Chapter 5: Natural methods to preserve or whiten your teeth

Reviewed by Dr. Joseph Salim, DMD (written by the Sutton PDA editor)

Introduction

Since this guide is not just any guide 😉 but a definitive one, we had to include some information on:

  • Foods that protect your choppers
  • and natural teeth whitening methods.

In your pursuit of a sparkling smile you may be tempted to test some natural methods.

The absence of any bleaching chemicals and their low cost, certainly makes them attractive.

Maybe that a more alabaster smile is only an oil swish away?!

Let’s explore whether what we eat can protect our teeth’s natural shade.

During the second part of the chapter we will learn what science says about some DYI and natural whitening methods.

Foods that preserve your teeth

Which foods protect your ivory grin?

Are foods a level playing field when it comes to staining?

Unlikely, right?

I mean, you do not even have to scratch far below the surface to see that not all of them will discolor your pearly whites (see also What can I eat or drink after teeth whitening?) … so it is not suprising that some will, and others will not, protect your teeth.

Let’s see which ones can help you maintain their natural ivory shade.

Here are your allies when trying to protect your gleaming smile:

  • Apples, celery, pears, almonds, and carrots. Since they are high in fibers, when you chew them, they will have the same effect as a natural toothbrush.
     
    The fibers will act as “micro toothbrushes”, scrubbing the surface of your teeth.
    They also stimulate the production of saliva which neutralizes acids produced by bacterial food fermentation.
  • Cacao, cauliflowers, rhubarb, broccoli, spinach, carrots. They are rich in oxalic acid, hence the odd feeling in your mouth, after consuming them.

     
    Oxalic acid forms calcium oxalate, which in turn creates a protective layer covering the tooth.
    You should avoid these foods if you suffer from gout or renal insufficiency.

Let’s now learn about the science (or lack of thereof) for certain natural teeth whitening methods.

DIY, natural teeth whitening methods

What is the best and safest DIY method of whitening your teeth?

Thinking about something new and exotic?

Let’s keep things simple instead.

Although not very exciting, proper, routine oral hygiene, with regular brushing and flossing of your teeth, are tried-and-true methods.

How do they work?

They will avoid food and bacteria hardening into plaque, which will then stain your teeth.

Ideally, you should brush and floss your teeth after every meal or snack.

And a special warning for the gluttons…

Avoid frequent snacking, if you cannot brush your teeth and floss them regularly.

Next, we will talk about hydrogen peroxide gargling.

Can I whiten my teeth just by rinsing my mouth with hydrogen peroxide?

Hydrogen peroxide is used in many OTC and professional teeth whitening products (see also How are carbamide peroxide and hydrogen peroxide used in dentistry?).

Nobody can object to that.

So, using it as is, will be even more effective right?

Not so fast.

This approach would not whiten your teeth.

Using undiluted hydrogen peroxide may also cause serious damage to your soft tissues including gums, and even your teeth.

Instead, consider swishing with hydrogen peroxide mouthwashes. Albeit, you will need to be perseverant and use them over several months to see an effect.1

Can I use baking soda mixed with lemon juice, water, hydrogen peroxide, oranges or apple cider to whiten my teeth?

The whiteness of baking soda brings to mind the pure whiteness of an ideal sparkling grin.

Baking Soda Lemon
Lemon and baking soda

But what is baking soda?

It is a little alkaline and white product, with a crystalline structure.

The chemical compound’s name is sodium bicarbonate, and baking soda is the more common name.

So, is a pure bright white smile one spoonful of baking soda and lemon juice away?

Unfortunately, … not.

Baking soda mixtures will damage your enamel since they are abrasive.

Besides, lemon juice, orange or apple cider contain natural acids.

They may erode your teeth, weakening your enamel.

This is especially true of lemon juice since it is very acidic. It will make your teeth more prone to decay and sensitivity.

So, moving beyond the evocative immaculate whiteness of baking soda, the unvarnished reality is that …

The cumulative effect of the acids and baking soda may lead to permanent loss of your enamel.

Even though your teeth may look whiter and shinier in the short term, in time, they may darken. This is due to the underlying dentin becoming more visible through a thinner enamel layer.

You could also get dark spots if you decide to brush your teeth with baking soda while wearing braces or permanent retainers.

Remember also that a thinner layer of enamel makes your teeth more prone to cavities.

By now, you must be objecting that “surely baking soda can also do some good.”

For instance, maybe, because of its alkaline characteristics, it will kill bacteria and help you prevent cavities.

Not really, you will have to brush your teeth with toothpaste, after using baking soda.

Let’s see now see whether mixing it with less acidic fruits can be useful (?)

Can I use baking soda mixed with strawberries to whiten my teeth?

We are fortunate enough to have a recent study that can help us answer the question.

In a 2015 study2, the efficacy of baking soda mixed with strawberry (DIY method) was compared to standard whitening procedures.

These included:

  • OTC methods, following manufacturers’ instructions;
  • dentist-dispensed whitening products for home use;
  • in-office teeth whitening.

What did the authors find?

The lowest lightening effect was obtained with the baking soda strawberry mixture (DIY) method.

And this, notwithstanding the abrasive nature of baking soda.

Okay, … That’s all we have to say about baking soda and its mixtures.

Let’s now talk about fruits containing digestive enzymes.

Will fruits with digestive enzymes, like pineapple and mango, improve teeth whitening?

Have you read the effects of natural enzymes being touted in health magazines?

Sorry to disappoint you.

There is no scientific proof about their effects on teeth whitening.

But eating fruits regularly is a very healthy choice for sure!

Next, we will investigate charcoal’s potential role in teeth whitening.

Is charcoal powder useful for teeth whitening?

Unfortunately, another bummer …

Charcoal purported teeth whitening virtues are also not backed by science.

There is no evidence that scrubbing your teeth with charcoal powder will lighten them.

A 2017 review article3 in the Journal of the ADA showed that:

  • There is limited data to make claims about its efficacy and safety;
  • some results seem to show a negative effect. Because of its abrasive nature, the enamel layer wears out. It becomes thinner, and dentin (which is more yellow) shows through.

Last on the list is oil pulling … Continue reading.

Can oil pulling or swishing your mouth with natural oils help you whiten your teeth?

The ADA does not recommend oil pulling as a replacement for dental therapy.4

Where you hoping for more?

Stay with us because all is not lost 😉 …

Meaning that it could have some positive effects on your health.

Despite the limited evidence, some studies show that you can improve your oral hygiene by swishing oil.5

Coconut oil

By “pulling out bacteria” this procedure may help you reduce:

  • Plaque formation,
  • inflammation of the gums.

However, you need to use it regularly and correctly.6

It has been shown that oil swishing may reduce the presence of the two groups of bacteria that cause fermentation:7

  • Streptococcus mutans,
  • and Lactobacillus species.

Hence, they initiate caries and inflammation of the gums.

Yes, nothing less!

The result is pain, potential tooth loss, and infections.

Several studies show a preventive efficacy of oil-pulling in:

  • Reducing plaque formation,
  • and plaque-induced inflammation of the gums.

Moreover, in some other studies, the effect of oil swishing was not inferior to that of a chlorhexidine-containing mouthwash.8 9

Do you know what chlorhexidine is?

It is an antiseptic compound considered the “gold standard” to treat oral infections.

It can help prevent tooth decay.

Unfortunately, it has a bad taste, and stains teeth brown.

So, maybe that oil swishing could be a better alternative.

Are different oils providing similar benefits or are there differences?

… Let’s see.

Olive, sesame, sunflower and coconut oils effects of teeth whitening?

If you enjoy Mediterranean cuisine, you must be using it all the times.

But the benefits of olive oil, do not stop at its fragrance.

Instead, its constituents have “antimicrobial, immunomodulatory, and antioxidative effect.”10

And if you are an aficionado of Asian food …

Then you may be curious to learn that sesame seeds oil does not just enhance foods with natural flavors and aromas.

Instead, sesame oil, which “contains:

  • Sesamin,
  • sesamolin,
  • sesaminol”

also has detoxification, antioxidant, and antibiotic actions.11

For instance, it was shown to have antibacterial properties against Streptococcus mutans.12

Now, this strain (see previous section Can oil pulling or swishing your mouth with natural oils help you whiten your teeth?) is one of the culprits when it comes to caries and periodontitis.

Of equal importance is sunflower oil’s role.

It displays antimicrobial activity against C. albicans.

This is a yeast that plays a role in the formation of children’s plaque and caries.13

Finally, we should talk about the beneficial properties of coconut oil.

These may be due to the presence of lauric acid (a fatty acid). Approximately 45-53% of coconut oil is made of this fatty acid.14

Now, lauric acid shows several interesting properties:

  • for one, it has antimicrobial characteristics against gram-positive bacteria and several fungi and viruses. For instance, coconut oil was active against both Streptococcus mutans and C. albicans.15
  • It “can react with alkalis present in saliva, to form sodium laureate-soap like substance, which reduces plaque adhesion and accumulation, and possesses cleansing action.”16

You may thus want to consider a more natural, safer approach to protect your teeth and gums.

Oil pulling may not be just the latest craze.

Edible oils may replace artificial, chemically produced antiseptics while maintaining oral hygiene, without any side effects.

Are you going to give oil swishing a try?

If so, how do you do it practically?

How do you actually do oil pulling? What is the procedure?

According to published literature17, you may use the following steps to carry out oil pulling:

  1. Take a tablespoon full of oil. You can use a teaspoon if your child undertakes the procedure.
  2. Swish the oil around your mouth for about 20 minutes. Ideally, you should do this before breakfast and with an empty stomach.
  3. If your jaw aches, consider reducing the time to 5-10 minutes.
  4. You should adopt a sitting position with chin up.
  5. Ensure that when you swish it, the oil is forced through your teeth.
  6. If done correctly, the oil should become milky white.
  7. Spitting it out in a paper towel or trashcan to avoid clogging the pipes.
  8. Do not swallow the oil as it contains bacteria and toxins.
  9. You should then consider rinsing your mouth with water and proceed with routine tooth brushing.

