TOOTH WHITENING (BLEACHING) By Dr. Mike Kimberly Dr. Mike Kimberly Offers  Zoom Teeth Whitening System as seen on the reality television show Extreme Makeovers

What causes tooth discoloration?
There are many causes. The most common include aging, consumption of staining substances (coffee, tea, colas, tobacco), trauma, tetracycline (antibiotic) staining, excessive fluoride, nerved degeneration, old restorations, old fillings, tooth nerve damage, or trauma to teeth. 

What is it Tooth Whitening?
Tooth whitening basically is the process of lightening ones natural teeth by applying a carbamide peroxide gel or paste to the teeth.  This process works much better than whitening toothpastes. Teeth are porous like a sponge and naturally develop stains externally as well as internally over time. The bleaching process simply removes these stains from the teeth allowing them to be as light as possible.

Will it harm my teeth? 
Extensive research by the Journal of the American Dental Association (JADA) has shown that tooth bleaching is a safe process provided one is using a professionally dispensed and tested bleaching gel or paste.

Who is a candidate?
Not everyone is a good candidate for tooth whitening and therefore should seek the 
professional opinion of their dentist.
- Heavy smokers, coffee and tea drinkers are less likely to achieve good results if they do not discontinue such habits during the whitening process.
- As a rule of thumb younger patient's teeth tend to lighten more easily as they tend to have more yellowish teeth.  Grey is perhaps the most difficult color to remove from teeth and often is found in the older patients. This is not to say that dramatic results can not be achieved with grayer teeth just that extended bleaching times may be required. 
- The bleaching process will not lighten crowns (caps) or tooth colored fillings called composites (bondings).  This is important to be aware of prior to bleaching, often  following the bleaching process fillings and in some cases crowns may need replaced as they will no longer match the now lighter bleached teeth.
- Some individuals also have very translucent teeth particularly at the tips of their front teeth. The bleaching process can actually increase the translucency. This can create the appearance of gray teeth following the bleaching process, due to the darkness of the oral cavity (mouth) behind them.
- Teeth that are heavily stained with brown spots or dark gray tetracycline banding generally do not respond well to bleaching. Also non-vital (dead teeth) that have been stained internally generally do not lighten well from external bleaching and often need to be lightened by an internal bleaching process.

How is the Whitening Process Done?
There are basically two options when bleaching teeth, In office vs. at home bleaching.
- In office bleaching involves having the patient come in for appointments where the teeth are isolated and a very strong peroxide paste is applied to the teeth with several applications. In some cases lights and lasers may be applied to the peroxide paste to attempt to enhance the process.  This generally takes several applications and requires a lot of "chair time" therefore increasing the cost significantly.  My personal experience has not been good with this method.
- At home bleaching ("tray bleaching") involves having the patient wear bleaching mouth guards filled with a carbamide peroxide gel. This process involves having the patient come in for impressions (molds) of their mouths on which custom bleaching trays are made.  The bleaching trays are a clear, thin, soft material. The patient applies a thin bead of bleaching gel inside the tray, places the trays on their teeth, wearing the trays for the recommended bleaching time.  The bleaching time per treatment varies from 45 minutes to 4 hours depending on the strength of the bleaching gel being used.  This process is repeated until desired results are achieved, generally this takes 2-3 weeks, in some cases longer.  This process is more cost effective and better, more predictable results are achieved. I highly recommend this method over the in office technique. 
- Gel strengths for at home bleaching vary widely from 10% to 30% carbamide peroxide. The reason for this has to do with the abundant number of manufactures and patient variability. The more concentrated the gel strength the less the wear time needs to be, meaning faster whitening.
I recommend at home bleaching trays from your dentist not kits bought at your local store.  A few reasons:  The first is that your dentist can monitor your progress and make sure it is done properly and other reasons are that there are very poor results and the trays are a standard fit which can cause the gel to seep and irritate gums.

What are potential problems?
Probably the biggest problem is tooth sensitivity to cold while bleaching, followed by bleeding gums due to excessive gel use in the bleaching trays. These problems tend to be eliminated simply by stopping the bleaching process or varying the bleaching times. 

How long does it last?
There are a variety of factors that can impact the duration bleached teeth will remain light. Such as how long the patient bleached and whether the patient resumed smoking and/or coffee and tea drinking. Generally though the teeth will remain white for several years. I generally recommend to patients to maintain white teeth they have to apply the trays with gel for one day every three to six months.

How much does it cost?
The cost of bleaching varies greatly depending on where you live (what state). Generally, in office bleaching can cost $600 to $1000 dollars.  If you use lasers the cost can be much higher.  Professionally dispensed at home bleaching costs $300 to $600 dollars depending on the area you live and the gel concentration dispensed.

If you have any questions please contact your dentist or email me at drmike@raex.com or look at our message board.