14 Dec A brighter smile – is it safe?

Most of us would like their teeth a shade or two lighter. As we get a little older or we consume tea, coffee, red wine, we do see our teeth darken and even with electric toothbrushes and a whitening toothpaste it’s hard to keep them as bright as they used to be.

Tooth whitening is a great way to brighten teeth without actually doing any damage to the teeth. That is, of course, if you use the right products and they are used in a safe controlled manner.

The active ingredient used to whiten teeth is hydrogen peroxide either in it’s own format or as carbamide peroxide which releases hydrogen peroxide.

Lots of other ingredients have been tried and tested and you will see claims about strawberries and coconut oil amongst others. These simply do not change the colour, they may change the hydration of the tooth which changes the colour ever so temporarily but the only real effect of change is using these peroxides.

The active peroxides are delivered in a gel and again there are lots available on the market for dentists to buy and the general public. There have been guidelines put into place both in Europe and the UK and the maximum concentration of hydrogen peroxide in the gel that can be used is 6% which equates to around 16% carbamide peroxide.

As dentists we can choose from all sorts of gels but in essence like everything in life you get what you pay for. We want to use a gel that will do what is says and whiten in the recommended time scale for our patients.

We don’t recommend ever buying gels to top up off the internet as these often can be perborate based, an active ingredient in carpet cleaners. We are also concerned that some of the gels can actually damage the outer layer of the tooth permanently and any gels in the wrong hands can cause severe burning and damage to the soft tissues of the mouth.

Who can have whitening?

• In the UK whitening is only licensed for over 18s
• Most teeth can be whitened
• Teeth that are crowned or veneered will not changed colour
• Teeth with large fillings in will change slowly in colour and afterwards the filling may not match – this needs to be considered as part of the treatment process
• If the teeth are covered in calculus or tartar then this all needs to be removed before whitening

Why do I need to go to my dentist, can I not use a beautician?

• Before whitening is decided upon or started, a full assessment of the teeth needs to be carried out. If there is any undiagnosed decay or a leaking filling when whitening commences the active ingredient will get into the heart of the tooth. This can cause severe irritation of the nerve of the tooth, even leading to death of the tooth and the subsequent pain associated with that.

• Tooth whitening has been deemed to be “Dentistry” and in the UK the only people allowed to carry out dentistry are the dental profession. This is to protect the public to ensure they receive a proper assessment and treatment from trained and knowledgeable individuals. Some aspects of dentistry can seem very simple but remember this is about knowing what can be done, when not to do it and what to do when it goes wrong.

• We are also concerned about cross infection risks when patients use beauticians. Dental surgeries have to reach stringent standards with their decontamination policies that are inspected by the Care Quality Commission in England. We are particularly concerned when we see whitening being carried out in shopping centres with technicians going from mouth to mouth without washing hands or using proper disposal methods.

Now more and more our patients are incorporating a tooth whitening treatment into their treatment plans often as part of a larger plan to improve the overall appearance by moving teeth around or correcting minor imperfections.

It is a great idea to consider this before you have any major restorative work as the colour of fillings does not change during the process and therefore fillings may need changing after.

In our next blog we will discuss the actual procedure and what to expect.

For more information on safety you may wish to click these links.

https://www.bda.org/public/whitening

http://safetoothwhitening.org