Background Information:

What are the other Names for the Procedure?

• Teeth Bleaching Process
• Teeth Whitening Treatment

What is Teeth Whitening Process?

• Teeth Whitening Process is a safe and generally inexpensive cosmetic procedure to whiten teeth by removing stains and discoloration. This helps provide with a more confident smile and presentation
• The bleach in the whitening agents include hydrogen peroxide or carbamide peroxide, chemicals that dissolve or break stains on teeth to give a brighter appearance. The process is generally more effective on stains that are confined to the surface
• The procedure may be performed using either over-the-counter dental care chemical products or in a dental clinic, by a dental professional
• Teeth Whitening Process is usually performed in adults, but children over 10-12 years may also be candidates for the same. The process is not considered for milk teeth (in children), unless really necessary

Two types of Teeth Whitening Process are defined: (to match the shades after whitening)

• Vital whitening process: It involves teeth with ‘live nerves’ and is the most common procedure undertaken
• Non-vital whitening process: It involves teeth that have been subject to root canal treatment, and hence, no live nerves are present

In the latter case, the whitening process is undertaken from inside the teeth.

What part of the Body does the Procedure involve?

Teeth Whitening Process involves the entire set of teeth within the mouth.

Why is the Teeth Whitening Process Performed?

A Teeth Whitening Process is performed to remove yellow, brown, gray stains and other discoloration on teeth to improve one’s overall appearance (to give an enhanced look). The stains may be extrinsic and intrinsic (confined to surface or moved deeper into the enamel respectively) and may be caused due to:

• Food and lifestyle habits that include tea, coffee, wine, soft drinks, nicotine (smoking or chewing tobacco), and certain medications
• Aging, which tends to lose the natural shine and brightness of teeth
• Trauma to teeth
• Radiation therapy to the head and neck region, or chemotherapy, may cause its discoloration

Also the type of teeth one has (determined by ones genes) dictates the color of teeth; some have smoother teeth (lesser prone to staining), while others have rougher surfaces (more prone to stains).

What are some Alternative Choices for the Procedure?

Currently, there are no specific alternatives to a simple Teeth Whitening Process.

• However, one may choose to have one’s teeth bleached using over-the-counter whitening agents at home
• Use of dental implants, veneers (made of ceramic, porcelain or other synthetic products), and composite bonding, especially when the staining is caused over several years and goes into the tooth enamel, may be considered by the dentist

The Teeth Whitening Process may also be undertaken through laser therapy. However, this is generally an expensive process.

What are the Recent Advances in the Procedure?

There are no recent advances in the field of Teeth Whitening Process.

What is the Cost of performing the Teeth Whitening Process?

The cost of Teeth Whitening Process procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Teeth Whitening Process procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

https://www.smile.com.au/treatments/dental-dentist-teeth-whitening-tooth-whitening-cleaning (accessed on 01/02/2018)

https://www.colgate.com/en-us/oral-health/cosmetic-dentistry/teeth-whitening/tooth-whitening (accessed on 01/02/2018)

Prior to Teeth Whitening Process:

How is the Teeth Whitening Process Performed?

Teeth Whitening Process/Treatment may be undertaken in any of the following manner:

In-office whitening or chairside bleaching using in-practice products:

• Whitening agents that contain higher levels of peroxide are applied to teeth by dental professionals
• The process is easier and quick, but may not be suitable for those with sensitive teeth
• Sometimes, for deeper stains, the dentist may advise using the whitening agent at home for a few days/weeks, following the procedure in office
• In many individuals, the results are seen in 10-14 days; while, for some, it may even take a month

Using home whitening gels or take-home products:

• Under supervision of a dentist, the whitening agent is applied to teeth and held in place using special custom-made trays (mouthpiece) for a period of time (usually for a few hours or overnight)
• It has lower peroxide content and produces results in 1-2 weeks
• The procedure may take 7-14 days and a daily whitening regimen may be necessary

At-home bleaching using over-the-counter (OTC) kits/products:

• This technique may bring about results over 3-6 months and consists of an all-size tray (or strips that stick to the teeth) to hold the peroxide product
• Some of these products are not recommended by dentists due to their effectiveness and potential for containing strong acids (that may damage tooth enamel)
• It is important to follow directions for use
• Also, avoiding the over usage of such products is advised

Using OTC toothpaste:

• Whitening toothpastes also have some small amounts of peroxide or other compounds for giving the polishing effect
• Some contain harsh abrasives and chemicals that over time may damage teeth and cause more yellowing of teeth (in future). It is better to consult dental professionals prior to using such products
• Besides only the surface of teeth are whitened and this method is not considered very effective
• It is advised that only American Dental Association (ADA) approved toothpastes are used

The chemical products have a substance based on peroxide that helps restore teeth whiteness. These may be activated by heat, lasers, special light for bleaching to take effect. Before applying the whitener, the gums are protected using a special substance.

Where is the Procedure Performed?

