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Tooth Whitening
1. What is Tooth Whitening?
2. How to do a "Tooth Whitening"?
3. How many types of "Tooth Whitening"? What are they? And what are the differences among those?
4. The best method?
5. Is Teeth Whitening necessary
6. What are the pros & cons for "Tooth Whitening"?
7. What is the price of "Tooth Whitening"?
8. Can "Tooth Whitening" be done on everyone?
9. Can we do "Tooth Whitening" on every tooth? or is it possible only for some?
10. How often can we do "Tooth Whitening"?
11. How to get oneself ready for the "Tooth Whitening"?
12. How long will the "Whiteness" last?
13. What have effect on tooth color?
14. What is the post-op care after "Tooth Whitening"?
15. Besides "Tooth Whitening" done by a dentist, are there any other types of "Tooth whitening"? What about those toothpastes on the ads that claim to be able to "whiten" the teeth? Are they reliable?
16. Is tooth whitening with LASER the best?
17. How to do the Home Bleach? And at least for how long?
18. Home Bleach retouching (or Re-bleaching) should be done in how many years?
19. Can Home Bleach be done continuously? Or is there any time limitation?
General Knowledge
Q : What is Tooth Whitening?
A : "Tooth Whitening" is to make a darker shade of teeth looks lighter.
There are 2 major causes of discoloration of teeth. The first cause is "Extrinsic Factor" which is the factor from the environment; that is, coloration from food, drinks, or smoking. The second cause is "Intrinsic Factor" which is the factor from within oral cavity; that is, the accumulation of pigmented substance within the tooth structure upon tooth development or in non-vital tooth. There are various ways of "Tooth Whitening" to perform which depend on various causes of discoloration.

Q : How to do a "Tooth Whitening"?
A :

Hydrogen Peroxide is a chemical substance which is always needed in any "Tooth Whitening" techniques -- both "Internal Tooth Bleaching", the whitening from within a tooth, or "External Tooth Bleaching", the whitening from outside of a tooth. The Hydrogen Peroxide can be in various forms and will help ionizing pigmented molecules, results in reduced size of molecules, and will eventually come out of the tooth -- making the tooth whiter.


Q : How many types of "Tooth Whitening"? What are they? And what are the differences among those?
A :

"Tooth Whitening" in discolored tooth can be divided into 2 major types; that is, Tooth Whitening in Vital Teeth, and Tooth Whitening in Non-Vital teeth. There are 5 kinds of Tooth Whitening as explained below :-
 1. In-office Power Bleaching
A use of high concentration (approximately 35%) of Hydrogen Peroxide by a dentist in the dental office.
2. At-home Bleaching
A use of lower concentration (approximately 10%) of Hydrogen Peroxide by the patient at home.
3. In-office assisted Bleaching
A combination between the use of In-Office power bleaching and At-Home bleaching. This is helpful when the original color of teeth is very dark. In-Office power bleaching will then be done with a high concentration Hydrogen Peroxide to make the shade lighter, then followed by At-Home bleaching with a lower concentration Hydrogen Peroxide for some period of time. The teeth can get whiter and stay such white longer.
4. Over-the-counter Bleaching
A use of low concentration Hydrogen Peroxide that is found easily in the market or over the counter, for example, whitening strips, or toothpaste with bleaching substances. The products can be self-obtained and not necessary to be under dentist's supervision. It is believed that these products can help whiten the teeth; however, the result of the whitening effect is not yet officially approved.
5. Walking Bleaching
Tooth Whitening on a non-vital tooth that is already discolored. There is normally only one tooth that has color changed, not all the teeth. The tooth that has root canal treatment or normal teeth that have been traumatized may seem to be dark. This is due to the blood accumulation in the dentinal tubules within the teeth. The non-vital tooth whitening can be done in that specific tooth, not having to do on all teeth, by putting the bleaching agent “inside” the discolored tooth by a dentist so that it will be whiter, then temporarily close the opening. Leave the bleaching agent inside the tooth to make it white, then let the patient come back in about a week for a recheck of the tooth shade. If the shade is not satisfying, then redo the process again. If both the dentist and the patient are satisfied with the shade, then permanently close the opening.


Q : and... which is the best method?
A : Because the discoloration resulted from various causes, including the original shade of the teeth, each type of teeth whitening will be appropriate to each teeth condition and each shade. Therefore, consultation about the proper teeth whitening technique with a dentist is recommended for each individual.
One of the safest ways of teeth whitening is "at-home bleaching". This is because of the use of the lowest concentration of the bleaching gel. Although the "over-the-counter" type also uses a low concentration type of bleaching agents, the results is not stable and the scientific evidence of this method is not sufficient. Therefore, this "over-the-counter" type cannot be guaranteed that it is effective or safest. However, the "in-office power bleaching" and the "in-office assisted bleaching" are not dangerous to use if they are done under supervision of dentists although using the bleaching agents with a much higher concentration.

