Resources From ADA

Tooth Whitening Treatments
http://www.ada.org/public/topics/whitening.asp

Everybody loves a bright white smile, and there are a variety of products and procedures available to help you improve the look of yours.

Many people are satisfied with the sparkle they get from brushing twice daily with a fluoride-containing toothpaste, cleaning between their teeth once a day and the regular cleanings at your dentist’s office. If you decide you would like to go beyond this to make your smile look brighter, you should investigate all of your options.

You can take several approaches to whiten your smile:

In-office bleaching
At-home bleaching
Whitening toothpastes

Cosmetic Dentistry http://www.ada.org/public/topics/cosmetic.asp

A smile can be the most eye-catching feature of a face. With dentistry's many advances, you no longer have to settle for stained, chipped, or misshapen teeth. You now have choices that can help you smile with confidence.

Even the most subtle change in your smile can make a dramatic difference in the way you look and feel about yourself. Talk to your dentist about the options most suitable for you, what your expectations are and the dental fees involved. Some options are:

Tooth whitening ( bleaching) brightens teeth that are discolored or stained. Bleaching may be done completely in the dental office or the dentist may dispense a system for you to use at home.

Bonding can improve the appearance of teeth that are chipped, broken, cracked, stained, or have spaces between them. With bonding, tooth-colored materials are applied, or bonded, to the tooth surface.

Enamel shaping involves modifying teeth to improve their appearance by removing or contouring enamel. The process, which often is combined with bonding, usually is quick and comfortable and the results can be seen immediately.

Veneers are thin custom-made shells designed to cover the front side of teeth. Made of tooth-colored materials, veneers are used to treat spaces between teeth and teeth that are chipped or worn, permanently stained, poorly shaped or slightly crooked.

Braces are not just for kids. Orthodontics may be needed if teeth are crooked, crowded or do not meet properly. If your dentist thinks you should see a specialist for treatment, he or she will refer you to an orthodontist.

Tooth Whitening Treatments http://www.ada.org/public/topics/whitening_faq.asp

What should you ask your dentist?

You may want to start by speaking with your dentist. He or she can tell you whether whitening procedures would be effective for you. Whiteners may not correct all types of discoloration. For example, yellow-ish hued teeth will probably bleach well, brownish-colored teeth may bleach less well, and grayish-hued teeth may not bleach well at all. Likewise, bleaching may not enhance your smile if you have had bonding or tooth-colored fillings placed in your front teeth. The whitener will not effect the color of these materials, and they will stand out in your newly whitened smile. In these cases, you may want to investigate other options, like porcelain veneers or dental bonding.

What is in-office bleaching?

If you are a candidate for bleaching, your dentist may suggest a procedure that can be done in his or her office. This procedure is called chairside bleaching and may require more than one office visit. Each visit may take from 30 minutes to one hour.

During chairside bleaching, the dentist will apply either a protective gel to your gums or a rubber shield to protect the oral soft tissues. A bleaching agent is then applied to the teeth, and a special light may be used to enhance the action of the agent.

A number of in-office bleaching agents have the ADA Seal of Acceptance, your assurance that they have met ADA standards of safety and effectiveness.

Lasers have been used during tooth whitening procedures to enhance the action of the whitening agent. No whitening products using lasers currently are on the ADA list of Accepted products.

What are at-home procedures and products?

There are several types of products available for use at home, which can either be dispensed by your dentist or purchased over-the-counter.

Bleaching solutions. These products contain peroxide(s), which actually bleach the tooth enamel. These products typically rely on percent carbamide peroxide as the bleaching agent, carbamide peroxide comes in several different concentrations (10%, 16%, 22%).

Peroxide-containing whiteners typically come in a gel and are placed in a mouthguard. Usage regimens vary. Some products are used for about twice a day for 2 weeks, and others are intended for overnight use for 1-2 weeks. If you obtain the bleaching solution from your dentist, he or she can make a custom-fitted mouthguard for you that will fit your teeth precisely. Currently, only dentist-dispensed home-use 10% carbamide peroxide tray-applied gels carry the ADA Seal.