Teeth Whitening Process procedure is usually performed in a dentist clinic or office.

Who Performs the Procedure?

A dentist or dental hygienist usually performs the Teeth Whitening Process.

How long will the Procedure take?

The time taken for the Teeth Whitening Process depends on the type of technique employed by the individual. This can vary widely from a single sitting at a dental clinic (ranging from 30 minutes to 1.5 hours), to several sessions in the clinic or at home, depending on each individual’s specific condition.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Teeth Whitening Process procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are currently being taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time before the procedure is performed
• Inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products for a while before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For individuals suffering from diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

Pregnant women and individuals with severe underlying sicknesses are advised not to undertake this procedure.

What is the Consent Process before the Procedure?

A physician will request your consent for Teeth Whitening Process procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

Note: In case of OTC products used at home for cosmetic enhancement, there is no question of a consent form. However, when the process is undertaken at a medical facility, consent may be required.

What Tests are needed, before the Teeth Whitening Process?

In many cases, no tests are typically necessary prior to a Teeth Whitening Process. However, if required, the dentist may recommend the following tests such as:

• Routine blood and urine analysis
• X-ray of the mouth

Before the procedure, any dental issues may have to be addressed such as dental cavities, gum disease, or receding gum line. The dental professional may also take photographs of the teeth for later comparison, or to monitor progress.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Teeth Whitening Process procedure?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests or periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Teeth Whitening Process:

What kind of Anesthesia is given, during the Procedure?

There is no anesthesia administered during the procedure.

How much Blood will you lose, during the Procedure?

There is no blood loss involved during the Teeth Whitening Process.

What are the possible Risks and Complications during the Teeth Whitening Process?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally, the greater the degree of obesity, the greater the surgical risk
• Smoking: The longer the smoking history (in pack years smoked), the greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders and chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Teeth Whitening Process are:

• Any crowns, synthetic dentures or fillings are generally not affected by this process. However, some may stand out (have a different shade) after teeth whitening
• Some techniques are ineffective when causative factors for discolored teeth include cancer therapy, use of medication, or trauma

What Post-Operative Care is needed at the Healthcare Facility after the Teeth Whitening Process?

At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise.

After the Teeth Whitening Process:

What are the possible Risks and Complications after the Teeth Whitening Process?

Risks and complications after the Teeth Whitening Process procedure are generally not noted. However, in some cases, the individual may experience the following:

• Pain of gums, soft mouth tissues, and tongue
• Mild gum irritation may be noted that resolve in a few days
• Tooth sensitivity
• Over-whitening of teeth, if the process is prolonged (rare)
• Ingesting some over-the-counter products may cause nausea/vomiting sensation
• Some peroxides may cause burns to the gums and oral cavity tissue, if they are not adequately protected
• Sometimes, brown or gray teeth may not be restored using bleach

The results of the procedure are known to vary depending on the discoloration, the reason why it was caused, and on the specific treatment steps undertaken.

What is the Prognosis after the Procedure?

• The prognosis after a Teeth Whitening Process is usually good. However, it is not permanent and the process may have to be repeated regularly for retaining the state of whiteness
• With regular brushing and flossing, the whiteness can be retained for a few years before the next Teeth Whitening Process is necessary, especially if staining foods are avoided
• Also, professional teeth whitening yields better results than home bleaching measures using OTC products

When do you need to call your Physician?

Severe side effects are very few and unlikely. Nevertheless, do contact your physician if you notice any of the following symptoms:

• Pain involving the tongue or gums that worsen: Usually no pain is felt, but some discomfort may be noted for 1-3 days after the process. If required pain medications can be taken
• Severe tooth sensitivity: Temporary tooth sensitivity may be noted that can be reduced by using gel-based fluoride toothpastes
• Swelling around the gums and teeth
• The occurrence of any symptom that causes uneasiness such as nausea or vomiting
• Signs of an infection
• Headache
• Fever, feeling sick

What Post-Operative Care is needed at Home after the Teeth Whitening Process?

After treatment, the teeth are slightly more porous for a period of time, and hence are more susceptible to staining. At home, the following post-operative care is recommended after a Teeth Whitening Process procedure:

• Avoid staining food items (such as soft drinks, wine, coffee, etc.); use straw if you need to drink these
• Avoid smoking or chewing tobacco
• Some tooth sensitivity may be experienced, so individuals are advised to avoid very hot or cold food items for a few days following the procedure

How long does it normally take to fully recover, from the Procedure?

There is no recovery period involved, and the results can be seen within a few days to a few weeks.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

Generally, the procedure does not involve the surgical removal of any tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Usually, no tissue is sent for a pathological analysis.

Who will you receive a Bill from, after the Teeth Whitening Process?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• An out-patient surgery center facility, the dentist or oral surgeon’s clinic/office, or a hospital
• An anesthesiologist (if anesthesia was administered)
• A dentist or dental hygienist

The patient is advised to inquire and confirm the type of billing, before the Teeth Whitening Process procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA