Esthetic Dentistry

Teeth Whitening

Teeth whitening is the process of removing stains and discolouration from teeth through a bleaching process to make them look "whiter".

For heavily stained teeth, a procedure as simple as a scale and polish from a dental hygienist can significantly improve their appearance and make them look "whiter" .

What are the different types of teeth whitening available?

Most dental practices offer two types of whitening:

  • Laser / in-surgery Teeth Whitening
  • Professional home whitening kits

Both procedures are based on a bleaching process that uses a peroxide-based bleaching gel of varying strength (3%-6% peroxide). The higher the concentration of peroxide in the gel, the more powerful it is. While a higher concentration gel is more effective at whitening the teeth, it also has greater potential to cause side effects such as sensitivity and damage to the surrounding gum tissue and your lips.

Laser Tooth Whitening

Laser tooth whitening or in-surgery whitening is a procedure that takes place at the dental practice and uses a light-activated bleaching gel to whiten your teeth. The procedure usually takes approx 1 -2 hours and produces instant whitening results. Many dentists recommend that laser whitening should be followed up by professional home whitening.

The Laser Tooth Whitening procedure

Prior to carrying out the procedure you would have a consultation with your dentist to make sure that you are suitable for teeth whitening and to explain possible risks and side effects of the procedure. Most dental practices will ask you to sign a teeth whitening consent form to confirm that you have fully understood the procedure and all risks.

Before the teeth whitening process is started a dentist or a hygienist will thoroughly clean the teeth, removing any surface stains and tartar. This procedure is commonly referred to as a scale and polish.

The next step will be for the dentist to make a record of the shade/colour of the teeth before the procedure. This is either recorded using a tooth coloured shade guide/chart or by taking a digital photograph of your teeth.

The area is then prepared for the procedure. The bleaching compound usually contains a high concentration of peroxide (up to 6%) and so the dentist will usually place some form of protection around the gums so that only the teeth are exposed to the compound. This involves covering the gums with rolls of cotton and a protective gel material that hardens once applied to the gums. A cheek retractor is used to keep the lips and cheeks away from the teeth.

It is very important that your dentist isolates your gums and lips with a protective material in order to avoid any potential damage or burning. Home whitening kits usually have a low concentration of peroxide so that there is less chance of any damage occurring. Recently, high-strength home whitening kits purchased online and from certain stores have attracted media attention with horror stories of people with badly burnt lips and gums. It's for this reason that teeth whitening should always be carried out under the supervision of a dentist.

Eye protection (goggles) is also provided to prevent any damage to the eyes from the laser used or any accidental splashes of the peroxide. Many cosmetic practices now offer "DVD glasses" so that the patient can watch a movie during their treatment!

The whitening gel is then applied to the surface of the teeth and exposed to a light or laser, which activates it. Some systems do not use an activating laser and many dentists argue that the laser doesn't make any difference to the end result. During this process if you feel that your lips or gums start to burn then you should let your dentist know immediately. After approximately 15 minutes the gel is removed and the process repeated another 2 times. During the procedure some people may feel sensitivity in their teeth, which are described as short-lived shooting pains.

The dentist will finally wash off the whitening gel and remove any gum protection before evaluating the final result by taking a photograph or using a shade chart. The results are usually quite dramatic and can often be up to 10 shades lighter. A kit for home whitening may also be provided with custom trays and professional whitening gel.

Many patients' teeth are quite sensitive immediately following this procedure and it is advised to try and avoid hot or cold drinks for a while. Some dentists offer fluoride treatment following teeth whitening to reduce this effect on sensitivity. Your home whitening kit usually contains a solution to reduce tooth sensitivity. Sensitivity rarely lasts more than 48 hours, if symptoms persist for longer than this then contact your dentist.

Once your treatment is complete your dentist will remove the gel and a shade guide will then be used to measure how much whiter your teeth have become during the procedure. The results are instant and can often be up to 10 shades lighter.

Professional home whitening kits provide more permanent results over a longer time scale, whereas laser tooth whitening offers immediate results. A combination of the two provides the perfect solution to both immediate and long-term whitening needs.

Professional home whitening kits

To make a professional home whitening kit, your dentist will take a impression (mould) of your teeth using a special dental putty. Your dentist's technician will then use this to cast a model of your teeth from plaster and make your custom teeth whitening trays from this. Once these trays have been made (usually takes 5-10 days) you use them in combination with professional whitening gel (provided by your dentist) until you are happy with the results. Depending on the teeth whitening system, some trays need to be worn overnight while others for only 1-2 hours a day.