You also may want to speak with your dentist should any side effects become bothersome. For example, teeth can become sensitive during the period when you are using the bleaching solution. In many cases, this sensitivity is temporary and should lessen once the treatment is finished. Some people also experience soft tissue irritation—either from a tray that doesn’t fit properly or from solution that may come in contact with the tissues. If you have concerns about such side effects, you should discuss them with your dentist.

Toothpastes. All toothpastes help remove surface stain through the action of mild abrasives. "Whitening" toothpastes in the ADA Seal of Acceptance program have special chemical or polishing agents that provide additional stain removal effectiveness. Unlike bleaches, these ADA Accepted products do not alter the intrinsic color of teeth.

ADA Positions & Statements
http://www.ada.org/prof/resources/positions/statements/whiten2.asp

ADA Statement on the Safety and Effectiveness of Tooth Whitening Products 
 
For more than a decade, the ADA Council on Scientific Affairs has monitored the development and the increasing numbers of whitening oral hygiene products. As the market for these products grew, the Association recognized a need for uniform definitions when discussing whiteners.

For example, "whitening" is any process that will make teeth appear whiter. This can be achieved in two ways. A product can bleach the tooth, which means that it actually changes the natural tooth color. Bleaching products contain peroxide(s) that help remove deep (intrinsic) and surface (extrinsic) stains. By contrast, non-bleaching whitening products contain agents that work by physical or chemical action to help remove surface stains only.

Whitening products may be administered or dispensed by dentists or purchased over-the-counter (OTC) and can be categorized into two major groups:

Peroxide-containing whiteners or bleaching agents; and
Whitening toothpastes (dentifrices).
Peroxide-containing whiteners or bleaching agents

Dentist-dispensed and OTC home-use products
All of the products in this category that bear the ADA Seal of Acceptance contain 10 percent carbamide peroxide; however, participation in the program is not limited to products of this concentration. There are many whitening options currently available to consumers both from the dentist as well as from retail outlets. The ADA recommends that if you choose to use a bleaching product you should only do so after consultation with a dentist.

In a water-based solution, carbamide peroxide breaks down into hydrogen peroxide and urea, with hydrogen peroxide being the active bleaching agent. Other ingredients of peroxide-containing tooth whiteners may include glycerin, carbopol, sodium hydroxide and flavoring agents.

Accumulated clinical data on neutral pH 10 percent carbamide peroxide continue to support both the safety and effectiveness of this kind of tooth-whitening agent. The most commonly observed side effects to hydrogen or carbamide peroxide are tooth sensitivity and occasional irritation of the soft tissues in the mouth (oral mucosa), particularly the gums. Tooth sensitivity often occurs during early stages of bleaching treatment. Tissue irritation, in most cases, results from an ill-fitting tray rather than the tooth-bleaching agents. Both of these conditions usually are temporary and stop after the treatment.

Professionally applied bleach whiteners
There are many professionally applied tooth whitening bleach products. These products use hydrogen peroxide in concentrations ranging from 15 percent to 35 percent and are sometimes used together with a light or laser, which reportedly accelerates the whitening process. Prior to application of professional products, gum tissues are isolated either with a rubber dam or a protective gel. Whereas home-use products are intended for use over a two-to-four week period, the professional procedure is usually completed in about one hour. Currently, all of the professionally applied whiteners that have the ADA Seal contain 35 percent hydrogen peroxide, although this concentration is not a requirement of the program.

As with the 10 percent home-use carbamide peroxide bleach products, the most commonly observed side effects of professionally applied hydrogen peroxide products are temporary tooth sensitivity and occasional irritation of oral tissues. On rare occasions, irreversible tooth damage has been reported.

The ADA advises patients to consult with their dentists to determine the most appropriate treatment. This is especially important for patients with many fillings, crowns, and extremely dark stains. A thorough oral examination, performed by a licensed dentist, is essential to determine if bleaching is an appropriate course of treatment. The dentist then supervises the use of bleaching agents within the context of a comprehensive, appropriately sequenced treatment plan.

Whitening toothpastes
Whitening toothpastes (dentifrices) in the ADA Seal of Acceptance program contain polishing or chemical agents to improve tooth appearance by removing surface stains through gentle polishing, chemical chelation, or some other non-bleaching action. Several whitening toothpastes that are available OTC have received the ADA Seal of Acceptance.

Get the Facts on Tooth Whitening
adha.org/downloads/tooth_whitening_factsheet.pdf