Fact vs Fiction on Professional Teeth Whitening – Whitening Wisdom: Part ThreeMay 8, 2018
Part one of our Whitening Wisdom series looked at how and why teeth stain, and which foods are the main culprits. Part two examined which home whitening remedies are effective, which are dangerous and which are just marketing spin.
The simple fact is that people are investing more money into looking good - and the teeth whitening industry as a whole has benefited from that. We wrote these Whitening Wisdom articles to offer a well researched, balanced perspective on teeth whitening without the spin.
At Laser + Holistic Dental we have been offering professional whitening services for a long time and have seen the rise and fall of fad products - both for consumers and professionals. With advancements in technology over the last few years - we believe that a combination of laser teeth whitening and high quality gels for home use is the best way to get a great whitening result that actually lasts.
In this article Dr Simon Javadi goes through a range of common points of interest that we are often asked about, and compares the different treatments available on the market to see what is fact and what is fiction when it comes to professional teeth whitening.
Facts vs Fiction
Anyone have a pearly white, celebrity smile through teeth whitening.Unfortunately there are a lot of unrealistic expectations when it comes to teeth whitening as the result of ‘the perfect smile’ being heavily used in marketing images. A lot of marketing images are heavily edited, and for most celebrities - they actually have veneers. It is important to understand that some stains are intrinsic - they are inside the structure of the tooth often due to developmental defects of the enamel or dentine.
Some types of medical treatments will also cause staining of the teeth. Dr Simon says “when you have intrinsic stains in the teeth, it can be very challenging to get complete resolution and an even whitening result.”
As we know from Whitening Wisdom Part One - teeth whitening works by triggering a chemical reaction to break down chromophores in the outer layer of tooth structure. Intrinsic stains caused by pharmaceuticals or genetic factors will not be treated by teeth whitening.
Dr Simon suggests “if you are self conscious about the appearance of your teeth and have intrinsic staining, then a cosmetic restoration using veneers will be your best treatment option.”
Verdict: FictionMost images of the ‘perfect smile’ are either edited or are the result of veneers - not teeth whitening. Professional teeth whitening works well, but it cannot deliver the perfect smile to everyone.
Professional whitening at the dentist rarely every works.
According to Dr Simon, “professional whitening is like any other dental treatment and needs to be prescribed specifically for that patient after they have been assessed for their suitability, the potential risks and benefits, as well as their individual goals. All teeth have an ability to become lighter in shade. Some people will experience vast improvement, whilst in others the improvement may be only moderate – this, in most instances, depends on the initial or base line shade of the teeth.”
Verdict: FictionThere are some types of teeth which are difficult to whiten, no matter what method is used - but for many people professional whitening delivers great results. Everyone is a little bit different, so to find out if professional teeth whitening is going to work for you - ask your dentist.
Peroxide is dangerous and should be avoided for teeth whitening.
High concentrations of hydrogen peroxide can be harmful - which is why it must be legally administered by a professional. “Five to ten years ago the regulations around the use of peroxide was not regulated properly, and a lot of people ended up with burned lips and damaged gums,” says Dr Simon - “using peroxide in high concentrations for whitening is dangerous when it isn’t done in a professional environment. A properly trained dentist will take precautions when using peroxide, so when it is used correctly it is actually very safe.”
“It is really important to understand that most peroxide gels have different chemical structures - one brand will not be the same as another. We are very strict about what gels we use and provide our patients at Laser + Holistic Dental. Poor quality gels will have degraded a lot, which increases the acidity and is likely to cause sensitivity and potentially damage to the tooth enamel. If your gel isn’t constantly kept cool and away from UV light it will be degraded before you even use it.”
Verdict: Part Fact, Part FictionPoor quality gels are degraded and highly acidic - which poses a risk to your teeth. Ask Laser + Holistic Dental about which whitening gels are high quality, and which are not. Don’t use degraded whitening gels! Also remember - high concentrations of peroxide can cause burns so should only be used by professionals.
There is no difference between dentists who offer professional teeth whitening.
Any dentist can whiten their patient’s teeth - the difference comes down to their understanding of the whitening reaction, their experience and the technology that they use. Dr Simon points out “the main difference between dentists is going to be their choice of gels and the equipment that they use to whiten a patient’s teeth. There are a whole range of gels on the market and a few different whitening technologies such as LED or laser activated teeth whitening.”
At Laser + Holistic Dental our teeth whitening protocol has been extensively researched and trialled by our dental team to make sure we are using the best products available.
