Professional whitening

Research has shown no significant long-term effects associated with professional at-home whitening treatments containing 10%, 16% carbamide peroxide or 6% hydrogen peroxide.

The effect of teeth whitening is less likely to last as long if you smoke or eat or drink products that can stain your teeth. These things can cause extrinsic staining (surface stains) which reduces the brightness of your teeth, however, that doesn’t mean you can’t drink them. For the maximum effect, we generally advise patients to avoid such staining foods/drinks only DURING the course of whitening.

With good maintenance, regular visits to the dental hygienist to remove any stains and following the whitening advice provided to you by your dentist you should be able to continue your diet as normal.

Teeth whitening is more effective on teeth that are on the yellow and white spectrum. Teeth that are shades of brown and grey are more difficult to whiten and may require a longer treatment, or stronger whitening agents. 

If you have local discoloration that does not respond very well to whitening, then your dentist may discuss whitening in conjunction with more in-depth procedures, such as micro-abrasion, ICON resin infiltration treatment, composite bonding, crowns or veneers. 

With all types of teeth whitening products, the results will vary from person to person, and depend largely on the original colour of the teeth, the condition of the teeth, the type of staining present and compliance with the teeth whitening regime. 

The most difficult staining to remove is deep, intrinsic staining from factors such as tetracycline use. This type of staining can take many months of whitening to achieve a good result.

A man named Louis Jacques Thenard discovered hydrogen peroxide in 1818. Hydrogen peroxide is a potent oxidising agent. The whitening action is a result of peroxide breaking down to form oxygen free radicals. These then oxidise, or break up, larger pigment molecules into smaller, less visible molecules that can be absorbed by the body – this is whitening!

By the European Directive on teeth whitening, dental professionals are only permitted to sell products that contain a maximum of 6% hydrogen peroxide. 

Over-the-counter products that do not require the supervision of a dental professional may contain only 0.1% hydrogen peroxide by law. These products are ineffective in whitening the teeth as the concentration of peroxide is simply too low.

Carbamide peroxide is hydrogen peroxide compounded with urea. Urea helps stabilise the formula, giving carbamide peroxide a more predictable, and longer shelf life, than hydrogen peroxide alone.

The European Directive allows dental professionals to prescribe up to 16% carbamide peroxide. In the presence of water, carbamide peroxide degrades into urea and hydrogen peroxide. Any given volume of carbamide peroxide will yield 35% volume of hydrogen peroxide when it breaks down. 

A notable difference between hydrogen peroxide and carbamide peroxide is the rate of breakdown, and therefore, the rate of release of oxygen ions. Carbamide peroxide is a more stable molecule and breaks down much more slowly than hydrogen peroxide. Carbamides release about 50% of their available peroxide in the first 2 to 4 hours, then the remainder over the next 2 to 6 hours.

Hydrogen peroxide breaks down almost immediately, releasing active oxygen ions entirely within the first hour. It is thought that because of this relatively concentrated bombardment of peroxides on the pulp, hydrogen peroxide produces more sensitivity than carbamide peroxide of a comparable concentration.

Dentist supervised home whitening is a gradual process, so you can decide quite easily when you are happy with the shade of your teeth and when you would like to stop the process.

With teeth whitening, even when the teeth become very white, they should still look natural and pleasing without looking fake. This effect is often owing to the use of overly white porcelain crowns or veneer, which are often more opaque and less natural looking than your own teeth.

In some cases, people can get to the end of the course of whitening and they are not happy with the colour of their teeth.

We know that peroxide will whiten teeth in virtually 100% of cases. Because of the manufacturing process at Orthoclear, it is rare that the problem will be an issue with the whitening gel itself. It is advisable to see your dentist, who will check what the issue may be. Usually, the first thing to try is continuing with the whitening. Usually, you just need an extra syringe or two of gel to achieve a good result.

The other check the dentist will make at this stage is the fit of your whitening trays. If your whitening trays are not well sealed, then saliva may be able to get into the trays. If this happens, there is an enzyme in the saliva which will neutralise the peroxide in the gel and render it useless, so your teeth will not whiten. If you can taste an excessive amount of gel throughout your whitening session, it may well be that the trays are not sealed enough to allow for adequate whitening.

