Whitening (2024)

For some time, there has been consistent consumer demand for whiter, brighter teeth and an attractive smile.1-3 Professionally administered (in-office) tooth whitening, also known as dental bleaching, remains a popular esthetic procedure and can be performed using a wide range of techniques and application protocols. Another common approach is at-home whitening with custom-fitted trays, which patients use to apply professional-strength bleaching gel (for use at night or during the day). Numerous over-the-counter (OTC) whitening products (e.g., strips, gels, rinses, chewing gums, or paint-on films) are also widely available for self-application at home.4

Extrinsic vs. Intrinsic Stains

Tooth (and dental) discoloration are terms used to describe any change in the color or translucency of a tooth,1 as well as discoloration in multiple teeth or the entire dentition. Tooth discolorations are typically classified as extrinsic, intrinsic, or a combination of both types.5

Extrinsic stains commonly result from an accumulation of colored compounds on enamel. Extrinsic discoloration is primarily associated with environmental factors or individual behaviors, such as tobacco use, exposure to metal salts (e.g., iron or copper), or the consumption of highly pigmented foods (e.g., dark fruits) or beverages (e.g., red wine, coffee, tea, or cola drinks).1, 6-11

Extrinsic tooth stains vary widely in color and severity, and can be exacerbated by lifestyle habits (e.g., smoking or chewing tobacco), poor oral hygiene, or frequent consumption of pigmented food or beverages.12, 13 A wide range of extrinsic stains can be effectively reduced with mechanical interventions such as brushing with a whitening toothpaste or professional prophylaxis.6, 7, 14 Some OTC whitening products (e.g., toothpastes, chewing gums) are effective primarily in removing extrinsic (surface) stains on enamel, and will not have a significant impact on intrinsic stains or the intrinsic color of the tooth.4, 15

Intrinsic stains occur inside the tooth (within the enamel or the underlying dentin), and can arise due to systemic causes such as genetic disorders (e.g., dentinogenesis imperfecta, amelogenesis imperfecta) or local factors during tooth development or after eruption (e.g., fluorosis).1, 16, 17 Aging is another common etiology of intrinsic discoloration. With increasing age, enamel becomes more translucent and thinner, which allows the yellower dentin to show through and the overall tooth color may darken.1, 18 Other causes of intrinsic discoloration include certain antibiotic use in childhood (e.g., tetracycline),19 caries, amalgam restorations, and pulpal hemorrhage, decomposition or necrosis.5, 7, 20 Intrinsic discoloration can also occur with prolonged use of antiseptic mouthrinse (e.g., chlorhexidine rinse).21

Whitening Agents

Reducing intrinsic stains involves a chemical reaction that changes the color of the tooth. The most common ingredients used in bleaching are carbamide peroxide and hydrogen peroxide, which are used at different concentrations depending on the products or regimens used.22

The bleaching action in chemically induced whitening is due primarily to the effects of carbamide peroxide, which releases about one-third of its content as hydrogen peroxide, a strong oxidizing agent.23, 24 Hydrogen peroxide diffuses easily through interprismatic spaces in the enamel, allowing for passage from enamel and dentin to pulp within 15 minutes of exposure.25, 26 The bleaching process is generally believed to occur when reactive oxygen molecules (generated from hydrogen peroxide) interact with organic chromophores (colored compounds) within enamel and dentin through a chemical oxidation process, which is influenced by various environmental factors (e.g., pH, temperature, light).17, 25, 27

The extent of whitening attained through bleaching may be influenced by the type of intrinsic stain being addressed. For example, brown stains due to fluorosis or tetracycline28, 29 may be more responsive to bleaching than white stains associated with fluorosis or orthodontic treatment, which may appear less noticeable as the background of the tooth lightens.30 The type of stain also can affect the length of and/or number of treatments required to arrive as close as possible to the desired result. For example, although stains due to tetracycline may be diminished, treatment can require three to four months of nightly treatment (on average).28, 31

Patient Considerations and Preferences

Tooth whitening is a common elective procedure and a popular, less-invasive aesthetic treatment for patients seeking to enhance their smile and appearance. A clinical exam prior to the start of tooth bleaching procedures, with radiographs and other screening and diagnostic tests as appropriate, can help diagnose various factors contributing to the patient’s tooth discoloration.32 A standard dental exam, beginning with a health and dental history, may include questions about the patient’s perception of the cause of the dental discoloration, as well as allergies (which may include ingredients in bleaching materials), and any past or recent history of tooth sensitivity.32, 33

Patient dentition characteristics also influence the safe provision of care and the treatment’s level of success in whitening vital teeth. Patients who have tooth-colored restorations (including crowns or implants) should be aware that only natural teeth will be affected by the bleaching agent and treatment could result in differences between natural teeth and restorations, which will not change color.28 The American Academy of Pediatric Dentistry discourages full-arch cosmetic bleaching for child and adolescent patients in the mixed dentition and primary dentition.34 Additionally, some research suggests that bleaching protocols may alter the surface roughness of enamel, which may also reduce the shear bond strength between enamel and composite and ceramic restorative materials.35

Whitening (2024)


Whitening? ›

Whitening treatments can be effective on both extrinsic and intrinsic staining. Only natural teeth can be whitened, not tooth-colored restorations. Whitening treatments include in-office bleaching procedures, dentist-supplied products for use at home, and over-the-counter (OTC) whiteners.

