Teeth whitening treatment

We look at the pros and cons of DIY kits, kiosk and professional dental whitening services.
 
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01 .Introduction

teeth whitening

Teeth whitening kiosks are suddenly everywhere, promising lighter, brighter teeth at a fraction of the cost you’d expect to pay for a full dental clinic treatment. Coupon websites like Spreets offer deals for as little as $75 for a 45-minute UV Laser Teeth Whitening Session. You can’t argue with the price, but how safe and effective are these treatments – and are they any better than a DIY kit you can buy over the internet? CHOICE takes you through the pros and cons.



Salon and kiosk services

With little or no training and an outlay of a few thousand dollars for an activating light and bleaching equipment, entrepreneurs can establish a lucrative little money earner in hair and beauty salons, shopping centre kiosks, or even mobile home-based teeth whitening parties.

Typically costing less than $200, it's cheaper than a similar process provided by a dentist. However, the industry is unregulated and the practitioners have no dental training. Potential problems include lack of proper infection control, careless application or ill-fitting bleaching trays, causing irritation to gums and lips, and using bleaching products that are too strong, too acidic or left on for too long.

Practitioners are unable to advise on whether the process is appropriate for someone (some kinds of discolouration don’t respond to certain treatments), and they’re not qualified to check for problems such as cracked enamel, cavities, restorations and exposed root surfaces that need special care. In most cases, however, the worst outcome will be temporarily sore gums and sensitive teeth. There have been no reported cases of permanent tooth damage, although the industry is in its early days.

Dentists have accused these operators of illegally practising dentistry. However, the beauticians exploit a legal loophole by asking the patient to insert the trays in the mouth themselves (so they're not touching the teeth), and in turn accuse dentists of trying to protect business interests.

The Australian Cosmetic Tooth Whitening Association (ACTWA) is a self-regulated industry association whose members agree to a code of conduct that specifies a maximum bleaching strength of 12% hydrogen peroxide and a limit to power bleaching (the use of a light) of no more than 20 minutes in a 24 hour period.

In-office dentist whitening services

instrumentsThe main advantage of dentists over cosmeticians is that they’re qualified to assess the status of your teeth, including taking a dental history, which may have a bearing on the treatment they’re prepared to give you. They can also assess and redress underlying problems causing discolouration.

They’re more likely to offer custom-fitted bleaching trays, which means better control of the bleach and less gum irritation. However, they’re likely to be a lot more expensive – around $1000, give or take a few hundred dollars – which for many people is the main disadvantage.

What is 'power bleaching'?

Strong hydrogen peroxide bleach (up to 38% hydrogen peroxide) is placed in trays and fitted to your teeth, and the bleaching effect is often enhanced with the use of a light or heat source, such as laser, LED or halogen lamps. 

In general, the stronger the product and the longer the contact, the whiter the results. However, teeth are also likely to be more sensitive afterwards. Using light or heat to enhance the effect of the bleach appears to have a greater whitening effect than bleach alone. However, much of this extra effect appears to be due to dehydration of the tooth, and the colour will darken slightly as the tooth rehydrates. 

The effects of power bleaching are immediate, but more than one treatment may be needed to get the desired results. It’s not uncommon for an initial treatment at the dental surgery to be followed up with further treatment or maintenance at home.

Power bleaching is offered by dentists and cosmetic entrepreneurs. Have realistic expectations – many model and celebrity photos have teeth digitally whitened. Teeth shouldn’t be whiter than the whites of your eyes.  

Tips and traps

  • Avoid staining your teeth with tea, coffee, red wine, cola and smoking for a couple of days after whitening (which may mean giving up for a few weeks for longer-term treatments).
  • Bleach won’t whiten caps, crowns or fillings, and these may need to be replaced if they no longer match the rest of your teeth.
  • Your teeth may need re-whitening after a couple of years or so.
 
 

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DIY kits

DIY home bleaching kits can be easily purchased via the internet, and anecdotal reports suggest some satisfaction with them, though experiences vary. The kits generally contain mouldable bleach trays (dip in boiling water and fit to teeth), the bleaching chemical and sometimes remineralising gel or paste to reduce sensitivity. 

bdazzledThe active bleaching ingredient is hydrogen peroxide, usually in the form of carbamide peroxide: 10% carbamide peroxide releases 3.5% hydrogen peroxide in the presence of water.

The European Scientific Committee on Consumer Products (EU SCCP) recommends strengths of no more than 6% hydrogen peroxide (approximately 17% carbamide peroxide) be used at home, and at this strength only after consultation with a dentist. The Dental Board of Australia also recommends concentrations of hydrogen peroxide of more than 6% are left to qualified dentists. This 6% is based on risks of toxicity, rather than the effects on your teeth.

