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Tooth whitening

Published by Bupa's health information team, August 2007.

This factsheet describes bleaching methods that can be used to lighten the natural shade of your teeth.

Tooth colour varies from person to person - just like skin and hair colour. There are a number of ways that teeth can be made to look whiter if they become discoloured.

Why do teeth get discoloured?

There are many reasons why your teeth can become discoloured. This can include drinking tea, coffee, red wine or other food and drink with strong colourings. Another major cause is smoking, which can make the teeth appear yellowed.

As you grow older your teeth can become darker naturally. Tooth decay, fillings and tartar build-up can also contribute to discolouration.

Teeth have nerves and blood vessels inside them. If these nerves and blood vessels are damaged the tooth may become darker (this can happen because of decay, or if the teeth are knocked).

Some types of staining can be caused by diseases or medicines. For example, if a type of antibiotic called tetracycline is given to children whose teeth are still developing, their adult teeth may form with a yellow or greenish tinge. There are many simple ways to improve the appearance of discoloured teeth.

  • Visit your dentist or hygienist to have your teeth scaled and polished on a regular basis. This involves removing any tartar that has built up. Your dentist or hygienist will also give you advice about preventing tooth decay.
  • Regular brushing, stopping smoking and cutting down on strongly coloured food and drink will help stop stains returning.
  • Whitening toothpastes are slightly abrasive, which may help to remove surface staining. However, they do not alter the natural shade of your teeth.
  • Your dentist can also give you advice about replacing your metal fillings and crowns with tooth-coloured ones.

There are a number of different products available to bleach your teeth. Some you can buy and use yourself, while others require a visit to the dentist.

Types of teeth whitening products

Over-the-counter kits

Over-the-counter (OTC) kits are sold in most major chemists throughout the UK. Usually they contain rubber mouth trays (moulds that are approximately the same shape as your teeth) and tubes of bleaching gel.

After squeezing some of the gel into the mouth trays, you place them over your teeth for about 30 minutes at a time. The bleaching ingredient in the gel is usually hydrogen peroxide. OTC kits only contain weak hydrogen peroxide, and tend not to be as effective as stronger products that may be used by your dentist.

Using bleaching gels in this way may not work for certain types of discolouration, such as that caused by metal fillings or damaged blood vessels inside a tooth. Ask your dentist for advice before using one of these kits, as there may be a more effective way to achieve the result you are looking for.

Professional tooth bleaching

There are several different ways that dentists can bleach your teeth. These are separated into external techniques (where the bleach is placed on the outside of the tooth) and internal techniques (where the bleach is placed inside the tooth).

External bleaching

This means that the colour of the teeth is lightened by placing a bleaching gel on the outer (external) surfaces of the teeth. Once again, using bleaching gels in this way may not work for certain types of discolouration, such as that caused by metal fillings or damaged blood vessels inside a tooth. There are three ways to do external bleaching.

  • "Home" bleaching - this is similar to the over-the-counter kits, but with two main differences. Firstly, your dentist makes the rubber mouth trays so that they fit your teeth precisely, and secondly, the bleaching gel is stronger so it tends to be more effective. Your dentist will give you tubes of bleaching gel and instructions on how to put the gel in the mouth trays. You will need to wear the mouth trays for at least a few hours each day. It may take a few weeks to achieve the colour that you want. Your dentist will give you detailed instructions.
  • In the dental surgery -"power" or "laser" bleaching. Your dentist may put a rubber seal around your teeth to protect your gums depending on concentration of bleaching agent used. Then, the bleaching gel is placed onto your teeth and a special, bright light is used. This light enhances the whitening process. The appointment may take between one to two hours.
  • Combined bleaching - this may also be known as "power" bleaching - both the home and surgery bleaching are used in combination to obtain the desired result. The home bleaching stage may occur before or after surgery treatment - this depends on the type of product used. Your dentist will give you instructions.

Internal bleaching

This means that the colour of a tooth is lightened by placing a bleaching product inside the tooth. Internal bleaching can only be done on teeth that have been successfully root treated. This means that the blood vessels and nerves inside the tooth have been replaced with a rubber filling.

