What whitening options are available?

Two: an in-chair procedure and a take-home kit. They suit different situations, and many people use both — in-chair for the initial change, take-home to maintain it. The service page is professional teeth whitening, and what are the different teeth whitening options available at Smile Solutions? covers the same ground in a different order.

This page began as a note marking World Smile Day, the first Friday in October, in 2017. The whitening information below is the part that is still useful; the date has passed.

Have the examination first

Before any whitening, have your teeth checked by a dentist. There are two reasons, and both save money rather than costing it. Why should I go to a dentist for teeth whitening? sets out the wider case, and understanding your treatment what an examination covers.

To make sure nothing will hinder the treatment. An examination identifies existing problems that would compromise the result or make it uncomfortable — untreated decay, gum disease, cracks, exposed root surfaces from over brushing.

To establish whether whitening is suitable for you at all. Whitening works on natural enamel. It will not change the colour of crowns, veneers, bridges or tooth-coloured fillings — so a white filling or crown on a front tooth will begin to stand out as the natural teeth lighten around it. That may mean replacing it afterwards, which is a significant cost and one worth knowing about in advance. I want to whiten my teeth but one of my front teeth has a porcelain crown — what are my options? is the article devoted to exactly that problem; dental crowns, porcelain veneers and the price guide give a sense of what replacement involves.

Discolouration also has different causes with different prospects. Surface staining responds well; age-related yellowing responds moderately; tetracycline staining, fluorosis and a single dark root-treated tooth respond poorly or need a different approach entirely. What causes white spots on teeth? covers fluorosis and the other mottling causes; everything you need to know about root canal treatment covers the single dark tooth; and teeth and aging: how can I keep my smile looking younger? the gradual kind. If the yellowing is from thinned enamel rather than stain, whitening is the wrong tool — see what is dental erosion and how is it addressed? and how can I change my smile naturally, which contains a short diagnostic for telling these apart.

Have a clean first, too

We recommend having your teeth cleaned before whitening, to remove any build-up of plaque and calculus — dental cleans and hygienists and your Smile Solutions dental hygienist visit: what to expect.

This is not an add-on. Plaque and tartar sit over the enamel and prevent the gel reaching it — and worse, they take up the whitening themselves, so the teeth appear to lighten and then revert to their true shade once the deposits are removed. A clean is what lets the whitening act on the tooth.

For some people, a professional clean alone achieves a surprising amount of what they wanted, because much of what looks like discolouration is surface staining rather than a change in the tooth itself. It is worth having the clean and then deciding whether whitening is still needed. How can I improve the whiteness of my teeth? and what should I know about teeth whitening? both start from the same premise. The usual sources of that surface staining are tea, coffee, red wine and smoking — see are there antibacterial properties in tea? and what impact does wine have on my teeth?.

In-chair whitening

The in-chair procedure, Zoom, takes around an hour to ninety minutes in the dental chair and gives an immediate improvement in the colour of the teeth. A good option for anyone wanting a visible result quickly, or with heavier discolouration.

The trade-offs to weigh: sensitivity is more common with in-chair whitening than with take-home — what to do if you suffer from sensitive teeth — and because it happens quickly, there is less control over stopping at a precise shade, which matters if you are trying to match an existing crown.

Take-home whitening

The at-home kit contains a close-fitting custom-made tray and a lower-concentration gel, available in a day or a night system.

The custom tray is the important part. It is made from a scan or impression of your teeth, so the gel is held against the enamel rather than being squeezed onto the gums — which both improves the result and reduces the risk of the chemical gum irritation that generic boil-and-bite trays cause. The difference between pharmacy whitening kits and dentist whitening and home teeth whitening vs having your teeth whitened at the dentist explain why the tray is the thing you are actually paying for. The same argument applies to mouthguards: getting a new mouthguard — a trip to the chemist or the dentist?.

Take-home whitening is gradual, which means you can watch the shade change and stop when you are happy. It also produces less sensitivity. The trade-off is that it takes one to two weeks and depends on doing it consistently. The do’s and don’ts of home teeth whitening covers the practicalities, and home whitening and charcoal whitening: does it work? Is it safe? the products that are best avoided — as does can oil pulling make my mouth healthier and my teeth whiter?.

What the law restricts

The difference between what a pharmacy can sell you and what a dentist can supply is not a marketing distinction. It is set out in the Poisons Standard, and the bands are worth knowing before comparing prices.

The Australian Dental Association records that these provisions are enshrined in all state and territory poisons legislation (ADA Policy Statement 2.2.8, Teeth Whitening (Bleaching) By Persons other than Dental Practitioners). This is not a professional guideline a retailer can decline to follow.

The two actives are related by a fixed ratio, which is the conversion to apply when two products label themselves differently: the ADA notes that one-third of a carbamide peroxide concentration is equivalent to hydrogen peroxide — so 18% carbamide peroxide approximates 6% hydrogen peroxide.