Oil pulling is not recommended if you have children under 5 years of age, because of the risk of inspiration.

Final remarks

This is was the last article of the Teeth Whitening: The Definitive Guide for 2020 series.

Have you read all the chapters?

If so, how do you feel?

Ecstatic right?

That is not surprising, because you have reached the state of “infinite teeth whitening knowledge”.

😉 Hey, here at SPDA we are amused by simple jokes.

On a more serious note, if you have not read all the chapters, you can find them here below:

Please leave us your feedback in the comments.

Anything else you want us to write about?

Any questions?

Just let us know in the comments!


Bibliography

Chapter 4: Sensitivity and gums’ irritation after teeth whitening

Reviewed by Dr. Joseph Salim, DMD (written by the Sutton PDA editor)

Introduction

We covered the basics.

It is now time to get more advanced.

I think you will agree with me when I say that safety comes first.

After all, teeth whitening is a cosmetic procedure, and it should not come at the expense of oral health.

But is that really a concern?

Not really, because as long as you follow your dentist’s advice and the product’s directions, you are home and dry.

Teeth whitening procedures are actually very safe.

While there are some side effects like teeth sensitivity or irritated gums, these can be either addressed (sensitivity) or will go away (irritation) after your treatments.

With that, here is more information to alleviate your concerns.

Let’s begin by addressing a question which is usually top of mind.

Can teeth-whitening increase the risk of oral cancer?

Negative.

The risk of oral cancer does not increase with the use of bleaching agents of any type. Studies have demonstrated this.1 2 3

There is insufficient evidence to classify hydrogen peroxide as cancerogenic.

The IARC has evaluated hydrogen peroxide. As a result of its investigation, it considers it unclassifiable regarding carcinogenicity to humans. Indeed the chemical belongs to Group 3: Unclassifiable.4

According to the SCCNFP:

  • The use of 3.6% hydrogen peroxide products (10% carbamide peroxide) in the oral cavity, does not represent a cancer risk.
  • This is the case when the users “do not have an increased risk of oral cancer due to tobacco use, alcohol abuse, or genetic predisposition.”
  • Although, repeated use of tooth whitening products might increase the risk of oral cancer.

So, now that we have put this major concern to rest let’s look at some common (but minor) side effects.

What are the most common side effects of teeth whitening?

There are not many side effects.

In fact, there are just two typical issues you may encounter:

  • More tooth sensitivity to cold, hot, or sweet;
  • Irritation of your gums because of the oxidizing effect of bleaching agents. Hence, your gums need to be protected.

These symptoms tend to disappear once the bleaching stops.5

And for the excellent news … no study has ever shown an irreversible effect.

But just how frequent is sensitivity after teeth whitening?

Next …

Frequency of sensitivity after teeth whitening with OTC products

A study showed6 that for chemically based OTC tooth-whitening products (gel in trays, paint-on films, and whitening strips):

  • two-thirds of patients experienced a transient mild to moderate sensitivity;
  • ” ‘mild’ to ‘moderate’ tooth sensitivity and gingival irritation were the most common side effects”;
  • patients experienced sensitivity during the first period after the teeth-whitening procedure;
  • “whitening strips and products with high concentrations of hydrogen peroxide caused more users to complain about tooth sensitivity.”

That leads us on naturally to the next set of questions (about sensitivity).

Sensitivity after teeth whitening: why, when and how long?

Let’s address the “why” first …

It all results from the penetration of hydrogen peroxide, for it will not stop at your enamel or dentin. Instead, it will go all the way down to the pulp during a 5-15-minutes exposure period.

Sensitivity can last several days and usually starts at the time of treatment.7

According to the ADA, it (sensistivity) 8:

  • “is generally related to:
    • the peroxide concentration of the material
    • the contact time.”
  • “may depend on:
    • the quality of the bleaching material,
    • the techniques used,
    • an individual’s response to the bleaching treatment methods and materials.”

Let’s now see how sensitivity can be addressed.

How can I treat tooth sensitivity after teeth whitening?

On the plus side … There is a simple solution.

You just need to use a type of toothpaste that can provide relief for sensitive teeth.

For example, you may use Sensodyne or other similar products by Colgate or Crest. They contain potassium nitrate and sodium nitrate.

You can use them both before, during, and after the procedure.

What is their mechanism of action?

They soothe the dental nerve endings.

But maybe you are still feeling concerned …

If so, here is another quick tip to make the post-whitening period uneventful: consider chewing sugarless gum to reduce peroxide levels.

Finally, if you have a headache, take what you usually use (for headache), such as Ibuprofen.

We talked about teeth sensitivity, but what about gum irritation?

Jump over to the question.

Gums irritation after teeth whitening.

This is an issue you will encounter mainly with OTC products.

Why?

Because your dentist’s supervision will reduce inconveniences to a minimum. This will be true both for in-office as well as for at-home teeth whitening.

Now, gum irritation begins within a day of the treatment, and can last several days.9

If you see that your gums are white or sore after any bleaching procedure, please follow up with your dentist.

Since we mentioned the role of your dentist in relation to safety, let’s expand on that a little bit.

Seeing a dentist before teeth whitening. Safety, risks, and contraindications of teeth whitening.

Do I need to see a dentist before teeth whitening?

Things are not always straightforward when it comes to teeth discolorations. There are many possible causes of staining.

If the color change results from food pigments, then solutions will be more straightforward.

But what about if it results from tooth decay?

That is why your dentist needs to assess your situation before taking any decision.

If you have cavities (tooth decay), teeth whitening will be contraindicated. You will need to treat your cavities before attempting any procedure.

That is common sense, right?

What could happen if you undergo teeth bleaching in the presence of tooth decay?

You will likely suffer from significant sensitivity because bleaching agents will penetrate the inner areas of the tooth.

So, it is important that your dentist gauges if teeth-whitening is the right treatment for your staining.

He will also discuss the whitening products or procedures that are best suited for you.

All of this could be part of your routine 6-month regular visit to your dentist.

This is something we highly recommend.

The ADA also advises patients to discuss with their dentists what whitening procedure is best for them.

Let’s now explore in more detail how a dental examination takes place.

Description of a dental examination before teeth whitening

In a way, your dentist’s work will resemble that of a detective 🕵️‍♂️.

Gradual process of tooth cavity formation

He will look for clues, find incriminating evidence and round-up the suspects (for your teeth color changes).

Usually, he will begin to:

  • Check for tooth abnormalities such as caries or leaking dental restorations (fillings).
    • Some changes in tooth color could be the only visible sign of such problems. They cause teeth to appear darker.
    • Teeth whitening will mask the underlying tooth decay.
    • Tooth decay may continue to worsen if left untreated. And, it will likely lead to the need for more expensive and extensive treatments.10
  • Verify the presence of cracks and gum disease (periodontitis).
    • If present, your dentist will delay the whitening procedure until correction of these problems.
    • This approach will avoid irritations or other unpleasant outcomes.

      Images of a normal tooth and a tooth with gum disease (periodontitis)
      Normal tooth and tooth with gum disease (periodontitis)

  • Identify your dental restorations, such as existing crowns, veneers or fillings.
    • As discussed in a previous article (see Teeth whitening’s impact on the color of crowns, veneers, implants, bridges or fillings.), their shade is not affected by conventional whitening agents. Your dentist will discuss with you whether teeth bleaching will have a desirable outcome.
    • You should expect extra costs and/or minor risks from replacing your dental restorations after teeth whitening. Replacement may be necessary to get a uniform post-procedure tooth color.
    • Identify a devitalized tooth. If it is discolored, it will need a very different whitening procedure than a live tooth. Though it is a low-risk routine treatment.11

Now, before any treatment, what will you do to help your dentist’s sleuthing?

The answer is easy…

Share the following information with him:

  • Any past issues about tooth sensitivity.
  • A history of allergies to specific compounds used in the bleaching gels.

It will enable him to adapt the teeth whitening procedure to your specific needs.

So, the bottom line is that …

Your dentist will take all reasonable precautions to avoid potential issues or any discomfort.

One last point we should not forget.

He may use x-rays to gauge and determine your oral dental health. These will help identify:

  • Cavities,
  • oral infections,
  • gum disease,

even at their early stage.

Now, let’s take a closer look at the safety of teeth-whitening procedures and products.

Are OTC, in-office and home teeth whitening with trays safe?

Were you concerned before reading “Can teeth-whitening increase the risk of oral cancer?” ?

If so, you should now be reassured.

Teeth whitening is not harmful.

However, some potential side effects do exist.

The most significant ones are:

  • Increased sensitivity to cold during the first 1-3 days after treatment. Otherwise, its side effects are no different than those observed during regular food ingestion.
  • Irritation of the gums only if they are not adequately protected during the procedure.

Peroxide-based products can indeed irritate or corrode your gums.

How can you tell if you are experiencing this?

You may feel a burning sensation. This effect will increase with the chemicals’ concentration, time, amount of product, etc.12 13 14 15 16

So, how will a dentist protect your gums?

The answer is simple… Protective gels or a rubber sheath will do the trick for in-office teeth whitening.

These cover your gums (during in-office teeth whitening). And they drastically reduce any risk of gums’ irritation due to contact with the bleaching agents.

As for home teeth whitening…

There are no safety issues if:

And really, you can sleep quietly because:

  • data accumulated over 20 years did not show any long-term negative impact on patients’ health.
  • The data also included some long-term studies.