What is the best thing to whiten your teeth with? ›

If you're looking for long-lasting results, Bianca Velayo, DMD of Green Valley Smiles Dentistry, recommends looking for peroxide-based products if you're hoping to whiten tooth enamel. You can opt for either carbamide peroxide or hydrogen peroxide as both will reverse internal and external stains on teeth, she notes.

Is it OK to whitening teeth? ›

If your goal is to get a bright white smile, teeth whitening can be a safe option. But it's important to talk to a dentist first about your options and do your research. Research shows that hydrogen peroxide products might damage proteins in your teeth's dentin layer.

What is the process of whitening? ›

Teeth whitening methods include sanding down stains, bleaching, ultraviolet (UV) light therapy, and more. Many different teeth whitening products are available, and you can try many approaches at home. You can also get your teeth whitened at your dentist's office.

Does whitening actually work? ›

Tooth-whitening works best for people with yellow teeth and is less effective for people with brown teeth. If your teeth are gray or purple, tooth bleaching probably won't work at all. To be sure tooth-whitening is worth your time and money, talk to your dentist before you use an over-the-counter tooth whitening kit.

What whitens teeth really fast? ›

Using hydrogen peroxide

Hydrogen peroxide is a mild bleach that can help to whiten stained teeth . For optimal whitening, a person can try brushing with a mix of baking soda and hydrogen peroxide for 1–2 minutes twice a day for a week.

Can old yellow teeth be whitened? ›

It's natural for teeth to appear darker as they age, but a bleaching product with hydrogen peroxide or urea peroxide can help turn back the clock – and a whitening toothpaste is an easy way to get a jump-start.

How to whiten yellow teeth naturally? ›

Seven Ways to Naturally Whiten Teeth
  1. Eat Strawberries. One of the simplest ways to naturally whiten your teeth is just by eating strawberries. ...
  2. Eat Plenty of Fruits and Vegetables. ...
  3. Brush After You Eat or Drink. ...
  4. Rinse with Apple Cider Vinegar. ...
  5. Apply Coconut Oil. ...
  6. Brush Your Tongue. ...
  7. Use Baking Soda and Hydrogen Peroxide.

How do people get their teeth so white? ›

Follow good oral hygiene practices. Brush your teeth at least twice daily, floss at least once daily to remove plaque, and rinse with an antiseptic mouthwash at least once a day to kill bacteria that cause plaque. Use a whitening toothpaste (once or twice a week only) to remove surface stains and prevent yellowing.

What do dentists use to whiten teeth? ›

Carbamide peroxide and hydrogen peroxide are commonly used in whitening interventions and can readily permeate dental hard tissues. Temporary tooth sensitivity and gingival inflammation are the most common adverse effects of vital tooth whitening.

Do crest white strips work? ›

Depending on the type of discoloration you have, Crest whitening kits may or may not work for you. If you have yellowing due to aging, poor nutrition, smoking, this whitening method may work for you. But if you have dark and greyed teeth, Crest Whitestrips may not work for you.

How long do teeth whitening last? ›

The most effective way to whiten your teeth is professional teeth whitening treatment applied by your dentist in the office. The results of this type of treatment can last between 1 and 3 years. In-office teeth whitening involves the following process: The gum tissue is protected from the effects of the bleaching gel.

Is dentist teeth whitening worth it? ›

As a result, you may wonder if professional tooth whitening is worth the cost. Lots of patients are curious about in-office treatment and ask if it is really better than at-home options. The answer is a resounding yes. The most effective way to whiten teeth is with a professional in-office treatment.

Can baking soda whiten teeth? ›

Baking soda can be used with some water to remove the stains on the surface of the teeth. It can also be used with hydrogen peroxide to enhance its whitening effects. Baking soda can be used by individuals with regular toothpastes too. It is also used commercially in some teeth whitening products and toothpastes.

What are the cons of teeth whitening? ›

Schedule an appointment with our dentist in Gainesville for more information or a consultation about your specific concerns.
  • Tooth sensitivity. ...
  • Doesn't work on all teeth. ...
  • May exacerbate certain conditions. ...
  • Temporary. ...
  • Don't use if you're pregnant.

What is the most effective teeth whitening method? ›

laser teeth whitening is the safest, quickest, and most effective option among the types of teeth-whitening treatments available. However, there are ultimately several ways to whiten teeth, and the most suitable option will depend on your timeline, budget, and priorities, as well as the nature of the discoloration.

Can I brush my teeth with hydrogen peroxide and baking soda? ›

Mix a few teaspoons of baking soda in a dish with a small amount of peroxide. Start to mix the soda and peroxide with a clean spoon. Keep adding a little bit more peroxide until you get a thick — but not gritty — paste. Use a toothbrush to apply the paste to your teeth using small circular motions.

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