Index / Cosmetic
Teeth whitening
Bleaching works.
Just not on
everything.
Whitening is the cheapest cosmetic change available and often the only one a patient needs. It also has real limits, and knowing them before you start is the difference between a good result and a disappointment.
Why people come here
- He teaches occlusion and full-mouth rehabilitation to other dentists
- Fellowships in three academies — FAGD, FACE and FICOI
- The complex cases other practices refer out
- A written, itemized plan before anything is scheduled
Debunking the myths
What bleaching actually does.
Dr. Nosti published Debunking the Bleaching Myths in Dentaltown in December 2015. The short version is below.
Peroxide diffuses through enamel into dentin and breaks apart the pigmented molecules that have accumulated there. It does not strip or etch the tooth, and it does not change the shape, position or translucency of anything. It lightens what is already tooth.
That last point is the one that catches people out. Whitening does nothing to existing fillings, crowns, veneers or bonding, because those are not tooth. If a front tooth has a large white filling, bleaching the tooth around it will make the filling more obvious, not less. Plan the order accordingly: whiten first, then match any restorations to the new shade.
What whitening will not fix
- Existing crowns, veneers, bonding or fillings — they stay the shade they were made
- Gray discoloration from tetracycline, which responds slowly and incompletely at best
- A single dark tooth after root treatment, which usually needs internal bleaching or a restoration
- White or brown fluorosis mottling, where the issue is contrast rather than overall shade
- Thin, translucent worn enamel that lets dark dentin show through at the edges
Options
In-office, take-home, or both.
In-office
One appointment, visible change the same day
- A high-concentration gel applied with the gums and lips isolated
- Roughly an hour in the chair, usually in two or three applications
- The fastest route to a result, and the one to choose before an event
- Sensitivity is more common with this method and is managed, not ignored
- Often combined with take-home trays to hold and extend the result
Custom take-home trays
Slower, gentler, and better value over time
- Trays made from a scan of your own teeth, so the gel stays on the teeth
- A lower-concentration gel worn for a set period over one to two weeks
- Gentler on sensitive teeth, and you control the pace
- The trays are kept, so topping up later costs only a syringe of gel
- This is what most patients here end up using, alone or after an in-office visit
Questions
Whitening, answered.
Does it damage enamel?
Peroxide whitening at dental concentrations has been studied for decades and is not considered to damage enamel when used as directed. What it reliably causes is temporary sensitivity, because peroxide passing through the tooth irritates the nerve. That settles after treatment stops and can be reduced with desensitizing gel and a slower schedule.
Why are store-bought strips cheaper?
Lower concentration, and no custom tray, so less gel stays on the teeth and more ends up on the gums. They do work, more slowly and less evenly, and they are a perfectly reasonable place to start. Where they fall short is on uneven discoloration and on patients whose gums react to the gel.
How long will it last?
Typically one to three years before a top-up is wanted, and far less in heavy coffee, tea, red wine or tobacco use. This is why the custom trays are worth having: a single evening with a syringe of gel restores it, instead of starting the whole process again.
Should I whiten before veneers?
Yes, always, if any natural teeth will remain visible next to the ceramic. The veneers are made to a shade, and that shade should be the one your natural teeth are going to stay at. Whitening afterward will change the teeth and not the porcelain, and you will see the difference.
Keep reading
Next step
Start with an examination and a straight answer.
A consultation includes an examination, the records the case needs and a written, itemized plan. If what you are asking for is not the right treatment, Dr. Nosti will say so and tell you what is.