Q : Is it necessary to do the "Tooth Whitening"?
A :

This depends on each individual's satisfaction on his own tooth color. If one feels he would like to have a lighter shade of teeth because the present shade is too dark, resulting in a lower self-confidence, then the "tooth whitening" is necessary. Vice versa, if one feels fine with his own tooth color although it is dark, but it is still satisfactorily, then the "tooth whitening" is not necessary.


Q : What are the pros & cons for "Tooth Whitening"?
A :

The side effects of "tooth whitening" are "teeth sensitivity" and "soft tissue irritation" which will be back to normal when not in contact with bleaching agents.

It is found from the research that the effect on tooth surface and dentin is not significant. Therefore, "tooth whitening" is the most conservative and the most money-saving way to change tooth color.

However, the limitations of "tooth whitening" are :-

1. The original color of the teeth.

If the original shade of the teeth is not too dark, that is, yellowish or a little dark, "tooth whitening" alone may be sufficient to change teeth color. However, if the original shade of the teeth is very dark, that is, grayish or black, then other techniques might be more effective. The techniques are Veneers, Tooth Surface Conditioning, or Crowns. The "tooth whitening" might be, but not always, effectively used along with any of those techniques.

2. The natural teeth.

Only the color of natural teeth can be changed. Others, for example, fillings materials, false teeth, or crowns, cannot be changed. Therefore, if any fillings are necessary, a lighter shade when compare to the original shade of natural teeth might be used so that the shade after tooth whitening will be about the same. If there are existing crowns, or other types of false teeth, then it might be necessary to replace those crowns or false teeth to match the after-bleaching shade.

Q : What is the price of "Tooth Whitening"?
A :

The price of bleaching on only ONE tooth (in the case of non-vital tooth) is approximately 1,000 baht per tooth, while the price of bleaching on every tooth varies. The "at-home" bleaching costs approximately 5,000 - 8,000 baht, while the "in-office" type costs around 8,000 - 15,000 baht. The price varies depending on each clinic and promotional campaigns.

Q : Can "Tooth Whitening" be done on everyone?
A :

"Tooth Whitening" can be done on "natural teeth" only. It cannot be done on any other materials. Therefore, if anyone who wants to have "tooth whitening" has natural teeth, then it is possible to do. This also depends on the original shade and condition of the teeth.

In those who have abnormality of the outter and inner layers (enamel & dentin) of the teeth, it might not be a good idea to do the tooth whitening. Other procedures might be more helpful.

In those who have tooth decay, gum inflammation, cracked tooth, or even gum recession, it might also not be a good idea to do the tooth whitening as there may be more sensitivity than usual. Those abnormalities needed to be corrected prior to the tooth whitening procedure.

Therefore, if anyone would like to whiten thier teeth, it is highly recommended to go see a dentist to have a consultation, select, and pursue a proper tooth whitening technique.


Q : Can we do "Tooth Whitening" on every tooth? or is it possible only for some?
A :

"Tooth Whitening" can be done on every single tooth that has no tooth or gum diseases. Mostly, we do the "tooth whitening" on those teeth that are dark and visible (especially when smile or during speech). The dentist will be the one who choose the best and most appropriate technique for each individual for the best result.
If there are dark teeth or even only one tooth is dark, "tooth whitening" is possible, but the cause of the discoloration is to be analyzed to obtain the most appropriate method, which may not be merely "tooth whitening".


Q : How often can we do "Tooth Whitening"?
A :

"Tooth Whitening" is the safest and the most conservative way of making teeth white. Therefore, it is alright to do the "tooth whitening" as often as one wishes. This also depends on each individual's satisfaction. Mostly, one will do the "tooth whitening" according to the dentist's precription; for example, the times in a week, or the hours the bleaching gel needs to touch the teeth. Then, it is recommended to do the "touch up" every year in order to refresh the whiteness and make it become more stable and last longer.

Q : How to get oneself ready for the "Tooth Whitening"?
A :

It is a good idea to come and see a dentist to have a thorough check-up of the oral cavity. If everything is not ready; for example, there might be gum diseases, tooth decayed, or even calculus (tartar), then these have to be treated prior to the "tooth whitening" process
Taking pain-killer is believed to be helpful in preventing tooth hypersensitivity up to a certain level. The use of desensitizing agents in the form of tooth paste, mouth rinse, or gel, which can be Fluoride, about 2-3 weeks prior to the "tooth whitening" procedure will also be helpful in reducing the tooth hypersensitivity that might happen during the process.