What a dentist is required to do before supplying a take-home kit

The Dental Board of Australia is specific. Teeth whitening products can be supplied for home use if the patient is assessed as suitable, which includes carrying out an appropriate assessment and examination, considering their history, and applying the principles of risk minimisation and management.

The ADA's position adds that teeth whitening should only be performed if the treatment can be justified, and after a comprehensive dental examination has been conducted by a dental practitioner; that risks should be explained to the patient and documented along with informed consent; and that practitioners should ensure that patients have realistic and reasonable expectations regarding the results of the bleaching treatment.

So the examination and the clean described further up this page are not a preference about sequencing. They are the condition on which a higher-concentration product may be supplied at all.

A consumer-protection point most people do not know

The Dental Board also records that dental practitioners who supply or sell teeth whitening products for home use must meet the Australian Consumer Law. That includes consumer guarantees that products are of acceptable quality; replacing, repairing or refunding a product in certain circumstances; and compensating a patient for damages and loss.

A kit supplied by a registered practitioner in Australia carries those obligations. A kit ordered from an overseas website does not, in any practical sense — which is worth weighing against the price difference rather than only after something goes wrong.

What the evidence says to expect

The ADA reports that peer-reviewed studies indicate peroxide-containing products are safe and effective when used by or under the supervision of a dentist and according to the professional directions for use, and that the most common side-effects are transient tooth sensitivity and soft tissue irritation during or immediately following treatment.

That matches the sensitivity note below: expected, usually temporary, and a normal feature of the procedure rather than a sign that something has gone wrong.

Combining the two

Many patients follow an in-chair treatment with the at-home kit, to make the effect last longer. This is a sensible approach: the in-chair session does the heavy lifting, and keeping the trays means topping up later costs only a syringe of gel. The difference between in-chair whitening and take-home whitening, and how I choose which one is right for me works through the choice properly.

Results are not permanent in either case. Expect gradual relapse over months to years, depending on diet and smoking. How long do teeth whitening effects last? and how long do the effects of teeth whitening last? give the honest range.

What to expect

If whitening turns out not to be the answer for your teeth, the next options are covered in cosmetic dentistry, cosmetic dentistry options, composite bonding and I want a smile makeover — where should I start?. The mock-up reveal lets you see a proposed result before anything irreversible is done.

Common questions

A salon near me does whitening for a fraction of the price. Is that the same thing?

No, and the reason is a legal one rather than a matter of opinion. The Australian Dental Association records that whitening is now “increasingly offered by unregulated, unqualified non dental practitioners in settings such as beauty and hair salons, shopping mall kiosks, dedicated teeth whitening salons, or via mobile services” (ADA Policy Statement 2.2.8).

Work through what the Poisons Standard means for that service and it resolves into two possibilities, neither of which is the bargain it looks like.

Either the product is at consumer strength — up to 6% hydrogen peroxide or 18% carbamide peroxide, Schedule 5 — in which case it is a product you could have bought yourself over the counter, and you are paying for a room and a chair.

Or it is above those concentrations, in which case Schedule 10 says it “may only be sold, supplied and used by registered dental practitioners as part of their dental practice”, and those provisions are enshrined in all state and territory poisons legislation.

The ADA also notes that many such services claim their operators are “teeth whitening specialists”, and states that only registered dental practitioners “have the expertise to assess whether bleaching is safe for individual patients, to recommend the most appropriate technique and materials, and to provide treatment that meets regulated safety and quality standards of care”. If you want to check whether whoever is treating you is registered at all, the AHPRA public register is free, public and takes a minute.

Does whitening damage enamel?

The evidence the ADA cites says no, when it is done under supervision and to the professional directions — and the same policy is equally clear about why the supervision is the load-bearing part.

The positive finding first: the ADA reports that peer-reviewed studies indicate peroxide-containing bleaching products are “safe and effective when used by or under the supervision of a dentist and according to the professional directions for use”, with the most common side-effects being “transient tooth sensitivity and soft tissue irritation during or immediately following treatment”.

The caution sits alongside it, and is specific. WorkSafe Australia's guidelines designate hydrogen peroxide above 5% as a hazardous substance; the ADA records that direct exposure of skin, eyes and mucous membranes can cause severe irritation or burns. More relevant to a tooth: percolation of hydrogen peroxide into the nerve tissues — “often accelerated by exposed dentine and enamel fractures” — can lead to nerve inflammation.

That single clause is the whole argument for the examination. A crack, an exposed root surface or an untreated cavity is a route in. Whitening over the top of one is not the same procedure as whitening a sound tooth, and it is not something you can assess in a mirror. See chipped and cracked teeth.

The bright light they use — does it actually do anything?

Less than the marketing suggests, and it carries its own risk profile. The ADA describes the light or heat source as something that “may shorten the application time required” — a claim about how long you sit there, not about how white you finish.