As for OTC products …

You are probably surmising already that things are different.

And you are right.

  • Gum protective measures are not available.
  • Also, and unfortunately, there is limited clinical evidence about the safety and effectiveness of these (OTC) products.20 21

Now, patients are generally not aware of how to report negative events (adverse events) through the FDA’s MedWatch system.

(By the way, were you aware of this possibility?)

Hence, these (events) are probably seldom reported.

Nonetheless, excessive usage of OTC products may damage the glossy outer surface of your teeth (enamel).

Two cases of patients with significant enamel damage have been reported. These events may have been due to the overuse or the low pH (acidity) of OTC whitening products.22 23

Thus, if you consider using OTC products, you should first have a dental examination.

Seeing your dentist will help you choose the best method for your specific situation. It will limit the risk of harm and improve the quality of the whitening effect.

Let’s now learn about the use of teeth whitening in special age groups?

Is teeth whitening safe during pregnancy or lactation?

The answer looks simple at first …

Since there seem to be no specific side effects for pregnant women.

Though, after careful consideration, it is preferable that you don’t undergo this procedure because of the lack of safety data.

Teeth whitening is also not recommended if you are lactating.

And what about younger age groups?

Next …

Can children and teenagers do in-office teeth whitening?

The situation is somewhat similar to that we have just seen.

Meaning that there is a general lack of data to establish appropriate use and indications in these populations.

Also, young patients should ideally be responsible.

Now, if you have a child who may benefit from teeth whitening, he/she should at least have all his/her permanent teeth.

Generally, though, sensitivity can be significant in children under 16.

Why?

Because they have an enlarged pulp chamber or nerve within their tooth.

So, it is not a surprise that bleaching is usually not advised in this young age group (under 16).

As for teens … it is preferable or them to wait until they turn 18. Though, some may benefit from the procedure before this age.

In anyway, before taking any decision, your kids should first get their dentist’s approval.

Consider using a tailored made teeth whitening tray to avoid leakage of the gel if a home-based procedure is the choice.

As advised by the ADA, “close professional and parental/guardian supervision are needed to maximize benefits and minimize adverse effects and overuse.”24

Last but not least, after mothers, children or teens, we are left with a third age group, where one needs to evaluate safety carefully.

Let’s talk about the elderly population.

Am I too old for tooth whitening?

Be reassured. Age is not an issue per se.

Teeth whitening can provide benefits to all adults irrespective of age.

Although maturity can play an indirect role.

How?

It may increase the probability that you have dental restorations (crowns, implants, …).

Now, teeth whitening may not be appropriate for you if you have crowns, implants or bridges on the front facing teeth.

Another problem could result from your experiencing increased gum sensitivity over the years.

We always recommend that you seek professional advice before considering this treatment.

So, other than what we have discussed for these three age groups, are there more contraindications?

Scroll down and you wil find out.

Is teeth-whitening for everybody? What are its contraindications?

Some “times” teeth whitening may not be the best treatment for you.

Here is a brief but comprehensive summary of those “times”:

  • Your dentist informs you that your dental restorations are defective. Priority goes to treating them.
  • Your dentist has identified tooth decay. Again, you must first deal with this problem (before considering teeth whitening).

    Stages of caries formation: enamel caries, dentin caries, pulpitis and periodontitis

  • You have decalcifications (which show as white spots) – see also How effective is in-office teeth whitening if you have decalcifications?
  • You are suffering from the loss of a tooth’s surface, exposing the dentin. This issue may be due to:
    • tooth decay (see the previous point),
    • trauma,
    • excessive consumption of citrus fruits or carbonated soft drinks,
    • teeth grinding,
    • aggressive brushing,
    • defects in enamel development.

      Tooth anatomy: root, neck, and crown of a tooth

  • Your expectations are unrealistic.
  • You have gum disease (gingivitis or periodontitis).
  • You have developed gum recession. This happens when the gum line pulls back or wears away exposing the root. This is yellow and does not bleach like the rest of the tooth (also called the crown). Roots do not have an enamel layer, and whitening procedures will not work.

The above list speaks volumes about the importance of a consultation (before any teeth whitening procedure).

Let’s now peek at what governmental agencies say about teeth whitening agents and products.

What concentrations of tooth whitening agents are safe?

If we cross the Atlantic, we discover that …

The European Union’s SCCP says that:25 26

  • Only dental professionals can provide tooth whitening products with 0.1 – 6% hydrogen peroxide. These products include compounds releasing hydrogen peroxide (like carbamide peroxide) or hydrogen peroxide.
  • Higher concentrations of these molecules are unsafe.
  • The first cycle of usage of said products shoud involve a dental professional or be under his direct supervision. This approach would reduce certain risks. For example, the risk that a patient may inadvertently swallow bleaching gel because of inappropriate use of whitening trays.
  • As a patient, you must be at least 18 years old.

Tooth whitening (or oral hygiene) products for home use (in the European Union) cannot contain more than 0.1% of hydrogen peroxide (or equivalent amounts of carbamide peroxide).

In the USA much higher concentrations (3–6% hydrogen peroxide)27 are instead present in OTC products for home use. These include teeth whitening strips, paint-on products …

Talking about the USA, let’s hear what the FDA has to say.

Are whitening products safe because the FDA regulates them?

The FDA does not regulate any teeth whitening products28 irrespective of the usage or type.

So, the FDA will not provide any oversight for:

  • Teeth whitening products used in a dental office,
  • “dentist-dispensed products for at-home use,”
  • OTC (patient-purchased) products,
  • “products used in non-dental settings.”

Tooth whitening products fall under the U.S. cosmetic regulations. These are less strict than those for medical products.

Hence, tooth whitening products make it to market very easily because the FDA has not identified any of the ingredients (in the products being sold) as unsafe.

Does this mean they are basically innocuous?

Nope.

The ease with which you can get them, should not deceive you.

We have seen (check Gums irritation after teeth whitening) how their inappropriate use may result in:

  • Irritation of your gums,
  • undesirable effects on your teeth.

These effects may also be due to their low pH and poor product quality.

You should note, though, that the FDA regulates dental lasers used for in-office teeth whitening.29

Let’s now briefly talk about the ADA seal of acceptance.

How can you ensure a whitening product is safe?

Did you know that there is a way to see whether a teeth whitening product is safe?

Curious?

If it carries the ADA seal of acceptance, you can stop worrying.

It will mean that the manufacturer:

  • Has supplied data about its safety and efficacy,
  • members of the ADA’s Council on Scientific Affairs have reviewed the submissions and believe it adheres to their standards

But there is a problem …

The list of OTC whitening products carrying this seal is limited.

Actually, as limited as can be, since it contains only one product: the Crest 3D White Whitestrips (Glamorous White).

The ADA, in fact, believes that oversight by your dentist is necessary for safe and effective use of whitening products.

Final remarks

Thanks for staying with us all the way.

We hope you have enjoyed this article.

And please provide your feedback in the comments.

By the way … You are now within a whisker of “teeth whitening enlightenment” 😉.

What is missing then? 🤔

Chapter 5: Natural methods to preserve or whiten your teeth

So, only one chapter to go before reaching infinite teeth whitening knowledge!

And in case you have not read them all, as a reminder, the guide also comprises the following chapters:


Bibliography

Chapter 3: Teeth whitening results

Reviewed by Dr. Joseph Salim, DMD (written by the Sutton PDA editor)

Introduction

In the time and age of selfies and social media, a beautiful smile is often the place to start.

And here is something you and I can agree on:

the whiter your smile, the more natural and gleaming it will be… right?

Well … not really. A white smile may be bright, but it will not necessarily be natural.

In this article you will discover why, and many other things such as:

  • the types of results you can hope for with different teeth whitening procedures and products
  • how you can maintain them over time
  • the correct teeth whitening choices when you have dental restorations (crowns, veneers, implants, fillings, bridges …)
  • and more …

Happy reading!

What is a natural tooth shade?

Did you know that the natural color of teeth is off-white, similar to that of bone?

It is a step darker than pure white.

This contrasts with the popular, pure white, cosmetically enhanced smiles, presented in the media.

I know we are all influenced by the airbrushed celebrities and tooth whitening commercials, but reality is a little different.

Public opinion of what natural tooth color should be, is somewhat biased.

Stylised tooth shade chart
Stylised tooth shade chart

The explanation of why natural tooth color is darker than pure white is simple.

As you may already know, teeth consist of an outer enamel layer and an underlying dentin layer.

The latter is less transparent and darker than the former and shows through the enamel layer giving it light gray or (light) yellow color.

Let me reveal you some curious facts.

These are easy to understand based on what we said.

Why are larger teeth like molars or canines darker than other teeth?

Easy! This is due to a larger bulk of dentin showing through the enamel.

Likewise, females’ teeth are somewhat whiter than those of males. This is because they are smaller and hence have less dentin.

So, the obvious question is how white your teeth can get with the different teeth whitening methods available (?)

You are now ready for the next section.

How white will my teeth get after in-office teeth whitening?

Here are the facts.

After the 30-60 minutes treatment, your teeth whitening may vary:

  • from 10 to 15 shades whiter,
  • to 2 to 5 shades lighter.

However, 10-15 shades lighter in color is only seen in a small percentage of patients.

Most patients have an average result of 7-8 shades lighter when using Zoom® Whitening.

The average whitening potency of Opalescence® Boost is approximately four shades lighter.

As previously said, your results will be quicker if you choose in-office whitening versus OTC products.

And the reason is that higher concentrations of bleaching agents are used in the former.

Let’s now briefly summarize the advantages of in-office teeth whitening.

The benefits of in-office teeth whitening

The avid readers of this guide already know some of this information, but it is still worth presenting the below synopsis for the benefit of all.

