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What to Expect from Teeth Whitening

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Before & AfterIn the early nineties, I worked in a dental office in the heart of Hollywood, California, home to the stars and glamour. I remember the doctor that I worked for explained to me how his office worked, what type of clientele his patients are, and what procedures were the norm. He went on to say how the patient’s main concern was to have nice white teeth and how we must cater to that. Veneers, white fillings, and teeth whitening were the procedures we did most often. I still remember whitening was about $1,000 and the procedure was long and painful. I recall the solution was packaged in two dark bottles, with a poison warning label and skull to emphasize that it was a dangerous chemical.

Fast forward some 20 years or so and boy have things changed. You can buy over the counter whitening products or go on Youtube for home remedies to have your teeth whitened with strawberries. I’ve even seen whitening booths at the mall, which amazes me how much the procedure has evolved. Or you can go to your local dentist and have your teeth professionally whitened. Any solution you choose will be cheaper and faster than it used to be 10, 15, 20 years ago. With the market so saturated with whitening products and techniques, it’s hard for the average consumer to know which one is best for them.

The truth is most of the options I mentioned above work to some degree. The best option is still to have your teeth examined by a licensed dentist so that they can determine if whitening is a good option for you before whitening, its best that the dentist checks that your enamel is thick enough for whitening, that your gums are healthy and that you are cavity free. What this does is ensure that you will have the best results with the least amount of discomfort.

Before any type of whitening, the patient should be plaque and tartar free, a cleaning is usually recommended at least one week prior to whitening. There are two ways that most dentists recommend you whiten your teeth. In-office whitening or take home whitening. What’s the difference? Let’s dive into to the differences.

With the In-office whitening most patients can see a difference of 2-6 shades lighter after one visit (usually 3 twenty minute sessions). The complete visit takes about one and a half hours. The procedure is somewhat invasive as it requires complete isolation which includes gauze and a dam around the soft tissue so that only the teeth are exposed. Once the procedure starts, the patient can’t move or close their mouth. The immediate concern with this method is post operative sensitivity because of the high concentration of peroxide used and soft tissue irritation because the gel sometime leeks into the soft tissue. Although the patient sees immediate results, the concern with this method is fade back because the patient fails to comply with the post operative instructions (the tubules on the teeth remain open for 48 hours after whitening, leaving the teeth vulnerable to re-staining from eating or drinking dark foods). Cost for this method varies but on average is about $200-$500 per session

The second method is to make custom fit trays for the patient. This process requires two visits. The first visit is about half hour to take impressions. The dental assistant then fabricates the custom fit trays. The patient is then brought back about a week later. The second appointment is also about half an hour. This appointment is not invasive at all, it consist of fitting the trays and giving the patient whitening gel to dispense into the trays, and post operative instructions. Pros and cons with this method: Patient compliance. For best results, patients are to wear the trays for 10-14 consecutive days over night or for at least 1 hour each day (wear time depends on strength of gel). Usually that’s a tall order for even the most compliant patients. While whitening, the patient is instructed to stay away from any foods or drinks that stain, which is tough to do for such a long period of time. What I love about this method is the contact time of peroxide on the teeth as opposed to the in-office whitening. Clinically, the longer the peroxide is in contact with the teeth, the better and longer the results are. I also like that you can control how white your teeth get. With the in-office whitening, it’s a little bit of a crap shoot (the results are not as predictable). I like the long term results with the custom trays. Cost for this method also varies but on average the cost is between $99-$300.

So what is the best method? In my opinion, the best method is a combination of both. Do the in-office whitening and send the patient home with gel and custom made trays. Think of whitening like dying your hair, eventually your natural color will come back and you will have to redo your hair again. With whitening, it’s the same thing, no matter what the results, your teeth will eventually return to their original color. The combination method works great because you see immediate results with the in-office method and then you have the trays to “touch up” when the teeth begin to fade back. You will get more bang for your buck this way. The cost for the combo technique is either the same price as the in-office whitening or some office increase the fee by $100-$200.