Teeth Whitening: How It Works, Types, and Side Effects

How Teeth Whitening Works

The most common active ingredient in professional and at-home teeth whitening products is some type of peroxide formulation - typically either hydrogen peroxide or the more mild carbamide peroxide.

Peroxide functions as a bleaching agent, able to penetrate below the hard enamel surface of teeth to reach the dentin layer underneath. When peroxide is absorbed into the teeth, it degrades into various reactive oxygen species, including free radicals and hydrogen peroxide ions. These oxidizing molecules are able to break the carbon bonds in long chain pigment molecules that have become embedded deep within tooth structures or bonded to dentin over time. The smaller molecules that result reflect less light and have reduced pigmenting power, thereby lightening coloration and making teeth appear whiter.

Whitening Agent	Typical Concentration in Products	Usage Recommendations
Hydrogen Peroxide	10-35% (in-office) <br> 3-10% (at-home)	20 mins (in-office) <br> 30-60 mins (at-home)
Carbamide Peroxide	10-35% (in-office) <br> 5-20% (at-home)	60 mins (in-office and at-home)

LED light tools used during in-office and some kinds of at-home whitening are able to optimize and accelerate decomposition of peroxides. The blue wavelengths of light cause additional oxidative stress and the release of even more free radicals from the gel, boosting its overall efficacy. This allows patients to see dramatic whitening with shorter wear times. However, in some cases this enhanced peroxide activation can increase likelihood of tooth sensitivity during treatment.

Over-the-counter whitening products contain lower peroxide concentrations than professional gels used in a supervised clinical setting. Lower concentrations mean longer wear times are necessary to see significant results, sometimes 2 weeks or longer of consistent daily use. The gradual process also often reduces side effects like sensitivity. Popular and affordable at-home options include:

• Whitening strips - thin strips coated with gel that adhere directly to front tooth surfaces
• Custom-fitted trays - trays filled with gel that are molded to your teeth, allowing full coverage of teeth

Both dentists and consumers should carefully review product usage instructions. Following guidelines for application times and frequency will maximize whitening while controlling for increased risk of tooth sensitivity or gum irritation. Consult your dentist before beginning use of any new whitening product if you have concerns.

Types of Whitening Treatments

There are two main categories of professional teeth whitening treatments: in-office procedures performed by your dentist, and at-home whitening kits that can be custom-fitted by your dentist or purchased over-the-counter.

In-Office Whitening

In-office teeth whitening procedures involve using higher concentrations of whitening gels along with specialized tools and lighting under professional supervision.

During a typical treatment, the dentist will first isolate your teeth with cheek retractors, barrier gels, and occasionally a rubber dental dam to prevent contact between the whitening gel and sensitive lip and gum tissue. Your teeth will be professionally cleaned to remove debris and prepare the tooth enamel.

Next, a powerful peroxide-based gel containing between 15-43% hydrogen peroxide or 10-35% carbamide peroxide will be directly applied or painted onto all tooth surfaces. Many practices use proprietary whitening gels like Opalescence Boost or trademarked systems like ZOOM Whitening.

An LED light is then shone on the teeth to accelerate and maximize results through enhanced oxidation. In-office sessions utilize stronger intensity blue light than most over-the-counter kits.

In-Office Whitening Pros	In-Office Whitening Cons
Very fast visible results	More expensive - $500-$1500 per treatment
Customized to your teeth issues	Multiple sessions often required for full effect
Higher strength gels more effective on stubborn stains	Does not lighten artificial teeth
Desensitizing gel options	Increased tooth sensitivity risk
Minimal effort by patient	Not typically covered by dental insurance

Dramatic, long-lasting whitening with relatively little effort is possible with professional procedures. But it does come at increased financial costs versus drugstore options.

At-Home Whitening Kits

There are a wide variety of whitening products available for home use without requiring a dentist visit. These contain milder concentrations of peroxide whitening agents, but offer affordability and convenience for gradual lightening over time.

Some popular over-the-counter options include:

• Whitening strips: Administered for 30-60 minutes 1-2 times per day.
• Whitening trays and gels: Worn for 1-4 hours once or twice daily. Custom trays allow personalized fit.
• LED light kits: Used as directed in short daily sessions to accelerate breakdown of applied peroxide gel.
• Whitening toothpastes: Brushed liberally for 1-2 minutes twice per day. Contain mild abrasives and low levels of hydrogen peroxide.

At-Home Whitening Pros	At-Home Whitening Cons
Convenient application on your own schedule	Gradual lightening takes days to weeks
Affordable for most budgets	May not remove deep-set intrinsic stains
Customizable choices for needs	Less powerful effects overall
Lower peroxide levels reduce sensitivity risk	Requires diligent daily application

Consult your dentist before starting use of any over-the-counter whitening products if you have dental restorations, veneers, or other specialized conditions to ensure safety and efficacy of treatment.

