Teeth whitening is ideal for patients who have healthy, unrestored teeth (no
fillings) and healthy gums who would like a brighter smile. Patients with
yellow tones to their teeth respond best. But this cosmetic procedure is not
recommended for everyone.
Teeth whitening is not recommended or will be less successful in the following
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 to products. 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 do and
do not 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
composite fillings, bonding, veneers, crowns, dentures, or porcelain
restorations in order to best match the degree of whitening to your new tooth
color. A minimum of 2 weeks following a whitening procedure should be allowed
before crowns, bondings, or veneers are completed. This will allow enough time
for the enamel to remineralize and optimize the bonding strength. Tooth-colored
fillings will need to be replaced after the bleaching process is complete.
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 may be 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. Yellow-ish teeth respond well to bleaching,
brownish-colored teeth respond less well, and grayish-hue or purple-stained
teeth may not respond well 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 your situation.
Will all types of bleaching procedures, the degree of whiteness will vary from
individual to individual depending on the condition of the teeth, nature of the
stain, the concentration of the bleach and the duration of time and bleaching
Teeth Whitening Options
There are three general approaches:
Whitening toothpastes (dentifrices)
Over-the-counter whitening strips
Over-the-counter whitening gels
Over-the-counter tray-based bleaching systems (purchased at your local drug
store, over the Internet, by mail)
Dentist supervised tray-based whitening system (whitening supplies are
purchased through your dentist's office)
In-office bleaching, also called chairside bleaching or power
All toothpastes help remove surface stains through the action of 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. None of the home use whitening toothpastes can
come even close to producing the bleaching effect you get from your dentist's
office. 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.
Whitening Strips and Whitening 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.
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.
Both of these products contain peroxide in a concentration that is much lower
than the peroxide-based products that are used in your dentist's office.
Although some teeth lightening will be achieved, the degree of whitening is
much lower than results achieved with in-office or dentist-supervised whitening
systems. Additionally, use of over-the-counter products do not benefit from the
close supervision of your dentist to determine what whitening process may be
best for you, to check on the progress of the teeth whitening process and look
for signs of gum irritation.
Tray-Based Tooth Whitening Procedures:
The more traditional types of teeth whitening procedures use a tray-based tooth
whitening systems purchased over-the-counter or through your dentist's
office. The first step involves filling a mouth guard-like tray with a
gel-like whitening solution which contains a peroxide-bleaching agent. This
tray is then placed over the teeth and worn for a period of time, generally
from a couple hours a day or overnight for up to 4 weeks (depending on the
degree of staining and desired level of whitening).
Bleaching procedures performed in the dentist's office involve a few different
or additional steps. A protective gel or guard is positioned over
the gums before the bleaching agent is applied, the bleaching agent is applied
directly to the teeth, and the whitening process is hastened with the use of a
special light that is directed at the teeth. There are other differences
that are addressed in the next question.
At-Home vs At-the-Dentist Dental Bleaching:
The main differences are:
Strength of bleaching agent. For starters, 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 percent hydrogen peroxide up to 22% carbamide peroxide). In-office,
professionally applied tooth whitening products contain hydrogen peroxide in
concentrations ranging from 15 to 43 percent.
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 do 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.
Speed of the bleaching process. Dentist-supervised at-home
bleaching and over-the-counter bleaching products typically need to be applied
every day for 1 or 2 hours or overnight for up to 4 weeks. 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 a special light. The
light accelerates the whitening process. Results are seen in only 1, 30-
to 60-minute treatment. To achieve dramatic results however, several
appointments are usually needed. The results can be enhanced with home
Supervised versus 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 of stains and number, type, 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.
If you have made up your mind to assume the risks associated with
over-the-counter, tray-based bleaching kits, here's some sound advice:
Risks Associated With Teeth Whitening
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 stock mouthpiece.
Try to gain the opinion of others who may have already tried the kit you are
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.
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
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 versus 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. No over-the-counter
products have received the 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:
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
Teeth whiteners are not drugs and therefore are not regulated by the FDA.
Whitening is not permanent. People who expose their teeth to a
lot of 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.
Tips for maintaining your newly whitened teeth include:
Frequently Asked Questions
Does insurance cover the cost of whitening procedures?
Avoiding the consumption of or exposure to products that stain your teeth (see
first question in this document on what causes teeth to become stained). If you
do choose to consume beverages that stain, consider using a straw so that the
liquid bypasses your front teeth.
Brush or rinse immediately after consuming stain-causing beverages or foods.
Follow good oral hygiene practices. Brush your teeth at least twice daily and
floss at least once daily to remove plaque. Use a whitening toothpaste (once or
twice a week only) to remove surface stains and prevent yellowing. Use a
regular toothpaste the rest of the time.
Consider touch-up treatments. Depending on the whitening method used, you may
need a tough-up every 6 months or after a year or two. If you smoke or drink
lots of stain-causing beverages, you may need a touch up more often.
No. Dental insurance does not typically cost the cost of the tooth whitening
Do teeth whiteners damage tooth enamel?
Studies of whitening products using 10% carbamide peroxide showed little to no
effect on the hardness or mineral content of a tooth's enamel surface.
Do teeth whiteners damage existing dental restorations?
Over 10 years of clinical use of whitening products containing 10% carbamide
peroxide have not shown any damage to existing fillings. The issue is not
"damage" to existing restorations; rather, keep in mind that existing
restorations such as tooth-colored fillings, crowns, bonding, veneers, and
bridges do not lighten. This means that any preexisting dental work may need to
be replaced to match the new tooth shade achieved in the natural teeth, should
a bleaching process proceed.
Do teeth whiteners damage a tooth's nerve?
There's no evidence to date that the tooth whitening process has a harmful
effect on the health of a tooth's nerve. One study reported that at both a 4.5
and 7-year follow up, no individual who used a tooth whitening system needed a
root canal procedure on any teeth that had been whitened.