Health
Bleaching your way to a brighter smile

By Katherine Nichols
Advertiser Staff Writer

Dentist Jonathan Cross uses a laser to bleach Flo Jalinâs teeth. Richard Ambo • The Honolulu Advertiser

Flo Jalin knows that her white teeth help more than her career as a model and actress. An attractive smile, she said, "is so important to your confidence."

Honolulu dentist Wynn Okuda agreed. "People evaluate you within the first 15 seconds," he said. "It's essential to put your best impression forward." One relatively simple way to improve your appearance and deduct years from your face is teeth bleaching.

Despite advertisement claims, however, bleaching doesn't work for everyone. "Whitening is individual in nature," said dentist Jonathan Cross. "We can't guarantee it."

Okuda concurs. "Not everyone is a candidate for bleaching. Restorations like crowns, cavities, porcelain veneers, composite resin and fillings will not bleach." And stains from the drug tetracycline often cannot be erased.

Bleaching may help people with banding (multiple shades in their teeth), but those bands will not necessarily disappear. "These patients will still have multiple colors in their teeth," said Cross. "But it might not be as noticeable because everything will be lighter."

Almost everyone sees results, however subtle. Most say they have good luck erasing coffee and wine stains. Jalin, who had a recurring role on Baywatch Hawai'i, confesses to a few tricks beyond brushing and flossing to keep her teeth white after bleaching. "I love coffee and tea, and I have to have it," she said. "But I drink it through a straw so it won't hit my teeth. Especially the front."

Bleaching methods include power bleaching, home treatment under the supervision of a dentist and over-the-counter products.

Power bleaching

In-office whitening methods are commonly referred to as "power bleaching." Dennis Nagata, a dentist in Kalihi who offers the BriteSMILE system, described the tool he uses as a "high-intensity light that also creates a little bit of heat."

Cross uses the Apollo Secret Whitening Formula with a plasma arc light. A mouthpiece — much improved from rubber dams that were uncomfortable and sometimes leaked — holds gums and lips away from the teeth. If the 35 percent hydrogen peroxide solution comes in contact with gums, it may whiten them temporarily and cause irritation. In Cross's office, patients can relax with a DVD movie system that serves two purposes: entertainment and eye protection. Though Jalin admits to suffering from tooth sensitivities, she said that "you don't even notice that you're getting work done" with the diversion the movie provides.

Cross cleans the teeth, syringes on the gel and points the light — programmed to shine for only three seconds on each tooth — twice. He waits 10 minutes, rinses, reapplies the gel and goes through the same process. He repeats this three times during the one-hour appointment. Other practitioners may use different gels, heat sources or timing. The heat provides a catalyst for the hydrogen peroxide to whiten the teeth.

Power bleaching prices typically range from $280 to $650 per appointment, for both upper and lower teeth.

Home treatment

Home bleaching is a multi-step process and requires a commitment to the time and hassle involved. First, your dentist creates molds of your upper and lower teeth. From these, plastic trays are made that will hold the 10 percent carbamide peroxide solution, milder than the solutions used in power bleaching. You must brush and floss, then syringe the solution into the trays and wear them against your teeth for a designated time period. Extended contact allows the carbamide peroxide to soak into the tooth's surface layers.

Nightly treatment is considered by many dentists to be the most effective, probably because patients follow the assigned regimen more reliably that way. If you want to sleep with your trays (not terribly comfortable, but often the most practical time if you can't avoid talking during the day), you can purchase a night whitening solution. More powerful solutions for use during the day need to be left in for only about two hours at a time. Some people may want to experiment with as high as 22 percent carbamide peroxide. This may yield faster results, said Cross, but the solution puts you at greater risk for gum irritation if it leaks from the tray. Despite the custom fit, leakage is inevitable.

Dentist Torin Torigoe said he shifted from power bleaching to home treatment for a number of reasons: "It was uncomfortable for the patient, and in the end, we had no control over the final shade. This was the most predictable for us."

Simpler at-home methods include Crest's Whitestrips. No fittings or trays are necessary; patients just wear the upper and lower strips for 30 minutes a time for 14 days, and it's cheaper than dentist treatments.

The drawback is that trays, when they're required in over-the-counter systems, may be be ill-fitting and when something goes wrong, said Okuda, "you have nobody to call to ask questions." Most importantly, he said, there is no pre-whitening exam.

Dentists usually require X-rays, a gum exam and a full cleaning before teeth are bleached. The price of the service assumes that the dentist already has accomplished these basics. This is why dentists focus bleaching services on returning clients; patient records are already on file. Exams are important because if you have an allergy or underlying pathology, like a hidden abscess, said Cross, the bleaching process could exacerbate the condition.

Fees for home bleaching usually range from $250 to $500. Cost includes patient education about the process, molds and tray fitting to prevent leaking and gum irritation, bleaching solution and follow-up.

Some people have problems with teeth sensitivities during the bleaching process. Several products on the market can bring relief; Cross said that patients should address this issue with their dentist before bleaching.

Toothpastes

Designed only for stains that appear on the outside of the tooth, they will not change the internal color. Brands that contain peroxide may be used to help maintain white teeth after the teeth have been professionally lightened.

Teeth whitening doesn't last a lifetime. "It's something that needs to be done every now and then," said Cross. If the cause for staining continues — like smoking — the teeth may discolor again more rapidly.

"It's important that people understand that it isn't necessarily going to work in one session ... or at all," said Cross. "And if it doesn't work on that individual, there are other ways of getting white teeth," said Okuda. "Every patient should be informed of his or her options."

Most dentists promote a natural look. This includes some coloring in the teeth. If you covet a china-white smile, you may harbor unrealistic expectations. Yet no matter what your needs are, your dentist should be able to help you find a method to improve your smile.

Katherine Nichols can be reached at knichols@honoluluadvertiser.com