The risk side is stated plainly in the same policy: “the incorrect application of heat and other forms of energy during teeth whitening procedures, such as light from a plasma arc lamp or high-power (Class 4) laser may cause nerve damage to the tooth and burns to adjacent soft tissues”, and failure to ensure the use of appropriate protective eyewear “may also cause irreversible injury”. Training and equipment standards for this are set out in AS/NZS 4173:2018, Safe use of lasers and intense light sources in health care, which the ADA notes covers the cosmetics industry as well as dental practices.

There is a Victorian detail worth knowing. The ADA records that all registered dental practitioners with appropriate training may undertake procedures using Class 4 lasers, but that Western Australian, Queensland, Victorian and Tasmanian legislation requires practitioners in those states to first obtain a licence to do so from the state regulatory authority. So in Victoria there is a licence behind that equipment, and it is a fair thing to ask about.

How often can I top up before it becomes too much?

Nobody can give you a number, and the honest reason is that the studies have not been done. This is the gap in the evidence that the industry is least keen to mention.

The ADA puts it directly: the marketing of some consumer whitening products “encourages unrealistic expectations about whitening results and promotes regular ongoing use to maintain desired effects”, and it calls this “a concern given the lack of clinical data supporting frequent home use of such products over long periods”. The reference attached to that sentence is the Cochrane review of home-based chemically-induced whitening in adults (Eachempati and colleagues, Cochrane Database of Systematic Reviews, 2018, CD006202).

So the answer is not a frequency; it is a principle. Top up to a shade, not to a schedule. Whitening on a recurring calendar, indefinitely, because a subscription arrived is exactly the pattern the ADA is describing. If you have custom trays and gel from a practitioner, ask them what interval they want you on and why, and have the teeth looked at rather than assuming that what was suitable two years ago is still suitable now.

I found a much stronger kit online from overseas. Why not just buy that?

Because the two things that make a kit work are the two things the parcel does not contain — and because the strength itself may be the problem rather than the selling point.

On legality, the ADA records that “from time to time, some products containing concentrations of bleaching agents that exceed legal limits in Australia have been found to be available online to Australian consumers”. A concentration being available to order is not evidence that it is lawful to supply here, and it is certainly not evidence that it has been assessed as suitable for your teeth.

On the practical side: the custom tray is most of what a professional kit is, because it holds gel on enamel instead of on gum tissue — a stock tray with a stronger gel is the worst combination of the two, not the best. And as set out above, a practitioner who supplies a kit in Australia carries obligations under the Australian Consumer Law, including guarantees of acceptable quality and the possibility of repair, replacement, refund or compensation for loss. An overseas website carries none of that in any way you could practically enforce.

If the price is the real issue, say so at the appointment. It is a reasonable thing to discuss, and the price guide is published so you can look before you ask. See also the difference between pharmacy whitening kits and dentist whitening.

The sensitivity has not settled after a week. Is that still normal?

A week is longer than the description in the evidence, so it is worth a phone call rather than a wait-and-see. The ADA's summary of the peer-reviewed literature describes the common side-effects as transient sensitivity and soft-tissue irritation “during or immediately following treatment”. Transient means it goes; a week of it is outside that description.

What makes this worth checking rather than enduring is the mechanism set out above — peroxide reaching nerve tissue is accelerated by exposed dentine and by enamel fractures. Persistent sensitivity after whitening can simply be sensitivity, and usually is. It can also be the first time anyone has noticed a crack, a leaking margin on an old filling, or a stretch of exposed root surface.

Practical steps: stop the gel rather than pushing through the course, use a sensitivity toothpaste, avoid very cold and very hot things for a few days, and ring the practice to describe what you are feeling and where. Sensitivity to cold that fades in seconds is different information from a deep ache that lingers, or pain on biting — and the difference matters, so describe it rather than summarising it. What to do if you suffer from sensitive teeth and contact us.

Related reading

Practical details

We have a dedicated whitening centre with chairs set aside for whitening procedures, open on Saturdays as well as during the week, and a large team of general dentists at one location — see our team — so appointments can usually be found at a time that suits. Contact us to arrange one.

Outcomes vary between individuals, and all treatment carries risks. Product names are those of the whitening systems used.

Specialist registration can be verified on the AHPRA register, or by calling 1300 419 495. The practice’s registered specialists are identified as such within the full team.

Smile Solutions, Level 1, 220 Collins Street, Manchester Unity Building, Melbourne VIC 3000 — getting here. Phone 13 13 96, or theteam@smilesolutions.com.au. Monday–Friday 8.00am–6.00pm, Saturday 8.30am–1.30pm, Sunday by appointment.

Originally published 5 October 2017 to mark World Smile Day; the whitening information has been updated. General information only; it does not replace advice from your treating practitioner. The scheduling bands and practitioner obligations described above are as stated in ADA Policy Statement 2.2.8 and Dental Board of Australia guidance; concentrations and regulatory arrangements are subject to change and should be checked against the current instruments.

Smile Solutions trades under ABN 28 193 514 103.

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