak to your dentist about other options, like veneers.

What are the different whitening options?

Internal whitening.  This option is used on individual root canal teeth that have discolored. It is performed in the dental office and may be done in combination with external whitening.  

Supervised in-office teeth whitening.  This option achieves whitening the fastest.  A very high concentration whitening gel is applied while in the dental office.  This works best when combined with pre and post at-home whitening.  There is no advantage to adding light or heat to the whitening process.

Supervised at-home whitening.  This may be accomplished in two different ways.  One option is your dentist makes custom fitted trays for you and dispenses whitening gel for you to use at home.  The other option is dispensing disposable trays, also to be used at home.  Whitening materials vary in concentration and how long they need to be worn.  For teeth with minimal staining, the desired whitening may be achieved in as little as a few days but most often 10-14 days.  More intense staining will take longer.

Over-the-counter and online whitening.  These products are sold in drug stores and over the internet for at-home use.  Drug store recognized brand name versions tend to be reliable but do not contain desensitizers which protects the teeth from becoming sore.  Internet versions can be effective however there is a large black market of copycat materials which may not be effective.

If you are looking to brighten your smile whitening is a great option and the dental team will discuss the expected outcomes and monitor your progress for dental office dispensed products.

Dr. Robert A. Gallegos is a Fellow in the Academy of General Dentistry, visiting faculty at Spear Education, alumnus of Pankey Institute, Qualified Invisalign provider, member of the American Academy of Cosmetic Dentistry, the American Academy of Dental Sleep Medicine and the American Dental Association.  Dr. Gallegos practices dentistry in Middleburg, VA.  www.MiddleburgSmiles.com.

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