  • If performed by a professional, results are consistent. This is different from home whitening procedures with OTC products.
  • It is one of the safest dental treatments available (since it is supervised by a dentist).
  • Sensitivity levels generally remain low, both during and after the procedure.
  • Results can be immediate. It only requires a short time (1-1:30 hours). So, it is ideal for busy patients.
  • Whitening results are long-lasting.

But wait! Are teeth whitening results after an in-office procedure, set and done? Or may they vary during the following days?

Just continue reading.

How will my teeth color change shortly after teeth whitening?

Your teeth color may lose some of its light shade the week following the procedure.

Sometimes, part of the color change is due to dehydration. This regresses with time.

As your teeth rehydrate, the color rebounds back to a shade darker than the one observed immediately after treatment.

I think I know what you are asking yourself. It is probably along the lines of “yes I understand, but what about the final result? What will it be like?”

The next section is awaiting you.

What will my final result be like after in-office teeth whitening?

This will depend on the types of stains initially present.

Now, different stains present different challenges.

For instance, yellowish stains respond better to treatments than brownish stains.

These are more challenging. Yes … unfortunately, not everything in the garden is rosy.

But this notwithstanding, it is impossible to predict the exact final result of teeth whitening.

Even if all your stains were yellow, it would be impossible.

It is also impossible to tell (in advance) how many shades lighter your teeth will become.

The actual outcome depends on:

  • your initial level of staining.
  • On the mineral composition of your teeth.

The only way to know for certain is by trying an in-office teeth whitening procedure.

You may not know this … but your dentist will always take an initial and final measure of your teeth’s shade.

He will use these for comparison purposes.

Tooth shade guide with a patient
Tooth shade guide

The final natural shade is different for each patient.

Now, some patients want their teeth to look natural, as they were before their staining. Although not a guarantee, this is possible.

In-office procedures bring out your natural color by removing deep as well as surface stains.

Hence the results will look more natural than with other less robust methods that cannot treat deep stains.

We talked about yellow and brown stains, but what about gray stains?

Can in-office teeth whitening treat grayish stains?

Let’s address the elephant in the room first.

Why do teeth have gray stains (at all)?

The reason is that grayish undertone may be due to certain medications taken at a young age.

These include:

  • tetracycline, to treat a disease;
  • minocycline in adolescence or young adulthood to treat acne.

Tetracycline and minocycline staining involve the dentin layer which is underneath the enamel. Prolonged bleaching may thus be required because the gel takes longer to reach this inner layer.

This type of discoloration does not respond well to tooth whitening.

Though it should improve after treatment, it may persist, at least partially.

Before we finish the stains-related questions … what about those white spots (on your teeth) that look like stains but are instead decalcifications?

How effective is in-office teeth whitening if you have decalcifications?

These will become more visible (and show as white spots) after the first procedure.

Though, they will become less noticeable after a few treatments.

Another question that may have been on your mind is ….

Does the use of high-intensity light improve in-office teeth whitening?

A few believe it improves the quality of the bleaching process.

Studies, though, say something different (see also https://www.suttonpda.com/in-office-teeth-whitening/#laser-light.

No study has shown an advantage in whitening procedures using these lights.1 2

One 2012 article 3 indicates that their usage:

  • “increases the risk of tooth sensitivity during in-office bleaching”;
  • “may not improve the bleaching effect for high concentrations of hydrogen peroxide (25–35%)”.

So, the article encourages dentists to avoid or to be cautious when using this type of light-activation.

Finally, some more recent articles report that the use of in-office high-intensity light:

  • did not increase efficacy nor speed-up in-office bleaching;4 “The in-office bleaching treatment of vital teeth did not show improvement with the use of light activator sources for the purpose of accelerating the process of the bleaching gel and achieving better results.”
  • tended to increase the temperature of dental pulp.5

Hence, the ADA does not endorse these whitening procedures.6

Let’s now answer an important question you may have.

Can teeth be re-whitened?

Yes, it is possible.

Your dentist can re-whiten your teeth in the dental office.

But you can also do it at home if you have custom-made bleaching trays and whitening gels.

You will be able to whiten your teeth as often as you need to.

Talk to your dentist to find out how often you should repeat your whitening procedure.

You can then determine which whitening products would work best for you.

Base your decision on your individual needs and lifestyle.

Let’s now look at results obtained with other teeth whitening strategies.

Do whitening washes, strips, gels on trays and paint-on films for home use, whiten teeth effectively?

Teeth whitening strips
Teeth whitening strips

Before we answer the question, a brief reminder … You can get these whitening products from a dentist or OTC.

Now, on to the question.

These products work proportionally to the concentrations of the bleaching agents (hydrogen peroxide or carbamide peroxide) present.7 8

And based on all we previously said, it is probably not a surprise for you.

The good news is that there is evidence they are better than no treatment at all or a placebo.9

Though, most of the studies were short-term and financed or run by the manufacturers. Hence, the likelihood of bias remains high.10

Also, there is a general lack of data to assess their long-term effects, on diverse populations.

As a general rule, one can say can they lighten your teeth by 1 or 2 shades, after several days of use.11

For instance, paint-on whitening gels can lighten your teeth by 1 or 2 shades.12

Likewise, whitening washes usually take 3 months to lead to 1 or 2 shade improvement in tooth color.13

The same is true for tray-based methods. You can observe a lightening effect of 1-2 shades within a few days.14 Though, you must follow manufacturers’ instructions.

What about whitening toothpastes?

They are not the open sesame to a glitterings smile. Their effect on the tooth color is also in the order of one or two shades.15

Although, they are better than standard toothpastes because they can remove or prevent surface stains.16

And, last but not least, is charcoal toothpaste good at the job of stains removal?

Sorry to disappoint you but the evidence is not there.

Despite being touted as effective whiteners, there is no data to back up these assertions.

A 2017 review article in the Journal of the ADA concluded saying that:17

  • There is a lack of data to draw any conclusions about the safety and efficacy of this type of toothpaste.
  • Dentists “should advise their patients to be cautious when using charcoal and charcoal-based dentifrices with unproven claims of efficacy and safety.”

To ensure you choose a safe and effective dental product, select those that have the ADA seal of acceptance.

As explained before (see Which are the best whitening strips?) for a product to qualify for the seal, the manufacturer must submit safety and efficacy data to the ADA.

Let’s now investigate how you can continue enjoying a bright smile after your teeth whitening endeavors.

Maintaining teeth whitening results

How can I enjoy prolonged results after Zoom® teeth whitening or Opalescence® Boost?

Custom-fitted touch-up trays or take-home bleaching kits are the solution.

Your dentist can provide them to you.

He should also give you instructions for when and how to use them.

If you follow them, you should be able to maintain the effectiveness of the results.

Okay, I know what you are thinking.

All this is interesting, but for how long should I use the trays at home? A few days, a few weeks or longer?

A teeth whitening tray filled with gel for home use

Although there is not an absolute rule, the general advice is to use them for:

  • about 1 hour a day for a period of 7 to 10 days;
  • then 1-2 days every 6-12 months to maintain a lighter shade.

Each patient is undoubtedly unique. While some may not need them at all, others may need longer treatment periods.

So, can you conclude from the above that – as long as you continue using trays with gel – then prolonged results are forever?

That is very unlikely.

But the answer really depends on your lifestyle.

Read on to find out.

How long do in-office whitening results last for?

Teeth whitening is not a permanent solution.

You need to repeat it periodically, to maintain the whiteness of your teeth.

Stains will come back gradually over time.

This also depends on your lifestyle. For example :

  • if you are a smoker,
  • if you consume large amounts of staining foods or drinks such as coffee, red wine, tea, etc…

You may see the whiteness begin to fade in as little time as 4 to 6 weeks.

If instead, you avoid or dramatically reduce these sources of staining, you may not need another whitening treatment for at least 6 to 12 months.

Some good habits to maintain your teeth-whitening results

As explained above, teeth-whitening results are not like diamonds, they are not forever.

But you can still make yourself less susceptible to further staining.

How?

The best way to maintain your teeth’s natural color is through:

  • following proper dental hygiene regimens such as:
    • brushing your teeth two to three times a day
    • flossing once a day to remove plaque
    • brushing immediately after meals
    • rinsing your mouth with water after meals
    • using daily antibacterial mouthwashes to kill plaque bacteria.
  • Avoiding consumption of beverages that easily stain teeth such as:
    • dark colas
    • red wine
    • coffee
  • Using a straw to avoid direct contact between these drinks and your front facing teeth.
  • Brushing or rinsing quickly after consumption of these foods and beverages.
  • Using a whitening toothpaste occasionally (4-6 times a month) to prevent staining.
  • Doing touch-up treatments by wearing custom-fitted trays or disposable trays.
    • A few hours for a couple of weeks should be enough.
    • Their frequency will depend on the method used, and on your lifestyle. The need for touch-up treatments may vary from once every six months to once every 1-2 years.

We are now going to change subject.

Any thorough article about teeth whitening cannot omit discussing whitening results in the presence of dental restorations (crowns, veneers, implants …).

So, let’s investigate this topic.

Teeth whitening and crowns, veneers, implants, fillings, and bridges

Teeth whitening’s impact on the color of crowns, veneers, implants, bridges or fillings.

Have you thought about the effect of teeth bleaching on preexisting dental work?

If not, then you should.

On the bright side …

Teeth whitening has a very limited impact on the color of materials used in fabricating crowns, bridges, and implants.

Four units dental bridge
Four units dental bridge

Ceramics or composite materials (composite resins) as well as gold alloy, do not change color (unless you polish them).

Why?

Because they are very hard materials that can withstand the bleaching procedure.

But the bad news are that … (read on).

Teeth whitening’s impact on the structure of crowns, veneers, implants, bridges or fillings may not be negligeable.