Another thing to be aware of –  if you grind your teeth at night, the displacement of the whitening trays will again allow saliva to ingress and hinder the teeth whitening process. If you know you grind your teeth at night, let your dentist know.

Basically, we know that peroxide works! So if your teeth are not becoming whiter, there is usually a good reason why; you just need to work with your dentist to find it.  

Teeth whitening is not permanent. With no intervention, the colour of your newly whitened teeth will begin to slowly fade back to your previous colour. The duration between topping up your teeth whitening depends mainly on lifestyle choices. People who smoke or consume food and beverages that stain teeth, such as red wine, coffee and curries, will find that they need teeth whitening at more regular intervals after their initial whitening treatment. If your lifestyle involves one or more of these factors then you may require top-ups every 3 to 4 months. In the absence of these habits, most people will require a top-up on their teeth whitening at 6 monthly or yearly intervals. 

Age and habitual factors also play a role in how long your whitening treatment will last.

If you grind your teeth, the enamel can develop micro cracks. These will accumulate stains much more readily and mean you need whitening treatments more regularly. Your dentist will be able to help you determine how often you should top up your whitening.

Thanks to the wealth of research that exists around teeth whitening products, people no longer have to walk around with stained or yellow teeth.  A visit to the dentist, and you can be smiling like a movie star after a short course of teeth whitening, which can be done in the comfort of your own home. 

The dentist can help get your teeth beautiful and white, using prescription strength teeth whitening gels.  However, there are some habits that you can adopt to ensure your teeth stay whiter for longer. Here are three top tips to help you keep your beautiful white smile.

Good oral hygiene is essential for anyone wanting to maintain a brighter, whiter smile. Use one of the market-leading electric toothbrushes (we particularly like the Oral-B ones) and a good quality fluoridated toothpaste, and brush twice a day. Floss at least once a day. Plaque build-up on the teeth looks unsightly and can lead to staining. Daily cleaning will remove surface staining and plaque, giving the teeth a much nicer appearance to help maintain your teeth whitening.

Keeping your teeth white requires a little care and attention in your dietary and social habits. While practicing good oral hygiene is clearly important, watching what you eat or drink is just as critical. Red wine, sports drinks, tea and coffee, soft drinks and curries are just some of the foods that can cause staining of your teeth and diminish the effects of teeth whitening.  Smoking should also be avoided as much as possible.

Teeth whitening will improve the colour of your teeth, but they will eventually begin to fade back towards a darker shade. It is not enough to get your teeth whitened once – you must commit to a programme of top-up whitening in order to keep them that way. Your dentist will be able to advise you on the best maintenance programme for your smile. Typically, 3 to 5 days of top-up whitening every 3 months will be enough to keep your teeth looking beautifully white.

Lifestyle factors, such as smoking and dietary choices, will affect how often you require top-up teeth whitening treatments.

Dentist-supervised home-whitening is the safest, most popular, and most well-researched whitening procedure.  As with all dental procedures, the first step is a thorough assessment and diagnosis, coupled with good quality photographs showing the closest matching shade tab (always ensure you can see the label of the shade tab).

The trays you wear to do home supervised teeth whitening are very important to ensure a successful outcome.  The trays from Orthoclear are manufactured in a very specific way.

Laboratory made trays versus in-house trays for teeth whitening:

This technique requires the manufacture of custom fabricated trays by a laboratory skilled in the use of thermoplastic materials.

Trays should ideally be made with a 1.5mm single-skin, semi-rigid material. Vacuum and pressure forming together will ensure a tray that is a close fit to the model. Vacuum forming alone usually results in a poor fitting tray. The gingival margins should be carved prior to forming. This creates a marginal seal to prevent ingress of saliva, and wash-out of the gel. There are two schools of thought as to how the margins of the tray should be finished – scalloped or straight. Orthoclear trays come with a straight margin. This requires less finishing, which results in a closer fitting, more stable tray. If a whitening tray has reservoirs, then a scalloped margin is better to ensure excess gel can be removed easily.The literature shows that reservoirs are not required. Orthoclear trays are manufactured with no reservoir, but they do have a ‘dosing dot’, basically a small dimple on the labial surface of each tooth. The patient simply has to fill the dot to ensure the correct volume of gel is dispensed. This means fewer problems with sensitivity from over-filled trays and gel touching the gingivae. The kits also last longer, which in turn gives better results.

