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For an "Update" comparing   In-Office "Power Bleaching"  to "At-Home Bleaching" and other advances in  teeth whitening, go to the  bottom half of this page

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Update

The trend lately has been to use much stronger concentrations of Carbamide Peroxide in  trays at home but for much shorter   periods of time. The  stronger mixtures  bleach out stains much faster (fewer days) and the shorter application times each day seem to cause less sensitivity.

30% Carbamide peroxide  is often being recommended for use  for only 30 minutes each day which is much easier to fit into a busy schedule and the results are better!

Some brands are adding additives to give a "pleasant" taste or Potassium Nitrate and/or Fluoride to help  cut down sensitivity.  There is a concern about the Nitrate reacting with proteins in the   body to produce nitrosamines which are know to be very carcinogenic.

It gets a little complicated to   explain but  in brief I recommend staying away from flavorings, fluorides, and nitrates.  If sensitivity is a problem we should talk about it and come up with   a strategy that will help you.

 

Hard stains like Tetracycline and fluoridation discoloration have been greatly improved by MUCH LONGER USE of the home bleaching ...3 months to a year! 

Power Bleaching !!

As opposed to the  "take home" bleaching  technique described above, there are a number of variations of "in-office" bleaching techniques.

They are all  similar in that they use a much stronger bleaching (oxidizing) chemistry which is made even stronger  by heating it while it is on your teeth.

Different systems look different  mainly because of the   way the  chemicals are heated.  For example, originally a heat lamp was placed a foot or two in front of your face and the radiant heat activated the chemicals while your lips were held back out of the way by some mechanical means.

Another system uses the bright light used  for  curing bonded filling materials.  It gives off some heat directly, but also the light   probably sets off a chemical reaction  in their specific chemical mix that produces more heat and oxidation.

Yet another - and the one that has generated a lot of   talk - is the laser.  As far as I can tell, the laser doesn't do anything special....it's just another heating source.  But it "sounds" more high tech than the others....usually spelled "more   expensive".

There is an advantage, however, to these POWER BLEACHING systems.   They are faster.  Sometimes one or two visits are enough.

There's a possible downside, too.  Being much stronger and quicker, there's a greater chance of having sensitive teeth afterward -  or even doing permanent damage to the nerves of the teeth due to the heat.  With the home technique, if you begin to  experience sensitivity, you can stop...or you can go slower, or you can take a break - days or weeks - and start up again gently.  Power bleaching can be TOO powerful and TOO fast, so the damage might already be done by the time you realize there might be a problem!!!

Also, because the chemicals are so much stronger, they can cause burns if they accidentally get on your gums, lips or..........face.  Significant effort would always be made to prevent that from happening...but, best be aware it's a possibility.  It can still happen!

If you have sensitive teeth and there's no great emergency time wise (like you were not just notified you are to be  given an award on TV in front of millions of people - close up - and it will be this Friday at 3!)...then go for the slower and gentler - and less expensive home bleaching.

If it's Wednesday and you need it by Friday at 3...  You should know also that some of the better home bleaching systems if well done can bring about dramatic whitening in even as little as a day or two or three.   A lot depends on the nature of your specific discoloration.

Tetracycline staining (usually blue-purplish banding) is probably the most difficult to correct. But it's still worth a try; sometimes it works, especially if you stick with it longer than  for the rest of us.

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Cost !!

Regarding the cost , there are a couple of angles  for you to consider. First, the in-office "Power Bleaching" systems will cost you an estimated  $800- to $2400-,  3 to 10 times  the  cost of the "Home Bleaching" depending on whether you need do the in-office method   only once or  two or three times.

Then if you want to  brighten  up  again in   six months or two or three years, you probably will have to  do the   Power Bleaching again  at  a high cost, whereas if you did the   at-home method and  kept your little mouth guard-like trays, you can just buy a tube of the gel from your dentist at a total estimated cost of  $20 to 40- and   go home and do it for a week to bring the  whiteness back up.

Relative Effectiveness?

In a  study reported  March/April 2003 in   "Operative Dentistry" a clinical evaluation  of In-Office and At-Home bleaching treatments was reported to give the following  results:

  • at-home  treatment  produced significantly   lighter teeth than in-office treatment for all active  periods and follow-up visits

  • no difference in tooth sensitivity  overall between the two systems

  • 84% of patients  in the study  found at-home   treatment to be more effective while 16% found no difference

  • no patients found the in-office treatment to be MORE effective overall than  at-home treatment

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Painless whitening!   update: January 2009

I recently started using a new formulation for  whitening that is based on a different bleaching agent that is based on Calcium peroxide.  Nu Radiance Forte. It uses Calcium peroxide  with carbamide peroxide.   NONE of the other whitening products, as far as I know , are made with these ingredients.  Since I have been using it, patients have  told me there is no problem with sensitivity - even patients that have not been able to use other products because it was too painful!!!

Not only that but the temporary weakening  of enamel seen with many other products does not occur with this one... infact it actually seems to add calcium to the enamel and strengthen it to the point that  has been used to help DE-sensitize teeth and to help RE-mineralize teeth that have begun to get softened by  decay and/or poor hygiene habits.  I have been using it for about one year so far and I can only say it seems to be great!!!! ANd yes it whitens just as well as any of the other products that cause pain for many patients.

UPDATE 2011:

I am no longer using this  system much.  Not because it doesn't work, but because it's difficult for the patient.  The little mixing tips [it's a 2-barrel system where the 2  components need to mix with each other when you  go to use and dispense it] get clogged up and there are usually not enough of them in the kits.  My impression is that it works, but without good patient  compliance it can't do its job.  I still  consider this product for patients with sensitivity problems whether they are looking for  whitening or not.

 

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UPDATE 2014:

I have been increasingly recommending patients try Crest 3D White Strips to whiten their teeth.  I don't recommend any other over-the-counter systems because I know the Crest strips have been well tested and are safe as far as we know at this time.  Also, they are inexpensive and fairly easy to use.  So try them and probably save a bundle of  $$$$!  As far as I know, the results seem to be comparable to most  home bleaching systems offered by dentists.

Was that helpful?  Let me know...

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Holism in dentistry is an approach to dental treatment, primarily  caring for  patients' health and safety from both a conventional as well as  "alternative healthcare" point of view.   It is sometimes called "biological" dentistry or "biocompatible" dentistry.  In it's fullest sense, I believe it   acknowledges and deals with  the mind, body and spirit of the patient, not just his or her "teeth".  See Topics / Info.....

Cosmetic dentistry is about doing   quality , esthetic dentistry in a way that looks natural to begin with, and furthermore,   can even  improve  one's  attractiveness through techniques such as bonding, bleaching, veneers, caps, implants and more.  It can   be like "instant orthodontics" in correcting  crooked, twisted or misplaced teeth in many instances.  Dark or misshapen teeth can be restored.   Smiles that lack youthful vigor or beauty can be revitalized! See Topics / Info..

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