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How often do you hear the phrase 'a Hollywood smile'?

It's a funny phrase and makes the assumption everyone in Hollywood has the most perfect smile..... and many of them actually do!

Me and my good friend Dr Mark with Dr Dorfman

In the summer of 2003 I entered a world that I had only seen before on Television and at the cinema. I spent a summer as a Dental Student in California and stayed for part of it in Beverly Hills. During this time I was fortunate to spend a few days with a very well known American Cosmetic Dentist called Bill Dorfman. Bill was the Dentist to many Hollywood starts such Anthony Hopkins, Matthew Perry from Friends and the Osbournes, even featuring in an episode of the Osbournes when Ozzy visits the dentist and has sedation! (Very funny!) I am grateful to Bill and his staff for allowing us to spend some time in their office with them. Cosmetic dentistry wasn't really my thing but the experience was incredible. I was amazed at the desire for such incredibly white teeth from patients. This trend wasn't evident in the UK at the time but with programmes such as Extreme Makeover and 10 years younger there was a shift in the tides. Bill Dorfman was the founder of Zoom Whitening and this would help to revolutionise in surgery whitening techniques. The jury is probably still out on whether the early Zoom whitening lamps every really did anything to whiten teeth (except for drying them out short term) but take home whitening kits are more popular than ever. In America the supermarkets have shelf upon shelf of whitening products from tooth paste to pens to whitening strips. It is possibly one of our most asked about treatments in the dental practice and in this first blog let’s look at some of the questions we are often asked and hopefully try to answer them for you:

‘Why are my teeth stained?’

There are two types of staining which occur with teeth; intrinsic and extrinsic.

Intrinsic staining is staining within the tooth. This can be due to medications such as tetracycline taken when teeth are developing, tooth decay, greyness from amalgam fillings, teeth which have died and also as teeth get older the dentine becomes thicker so teeth become more yellow.

Extrinsic staining is caused by chromogenic food material; food and drinks which cause staining. Typically tea, coffee (my downfall!), red wine (my Wife's downfall!), dark Chinese food and Indian food. Smoking is particularly effective at staining teeth - whitening a smoker's can take twice as long as a non smoker!).

‘How does whitening work? ‘

Whitening is the 'process of removing staining from Enamel and Dentine'. Enamel is the hard outer glass like surface of teeth and contains many small pores and cracks. Dentine is the next layer which is more porous and contains millions of tubes. Both of these surfaces can build up 'dirt' in the micropores and this reduces the transparency of light through teeth so they appear darker and stained. Whitening uses a carbamide peroxide which can break down these stains in the pores and therefore increases the transparency of light passing through which allows teeth to appear lighter. The carbamide peroxide comes in various strengths from 10-16% and when it works it breaks down to hydrogen peroxide at roughly a third of the percentage. Some dentists prescribe hydrogen peroxide but it is normally a personal choice and there is limited evidence as to which is the best.

How do I apply it to my teeth?

At 183dental we use a 'take home' whitening procedure as we have tried various methods and this appears to be the most effective for our patients. 'Take home' whitening requires us to take impressions of your teeth and these are sent to a dedicated whitening laboratory where bespoke, custom made whitening trays (like thin gums shields) are made to fit each individual. Personally I feel they are the best whitening trays I have ever made for patients. The trays are returned to us a few days later. In each of the teeth on the tray is a small dimple/reservoir for you to add a precise amount of whitening gel and then you wear the trays in order for the whitening gel to contact your teeth and the whitening process begins!

How soon will I notice results?

The whitening treatment course we prescribe normally is over a period of two weeks. However, after a few days you should probably notice some results. We advise most patients to whiten their teeth during sleep as it is convenient and the trays normally fit comfortably enough to not disturb your sleep. Saliva flow slows down during sleep so is less likely to dilute the gel and reduce its effectiveness. However, some patients choose to just whiten their teeth for one to two hours each day. The best results come from having the trays in overnight and doing this each day. Prior to fitting you with your bespoke trays we take a shade record of several of your teeth using our whitening shade guide and also a quick photograph of your teeth. Then at a review appointment around two weeks later we will assess the shade again to see how far you have progressed. Not everyone gets to the same point in the same time and teeth will reach a saturation point. However, we have a B1 shade on our guide which we hope most patients get to.

Smokers can take twice as long to see results. Sometimes patients who have severe grey shade staining such as with tetracycline staining, it can take months to achieve the desired result beyond our prescribed two week course.

Does it hurt?

No. On occasions some patients can have temporary sensitivity. However this is only short lasting and normally resolves quickly once the process is completed or stopped. We advise using sensitive toothpaste prior to commencing whitening and we give you some sensodyne toothpaste to use during whitening. If the sensitivity becomes too uncomfortable then we advise our patients to alternate the days they whiten teeth and to maybe do it for less time. Obviously this reduces its effectiveness and takes longer but it may be more manageable. Equally some patients prefer to whiten the upper teeth first and then the lowers after the uppers.

Some patients find the trays uncomfortable to sleep in so you may have to just find time in the day. Typically the evening whilst watching TV or reading etc.

It is useful to have a drink with a straw to take sips of whilst the trays are in.

Does it damage my teeth?

Absolutely not! There is no way we would whiten our patient’s teeth if there was a chance it would cause any damage to them. There have been many studies investigating if whitening harms the nerves of teeth and none have shown anything of any concerns. The whitening gel we use is within the recommended guidelines. If an inappropriate strength were to be used then is may cause damage to teeth.

Can everyone have it done?

Sadly not. We wouldn't advise patients who already have acute sensitivity problems to whiten their teeth as this could make the problem worse. Also patients who have tooth decay which needs fixing or ongoing gum problems need to avoid whitening until the current problems are resolved and stable. Although the guidelines recently become more flexible we normally will only whiten patient’s teeth when they are 18 or over. There is no upper age limit to whitening teeth!

Whitening will not change the colour of crowns, bridges, veneers or fillings.

There are a few medical conditions which can prevent whitening. These are fairly uncommon and we can advise you where appropriate.

I have seen it on offer at the local beauticians and it is very cheap, can't I go there?

Whitening is a dental procedure which can only legally be carried out by a dental care professional; a dentist, a hygienist or therapist who are registered with the General Dental Council. Currently the General Dental Council are in the process of prosecuting many beauticians who are carrying out tooth whitening illegally. Unfortunately some of these people may not even realise they are doing something illegal and have the strong potential to be taken to court. The laboratory we send our impressions to requires us to write our General Dental Council registration number on the tickets to prove we are registered. We use one of the very best whitening gels available. There are cheaper alternatives but we want our patients to get the best results and we know this product is both effective and safe.

After I have whitened my teeth do they stay white?

After whitening your teeth will 'rebound' ever so slightly. This means at the end of whitening they will dull down just a little immediately after. However with the technique we use it can be quite subtle in most cases. Normally at the end of your two week course it is likely you would still have some gel left. I advise my patients to whiten their teeth once a month to keep them tip top. Providing you keep the trays safe and do not have any major dental treatment carried out the trays should fit for a long time to come, so you can top them up whenever you want. You can always purchase tubes of whitening gel from us. From time to time would would ask to check the trays still fit accordingly and we will have a look at them with you in the surgery. We advise patients during the whitening treatment to be a little more conscious of the foods you are eating and drinking in terms of their colour. Patients often try to stick to a ‘white diet’ such as avoiding dark staining foodstuffs. As mentioned earlier tea, coffee, red wine. However, there are some ideas that you should avoid dark meats and veg whilst carrying out the whitening procedure. There is limited evidence whether this is really true.

Some places use a blue light or a 'laser' and apply the gel in the surgery. Why don't you do that one?

The short answer is that it doesn't really work! The light is there to heat up the gel and 'activate it'. The teeth also become hotter so become dehydrated loosing water. As the water leaves the teeth they will become whiter but instantly more sensitive. This process of whitening undergoes massive rebound and results disappear quickly. Most likely when this process is carried out patients would then follow it up with home tray whitening also.

I have one grey tooth, can I whiten just that one?

Sometimes a single tooth goes darker due to the nerve on the tooth dying. Sometimes these teeth have had root canal treatment previously. Essentially there is a bruise left inside the tooth so the tooth appears greyer/darker. External conventional whitening will not improve this and a special process called inside outside whitening is needed. Normally the tooth needs to be whitened both internally and externally and can have fantastic results. Sometimes further aesthetic treatment may be needed.

How do I book in to get it done?

If you are a regular patient at 183dental, then at your next examination discuss it with either myself, Emma or Jonathan and we can advise you on your suitability and give you an idea on the likely results you could expect.

If you are keen to go ahead we can make an appointment to take impressions, photographs and a shade and guide you through the process.

If you are not a patient at our practice then we would need to see you first for a full ‘New Patient’ examination to assess your dental health which looks at your teeth, gum health, oral cancer screen and normally involves taking up to date x-rays. Please do contact us to find out more!

Please look out for some of offers as occasionally we have special tooth whitening offers!

I hope this information has helped to answer some familiar questions.

We will look forward to seeing you soon

Dr Dave Baker

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