Whitening (2024)

For some time, there has been consistent consumer demand for whiter, brighter teeth and an attractive smile.1-3 Professionally administered (in-office) tooth whitening, also known as dental bleaching, remains a popular esthetic procedure and can be performed using a wide range of techniques and application protocols. Another common approach is at-home whitening with custom-fitted trays, which patients use to apply professional-strength bleaching gel (for use at night or during the day). Numerous over-the-counter (OTC) whitening products (e.g., strips, gels, rinses, chewing gums, or paint-on films) are also widely available for self-application at home.4

Extrinsic vs. Intrinsic Stains

Tooth (and dental) discoloration are terms used to describe any change in the color or translucency of a tooth,1 as well as discoloration in multiple teeth or the entire dentition. Tooth discolorations are typically classified as extrinsic, intrinsic, or a combination of both types.5

Extrinsic stains commonly result from an accumulation of colored compounds on enamel. Extrinsic discoloration is primarily associated with environmental factors or individual behaviors, such as tobacco use, exposure to metal salts (e.g., iron or copper), or the consumption of highly pigmented foods (e.g., dark fruits) or beverages (e.g., red wine, coffee, tea, or cola drinks).1, 6-11

Extrinsic tooth stains vary widely in color and severity, and can be exacerbated by lifestyle habits (e.g., smoking or chewing tobacco), poor oral hygiene, or frequent consumption of pigmented food or beverages.12, 13 A wide range of extrinsic stains can be effectively reduced with mechanical interventions such as brushing with a whitening toothpaste or professional prophylaxis.6, 7, 14 Some OTC whitening products (e.g., toothpastes, chewing gums) are effective primarily in removing extrinsic (surface) stains on enamel, and will not have a significant impact on intrinsic stains or the intrinsic color of the tooth.4, 15

Intrinsic stains occur inside the tooth (within the enamel or the underlying dentin), and can arise due to systemic causes such as genetic disorders (e.g., dentinogenesis imperfecta, amelogenesis imperfecta) or local factors during tooth development or after eruption (e.g., fluorosis).1, 16, 17 Aging is another common etiology of intrinsic discoloration. With increasing age, enamel becomes more translucent and thinner, which allows the yellower dentin to show through and the overall tooth color may darken.1, 18 Other causes of intrinsic discoloration include certain antibiotic use in childhood (e.g., tetracycline),19 caries, amalgam restorations, and pulpal hemorrhage, decomposition or necrosis.5, 7, 20 Intrinsic discoloration can also occur with prolonged use of antiseptic mouthrinse (e.g., chlorhexidine rinse).21

Whitening Agents

Reducing intrinsic stains involves a chemical reaction that changes the color of the tooth. The most common ingredients used in bleaching are carbamide peroxide and hydrogen peroxide, which are used at different concentrations depending on the products or regimens used.22

The bleaching action in chemically induced whitening is due primarily to the effects of carbamide peroxide, which releases about one-third of its content as hydrogen peroxide, a strong oxidizing agent.23, 24 Hydrogen peroxide diffuses easily through interprismatic spaces in the enamel, allowing for passage from enamel and dentin to pulp within 15 minutes of exposure.25, 26 The bleaching process is generally believed to occur when reactive oxygen molecules (generated from hydrogen peroxide) interact with organic chromophores (colored compounds) within enamel and dentin through a chemical oxidation process, which is influenced by various environmental factors (e.g., pH, temperature, light).17, 25, 27

The extent of whitening attained through bleaching may be influenced by the type of intrinsic stain being addressed. For example, brown stains due to fluorosis or tetracycline28, 29 may be more responsive to bleaching than white stains associated with fluorosis or orthodontic treatment, which may appear less noticeable as the background of the tooth lightens.30 The type of stain also can affect the length of and/or number of treatments required to arrive as close as possible to the desired result. For example, although stains due to tetracycline may be diminished, treatment can require three to four months of nightly treatment (on average).28, 31

Patient Considerations and Preferences

Tooth whitening is a common elective procedure and a popular, less-invasive aesthetic treatment for patients seeking to enhance their smile and appearance. A clinical exam prior to the start of tooth bleaching procedures, with radiographs and other screening and diagnostic tests as appropriate, can help diagnose various factors contributing to the patient’s tooth discoloration.32 A standard dental exam, beginning with a health and dental history, may include questions about the patient’s perception of the cause of the dental discoloration, as well as allergies (which may include ingredients in bleaching materials), and any past or recent history of tooth sensitivity.32, 33

Patient dentition characteristics also influence the safe provision of care and the treatment’s level of success in whitening vital teeth. Patients who have tooth-colored restorations (including crowns or implants) should be aware that only natural teeth will be affected by the bleaching agent and treatment could result in differences between natural teeth and restorations, which will not change color.28 The American Academy of Pediatric Dentistry discourages full-arch cosmetic bleaching for child and adolescent patients in the mixed dentition and primary dentition.34 Additionally, some research suggests that bleaching protocols may alter the surface roughness of enamel, which may also reduce the shear bond strength between enamel and composite and ceramic restorative materials.35

Whitening (2024)


Whitening? ›

Whitening treatments can be effective on both extrinsic and intrinsic staining. Only natural teeth can be whitened, not tooth-colored restorations. Whitening treatments include in-office bleaching procedures, dentist-supplied products for use at home, and over-the-counter (OTC) whiteners.