If you whiten your teeth in the presence of dental restorations, then you may have a problem.

This is due to … Structural changes.

Yes, bleaching agents may cause structural changes in your restorative materials.

For example, surface changes, like the weakening of certain materials, can occur.

These may also speed up their wearing down after frequent brushings.18 As a result, they may need to be replaced.

Among materials that are significantly altered you will find:

  • Amalgams,
  • glass–ionomer cements,
  • and compomers,

which are used to treat cavities.

For instance, the solubility of glass-ionomers and other types of cement has been reported to increase.

But that is not all!

Prolonged treatment with bleaching agents also increases the release of mercury from amalgams.

And if you are wondering why … It seems that this is due to microscopic changes in the amalgams’ surfaces. 19 20

The effect of bleaching on these materials depends on the time of application and peroxide concentration.

Negative effects increase proportionally with both factors: time of application and changes in the surfaces of amalgams.

Thus, your dentist should complete this treatment in the shortest possible time.

So, it makes sense that ….

The ADA and the SCCP advise to use lower concentrations of bleaching agents.21

You may also be interested to know that …

Many laboratory studies have shown how teeth whitening may affect the bond strength between:

  • The materials (crowns, implants, fillings, ..)
  • and your enamel or dentin.

For instance, it affects the bond strength between enamel and resin-based fillings.22

So, what general common-sense advice would you give someone, with dental restorations, about to bleach his teeth?

That it is always better to check with one’s dentist before deciding.23

Teeth whitening before or after veneers, bridges, crowns, implants or fillings?

Image of a dental crown
Dental crown

As we have seen above, restorations do not whiten during a bleaching procedure.

Let’s see how this may affect your teeth whitening plan.

First and foremost, it is always better to bleach your teeth before any restorations (veneers, crowns, implants, …).

Why?

Because it will help you to best match the color of the new restorations to that of your whitened teeth.

This is especially true for your anterior (visible) teeth.

And if you do not follow this common-sense approach …

Your whitened teeth will look lighter than your restorations. Hence, you will have an uneven whitening.

But what about if you already have restorations on your front facing teeth and you decide to undergo a teeth-whitening procedure?

Is all hope lost?

Nope, your dentist can do two things;

  • lighten your restorations by polishing them with a non-abrasive cleaning solution.
  • (The more involved solution) replace them if discoloration is important and polishing does not yield the desired result. The goal is to match the new whiter shade of your teeth.

Additionally, if you have several restorations (and not just one), you should consider alternative solutions.

These include veneers, crowns, bondings, instead of a whitening procedure.

Dental veneer

Let’s now move on (again) to a different subject.

In the next section we will take a closer look at foods and drinks, especially at those that can take a toll on your smile.

Food, drinks and teeth whitening results

What should I avoid eating or drinking after teeth whitening? (Post-care recommendations)

The question may be evocative of a long period of eating restrictions.

But that is not true, be reassured.

Restrictions apply only for 48 hours.

Why?

Because during this time it is easier for substances to penetrate the enamel. Teeth are dehydrated and enamel’s microscopic pores are open during the first 24 to 48 hours.

This phenomenon is due to the removal of the dental pellicle.

So, what should one avoid consuming?

The answer is quite simple: anything that could stain a white tee-shirt.

It is the best way to preserve the optimal results of the whitening procedure.

More specifically, you should avoid the following:

  • Dark staining drinks such as:
    • Coffee,
    • tea,
    • colored alcoholic beverages,
    • colored fruit juices,
    • colored colas,
    • red wine, etc.
  • Potato chips.
  • All tobacco products. Smoking a cigarette during the first 24 hours will leave a stain on your teeth (see How do teeth get stained from colored food and tobacco?). You can make moderate use of electronic cigarettes.
  • You should avoid all fruits especially berries, but you can eat bananas.
  • Colored lipstick.
  • All dark staining sauces including:
    • Soy sauce,
    • Bolognese sauce,
    • red sauces,
    • ketchup,
    • mustard, etc.
  • red meat,
  • chocolate,
  • lettuce and tomatoes.

During the first 48 hours (after teeth whitening) you should also avoid:

  • Red or blue toothpaste,
  • colored gels,
  • colored mouthwashes or fluoride treatments,
  • periodontal treatments,
  • Chlorhexidine, if you are using it to prevent dental plaque.
Teeth whitening mouthwash
Teeth whitening mouthwash

Now that we have seen the don’ts, let’s check the dos.

What can I eat or drink after teeth whitening?

Do you want to ensure that you will continue to say “cheese” without finding yourself tight-lipped?

If so, here are the drinks you can consume during the first 48 hours after teeth whitening:

  • milk
  • water (still / sparkling)
  • white wine
  • clear alcohol (Vodka/Gin)
  • white lemonade
  • clear soda (sprite, 7up)
  • club Soda or tonic water
  • coconut water but not coconut milk.

As for the foods, here are those you can consume within the first 48 hours after teeth whitening:

  • meats:
    • chicken breast without the skin or turkey (minus the fat),
    • canned chicken breast.
  • Fish: white fish, white tuna (without vinegar), fish and chips.
  • Carbohydrates:
    • white rice,
    • peeled potatoes (mashed, baked or fried),
    • plain pasta with white sauces (Alfredo sauce for instance),
    • flour tortillas (white),
    • white bread (no crust),
    • crackers,
    • oatmeal,
    • cream of wheat,
    • cereals (e.g., Rice Krispies),
    • pancakes with white syrup.
  • Fruits and vegetables: bananas, cauliflower, apples, white onion, pears (no peels).
  • Sauces: white gravy, sour cream, mayonnaise.
  • Egg whites.
  • Desserts: vanilla puddings
  • Dairy products:
    • White plain or vanilla low-fat yogurt,
    • white cheese (mozzarella, white cheddar, cottage cheese).

Consuming a staining substance shortly after teeth whitening

If a staining substance has come into contact with your teeth within 48 hours (after the procedure), then …

… you need to take immediate action!

Rinse with water and brush your teeth as soon as possible.

If you really you can’t do without a coffee (we empathize!) or a dark cola after teeth whitening, then use a straw.

Why?

Because it will limit contact to the back of your teeth.

Final remarks

Congratulations!

If you have read this chapter, you are one step closer to “teeth whitening wisdom”.

But after learning about:

  • natural tooth color,
  • results obtained with different teeth whitening strategies,
  • how to maintain teeth whitening result,
  • foods and drinks that do, or do not, impact your smile,
  • how to plan teeth whitening in the presence of dental restorations (crowns, veneers, implants, fillings, and bridges),
  • etc…

you may be curious to learn even more.

And that is great!

So, if that is the case, go on to read the remaining chapters:

And, if you have not checked them already, don’t forget the previous chapters of this guide:

See you soon!

Bibliography

Chapter 2: Whitening strips, toothpaste, paint-on films, and trays with gels

Reviewed by Dr. Joseph Salim, DMD (written by the Sutton PDA editor)

Introduction

You may have undergone a teeth-whitening procedure in a dental office.

Now you wish to maintain the results over time by doing something in the comfort of your own home.

Or you may be looking for a less pricey alternative than professional bleaching techniques.

Maybe you are simply curious.

Whatever your motivation, let us guide you through the different possibilities that exist outside the world of in-office dental procedures.

Starting with whitening strips that were introduced in the late eighties, all the way to

  • gels,
  • toothpastes,
  • rinses,
  • paint-on films …

you will see below, there is no shortage of choices!

To help you find your way among the numerous possibilities, we will focus on the more important ones.

We will explain how they work and highlight their pros and cons.

Just continue reading.

Which home teeth whitening products usually provide a bleaching action?

First things first.

Bleaching agents are important because they exfoliate or break stains (see also Chapter 4: Sensitivity and gums’ irritation after teeth whitening).

What role do they play here?

An important one, is the short answer.

You will find these agents present in many teeth whitening products.

Here are some examples:

  • OTC gels with trays,
  • gels with trays supplied by your dentist,
  • paint-on films,
  • and whitening strips.

Hence, all of these provide a bleaching action because of the presence of hydrogen peroxide or carbamide peroxide.

Let’s now look at how you can use them. We will start with paint-on films.

Usage of paint-on films.

Films are quite straightfoward

Here is a brief summary of the steps and of the way a film works:

  1. You should apply the peroxide-based bleaching gel on the teeth surface with a small brush.
  2. It then hardens and forms a coat covering the teeth and adhering to enamel.
  3. This film provides the whitening effect.
  4. After sometime the film dissolves and washes away.

Manufacturers advise twice daily application, during 14 days.1

As for any other teeth-whitening procedure, it is preferable to consult a dental professional before deciding.

Let’s now investigate how gels on trays work.

How do you whiten your teeth with gels on trays?

Teeth whitening trays fitting onto frontal upper teeth
Teeth whitening trays fitting onto teeth

Whitening trays (filled with gel) can be OTC or custom-made under your dentist’s supervision.

The latter approach makes use of higher concentration of bleaching agents.

As a result, if you are thinking you should handle gels with care, then your thinking is right.

And, your dentist is the one who should ideally choose the concentration best suited to your needs.

He can also prepare trays that ensure a perfect fit with your dental anatomy.

You can use trays between 2-4 hours over a few days.

Or, you can wear a tray during your sleep, 6-7 hours per night, for ten nights.

The length of treatment also depends on the extent of staining and desired lightening effect.

Next …

What are the advantages of custom-made teeth bleaching trays?

As mentioned above, they are custom made so that they perfectly fit your teeth and bite.

They are fabricated for home use under your dentist’s supervision.

How?

He will take impressions of your teeth.

After that, he will ask a laboratory to tailor-make the trays.

