Dr. Barbara Allison Perlitch

According to the American Dental Association there are different options to whiten one’s teeth that include: in-office bleaching, which is applied by a professional dentist; at-home bleaching, which is to be used at home by the patient; over-the-counter, which is applied by patients; and options called non-dental, which are offered at mall kiosks, spas, salons, or other similar places). Whitening products intended for home use include gels, chewing gums, rinses, toothpastes, among others. The ADA has published a list of accepted over-the-counter whitening products to help people choose appropriate whitening products.
The ADA recommends to have one’s teeth checked by a dentist before undergoing any whitening method. The dentist should examine the patient thoroughly: take a health and dental history (including allergies and sensitivities), observe hard and soft tissues, placement and conditions of restorations, and sometimes x-rays to determine the nature and depth of possible …irregularities.
There are two main methods of gel bleaching—one performed with high-concentration gel, and another with low-concentration agents. High-concentration bleaching can be accomplished either in the dental office, or at home. Performing the procedure at home is accomplished using high-concentration carbamide peroxide, which is readily available online or in dental stores and is much more cost-effective than the in-office procedure. Whitening is performed by applying a high concentration of oxidizing agent to the teeth with thin plastic trays for a short period of time, which produces quick results. The application trays ideally should be well-fitted to retain the bleaching gel, ensuring even and full tooth exposure to the gel. Trays will typically stay on the teeth for about 15–20 minutes. Trays are then removed and the procedure is repeated up to two more times. Most in-office bleaching procedures use a light-cured protective layer that is carefully painted on the gums and papilla (the tips of the gums between the teeth) to reduce the risk of chemical burns to the soft tissues. The bleaching agent is either carbamide peroxide, which breaks down in the mouth to form hydrogen peroxide, or hydrogen peroxide itself. The bleaching gel typically contains between 10% and 44% carbamide peroxide, which is roughly equivalent to a 3% to 16% hydrogen peroxide concentration.
Low-concentration whitening is far less effective, and is generally only performed at home. Low-concentration whitening involves purchasing a thin mouthguard or strip that holds a relatively low concentration of oxidizing agent next to the teeth for as long as several hours a day for a period of 5 to 14 days. Results can vary, depending on which application is chosen, with some people achieving whiter teeth in a few days, and others seeing very little results or no results at all. Dentists as well as some dental laboratories can fabricate custom fitted whitening trays that will greatly improve the results achieved with an over-the-counter whitening method.
A typical course of bleaching can produce dramatic improvements in the cosmetic appearance of most stained teeth; however, some stains do not respond to bleaching. Tetracycline staining may require prolonged bleaching, as it takes longer for the bleach to reach the dentine layer. Case studies have been performed on people with tetracycline stained teeth. They used custom bleaching trays every night for 6 months and saw dramatic results and improvement. White-spot decalcifications may also be highlighted and become more noticeable directly following a whiting process, but usually calm back down with the other parts of the teeth becoming more white. The white spots become less noticeable, with the other parts of the teeth becoming more white. Bleaching is not recommended if teeth have decay or infected gums. It is also least effective when the original tooth color is grayish and may require custom bleaching trays. Bleaching is most effective with yellow discolored teeth. However, whitener does not work where bonding has bee