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White Heat

By Chantel Guertin

Bright smiles are the ultimate style accessory.

Are you still in grey territory when it comes to your whitening options?

Next to hair care, teeth whitening is the most in-demand cosmetic procedure in North America right now,” says Hamilton-based cosmetic dentist Dr. Kevin Cooke. “It’s relatively inexpensive, much less invasive than some other cosmetic treatments, and results are quick and effective.”
“White teeth are very fashionable right now,” says Toronto-based dentist Dr. Mark Buzaglo, who adds that virtually all new patients he sees express that they want a brighter smile. “All you need to do is turn on the TV to see that.” News anchors and actors all have pearlier-than-pearly whites and teeth whitening is a standard for all Reality TV makeover candidates.
While no Canadian statistics on teeth whitening have been kept to date, teeth whitening in the United States has increased 300 per cent over the last five years, according to the American Academy of Cosmetic Dentistry. The dizzying assortment of whitening products available in pharmacies and dentists’ offices is proof.

Physically changing the colour of teeth is achieved by applying peroxide-based bleaching compounds – whether you go for the in-office treatment or a dentist-prescribed at-home kit. (For pharmacy whitening kits, see sidebar below.) Both options have advantages and disadvantages.

In-office bleaching
In-office bleaching, also know as chair-side bleaching, is the most advanced whitening technique currently available in Canada, says Dr. Cooke. In one hour, teeth can be brightened six to eight shades on average. Typically, one treatment is enough, says Dr. Cooke, and results can last from six months onward before fading begins. Dentists offer numerous brands of whitening treatments – including Zoom, BrightSmile and LaserSmile – that all work under a similar principle: first, teeth are isolated by covering gums with a thin sheet of latex, called a dental dam (this prevents the bleaching agents from irritating soft oral tissues). Next, the bleaching compound is dabbed or painted onto the surface of your teeth. Then, a light or laser source directed at the teeth activates the bleaching agent. (Note, some recent studies indicate that the use of an “activation source” has no impact on the action of the bleaching agent.) This process may be repeated from two to four times, depending on the system. Sometimes an at-home whitening kit is sent home with the patient for upkeep.
Cost: one chair-side whitening session can cost from $400 to $1,000, depending on the system.

At-home bleaching
The compound used in chair-side bleaching typically contains between 15 to 50 per cent hydrogen peroxide. Comparatively, the compound used in at-home whitening systems contains about 10 to 16 per cent hydrogen peroxide. Since at-home compounds are used over a longer period of time than chair-side compounds, both systems are supposed to achieve the same result.
The process for at-home bleaching begins with the dentist taking an impression of the patient’s teeth. From that impression, plastic mouth trays are made for the patient. Once at home, you fill the tray with a small amount of the bleaching compound and wear it for two to four hours once or twice a day, or overnight for 14 nights straight. While the price of at-home kits is significantly lower – from $15 to $40 – some consumers have a difficult time wearing the plastic mouth trays that hold the bleach. “There’s definitely some labour involved in wearing the trays,” says Toronto-based dentist Dr. Mohsen Kermanshahi, who specializes in cosmetic dentistry. One of the biggest mistakes you can make, says Dr. Cooke, is to not wear the trays for consecutive days. “If you want this to be successful, don’t skip days.”
The upside is that once you have the tray, you can continue to use it with a bleaching compound of your choice. When refrigerated, tubes of the whitening product can be stored safely for years, says Dr. Buzaglo. Refills can cost from $15 to $100.
Jacintha Wesselingh, a Toronto-based writer, recently used an at-home teeth-whitening kit for two weeks. “I was getting married and I wanted [my teeth] to be perfect for the pictures,” she says. “My teeth weren’t badly stained, but I do drink a couple of cups of tea and coffee each day, and the occasional glass of red wine.” To combat tooth sensitivity, Wesselingh says she chose a daytime kit that required her to wear the tray for half an hour, twice a day. “I was happy with the results.”

