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Supervised
Bleaching of Teeth
Patients
are very interested in Tooth Bleaching. This is
because appearance is important to them and they
realize that the mouth and their smile is the
focus of considerable attention, as we go
through our daily routines. If we feel good
about our appearance we feel good about
ourselves. These good feelings in turn result in
better relationships with those around us.
Bleaching
procedures are not new in dentistry. Many
techniques have been developed by dentists to
lighten the shade of a patient's teeth. In the
past, treatments were done in the dentist's
office. Most methods involved isolating the
teeth and sealing them off from the remainder of
the patients mouth. This was necessary because
strong hydrogen peroxide solutions, heat, and
light were used to bleach the teeth. The large
amount of time involved made the procedures
costly. The results were generally good but one
major problem existed. The teeth would return to
their former shade in 3 to 6 months. The process
would have to be repeated again, with another
charge incurred. Needless to say few people had
their teeth bleached.
Current
techniques are usually done by the patient at
home. Much milder methods are used which are
much gentler and easier to control. Instead of
attempting to bleach the teeth in one session at
the dentist's office, the process takes 2-3
weeks and is done at home with supervision and
instructions provided by the dentist. This
technique utilizes a vacuum formed plastic
device, called a tray, that holds the bleach in
contact with the teeth. The bleach is still
basically hydrogen peroxide based. Usually the
chemical used is carbamide peroxide which breaks
down to hydrogen peroxide after it is applied to
the tray and teeth. The results are quite
similar to the former in-office treatments but
the advantage is that, periodically, every 3-4
weeks, the teeth can be retreated, at home, by
the patient, with no additional cost or bother
to the patient. This periodic re-treatment
maintains the desired colour and shade.
Bleaching
can remove many stains that are in the outer
layers of your teeth. Teeth tend to change
shades, usually yellow, with age. These changes
can be reversed. Stains in the gray family (such
as tetracycline) can be more stubborn, if not
impossible, to bleach. Usually, we cannot
predict the effectiveness of bleaching for each
individual patient. Bleaching must be tried
first to see what degree of bleaching is
obtainable. Bleaching will not change the color
of existing dental restorations. If restorations
are planned for the anterior part of the mouth
it is advisable to accomplish the bleaching
first, then match the new restorations to the
now bleached teeth.
So,
What do you need to do next if you want to have
your teeth bleached and whitened?
First
of all, your dentist should examine all of your
teeth and determine the health of your mouth.
After treatment plans are made and you are ready
to go ahead with bleaching, the dentist will
need to take moulds or impressions, of your
teeth. These moulds are used to make the custom
vacuum formed trays to hold the bleaching agent
against your teeth. After the trays are made
they will be tried in and adjusted. You will be
given instructions for wearing the trays and how
to apply the bleach. Usually, you will be
returning to the dentist office for a visit to
review your progress and determine the response
of the teeth to bleaching and any side effects.
There
are a few side effects that you need to be aware
of. At our practice, we have a printed sheet of
the side effects that you may experience. As
with any procedure we can have problems which
vary with each patient. The most common side
effect is sensitivity of the teeth and gums.
This can be controlled by fluoride mouth rinses,
and the use of Sensodyne (TM) or another
desensitizing toothpastes Usually, by cutting
down the time of bleaching this problem can be
controlled. Many times breaking up the amount of
time bleaching is done into smaller, longer
spaced segments, will alleviate the sensitivity
problem.
Another problem is sometimes the wearing of the
tray makes the teeth tender to biting pressure.
This can happen when the original impression was
distorted in some manner. This results in an
inaccurate model. When the tray is vacuum formed
to fit the model the inaccuracy is reproduced
and when the trays are placed in the mouth they
act like weak orthodontic appliances which
result in sore teeth. The trays will probably
have to be remade.
Other
effects of bleaching are really not known facts.
We have used hydrogen peroxide for years as a
mouth rinse and we have seen no apparent
problems with its use. In all honesty, we can't
say for sure that its use will not cause harm to
the teeth or gums that become apparent years
from now. All we can say is that we suspect no
long term problems will exist.
What,
if any, are the contra-indications for tooth
bleaching? And which people should not have any
bleaching process carried out? As of this
writing we would not recommend bleaching for
smokers. Smokers should stop smoking before
having their teeth bleached. The smoking not
only defeats the effect of bleaching but some
authors are concerned about the mixture of
hydrogen peroxide with smoking having a
potentiating effect on tissue damage already
known to be caused by smoking. As far as we are
aware, pregnancy and other diseases are not a
contra-indication.
So
I have now decided to have my teeth bleached, I
have my trays so what next? Brush your teeth
before putting in your bleaching trays. Apply a
small amount ofthe peroxide based gel provided
into the tray and insert into your mouth. Don't
try and eat or drink while the trays are in your
mouth. After about one hour of wear replenish
the bleach in the trays and replace them in your
mouth. We recommend that our patients wear the
trays about 3 hours per day for 2-3 weeks. The
hours do not have to be continuous. After
removing the tray and discontinuing bleaching
rinse your mouth. Avoid citrus fruits and other
acidic foods while in the process of bleaching.
They may contribute to sensitivity, and there is
concern that the fruit acids may cause damage to
the outer tooth surfaces.
After
the first 3-4 weeks your teeth are probably
bleached as much as possible. The time it takes
for you to attain the colour and shade that you
want, is very variable. The longer you wear the
tray and the bleaching gel, the quicker the
effects will be. But you have to balance this
with the degree of sensitivity you may have.
From here on, you may have to renew the
bleaching every 6 to 8 weeks or so by wearing
the tray with bleach for 2-3 hours. Above all
enjoy your bright smile!
For
a permanent change, you should consider the
placement of Veneers, and you can access this
information from our Patient
Information pages.
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