One of the concerns patients have at the end of appointments is "Do you think my teeth are too yellow", or "Does the product that the store sells provide any benefit". It is at this time that I usually can not answer this question as quickly as I would like, or the patient desires, asking themselves, "why did I ask this guy that question....?"
In reality, there is no easy answer, and a level of understanding of the topic goes a long way toward the patients expectations and satisfaction of tooth "whitening".
Patients generally do not have an understanding of tooth anatomy, and this is an absolute must, before expectations can be met. With this post, I will continue to put you to sleep, in hopes that people will understand what whitening will accomplish and what it won't. I am always amused by pictures in trade journals or lectures by the latest cosmetician who will be happy to show how effective bleaching can be today. My objective is to bring some sanity to the insanity that has become tooth whitening.
Have you ever been in a waiting room or office and had the pleasure of seeing a frosted glass door that is the partition between you and the personnel on the other side? Do you remember seeing things move in the background, but you can not seem to make out exactly what is going on (Play with me for a second)? If you have encountered this phenomenon before, you have just understood the concept of dental enamel. The body tissue that is known as enamel has varying degrees of opaqueness and translucency, and at the end of the day, every person has an individual characteristic of this property. If one envisions dental enamel as a thin shell with this frosty quality, you are halfway there!
What lies underneath this enamel is a structure known as dentin, and this material is again, variable in light yellow to very dark grey. Different shades can mean different things, but for the purposes of our blog we will assume a healthy tooth. So place the dental enamel over the dentin (yes, just like a tooth), and you have this individual value, hue, and chroma, or color of each tooth, and it does vary (like the genome) with different teeth in the same patient!
Whitening is proposed to remove the stains that accumulate in dental enamel from a variety of food and drink, tobacco, etc. My facebook page has a great article on the substances which stain teeth! Whitening will effectively remove years of accumulated stains in dental enamel alone. SO, it stands to reason and is what we actually see, that the tooth is whitened by removing this surface stain, but in no way will correct the underlying color. Why? theoretically, enamel should cover the entire tooth; in reality this does not occur, usually for numerous reasons, and should not reach dentin, and anyone who has experienced extreme sensitivity form this treatment can attest to this adverse effect of tooth bleaching. It is at this moment, that I require a very large cross and a steroid laden bulb of garlic to fend off the the anger that ensues.
Performed properly and responsibly, tooth whitening can be accomplished with good results. A couple of caveats; One, there have been some assertions that this treatment can "ruin" the enamel; studies have shown that used responsibly, this cosmetic enhancement of your teeth will not do this, period. Like the adverse effects of anything, if you whiten too much, it may be harmful, but a patient would have to bleach a LOT. Another concern, and this addresses the original concern of over the counter treatments; the concentration of the active ingredient in the store whiteners is always much less that in professional formulations, so the pound for pound effect ends up being less, yet still mildly effective; it may be more expensive at the dentist, but more effective. Last, and certainly not least is who provides bleaching for the individual. I do not like mall bleaching. No one is there to monitor you if something needs to be addressed, ie sensitivity ( remember the cross and garlic). The state generally allows the dispensation of this product by technicians in the mall, but the state is not there when something goes wrong. A little more spent at the dentist will allow you to address concerns that invariably arise with tooth whitening!
You may awake again, and visit our office or facebook page with any further questions!