You will be able to fill this type of trays with a whitening gel without any risk of (the gel) leaking out.

Your gums will thus not get irritated.

Dental whitening trays and gel for home use

The outcome will be:

  • optimal results,
  • and no irritation to your gums.

You can use these products in different ways:

  • either as stand-alone home teeth-whitening procedures,
  • or as custom-fitted trays, after the in-office dental procedure, to maintain the whitening results.

What about the disadvantages of custom-made teeth whitening trays?

Just scroll down.

What are the disadvantages and side effects of custom-made teeth whitening trays?

The only con is price.

But that is normal.

They cost more than OTC trays because they involve more work.

And you get that back in terms of product quality (better fit, less gum irritation, etc…).

So, price is the main disadvantage of a dentist-prescribed tray for your home-use.

Dental laboratory for the manufacture of custom-made dental appliances

As for their side effect, albeit less common, is that you may experience jaw pain or a sore throat.

These happen because of excessively long tray usage.

But you will experience them also with OTC trays.

Since we mentioned the OTC alternatives, let’s investigate a little.

What are the pros and cons of OTC teeth whitening trays?

The main pros are price and the fact that you can quickly order them.

Yes, there are no other advantages for OTC trays.

As for the main cons, you know by now that gel (to whiten your teeth) may leak out if there is a poor fit.

This is likely to happen because we all have different mouth and bite anatomies. And OTC products offer limited or sometimes no possibility of proper fit and molding.

As a result, your gums may get irritated.

And, don’t forget! OTC trays may also decrease the whitening effect because you lose part or most of the gel.

That is why the American Academy of Cosmetic Dentistry recommends using patient custom-fitted mouth trays.

It also advises that they are made under your dentist’s supervision.

Okay, enough with trays!

Let’s move on to another product often used to restore your smile: teeth-whitening strips.

How do you use teeth-whitening strips?

Before answering the question in the title, let me ask you another question: do you know what teeth-whitening strips are?

If not, let me explain.

These are thin, flexible plastic strips with a layer of hydrogen peroxide whitening gel.

They were created in the late eighties to avoid the use of trays and gel.

They are shaped to fit the surfaces of teeth.

You find kits sold with two different sets of strips:

  • one will fit the anterior (buccal facing) lower teeth surfaces;
  • the other, the anterior upper (buccal facing) teeth.

Many types, with different instructions, currently exist.

Now let’s go back to the question asked in the title. In practice, how do you use strips? … and I would also add: how do they work?

Well, you need to gently press them across the teeth.

The gel layer should make good contact with the teeth’s surface.

Hydrogen peroxide in the gel will release oxygen during the bonding process with your teeth’s surface.

And the oxygen should wreak havoc among your stains.

That’s it.

By the way, hydrogen peroxide’s concentrations are low, in the order 5 to 14%.2 And that’s because it is a product intended for home use.

If you are considering testing this product, check the next section to help you with your choice.

Which are the best whitening strips?

Bold question? Can any product be considered the best?

As for whitening strips, it probably can.

Why?

Because, the only whitening strips to have received the ADA seal of acceptance are the Crest 3D White Whitestrips (Glamorous White). 3

They are also the only OTC bleaching product to have received this seal.

You should be aware that preparing all the safety and efficacy data for submission to the ADA involves a lot of work. Many manufacturers simply decide to avoid it. But it does not mean that their products would not meet the ADA standards (if they were to submit all the data).

Now, let’s move over to another product on the list: whitening toothpastes.

How does whitening toothpaste work?

It removes difficult surface stains.

But, as for deeper stains

……. it does not affect them, unfortunately.

Toothbrush in a little dog’s mouth

The best way to use toothpaste, is to keep the slurry that forms over your teeth for 5 minutes (after brushing).

Are you curious to know how it works?

If so, here is a brief explanation of the mechanism of action of whitening toothpastes:

  • They may rely on enzymes, although these are not always present. Enzymes are molecules that work like scissors and break down organic molecules in the biofilm (on teeth).4
  • They depend on large quantities of abrasive compounds. These eliminate surface stains from teeth surfaces. They include alumina, dicalcium phosphate dihydrate, and silica.5
  • They contain detergents.
  • They may make use of small quantities of bleaching agents like hydrogen peroxide or carbamide peroxide. But these are usually not present.6 7

One word of caution is necessary.

The quantities of abrasive compounds need to be calibrated to avoid the thinning of the enamel.

If that were to happen, not only would your teeth get weaker, but they would also get darker.

Why?

The explanation comes from the naturally yellow dentin becoming more and more visible (through a thinner enamel).

Let’s now briefly talk about one last product … whitening rinses.

How to use whitening mouthwashes or rinses

Last but not least come whitening washes or rinses.

There is nothing much to say other than that:

  • They contain bleaching agents like hydrogen peroxide, which react with stains.
  • Manufacturers advise rinsing for 60 seconds, twice a day.

Their use is very simple: you only have to swish the product around in your mouth.8

Final remarks

We hope you have found the article engaging.

If you have read this guide from the start, then:

  • you have seen how in-office dental teeth whitening is done, in Chapter 1,
  • and also how whitening strips, toothpaste, paint-on films, and trays with gels are used (in this Chapter 2).

You must probably be impatient to find out how well each of these methods works (?)

In other words, what results will you get with each technique or product?

And moreover, how long will these (results) last?

So, without further ado, let’s head over to Chapter 3: Teeth whitening results.

And remember … after Chapter 3, make sure you check:

(and also Teeth Whitening: The Definitive Guide for 2020 in case you have not read it yet).


Bibliography

Chapter 1: In-office teeth whitening

Reviewed by Dr. Joseph Salim, DMD (written by the Sutton PDA editor)

Introduction

Why choosing teeth whitening at a dental office rather at home?

What are the pros and cons?

How do different procedures work and what are the differences?

In this article we are going to address some of these questions and more, by focusing on in-office teeth whitening.

So, without preamble, let’s dive right in.

Dental cleaning: preparing for in-office teeth whitening

What do I need to do before in-office teeth whitening?

Getting your teeth whitened in your dentist’s office can yield quick results.

So, to score a gleaming smile it may be well worth its while to prepare yourself for the procedure.

Here is what you need to do. Before teeth bleaching at a dental office you:

  • Should brush your teeth.
  • Consider using lip balm before to avoid dry or sore lips.
  • Should also get your teeth cleaned.

A couple of comments regarding the last point.

If you are hoping that you can remove plaque and tartar at home … you will soon be disappointed.

They are hard to get rid of.

Unfortunately, you will require professional help, either by a dentist or by a dental hygienist.

Now, removing them is really necessary before teeth whitening.

Dental plaque and gum inflammation

Why?

Because a whitening gel cannot penetrate through calculus and plaque. Their presence will lead to blotchy results.

Besides, when a hygienist polishes your teeth, she will remove some of your surface stains.

Hence, the whitening gel will better penetrate within your enamel.

Finally, dental cleaning may show some cavities or leaking dental fillings.

And these need to be addressed before teeth whitening!

But could dental cleaning be enough to restore your teeth’s original color?

This would be great would it not?

You will avoid the extra cost and time of teeth whitening procedures, whether at home or the dental office.

The answer is negative, unfortunately.

Simple dental cleaning and polishing may be enough to remove your superficial stains (see also What will my final result be like after in-office teeth whitening?).

But for deeper stains that penetrate the enamel and even dentin, you will need to change to a more “robust approach.”

And that is typically where in-office teeth whitening comes in.

If you continue reading, we will unveil its secrets 😉.

How calculus can lead to gingivitis and finally periodontal disease

In-office dental bleaching

How does in-office teeth whitening work?

Dentist performing teeth whitening treatment

Now, not all procedures are created equal. 😉

Yes, there are some variations amongst different procedures.

But do not worry. We describe the main steps below, and we will explain the differences in the next sections.

All in-office teeth whitening procedures follow a somewhat standard routine. A trained dentist will:

  • Take a shade measurement of your teeth before the procedure begins.
    • Shade measurement aims to compare your existing tooth color to a shade with a stylized chart.
    • This provides a benchmark to gauge improvement after teeth whitening.
    • Once this (benchmark) has been determined, the whitening process will take place.
  • Polish your teeth using pumice.
  • Place a cheek retractor to expose all the teeth that are visible when you smile.
  • Cover your eyes, gums, and lips, to protect them from the bleaching gel.
    • A hardening resin or a liquid rubber dam is used and painted over the gums.
    • The tips of the gums between the teeth will also be protected from the bleaching agents.
    • Finally, only your teeth will be exposed. This process may take up to 10 minutes.
  • Apply a special whitening gel to your teeth.
  • Remove the previous layer during each session.
    Patient undergoing in-office teeth whitening. Gums are protected from contact with whitening gel. Cheek retractors are in place
    Patient with cheek retractors during in-office teeth whitening. Gums are protected.
  • Make you rinse your mouth with a lot of water, and polish your teeth with pumice again (if necessary).
  • Assess the degree of teeth whitening to gauge whether the procedure should be repeated or not.
  • Apply more whitening gel if necessary.
  • Remove your cheek retractors so that you can rinse your mouth.
  • Take your final teeth shade.

Temporary dehydration of your teeth may enhance the immediate postoperative result.

According to the ADA:

  • “heat and light application may initially increase whitening due to greater dehydration”;
  • “this reverses with time” and is also referred to as rebound;
  • the final color will be visible 2-6 weeks after the procedure.1

For some whitening procedures, your dentist will expose and activate the gel during each session.

He will use a special high-intensity UV light for this.

Let’s now talk about a topic which may be top of mind for you … number of treatments.

How many visits and in-office teeth whitening procedures do you need?

You will be happy to hear that …

Your dentist will usually not have to set up a regime with multiple visits to get your healthy grin back.