Side Effects and Safety Precautions

While teeth whitening is generally safe when products are used as directed, some people do experience side effects like sensitivity or gum irritation. Understanding the risks and taking proper precautions is important, especially if you have sensitive teeth or dental work.

Tooth Sensitivity

Tooth sensitivity, ranging from mild to severe, is the most commonly reported side effect of peroxide-based whitening treatments.

• Approximately 60-70% of patients experience some degree of sensitivity during or after professional in-office whitening.
• Most sensitivity develops within 24 hours post-treatment and resolves within a few days.
• At-home whitening strips, gels, and trays can also cause sensitivity, but at lower reported rates closer to 10-20%.

Tooth sensitivity stems from irritation to the dentin layer underneath the enamel caused by diffusion of peroxide through the tooth surface. Irritation of the dental pulp inside teeth triggers nerve pain signals.

People with thinner enamel or exposed dentin tubules are generally most susceptible:

• Younger patients still developing enamel thickness
• Acid erosion from bulimia or reflux disease
• Excessive grinders or tooth wear
• Periodontal disease recession
• Unhealthy cracks or fractures

Gum Tissue Irritation

Whitening gel leaking onto and contacting gum tissue during application can sometimes lead to burning, soreness, or whitening of the gums themselves:

• Take care applying wraps, strips, or trays to avoid contact with gums
• Seek professional application rather than risk a poor fit with over-the-counter trays

Other Risk Factors

Additional precautions are necessary for:

• Dental restorations: Whitening does not effective lighten porcelain, composite resin, or metal used in crowns, veneers, fillings, or bridges. Using peroxide on these materials risks corrosion and damage over time.
• Cervical erosion: Peroxide makes softened enamel more vulnerable by demineralizing surfaces. Focus application only on intact enamel.
• Children: Enamel and pulp chamber volumes are much smaller in children. Too much whitening too fast risks permanent damage.

Those with high risk of sensitivity or complications should consult a dentist about the advisability of whitening treatments and products tailored to their needs.

Recommendations for Sensitive Teeth

If you experience sensitivity from at-home or in-office treatments:

• Stop use and consult your dentist to evaluate causes
• Request lower dose whitening gels
• Pretreat with desensitizing toothpastes containing potassium nitrate or stannous fluoride
• Try products like Sensodyne Pronamel specifically formulated for sensitivity
• Ask dentist about take-home fluoride rinses or desensitizing gels to use following whitening sessions
• Wait 3-6 months between treatments for full pulp recovery

Carefully following all label instructions and heeding any symptoms of sensitivity can help maximize your whitening experience while preventing short and long term dental health issues.

Caring For Your White Smile

Successfully maintaining your bright smile after investing time and money into teeth whitening requires adopting dental care habits to prevent new stains or color changes.

Avoid Staining Foods and Drinks

Minimize contact between teeth and common staining culprits:

• Dark berries
• Soy sauce, BBQ sauce, tomato sauces
• Curries and saffron
• Coffee and black tea
• Red wine and dark sodas
• Tobacco products

Rinsing promptly after consuming and drinking through a straw can help reduce clinging pigments.

Touch Up Treatments

Consistency is key when it comes to upkeep. Over-the-counter whitening strips used 2-4 times per year can preserve professional whitening results.

• Use touch up strips after particularly staining events like red wine or coffee staining.
• Apply strips once a month according to package instructions.

Whitening Strip Options	Time Commitment	Cost
Crest 3D White Professional Effects	up to 45 minutes daily	$$
Crest 3D White Whitestrips Gentle Routine	up to 60 minutes daily	$
Colgate Optic White Mini Dental Whitening Strips	15 minutes twice daily	$

Custom whitening trays from your dentist filled with mild peroxide gel can also supplement at home.

Daily Oral Hygiene

Good daily brushing and flossing removes new debris and surface stains constantly forming on teeth, preventing discoloration buildup.

Whitening toothpastes containing silica or baking soda provides additional polishing without high peroxide levels that degrade enamel over time. A qualifying ADA Seal means the product safely meets government standards for efficacy claims.

Improving daily flossing is critical - nearly half of American adults have visible plaque buildup called gingivitis that yellows tooth appearance.

Regular professional teeth cleanings allow for deep elimination of substances wedged under gums. Most dentists recommend a teeth cleaning and checkup at least once every 6 months.

Caring for your smile doesn’t end when you finish the bottles of whitening gel! Maintaining your glowing smile requires commitment to minimizing staining and maximizing cleaning long after treatment.

Frequently Asked Questions

Undergoing teeth whitening for the first time often gives rise to many questions about what to expect before, during, and after treatment. Here we answer some of the most common whitening FAQs:

How Long Do Teeth Whitening Results Last?