There is a perception amongst the public that in-surgery whitening using lamps or lights (it is never a laser!) is a superior way to whiten teeth.

This raises some controversy and polarises opinion. The theory is that the light ‘activates’ the teeth whitening gel in some way, increasing the rate of free radical release.

There are numerous studies showing the lights to be effective, but these are usually done by the companies that manufacture the lights themselves, so you draw your own opinion as to how credible these are. These should be approached with an open mind!

So, although there is questionable evidence to prove the effectiveness of lamps, if you wish to use this method and you enjoy the experience, then the choice is up to you.

There is, however, an overwhelming body of evidence to show that dentist supervised home whitening is very effective, and produces consistently superior results. Orthoclear Whitening is designed using the most up to date scientific data available, so we do NOT use in-surgery whitening, because the evidence does not support this as a good option for teeth whitening when using a 6% hydrogen peroxide whitening gel.

The concept of whitening toothpastes has been around for over 50 years. Originally, these pastes were excessively abrasive and worked by aggressive removal of stain and surface enamel.. Modern whitening toothpastes are much more tooth friendly, so can be used regularly to help maintain a whiter, brighter smile. The key word here is MAINTAIN! These pastes will rarely whiten your teeth to any great degree.

Whitening toothpastes usually contain a detergent and very mild abrasive to gently scrub staining from the surface of the enamel. Silica is the most commonly used abrasive in whitening toothpastes. Some toothpastes designed for teeth whitening may also contain alumina or dicalcium phosphate. Often, they will use some form of chemical polishing agents such as peroxides, titanium dioxide or baking soda – although the concentration of these would be so low that they would have very little effect on the shade of the teeth.

Coconut oil, oil pulling, charcoal, bicarbonate of soda….none of these ingredients work to safely and effectively whiten the teeth.  

Coconut oil is effectively useless, and charcoal and bicarbonate are excessively abrasive. Whilst they may lift some surface staining, they will do so by removing some of the enamel, which will never grow back. The result after multiple uses will be thinner enamel, which will allow the yellow dentine underneath to shine through, and in turn cause the teeth to appear darker and more yellow – the exact opposite effect you want!

Some of these products also work by dehydrating the teeth so that they initially appear whiter.  However, the effects will quickly fade and the teeth will return to the same shade that they were previously.

The only proven, safe and effective way to whiten your teeth is dentist supervised whitening using a peroxide-based formula. 

Peroxides that can be prescribed by a dentist have a wealth of clinical evidence behind them, and are 60 times stronger than the products available over the counter, or from the internet.

Also, do not forget that using an unregulated product from someone who is not a dental professional, or a product ordered from the internet, is risking your oral health. Without knowledge of what the product contains, or how to use it safely, you may burn or permanently scar your gums, lips and soft tissues. 

The main side-effect of teeth whitening is sensitivity. Up to 70% of people who have teeth whitening will experience some form of sensitivity, from mild discomfort to severe pain.  Some people may also feel some slight irritation of the gums or lips. Both of these effects are temporary and will resolve, given a little time, after stopping or finishing your treatment. 

The effects of sensitivity when whitening your teeth can be mitigated in most cases by following this protocol:

1.  Full examination.

2.  Photographs with time-stamp and shade tab visible.

3.  Restore any exposed root dentine with composite or glass ionomer.

4.  Use a chair-side desensitising agent on any areas of sensitivity, as directed in instructions. Gluma, Hurriseal or Vivasens all work well.

5.  Use Sensodyne Toothpaste in the whitening trays, overnight, for 3 nights.

6  Use Goodbrush Toothpaste in place of your regular toothpaste for 2 weeks prior, and throughout, the whitening process.

7.  If sensitivity is severe, use the ramp technique. Start on 10% Carbamide Peroxide with only 1 or 2 hours of wear time, gradually increasing the wear time so that after 2 weeks you can manage to wear the trays overnight. 

8.  If the sensitivity persists, you can whiten on alternate nights, and wear the Sensodyne Toothpaste in the trays overnight on the days in between.

Tooth whitening is a very safe procedure when performed correctly. However, there are some potential side effects:

Gingival Irritation:

Another potential side effect of the whitening process is gingival irritation. This occurs when the whitening gel has  prolonged contact with the gingival tissue. This can be avoided by only filling the dosing dots on the tray and no more. This will avoid an excess of gel and the subsequent gingival irritation. If you do have any excess of gel on your gums, this should be removed with a clean tissue or soft toothbrush.

