Tooth enamel contains pores, which allow external stains to penetrate. Bleaching alters the light-absorbing or light-reflecting quality of teeth. Yellow stains bleach more rapidly than gray stains, and some areas cannot be whitened by bleaching (crowns, veneers, roots of teeth).
The degree of colour change that may occur depends on the types of stains present, the strength of the chemicals, the amount of time bleach remains on the teeth and how frequently it is used. For a natural look, teeth should be bleached no whiter than the whites of the patient's eyes.
Different types of stains respond variably to bleaching.
*Extrinsic stains are superficial stains that extend no deeper than the tooth enamel. These stains can be caused by smoking, dark beverages (tea, coffee, chocolate, red wine) or foods (tomato sauce). These stains tend to respond very well to bleaching.
*Intrinsic stains are deeper stains that develop in the dentin of the tooth. These may be caused by certain chemicals or medications used in childhood when the teeth are developing (excessive fluoride, tetracycline). The stains tend to be gray in appearance and bleach very slowly or don't respond to bleach at all.
*Age-related stains occur from both intrinsic and extrinsic factors. The enamel becomes thinner with age and dentin becomes slightly yellow. These stains tend to respond well to bleach.
For best results, a teeth cleaning is recommended before bleaching the dentition. A follow-up visit can be beneficial to check the shade changes of the teeth as well as to check for gum and tooth sensitivity. Bleaching tends to last for about one to five years, depending on the patient's lifestyle habits. A touch-up can be performed to maintain the brighter appearance of the teeth.
Types and differences of bleaching
*In-Office bleaching – a dental professional applies a 15%-35% hydrogen peroxide gel or paste to the teeth. It is usually an expensive procedure but it provides the fastest results. It can usually be completed in an hour, but sometimes requires more than one application.
*At-home dental-supervised bleaching – patients use a mouthpiece molded for their teeth to apply the bleaching agent at home. A custom fit mouth piece, bleaching agent, and instructions for use are provided for the patient. A 10-16% carbamide peroxide gel is used. The mouthpiece is lightweight enough to be worn comfortably and is often thin enough to talk or work while wearing it.
*Over-the-counter products – these products do not have custom fit mouthpieces and leak with potential swallowing of the bleaching agent. This can irritate the gums and reduce the bleaching effectiveness. Overuse can damage the teeth, gums and mouth.
Risks and benefits of bleaching
Bleaching is a safe procedure that does not tend to cause serious problems. It is successful in 90% of patients. There is typically at least a two shade improvement. The rate of success depends on many factors, including the types of stains present, patient compliance with treatment and the type of product used.
Side effects of bleaching include tooth sensitivity and gum irritation. They tend to go away when the treatment is completed.
Bleaching is not for all patients. Patients who are allergic to peroxide, women who are pregnant or breastfeeding, as well as children under the age of 16 should avoid bleaching. Also, bleaching may not be appropriate for people with sensitive teeth, periodontal disease or worn tooth enamel.
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Penny Judson-Benny, RDH, is the owner and operator of Mountain View Dental Hygiene Clinic in Black Diamond and can be contacted at 403-933-7722.
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