To bleach a tooth in this way, the dentist will drill a hole and put the bleaching product into it (if it's a front tooth, the hole will be on the back so that you can't see it). The hole will be sealed with a temporary filling, leaving the bleach inside the tooth. The procedure won't hurt because the tooth has no nerve inside it.

You'll have to go back to your dentist about a week later to have the temporary filling and bleach taken out. If you are satisfied with the new shade, your dentist will fill the hole with a tooth coloured filling. Sometimes, the colour doesn't lighten enough, and the process needs to be repeated. Occasionally, internal bleaching needs to be combined with other whitening techniques to achieve the desired effect.

How long will the whitening last?

The whitening effects of different bleaching methods can last for a few years, but this varies from person to person. Research on dentist prescribed "home" bleaching treatment has found that for people who achieved a lighter shade, only half of them still had whiter teeth six months later. Your eating, drinking, smoking and brushing habits may have an effect on how long the treatment lasts.

It's important to bear in mind that bleaching doesn't always result in the whiteness that you expect. The results vary from person to person and depend on the shade of your teeth before bleaching. For this reason, it's important to discuss all the possible options for improving the appearance of your teeth with your dentist before you decide on treatment.

Special considerations

There are some instances when a dentist may recommend that you don't have bleaching. For example, if you have tooth decay, this should be treated before starting any whitening treatments. Similarly, your gums should be healthy, so if you have any gum disease this should be treated.

If your teeth are extremely sensitive to hot and cold food or drinks, bleaching may not be recommended.

Some types of staining (eg tetracycline antibiotic staining) doesn't respond to bleaching as well as others. Bleaching, if successful, may take longer on tetracycline stained teeth.

Bleaching won't work on false teeth, crowns, veneers or fillings (including tooth coloured fillings). Instead, your dentist may be able to replace these with lighter ones.

Bleaching isn't usually recommended for children whose teeth are still developing or for pregnant or breastfeeding women.

Deciding on treatment

There is no evidence to suggest that tooth bleaching is harmful to the gums, but it isn't clear what the long-term effect on the nerves and blood vessels inside the teeth are.

All dental treatment carries a risk of side-effects, which are the unwanted, but mostly temporary effects of a successful treatment. Side-effects include temporary sensitivity of the teeth to hot and cold, a sore throat, tender gums and white patches on the gums. These side-effects should disappear after a few days. Contact your dentist if the symptoms persist.

Related topics

Further information

Sources

  • Dunitz M. Bleaching techniques in restorative dentistry. London: Taylor and Francis, 2001:91
  • Hasson H, Ismail AI, Neiva G. Home-based chemically-induced whitening of teeth in adults. The Cochrane Collaboration. August 21 2006
    www.cochrane.org
  • Hemmings K, Griffiths B, Hobkirk J, Scully C. ABC of oral health: Improving occlusion and orofacial aesthetics: tooth repair and replacement. BMJ 2000;321:438-441
  • Malcolm Bruce. Tooth whitening is effective, with neither adverse nor beneficial effects to gingiva or plaque. Evid Based Dent 2002; 3:76
  • Mitchell DA, Mitchell L, Brunton P. Oxford Handbook of Clinical Dentistry. 4th ed. Oxford: Oxford University Press, 2005:316-317
  • Neiderman R et al. Effectiveness of Dentist-Prescribed, Home-Applied Tooth Whitening. A Meta-analysis. J Contemp Dent Pract 2000; 1(4):20-36)Mitchell DA, Mitchell L, Brunton P. Oxford Handbook of Clinical Dentistry. 4th ed. Oxford: Oxford University Press, 2005:316-317
  • Sharif N, MacDonald E, Hughes J, Newcombe RG, Addy M. The chemical stain removal properties of 'whitening' toothpaste products: studies in vitro. Br Dent J 2000; 188:620-624
  • Tooth whitening. British Dental Health Foundation
    www.dentalhealth.org.uk
    accessed 29 May 2007

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Brian Franks BDS (U. Lond) LDS RCS (Eng) MFGDP (UK) FPFA ACIArb, clinical director (dentistry) Bupa Wellness and other Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2007

 

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