What is the best thing to whiten teeth? ›

If you're looking for long-lasting results, Bianca Velayo, DMD of Green Valley Smiles Dentistry, recommends looking for peroxide-based products if you're hoping to whiten tooth enamel. You can opt for either carbamide peroxide or hydrogen peroxide as both will reverse internal and external stains on teeth, she notes.

Can yellow teeth become white again? ›

What Can Be Done to Whiten Yellow Teeth? If you're looking for a radical change in the coloring of your teeth, you need professional-grade whitening to get the job done. Your cosmetic dentist can provide treatment that penetrates deep into the enamel and removes years of stains with a powerful bleaching agent.

Does whitening actually work? ›

Tooth-whitening works best for people with yellow teeth and is less effective for people with brown teeth. If your teeth are gray or purple, tooth bleaching probably won't work at all. To be sure tooth-whitening is worth your time and money, talk to your dentist before you use an over-the-counter tooth whitening kit.

How can I naturally whiten my teeth? ›

Brush with baking soda and hydrogen peroxide paste:

Baking soda has teeth whitening properties; that's why it's prevalent in toothpaste commercials. It helps in rubbing off stains from the tooth surface due to its mildly abrasive nature. Hydrogen peroxide, on the other hand, is a natural bleaching agent.

How can I make my yellow teeth white again? ›

Using a paste made of baking soda and hydrogen peroxide is said to remove plaque buildup and bacteria to get rid of stains. Mix 1 tablespoon of baking soda with 2 tablespoons of hydrogen peroxide to make a paste. Rinse your mouth thoroughly with water after brushing with this paste.

How can I whiten my yellow teeth fast? ›

1 part of 3% hydrogen peroxide mixed with 2 parts water makes an easy and affordable tooth-whitening mouthwash. Alternatively, create a paste using 3% hydrogen peroxide and baking soda and brush with this to remove yellow stains on teeth.

Do whitened teeth look fake? ›

This is a common concern, but we can assure you that professional teeth whitening treatment won't make your teeth look unnaturally white. If you've seen people whose teeth look too white to be natural, you're probably seeing their veneers, not their real teeth.

Is 6% hydrogen peroxide safe for teeth whitening? ›

Choose the right concentration: A low concentration of Hydrogen Peroxide (around 3% to 6%) is safe to use for teeth whitening usually without any side effects. Hydrogen Peroxide can produce certain side effects like gum or tooth sensitivity if used often in high concentration.

How to whiten teeth in 2 minutes? ›

Baking-powder eliminates stains on the surface of your teeth and lemon juice as we already said has multiple components that lighten teeth. Just mix a teaspoon of baking powder and a teaspoon of freshly squeezed lemon juice and brush your teeth with the paste this mixture will work wonders in just two minutes.

Do crest white strips work? ›

They definitely worked to make my teeth whiter. It's a 21 day program so you need to make sure you understand that but once you get the hang of applying them it's not that big of a deal to do. It caused some minor gum irritation for me but that went away quickly after I was done using them.

Why do strawberries whiten teeth? ›

"Strawberries contain citric acid which may give teeth a very temporary whiter appearance after you apply it," she says. But that doesn't mean the stains on your teeth have been removed. The acid from the berries breaks down your tooth enamel and causes dehydration. So, the teeth may temporarily appear whiter.

What is the fastest home remedy to whiten your teeth? ›

Combine about two tablespoons of hydrogen peroxide with one tablespoon of baking soda. Stir it into a paste and start brushing. Let the paste stand about a minute and then rinse thoroughly with water. It is safe to use this teeth whitening home remedy 2 or 3 times a week.

Can I brush my teeth with hydrogen peroxide and baking soda? ›

Baking soda is abrasive and helps remove stains from the surface of your teeth which makes them appear whiter. However, baking soda does not help remove the old stains. Therefore mixing it with hydrogen peroxide helps whiten your teeth. The mixture forms a paste which stays on your teeth while brushing them.

What is the fastest most efficient way to whiten teeth? ›

Zoom in office whitening

Zoom-in-office whitening is the best teeth whitening system out there. It is fast (takes about an hour) and you get great results. This is the one you have probably seen before where the patients are under that blue light and it turns your teeth up to four shades of whiter.


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