The average is one visit.

Albeit, depending on the results, or your desired outcome, another session may be necessary.

Your dentist may also suggest continuing the treatment with home whitening trays.

So, tray delivery may help complete the whitening process.

Albeit, depending on the individual case, the exact approach could vary.

We previously mentioned the use of light sources.

Let’s investigate a little.

How many light sources can be used during accelerated or LED in-office teeth whitening?

Your best guess? One, two or more sources?

Actually, the correct answer is three.

The following sources of light are the most frequently used:

  • LED,
  • plasma arc,
  • and halogen.

The type of light that best activates hydrogen peroxide is in the blue spectrum.

This is because hydrogen peroxide’s molecules absorb light in these wavelengths.

What about laser light?

Is it ever used?

Scroll down.

Is laser light, used for in-office teeth whitening, effective?

The short answer is that there is not a lot of data about the efficacy of laser bleaching.

Also, the data is difficult to compare because of the differences:

However, some comparative studies with high concentrations of hydrogen peroxide showed improved whitening.

Bear in mind though that:

  • “Most often, comparable results were found irrespective of light exposure.”3
  • “There is no evidence that light activation (power bleaching with high-intensity light) with high concentrated hydrogen peroxide bleaching gels results in more effective bleaching with a longer lasting effect.”4

Let’s leave the world of light sources and get back to some more practical questions.

Is in-office teeth whitening painful or uncomfortable?

Fear not, my young Padawans. 😉

The procedure is neither painful nor uncomfortable.

To the point that most patients usually listen to music, watch a DVD or doze off, during the entire procedure.

Yes, you understood right, most patients are very relaxed.

Light activation of teeth whitening gel during an in-office teeth whitening procedure

What are the advantages and disadvantages of in-office teeth whitening?

If you want fast results, in-office procedures are the way forward.

Unlike home bleaching techniques, results are quick and visible after a one-hour session.

Home whitening techniques instead are slower and are intended to be used over a period of 2-4 weeks.5

However, you will benefit from staying in the comfort of your own home.

Also, they are less expensive.

Zoom® and Opalescence® Boost

Which in-office teeth whitening procedures are most common?

You probably remember that we promised explaining variations amongst different in-office teeth whitening procedures.

Since a promise is a promise!

… Let’s look at the two most popular ones.

These are:

  • Zoom®
  • Opalescence® Boost

What is Opalescence® Boost?

It is an in-office teeth bleaching procedure that:

  • Lasts about an hour, depending on the degree of tooth discoloration.
  • Does not need light to activate the gel.
  • Whitens your teeth with a sticky and viscous gel, which stays in place on your teeth.
  • Can remove common stains brought about by your lifestyle (eating, drinking smoking, …).
  • Can also treat other difficult stains like those resulting from:
    • trauma;
    • prescription medications (tetracycline).

Now, after the procedure, you may experience post-whitening sensitivity.

To alleviate that, your dentist should give you a potassium nitrate gel.

You can use it in a customized tray until the condition subsides.

So, nothing to be too concerned about.

Let’s now learn about the other most popular in-office (teeth whitening) method.

What is Zoom® teeth whitening?

Patient with a light source device irradiating teeth whitening gel, during an in-office procedure

Zoom® is a very popular teeth whitening procedure that:

  • Generally, lasts about 1 hour and is done at the office.
  • Consists of three 15 minutes applications of a whitening gel. These contain hydrogen peroxide (25%). They lighten both enamel and dentin stains.
  • Makes use of an ultraviolet lamp to speed up the whitening process.

So unlike Opalescence® Boost, light is part of the bleaching process.

A small percentage of patients (about 7-8 %) experience sensitivity.

It subsides significantly after 24 hours and should completely disappear within 48 hours.

Are you concerned about sensitivity? Then check Chapter 4: Sensitivity and gums’ irritation after teeth whitening)

To address that, post-treatment care instructions include the application of a fluoride paste-gel to your teeth.

This is done right after the procedure.

Final remarks

Was the discovery of in-office dental procedures interesting?

This chapter should serve as a stepping stone to a better decision making when you want to restore your pearly whites’ natural color.

And to really take good decisions …

Well, you should really have all the necessary information.

For that, check also the remaining chapters:

(and also Teeth Whitening: The Definitive Guide for 2020 in case you have not read it yet).


Bibliography

Teeth Whitening: The Definitive Guide for 2020

Reviewed by Dr. Joseph Salim, DMD (written by the Sutton PDA editor)

Introduction

Are you concerned about your pearly whites not being so pearly anymore?

Maybe that your gleaming smile belongs to days long gone?

If so, then you are not alone.

The American Association of Orthodontists did a survey in 2013. They found that nearly 90% of the interviewed doctors (sample of 1200) had had such a request from some of their patients.

The need for a better smile explains why teeth whitening is so popular.

But it is not the only reason.

It is also one of the least invasive procedures in cosmetic dentistry.

Now referring to teeth whitening as “one of the least …” is a bit simplistic.

Why?

Because, it comprises several different approaches, so it is not just one well-defined procedure.

And maybe that you have come here because you are confused by the numerous methods proposed.

Or you simply need more information in order to choose the best approach for yourself.

Whatever the reason, you have come to the right place.

Our team of dentists with over 175 years of cumulative dental experience has written this guide.

It is a promise … We will try to cover all the methods available.

In other words, we will not limit ourselves to describe the teeth whitening strategies that we offer at Sutton Place Dental.

Instead, we will try to provide an unbiased assessment of all the existing approaches.

And we will use published literature as much as possible during this process.

So, what more can we say (?) other than … enjoy!

Teeth whitening methods

What is teeth whitening?

In short, the goal of teeth whitening procedures is to reduce or remove surface stains from your teeth.

You can have varying degrees of whitening, for instance, you can:

  • restore the original tooth shade
  • or whiten your teeth beyond the original tooth color.

And if you have guessed that the different shades of white may have some relation to the type of approaches used, … that is correct.

But the duration of a procedure, or the number of times one repeats it, is also significant.

Likewise, the types of stains play a role too.

I have mentioned “teeth whitening procedures” … so how many are there?

Many, but you can group them into three broad types of products/methods which are commonly used.

Let’s look at them!

A brief summary of the teeth whitening methods

Since we are dentists, we will start with…. well, with what is used at a dental office (see also Chapter 1: In-office teeth whitening). 😉

Your dentist will:

  • Use a range of high-tech clinical equipment to achieve the desired results.
  • Use high concentration of bleaching agents which will penetrate your enamel (and even dentin) deeper than the other two methods (see below).
  • Provide supervision throughout the process.

What are the advantages of dental office whitening procedures?

First and foremost, they provide immediate results.

But that is not all.

The procedures are also safe, and they will not harm your tooth enamel or dentin.

In-office bleaching procedures are in fact the safest.

Given the high concentrations of bleaching agents used … Are you surprised?

Yet, there is a simple explanation.

Conditions are controlled ensuring a safe and pain-free experience.

How?

Measures are taken to protect your gums from the (bleaching) agents. These (measures) consist of a protective gel or a rubber shield placed over your gums.

OTC products do not offer this possibility.

Another family of procedures takes place in your home with products prescribed and dispensed by your dentist:

Finally, the last group is for those who want to decide on their own.

Does that sound like you?

If so, then read on.

To remove your teeth’s stains, you will purchase your own OTC whitening products (see also Chapter 2: Whitening strips, toothpaste, paint-on films, and trays with gels).

These include many possibilities, suiting different budgets and temperaments, but:

  • They all use low concentrations of whitening agents.
  • and results are not immediately visible.
Young woman applying a teeth whitening strip

Some of the most common ones include:

  • Disposable trays that hold the gel in place. These are malleable to fit your dentition. They are pre-loaded with proper amounts of whitening gels.
  • Whitening strips where the gel is embedded. You will apply the plastic strip on your teeth.
  • Bleaching pens.
  • Toothpaste with hydrogen peroxide.
  • Paint-on gels or varnishes, …

All these OTC methods are cheaper than in-office procedures.

But since OTC products use low concentrations of bleaching agents, results take some time to show.

It is also possible to use products that do not contain whitening agents. These include toothpaste with abrasives (e.g., charcoal particles).

So, this leads us on to an inevitable question…

Which is the best teeth-whitening system for me?

You might be wondering whether there is a right or wrong method (?)

Negative.

There is no wrong or right teeth whitening procedure/product … as long as your dentist supervises it.

If your teeth are sensitive and you want quick results, then you are a better candidate for in-office treatment.

An in-home treatment system is better suited if you are on a budget.

You may also want to whiten your teeth in the comfort of your own home.

And who can object to that?

Your dentist will provide you the best advice after a thorough dental examination.

The optimal solution will depend on your dental health, budget, temperament, and lifestyle.

Let’s now move on to a different but related subject.

You have had a bird’s eye view of the different teeth whitening products and methods.

But it is no secret that price is also something to consider.

So, let’s look at what costs one should expect.

How will these vary depending on the products and chosen strategy?

Next.

Costs of teeth whitening

Teeth whitening cost and insurance coverage in the USA

Money cannot buy happiness, but it can buy a perfect smile.

We have seen the different methods, products, procedures used to restore your teeth whiteness.

Here below you can find a summary of what they cost.

Prices in the market can vary significantly:

  • In-office procedures cost up to $1000 but usually range between $300-$800.
  • Whitening trays provided by a dental professional, differ anywhere between $300-$600.
  • For OTC products prices vary widely starting:
    • As low as $3-$8 for a toothpaste;
    • $10-$40 for an OTC tray at the local pharmacy;
    • between $40-$70 for whitening strips.

And do insurances cover teeth whitening?

Unfortunately, not.

Most health insurance options do not comprise teeth bleaching.

