Whitening (2024)

For some time, there has been consistent consumer demand for whiter, brighter teeth and an attractive smile.1-3 Professionally administered (in-office) tooth whitening, also known as dental bleaching, remains a popular esthetic procedure and can be performed using a wide range of techniques and application protocols. Another common approach is at-home whitening with custom-fitted trays, which patients use to apply professional-strength bleaching gel (for use at night or during the day). Numerous over-the-counter (OTC) whitening products (e.g., strips, gels, rinses, chewing gums, or paint-on films) are also widely available for self-application at home.4

Extrinsic vs. Intrinsic Stains

Tooth (and dental) discoloration are terms used to describe any change in the color or translucency of a tooth,1 as well as discoloration in multiple teeth or the entire dentition. Tooth discolorations are typically classified as extrinsic, intrinsic, or a combination of both types.5

Extrinsic stains commonly result from an accumulation of colored compounds on enamel. Extrinsic discoloration is primarily associated with environmental factors or individual behaviors, such as tobacco use, exposure to metal salts (e.g., iron or copper), or the consumption of highly pigmented foods (e.g., dark fruits) or beverages (e.g., red wine, coffee, tea, or cola drinks).1, 6-11

Extrinsic tooth stains vary widely in color and severity, and can be exacerbated by lifestyle habits (e.g., smoking or chewing tobacco), poor oral hygiene, or frequent consumption of pigmented food or beverages.12, 13 A wide range of extrinsic stains can be effectively reduced with mechanical interventions such as brushing with a whitening toothpaste or professional prophylaxis.6, 7, 14 Some OTC whitening products (e.g., toothpastes, chewing gums) are effective primarily in removing extrinsic (surface) stains on enamel, and will not have a significant impact on intrinsic stains or the intrinsic color of the tooth.4, 15

Intrinsic stains occur inside the tooth (within the enamel or the underlying dentin), and can arise due to systemic causes such as genetic disorders (e.g., dentinogenesis imperfecta, amelogenesis imperfecta) or local factors during tooth development or after eruption (e.g., fluorosis).1, 16, 17 Aging is another common etiology of intrinsic discoloration. With increasing age, enamel becomes more translucent and thinner, which allows the yellower dentin to show through and the overall tooth color may darken.1, 18 Other causes of intrinsic discoloration include certain antibiotic use in childhood (e.g., tetracycline),19 caries, amalgam restorations, and pulpal hemorrhage, decomposition or necrosis.5, 7, 20 Intrinsic discoloration can also occur with prolonged use of antiseptic mouthrinse (e.g., chlorhexidine rinse).21

Whitening Agents

Reducing intrinsic stains involves a chemical reaction that changes the color of the tooth. The most common ingredients used in bleaching are carbamide peroxide and hydrogen peroxide, which are used at different concentrations depending on the products or regimens used.22

The bleaching action in chemically induced whitening is due primarily to the effects of carbamide peroxide, which releases about one-third of its content as hydrogen peroxide, a strong oxidizing agent.23, 24 Hydrogen peroxide diffuses easily through interprismatic spaces in the enamel, allowing for passage from enamel and dentin to pulp within 15 minutes of exposure.25, 26 The bleaching process is generally believed to occur when reactive oxygen molecules (generated from hydrogen peroxide) interact with organic chromophores (colored compounds) within enamel and dentin through a chemical oxidation process, which is influenced by various environmental factors (e.g., pH, temperature, light).17, 25, 27

The extent of whitening attained through bleaching may be influenced by the type of intrinsic stain being addressed. For example, brown stains due to fluorosis or tetracycline28, 29 may be more responsive to bleaching than white stains associated with fluorosis or orthodontic treatment, which may appear less noticeable as the background of the tooth lightens.30 The type of stain also can affect the length of and/or number of treatments required to arrive as close as possible to the desired result. For example, although stains due to tetracycline may be diminished, treatment can require three to four months of nightly treatment (on average).28, 31

Patient Considerations and Preferences

Tooth whitening is a common elective procedure and a popular, less-invasive aesthetic treatment for patients seeking to enhance their smile and appearance. A clinical exam prior to the start of tooth bleaching procedures, with radiographs and other screening and diagnostic tests as appropriate, can help diagnose various factors contributing to the patient’s tooth discoloration.32 A standard dental exam, beginning with a health and dental history, may include questions about the patient’s perception of the cause of the dental discoloration, as well as allergies (which may include ingredients in bleaching materials), and any past or recent history of tooth sensitivity.32, 33