The best way to limit most problems is to ensure that the trays are well made by a laboratory. The quality and precision required is impossible to recreate in surgery made trays.  Isolation of the bleaching product from the rest of the mouth will successfully limit most problems.

Likewise, patient education on how to properly fill the trays will also help.

Disappointing Results:

Teeth whitening is not an exact science, and 1 pack of whitening does not always equal the perfect result for your patient. It may take more. This should always be made clear from the outset.

We know from the Van Haywood studies that hydrogen peroxide will whiten the teeth in almost all cases. If the teeth do not whiten, the answer is to extend the treatment time. This approach will rarely fail.

Other factors that lead to poor results are lack of compliance, poorly fitting trays and bruxism.

Bruxists and Tooth Whitening:

If you are attempting whitening but you suffer from nocturnal bruxism (teeth grinding), the results will likely be poor.  As you clench and grind, the flexing of the trays will cause saliva ingress and washout of the whitening gel. In these cases, the best option is to use Day gel.

Some people have very translucent, or slightly see-through, edges on their front teeth. These can appear as black, grey or blue bands near the biting edge of the front teeth. When you whiten your teeth, the contrast between the much whiter tooth, and slightly darker band, can become more noticeable. The whitening has not damaged, or worn away your tooth in any way – it is simply the greater contrast becoming more apparent. In these cases, you may need a little composite (white filling) adding to the front or the back of the tooth to mask the translucent area. Your dentist will discuss this with you prior to whitening.

This can happen in some cases and is owing to a number of reasons. The white layer on your teeth, the enamel, is naturally thinner near the gum line and can therefore allow the much yellower layer beneath it, the dentine, to show through.

We can solve this in most cases by continuing to whiten the teeth until they will not go any whiter. If there is still a band of darkness across the gumline this may need some white filling to rectify.

Teeth whitening is regulated as a cosmetic product in the UK and Europe and must adhere to the UK and EU Cosmetic Regulations. This dictates that the strength of hydrogen peroxide cannot exceed 6% by weight in professional teeth whitening solutions.

At 6% strength, professional tooth whitening is very safe when used under the supervision of a dentist.

Orthoclear Whitening is registered (through Whitesmile and Pola) with the UK and EU Cosmetics Portal and has been passed by an EU assessor as safe to use. We also have FDA approval pending and our products are approved for sale in Australia. 

If you use our products as directed, provided you have no allergies to the ingredients, you should have a safe and comfortable experience with Boutique Whitening.

Teeth whitening should not be painful. However, up to 70% of people who have teeth whitening will experience some form of sensitivity, from mild discomfort to severe pain. Some sensitivity is normal. It is only very few people that get pain to the point of being unable to continue with the treatment. Some people may also feel some slight irritation of the gums or lips. Both of these effects are temporary and will resolve, given a little time, after stopping or finishing your whitening treatment. 

We have a wealth of products and strategies to combat sensitivity. Your dentist can ensure that your teeth and gums are in good health to reduce that chance of sensitivity. They can also use some chairside desensitising agents to make your teeth more comfortable.

Your dentist will recommend which gels and protocols work best to combat sensitivity, if it is a serious issue for you.

The short answer is that the hydrogen peroxide and carbamide peroxide used in the whitening gel, will most definitely NOT harm your teeth.

The longer answer is below!

The effect of whitening gel on enamel, dentine and pulp:

Teeth whitening is one of the most researched cosmetic procedures in the world and comes with a wealth of evidence to support the effectiveness and safety of the take home technique, if correct protocols are observed. There are many studies that exist which demonstrate the effects of teeth whitening using peroxide on the various layers of the human tooth.

Enamel

Enamel is not significantly affected by the use of peroxide based products such as those used in teeth whitening. A study by Leonard, et al, in 2001 assessed the effect of 10% carbamide peroxide on the surface morphology of enamel after 2 weeks, and again after 6 months, using electron microscopy at 2000 times magnification. There was no significant effect on the surface of enamel immediately after teeth whitening and it did not worsen over time.

