Tooth Whitening & Cosmetic Options for Managing Intrinsic & Extrinsic Discolorations to Teeth
Dr. Karen is very aware of the esthetic demands of her patients, hence her commitment to the unrivaled esthetic appeal of all-white zirconia crowns! This concern of an alluring, crisp-white smile is no different to her. In fact, Dr. Karen initially started down this path to a more cosmetic smile because of the incidence of MIH (molar-incisor hypoplasia) seen in many children affecting their smile line. Many are concerned with the bright white to dark amber markings left on their teeth from this disrupted enamel development.
The most commonly used agents in whitening products are hydrogen peroxide and carbamide peroxide (add urea to hydrogen peroxide and the result is the more stable carbamide peroxide). Both are susceptible to rapid salivary breakdown because of a key ingredient to our saliva—hydroxylase. Because of this consideration in all whitening attempts, Dr. Karen encourages only night-time whitening (less salivary flow) and tight-fitting custom trays to avoid wash-out of the whitening key ingredients.
Why not a LED light whitening product?
The ADA has found that LED-based whitening attempts are not a long-term solution. The initial whitening seen is a dehydration process—much like if you have white spots to your front teeth and you are a mouth breather, you see them more poignantly. This process of whitening is considered unfavorable and short-term because it is highly reversible, thereby not endorsed by Dr. Karen. Many whitening processes take tooth sensitivity into concern. LED approaches increase pulpal sensitivity and can cause much more prolonged sensitivity.
Why not over-the-counter (OTC) whitening products?
Most products that are OTC, have been sitting on shelves from production time in the factory to delivery and in-store shelf time. The majority of these OTC whitening products contain hydrogen peroxide—a “lifting” of stains agent; not an intrinsic alteration within the enamel. Often the solution has been exposed to variations in temperature (especially heat) and light penetrations that weaken the already more delicate hydrogen peroxide active ingredient.
Secondly, these applications are not custom-fit. The approach is to be a general audience fit and can cause gingival sensitivities and even burns with the peroxide. The general fit does not reduce salivary contact time with the whitening agent and is thereby quickly broken down by hydroxylase naturally found in saliva. These are all non-ideal experiences for effective whitening.
Thirdly, the concentration of peroxidase is much lower in the OTC options. Most professional lines are 16% carbamide peroxide to achieve results that patients expect in real-time. The in-office final step or the in-office rapid result options are 30-40% variations and highly effective.
Key concerns with whitening materials: exposure to heat, exposure to light, and reduced salivary interaction with the hydrogen peroxide or carbamide peroxide.
Dr. Karen’s approach to whitening will always prioritize a well-fitting custom-made tray with night-time application to optimize tooth-only contact time and optimize the product stabilization by using at night when salivary flow is lessened significantly.
(custom at-home trays & in-office treatment)
This system utilizes the most tight-fitting custom trays Dr. Karen has experienced. KoR whitening is highly effective in sensitivity concerns and is Dr. Karen’s go-to for these considerations. It is only to be used at night for the wash-out concerns and is refrigerated to maintain optimal stabilization of the carbamide peroxide whitening agent.
Varying strengths are available depending on the tenacity of intrinsic staining and depth of penetration needed to achieve optimal white results: Home, Max & Ultra are the primary ones Dr. Karen utilizes. Ultra-T is an excellent choice for those affected by tetracycline staining. Aside from the Home option, the other alternatives are completed with an in-office higher carbamide peroxide solution. A liquid dam material is applied and light-cured to adapt and protect gingival margins form this stronger concentration material. Various applications (up to 3 per in-office session) are used within the final whitening session, all of approximately 20 minutes of contact time until the final result is achieved.
Opalustre Microabrasion Technique
For more persistent amber-colored or bright chalky-white markings, this hydrochloric acid pumice slurry material is used with a rubber cup in a slow motor application until a better esthetic result appears. Minimal enamel reduction occurs to achieve a more cosmetic result to more stubborn stains not easily removed via whitening alone or non-invasive composite penetrative materials, such as ICON (below). Composite materials would be used to finish the cosmetic result.
ICON Restorative Material
This most minimally invasive restorative material option is an excellent first line attempt at reducing the visibility of white-spot orthodontic demineralizations, early cavity lesions on smooth surfaces of teeth. It can also be applied to in-between early cavities.
Cosmetic Composite Shade Matching
We all come in varying shades of natural tooth structure. Many children often present with tooth shade-matching needs because of early injury to permanent anterior teeth in fracture injuries. Dr. Karen is highly skilled at restoring these fracture injuries to provide optimal nerve and continued root development as well as barely noticeable restorations in which shade matching with a vast pool of enamel and dentin shade matches are necessary!
Opalescence BOOST (in-office, rapid result)
This is an in-office higher carbamide peroxide solution for instant result. You do not do the at home custom whitening trays for this option. It is a great alternative when you have a quick need to whiten! Similar to the KoR in-office whitening session, a liquid dam material is applied and light-cured to adapt and protect gingival margins form this stronger concentration material. Various applications (up to 3 per in-office session) are used within the final whitening session, all of approximately 20 minutes of contact time until the final result is achieved. Keep in mind, sensitivity may occur and we can alter the duration and number of applications based on the progression of possible sensitivity in the chair. We encourage the use of Ultra EZ trays to help limit post-whitening sensitivity.
Opalescence for Aligners (refills available)
With many children in Invisalign First & Invisalign aligners, this material is a great 10 dose fit to your child’s busy life! We encourage nighttime use to limit wash-out. Various other professional whitening gel products can be used in your aligners. This system is convenient and easy to use!
This option is NOT a custom-fit tray design, but it is a great introductory start to whitening or a maintenance method. It comes in MINT and MELON flavors you are sure to love. Please use at night only to maximize contact time, considering this is an adaptable tray, but not a custom fit tray and wash-out is more likely.
Opalescence Ultra EZ Desensitizing Trays
Many of us experience sensitivity. It is imperative that these concerns be taken into consideration when deciding between approaches and products. Potassium nitrate is the key ingredient in sensitivity toothpastes and general fit tray applications, such as Ultra EZ. This is a great product to help prevent or manage sensitivity concerns from whitening products.