This is also true of most other cosmetic dentistry treatments.

But many patients use their Flex-spending programs. They are offered by their employers to pay for these procedures and they are tax deductible.

Okay, now that we have peeked at prices, let’s learn about dental stains and the indications for teeth whitening.

You just need to scroll down.

Dental stains and indications for teeth whitening

What types of discolorations affect teeth?

There are two possible discolorations:

  • extrinsic
  • or intrinsic.

How do they differ?

The former is limited to the tooth surface and involves dental pellicle.

Yellow calculus and plaque on teeth

Some causes of extrinsic discoloration include:

  • Ingestion of certain colored foods and drinks.
  • Use of tobacco.
  • Use of topical medications like an antiseptic mouthwash. These may combine with tannins (naturally occurring substances) found in tea, wine, … and stain your teeth.
  • Plaque and calculus. Calculus is mainly found around the gumline.

Intrinsic discoloration instead involves the internal structure of the tooth (or of all the teeth). Some causes include :

  • Use of antibiotics for the treatment of acne, like tetracycline.
  • Tooth decay (dental caries).
  • Dental trauma.
  • Fluorosis which results from excessive ingestion of fluoride during enamel formation.

All this is intriguing and leads to the next question …

How can teeth change color over time, and sometimes also quite quickly?

For that, we need to understand stains.

How do teeth turn yellow or even dark?

Your teeth may change from white to a less bright, dull color as a result of many causes.

Yes, there is not just one culprit but many.

So, let’s look at these factors.

Ready to go?

Buckle-up, because the list is long:

  1. Natural aging, because of your brushing. Your enamel will wear out, get thinner and darken over time. Yellowish dentin will thus show through.

    Internal tooth anatomy

  2. Plaque and tartar build up. They cause your teeth to look yellow.
    They get stained if you:
    • Smoke on a regular basis.
    • Drink coffee, tea, or red wine (also on a regular basis)
    • Consume drinks and foods containing pigments (see also Food, drinks and teeth whitening results).
      • These coloring agents impact your teeth over time by attaching to your enamel (more explanations about this later).
      • Some foods and beverages containing pigments include:
        • dark sodas
        • coffee
        • wine
        • fruit juices
        • and tea.

          Teeth with braces

  3. Orthodontic treatments:
    • tend to discolor or stain teeth over time.
    • The metal brackets and wires used in these procedures trap bacteria and food.
    • This is also true, albeit to a lesser degree, if you choose Invisalign® instead of traditional braces.
  4. Trauma, such as when you receive a blow or suffer from a fall. These events may stain or discolor your teeth. The darkening results from the production of dentin. If this incident happened during your childhood, the change in structure could show later in adulthood.

    Whitening is not as effective in such situations because discoloration comes from deep within the teeth.

  5. Sometimes teeth look yellow because the outer hard enamel has never grown. Your enamel’s lack of growth could be due to genetic malformations or trauma suffered during childhood. The darker, naturally yellower dentin is thus exposed.
  6. Exposure to tetracycline and doxycycline (antibiotics) may interfere with your teeth formation.
    • This phenomenon happens either as a baby or when in the womb.
    • Teeth discoloration can then show later during your adulthood. It will reflect the darkening or yellowing of dentin in the inner layers of your teeth.
    • For these types of cases, whitening treatments tend to be less effective.

      Image a smoker's stained teeth
      Smoker’s smile

  7. Tobacco use can lead to stubborn stains. These result from smoking cigarettes, pipes, cigars or even chewing tobacco (more on this later).
  8. Excessive absorption of fluoride compounds during enamel formation.
    • It may lead to staining or darkening of teeth (fluorosis).
    • Fluoride has benefits in helping to prevent cavity formation. Hence, it is often present in drinking water. Yet, an excess of fluoride intake may result from:
      • abundant consumption of fluoridated tap water;
      • ingestion of fluoride toothpaste;
      • mouth rinses (which children tend to ingest).

Phew, that was long!

We said above that we would later explain how enamel gets stained from pigments and tobacco.

Now is later, so check the next section.

How do teeth get stained from colored food and tobacco?

When you look at your teeth’s enamel surface with a naked eye, it looks very compact, doesn’t it?

But if you move to a microscopic level, you will discover that it is porous. Tiny organic particles can thus penetrate the pores and remain attached.

And a higher porosity will lead to more persistent stains. Hence, your teeth turn purple and may stay purple when you eat blueberries if your teeth’s porosity is significant.

By now, you may be wondering whether porosity can change (?) and what you can do to protect your teeth.

The answer to the first question is that it can indeed. For instance, it will increase after contact with acidic substances. These demineralize enamel’s crystals making it easier to penetrate it.

So, any substance whose fermentation produces acids will affect the porosity.

Good dental hygiene will, therefore, go a long way in protecting your enamel’s porosity.

As for tobacco, its stains result from two chemical compounds:

  • nicotine which is colorless but gives teeth a yellowish color in the presence of oxygen,
  • tar which instead is naturally dark

Now, I guess we all know how to avoid staining from tobacco.

But how does one reduce staining from foods? I mean, you can quit smoking, but drinking and eating is not an option, right?

Continue reading to discover the answer.

How do you prevent teeth staining from foods’ pigments?

We have seen that the consumption of certain colored drinks and foods can affect the color of your pearly whites.

Now, it is possible to reduce this by changing your habits somewhat:

  • Decreasing (or avoiding) the consumption foods and drinks that darken your teeth.
  • Rinsing and brushing your choppers after consumption (of such foods or drinks).
  • Using a straw to avoid direct contact with staining drinks, such as wine, coffee, or tea.

Let’s now look at how well in-office dental whitening works for different types of stains.

Which stains does in-office dental whitening remove?

The answer to this question is well-known.

Good candidates for in-office teeth whitening are those with stains that have accumulated from:

  • dark soda,
  • sauces,
  • fruits, in particular berries,
  • coffee,
  • red wine,
  • fruit juices,
  • colored foods,
  • tea,
  • antibiotic tetracycline stains.

Now, before we study more closely the different methods available to improve your smile, let me ask you a question…

Do you know which compounds are at the heart of most teeth whitening methods?

If you do not, check the next section, because it will be useful to understand this guide better.

The compounds we will discuss are at the heart of many teeth whitening products.

Hydrogen peroxide and carbamide peroxide

How are carbamide peroxide and hydrogen peroxide used in dentistry?

So, as you have surmised already from the title …

… the compounds that are responsible for improving the appearance of your teeth are:

You may have childhood memories of getting scraped or cut and then cleaning the wound with a liquid from a brown plastic bottle.

The magical bubbling, fizzy, and crackly sound, that you have most probably witnessed, is due to hydrogen peroxide.

Its chemical formula is:

Hydrogen Peroxide Chemical Formula

When it comes into contact with your tissues, moisture or chemicals (e.g., pigments) on your teeth, it breaks down into water and oxygen. Hence the fizzy sound.

It releases oxygen in a burst. And oxygen is what makes it a powerful cleaner.

And what about carbamide peroxide?

Carbamide peroxide decomposes to release hydrogen peroxide in an aqueous medium (10% carbamide peroxide yields roughly 3.5% hydrogen peroxide)”1 along with urea.

So carbamide peroxide is nothing other than an alternative source of hydrogen peroxide.

Reason why some whitening products contain carbamide peroxide, while others use hydrogen peroxide instead.

You will find them both as active ingredients in tooth whitening products used in dental offices.

Most OTC bleaching products instead are hydrogen peroxide-based, although some contain carbamide peroxide.2

The concentrations used in a dental office will be high, in the order of 15–38% of hydrogen peroxide (or an equivalent level of carbamide).

But these products will be used for shorter time periods.3

Otherwise, when lower concentrations are present (3%-10%) 4, you will find them:

  • In oral hygiene products. These include toothpaste and mouth rinses. Their disinfecting action will help prevent plaque formation and inflammation of your gums.5
  • Mass market products, or OTC teeth whitening products.

Differences between carbamide peroxide and hydrogen peroxide

As we have seen above, both are bleaching agents.

Because of their “bleaching nature,” they do not just remove surface stains (like non-bleaching agents).

Instead, they penetrate the enamel, exfoliate or break stains up and eliminate them.

So, they also clean deep (intrinsic) stains and can thus bring your teeth back to their natural color.

As we have explained, it is the oxygen molecules within the whitening agents that decompose the pigments.

But there may be some differences, between carbamide peroxide and hydrogen peroxide, in terms of:

  • efficacy,
  • sensitivity, …

Don’t you think?

Actually not, at least according to a study by the Journal of the ADA6

Provided resulting concentrations of hydrogen peroxide were equal:

  • both produced important results;
  • were equally effective at removing deep stains (intrinsic) as well as surface (extrinsic) stains;
  • did not show any significant differences in teeth sensitivity.

The only difference is that hydrogen peroxide is faster. Its bleaching effect will occur within 30-60 minutes.

Carbamide instead will break down your stains more slowly. It will release 50% of its whitening effect within 2 hours of its application. Its activity may continue for up to 6 hours afterwards.

Another difference is that carbamide peroxide has a slightly longer shelf life than hydrogen peroxide. This difference disappears when both are refrigerated.

In-office teeth whitening procedures make use of gels containing either carbamide peroxide or hydrogen peroxide.

Final remarks

I hope you have enjoyed this first article.

Its goal was to serve as an introduction to the world of teeth whitening.

Let us know in the comments if you have any questions, but also consider reading the next articles in this guide.

They will help you become a teeth-whitening erudite 😉.

Begin with Chapter 1: In-office teeth whitening!

It will take you by the hand and show you how in-office teeth whitening procedures work.

After that, also check the remaining chapters:

See you soon!


Bibliography