Dentine

Dentine is affected more by the whitening process than enamel tissue. Spyrides GM, et al, study from 2000 showed that dentine bond strength decreased by as much as 76% post whitening. Further research from Na-Young Jeong, et al, in 2006 showed that 2 weeks was sufficient to allow the dentine to recover, and bond strengths returned to nearly the same as pre-whitening levels. Always schedule any restorative work for at least 2 weeks after the patient has finished whitening. If there is any immediate bonding required,  soaking the dentine in a 70% ethanol solution for 2 minutes can restore bond strengths  to near pre-whitening levels.

Pulp

Owing to the sensitivity associated with tooth whitening, it is often wrongly assumed that whitening causes pulpal damage.  JO Fugaro, et al, did a study in 2004 on the reaction of pulpal tissue to two weeks’ use of 10% carbamide peroxide. The findings from this study demonstrated that 10% carbamide peroxide can cause mild, localized pulp reactions.  However, these did not affect the overall health of the pulp tissue and were reversible within two weeks post-treatment. Therefore, two weeks of treatment with 10% carbamide peroxide is considered safe for the pulp.

Another study by Cohen showed that hydrogen peroxide of up to 35% concentration was harmless to the pulp. It is a safe assumption that no long term harm will come to the pulp from the concentrations of whitening solution that are used in home whitening

There are numerous studies to show that teeth whitening gels do not in any way damage dental restorations.  Restorations such as tooth-coloured fillings, crowns, bonding, veneers and bridges will not whiten. However, be aware that any pre-existing dental work may need to be replaced to match the new colour of the teeth after they have been whitened.

Teeth whitening will only work to whiten the natural teeth. It will not lighten existing dental work at all. Be aware that you may need to change any crowns, veneers or fillings after you have had teeth whitening. You will need to discuss this with your dentist prior to having the treatment, to ensure you are aware of the costs and appointments involved if this is required.

Absolutely not! There are several reasons as to why this is a dangerous idea. Teeth whitening is an act of dentistry and can only be done by a dentist, or under the supervision of a dentist, by appropriately qualified professionals. You must have a comprehensive dental examination prior to teeth whitening and this cannot be done by hairdressers and beauticians. Any underlying oral health conditions will need rectifying prior to a course of teeth whitening, and a beautician is not qualified to understand the implications of these conditions, so you should never take these kinds of risks with your health.

The peroxides used by dentists are strictly monitored and used in a way that we know will give maximum benefit with little to no adverse effects.

By letting unqualified people with no knowledge of chemistry and dentistry work in your mouth, you are risking burns, scarring and permanent disfigurement. Please follow this link to see the stories below of issues that have occurred when people let hairdressers and beauticians provide teeth whitening.

Contradictions for Whitening:

Teeth which seem at an acceptable shade, which is subjective for clinician and patient to decide.

Presence of composite restorations mixed with natural tooth structure, which will not lighten with treatment. They may need replacing post whitening. If the restorative needs are too high, whitening may not be a good idea.

Porcelain restorations such as crowns and veneers will not lighten, and may require replacement after whitening treatment. You need to be aware of the process and costs for doing this prior to teeth whitening, to ensure you consent to this.

Pregnant or lactating women.

If you are unable to be compliant.

If you have unrealistic expectations.

If you have exposed cementum and exposed root surfaces, as cementum does not lighten with teeth whitening agents.

The Regulations and EU Directive specifically state the product must NOT be used if you are aged under 18. 

This can create an ethical dilemma for dentists who wish to act in the best interests of their patients, but where the treatment is prohibited by the Regulations by virtue of the patient’s age.

In this scenario, it is an individual clinical decision whether to breach the Regulations and provide the treatment in the best interests of the child – this may be in the treatment of disease. It is arguable that if the child’s mental wellbeing is being affected by discoloration of the teeth, owing to bullying, etc, then whitening the teeth is indeed treatment of disease, in order to best help their mental state.

In order to do this, the dentist must follow the following protocol:

• Have a detailed discussion with the patient/parents or guardian, as part of the consent process.
• Ensure that patient/parents or guardian are fully informed as to the risks and benefits of both whitening procedures, and the more invasive alternatives.
• Discuss whether it is appropriate to delay treatment until the patient is 18 years of age.
• Contact an indemnity provider for advice.

If there is a clear case of disease whereby the child can be helped by teeth whitening, the case is more compelling, but the dentist must still follow the steps laid out above to best defend their position, should they be required to do so.