Birmingham Area Whitening Process and Products Overview
An increasing number of at home teeth whitening kits or over the counter teeth whitening products are becoming available for patients who wish to circumvent a professional appointment or who do not have the time for in-office treatments. Gels, trays and pastes are just some of the teeth whitening systems that can be bought at the store and used in the comfort of a patients’ home. Professional services are required when treatment of discoloration cannot be achieved with take home or over the counter products, either due to intrinsic discoloration or excessive extrinsic discoloration. Dental-grade compounds contain significantly higher ratios of the bleaching/whitening agent than store-bought alternatives. Thus, the oxidizing effect must be carefully controlled and monitored to prevent damage to the tooth enamel and surrounding tissue.
BASIC CHEMISTRY OF TOOTH WHITENING
Carbamide peroxide – also known as urea peroxide and percarbamide – serves as the active ingredient in most tooth whitening products. When exposed to light and moisture (such as a oral environment), carbamide peroxide reduces into hydrogen peroxide and urea. The hydrogen peroxide oxidizes the stain by breaking the chemical bonds of a chromophore (colored portion of a molecule), changing the color properties of the molecule, rendering the color imperceptible to the human eye.
The enamel of the tooth is porous, comprising of hydroxyapatite crystals, which form to make microscopic, hexagonal rod-like structures. Percarbamide penetrates the enamel in the form of oxidized free radicals, creating a chemical reaction within the structure or on the surface of the tooth.
TYPES OF PROCEDURES AND PRODUCTS
The American Dental Association categorizes teeth whitening products into two types: peroxide containing bleaches/agents, and whitening toothpastes (dentrifices).
The ADA recommended level of carbamide peroxide concentration in take home whitening products is 10%, as this ratio is deemed safe for the surrounding tissue. However, products do not always have to contain 10% concentration for ADA seal approval.
At home teeth whitening kits can be carbamide peroxide based bleaching solutions in the form of a gel or trays. Most take home whitening kits contain a concentration of 10% carbamide peroxide or less, while in-office procedures utilize bleaching agents with concentration levels of 15%-35%, sometimes up to 45%. The higher concentration-based solutions require professionally administered services for safety, as the chemicals are capable of burning the supporting tissue area or damage the tooth itself.
In-Office/At Home Carbamide Peroxide Bleaching
Heavier discoloration may require professionally administered procedures due to the nature of the treatment agents involved. Because dental grade bleaches and peroxides contain significantly higher concentrates of carbamide peroxide, careful monitoring is required to prevent burning of gum tissue or damage to the tooth itself.
In-office teeth whitening procedures usually take between 30 minutes to an hour, with several office visits being required. Dental dams or rubber shields are used to protect the soft oral tissue from possible chemical burns. If the patient requires no supervision, or if the treatment is far along enough to allow independent application of whitening, the dentist will prescribe take home whitening kits that are ADA compliant. However, as of December 2007, no professionally distributed gel trays carry the ADA seal of approval.
Over the counter gels and take home teeth whitening products vary in strength and duration of application depending on the brand. Generally, the concentration of carbamide peroxide in whitening strips will be lower than gels or trays, for strip-based treatment is usually done in cases of light discoloration or when overnight light whitening is needed.
Modern teeth whitening practices incorporate specially tuned lights or lamps designed to excite the bleaching ingredients in whitening gels. The energy from the light stimulates the carbamide peroxide molecules, effectively forcing the particles to act quicker. The energy can come from various sources of light such as LEDs, halogens, lasers or plasma arcs.
Eight different types of whitening toothpastes are available, each serving a different type of whitening purpose. Toothpastes use polishing chemicals rather than peroxides to deliver microscopic superfine abrasion molecules, essentially ‘scrubbing’ the stains off.
- Caries Control– Helps prevent decay using sodium fluoride and monofluorophosphate. Developed in the 1970’s, the worldwide decrease in decay by 50% is largely attributed to the conversion to monofluorophosphate-based pastes from stannous fluoride.
- Whitening – Uses microscrubbing particles such as carnuba wax to polish the teeth
- Gingivitis Control – Contains triclosan, a common antibacterial agent found in soaps and deodorants, and the only agent approved for toothpaste use by the ADA. Triclosan based toothpastes use co-polymers to bind the cleaning agent to the tooth, preventing the chemical from being washed away by saliva or food.
- Sensitivity – Contains ingredients for differing levels of pain. Stannous fluoride and strontium chloride block the pores of the tooth, while potassium nitrate is used for severe cases of sensitivity by inhibiting nerve activity.
- Smokers’ toothpastes – Similar to whitening toothpastes with the difference being the abrasive particles are larger and sharper. As such, usage should be limited
- Baking soda – Used as breath freshener. Knowledge of actual effectiveness on teeth whitening is limited.
- Tartar Control – Uses pyrophosphate to prevent minerals in the saliva from bonding on teeth that create plaque and tartar buildup. Tartar control toothpaste should not be used or considered a substitute for dental services for cases such as subgingival calculus (plaque buildup below the gumline), which must be handled by a dental professional.
- Remineralization– Recently developed type of paste based on the idea that cavities are caused by deficiencies in calcium, magnesium and phosphate. The purpose is strengthening the tooth, and packaged so the oppositely charged ions are separated. Long term clinical trial data is not yet available, making it difficult to assess the effectiveness of these pastes.
Dr. Michael Maniscalco and his staff recognize the importance of educating our patients with the relevant information they need to make informed choices on their own, should in-office procedures not be required (or out of reach). We offer some of the best teeth whitening services – including Lumibrite™ teeth whitening – in the Birmingham area, so read on and find out how the Lumibrite™ teeth whitening process works and if it can work for you.