Many teeth whitening systems are available, including whitening toothpastes, over-the counter gels, strips and trays,
and whitening agents obtained from a dentist.
Teeth whitening is ideal for people who have healthy, unrestored teeth (no fillings) and gums. Individuals with yellow
tones to their teeth respond best. But this cosmetic procedure is not recommended for everyone.
Find out if teeth whitening is right for you.
All toothpastes help remove surface stains because they have mild abrasives. Some whitening toothpastes contain gentle
polishing or chemical agents that provide additional stain removal effectiveness. Whitening toothpastes can help remove
surface stains only and do not contain bleach; over-the-counter and professional whitening products contain hydrogen
peroxide (a bleaching substance) that helps remove stains on the tooth surface as well as stains deep in the tooth.
Whitening toothpastes can lighten your tooth's color by about one shade. In contrast, light-activated whitening
conducted in your dentist's office can make your teeth three to eight shades lighter.
Over-the-Counter Whitening Strips and Gels
Whitening gels are clear, peroxide-based gels applied with a small brush directly to the surface of your teeth.
Instructions generally call for twice a day application for 14 days. Initial results are seen in a few days and final
results are sustained for about 4 months. The retail cost for this product is about $15 for a 14-day treatment.
Whitening strips are very thin, virtually invisible strips that are coated with a peroxide-based whitening gel. The
strips are applied twice daily for 30 minutes for 14 days. Initial results are seen in a few days and final results are
sustained for about 4 months. The retail cost for this product ranges from $10 to $55 for a 14-day treatment.
Tray-Based Tooth Whitening Products
Tray based tooth whitening systems, purchased either over-the-counter or from your dentist, involve filling a mouth
guard-like tray with a gel whitening solution – which contains a peroxide-bleaching agent – and wearing the tray for
a period of time, generally from a couple hours a day to every day during the night for up to 4 weeks and even longer
(depending on the degree of staining and desired level of whitening).
Learn more about the differences between over-the-counter tray-based whitening systems and one obtained from the
In-office bleaching provides the quickest and most effective way to whiten teeth. With in-office bleaching, the
whitening product is applied directly to the teeth. These products can be used in combination with heat, a special
light, and/or a laser. The light and/or heat accelerate the whitening process. Results are seen in only 1, 30- to 60-minute
treatment. But, to achieve dramatic results, several appointments are usually needed. However, with laser-enhanced
bleaching, dramatic results can be seen after the first treatment.
How Long Do the Whitening Effects Last?
Whitening is not permanent. People who expose their teeth to foods and beverages that cause staining may see the
whiteness start to fade in as little as 1 month. Those who avoid foods and beverages that stain may be able to wait
one year or longer before another whitening treatment or touch-up is needed.
The degree of whiteness will vary from individual to individual depending on the condition of the teeth, nature of
the stain, the type of bleaching system used and for how long.
Over-the-Counter At-Home Teeth Whitening Vs. Dentist-Supervised Teeth Whitening Products
There are differences between the two, including:
Who Should Not Undergo Teeth Whitening?
- Strength of bleaching agent: Over-the-counter home use products and dentist-supervised at-home products usually
contain a lower strength-bleaching agent from 10% carbamide peroxide, which is equivalent to about 3% hydrogen peroxide,
up to 22% carbamide peroxide. In-office, professionally applied tooth whitening products contain hydrogen peroxide in
concentrations ranging from 15% to 43%.
- Mouthpiece trays: With dentist-supervised at-home bleaching products, your dentist will take an impression of
your teeth and make a mouthpiece tray that is customized to exactly fit your teeth. This customization allows for maximum
contact between the whitening gel, which is applied to the mouthpiece tray, and the teeth. A custom-made tray also
minimizing the gel's contact with gum tissue. Over-the-counter whitening products also contain a mouthpiece tray, but the
"one-size-fits-all" approach means that the fit will not be exact. Ill-fitting trays can irritate the gum and soft tissue
by allowing more bleaching gel to seep onto these tissues. With in-office procedures, the bleaching agent is applied
directly to the teeth.
- Additional protective measures: In the office setting, your dentist will apply either a gel to the gum tissue or
use a rubber shield (which slides over the teeth) prior to treatment to protect your gums and oral cavity from the effects
of the bleaching. Over-the-counter products don't provide these extra protective measures.
- Costs: Over-the-counter bleaching systems are the least expensive option, with costs ranging from $20 to about $150.
Depending on where you live and the extent of the procedure, dentist-supervised home bleaching systems range in cost from
approximately $150 to $300 per upper or lower set of teeth, or $300 to $600 for the whole mouth
- Supervised vs. unsupervised process: Dentist-supervised at-home bleaching and in-office treatments offer additional
benefits compared with over-the-counter procedures. First, your dentist can perform an oral examination and consider
your complete medical history, which can be helpful in determining how your teeth became discolored and if bleaching
is an appropriate course of treatment based on your type and extent of stains and type, number and location of
restorations. Your dentist can then better match the type of stain with the best treatment, if appropriate, to lighten
those stains. With dentist-supervised bleaching procedures, your dentist will likely want to see you a couple of times
to ensure you are following directions, to make sure the customized tray is fitting properly, to inspect your gums for
signs of irritation, and to generally check on how the teeth whitening process is proceeding. With over-the-counter
bleaching products, you are on your own.