Q : How long will the "Whiteness" last?
A :

"Tooth Whitening" can help making the tooth color become lighter up to a certain level depending on the original color. The tooth will not be more white if the whiteness has reached its peak. This white-most will stay for about 1 year or longer (about 3-5 years) depending on the behavioral and the post-op care of each person. It is recommended to have a "touch-up" visit every year so that the result will last longer and more stable.

Q : What have effect on tooth color?
A :

Factors that have effect on tooth color are the following :-
1. Colored food; e.g. fermented vegetable, coloring deserts, soy sauce.
2. Colored beverages; e.g. Sodas (Coke, Pepsi), Tea, Coffee, Red Wine.
3. Smoking cigarettes.
4. Aging. When we get older, the tooth color will look darker or yellower. This is because the composition of the tooth itself has changed. The outtermost layer (enamel) is thinner, so the yellow color of the inner layer (dentin) shows.
5. Position of the tooth. The neck of the tooth has darker shade of color when compare to the edge. The canine will have darker color when compare to other front teeth.
6. Complexion. When we compare the same tooth color on a different background of each individual's complexion, we'll see that the teeth in "white" people seem to look more yellow than those in "dark" people. This is because the background can make teeth looks whiter.


Q : What is the post-op care after "Tooth Whitening"?
A :

After "tooth whitening", it is strongly recommended to avoid food or beverages that can stain the teeth. Smoking is also not recommended. In order to stabilize and maintain the whiteness of the teeth for a longer period of time, it is advisable to have "home bleach" after the "in-office" type. Besides, to use desensitizing agent might be necessary, especially, immediately after "tooth whitening" or even during the "home bleaching" procedure so that the teeth sensitivity will then be reduced.

Q : Besides "Tooth Whitening" done by a dentist, are there any other types of "Tooth whitening"? What about those toothpastes on the ads that claim to be able to "whiten" the teeth? Are they reliable?
A :

Other forms of "tooth whitening"; for example, toothpastes, bleaching strips, can "whiten" the teeth. Since the bleaching property in those products is in a much lower concentration, the use has to be prolong till the result becomes visible. However, there is not sufficient study on the result of such products; therefore, it is still unclear about the exact result and the side effects of those products.

Q : Is tooth whitening with LASER the best?
A :

Esthetic and Cosmetic Dentistry nowadays is very popular, and tooth whitening is becoming very well known and seems to be quite interesting to people. Advertisement about Laser Teeth Whitening makes people feel that the teeth that have been "bleached" within just ONE hour will be "white". Some people just ask for merely Laser Teeth Whitening and will immediately left the premise once they heard there is not Laser machine available. This is because the perception about Laser teeth whitening being "best" that can make their teeth the most "white". In fact, Laser Teeth Whitening and other types of In-Office Teeth Whitening have similar effects. Oftentimes, a dentist needs to provide "Home Bleach" set as well so that the patient can improve the "whiteness" and maintain it for a longer period of time. Sensitivity from "any" Tooth Whitening system is likely to happen after the procedure for about a few days.

Q : How to do the Home Bleach? And at least for how long?
A : Bleaching substance that already contacted tooth surfaces for 2 hours long will be about 80% deteriorated. Therefore, it is suggested to wear bleaching trays for about at least 2 hours each time. However, wearing bleaching trays with low concentration of bleaching agent overnight might be recommended. Wearing the tray with gel in daytime is not suggested because salivation will wash away the gel easier during speech than during sleeping at which time the salivation is less. Nonetheless, bleaching at night time during sleep can cause the gel to drip into the throat resulting in sore throat when waking up. Some people may experience problem with jaw joints due to wearing the trays during sleep; therefore, if jaw joint problem is found, then the whitening strips may be introduced and can be used for about 1 hour a day.
Q : Home Bleach retouching (or Re-bleaching) should be done in how many years?
A : The frequency in re-bleaching depends on each individual. If the teeth are difficult to whiten, the shade may soon turn back to original shade or almost. The re-bleaching should then be done sooner; for example, every year. The report says that the whiteness from each bleaching can stay for about 3 years, then the re-bleach should be done. The second bleaching will consume less time than the first time which can be for months. Mostly, a dentist will give one syringe of home bleaching gel for the top teeth and another one syringe for the bottom teeth, and the teeth will certainly become whiter.
Q : Can Home Bleach be done continuously? Or is there any time limitation?
A : Home Bleaching with Carbamide Peroxide 10-15% for 3 years long had been reported. The teeth were whiter and whiter, but no clinically symptoms that showed harm. Therefore, there is no report for maximum timing in the bleaching although there might be sensitivity during the procedure which can be avoided by stopping it. In one prescription of bleaching gel, a dentist has to be careful not to prescribe more than 20 syringes which is a fatal dose. The safest concentration has to be low; that is, about 10% Carbamide Peroxide.
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