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
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.
********
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
*****************
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.
***********************
Was that helpful? Let me know...
*****
Holistic 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..
In holistic dentistry there is an effort to find biocompatible materials to use to reduce toxicity for everyone, especially the chemically sensitive. Amalgam use is avoided in holistic dentistry (" amalgam free" or "mercury free") due to concern about possible toxicity problems. Amalgam removal and replacement with natural-looking bonded materials is a common holistic dentistry treatment as well as a common cosmetic dentistry treatment. Detoxification, especially of residual mercury deposits in body tissues from amalgams is often done. Root canals are controversial in holistic dentistry and are discussed under topics. And much more....
Bleaching, veneers, bonding, caps, bridges, and implants are cosmetic dentistry treatments that are also discussed in Cosmetic Dentistry, and more...located in the Bethesda, Chevy Chase, Maryland 20815 area near Washington DC