Verdict: FictionIt is important to find out how deep a dentist’s understanding of their whitening process is. Do they use a quality gel? Has the gel been cooled to keep it chemically stable? Does it have a range of additives? Does it have a neutral pH to protect tooth enamel? If they are using a light activated whitening method - which technology is it? Does it heat the tooth pulp as a side effect? If so, how do they manage sensitivity? If a dentist cannot answer questions like these, then they are not going to deliver the highest standard of teeth whitening available.
My natural home remedy is just as good as professional teeth whitening.
This topic was covered in detail in Whitening Wisdom Part Two. There are very few home whitening remedies that actually work, and some are very dangerous to your teeth. Check out the other article to look at whitening methods like charcoal, turmeric, baking soda, lemon juice and the popular social media whitening kits.
Dr Simon says “most of the home whitening kits on social media may seem appealing with minimal equipment and ingredients, short application times and the convenience factor. They do not stand up scientifically, so you should not expect a great result for the amount of money invested.”
Verdict: FictionA lot of home remedies damage the enamel surface through abrasion or acidity. Most of the social media whitening devices do not use the right wavelength of light to activate the gels, and the gels certainly will not have been kept cold so they are likely to be degraded and acidic.
Teeth whitening can damage the nerves of your teeth, causing pain and sensitivity.
Teeth whitening does not have any impact on the nerve of the tooth, however it can definitely play a role in sensitivity. “This is a complex topic that is not completely understood - the general theory is that oxidising compounds such as hydrogen peroxide interact with chemosensitive ion channels (TRPA1) within the dental pulp to trigger tooth sensitivity” says Dr Simon.
“When whitening is carried out by a properly trained professional teeth whitening is very safe and poses no risk of damaging the nerves of teeth. Sensitivity can be common after professional whitening but will be substantially reduced by using quality gels, Er:YAG laser energy and assessing the patient for any areas like exposed roots which will be more sensitive than the normal tooth surface.”
Verdict: FictionTeeth whitening cannot damage tooth nerves, however it may cause increased sensitivity if you have receding gums and your tooth roots are exposed. There are a number of ways to reduce sensitivity - ask the Laser + Holistic Dental team about our whitening protocol to find out more.
Teeth whitening results are permanent.
Dr Simon says “this is actually a common misconception about teeth whitening treatments. Most people will never return to their original shade so their is going to be a long term benefit from professional teeth whitening. However certain foods, drinks and lifestyle habits will take their toll over time and slowly stain your teeth again.”
“To maintain your white smile over time we recommend that you have custom whitening trays made so you can regularly boost your smile at home after the in-chair whitening procedure.”
Verdict: FictionProfessional whitening does lighten your smile - even in the long term. However for optimal results you will need to regularly whiten at home with one of our take home kits.
In chair, professional teeth whitening gets you an instant result.
Teeth whitening results ultimately will vary from person to person - “a significant improvement is noticeable in a short period of time and largely depends on the baseline teeth shade. Patient’s who are wishing to achieve that ‘Hollywood smile’ will often need to continue with home whitening treatments” says Dr Simon.
Verdict: FictionYou will normally see a substantial improvement after a professional in-chair whitening treatment, however the best results will take a few weeks of home whitening as well.
Bleaching & Whitening Gels
Hydrogen peroxide and carbamide peroxide are basically the same thing.
This is not really true - although the different gels work in nearly the same way. “Hydrogen peroxide is released when carbamide peroxide breaks down. Hydrogen peroxide is more reactive so it releases most of its whitening power in the first 30-60 minutes whereas carbamide peroxide will release about half of its whitening power in the first two hours, and will remain active for another six hours after that,” explains Dr Simon.
Verdict: FictionHydrogen peroxide is more reactive which is why it should be used in a professional environment, carbamide peroxide is slower to activate so it is best suited to at home whitening use.
All teeth whitening gels damage your tooth enamel.
“The risks to tooth enamel come from the concentration of acid in the gels. When peroxide gels break down and degrade they naturally become more acidic - so poor quality gels are more likely to harm your tooth enamel.” Dr Simon stresses “it is really important to use a whitening gel with a neutral pH so you know it has not been chemically degraded.”
A quality, neutral pH whitening gel will reduce the risk and the severity of tooth sensitivity. Make sure your whitening gels have been kept cold at all times and have not been exposed to sunlight.
Verdict: FictionIt is important to understand that there are quality whitening gels, and poor quality whitening gels. The latter are a risk to your tooth enamel.
It is very important to keep whitening gels cold.
