One of the easiest and most cost-effective methods of improving a smile is through tooth whitening. These procedures can be accomplished quickly or over an extended period, and most patients feel they are well worth the cost and effort.

When we are born, the baby teeth are generally whiter than the permanent dentition. Then as the permanent teeth age, they become more discolored both inside and outside. Oftentimes antibiotics like tetracycline, administered in childhood, can discolor a smile with dark stained bands. Regardless, most dentists are very adept at changing the color of the teeth through various types of whitening.

There are essentially three different types of whitening.

Over-the-counter whitening products. These are mostly toothpastes and rinses that are generally ineffective. Whitening strips sold over the counter can tend to cause a lot of gingival irritation, leaving the patient frustrated and sore without really achieving any sort of positive improvement. These strips have a very weak version of the ingredient that is used in dentists’ offices. They can, however, be mildly effective if carefully used on lightly stained teeth of younger patients. Another problem with these over-the-counter options is that a patient should not use them if they have any preexisting sensitivity or decay present. Those situations require the consult of your dentist.

Custom-made take-home trays that are custom-fit and cut for each person. This is by far the most commonly recommended treatment. A dentist will simply take impressions of your teeth and fabricate a very thin comfortable plastic retainer to wear each day. This retainer is filled with a concentrated whitening agent, carbamide peroxide, that can penetrate the enamel down to the dentin and lighten both the external and internal structures of the teeth. Occasionally, transient sensitivity to cold temperatures may occur, which is minimized with desensitizing ingredients contained within the gel. Nearly everyone can complete their whitening entirely if these desensitizers are used. One can use the gel from one to four hours per day (any time) for a period of approximately 10 days depending on the concentration of the gel. The important thing is that it be used every day during that period and not intermittently with days missed. Since the trays are owned by the patient, they can be used repeatedly for the minimal cost of the gel. When patients change dentists, they can simply show their trays to the next dentist and just get refills on the gel. The whitening performed in this fashion is very long-lasting and in most cases only needs to be "touched up" with one or two nights of whitening per year. In order to have minimal "fade back," it is most critical to limit color containing foods and beverages for the 24 − 48 hours after the last day of whitening. If used for much longer periods, this type of whitening is quite effective in significantly improving hard-to-bleach teeth, such as tetracycline-banded teeth. We have seen incredible results in such cases simply by increasing the time of whitening from 10 days to 3 months. Many of these patients are very satisfied with this treatment since quite often the only option for them is much more expensive veneer and crown restorations to mask the underlying tooth colors.

In-office tooth whitening or power whitening. This is a significantly more expensive option for most patients. The patient must remain in the dentist’s chair for up to an hour. In this process the dentist will apply something to protect the gingiva from the whitening agent and then use a highly concentrated version of the whitening agent. The process dries out the teeth, which initially makes them seem very white, giving the patient a wow first impression of the result. Most of the time the teeth rehydrate and fade back over the next few days with the result being less impressive. People who have sensitive teeth should avoid this type of whitening since it cannot be slowed down or sped up if sensitivity occurs and the patient experiences significant discomfort. Many times if someone is getting married or is having professional pictures taken in a relatively short period of time, this method is chosen. Since there are no trays made, the patient may face significant expense when it is time to re-whiten.

Regardless of the option a patient chooses, a dentist should be consulted before making the decision.