Whitening is not recommended or will be less successful in the following circumstances:
Risks Associated With Teeth Whitening
- Age and pregnancy issues: Bleaching is not recommended in children under the age of 16. This is because the pulp chamber,
or nerve of the tooth, is enlarged until this age. Teeth whitening under this condition could irritate the pulp or cause it to
become sensitive. Teeth whitening is also not recommended in pregnant or lactating women.
- Sensitive teeth and allergies: Individuals with sensitive teeth and gums, receding gums and/or defective restorations
should consult with their dentist prior to using a tooth whitening system. Anyone allergic to peroxide (the whitening agent)
should not use a bleaching product.
- Gum disease, worn enamel, cavities, and exposed roots: Individuals with gum disease or teeth with worn enamel are
generally discouraged from undergoing a tooth whitening procedure. Cavities need to be treated before undergoing any
whitening procedure. This is because the whitening solutions penetrate into any existing decay and the inner areas of the
tooth, which can cause sensitivity. Also, whitening procedures will not work on exposed tooth roots because roots do not
have an enamel layer.
- Fillings, crowns and other restorations: Tooth-colored fillings and resin composite materials used in dental restorations
(crowns, veneers, bonding, bridges) do not whiten. Therefore, using a whitening agent on teeth that contain restorations will
results in uneven whitening-in this case, making the teeth without restorations appear lighter than those with restorations.
Any whitening procedure should be done prior to the placement of restorations. Individuals with numerous restorations that
would result in uneven whitening may be better off considering bonding, veneers or crowns rather than a tooth whitening system.
Ask your dentist what strategy is best for you.
- Unrealistic expectations: Individuals who expect their teeth to be a new "blinding white" may be disappointed with their
results. Smokers need to be aware that their results will be limited unless they refrain from continued smoking, particularly
during the bleaching process. A healthy guide as to a reasonable degree of whiteness to achieve with a whitening process
that would give a natural appearance to a person's teeth is a slightly whiter color than the whites of your eyes.
- Darkly stained teeth: Yellowish teeth respond well to bleaching, brownish-colored teeth respond less well and grayish-hue
or purple-stained teeth may not respond to bleaching at all. Blue-gray staining caused by tetracycline is more difficult to
lighten and may require up to 6 months of home treatments or several in-office appointments to successfully lighten. Teeth
that have dark stains may be better candidates for another lightening option, such as veneers, bonding, or crowns. Your dentist
can discuss the options best suited for you.
The two side effects that occur most often are a temporary increase in tooth sensitivity and mild irritation of the soft tissues of the
mouth, particularly the gums. Tooth sensitivity often occurs during early stages of the bleaching treatment. Tissue irritation most
commonly results from an ill-fitting mouthpiece tray rather than the tooth-bleaching agent. Both of these conditions usually are
temporary and disappear within 1 to 3 days of stopping or completing treatment.
If you do experience sensitivity, you can reduce or eliminate it by:
- Wearing the tray for a shorter period of time (for example, two 30-minute sessions vs. two 60-minute sessions)
- Stop whitening your teeth for two to three days to allow your teeth to adjust to the whitening process
- Ask your dentist or pharmacist for a high fluoride-containing product, which can help remineralize your teeth. Apply the fluoride product to the tray and wear for 4 minutes prior to and following the whitening agent.
- Brush your teeth with a toothpaste made for sensitive teeth. These toothpastes contain potassium nitrate, which helps soothe your teeth's nerve endings.
Some bleaching products dispensed through dentists' offices as well as professionally applied (in-office) bleaching products have received the ADA Seal of Acceptance, which indicates that the product has met ADA guidelines for safety and effectiveness. Currently, only dentist-dispensed home-use products containing 10% carbamide peroxide and office-applied products containing 35% hydrogen peroxide have received the ADA Seal of Acceptance. Over-the-counter bleaching products are not endorsed by the ADA because the organization believes that professional consultation is important to ensuring safe and effective use. No whitening products using lasers currently are on the ADA's list of accepted products. Several whitening toothpastes that are available over-the-counter have received the ADA Seal of Acceptance. For a list of specific toothpastes that have gained the ADA's Seal of Acceptance, visit: www.ada.org
It should be noted that not all manufacturers seek the ADA's Seal of Acceptance. This is a voluntary program that requires considerable expense and time on the part of a manufacturer. Just because a product does not have the ADA Seal of Acceptance does not necessarily mean that the product is not safe and effective. You can be assured, however, that products that do carry the seal have meet the ADA's standards for safety and effectiveness when used as directed.
Teeth whiteners are not drugs and therefore are not regulated by the FDA.
Tips to Consider When Choosing an Over-the-Counter Whitening Kit
- Try to select a kit that allows some customization of the mouthpiece. Some kits come with a mouthpiece that can be molded to some degree. These are better than others that come with a standard mouthpiece.
- Try to gain the opinion of others who may have already tried the kit you are considering.
- If at any time you experience a prolonged change in the color of your gums or an increased tooth sensitivity to hot or cold foods and beverages, stop wearing the mouthpiece and see your dentist immediately.