This is a really important point. Dr Simon discusses, “the chemical structure of whitening gels will break down when they are not kept cool. For the product to be effective at whitening teeth it needs to maintain the potential of the chemical reaction. Our supplier is the only one on the market that keeps the gels cool throughout the whole delivery process to ensure the product remains stable meaning you are going to get a better whitening result.”
Verdict: FactCool temperatures stop whitening gels from chemically degrading which means they will have a better whitening effect and will not be as acidic as gels kept at room temperature.
Whitening gels can have some nasty chemical additives.
Many brands will add chemicals such as sodium benzoate and/or methyl propylparaben to act as antimicrobial agents and improve the shelf life of the product. Some chemical stabilisers will be added in an attempt to reduce the cost of shipping and storage so that the gels do not need to be kept cool. Unfortunately, most standard bleaching gels still break down when exposed to normal temperatures and sunlight - reducing the effectiveness of the gel and increasing the acidity and the risk of damaging your tooth enamel.
Dr Simon says “Good quality products that ensure cold chain delivery and correct storage eliminate the need for most of these additives and result in a better whitening outcome with reduced side effects like sensitivity. Some gels that require the use of additional chemical stabilisers to avoid the need for refrigeration create an osmotic ‘pull’ on the dentinal tubular fluid inside the teeth – which can increase the risk of sensitivity.”
Verdict: FactSome gels do have a lot of chemical additives which are designed to improve shelf life and profit margins. These gels are likely to cause tooth sensitivity and may also be more acidic that a high quality, neutral pH gel. With teeth whitening gels - you will get what you pay for. Ask the team at Laser + Holistic Dental about the teeth whitening products we actually recommend.
At Home Teeth Whitening Kits
You need custom whitening trays to fit your teeth.
Dr Simon weighs in - “Yes - a custom whitening tray ensures optimum results and helps to protect your gums. A stock tray that has not been designed for your teeth will lead to an uneven spread of gel which means you may end up with too much gel on one tooth and too little on another. This will result in uneven whitening. Stock trays also often end up with the patient loading too much gel which causes irritation of the gums.”
Verdict: FactIf you want to get a good, professional teeth whitening result then you definitely need custom whitening trays.
You need to whiten your teeth every one or two days.
Your dentist will advise you on how often you should be whitening to get the desired result. Dr Simon explains “ Home whitening should take place until the desired outcome is reached - usually within about two weeks. Once your teeth have reached the target shade then you will not need to keep whitening at home. If desired results have not been reached after two weeks it is important to check back in with your dentist. ”
“ Whitening agents are chemically active components with potential to substantially alter the structure of dental enamel if overused. Some of the risks include increased porosity of the superficial enamel structure, demineralization and decreased protein concentration, organic matrix degradation, modification in the calcium:phosphate ratio, and calcium loss.”
Long term and excessive teeth whitening can eventually lead to a condition called external resorption. This is very difficult to treat and in most cases leads to having the affected teeth extracted.
Laser + Holistic Dental has designed our whitening protocol to include a range of mineralising pastes and Vitamin C hydrogels which support enamel health and protect teeth against the possibility of demineralisation.
Verdict: FictionWhitening every day would be excessive use that does pose some serious risks. You should not need to whiten very often once the first course of whitening has been completed - ask your dentist about what they recommend. To look after your teeth as well as possible, make sure you use the mineralising pastes and hydrogels - check with the team at Laser + Holistic Dental about these.
Home whitening gels always make your teeth sensitive.
Teeth sensitivity will come down to three main things - the formulation of the whitening gel, the type of whitening method used and individual variation. Dr Simon says “some people naturally have sensitive teeth and will not find it comfortable to whiten every day. Personally I find my teeth getting sensitive if I whiten for five consecutive days. Things like receded gums that expose the tooth root will make sensitivity issues worse. When I am assessing a patient as a candidate for teeth whitening I’ll identify individual factors that may play a role in sensitivity and discuss those with the patient.”
With a good quality gel, the risks of teeth sensitivity are going to be reduced substantially. If you are getting bad sensitivity, switch to a better whitening gel. Dr Simon recommends that “if you cannot tolerate liquids at room temperature then it is best to stop whitening and start daily use of the ACP mineralising paste that we give our patients. Once room temperature liquids are no longer a problem then you can start whitening again. Some people may be better off ‘pulsing’ their whitening to complete their home whitening plan. Instead of whitening every day, try every second or third day.”