Longevity of whitening depends greatly on your habits following treatment:

• Avoiding dark staining foods/drinks => longer lasting
• Smoking or tobacco use => faster re-staining
• Consistent touch-ups (strips, custom trays) => extended effects

With ideal maintenance of results, you can expect:

• In-office whitening: 12-36 months
• At-home whitening: 6-18 months

Additional whitening sessions can renew results once you notice fading. But allowing 3-6 months between treatments helps safeguard enamel and prevent sensitivity.

Can All Types of Stains Be Removed By Whitening?

Whitening works exceptionally well on extrinsic stains that accumulate on the enamel surface over time. This includes pigmentation from foods/drinks, tobacco, plaque buildup, medication use, or environmental factors.

Gray or brownish intrinsic discoloration within the tooth structure itself is harder to lighten significantly:

• Fluorosis mottling
• Trauma, injury, or death of the nerve
• Aging over decades

In these instances other solutions like dental bonding, crowns or veneers may be necessary to alter tooth color.

Is Whitening Safe During Pregnancy?

To date there have been no definitive studies conclusively demonstrating health risks to developing fetuses from dental whitening.

However, as a best practice guideline - all unnecessary procedures should be avoided during the first trimester when foundational development is occurring. Discuss options with your obstetrician and dentist during 2nd/3rd trimesters if considering whitening while pregnant.

Does Insurance Cover Teeth Whitening Treatments?

As whitening is an elective cosmetic procedure, most routine or major dental insurance plans do NOT provide coverage. Exceptions include instances where staining is documented as traumatic (e.g falls, sports injuries).

Some medical insurance plans with extensive dental riders may allot a small annual allowance, but this is relatively rare. Check your specific insurance documentation or speak to reps to confirm details.

Out-of-pocket costs can be expensive - $300-$1500 per session depending on type of whitening system used and number of sessions recommended for optimal effect. Budgeting appropriately will help avoid frustration.

Should I Use Activated Charcoal To Whiten My Teeth?

No! While stunning white smile transformations flood social media daily showing charcoal results, dentists strongly advise against using this abrasive and porous substance.

Yes, activated charcoal can scrub away some surface stains - but at the risk of eroding protective enamel and damaging gum tissue. Any pigment removal is extremely superficial and temporary.

Additionally, charcoal traps chemicals, leaving them in extended contact with your teeth. Look to safer whitening alternatives that use regulated concentrations of common bleaching agents.

Choosing the Best Dentist for Whitening Treatments

Under the supervision of an experienced dentist, in-office whitening procedures can safely provide dramatic results. But not all dentists have the same training, experience, and equipment to properly administer treatment.

When searching for a practice to trust for whitening consultations or procedures, keep the following credentials and specializations in mind:

Advanced Training and Education

Post-graduate specialty training in esthetic or cosmetic dentistry involves extensive instruction in techniques and materials for whitening beyond basic dental school curriculums. Those with credentials like:

• AACD - American Academy of Cosmetic Dentistry Member
• EAED - European Academy of Esthetic Dentistry Member
• ABGD - American Board of General Dentistry

have sought supplemental targeted instruction demonstrating knowledge and skill.

Use of Cutting-Edge Whitening Tools

The most effective in-office treatments utilize high intensity blue LED light to accelerate and maximize results. Variable peak wavelength output between 430-490 nm provides superior activation of the hydrogen peroxide or carbamide peroxide whitening gels.

Adjustable spot curing lights allow dentists to control lightning exposure times on each individual tooth as needed. Look for in-office use of state-of-the-art whitening lamps rather than outdated overhead exam lights.

Sample In-Office Whitening Systems	Light Source Details
Philips Zoom Whitening	45mw/cm2 LED Light, 430-490 nm wavelength
Ultradent Opalescence Boost	38mw/cm2 LED Light, 430-490 nm wavelength

Experience with Sensitivity Prevention

Sensitivity during and following whitening is a common patient complaint. An experienced dentist will be able to evaluate your risk factors and take proper precautions to maximize whitening while preventing this painful issue.

Desensitizing steps prior to and following treatment may include:

• Fluoride varnish or gel application
• Potassium nitrate sensitivity toothpastes
• Pre-medication with non-steroidal anti-inflammatories

Services Tailored to Your Needs

There is no true “one-size-fits-all” teeth whitening procedure. An outstanding dentist will conduct a thoughtful clinical exam, inquire about desired goals, identify causes of staining, and educate you on options customized to your dental history and needs.

They should happily provide references and before/after photo results from real patients showcasing their expertise in whitening services for diverse needs from simple stains to complex cases. This level of personalized care yields superior outcomes.

Prioritize dentists who emphasize listening to patients first when seeking optimal whitening care.

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