IF THE gleam on your choppers is less than pearly, help is at hand. The latest whitening methods are effective, safe and increasingly affordable – so long as you follow a few golden rules.

The gradual yellowing and discolouration of teeth is a normal part of ageing. Usually, this is the combined staining effect of surface agents such as coffee, tea, red wine and cigarettes, along with changes to the internal makeup of the tooth.

The right treatment for you depends very much on the state of your teeth, what surface staining there is and the degree of internal discolouration due to the effects of decay, nerve damage, dental work such as fillings or worn enamel that lets the darker, yellower dentine show through.

Dr Don Wilson is a dentist and member of the Oral Health Committee of the Australian Dental Association (ADA). He says that tooth whitening considerations for those aged from around 45 – the pre-fluoride generation – may differ from the concerns of those who grew up with the dental health benefits of fluoride.

“In general, younger people will respond better to some of the over-the-counter products which tend primarily to address surface staining,” he says. “They may also require less intensive tooth whitening treatments in the dentist’s rooms. Of course, there are exceptions, such as those who have internal discolouration due to things like antibiotic use in childhood or are heavy smokers.”

Dr Wilson explains that an older person is likely both to have more discolouration – internal and external – and more dental work such as bridges, crowns and fillings.

“Because you are dealing with different materials and surfaces in such cases it can be difficult to get a good colour match to give even results,” he says. “And it is very much an evenness that we aim for in the whitening process.”

Dr Wilson says that anyone considering a whitening treatment should first visit his or her dentist and go through the options.

“The likely outcome will depend very much on the state of your teeth, their natural colour and the cause of discolouration,” he says. “Many people have unrealistic expectations so it’s important to ask your dentist what kind of improvement you can expect, what costs are involved and what sort of maintenance you are looking at as most people will require some kind of ‘top up’ treatment every year or so,” he says.

Dr Wilson also warns against seeking whitening treatment from a non-dentist. Such treatments are increasingly available from salons where other ‘cosmetic’ procedures are performed.

“This is a specialised area and to safeguard your teeth and ensure best results it’s best to consult a qualified professional,” he says.

Professional whitening or bleaching options

Whitening or bleaching is different from the polish you might receive at an ordinary dentist’s visit (also known as ‘lightening’ because the process may cause the teeth to reflect more light, hence ‘lightening’ their appearance).

It also differs from the removal of surface stains, for example when using over-the-counter products. This is because the materials used by the dentist in a whitening treatment actually penetrate the tooth to reduce internal stains by bleaching coloured particles inside the tooth known as chromophores. The treatments involve oxygen-releasing chemicals such as hydrogen peroxide, carbamide peroxide or sodium percarbonate peroxide.

“So long as they are professionally performed on the right type of patient, these procedures are highly effective and don’t cause long term damage to the teeth,” says Dr Wilson. “We do have to be careful that the gels and bleaches, which are very strong, don’t cause undue problems with the gums and some gum tenderness can be a short term side effect.”

Dr Wilson says that the price of these treatments can vary considerably, starting from around $500. Cosmetic bleaching is not covered by private health insurance.

Generally speaking, you can choose from several whitening options, the most common of which are:

• Nightguard or home tray vital bleaching, when a gel is applied to the teeth for several hours or overnight in a mouthguard-style device known as a ‘ tray’. Trays can be standard or custom-made. The custom-made trays tend to produce better results – but are also more expensive. Trays can be kept and reused for ‘top up’ treatments. Some over-the-counter nightguard treatments are available, but they tend to use a lower dose of active ingredients than those your dentist can use. There is also an intensive form of this treatment that can show results in only a few hours, depending on the condition of your teeth.
• Power bleaching, when the bleaching gel on the teeth is activated using high intensity lights, lasers or ozone. This type of treatment is usually via a proprietary procedure that your dentist is licensed to use, with common ‘brand names’ including SDI Pola-Office ™, Opalescence Xtra Boost ™, Zoom ™, LaserSmile ™, OpusWhite ™, Rembrandt ™, BriteSmile ™ and Smartbleach ™. It is very common to experience tooth sensitivity during and after this type of procedure. This generally stops by itself after a few days.
• Walking bleach is when a whitening substance is applied inside the tooth then sealed in place – this may be suitable if you have had root canal or other problems that might reduce the effect of other types of treatment.

• ’Advanced’ whitening toothpastes contain special abrasives which help remove some more accessible surface stains during normal toothbrushing.
• Paint-on whitening treatments applied once daily for 14 days can be effective in dissolving surface stains.
• Adhesive strips that are applied to each tooth and kept on overnight generally for 14 nights can be effective and may even enable some penetration of the bleaching material for some reduction in internal staining. Some sort term gum and tooth sensitivity may be experienced after their use.
• Home tray vital bleaching is as described in professional treatment section above – this can be effective but generally less so than when using a custom tray and ‘professional strength’ bleach.

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