The type of whitening method used will also play a big role in sensitivity - some types of lasers and LED lights will heat the tooth pulp which will trigger nerve pain. Make sure that your dentist is using a Er:YAG laser so this does not become a problem.
Verdict: FictionSensitivity is a common issue with whitening, but it can be easily reduced for most people. Use a high quality gel without the additives that increase sensitivity, if your professional whitening is light activated - only see a dentist that uses a Er:YAG laser to avoid heating the tooth pulp, and finally do not over do it! If you have sensitive teeth, break up your whitening schedule and use your mineralising paste and Vitamin C hydrogel.
In-chair LED whitening
A LED is the best way to professionally whiten teeth.
Dr Simon discusses the LED technology - “without getting too technical, the theory behind a LED light is to activate the whitening gel which increases the speed of the chemical reaction that whitens your teeth. In reality the heat from the LED light actually causes short term dehydration of the tooth which makes the teeth appear whiter. The heat created can be damaging to the nerve and pulp within each tooth which is one of the main causes of tooth sensitivity.”
“In my opinion LED technology is definitely not the best way whiten your teeth.”
Verdict: FictionLEDs are not that effective and the heat penetrating into the tooth pulp is likely to cause sensitivity after the treatment.
Some lights will damage your lips and gums.
This idea comes from back when whitening technology used UV lamps to activate the whitening gels. This is an outdated technology and is not recommended by Laser + Holistic Dental. UV lamps for whitening pose the same risk as tanning beds - potentially damaging sensitive tissues. It would be rare to find a dental clinic that uses UV technology in Melbourne, most have switched to LED lamps, and the best ones will be using laser teeth whitening.
Verdict: FactUV teeth whitening exposes you to unnecessary radiation - to protect your lips and gums avoid it!
LED lights have UV which can be harmful.
Dr Simon says “ UV light has a different wavelength to visible light (LED light) on the electromagnetic spectrum. LED lights do not emit UV light so there is no risk of harm from UV exposure. ”
Verdict: FictionLED technology uses a different wavelength of light that does not contain UV radiation.
Laser Teeth Whitening
There is no difference between laser whitening and LED whitening.
“The principles behind professional whitening user a LED light or a laser are basically the same,” says Dr Simon. “The idea is that the light sources accelerate the whitening reaction using heat. With a LED light there is no targeting of the heat so it heats up the tooth as well as the gel which can cause sensitivity. The scientific research on LED whitening found that there was little advantage for the price the average patient will pay. Laser’s also vary in effectiveness for whitening - the best type is an Er:YAG laser that can accelerate the whitening action of the gel without actually heating the tooth pulp.”
Verdict: FictionThe scientific research on LED whitening found the technology to not offer a significant advantage over home whitening, with the increased risks of tooth sensitivity. Laser whitening has been proven to be more effective, and with the right laser the risks of sensitivity are greatly reduced.
Dental lasers for teeth whitening come in a range of different types.
According to Dr Simon “there are a few different types of lasers that are used for teeth whitening. The best type of laser for whitening is the Er:YAG because the energy is fully absorbed by the water content of the whitening gel. The Er:YAG uses energy to laser activate the gel, accelerating the whitening effect without heating the underlying tooth pulp like a diode laser or LED light. The Er:YAG is able to speed up whitening without the risks of increased sensitivity and shooting pain that can happen when you expose the tooth to a lot of heat.”
Verdict: FactThere are big differences in the types of lasers and the energy they emit. If a dental clinic is offering laser whitening, find out what sort of laser they use because the effectiveness of the whitening and comfort of the treatment will depend on it.
Laser teeth whitening will make your teeth more sensitive.
This depends on the type of laser being used - if the laser energy gets absorbed by the tooth then that is likely to cause tooth sensitivity after the treatment. Dr Simon says “at Laser + Holistic Dental we only use the Er:YAG lasers for teeth whitening so there is no heating of the tooth pulp. This means you can get a faster whitening reaction without painful symptoms like those common with LED and diode laser whitening treatments. We also use the best whitening gels on the market which are chemically unique and help to reduce sensitivity.”
“We take our patient’s comfort seriously - even after they have left the dental chair. Our professional teeth whitening method is going to be the best whitening option available for those who are concerned about sensitivity.”
Verdict: Part Fact, Part FictionA diode laser will cause tooth sensitivity after a whitening treatment because it heats up the tooth pulp. An Er:YAG laser like what we use at Laser + Holistic Dental doesn’t heat the pulp so this treatment is much better for people with sensitive teeth.
The Whitening Wisdom Series
If you would like to read part one and two, please use the links below.