Kits we found ranged in concentration from 8% carbamide peroxide/3% hydrogen peroxide (Bdazzled Teeth Whitening Kit, pictured) to as high as 44% carbamide peroxide/16% hydrogen peroxide (Whiter Smile's Advanced Home Whitening Kit).

Clearly some home and salon products are a lot stronger than 6%, and many people have used them with very few problems with toxicity or tooth damage reported - though the EU SCCP notes that more clinical studies, especially long-term studies, are needed. However, we’d still recommend you try one of the milder products at home. Try to avoid bleach contact with gums as much as possible, and avoid swallowing the bleach. There is some concern, though no conclusive evidence, that peroxides may cause oral cancer, though it's more likely in people already at risk - smokers and those who abuse alcohol. 

Excessive strength or excessive bleaching attempts can damage enamel, as can overly acidic products. You may end up with more porous enamel or a bluish tinge.

Your dentist can also provide home bleaching kits, either as a stand alone bleaching process or to supplement in-office power bleaching. These are likely to be more expensive, simply because the dentist will have made custom-fitted trays, though you can be reassured the strength of the product will be appropriate for you.

Update:

After the original version of this article was published in 2011, the ACCC recalled in-home products containing more than 6% hydrogen peroxide. New regulations restricting the sale of kits containing more than 6% hydrogen peroxide come into force on 1 May 1 2013. However, dentists may still sell kits exceeding this level for in-home use, based on their professional judgement.

If the tray fits…

The fit of the trays is an important aspect of this sort of whitening. If you’re leaving them on for a long time (30 minutes or so), they need to be comfortable, and not cause gagging or excessive salivation. And the closer they fit, the less bleaching product you need to use. Excessive bleach can ooze out, and while not toxic in small amounts can taste unpleasant and may damage soft tissues.

Some DIY kits involve you making impressions of your teeth, and sending them back to the distributor, who’ll then make and post out a set of custom-fitted trays for you, much like those a dentist would make. They’re a little more expensive, but you can use them for many years.

Pre-filled trays promise the convenience of not having to muck around with tubes of bleaching gel and so on, but because they’re one-size-fits-most, there needs to be a lot of gel in there to make sure teeth surfaces are contacted . Excess gel oozes out and irritates the gums. And you might not be among the ‘most’, in which case it could be uncomfortable, ineffective and messy.

Adhesive strips

If the idea of mucking around with gels and trays doesn’t appeal, you might prefer adhesive bleaching strips which you stick on your teeth. They’re impregnated with bleach, and once you get the hang of it, can be applied with little fuss, although sensitivity is still a potential problem. 

The main disadvantage of strips is that they only bleach the front six or so teeth, and they don’t perfectly fit the teeth, meaning some gaps may be left.

Tips

If you’re going to go down the home bleaching path:

  • Before buying a DIY kit, visit your dentist for a check up and clean - you want to be sure your teeth are in good condition before you start bleaching. 
  • Work on one set of teeth (top or bottom) at a time. You’ll notice the whitening effect more if you have a point of comparison and wearing one tray is more comfortable than wearing two. 
  • Choose products from reputable Australian or US suppliers . Don’t be tempted to save a few dollars buying unreliable products subject to poor hygiene and quality control. Also, there are plenty of scam companies out there, so check the credentials of the company first.
  • Start with a mild product before going stronger.
  • Be prepared for increased sensitivity. Using the product less often will help, though the whole process will take longer. A sensitive tooth paste and/or Tooth Mousse (see Tooth Mousse: is there anything it can’t do? below) can reduce sensitivity.
  • Don’t over bleach – don’t use more product (it won’t help), leave it on too long or do it too often. And you only really need to bleach the front surface of your teeth.

Tooth mousse: is there anything it can’t do?

GCmousseDeveloped initially by a team of dentists and scientists at the University of Melbourne, this great Aussie innovation has taken the dental world by storm. Tooth Mousse contains calcium and phosphate derived from milk protein (casein), and it remineralises the enamel surface of the tooth, preventing and reversing surface damage. 

It’s recommended for tooth erosion, early decay, fluorosis, lesions due to orthodontic treatment and tooth sensitivity – including post-bleaching sensitivity. By strengthening the enamel, it also protects against erosion and caries, and can be used pre-whitening to prevent sensitivity. Applied after fluoride treatment, it enhances fluoride penetration to further protect teeth. Apart from relieving post-bleaching sensitivity, it also helps keep your teeth white longer by resisting staining . And while the company doesn’t make any claims about whitening, anecdotal reports indicate that with regular use it slowly whitens unbleached teeth. 

You can buy some online (search for GC Tooth Mousse) or from your dentist, for around $20-25 a tube. Chewing gum products are also available.

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