Suitability for whitening

Many people are not suitable for teeth whitening and a dentist will assess your suitability during a consultation. If you have gum disease or other dental health problems, you may not be suitable. The teeth whitening process does not change the colour of crowns, veneers or fillings so it is important to understand that you may need to change these to match the colour of your whitened teeth.

How much whiter will my teeth look?

This varies from individual to individual, and also depends on the type of whitening system used. Some people respond very well to teeth whitening and have dramatically whiter teeth as a result, whereas others may notice very little difference at all. People with heavily stained yellow teeth tend to have more dramatic results than those with slightly discoloured teeth.Your dentist will be able to advise you on the likely results following a consultation.

Porcelain Veneers / Laminates

  • If your front teeth are stained, chipped, or malaligned, veneers will give you a good life-like appearance with minimum tooth adjustment.
  • A veneer is a porcelain facing on the front of your teeth usually your top teeth, it is just like a false finger nail.
  • Veneers are made out of porcelain and are used mainly for esthetic reasons.
  • Veneers make teeth look natural and healthy, and because they are very thin and are held in place by a special strong bond (rather like super-glue) very little preparation of the tooth is needed.
  • Porcelain veneers can improve the colour, shape and position of teeth.
  • A precise shade of porcelain can be chosen to give the right colour to improve a single discoloured or stained tooth or to lighten front teeth (usually the upper ones) generally.
  • Veneers can also be used to close small gaps, when orthodontics (braces) are not suitable.
  • If one tooth is slightly out of position, a veneer can sometimes be fitted to bring it into line with the others.

Composite Bonding

Why should I consider white fillings?

Most people have fillings of one sort or another in their mouths. Nowadays fillings can be natural looking, as well as doing the job they're meant to do. Many people don't want silver fillings that show when they laugh or smile because they are more conscious about the way they look.

Both procedures are based on a bleaching process that uses a peroxide-based bleaching gel of varying strength (3%-6% peroxide). The higher the concentration of peroxide in the gel, the more powerful it is. While a higher concentration gel is more effective at whitening the teeth, it also has greater potential to cause side effects such as sensitivity and damage to the surrounding gum tissue and your lips.

Are white fillings expensive?

Because many white fillings are classed as a 'cosmetic' treatment, you can only have them done privately. So costs can vary quite a lot from dentist to dentist. Costs usually depend on the size and type of white filling used, and the time it takes to carry out the treatment. Costs may also vary from region to region, but your dentist will be able to give you an idea of the cost before you agree to treatment.

Are they as good as silver amalgam fillings?

White fillings have always been considered less long lasting than silver amalgam fillings. But there are now new materials that are almost as good as silver amalgam, and these are proving to be very successful. How long a white filling lasts can depend a lot on where it is in your mouth and how heavily your teeth come together when you bite. Your dentist can tell you about how long your fillings should last.

Is it worth replacing my amalgam fillings with white ones?

It is usually best to change fillings only when your dentist decides that an old filling needs replacing. When this happens you can ask to have it replaced with a tooth-coloured filling.

Some dentists prefer not to put white fillings in back teeth as they are not always successful. One way around this would be to use crowns or inlays, but this can mean removing more of the tooth and can be more expensive.

What are tooth-coloured fillings made of?

It can vary, but they are mainly made of glass particles, synthetic resin and a setting ingredient. Your dentist should be able to give you more information about the material they use. Here are some of the choices.

Composite fillings

Composite fillings are strong, but may not be as hard wearing as ordinary amalgam fillings.

Composite fillings are tooth coloured and are made from powdered glass, quartz, silica or other ceramic particles added to a resin base. The dentist will choose a shade to match your own teeth, although over time the filling can get stained. After the tooth is prepared, the filling is bonded onto the area with an adhesive and a light shone onto it to set it. With this type of filling, the dentist may have to remove less of the tooth, which is obviously better.

Glass ionomer

Glass ionomer fillings form a chemical bond with the tooth. They may also release fluoride, which helps prevent further tooth decay. This type of filling is fairly weak. Because of this, they are usually used on baby teeth and non-biting surfaces, such as around the neck of the tooth. Little preparation is needed as the filling bonds directly to the tooth.

Porcelain inlays

Your dentist can now use computer technology (called CADCAM) to design and prepare perfectly fitted porcelain inlays in just one or two visits. Porcelain inlays can also be made in a laboratory, but this will need at least two visits to your dentist. Porcelain can be hard wearing and long lasting, and it can be coloured to match your own teeth. This type of filling can be quite expensive.

Where can I get white fillings done?

Most dental practices offer white fillings as a normal part of the treatment they give you.

Are there any alternatives to fillings?

There are alternatives such as crowns and inlays although they can cost a lot more. Veneers can be used on front teeth instead of crowns or fillings. For more information, see our 'Tell me about' leaflets on crowns and veneer