Patient dentition characteristics also influence the safe provision of care and the treatment’s level of success in whitening vital teeth. Patients who have tooth-colored restorations (including crowns or implants) should be aware that only natural teeth will be affected by the bleaching agent and treatment could result in differences between natural teeth and restorations, which will not change color.28 The American Academy of Pediatric Dentistry discourages full-arch cosmetic bleaching for child and adolescent patients in the mixed dentition and primary dentition.34 Additionally, some research suggests that bleaching protocols may alter the surface roughness of enamel, which may also reduce the shear bond strength between enamel and composite and ceramic restorative materials.35

Whitening (2024)

FAQs

Why is my whitening gel not working? ›

If teeth whitening does not work for you, it might be because of the product you are using, the type of tooth stains or spots, or strength of the bleaching gel.

Why won't my teeth whiten after whitening? ›

Intrinsic Stains

They can be caused by factors like trauma, excessive fluoride exposure during tooth development, or certain medications. Since teeth whitening treatments primarily target the outer layer of the teeth, they may have limited effectiveness in removing these deeper stains.

Can yellow teeth become white again? ›

Fortunately, there are ways of making your yellow teeth white, from improving your oral hygiene and diet to visiting the dentist and having them professionally whitened. There's no need to feel ashamed of your smile anymore.

Does enamel grow back after teeth whitening? ›

Interesting fact: although almost anything else can be regenerated, our bodies can't naturally regenerate enamel. Once enamel has eroded, it's gone.

Why do my teeth look more yellow after whitening gel? ›

Also, if you have poor oral health or an underlying medical condition that affects the teeth, the teeth whitening procedure may make the teeth yellow. This is because the dentin has a yellowish hue under the enamel. So, when the enamel thins, your teeth become translucent and may look yellow.

Why are only the tips of my teeth whitening? ›

A lot of the time, the edges of your teeth respond more quickly to bleaching than the inner areas since the bleach can penetrate the enamel more rapidly. The center of your tooth has more enamel than the outside, so it takes longer to show results.

What is the best method to whiten teeth? ›

In-office bleaching provides the quickest way to whiten teeth. With in-office bleaching, the whitening product is applied directly to the teeth. These products can be used in combination with heat, a special light, or a laser. Results are seen in only one, 30- to 60-minute treatment.

What vitamin deficiency causes yellow teeth? ›

In adults, low vitamin D status can lead to gingivitis and periodontal disease. Does vitamin D deficiency cause yellow teeth? Yes, vitamin D deficiency can show up as yellow teeth. Yellow or brown spots on teeth are a symptom of rickets, a condition caused by chronic low levels of vitamin D.

How long does it take for my teeth to go from yellow to white? ›

Ideally, you will use an electric toothbrush to eliminate as much staining as possible. Use teeth whitening toothpaste two times per day and you might notice whiter teeth in as little as half a month's time. However, it could take upwards of a month and a half to produce meaningful results.

Can I whiten just my front teeth? ›

If you would like to whiten the front teeth only, this is certainly a question for the dentist! Most likely, he or she may have a special procedure, where a whitening treatment could be customizable to the front teeth only.

Does baking soda whiten teeth? ›

Baking soda can be used with some water to remove the stains on the surface of the teeth. It can also be used with hydrogen peroxide to enhance its whitening effects. Baking soda can be used by individuals with regular toothpastes too. It is also used commercially in some teeth whitening products and toothpastes.

Do and don'ts after teeth whitening? ›

Don't Consume Foods that Can Stain Your Teeth

For both over-the-counter and professional teeth whitening, the first few days after treatment are the most critical. Avoid dark foods/liquids, drink through a straw when you can, don't smoke, brush/floss frequently and you should be looking great.

How can I make my whitening gel work better? ›

The whitening gel is the most effective with clean teeth. Try the trays in first without any beach to check the fit and comfort. Make sure that the bleaching trays are clean and dry before applying the whitening gel. Moisture reduces the efficiency of the whitening gel and slows down the whitening process.

Does teeth whitening not work on some people? ›

If your teeth and gums aren't in the best shape or if you've had a lot of previous dental work, both issues can affect your results with traditional teeth whitening treatments. You won't be able to whiten either porcelain crowns or most commonly used dental bonding materials.

Why is my teeth whitening light not working? ›

Why is the blue light not working? Check to see that your Teeth Whitening Device is properly charged. If the green flashing light does not come on during charging: Make sure the power cord is plugged into both the power outlet and the charging case.

How long does whitening gel take to work? ›

How long does it take to see the results? Depending on the level of your staining and the type of whitening procedure you have done, you may be able to see results in about a week or two. To reach your desired whiteness, it may take about three weeks to a month.

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