Tooth sensitivity is a typical reaction to whitening, but this typically ceases two to three days following the treatment, says Dr. Kermanshahi. “If you have exposed roots or gum recession, the bleaching agent will cause discomfort,” he says.
The mistake some people make when they have an at-home bleaching kit is that they overload the trays, says Dr. Cooke, which makes the excess whitening material ooze out, burning the tissue and causing sensitivity.
For this reason, chair-side whitening is the best option if you’ve got sensitive teeth since contact with the gums and recession areas can be carefully avoided. Don’t worry if your gums turn white – it’s just temporary from leakage of the whitening compound, and your gums will return to their normal colour within a few hours. Other ways to avoid sensitivity are by taking ibuprofen prior to the whitening session and to follow up the treatment with a fluoride rinse. “If this doesn’t reduce sensitivity, then there’s a possibility that a root is exposed or you have a cavity, crack or fracture in one of their teeth,” says Dr. Buzaglo.
Before considering any type of bleaching process – professional or over-the-counter – it’s essential to discuss the options with your dentist, advises Dr. Buzaglo.
A thorough cleaning of plaque and tartar is necessary prior to whitening, but it’s also important that any cavities or other problems are cleared up or you will have extreme sensitivity once the whitening material is applied, he says.

The white aisle: What to look for at the drugstore.
For many people, pharmacies are usually the entrance to teeth whitening. Over-the-counter whitening toothpastes, paint-on gels, plastic strips and bleaching kits are available without having to visit a dentist, at prices ranging from $3 to $50.
But although the convenience and cost are attractive, Dr. Kermanshahi, Dr. Cooke and Dr. Buzaglo all agree that over-the-counter products are marginally effective, at best, and that many patients who approach them about professional whitening have usually tried an over-the-counter method already.
The least effective of these are whitening toothpastes since they contain no peroxide. Instead, they contain mildly abrasive compounds that will scrub the surface of the teeth but won’t reach the real source of tooth discolouration. “Paint-on” whiteners do contain peroxide that is applied directly to teeth with a brush, but, says Dr. Buzaglo, they have little effect since there is nothing placed over the teeth to prevent the product from being rubbed off by saliva. “Strips” – thin, clear pieces of plastic that are coated with a layer of peroxide gel – provide some coverage, keeping the peroxide in contact with teeth, but, says Dr. Cooke, since they are not custom fit, much of the gel oozes out and misses the teeth. The most effective of the drugstore options, says Dr. Cooke, is the tray system, similar to those offered by a dentist. But much like whitening strips, since the trays are not custom fit to the individual’s mouth, leakage can be a problem, causing sensitivity. “I really don’t recommend anyone attempt bleaching without a dentist’s supervision,” he says.


- Children under the age of 12 and lactating women, shouldn’t whiten their teeth because few tests have been conducted to see how whitening would affect them.

- Health Canada advises that peroxide-based whitening products should not be used more often than every six months.

How White is too white?
Sometimes patients can have unrealistic expectations about how white they want their teeth to be, says Dr. Cooke. “It’s not unlike a woman going to see a plastic surgeon and asking for a breast enhancement that isn’t proportionate to the rest of her body. The goal should be a whiter smile, not an unnatural-looking smile.” “It’s all about personal preference,” says Dr. Buzaglo, “but I advise patients to set a realistic goal using a shade guide and to ask friends and family to tell them when they’ve reached a natural white. If you keep whitening them, you’ll have a mouth full of Chiclets.”

What causes staining?
For most people, staining is a result of smoking or consuming high-staining foods such as coffee, tea, red wine, blueberries and certain spices, says Dr. Buzaglo. In some cases, people who took Tetracycline (an antibiotic) as a child might have brownish teeth, whereas people with bluish-grey teeth usually suffered some kind of trauma in the tooth causing it to trickle blood through the canal and into the tooth. On a standard shade guide used by dentists, patients with staining due to smoking or a dead nerve usually fit in at about 10 or 12 on the shade guide, while a perfectly white tooth is a 1 on the guide, says Dr. Kermanshahi. An average person might fit in around 4 to 8.

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