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Beautiful Smiles


By Dr. Shohreh Sharif – ELAN Magazine December 2019


Maintaining an attractive appearance is important to everyone. For some this may entail periodically updating a wardrobe, or changing a hair style– but for many an appealing look increasingly calls for a beautiful smile with whiter teeth.


There are many tooth whitening options available today. In-office bleaching, at-home bleaching and whitening products (toothpastes, strips, pens and mouth rinses) are sold over the counter. But it is always important to consult with your dentist to determine which whitening treatment is in your best interest. Your dentist will take into account the shade of your teeth and what can be done to make them whiter and more attractive.


Here’s a synopsis of the most popular teeth whitening procedures:


Over the counter and professionally supervised methods

Products directly available to consumers

Over-the-counter (OTC) products range from toothpastes to paint-on gels.


This is a burgeoning consumer category, but be sure to look for products that bear the American Dental Association’s (ADA) Seal of Acceptance. The seal is your best assurance that a product– when used as directed– is both safe and effective. Consider that toothpastes utilize abrasives to remove surface stains (though some may contain low levels of peroxide). Whitening strips bleach teeth by relying solely on peroxide. Therefore, do a little research; know what you’re dealing with.


Products available through dentists

Dentist-supervised methods include at-home and in-office options. Whitening brands supplied by dentists for home use, or in-office application, are considered “professional products” which–due to their high potency–should only be applied under a dentist’s care. T


The at-home option entails use of a whitening gel by the patient at home. Gels are applied via customized trays made in the dentist’s office to assure a comfortable fit and minimal contact between the gel and the gingiva (gums).


At-home systems may employ a range of peroxide concentrations (e.g., 10 to 38 percent carbamide peroxide). Treatment duration is dictated primarily by the concentration used. A systematic professional review found daily treatment programs ranging from 2 to 10 hours for periods of 6 to 28 days.


In-office treatment usually involves the application of a peroxide-containing gel used with or without a light beam designed to accelerate and enhance the bleaching process.


With regard to the effectiveness of light as a bleaching agent, some studies indicate that light-activated systems produce better immediate whitening than non-light systems when used with lower concentrations of hydrogen peroxide.


On the other hand, the risk of tooth sensitivity may increase when the light is used in combination with a concentrated whitening agent.



As always, cost may be a consideration. While OTC products are less expensive than at-home or in-office approaches, OTC products can take significantly longer to achieve the desire cosmetic result. Some studies showed that an OTC bleaching technique took 16 days to achieve a whitening level comparable to a seven-day at-home tray system or a one-day in-office procedure.


Whitening Side Effects

Temporary dental sensitivity is associated with all forms of bleaching– possibly due to inflammation of the pulp as a result of peroxide exposure during the procedure.


A number of factors can influence tooth sensitivity associated with bleaching. These include concentration of hydrogen peroxide, the presence of adhesive restorations, and the intensity and duration of light use.


Several approaches aimed at preventing tooth sensitivity resultant from bleaching have been examined. Although both pre-treatment use of non-steroidal anti- inflammatory drugs, and pre-treatment application of 5 percent potassium nitrate and 2 percent sodium fluoride gel, have been proposed as ways to reduce sensitivity without affecting bleaching efficacy– however, more research is needed.


Gingival Irritation

Gingival irritation can also result from contact with peroxide-based gels when whitening strips or any gelbased product are used. This may be a consequence of poorly fitted trays, or an improper application of the protective barrier or gel. I


t has been suggested that local anesthesia be avoided during in-office bleaching so that patients can detect any burning sensations (which could indicate gel seepage through the barrier), and that patients (as a monitor to barrier integrity) alert the dentist to any discomfort during the procedure. As with sensitivity, gingival irritation is usually transient and resolves shortly after the treatment is concluded.


Whitening and stain removal in children

Procedures such as enamel microabrasion and resin infiltration also may be applied for specific problems.


To avoid possible discoloration of the teeth prior to eruption of all permanent teeth, whitening is generally not recommended for children 14 years of age or younger. Certain enamel defects and congenital stains, however, can be removed by an experienced dentist without the harmful side effects.


Finally, lasers are now being used to assist in whitening procedures; in fact, the American Academy of Pediatric Dentistry recognizes lasers as a complementary method for administering soft and hard tissue dental procedures for infants, children, adolescents and persons with special health care needs.

“When considering whitening treatments consult with a dentist who will take into account the shade of your teeth, and what can be done to make them whiter and more attractive. ” –Dr. Shohreh Sharif


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