Home Teeth Whitening
Home teeth whitening is where you apply a special teeth whitening gel into a personally created gum shield or ‘tray’ and wear it overnight for 1 – 2 weeks. At Eden Dental Clinic we recommend the Boutique at home whitening system.
DIFFERENT METHODS OF TEETH WHITENING
This raises some controversy and polarises opinion. The theory is that the light ‘activates’ the teeth whitening gel in some way, increasing the rate of free radical release.
There are numerous studies showing the lights to be effective, but these are usually done by the companies that manufacture the lights themselves, so you draw your own opinion as to how credible these are. These should be approached with an open mind!
So, although there is questionable evidence to prove the effectiveness of lamps, if you wish to use this method and you enjoy the experience, then the choice is up to you.
There is, however, an overwhelming body of evidence to show that dentist supervised home whitening is very effective, and produces consistently superior results. Boutique Whitening is designed using the most up to date scientific data available, so we do NOT use in-surgery whitening, because the evidence does not support this as a good option for teeth whitening when using a 6% hydrogen peroxide whitening gel.
RISKS AND THINGS TO LOOK OUT FOR
The effects of sensitivity when whitening your teeth can be mitigated in most cases by following this protocol:
1 Full examination.
2 Photographs with time-stamp and shade tab visible.
3 Restore any exposed root dentine with composite or glass ionomer.
4 Use a chair-side desensitising agent on any areas of sensitivity, as directed in instructions. Gluma, Hurriseal or Vivasens all work well.
5 Use Sensodyne Toothpaste in the whitening trays, overnight, for 3 nights.
6 Use Boutique Biomin Toothpaste in place of your regular toothpaste for 2 weeks prior, and throughout, the whitening process.
7 Switch to using 10% Boutique by Night.
8 If sensitivity is severe, use the ramp technique. Start on 10% Carbamide Peroxide with only 1 or 2 hours of wear time, gradually increasing the wear time so that after 2 weeks you can manage to wear the trays overnight.
9 If the sensitivity persists, you can whiten on alternate nights, and wear the Sensodyne Toothpaste in the trays overnight on the days in between.
Tooth whitening is a very safe procedure when performed correctly. However, there are some potential side effects that you must inform the patient about prior to the procedure. It is also important to have the knowledge to circumvent these issues to help patients achieve a fantastic result.
Another potential side effect of the whitening process is gingival irritation. This occurs when the whitening gel has prolonged contact with the gingival tissue. This can be avoided by educating the patient that they need only fill the dosing dots on the tray and no more. This will avoid an excess of gel and the subsequent gingival irritation. If they do have any excess of gel, then this should be removed with a clean tissue or soft toothbrush.
The best way to limit most problems is to ensure that the trays are well made by a laboratory. The quality and precision required is impossible to recreate in surgery made trays. Isolation of the bleaching product from the rest of the mouth will successfully limit most problems.
Likewise, patient education on how to properly fill the trays will also help.
Teeth whitening is not an exact science, and 1 pack of whitening does not always equal the perfect result for your patient. It may take more. This should always be made clear from the outset.
We know from studies that hydrogen peroxide will whiten the teeth in almost all cases. If the teeth do not whiten, the answer is to extend the treatment time. This approach will rarely fail.
Other factors that lead to poor results are lack of compliance, poorly fitting trays and bruxism.
Bruxists (night grinders) and Tooth Whitening:
If you are attempting whitening but you suffer from nocturnal bruxism (teeth grinding), the results will likely be poor. As you clench and grind, the flexing of the trays will cause saliva ingress and washout of the whitening gel. In these cases, the best option is to use Boutique by Day gel.
WHO IS NOT SUITABLE FOR TEETH WHITENING
Presence of composite restorations (white fillings) mixed with natural tooth structure, which will not lighten with treatment. The fillings may need replacing post whitening. If the restorative needs of the patient are too high, whitening may not be a good idea.
Porcelain restorations such as crowns and veneers will not lighten, and may require replacement after whitening treatment. Patients need to be made aware of the process and costs for doing this prior to teeth whitening, to ensure they consent to this.
Pregnant or lactating women.
Patients who are unable to be compliant. for example have a strong gag reflex and are unable to wear trays.
Patients with unrealistic expectations.
Patients with exposed cementum and exposed root surfaces, as cementum does not lighten with teeth whitening agents. As this may cause teeth to become hyper sensitive.
People under the age of 18.