Brightening Your Smile
During the last 25 years, many advances in dentistry have focused on improved esthetics. Porcelain crowns, bonding techniques, implants and natural looking denture fabrication have all made a remarkable difference in the appearance of smiles. The most recent of these, the whitening of teeth through conservative at- home treatment with 10% carbamide peroxide in a custom-fitted mouthguard, has become an integral part of dental treatment. As people feel better about their smiles, they use them more often, seem to have a better outlook on life, and take better care of their teeth in general.
The procedure is simple and rewarding for both the patient and dentist. Impressions of both dental arches are made. Custom-fitted mouthguards are fabricated using very thin lightweight material which allows the patient to sleep with them in place. The peroxide gel comes in syringes and is easily expressed into the tooth indentations in the mouthguards. Most patients prefer to sleep with them in place because they must be worn for a minimal of 4 hours. A shade guide is included in the bleaching kit so the patient is able to check daily progress. After one week the patient is requested to return to the office for an evaluation to determine if there is any tooth sensitivity or gingival (gum) irritation and to check the shade change. At that time a decision is made whether or not to bleach for a longer period of time. Most frequently we find that patients are quite pleased with the 2 to 3 shade whitening of their teeth that has been achieved in just one week.
The at-home bleaching phenomenon, however, has not been without controversy and conflict. Some doubted that it worked, while others raised good questions on safety to teeth and tissues. All these differing perspectives have served to heighten the focus and prompt more research on the technique. The overriding consensus seems to be that nightguard vital bleaching, when professionally administered with ADA approved materials is as safe as any other routine dental procedure. Some patient conditions are better treated with at-home bleaching than with any other treatment option.
Teeth tend to darken with age due to ingestion of certain foods and medications. Stains from aging or inherent dark color appear to bleach more rapidly than other stains such as those resulting from childhood treatment with the antibiotic tetracycline. Depending on the cause, tooth bleaching can be unpredictable in regard to the length of time it will take for a noticeable difference. After a daily bleaching routine, most patients will see a substancial difference within several days to one week. Studies have shown that the efficacy rate of nightguard vital bleaching approaches 97% for non-tetracycline stained teeth and up to 90% for tetracycline stained teeth with extended treatment time. Shade retention can be expected in up to 90% of patients at 1 year post-treatment, 67% at 3 years post-treatment, and at least 35% at 7 years. In most cases the initial treatment kit supplies enough bleaching gel to retreat at 6 month intervals for a night or two should slight darkening occur. The carbimide peroxide gel has a shelf-life of three years with no refrigeration required.